Identified Bio-Outbreaks (2012) 4/4

BIOTERRORBIBLE.COM: The following outbreaks occurred within the calendar year of 2012. While some of the following reports may have been legitimate outbreaks, most if not all of them appear to be generated man-made outbreaks with the overall goal of convincing American and the world that it is on the precipice of a major pandemic. The fact that these outbreaks exists in mass confirms that an upcoming bio-terror attack is in the cards and may be played in a last ditch effort to regain political, economic and militarial control of society. 

Identified Bio-Outbreaks (October 1, 2012 - December 31, 2012)

Title: Saudis: Virus Does Not Pose Threat To Pilgrims
October 1, 2012
USA Today

Abstract: Saudi Arabia's health minister says a new respiratory virus related to SARS that has infected two people does not pose a threat to the more than 1 million Muslims set to embark on the annual Hajj pilgrimage in the kingdom.

Abdullah al-Rabeeah said Monday the virus has so far been contained.

The germ is a coronavirus, from a family of viruses that cause the common cold as well as SARS, the severe acute respiratory syndrome that killed some 800 people, mostly in Asia, in a 2003 epidemic.

Global health officials suspect two victims from the Middle East may have caught it from animals.

The World Health Organization issued a global alert asking doctors to be on guard for any potential cases of the new virus, which also causes kidney failure (USA Today, 2012).

Title: Haiti Takes On Dreaded Disease Elephantiasis One Mouth At A Time
Date: October 1, 2012
Washington Post

Abstract: In a sunny courtyard of the Evelina Levy School for Girls, hundreds of girls in blue uniforms did their part to rid Haiti of an ancient and reviled disease.

They lined up in pairs to get three pills dropped into their mouths. They swallowed them down with a quarter-cup of water. They got a second medicine, a flavored tablet, to chew as they walked back to class.

Two middle-aged women treated 12 girls every 21 / minutes, one pouring the water and the other shaking out the pills. Another woman ticked the columns for age, sex and drug on a white form with a green pen.

“Mass drug administration” is easy if your target is elementary school students. It’s harder when you want to reach nearly everyone else in a country of 10 million people.

That is the goal Haiti set this year in its campaign against a parasitic infection called lymphatic filariasis that is present in 80 percent of the country. Spread by mosquitoes, in severe cases it leads to permanent swelling of an arm or leg. That condition, called “elephantiasis,” can be grotesque and life-changing. In men, the worms can cause a swelling of the scrotum that is even more stigmatizing.

Lymphatic filariasis is a “neglected tropical disease,” the name for a group of maladies that have disappeared from industrialized countries or never existed there. Others include onchocerciasis (“river blindness”), schistosomiasis (“snail fever”), soil-based intestinal worms, and the eye infection trachoma. For 1.9 billion people, most of them poor, they are still threats.

Eliminating the diseases has been an object of intense effort and research over the past decade. The work is largely unknown outside the global health community, overshadowed by higher-profile campaigns against AIDS, malaria and tuberculosis.

In 2010, 484 million people worldwide took drugs against filariasis — more than for any other neglected tropical disease but still onlyone-third of the people at risk for it.

“You could argue it’s the world’s largest public health program,” said Peter J. Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston.

Most of the neglected diseases can be cured in their early stages with drugs taken once or twice a year. Pharmaceutical companies are donating drugs for mass administration. A bonus is that some treat more than one infection.

Ivermectin, donated by Merck, cures river blindness and filariasis. Albendazole, donated by GlaxoSmithKline, gets filariasis and intestinal worms. Some subsidiary effects are only now being discovered. When ivermectin was distributed for river blindness in Senegal, it reduced malaria transmission. When azithromycin (provided by Pfizer) was distributed twice a year to Ethio­pian villagers for trachoma, childhood mortality fell 50 percent.

“What’s that all about? That’s the $64,000 question,” Hotez said.

Congress began earmarking money for mass drug administrations in 2006, and in 2008 President George W. Bush announced a five-year program to fight neglected tropical diseases. This year, the United States will spend $89 million on them — roughly 10 percent of the Obama administration’s global health budget.

After years of mass drug administrations, nine countries — Burundi, Cape Verde, Costa Rica, Mauritius, Rwanda, Seychelles, the Solomon Islands, Suriname, and Trinidad and Tobago — were declared free of lymphatic filariasis in 2011 by the World Health Organization. Haiti hopes to join them.

Fear of Backsliding
Smartphone apps, pedometers and other devices can motivate walkers, amuse them and track their

Until the earthquake of Jan. 12, 2010, Haiti and its foreign donors fought the disease only where it was most prevalent. Over time, more and more parts of the country were included in the campaign. However, Port-au-Prince, a place where the disease was uncommon, was always judged out of reach. The capital was simply too crowded and chaotic for mass drug administration.

Ironically, the earthquake changed people’s minds about what was possible — and necessary.

One-third of Haiti’s population was affected by the quake. More than 2 million people became homeless or chose to move. Internal migration threatened to redistribute the disease, interrupt the every-year treatment for many people, and generally undo all the gains of the previous decade.

At the same time, the earthquake brought a flood of money and human energy to Haiti. Suddenly, nationwide drug administration — including in Port-au-Prince — became just one more ambitious task that had to be done.

“There was this feeling that we just couldn’t quit. Things had come too far to walk away,” said Patrick J. Lammie, a scientist at the U.S. Centers for Disease Control and Prevention who has worked on filariasis in Haiti for more than two decades.

As a consequence, for four weeks this past winter, two medicines — albendazole and diethylcarbamazine (DEC) — were handed out in Port-au-Prince’s schools, markets, churches, factories and public places. They were also delivered to the squatter camps where more than a half-million earthquake-displaced people still lived. In all, about 70 percent of the capital’s population took them, according to a CDC survey in the spring.

Today, more than two years after the earthquake, “everyone in Haiti has gotten the drugs,” Lammie said. (The actual estimate is 8.7 million.) “That’s the success story of Haiti. Now we have to do it on an annual basis.”

The rationale for such an ambitious effort is this: Albendazole and DEC kill off the larval form of the filariasis parasite, which if not treated matures into an unkillable worm in about a year. If an entire population takes the drugs regularly — adults once a year, children twice — the amount of parasite larvae circulating in people and mosquitoes falls so low that no new transmissions occur.

Biologists think that 70 percent coverage for eight years is enough to stop new cases, assuming the same people are not missed year after year. If they are, those people can become a permanent reservoir from whom mosquitoes can pick up the parasite and pass it on to new victims through bites.

Haiti will know by the end of the decade whether it has pulled the trick off.

Missed Mouths
In Haiti, the government’s health ministry is doing most of the work. Two charities, IMA World Health and RTI International, provide advice, along with the University of Notre Dame. A foundation associated with the 
drugmaker Abbott Laboratories is helping with salaries.

The target in a mass drug administration may be the whole population, but that does not mean you can take your eye off the individual. Abdel Direny, the 39-year-old Haitian physician in charge of the campaign in Jacmel, knows that.

After assuring himself that the drug distribution at Evelina Levy School was going well, he drove to another school. What he found was a platoon of volunteers in campaign T-shirts helping teachers pass out pills. The students, high school girls, were being told to take the medicine when they got home. The city water supply to the school was not working that day, and nobody had brought bottled water as backup.

“They’re not supposed to do that,” Direny said to Edgar Isidor, a community leader in a porkpie hat who came along to enhance the doctor’s authority. “The pills are supposed to be poured into their mouths.”

To much consternation, Direny stopped the drug distribution and ordered it rescheduled for the next day. Just as the principal was finally persuaded, somebody rolled a wheelbarrow full of blue five-gallon water jugs into the school’s courtyard. But it was too late.

How much difference can some missed mouths make?

In 2000, about 15 percent of the 150,000 people in the commune of Leogane, west of Port-au-Prince, had microscopically visible parasites in their blood. (Communes are like counties; Haiti has 140 of them.) After six years of mass drug distribution, that was down to less than 1 percent — a level that if maintained for a decade would have stopped the disease altogether. Civil unrest, however, prevented drugs from being handed out in the seventh year.

Filariasis roared back. By 2008, the prevalence of infection was up to 4.6 percent. More troubling, a survey found that 24 percent of people said they had never taken a pill against the disease — and thus were probably a hidden reservoir for it.

The lesson: Every mouth counts.

Medicinal Salt
Mass drug administration is the main tool against lymphatic filariasis. But it is not the only tool. In an industrial park in Port-au-Prince, a theoretically easier way to rid the country of the parasite is underway.

The Rev. Jean Michelet Dorescar, a Catholic priest, runs a factory that fortifies salt with DEC, one of the two drugs used in the mass campaigns. Eating that food additive year after year will kill off filarial larvae in an entire population. China used the strategy (which was invented by English biologist Frank Hawking, father of cosmologist Stephen Hawking) to eliminate filariasis in the 1980s.

The Haitian government has not mandated the use of medicated salt. The factory’s product, subsidized by charities, must compete with plain salt evaporated from seawater and sold by the handful in Haiti’s markets. Fortified salt, promoted heavily in Guyana a decade ago, never really took hold.

Dorescar knows his salt must look good and taste good, first and foremost. He has a hard time finding high-quality salt from Haiti. He recently bought a load from Jamaica and was disappointed by it, too.

“When I opened the bag I was very surprised to see the stones,” he said.

He stood next to a table covered with bright white salt. Four men were picking out pieces of gray gravel by hand.

The factory is owned by Haiti’s government but operated by the University of Notre Dame, which along with other donors subsidizes the product. Last year, it sold 71,000 pounds of treated salt to markets in the three communes with the most filariasis.

A survey is underway to see whether the rate of filariasis infection has changed in the places where people stir it into their rice and beans (Washington Post, 2012).

Title: Bagged Popcorn Recalled Over Possible Listeria Contamination
Date: October 1, 2012
Fox News

Abstract: The popcorn manufacturer “Popcorn, Indiana” has issued a voluntary recall of several ready-to-eat bags of popcorn due to a possible contamination of Listeria monocytogenes – bacteria that can cause serious infection.

According to Popcorn, Indiana’s product recall site, bags that were distributed on or after Aug. 8th, 2012 with ‘Best By’ dates between Feb. 4th, 2013, and March 12th, 2013, should be thrown away or returned for a full refund or replacement.  The bags were colored red and came in various sizes.

Consumers can also determine which bags are being recalled by checking the Bag UPC (code) located in the nutritional panel on bottom of the bag.  A full list of recalled bags can be found on the company’s website.

Apart from the recalled bags, Popcorn, Indiana - part of the company Dale and Thomas Popcorn - maintains that the rest of their products are safe for consumption.

“Nothing is more important to us than the health and safety of those who buy our popcorn and the employees who make up our company,” Popcorn, Indiana states on their website. “We hold ourselves to standards that are among the highest in the industry, and as such, we regularly conduct testing beyond FDA requirements.”

Listeria can be a serious infection that usually affects elderly people, pregnant women, infants and those that with weakened immune systems, according to the Centers for Disease Control and Prevention.  Often caused by eating contaminated food, listeria symptoms occur within two months of eating the contaminated food and include diarrhea and other gastrointestinal symptoms, followed by high fever and muscle aches.  Listeria infection is easily treated with antibiotics but can sometimes be fatal – particularly for the elderly or those with severe medical problems (Fox News, 2012).

Title: 2 Dead From Meningitis Outbreak At Tennessee Neurosurgery Center
Date: October 1, 2012
Fox News

Abstract: The Tennessee Department of Health (TDH) has teamed up with the Centers for Disease Control and Prevention (CDC) to investigate a cluster of meningitis cases, which have been linked to the Saint Thomas Outpatient Neurosurgery Center in Nashville, The Tennessean reported.

According to a statement from the TDH, of the 11 patients who have been affected, two have died.

The agency said this form of meningitis does not spread from person to person; however, the cause for the illnesses is still unknown.

The neurosurgical center was closed on Sept. 20 and will not open until both the TDH and CDC have resolved the matter.  Patients of the center who had lumbar epidural steroid injections between July 30 and Sept. 20 have been notified of the cluster, according to a TDH statement.

“We are extremely saddened by the impact this tragic situation has had on patients and their loved ones, and we are working quickly to get answers,” TDH Commissioner Dr. John Dreyzehner said in a statement. “As we continue our investigation, we will remain as transparent as possible, providing information to the people of Tennessee, and to our partners and allies in the health and medical communities.”

According to the National Institutes of Health, meningitis is a bacterial infection of the membranes that cover both the brain and spinal cord.  Symptoms include fever, mental changes, nausea and severe headaches, while more severe symptoms can include decreased consciousness and unusual posture.  Acute bacterial meningitis is a medical emergency and must be treated immediately (Fox News, 2012).

Title: Saudi 'Take Steps To Thwart Epidemic' At Hajj
Date: October 1, 2012
France 24

Abstract: Saudi Arabia has taken measures to deal with any epidemic that may break out during the annual hajj pilgrimage, a minister said in remarks published Monday, stressing that the spread of a mystery illness from the same family as the deadly SARS virus was "limited."

The kingdom has taken "preventive measures towards pilgrims ... and has made practical and scientific arrangements to deal with any epidemic that might be discovered," Health Minister Abdullah al-Rabeeah was quoted as saying in Al-Hayat daily.

Pilgrims in their thousands have begun arriving in the kingdom for this month's hajj, one of the five pillars of Islam which must be performed at least once in a lifetime by all Muslims who are able to do so.

The Geneva-based World Health Organisation (WHO) has identified a virus which caused the death of a Saudi national as being of the coronavirus family.

It has also left a Qatari man seriously ill in a London hospital after he was transferred there from Doha earlier last month, the WHO said, adding that he had previously been in Saudi Arabia.

The two cases occurred three months apart in June and September, said the WHO, stressing that the illness is not Severe Acute Respiratory Syndrome which swept out of China in 2003, killing more than 800 people worldwide.

What sets the new virus apart from SARS, the UN health agency added, is that it causes rapid kidney failure.

The WHO has said it is advising Saudi Arabia ahead of the hajj.

"The spread of the coronavirus which has lately registered two cases is still limited," Rabeeah said.

He said the "the virus has no vaccine on a global level and has no treatment," but added that the tens of thousands of pilgrims who have already arrived in the kingdom for the world's largest annual religious gathering had not been touched by any epidemics.

A Danish hospital said in August it had isolated five people with symptoms of a viral respiratory illness pending the result of tests.

Odense University hospital said those admitted were a family of four where the father had been to Saudi Arabia, and an unrelated person who had been to Qatar.

Two of the patients were children under five.

Last year, nearly three million Muslim pilgrims performed the hajj (France 24, 2012).

Title: CDC And Tennessee Health Officials Investigate Aspergillus Meningitis Cluster
Date: October 1, 2012

Abstract: Federal and state health authorities are investigating a cluster of fungal 
meningitis cases that have sickened a dozen and killed two in surgical centers in Nashville, Tennessee and North Carolina, according to a Tennessee Department of Health (TDH) news release Oct. 1.

The cluster includes 11 cases treated at Saint Thomas Outpatient Neurosurgery Center in Nashville and one case at a yet unidentified clinic in North Carolina.

Two patients related to this cluster of meningitis have died.

According to Centers for Disease Control and Prevention (CDC) spokesperson, Curtis Allen, at least 737 people who received lumbar epidural steroid injections between July 30 and Sept. 20 have been notified of the cluster of rare aspergillus meningitis infections.

The surgery center has been closed since Sept. 20 pending the conclusion of the investigation.

An NBC News Health report today notes that the patients were older people, between the ages of 40 and 80, who were receiving the steroid injections as treatment for musculoskeletal disorders, according to a TDH spokesperson.

Health officials are quick to point out that this form of meningitis, caused by the fungi, Aspergillus, in not transmitted from person to person.

In addition, they note that this type of meningitis is not the same as bacterial meningitis that is sometimes reported in school and college settings.

“We are extremely saddened by the impact this tragic situation has had on patients and their loved ones and we are working quickly to get answers,” says TDH Commissioner John Dreyzehner, MD, MPH. “As we continue our investigation, we will remain as transparent as possible, providing information to the people of Tennessee, and to our partners and allies in the health and medical communities."

It’s important to note the astute reporting of the initial case by a local clinician and the excellent cooperation we received from the Saint Thomas Outpatient Neurosurgery Center and other medical professionals in Nashville allowed us to quickly begin a thorough investigation with our partners at the CDC and FDA. Everyone involved has been fully cooperative and helpful.”

Aspergillosis is a fungal disease that can cause numerous syndromes in humans from a variety of Aspergillus species. There are about 180 species of this fungus, with approximately 40 species that have been implicated in human disease.

Aspergillus is found throughout nature particularly in decaying vegetation. It can be found in the indoor and outdoor air during all seasons of the year. Water and food can also be contaminated.

Aspergillus is considered an opportunistic pathogen and usually does not cause disease in people with intact immune systems. Aspergillus can cause several forms of pulmonary disease. Acute sinusitis and ear infections are also frequently seen.

Severe invasive disease to the kidneys, gastrointestinal tract and brain can be seen in people with severe immunosuppression due to neutropenia (low white blood cell count), HIV/AIDS, therapy with corticosteroids and other immunosuppressive agents as in organ transplant (Examiner, 2012).

Title: Probable West Nile Infection In Hudson Valley
Date: October 2, 2012
Wall Street Journal

Abstract: Health authorities in the Hudson Valley are investigating a probable case of West Nile virus infection.

The Ulster County health department says the case involves a person who'd traveled out of New York, so it isn't clear if the infection was contracted in the county.

Most people infected with the mosquito-borne virus either show no symptoms or have a mild, flu-like illness. A small proportion develop serious illness that can lead to neurological damage.

Investigators have found water bodies with West Nile-infected mosquitoes in southern and central New York this year, but none in Ulster County (Wall Street Journal, 2012).

Title: Tennessee: Meningitis Kills Two Who Received Steroid Injections
Date: October 2, 2012
New York Times

Abstract: Two people in Tennessee have died and nine others are ill after an outbreak of meningitis among patients given steroid injections in the spinal region for pain at the Saint Thomas Outpatient Neurosurgery Center in Nashville. A patient who received the same type of treatment in North Carolina is sick, and health officials say patients in other states may be affected. Meningitis is an infection involving the lining of the brain and central nervous system. The outbreak is an unusual type caused by a fungus and is not spread from person to person. Doctors think the infections were caused by contamination of the steroid with the fungus, known as aspergillus. One lot of the medication has been recalled, and more than 700 patients who received the shots at the Nashville clinic, which has closed, have been notified
(New York Times, 2012).

Title: Two Additional Cases Of Fungal Meningitis Identified In Nashville Outbreak
Date: October 2, 2012

Abstract: In a 
follow-up to a story yesterday, officials with the Tennessee Department of Health (TDH) announced they identified two more suspected cases of Aspergillus meningitis linked to lumbar epidural steroid injections at Saint Thomas Outpatient Neurosurgery Center in Nashvilleaccording to a report by ABC affiliate WKRN in Nashville Oct. 2.

This brings the total number of patients affected by this outbreak to 13. There is also one reported case in North Carolina.

TDH health authorities say, with these two additional cases, they feel comfortable calling the situation an outbreak. Previously, health officials referred to the situation as a “cluster”.

The investigation continues as health officials attempt to pinpoint the source of the outbreak.

In a Nashville Public Radio report Monday, TDH officials said a common factor might be tainted medical supplies, potentially affecting more than a dozen other states. At least one unidentified manufacturer of the medication in question has already issued a voluntary recall.

The North Carolina Department of Health and Human Services has also issued a warning over the meningitis outbreak.

“Meningitis is a very serious illness that can have tragic consequences,” said State Health Director Laura Gerald. “We are working diligently to determine the cause of the infections and prevent additional cases. In the meantime, we strongly encourage anyone who has had this type of procedure since July 1st that may be experiencing symptoms, however mild, to talk with their doctor or other health care provider right away” (Examiner, 2012).

Title: N.D. Agriculture Officials Report First Case Of Anthrax In Livestock This Year
Date: October 3, 2012

North Dakota’s chief veterinarian has warned livestock producers in the state to ensure their cattle are vaccinated against anthrax after the first confirmed case was reported in a beef cow in Stark County, according to a North Dakota Department of Agriculture news release Oct. 1.

State veterinarian, Dr. Susan Keller, said the anthrax case was laboratory confirmed by theVeterinary Diagnostic Laboratory at North Dakota State University. This is the first such case in North Dakota in 2012.

Dr. Keller warns cattle producers to ensure their livestock are current on their anthrax vaccinations.

“Producers should contact their veterinarians to determine when and if their animals should be vaccinated and that their boosters are up to date,” she said. “They should also monitor their herds for unexpected deaths and report them to their veterinarians.”

Anthrax has been most frequently reported in northeast, southeast and south central North Dakota, but it has been suspected in almost every part of the state. The state usually records a few anthrax cases every year, but in 2005, the disease killed more than 500 head of cattle, bison, horses, sheep, llamas and farmed deer and elk.

Elsewhere in North America, animal anthrax cases have been reported in TexasOregonColorado and hundreds of bison died from the bacterial disease in the Northwest Territories of Canada this summer.

According to the Merck Veterinary Manual, anthrax is a zoonotic disease caused by the sporeforming bacterium Bacillus anthracis. Anthrax is most common in wild and domestic herbivores (eg, cattle, sheep, goats, camels, antelopes) but can also be seen in humans exposed to tissue from infected animals, contaminated animal products or directly to B.anthracis spores under certain conditions.

In herbivores like cattle, anthrax commonly presents as an acute septicemia with a high fatality rate, often accompanied by hemorrhagic lymphadenitis.

B.anthracis spores can remain infective in soil for many years. During this time, they are a potential source of infection for grazing livestock, but generally do not represent a direct infection risk for humans. Grazing animals may become infected when they ingest sufficient quantities of these spores from the soil. In addition to direct transmission, biting flies may mechanically transmitB.anthracis spores from one animal to another.

Underdiagnosis and unreliable reporting make it difficult to estimate the true incidence of anthrax worldwide. However, anthrax has been reported from nearly every continent and is most common in agricultural regions (Examiner, 2012).

Title: Second Death In LA County From West Nile Virus
Date: October 3, 2012

Abstract: Public health officials announced Tuesday that a second person in Los Angeles County has died of 
West Nile virus.

Both of those who died were adults in their 80s who lived in the southeastern part of the county, according to health officials. Their names have not been released.

People older than 50 and those with weakened immune systems are the most at risk for developing severe symptoms.

A total of 54 cases of the illness have been reported locally. The latest death has prompted renewed warnings for people to take precautions and reduce their exposure to mosquitoes, which can transmit the virus through their bite.

Mosquitoes are infected with West Nile virus by feeding on birds that carry it, then transmitting it to humans. Horses are also susceptible to the virus, but there is a 
vaccination available for them. No vaccination exists for humans.

Symptoms of the illness -- 
headache, fever, nausea, skin rashes, and body aches -- can appear within three to 12 days after infection. The severe symptoms include meningitis and inflammation of the brain. Recovery can take months to years, and some people may never fully recover.

To date, vector control districts have detected the virus in 170 dead birds, five squirrels and 196 mosquito pools. Samples were found throughout the county
(KTLA, 2012).

Title: Mom Says Hospital Gave Son MRSA; Infection Spread To Entire Family
Date: October 3, 2012
Fox News

Abstract:  Sutter Memorial Hospital is potentially facing another lawsuit related to methicillin-resistant staph aureus (MRSA), FOX 40 reported. 

The 90-day notice alleges infant Gabriel Adams contracted the skin-borne bacteria when he had surgery at 1-month-old – and the infection spread to the rest of the family.

“Two days after his surgery, it started getting infected and he had a 104 temp,” said Beth DeRuelle, Gabriel's mother. 

The infection quickly spread to Gabriel's sister, and then to the baby's mother and father.

“For the last six or seven months, it's been a battle," DeRuelle told FOX 40 "We've all had it, maybe four or five times each, getting rid of it, and then it keeps coming back. “

DeRuelle said Sutter told her Gabriel’s infection and the rest of the family’s, are directly related to the surgery.

Family attorney Moseley Collins said the 90-day notice is about stopping an epidemic. 

“It's about stopping the hospitals from giving our children this deadly bacteria. It's about warning other hospitals you've gotta be more careful,” Collins said.

“Sutter Memorial Hospital and its staff follow all precautionary measures and recommended protocols during outpatient surgeries to ensure the safety of our patients," Sutter said in a response to the filing (Fox News, 2012).

Title: Fungal Meningitis Suspected In Four Deaths, 26 Cases As Outbreak Grows
Date: October 3, 2012
NBC News

Abstract: Four people have died and 22 were made sick by meningitis linked to a rare fungal infection blamed on contaminated steroids, health officials said on Wednesday. They are “almost certain” more will be identified before it’s over.

The 26 cases include 18 people in Tennessee, one in North Carolina, two in Florida, three in Virginia and two in Maryland, the U.S. Centers for Disease Control and Prevention reported. Two of the deaths were in Tennessee, one in Virginia and one in Maryland.

Several of the patients are seriously ill, says Tennessee Department of Health Commissioner Dr. John Dreyzehner. Two clinics have closed voluntarily and a third is no longer giving the injections.

Officials said the chief suspect is contaminated vials of a pain treatment injected directly into the spine. The drug is called methylprednisolone acetate.

“We have notified medical professionals the prime suspect for this outbreak is methylprednisolone,” Dreyzehner told reporters in a telephone briefing. He said it was not yet clear how widely the drug was distributed.

Late Wednesday, the Food and Drug Administration confirmed that New England Compounding Center, a Framingham, Mass., compounding pharmacy, on Sept. 26 voluntarily recalled three lots of 80-milligram injection doses of methylprednisolone acetate (PF) produced by the firm. The lots included #05212012@68 with a had beyond use date of Nov. 17, 2012; #06292012@26 with a beyond use date of Dec. 26, 2012; and #08102012@51 with a beyond use date of Feb. 6, 2013. The firm's website was not working on Wednesday evening.

It’s not entirely certain the steroid is to blame, said the health department’s Dr. Marion Kainer. The health officials, the CDC and the FDA are testing the pain medications and other materials used with the steroid injections, as well as samples from the patients. Patients were also treated with injections of lidocaine and a povidone iodine skin preparation solution, the CDC said. 

Meningitis is an inflammation of the spinal cord, usually caused by bacteria or viruses. It can be very serious and is marked by a headache, fever, often a stiff neck and balance problems. Fungi and parasites can also cause this inflammation and in this case the common mold aspergillus is suspected. “The type of meningitis we are dealing with in this situation is not communicable person to person,” Dreyzehner said.

The 18 Tennessee cases are associated with Tennessee centers: Saint Thomas Outpatient Neurosurgery Center in Nashville, a center in Crossville, and now a third center in Oak Ridge, the officials said. The cases were all injected from two lots of steroids. 

Everyone treated at the centers since July 1 is being cautioned to look for symptoms and to see a doctor immediately if they develop any. More than 700 people were treated, Dreyzehner said. “Everybody who been exposed to the lot numbers that are suspect, the vast majority have not been symptomatic,” he said.

The incubation period -- the time between treatment and the first symptoms-- ranges from two days to two months, the officials said. No one treated before July 30 has turned up sick but they said they were checking people back to July 1 out of an abundance of caution. The first 12 patients who were identified range in age from 49 to 89.

The CDC and FDA are testing samples of the drug, which has been recalled nationwide, as well as samples from the patients to be sure it’s aspergillus. Aspergillus has not been isolated yet from the steroid.

Aspergillus is tricky to treat. It’s an infection that patients with damaged immune systems can get – notably cancer patients and those with HIV infection. It’s often found in the lungs because the mold – found in dead leaves and elsewhere -- can be breathed in. An antifungal drug called voriconazole can treat the infection but the health officials said in this case they want to be sure before they try it. The side effects from the antifungal treatment can be severe and include kidney and liver damage.

It's also hard to reach an infection in the spinal cord.

The health officials stress that women who got epidural injections while giving birth are not at risk in this outbreak. In 2005, after a giant quake and tsunami devastated shorelines around the Indian Ocean, a team of doctors in Sri Lanka reported on an outbreak of aspergillus meningitis among women who got epidurals during childbirth. Five young women were infected and three of them died.

In that case, they reported in several medical journals, the anesthetics used had been stored in hot and dirty warehouses in the aftermath of the tsunami’s devastation (NBC News, 2012).

Title: Tennessee Fungal Meningitis Outbreak Grows To 18
Date: October 3, 2012

Abstract: The outbreak of fungal meningitis linked to epidural steroid injections (ESI) in several surgery centers has increased by five, bringing the total to 18 in 
Tennessee, according to a Tennessee Department of Health (TDH) Meningitis Teleconference Media briefing October 3.

TDH Commissioner John Dreyzehner, MD, MPH said one of the new cases received an ESI at the Specialty Surgery Center in Crossville, TN. The vast majority of cases have been linked to Saint Thomas Outpatient Neurosurgery Center in Nashville.

The “material” of interest is the corticosteroid, methylprednisolone acetate. Dreyzehner noted that one of the five newly identified cases received the steroid medication from a second lot.

Although no cases were reported out of a third clinic, Oak Ridge, Tennessee’s PCA Pain Care Center, the commissioner noted that they received some of the newly identified lot.

The species of the fungus, Aspergillus has been identified as Aspergillus fumigatus in at least one patient.

In two of the new patients identified, biopsy samples reveal fungi consistent with Aspergillus.

Health care providers have been notified of the material in question, methylprednisolone acetate and the Pharmacy that prepared the product.

Dr. Dreyzehner noted that all three clinics have fully cooperated with the investigation.

The investigation is ongoing and other potential cases are being evaluated. Health officials want to make clear that this outbreak is not related to other cases of viral and bacterial meningitis reported recently in the state (Examiner, 2012).

Title: FDA: Farm Tied To Salmonella Outbreak Was Unclean
Date: October 3, 2012
Fox News

Abstract: A federal inspector found two strains of salmonella and unclean conditions at an Indiana cantaloupe farm's fruit-packing plant during visits following a deadly outbreak linked to its melons.

The Food and Drug Administration posted a report on its website on the inspector's findings during mid-August visits to Chamberlain Farm Produce Inc., in Owensville.

The inspector reported finding improperly cleaned equipment and algae growing in standing water beneath conveyer belts in the plant. One of the two salmonella strains was found on cantaloupes that had been processed and boxed.

The FDA says the farm is the source of at least some of the salmonella outbreak that sickened 270 people in 26 states this summer. Officials say 101 people were hospitalized, and three deaths were reported in Kentucky (Fox News, 2012)

Title: Mother Recovering From Rare Strep Infection That Shuts Down Organs
Date: October 3, 2012
Fox News

Abstract: A Georgia woman is back home and recovering after fighting a rare infection, similar to the one that nearly killed Aimee Copeland. She and her family hope their emotional story of survival, will inspire others.

Doctors told Karen Thieken that the bacterial infection she had has two dangerous strains. One, the kind Aimee Copeland had, is flesh eating. The other, the one that nearly killed Karen, attacks the organs and tries to shut them down.

The story of the most difficult five months the Thieken family has ever been through began behind their Dacula home in April.

"I was in the yard, just raking out the thatch. I felt fine, there was no indication anything was wrong," said Thieken.

But later that evening, Karen Thieken began having flu-like symptoms. The next day, she collapsed.

"And that's when I heard her...thump, pass out right upstairs. Couldn't even touch her, couldn't even move her, called 911," said Paul Thieken.

Paramedics rushed Karen to Gwinnett Medical Center and doctors soon realized her organs were shutting down. In just 18 hours she went from doing yard work in the backyard to fighting for her life.

"It was a very emotional time, because at that point, I didn't know what to think. Honestly, I had no idea -- my mind went in 3 million places. And first and foremost was I didn't know what I was going to do without her," said Paul Thieken.

Paul Thieken was afraid to tell his daughters that doctors thought Karen would die within days.

"Going into the room with her, I was just a wreck. But I knew as soon as I opened up that door, I had to put on my dad face and just make them understand that everything was going to be alright. Because I didn't want them to understand the severity of it at that point," said Thieken.

Doctors believe Karen somehow got the rare, group A strep virus on her hands and scratched a part of her neck where the skin was already broken, sending toxins through her body.

For 11 days, she was in a coma while doctors desperately fought the infection. Then, something amazing began to happen.

"What actually woke her up is the girls playing outside the room. They were outside playing, you know typical 4- and 7-year-old girls playing and screaming, not understanding everything fully, but that's what started having her move," said Paul (Fox News, 2012).

Title: Meningitis Outbreak Growing In Tennessee, Expands To North Carolina And Other States
Date: October 3, 2012
Fox News

Abstract: Five new cases of meningitis have been confirmed in the past 24 hours in Tennessee, while new cases have been confirmed in North Carolina, Virginia, Maryland and Florida - and the outbreak could potentially spread to even more states. 

Dr. John Dreyzehner, the commissioner of health for the Tennessee Department of Health (TDH) said the total number of cases now stands at 18 – with patients ranging in age from 49 to 89 years old.  Dreyzehner said two people have died since the cases were initially discovered, and several others are listed in serious condition and could die from the rare form of Aspergillus meningitis.

While most of the cases have occurred in Tennessee, North Carolina has identified Monday at least one case that was linked to the meningitis outbreak.  According to the Centers for Disease Control and Prevention, other cases have been reported in Virginia, Maryland and Florida. Both Virginia and Maryland have reported one death each.

The TDH said 737 patients could have potentially been exposed by receiving methylprednisolone, a steroid that is usually injected into the spine to relieve back pain.  Pain management clinics in Nashville, Crossville and Oak Ridge are confirmed to have received the tainted injections dating back to July 30, 2012.  The Oak Ridge clinic confirmed it had received 2,000 injections; however, it is not known how many the Nashville and Crossville clinics received.

The TDH is advising anyone who visited the St. Thomas Neurological Outpatient Center in Nashville, PCA Pain Care in Oak Ridge or the Specialty Surgery Center in Crossville since July 1st to be alert for symptoms.  St. Thomas has been voluntarily closed since Sept. 20 and will not reopen until the TDH and CDC resolve the outbreak.

Dreyzehner said three lot numbers of the injection, which were produced by The New England Compounding Center in Farmington, Mass., have been pinpointed as the source of the fungus that caused the meningitis.  The compounding pharmacy has issued a voluntary recall for any health providers that received the tainted product.

Symptoms of meningitis include worsening to severe headaches, nausea, dizziness, fevers, slurred speech, weakness, problems with gait and sensory deficits.  Some patients who have contracted the infection have also suffered strokes.  The incubation period for this form of meningitis is between two to 28 days.  Dreyzehner said he is almost certain that more cases will surface in Tennessee.

Dr. Manny Alvarez, senior managing health editor for Fox News, said that this situation must be taken very seriously.  In outbreaks of this kind, transparency is key.

"When products get contaminated, they must be removed immediately and every state needs to be notified immediately," Alvarez said.  "We need to know who the manufacturer is, who the distributor is, and how many doses of this injectable were produced.  All health care specialists need to be aware of the possible contamination" (Fox News, 2012).

Title: Fungal Meningitis Outbreak Expands, Source Linked To Massachusetts Pharmacy
Date: October 4, 2012

Abstract: The 
Aspergillus meningitis outbreak that has been seen primarily in Nashville, Tennessee, has expanded to several other states, according to a NBC News Health report Oct. 3.

The report says at least four people have died and up to 22 others have been sickened in five states.

Other than Tennessee, which has accounted for the majority of the cases, infections have been reported in North Carolina, Florida, Virginia and Maryland.

The suspected source of the outbreak, the steroid medication, methylprednisolone acetate has been linked to a Framingham, Massachusetts specialty pharmacy.

According to a Washington Post report, the Nashville-based clinics which were the epicenter of the outbreak, received the largest shipment of the steroid medication. Eighteen cases have been associated with these clinics.

The pharmacy, the New England Compounding Center (NECC) says they have voluntarily suspended operations in light of the outbreak and investigation. The NECC instituted a voluntary recall of the product in question on Sept. 26.

The Massachusetts Department of Public Health (DPH) is working closely with federal and other state health officials in the investigation. The DPH released this statement yesterday:

“The Massachusetts Department of Public Health is collaborating with the CDC, FDA, and other state public health officials to identify the cause of an outbreak of more than 25 suspected cases of aspergillus (fungal) meningitis under investigation in Florida, Maryland, North Carolina, Tennessee and Virginia. The cause for this cluster of cases is not yet known. There are four products common to all of these cases. One medication, Methylprednisolone Acetate, a steroid, was prepared at the New England Compounding Center, Inc (NECC), a pharmacy in Framingham, Massachusetts. It has been recalled and quarantined as a precaution. NECC is voluntarily recalling all similar medications. In addition, at the request of DPH, NECC has agreed to voluntarily surrender their license to operate until this investigation is complete. The form of fungal meningitis in these patients is not transmitted from person to person. There are no known cases in the Commonwealth” (Examiner, 2012).

Title: CDC Reports More Than 400 West Nile Virus Cases Last Week
Date: October 4, 2012

Abstract: As of October 2, 2012, 48 states have reported West Nile virus infections in people, birds, or mosquitoes. A total of 3,969 cases of West Nile virus disease in people, including 163 deaths, have been reported to the Centers for Disease Control and Prevention (CDC).

This is up 424 cases and 16 deaths from one week ago.

Of these, 2,010 (51%) were classified as neuroinvasive disease (such as meningitis or encephalitis) and 1,959 (49%) were classified as non-neuroinvasive disease.

The CDC says the 3,969 cases reported thus far in 2012 is the highest number of West Nile virus disease cases reported to CDC through the first week in October since 2003. Almost 70 percent of the cases have been reported from eight states (Texas, California, Louisiana, Mississippi, South Dakota, Michigan, Oklahoma, and Illinois) and a third of all cases have been reported from Texas (Examiner, 2012).

Title: Chicago Fire Lieutenant Dies From West Nile Virus, Donates Brain To Science
Date: October 5, 2012
Fox News

Abstract: A Chicago Fire Department lieutenant bitten by a mosquito about two weeks ago died Thursday night from the West Nile virus, MyFoxChicago reported.

The mosquito bit Lt. Thomas Flahive, 58, during a family trip to Wisconsin two weeks ago, Fire Media Affairs Director Larry Langford said.

The men of Engine Company 108 from the Milwaukee and Laramie firehouse said they never thought a big, strapping guy like Flahive would lose his life because of a mosquito bite.

According to officials, he was bitten by a carrier mosquito and started exhibiting flu-like symptoms. He later slipped into a coma, suffered irreversible brain damage and did not survive.

Friday was a tough day for firefighters who knew that their brother was sick and in the hospital for a couple of weeks, but they never imagined this would happen to him.They said he had a lot of character, big personality, so they are all very saddened by this.

He is survived by his wife, Mary Faith, and three adult children, Langford said.

His family has decided to donate his brain to science so scientists can figure out more about the West Nile virus and how it affects the human body.

The Illinois Department of Public Health has confirmed 179 human cases of West Nile Virus in 2012, resulting in six deaths (Fox News, 2012).

Title: Peanut Butter Recall Expands To 240 Products
Date: October 5, 2012
Fox News

Abstract: More than 200 peanut products have now been recalled because they may contain Salmonella bacteria, U.S. health officials say.

The recalled products all contain peanut butter made at Sunland Inc., a manufacturing company in New Mexico. Today, the Food and Drug Administration said Salmonella bacteria has been found in samples taken from the company's production plant.

Sunland recalled about 100 of its products in late September because they may have been contaminated with Salmonella. Today, the recall was been expanded to include a total of 240 products.

The recall includes all products made at Sunland's product plant since March 1, 2010, the FDA said. Of the newly recalled products, about 50 have "Best-If-Used-By" dates that have not expired, and 90 have "Best-If-Used-By" dates that have expired, but may still be in consumer's homes.

A total of 35 people from 19 states have been sickened from the outbreak, most of whom are children. They were infected with a strain of bacteria called Salmonella Bredeney.

Salmonella can cause serious illness, especially in young children and older adults, the FDA says. Symptoms include diarrhea, fever and abdominal cramps that develop 12 to 72 hours after infection.

full list of the recalled products can be found on the FDA's site.

The Centers for Disease Control and Prevention recommends consumers do not eat the recalled products, and dispose of them or return them to the store (Fox News, 2012).

Title: Confirmed Case Of Crimean Congo Haemorrhagic Fever In The UK
Date: October 5, 2012

Abstract: The Health Protection Agency (HPA) is aware of a laboratory confirmed case of Crimean-Congo Haemorrhagic Fever (CCHF) in a UK traveller who has recently returned from Afghanistan. The patient has been transferred from Glasgow, Scotland to the high security infectious diseases unit at the Royal Free hospital in London using specialist air transport.

CCHF is a serious viral disease which infects a range of domestic and wild animals. Humans are usually infected directly from the blood or body fluids of infected animals or via tick bites. The disease is endemic in many countries in Africa, parts of Europe, the Middle East and Asia.

CCHF can be acquired from an infected patient, but this requires direct contact with their blood or body fluids Therefore, there is no risk to the general population. As a precautionary measure, close contacts of the patient including hospital staff involved in the patient’s care have been contacted and will be monitored.

The HPA is providing public health, diagnostic and other support to the teams currently handling this incident.

This is the first laboratory-confirmed case of CCHF in the United Kingdom (HPA, 2012).

Title: Germany: Batch Of Frozen Strawberries Blamed For Outbreak Of Gastroenteritis In Schools
Date: October 6, 2012
Fox News

Abstract: Authorities say a single batch of deep-frozen strawberries appears to have been behind an outbreak of gastroenteritis in eastern Germany that hit more than 11,000 people, mostly children at schools and day-care centers.

The national disease-control center, the Robert Koch Institute, said late Friday that studies showed a strong connection between eating food prepared with the strawberries and the cases of vomiting and diarrhea.

It says evidence has increased that norovirus, a mostly food- or water-borne illness, was the cause — though it can't yet entirely rule out other pathogens.

Agriculture Ministry spokesman Holger Eichele told news agency dapd that the strawberries are believed to have come from outside the European Union.

Officials have said the sicknesses were moderate and most children recovered quickly without needing to be hospitalized (Fox News, 2012).

Title: Six Johns Hopkins Students Diagnosed With Salmonella
Date: October 6, 2012
Global Dispatch

Abstract: An outbreak of Salmonella has sickened at least six students at the Johns Hopkins University (JHU) Homewood campus in North Baltimore, 
according to a report in the JHU student newspaper, The News-Letter.

According to the report, Dean of Student Life Susan Boswell sent an email to Hopkins students informing them of a salmonella outbreak occurring on the Homewood campus last Saturday.

All of those affected by the outbreak thus far are undergraduate students.

An investigation by city and state health officials is ongoing and they are working closely with the JHU Student Health and Wellness Center.

The one common link to the outbreak according to Baltimore City Health Department Communicable disease acting director, Kompan Ngasmsnga is the students ate at  theFresh Food Café.

There has not been a newly reported case in over a week. The investigation is ongoing.

Salmonella is an organism, which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain.

In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis (Global Dispatch, 2012).

Title: Hong Kong Health Officials Investigate Vibrio Vulnificus Death
Date: October 7, 2012

Abstract: An elderly man with an underlying chronic health condition recently died from a 
Vibrio vulnificus infection, according to a Hong Kong Centre for Health Protection (CHP) press release Oct.5.

The CHP investigation revealed that a crab injured the 80-year-old man last Sunday.

According to the release, the man developed fever and symptoms of vomiting, neck pain and right facial swelling on September 30. He was admitted to Tuen Mun Hospital the following day and was noted as having facial bruises and swelling around his right eye. His condition later deteriorated and he passed away on October 2.

Blood cultures revealed the pathogenic organism, Vibrio vulnificus.

Vibrio vulnificus is a bacterium that is found in warm seawaters. It has also been found in brackish waters. It may be normal flora in salt water and acquiring this organism from shellfish or water exposure does not imply that the water is contaminated by sewage. Most infections that happen are attributed to consuming raw oysters.

Oysters are sedentary bivalve mollusks that feed by filtering plankton (small plants and animals) from estuarine water. Because Vibrio vulnificus occurs naturally in the same waters that oysters feed, the bacteria is ingested and becomes assimilated and concentrated in the animal’s tissues.
Healthy, non at-risk individuals are not at risk for serious infection. Non at-risk patients with gastroenteritis have a relatively mild illness consisting of vomiting, diarrhea and abdominal cramps and rarely require hospitalization.

However, there are certain medical conditions that can put you at risk for very rapid, serious and possibly deadly disease. Individuals with diabetes, liver disease like cirrhosis, leukemia, AIDS or those who take immunosuppressive drugs or steroids are particularly susceptible to primary septicemia, a serious “blood poisoning”. In these individuals the bacteria gets into the bloodstream resulting in septic shock and death in more than 50% of those infected.

Wound infections are another problem with Vibrio vulnificus. These infections result either from contaminating an open wound with sea water harboring the organism, or by lacerating part of the body on coral, fish, etc., followed by contamination with the organism.

This infection can be diagnosed by isolating the organism in stool, wound or blood cultures. It can be treated with an antibiotic regimen and supportive care.

What can you do to prevent this infection? Patients with chronic liver disease or immunocompromised conditions are particularly vulnerable to infection and are advised to avoid raw or undercooked seafood. Persons with open wounds should avoid contact with warm seawater (Examiner, 2012).

Title: Case Count Rises To 91 In Fungal Meningitis Outbreak
Date: October 7, 2012
NBC News

Abstract: At least 91 people have been infected with an unusual type of meningitis caused by contaminated steroid injections, federal health officials said Sunday, with seven deaths. The drugs were given
starting May 21, much earlier than previously suspected, officials with the Centers for Disease Control and Prevention said.

They are urging anyone who has had an injection for lower back pain to watch for symptoms of meningitis, which include a stiff neck and balance problems.

Cases have been identified in nine states and health officials fear the numbers will rise as doctors check patients for the symptoms. Doctors and patients alike may not know to look for the unusual infection, which can take weeks to develop after an injection.

"Several of these patients have had strokes related to the meningitis," the CDC said in a statement posted on its website. "In several patients, the meningitis was found to be caused by a fungus that is common in the environment but rarely causes meningitis. This form of meningitis is not contagious. The source of the fungus has not yet been identified, and the cause of infections in the other patients is still being assessed."

The drug in question is called methylprednisone and is used mostly to treat older patients for lower back pain.

The contaminated drugs have been traced to a single pharmacy in Massachusetts, the New England Compounding Center. The pharmacy has closed voluntarily and recalled its products, which include steroids, painkillers and dozens of other drugs. At least one sealed vial of drug has been found to have fungus growing in it, the Food and Drug Administration said. The FDA does not regulate pharmacies like the one in Massachusetts but can be called in when contamination is suspected.

Compounding pharmacies usually make drugs to order, and the steroids suspected of causing the infections did not contain preservatives that can keep fungi and bacteria from growing.

The pharmacy sent products to clinics in California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas, and West Virginia, the CDC says.

In this case, the patients appear to have had contaminated drugs injected directly into their spinal fluid. CDC says the clinics do not appear to be to blame. The CDC said it has found fungus, including Aspergillus and Exserohilum, in specimens from nine patients.

Meningitis is an inflammation of the protective membranes covering the brain and spinal cord. Bacteria or viruses are the usual cause, but meningitis can also be caused by fungi and parasites. "In addition to typical meningitis symptoms, like headache, fever, nausea, and stiffness of the neck, people with fungal meningitis may also experience confusion, dizziness, and discomfort from bright lights. Patients might just have one or two of these symptoms," CDC said  (NBC News, 2012).

Title: Pakistan Reports Eighth Death Due To ‘Brain-Eating Amoeba’ This Year
Date: October 7, 2012
Global Dispatch

Abstract: An eighth person, a young male student, has died from the deadly waterborne parasite since May in Pakistan, according to a 
Dawn.com report Saturday.

“A senior physician from the hospital has informed me that a 21-year-old Naegleria patient from Federal B Area was admitted to the hospital on Sept 29 and died on Oct 3,” said Dr Shakeel A. Mullick, Infectious disease specialist, adding that this was the second death blamed on Naegleria in the past six days.

The student is the eighth fatality from the dreaded amoeba, mostly young males, during the past six months.

Naegleria fowleri is a relatively rare, pathogenic amoeba found in warm or hot freshwater like lakes, rivers and hot springs. It is also possible to get it from dirty unchlorinated or under-chlorinated swimming pools. This parasite is found worldwide.

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.

Although Naegleria is relatively rare, 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
(Global Dispatch, 2012).

Title: Egypt Mumps Outbreak More Than Triples In One Week
Date: October 8, 2012

Abstract: An outbreak of the viral infection, mumps, has spread through schools nationwide in 
Egypt, according to an Egypt Independent report Oct. 8.

The number of cases reported as of Monday is 583; this is up from 157 cases reported just one week earlier.

Despite the surge in mumps cases, a spokesman for the Education Ministry said that no schools have been closed due to the outbreak.

According to the report, Giza Governorate has so far reported the most number of cases, with 240. Minya has reported 95, Beni Suef 48 and Fayoum 38, with Cairo reporting only 12.

Last week, Health Ministry Undersecretary Amr Qandil projected rising numbers of mumps cases this winter season, but assured it would not be a public health emergency.

Mumps is also an acute viral disease that is characterized by fever and swelling and tenderness in one or more of the salivary glands. Maximum infectiousness occurs between two days prior to onset of illness to four days afterwards.

It is spread from person-to-person by respiratory droplets (for example, when you sneeze) or by direct contact with items that have been contaminated with infected saliva.

Complications to mumps may include; orchitis (which has been reported to be a risk factor for testicular cancer), encephalitis and spontaneous abortion. Sterility in males is a rare possible outcome.

Mumps can be prevented with vaccination. Two doses of mumps vaccine are 88% (range: 66-95%) effective at preventing the disease; one dose is 78% (range: 49%−92%) effective (Examiner, 2012).

Title: Mississippi Reports 213 West Nile Virus Cases, Most Ever Recorded In The State
Date: October 8, 2012

Abstract: Health officials in the Magnolia State reported 13 new human cases of West Nile Virus (WNV) today, bringing the total number of cases to 213, 
according to a Mississippi State Department of Health (MSDH) news release Oct. 8.

According to the MSDH, this is the highest number of WNV cases ever reported in Mississippi.
There have been five fatalities associated with this year’s outbreak.

This compares to 52 WNV cases and five deaths reported in all of 2011.

The new cases were reported in DeSoto (1), Forrest (1), Hancock (1), Hinds (2), Holmes (1), Lauderdale (1), Pike (1), Panola (1), Rankin (1), Scott (1), Walthall (1), and Winston (1) counties.

Since 1999, more than 30,000 people in the United States have been reported as getting sick with West Nile virus.

The Centers for Disease Control and Prevention (CDC) reports as of last Tuesday, 48 states have reported West Nile virus infections in people, birds, or mosquitoes. A total of 3,969 cases of West Nile virus disease in people, including 163 deaths, have been reported to CDC.

The 3,969 cases reported thus far in 2012 is the highest number of West Nile virus disease cases reported to CDC through the first week in October since 2003.

Almost 70 percent of the cases have been reported from eight states (Texas, California, Louisiana, Mississippi, South Dakota, Michigan, Oklahoma, and Illinois).

First discovered in Uganda in 1937, West Nile virus is a mosquito-borne disease that can cause encephalitis, a brain inflammation.

According to the Centers for Disease Control and Prevention (CDC), approximately 80 percent of people (about 4 out of 5) who are infected with WNV will not show any symptoms at all.

Up to 20 percent of the people who become infected have symptoms such as fever, headache, and body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Symptoms can last for as short as a few days, though even healthy people have become sick for several weeks.

About one in 150 people infected with WNV will develop severe illness.

The severe symptoms can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent.

There is no specific treatment for WNV infection (Examiner, 2012).

Title: Calls For Oversight Grow As Meningitis Scare Widens
Date: October 10, 2012

Abstract: Pressure mounted for greater regulation of a little known corner of the pharmaceuticals industry in response to a meningitis scare that widened to 11 states on Wednesday with the first case confirmed in Idaho.

Since the September 25 recall of three lots of a steroid produced by a Massachusetts company, 138 people have contracted meningitis and 12 have died, according to the latest tally from the Centers of Disease Control and Idaho on Wednesday.

The Idaho case was the first discovered in the western United States. The hardest hit state is Tennessee with 44 people sickened with the rare disease.

The number of cases has grown rapidly as health practitioners contacted some 13,000 people around the country who received injections from a potentially tainted supply of steroid medication shipped to 23 states.

Congress came under pressure to close what critics see as a loophole in regulation that left the company linked to the tainted product largely exempt from federal regulation.

"We urge Congress to give FDA (the Food and Drug Administration) the authority it needs to assure these kinds of outbreaks do not happen again," said an official of the U.S. Department of Health and Human Services, who declined to be identified because of ongoing investigations.

This followed leading U.S. House and Senate lawmakers from both parties asking federal health officials on Tuesday for briefings on the outbreak as a first step toward possible legislative action to strengthen federal drug safety regulations.

Some patients expressed anger that such a sensitive area as steroid medication was so lightly regulated.

George Cary, whose wife Lilian Cary is one of three people to die in Michigan, said on Tuesday that Americans have a strong belief in their medical and political system and the outbreak should be a wake-up call to the nation.

"We don't have expectations of a faulty regulatory medical system that allows these types of mistakes to be made," Cary told reporters on his front lawn after a memorial for his wife. "So perhaps the message is, wake up America."

In five states - Tennessee, Michigan, Maryland, Virginia, and Florida - the outbreak has claimed lives, with the latest victim a 70-year-old man in Florida.

As many as 13,000 people received the injections to relieve back pain and other complaints and are at risk of infection, the CDC said, although the number ultimately stricken is likely to be far fewer.

For the first time on Tuesday, Tennessee state health officials gave an estimate of the rate of infection among those patients who received injections from the recalled steroid supplies. Approximately 5 percent of patients treated with the suspect medication in Tennessee have contracted meningitis, said Dr. David Reagan, chief medical officer for the Tennessee Department of Health.

"We expect that most people who were exposed to this will not develop a fungal infection," Reagan said.

The rate of infection overall is not known.

Meningitis is an infection of the membranes covering the brain and spinal cord. Symptoms include headache, fever and nausea. Fungal meningitis, unlike viral and bacterial meningitis, is not contagious.

The outbreak has highlighted a gap in regulation of so-called compounding pharmacies, which are facilities that take drug ingredients and package them into medications and dosages for specific clients.

The federal Food and Drug Administration regulates only the ingredients and their suppliers, not the compounders, which are subject to a patchwork of state oversight.

Some of the thousands of people exposed may have to wait anxiously for weeks because the incubation period of the disease is up to a month, health experts said.

In Tennessee cases, officials said they had found the average incubation period to be 16 days, but they caution that it could range from six to 42 days for their patients.

Tennessee authorities believe they could still see new cases into the early part of November, though that could change as more information is collected, officials said.

The potentially tainted steroid vials, which have been recalled, were shipped to 76 facilities in 23 states, the CDC has said.

Tennessee has been the hardest hit state, with six reported deaths and 44 cases of meningitis, followed by Michigan with three deaths and 28 cases, Virginia with one death and 27 cases and Maryland with one death and nine cases.

The other states with cases are Indiana (15), Florida (6), Minnesota (3), North Carolina (2), Ohio (1), New Jersey (2) and Idaho (1) (Reuters, 2012).

Title: Avian Malaria The Cause Of Death Of Six Penguins At The London Zoo
Date: October 10, 2012
Global Dispatch

Abstract: Six Humboldt penguins died this August at the
 London Zoo after contracting a strain of avian malaria, according to a BBC News report Wednesday.

In an attempt to prevent the mosquito-borne disease, the Zoo reportedly increased the antimalarial medication for the birds fearing an increase in the mosquito population this summer from the wet weather, one of the wettest in decades.  In addition, lavender oil was sprayed around the bird’s nest boxes as a mosqiuito deterrent.

A London Zoo spokesperson said  avian malaria is “endemic” in the UK’s wild bird population.

According to the Merck Veterinary Manual, the parasite that causes avian malaria, several species of Plasmodium,  are not host-specific and infect a wide variety of domestic and wild birds in most areas of the world. Penguins, falcons, canaries, owls, domestic poultry, ducks, and pigeons are most often affected.

The parasite is particularly lethal to species which have not evolved resistance to the disease (e.g. penguins). Plasmodium relictum is the species  that most often causes disease in raptors and penguins.

Dr Stephen Larcombe, an avian malaria expert at Oxford University’s Edward Grey Institute told the BBC, “Generally where they live is cold and windy so they don’t get infected very often in their native conditions.

“In zoos it is quite likely that mosquitoes will be around, especially when, like this year, conditions are wet and there’s lots of things for them to bite.

“Because penguins will have almost no resistance, when one bird does become infected it will probably have a lot of parasites in its blood which makes it far more likely for other penguins to become infected.”

Speaking of the remaining penguins, the spokesperson said: “All the penguins appear healthy and well. Obviously our keepers are keeping a close eye on them, working with the vets, and just making sure we watch them carefully.”

London Zoo has three different species of penguin and it was six Humboldt penguins which died, although the spokesperson said no particular species is more at risk than another, according to a report in The Independent.

Avian malaria was recently in the news because of a study that showed the parasite is advancing northward and infecting birds in Alaska (Global Dispatch, 2012).

Title: Puerto Rico Health Secretary Declares Dengue Fever Epidemic
Date: October 10, 2012

Abstract: The Secretary of Health in 
Puerto Rico, Lorenzo Gonzalez Feliciano, in consultation with Centers for Disease Control and Prevention (CDC) Dengue director, Dr. Harold Margolis, declared a dengue fever epidemic on the Caribbean island, according to a Puerto Rico Department of Health press release Oct. 8 (translated).

According to Sec. Feliciano, "In consultation with the CDC today, and the fact that there has been a increase in reported cases for two consecutive weeks above the epidemic curve, and in recent weeks, more than 50 percent of the reported cases have been confirmed by laboratory testing leads us to make the decision to declare epidemic in Puerto Rico. Furthermore, we see that the trend of an increase in reported cases could continue in coming weeks.”

In the CDC Dengue Surveillance Weekly Report for Puerto Rico for week 37 (the week of Sept. 9), 342 suspected cases were reported.

For the whole of 2012 thus far, there has been 4,816 suspected cases reported with more than one-third laboratory confirmed (1,737), as of Oct. 5.

In addition, there have been 21 cases of the more severe form, dengue hemorrhagic fever reported and four deaths.

Feliciano has asked the health department’s epidemiologist to ensure the revised CDC guidelines for the management of patients with dengue are implemented and that the Department of Health’s policies and procedures are updated.

Other actions to be implemented include a call center to follow-up on dengue patients and a place for citizens to call when they find serious mosquito breeding areas that need to be resolved (Examiner, 2012).

Title: Squirrel Found At California Campground Tests Positive For Plague Exposure
Date: October 11, 2012
Fox News

Abstract: Authorities say a squirrel at a Southern California campground has tested positive for exposure to fleas infected with the bacteria that can cause plague.

Riverside County officials said Tuesday the discovery at the Fern Basin campground north of Idyllwild marks the first time in nearly a decade that a ground squirrel found in the San Jacinto Mountains has tested positive.

Officials says the risk of transmitting the bacteria to humans is minimal if people take proper precautions.

They recommend people avoid contact with squirrels and other wild animals and not camp near animal burrows.

People who become ill with such symptoms as fever, chills and tender swollen lymph nodes should see a doctor immediately.

Meanwhile, authorities say they plan to test other animals in the area later this month (Fox News, 2012).

Title: Pa. Records First Confirmed Case Of Fatal Disorder Affecting Deer
October 11, 2012
CBS Philly

Pennsylvania officials have announced what they say is the state’s first confirmed case of a deer found to be suffering from a disorder similar to “mad cow” disease.

Pennsylvania Agriculture Secretary George Greig says “Chronic Wasting Disease” (CWD) is a fatal disorder affecting deer and other animals in the “cervid” family, including moose and elk.

“There’s no scientific evidence that CWD can affect humans,” he said. “But the Centers For Disease Control and Prevention recommends that people or other animals do not eat any part of cervid diagnosed with or showing signs of CWD.”

The animal in question was found through random testing on a deer farm in Adams County, and the disease has not yet been confirmed in Pennsylvania’s wild deer population.

Hunters are advised to take precautions such as wearing gloves while field-dressing deer and washing thoroughly when they are finished.

Otherwise, they are free to enjoy hunting season (CBS Philly, 2012).

Title: Whooping Cough Detected At Pawt. School
October 11, 2012
Fox Providence

Whooping cough has shown up once again in Rhode Island, this time in a Pawtucket school.

Health officials announced Thursday that two cases have been detected at the Henry Winters Elementary School.

The Department of Health tells us they're monitoring the situation, and that letters have been sent home to parents.

There have been 86 cases in Rhode Island so far this year, up from 62 last year.

In September, researchers revealed that current whooping cough vaccines are losing their effectiveness faster than previously thought (Fox Providence, 2012).

Title: Jamaica Steps Up Efforts To Combat Dengue Fever
October 11, 2012

Jamaica is stepping up mosquito eradication across the island and urging school children to stamp out breeding grounds to combat an epidemic of dengue fever, the Caribbean country's health minister said Thursday.

Health Minister Fenton Ferguson told reporters there have been five suspected deaths from the mosquito-borne virus in Jamaica so far this year. Only one has been confirmed with an autopsy.

There have been more than 1,200 suspected cases as of Sept. 29, compared to 887 during the same period last year. About half the cases have occurred in the southern capital of Kingston. However, this year's cases are far less than in 2010, an outbreak year.

Officials have dispatched fumigation trucks to spray roughly 450 neighborhoods and teams are clearing storm drains that are clogged with debris. Thousands of premises have been inspected, Fenton said.

"We have been taking the necessary steps to reduce the mosquito population and limit the impact of the epidemic across the island," he said at the ministry's offices.

But since fumigation alone can't stop the insects, authorities have urged islanders to do their part in containing the population, such as making sure Aedes aegypti mosquitoes are not breeding in water standing in garbage and old tires.

The Jamaican government is trying to enlist energetic youngsters in the campaign by distributing 400,000 brochures in schools that show how mosquito larvae flourish in stagnant water.

Similar battles are being fought in other parts of the region, including the Dominican Republic and the U.S. island of Puerto Rico, where earlier this week the health department declared an epidemic after nearly 5,000 cases and at least six deaths were reported for 2012.

Dengue victims suffer symptoms like headaches, cramps and severe joint and muscle pain. Most recover after a week, but a severe hemorrhagic form can be fatal. There is no vaccination or cure for dengue, which is also known as "break-bone fever" because of the pain it causes.

Fenton warned that Jamaica's problem could worsen as the rainy season advances. Dengue cases usually flare up from August through December.

"We expect that in the coming weeks there may be even more adult mosquitoes given the recent rains," Fenton said.

The tropical virus was once thought to have been nearly eliminated from the region, but it has steadily gained strength in Latin America and the Caribbean since the early 1980s (AP, 2012).

Title: Dengue Fever Reported In Madeira, Portugal
October 12, 2012

At least 18 people have been confirmed positive for the mosquito borne viral disease, dengue fever since early October on the Portuguese island of Madeira, according to a European Centre of Disease Prevention and Control (ECDC) Rapid Risk Assessment published Oct. 11.

Since the first locally transmitted dengue infection was detected on the island on Oct.3, the ECDC says nearly 200 cases are under investigation, with at least 26 requiring hospitalization for their illness.

The British Health Protection Agency says this is the first time that dengue fever has been reported in Madeira, although the vector for the disease, the Aedes aegypti mosquito, is established on the island.

The ECDC says Portuguese public health authorities are implementing control measures to reduce the risk of sustained transmission locally, the export of infected vectors from the island, and to minimize the impact on the affected population.

The risk for travelers and for residents of the island will depend on the course of the outbreak in the coming weeks and the effectiveness of the control measures. People are advised to take individual protective measures to reduce mosquito bites.

The World Health Organization has estimated that 2.5 billion people are at risk of acquiring dengue fever and that approximately 50 million infections occur each year. It occurs in tropical and sub-tropical regions of the world affecting approximately 100 countries in Africa, South and Central America, Asia, eastern Mediterranean, and western Pacific (Examiner, 2012).

Title: Alberta Reports First West Nile Virus Death In 5 Years
October 13, 2012

The Canadian province of Alberta has reported the first fatality due to the mosquito-borne viral disease, West Nile virus (WNV) since 2007 according to an Alberta Health Services news release Oct. 12.

Health officials say a 66-year-old southern Alberta man succumbed to the infection. In 2012, there have been 10 WNV cases reported throughout the province.

According to an Edmonton Journal report Friday, the name of the victim is Ron Sept from the city Medicine Hat in the southeastern part of the province.

The report says that Mr. Sept, who survived two heart transplants and two heart bypass surgeries more than a decade ago, died after being treated in intensive care for two weeks.

In all of Canada, 386 clinical cases of WNV infection were reported in 2012, this compares the 102 cases reported in 2011, according to the Public Health Agency of Canada.

First discovered in Uganda in 1937, West Nile virus is a mosquito-borne disease that can cause encephalitis, a brain inflammation.

According to the Centers for Disease Control and Prevention (CDC), approximately 80 percent of people (about 4 out of 5) who are infected with WNV will not show any symptoms at all.

Up to 20 percent of the people who become infected have symptoms such as fever, headache, and body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Symptoms can last for as short as a few days, though even healthy people have become sick for several weeks.

About one in 150 people infected with WNV will develop severe illness.

The severe symptoms can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent.

There is no specific treatment for WNV infection (Examiner, 2012).

Title: Bottled Liquid Egg Whites Linked To UK Salmonella Outbreak
October 16, 2012

Abstract: At least seven cases of Salmonella infection linked to consuming pasteurized liquid egg white product has been reported in the United Kingdom, according to a Health Protection Agency (HPA) press release Oct. 16.

The government health agency reports that the tainted product, Myprotein’s own-brand Free Range Liquid Egg Whites sold through Myprotein® and Nutri Centre websites and Nutri Centre stores, tested positive for the same strain of the bacterium found in the seven patients, Salmonella Enteritidis PT1.

Myoprotein previously issued a recall of the product on Oct. 10, according to a Food Standards Agency (FSA) product recall announcement.

Specifically, the affected product, Myprotein® Free Range Liquid Egg Whites, 1kg, carried a batch code # L232203 and was labeled with a “Best before” date of 8 February 2013.

According to the chief of gastrointestinal diseases with the HPA, Dr. Bob Adak, “This egg product has been subject to a recall and so we hope that now that it is no longer in circulation that this will stop people becoming unwell. If anyone has any of this batch of product at home then they should dispose of it.

“Although there has been no increase in the number of cases of this type of salmonella over recent weeks we are still investigating whether newly identified cases might be related to this egg product. To do this we intend to interview patients using a food questionnaire. As usual we will be working with our colleagues in the Food Standards Agency (FSA).”

A similar outbreak of salmonella associated with liquid egg whites occurred in 2007, in which 70 people were sickened.

Salmonella is an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain.

In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis (Examiner, 2012).

Title: Meningitis Outbreak Expected To Escalate As FDA Widens Investigation
October 16, 2012

The death toll from the meningitis outbreak linked to a contaminated steroid drug rose to 16 on Tuesday night as a leading medical expert said the infections were "nowhere near the end".

William Schaffner, an infectious diseases expert at the Vanderbilt University Medical Center in Nashville, said he expects a "steady increase" in the number of fungal meningitis infections over the coming weeks.

His warning came as the Virginia health department confirmed that a second person had died in the state, just hours after the Centers for Disease Control said the number of cases had increased by 19 to 231. It also reported two cases of peripheral joint infections.

Earlier on Tuesday federal agents raided the New England Compounding Center, the pharmacy linked to the outbreak. US Attorney Carmen Ortiz, the top federal prosecutor in Massachusetts said agents from the Food and Drug Administration searched the NECC facility in Framingham.

Schaffner described the escalating FDA investigation into further NECC products as "ominous" and said they would have to warn more patients.

"We were concerned that there might be other medications that might be contaminated coming from that pharmacy," said Schaffner, a past president of the National Foundation for Infectious Disease. "The FDA has given us a heads up that that looks to be the case. We'll have to notify many more patients across the country that they may have been exposed to a fungal infection."

On Monday, after reporting unconfirmed infections from two more drugs made by the NECC, the FDA told medical personnel to contact all patients injected with any drug from the pharmacy, in particular heart transplant and opthalmic patients, as a precautionary measure, to alert them of the risk of infection.

The advice has confused some clinicians who accused the FDA of sending mixed messages which may panic patients.

During a conference call with clinicians and journalists on Tuesday, Dr Janet Woodcock of the FDA stressed that no other NECC products have been confirmed as being linked to the outbreak, but they were investigating such products following at least one infection in a heart transplant patient.

"None of the infections have been confirmed" said Woodcock. "No other products have been linked to documented infections."

Asked if they were in danger of issuing mixed messages in danger of scaring patients, Woodcock said: "I don't think we are asking you to tell them they should be concerned, we are asking you to reach out to them make sure they are healthy and they are no signs of infections."

The infections in patients that have been linked to two new drugs made by NECC, particularly that of a heart transplant patent, who are susceptible to infections, could have arisen from another source, officials said.

Already, 14,000 patients at risk from contracting the disease after having been injected with a potentially contaminated steroid, methylprednisolone, are on the lookout for symptoms of meningitis.

Asked about the spread of the outbreak, Schaffner said: "I think we're still in the middle. We're nowhere near the end of this problem. And we will see more patients reporting in ill and we'll have to treat many more going forward."

Hospitals, clinics and physicians have already been warned not to use any product made by NECC, as well as to contact patients who may have had an injection of the steroid associated with the 15 deaths.

So far, those infected with meningitis have received a spinal injection of the steroid as a treatment for back pain.

On Monday, the agency said it had reports of three patients, including two transplant patients, with possible meningitis who received an injection of another steroid made by NECC.

On Tuesday, the FDA issued a revised statement on its website saying that it was one transplant patient. The patient, who had received a heart drug known as cardioplegia solution made by NECC, had Aspergillus infection but the FDA said there may be another explanation for the infection.The investigation was ongoing, it said.

The second patient identified by the FDA as potentially having meningitis received an injection of the steroid triamcinolone, also supplied by NECC.

It cautioned that any injectable drugs made by NECC, including those intended for use in eyes, are of "significant concern".

The statement on the FDA website said:

At this point in FDA's investigation, the sterility of any injectable drugs, including ophthalmic drugs that are injectable or used in conjunction with eye surgery, and cardioplegic solutions produced by NECC are of significant concern, and out of an abundance of caution, patients who received these products should be alerted to the potential risk of infection.

It also advised physicians and medical personnel to "follow-up with patients for whom you administered an injectable product, including an ophthalmic drug that is injectable or used in conjunction with eye surgery, or a cardioplegic solution purchased from or produced by NECC after May 21, 2012."

The FDA said they were still investigating the two infections found in patients who had received cardioplegia and triamcinolone made by NECC to see if they were linked.

The NECC said in a statement that it was reviewing the new information from the FDA.

On Monday a Tennessee woman who contracted fungal meningitis after receiving an epidural injection with the NECC-prepared steroid filed a lawsuit against the company seeking $15m in damages. Tennessee has been the hardest-hit state, with 53 cases and six deaths.

Meningitis is an infection of the membranes covering the brain and spinal cord. Symptoms include headache, fever and nausea. Fungal meningitis, which also causes strokes, is not contagious.

All but eight of the 23 states that received suspect medications from the Massachusetts specialist pharmacy have reported at least one case of fungal meningitis, a rare and deadly disease that has proven difficult to treat.

The suspect lots of steroid were shipped to 76 facilities.

A list of recalled NECC products on the FDA website ran 70 pages.

The outbreak has raised questions over the oversight of pharmacies known as compounding centers, which are not directly regulated by the FDA.

In compounding, pharmacies prepare specific doses of approved medications, based on guidance from a doctor, to meet an individual patient's need.

However, state pharmacy regulators have said that NECC violated its license in Massachusetts by not requiring patient prescriptions before shipping products.

The 15 states reporting cases of meningitis are Tennessee, Michigan, Pennsylvania, New Hampshire, Illinois, Indiana, Minnesota, New Jersey, Texas, Idaho, Maryland, North Carolina, Virginia, Ohio and Florida (Guardian, 2012).

Title: South Dakota Officials Warn Of Campylobacter Risk With Black Hills Raw Milk
October 17, 2012

Officials are warning the public about the potential infectious disease risk with raw milk from Black Hills Milk after sampling of the product revealed the presence of Campylobacter, according to a South Dakota Department of Agriculture (SDDA) news release Oct. 16.

The SDDA is advising consumers to discard or return the raw milk, which was sold at a retail outlet in Spearfish, Black Hills Farmers Market at Founder’s Park in Rapid City and other locations in the Black Hills.

Black Hills Milk in located in Belle Fourche, S.D.

What is Campylobacter?

It is a bacterium that can also be found, with not quite the frequency as in chicken, in healthy cattle, birds, raw milk, and contaminated water. Most cases of campylobacteriosis are associated with eating raw or undercooked poultry meat or from cross-contamination of other foods by these items. Infants may get the infection by contact with poultry packages in shopping carts. It is also possible to be infected from the feces of an infected pet cat or dog. It is the leading cause of bacterial diarrhea in the United States, more than Salmonella and Shigella combined.

It doesn’t take a lot of this organism to get you ill. In some studies it showed that as little as 500 organisms can cause disease in some individuals. The Centers of Disease Control and Prevention says that you can get infected from one drop of juice from raw chicken meat.

Campylobacter jejuni, the species most often implicated in infection causes diarrhea, which may be watery or sticky and can contain blood and white blood cells. Other symptoms often present are fever, abdominal pain, nausea, headache and muscle pain. The illness usually occurs 2-5 days after ingestion of the contaminated food or water. Illness generally lasts 7-10 days, but relapses are not uncommon (about 25% of cases).

There can be complications associated with campylobacteriosis, which include arthritis and neurological disorder Guillain-Barré syndrome. It is estimated that the latter is seen in one out of every 1000 cases of Campylobacter.

Most cases of Campylobacter are self-limiting and do not require treatment. However, severe cases can be treated with antibiotics to shorten the length of the disease (Examiner, 2012).

Title: CDC Says Deaths Rise To 19 In Worsening Meningitis Outbreak
October 17, 2012

The number of U.S. deaths from fungal meningitis linked to potentially contaminated steroid injections rose to 19 with confirmation of two new fatalities in Tennessee and one each in Florida and Virginia, the Centers for Disease Control and Prevention said on Wednesday.

The deadly outbreak of the rare disease showed no signs of abating, as 14 new cases of meningitis were reported, bringing the national total to 245, plus two peripheral infections in joints.

The new cases were reported in Florida (1), Indiana (2), Michigan (1), Minnesota (2), New Jersey (2), Ohio (2), Tennessee (2) and Virginia (2).

The outbreak stems from medications shipped by the New England Compounding Center in Massachusetts. The company's offices near Boston were raided on Tuesday evening by federal agents in connection with investigations of the specialist pharmacy (Reuters, 2012).

Title: Japan Reports First Imported Case Of Plasmodium Knowlesi
October 18, 2012
Global Dispatch

Plasmodium knowlesi, sometimes considered the fifth human malaria species, is still mostly known as a malaria of macaques in southeast Asia where 78% of the monkeys tested were positive, according to a paper published in the online journal, PLoS Pathogens.

In a letter to ProMed mail Oct. 17, a physician  from the National Center for Global Health and Medicine in Tokyo writes about the first reported human P. knowlesi infection in Japan.

“We have recently confirmed Plasmodium knowlesi infection in a traveler returning from Malaysia to Japan.

In September 2012, a previously healthy Japanese man in his 30′s presented to the travel clinic of the National Center for Global Health and Medicine (NCGM) hospital in Tokyo with a 2-day history of fever, headache, and arthralgia.

He had visited Temenggor, Johor, and Kuala Lumpur in Malaysia during 2 months for field investigations of entomology and zoology, without malaria chemoprophylaxis.

His symptoms started 10 days after returning from Malaysia to Japan. On admission, his body temperature was 37.0 deg C [98.6 deg F], other vital signs were normal. Physical examination showed left upper abdominal pain and mild splenomegaly.

Laboratory investigations showed thrombocytopenia and slightly elevated liver enzymes. The thin blood smear with Giemsa stein showed malaria parasites including band forms similar to P. malariae, and heavily pigmented schizonts inside non-enlarged erythrocytes.

He was diagnosed with non-falciparum malaria and was treated with mefloquine (1500 mg base). He recovered in 3 days after treatments. He was discharged from our hospital on the 7th day of admission without any complications. We finally diagnosed human P. knowlesi infection based on nested multiplex PCR analysis.

This is the 1st reported case of imported human P. knowlesi infection in Japan. _P. knowlesi_ infection might be more popular among travelers returning from Southeast Asia than previously thought.

Plasmodium knowlesi is mostly found is mostly found in South East Asian countries particularly in Borneo, Malaysia, Myanmar, the Philippines, Singapore, and Thailand.

Plasmodium knowlesi is absent in Africa. This may be because there are no long-tailed and pig-tailed macaques (the reservoir hosts of P. knowlesi) in Africa and many West Africans lack the Duffy antigen - a protein on the surface of the red blood cell that the parasite to uses to invade.

Mosquitoes belonging to the Anopheles leucosphyrus group are known to transmit P. knowlesi from monkeys to humans (Global Dispatch, 2012).

Title: Ireland Health Officials Report E. Coli Outbreak Linked To Belfast Restaurant
October 18, 2012

Health officials in Ireland continue the investigation into a large outbreak of E. coli 0157 that has affected scores and has been linked to a Belfast restaurant, according to a Public Health Agency update Oct. 18.

According to the release, as of 3pm on Thursday 18 October 2012, there were 29 confirmed cases and 202 probable cases of the bacterial infection. At least 15 people required hospitalization for their illness.

Public Health Agency (PHA) and Environmental Health Officers from Belfast City Council continue the investigation into the outbreak and the link to Flicks restaurant in Cityside Mall, Belfast.

Health authorities say that the management of Flicks is cooperating with the investigation.

Dr Carolyn Harper, Director of Public Health, PHA, said: “The PHA has activated a full public health response to this outbreak and the situation is being managed and monitored very closely."

Investigations are continuing and conclusions will emerge when all cases have been identified and analyzed to identify any common links.

The PHA says at least two different strains of the bacterium have been identified. They confirmed today that the type of E. coli 0157 in cases in October is different from the type found in August cases associated with the same restaurant. These results are from a first phase of typing tests, which showed the cases in August to be Type 8. The confirmed cases in October are Type 54. It is too early to draw definitive conclusions at this stage.

E. coli is a type of bacteria commonly found in the intestines and feces of animals, including cattle, goats, sheep, deer and elk, or in raw meat from these animals. Some of these bacteria produce a toxin, called Shiga toxin, which can make humans severely ill.

Symptoms of the diseases caused by E.coli O157 include abdominal cramps and diarrhea that may in some cases progress to bloody diarrhea. The infection may lead to a life-threatening disease, such as hemolytic uremic syndrome (HUS). HUS is characterized by acute renal failure, hemolytic anemia and thrombocytopenia. It is estimated that up to 10% of patients with E.coli infection may develop HUS, with a case-fatality rate ranging from 3% to 5%.

Anyone can get this illness, but it is particularly dangerous for young children and the elderly. Symptoms may not appear for as many as 10 days after infection (Examiner, 2012).

Title: Vanderbilt Reports Chlamydia Outbreak Among Greeks
October 19, 2012
Global Dispatch

The Zerfoss Student Health Center at Vanderbilt University has reported a spike in the sexually transmitted infection, chlamydia on campus, according to a Inside Vandy report Wednesday.

The report notes that since September, there have been 14 confirmed chlamydia cases reported, mostly in students involved in with Greek affiliations.

Dr. Louise Hanson, director of the Student Health Center said, they typically see 0-2 cases of chlamydia each month. Hanson notes that the 14 cases  is a tiny percentage of the student body, but it does represent an increase in what is routinely seen.

The Nashville Metro Public Health Dept. has been notified of the cases, as chlamydia is a reportable disease.

Student Health offers comprehensive STD testing. Appointments can be scheduled by calling (615) 322-2427      .

Chlamydia trachomatis, specifically types D through K are responsible for sexually acquired genital infections in adults and perinatally transmitted infections in newborns and infants.

Like gonorrhea, chlamydia can be transmitted during oral, vaginal and anal sexual contact with an infected partner.

Sometimes chlamydia is called the “silent disease” because so many people have it and don’t know it. Asymptomatic infection in men is as high as 25%, in women 70%! If symptoms do appear, it’s usually within 1-3 weeks.

When symptoms are present in men it’s sometimes difficult to distinguish from gonorrhea; urethral discharge, itching and burning during urination. In women, symptoms are also similar to gonorrhea with discharge and bleeding being most common.

Men or women who have receptive anal intercourse may acquire chlamydial infection in the rectum, which can cause rectal pain, discharge, or bleeding. Chlamydia can also be found in the throats of women and men having oral sex with an infected partner.

Pelvic inflammatory disease (PID) and epidyimitis, in women and men respectively, are the most common complications with untreated chlamydia.

Rarer complications include: Bartholinitis, proctitis and Fitz-Hugh-Curtis syndrome.

In pregnant women, there is some evidence that untreated chlamydial infections can lead to premature delivery. Babies who are born to infected mothers can get chlamydial infections in their eyes and respiratory tracts. Chlamydia is a leading cause of early infant pneumonia and conjunctivitis (pink eye) in newborns.

Chlamydia can be treated with the antibiotics Doxycycline (twice daily for 7 days) or Azithromycin in a single dose. Erythromycin is the drug of choice for infants and Azithromycin for pregnant women.

It is common practice to treat for gonorrhea also when diagnosed with chlamydia. Co-infections are relatively common (Global Dispatch, 2012).

Title: Uganda: Marburg Outbreak Comes Just Two Weeks After Ebola Outbreak Declared Over
October 19, 2012

The Ugandan Ministry of Health is warning the public about another outbreak due to a deadly hemorrhagic fever in the Kibaale district, according to a report from the Ugandan news source, The Independent Oct. 19.

The outbreak, which has killed at least four people, comes just two weeks after the ministry declared the Ebola outbreak over.

The three of the four Marburg cases have been confirmed by the Uganda Virus Research Institute (UVRI). All of the cases were from the same family according to health officials.

In addition, preliminary reports from the district indicate that four other people had allegedly died of a strange disease since October 4th.

The Kibaale district was also the epicenter of the Ebola outbreak in the African nation earlier this year, which took the lives of 17 people.

Marburg hemorrhagic fever is a rare, severe type of hemorrhagic fever which affects both humans and non-human primates. Caused by a genetically unique zoonotic (that is, animal-borne) RNA virus of the filovirus family, its recognition led to the creation of this virus family. The five species of Ebola virus are the only other known members of the filovirus family.

Recent scientific studies implicate the African fruit bat (Rousettus aegyptiacus) as the reservoir host of the Marburg virus. The African fruit bat is a sighted, cave-dwelling bat which is widely distributed across Africa. Fruit bats infected with Marburg virus do not to show obvious signs of illness. Primates, including humans, can become infected with Marburg virus, which can progress to serious disease with high mortality.

Just how the animal host first transmits Marburg virus to humans is unknown.

After an incubation period of 5-10 days, the onset of the disease is sudden and is marked by fever, chills, headache, and myalgia. Around the fifth day after the onset of symptoms, a maculopapular rash, most prominent on the trunk (chest, back, stomach), may occur. Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea then may appear. Symptoms become increasingly severe and may include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction. The case-fatality rate for Marburg hemorrhagic fever is between 23-25%.

Confirmed cases of Marburg HF have been reported in Uganda, Zimbabwe, the Democratic Republic of the Congo, Kenya, and Angola. Cases of Marburg HF have occurred outside Africa, though infrequently (Examiner, 2012).

Title: Suspicious Cases Of Anthrax In Armenia
October 20, 2012
Armenian Life

Armenia’s Ministry of Health received an alarm with respect to suspicious anthrax cases recorded in the Vardenis district of the Gegharkunik Region, the Ministry informed Armenian News-NEWS.am.

As a result, an epidemiological study was conducted on location, and laboratory research samples were taken from the persons who are suspected of having caught this disease. The results will be known within the next few days.

The preventive measures are in progress.

To note, spokesperson Babken Pipoyan of the Agriculture Ministry’s State Service on Food Safety told Armenian News-NEWS.am on Friday that the last time when anthrax was recorded in Armenia was three years ago (Armenian Life, 2012).

Title: E. Coli Outbreak Linked To Cleveland County Fair Now Over 100 Cases
October 21, 2012

In a follow-up to a story last week, North Carolina health officials report that the E. coli outbreak linked to the Cleveland County Fair has surpassed 100 cases, according to a N.C. Department of Health and Human Services outbreak update Oct. 19.

Public health officials say at least 106 people who attended the Cleveland County Fair in late September to early October have been infected.

Of the 106 cases reported to date, 60% of those affected are children (64), while the remainder (42) is adults.

Twelve individuals required hospitalization for their illness. One fatality has been reported in a Gaston County toddler, Gage Lefevers, which is linked to the outbreak.

A majority of the illnesses are from residents in Cleveland County, NC (61). Residents from six other NC counties and two South Carolina counties are also affected by the outbreak.

Epidemiologists say that based on preliminary findings from the investigation, animal exposure may be the source of this outbreak.

E. coli is a type of bacteria commonly found in the intestines and feces of animals, including cattle, goats, sheep, deer and elk, or in raw meat from these animals. Some of these bacteria produce a toxin, called Shiga toxin, which can make humans severely ill.

Symptoms of the diseases caused by E.coli O157:H7 include abdominal cramps and diarrhea that may in some cases progress to bloody diarrhea. The infection may lead to a life-threatening disease, such as hemolytic uremic syndrome (HUS). HUS is characterized by acute renal failure, hemolytic anemia and thrombocytopenia. It is estimated that up to 10% of patients with E.coli infection may develop HUS, with a case-fatality rate ranging from 3% to 5%.

Anyone can get this illness, but it is particularly dangerous for young children and the elderly. Symptoms may not appear for as many as 10 days after infection (Examiner, 2012).

Title: Uganda Marburg Outbreak Spreads: Five Deaths Reported
October 22, 2012

In a follow-up to a breaking story Friday, the outbreak of Marburg hemorrhagic fever (MHF) that was first confirmed last week in the Kibaale district, has spread to the capital city of Kampala, when an infected woman traveled there, according to an AlertNet report Oct. 22.

According to a World Health Organization (WHO) Global Alert and Response Monday, the death toll to the dangerous Marburg virus, a relative to Ebola, has jumped to 5 fatalities.

UN health officials say there are nine probable and confirmed cases in the current outbreak, in which three cases have been laboratory confirmed.

Initial finding in the investigation reveals that all of the cases are linked to the initial index case as family members.

Marburg hemorrhagic fever was first identified in 1967 during epidemics in Marburg and Frankfurt in Germany and Belgrade in the former Yugoslavia from importation of infected monkeys from Uganda.

Recent scientific studies implicate the African fruit bat (Rousettus aegyptiacus) as the reservoir host of the Marburg virus.

Uganda's director general of health services, Dr. Ruth Aceng said that outbreaks of hemorrhagic fevers in Uganda tend to occur between June and September.

Aceng goes on to say that during this period, villagers who go into the wild to collect fruit are likely to encounter wild animals such as fruit bats.

The WHO says illness caused by Marburg virus begins abruptly, with severe headache and severe malaise. Many patients develop severe hemorrhagic manifestations between days 5 and 7, and fatal cases usually have some form of bleeding, often from multiple sites. The disease has no vaccine and no specific treatment.

Marburg virus is transmitted by direct contact with the blood, body fluids and tissues of infected persons. Transmission of the Marburg virus also occurred by handling ill or dead infected wild animals (monkeys, fruit bats). The predominant treatment is general supportive therapy (Examiner, 2012).

Title: JamaicanAuthorities Advise Public To Seek Medical Care For Dengue Symptoms
October 24, 2012

With this year’s outbreak of dengue fever in Jamaica quadrupling the number of cases in 2011, government officials on the Caribbean island are urging the public to seek medical attention if they are experiencing symptoms of the mosquito borne viral disease, according to a Jamaica Information Service report Oct. 23.

Dr. Marion Bullock DuCasse, Director of Emergency, Disaster Management and Special Services in Jamaica said, “If you are experiencing any of these symptoms and have any reason to believe you or a family member may have dengue haemorrhagic fever (DHS) or dengue shock syndrome (DSS), you need to go to the nearest health facility immediately.”
Since Jan. 1, the Jamaican Health Ministry has reported 1,710 suspected cases of dengue fever as of October 13, 2012. This compares to 429 cases reported during the same period in 2011.
Dengue fever is caused by one of four different but related viruses. It is spread by the bite of mosquitoes, most commonly the mosquito Aedes aegypti, which is found in tropic and subtropic regions
(Examiner, 2012).

Title: Ebola Outbreak In Democratic Republic Of Congo
October 26, 2012

As of 24 October 2012, 52 cases (35 laboratory confirmed, 17 probable) with Ebola haemorrhagic fever (EHF) have been reported in the Democratic Republic of Congo (DRC). Of these, 25 have been fatal (12 confirmed, 13 probable).

The cases are reported from Isiro and Viadana health zones in Haut-Uélé district in Province Orientale.

The Ministry of Health (MoH) continues to work with local health authorities and international partners in active surveillance, tracing of contacts of probable and confirmed cases, infection prevention and control in health care settings, management of patients in health care facilities, logistics, social mobilization, provision of psychosocial support and conducting anthropological analysis to support the control of the outbreak.

Surveillance activities are being strengthened in Isiro and neighbouring areas, including Bedhe and Nakwapongo. In Isiro, health care workers are being trained on basic infection prevention and control in health care settings. Through the Global Outbreak Alert and Response Network (GOARN), a field laboratory has been set up by the Public Health Agency of Canada (PHAC).

Social mobilization activities are being carried out in schools and churches in Isiro, Rungu and Ngosaku to provide information on protection against the Ebola virus and to discuss concerns of the local population (WHO, 2012).

Title: Madeira Dengue Outbreak Expands, Cases Reported In Other European Countries
October 26, 2012

In a follow-up to a story earlier this month, the outbreak of dengue on the Portuguese island of Madeira has tripled and now cases are being seen in other European countries linked to travel to the island, according to a European Centre for Disease Prevention and Control (ECDC) Epidemiological Update Oct. 25.

Portuguese Public Health officials have confirmed 52 cases of dengue fever and over 400 probable cases. This compares to 18 confirmed and almost 200 probable cases two weeks ago.
Cases of the tropical mosquito borne infection are now being seen in other parts of
Europe in travelers to the Portuguese island.

The ECDC reports cases in England (1), France (2) and Sweden (1). The British Health Protection Agency reports the person affected in England is recovering well.

The European Centre for Disease Prevention and Control (ECDC) does not recommend any restrictions on travel to Madeira, but travelers are advised to protect themselves from mosquito bites by taking necessary precautions.

The Autonomous Region of Madeira has also published recommendations on their website for individual protection measures.

The World Health Organization has estimated that 2.5 billion people are at risk of acquiring dengue fever and that approximately 50 million infections occur each year. It occurs in tropical and sub-tropical regions of the world affecting approximately 100 countries in Africa, South and Central America, Asia, eastern Mediterranean, and western Pacific (Examiner, 2012).

Title: Mobile County Man Hospitalized With Vibrio Vulnificus Infection
October 27, 2012

Mobile County, Alabama health officials say that a 75-year-old resident was diagnosed with an infection with Vibrio vulnificus, according to a Mobile County Health Department news release Oct. 25.

The patient is currently recovering from the bacterial infection in a local hospital. Health officials did not disclose how the man contracted the potentially lethal bacterial infection.

According to the release, Dr. Bernard Eichold, Health Officer, Mobile County Health Department, said Vibrio vulnificus occurs naturally in coastal areas of the Gulf of Mexico, Atlantic and Pacific Oceans. It is not caused by pollution or improper food handling, health officials said.

Vibrio vulnificus has previously been detected in Mobile Bay and other local waters.

Vibrio vulnificus is a bacterium that is found in all coastal waters of the United States. It has also been found in brackish waters of some interior states. It may be normal flora in salt water and acquiring this organism from shellfish or water exposure does not imply that the water is contaminated by sewage. Most infections that happen are attributed to consuming raw oysters harvested in the Gulf of Mexico during the summer. Because the oysters are shipped all over the country, infections are not limited to the Gulf States.

Oysters are sedentary bivalve mollusks that feed by filtering plankton (small plants and animals) from estuarine water. Because Vibrio vulnificus occurs naturally in the same waters that oysters feed, the bacteria is ingested and becomes assimilated and concentrated in the animal’s tissues.

Healthy, non at-risk individuals are not at risk for serious infection. Non at-risk patients with gastroenteritis have a relatively mild illness consisting of vomiting, diarrhea and abdominal cramps and rarely require hospitalization.

However, there are certain medical conditions that can put you at risk for very rapid, serious and possibly deadly disease. Individuals with diabetes, liver disease like cirrhosis, leukemia, AIDS or those who take immunosuppressive drugs or steroids are particularly susceptible to primary septicemia, a serious “blood poisoning”. In these individuals, the bacteria gets into the bloodstream resulting in septic shock and death in more than 50% of those infected.

Wound infections are another problem with Vibrio vulnificus. These infections result either from contaminating an open wound with sea water harboring the organism, or by lacerating part of the body on coral, fish, etc., followed by contamination with the organism.

This infection can be diagnosed by isolating the organism in stool, wound or blood cultures. It can be treated with a antibiotic regimen and supportive care.

What can you do to prevent this infection?

Patients with chronic liver disease or immunocompromising conditions are particularly vulnerable to infection and are advised to avoid raw or undercooked seafood. Persons with open wounds should avoid contact with warm seawater (Examiner, 2012)

Title: Seminole County Man Contracts Locally Acquired Dengue Fever
October 30, 2012

The Seminole and Orange County (FL) health departments are investigating a locally acquired case dengue fever case near the University of Central Florida area, according to an Orlando Sentinel report Oct. 30.

The patient, a 19-year-old Seminole County man, is the first locally acquired case of the mosquito borne viral disease in either county in approximately five decades. He is currently recovering from the illness.

The dengue virus was laboratory-confirmed according to the report.

Just one month ago, the Miami-Dade health department reported their first locally acquired dengue fever case in 60 years.

Dengue fever of multiple types is found in most countries of the tropics and subtropics particularly during and after rainy season. It has been seen repeatedly in Texas and Hawaii in this country.

A small number of patients in Florida were diagnosed with the illness in 2009 and 2010.

The World Health Organization (WHO) estimate 100 million cases annually, this includes 100-200 cases reported to the Centers for Disease Control and Prevention (CDC), mostly in people that have traveled abroad.

In recent years, there has been an increase in epidemics in many parts of the world.

There are four types of dengue virus: DEN-1, DEN-2, DEN-3 and DEN-4.

People get the dengue virus from the bite of an infected Aedes mosquito. It is not contagious from person to person.

There are three types of dengue fever in order of less severe to most: the typical uncomplicated dengue fever, dengue hemorrhagic fever (DHS) and dengue shock syndrome (DSS).

The symptoms of classic dengue usually start within a week after being infected. They include very high fever, up to 105°F, severe headache, pain behind the eye, severe joint and muscle pain, nausea and vomiting and a rash.

In cases of DHF and DSS, all four types can be the cause in descending order of frequency; type 2, 3, 4 and 1.

There is evidence that types 2 and 4 need to be secondary infection to cause DHF, while primary infection with types 1 and 3 can cause DHF.

Symptoms of DHF include all the symptoms of classic dengue plus severe damage to the blood vessels. Bleeding from the nose, gums or under the skin are common. This form of dengue can be fatal.

Symptoms of DSS include all of the above symptoms plus; fluid leaking outside of blood vessels, massive bleeding and shock. This form of the disease usually happens in children experiencing their second infection.

Two-third of all fatalities occurs among children.

There is no specific treatment for dengue, just treatment of the symptoms. Persons who think they have dengue should use analgesics (pain relievers) with acetaminophen and avoid those containing aspirin. They should also rest, drink plenty of fluids, and consult a physician.

There is not a vaccine for dengue fever (Examiner, 2012).

Title: Chickenpox Outbreak Locks Down San Quentin
October 30, 2012

San Quentin State Prison is on a medical lockdown following an outbreak of chickenpox, according to published reports.

San Quentin News and San Rafael Patch report that all programs at the Marin County facility were canceled last weekend and no visitors were being allowed to enter the Marin County prison as medical staff attempted to determine how many inmates had contracted the virus, characterized by itchy skin irritation and blisters.

According to the Centers for Disease Control, complications adults can experience as a result of chicken pox, also known as varicella, include dehydration, pneumonia, blood, bone and joint infections as well as inflammation of the brain. Deaths associated to chicken pox are rare, but not unheard of, according to the CDC.

As of last month, there were 3,842 inmates housed at San Quentin. Prison officials gave no timetable for resumption of normal activities (CBS SF, 2012).

Title: Dane County Health Officials Report A Shigella Outbreak
November 1, 2012

Health officials are investigating a small outbreak of shigellosis in Dane County, Wisconsin, with the lion’s share being reported from the capital city of Madison, according to a City of Madison news release Nov. 1.

Public Health - Madison and Dane County (PHMDC) says there have been 17 cases of shigellosis reported since Sept. 20. This compares to 19 cases reported in the county during all of 2011.

The source of the outbreak is still unknown; however, health officials say at least 12 of the cases were determined genetically similar via laboratory testing.

Fourteen of the cases are from Madison residents, while the remaining cases are from Belleville, Monona and Stoughton.

According to the release, PHMDC has alerted health care providers and other organizations (schools, daycares etc) of this outbreak asking them to make sure people are properly tested.

Shigellosis is an acute bacterial disease of the intestines caused by several species of the bacterium, Shigella. It is typified by loose stools, frequently containing blood and mucus (dysentery), accompanied by fever, vomiting, cramps and occasionally toxemia.

It can cause bacillary dysentery because of the invasive ability of the organism that may result ulcerations and abscesses of the intestines.

It rarely spreads to the bloodstream.

More severe complications may include convulsions in children, Reiter's syndrome and hemolytic uremic syndrome depending on the species of Shigella implicated.

This diarrheal disease is found worldwide with the vast majority of cases and deaths being in children. Outbreaks usually occur where there are crowded conditions and where personal hygiene is poor: prisons, day care centers and refugee camps are three examples.

It is transmitted primarily by fecal-oral person to person means. It can also occur through contaminated food or water. Those primarily responsible for transmission are people that fail to wash their hands thoroughly after defecation.

Because Shigella is resistant to gastric acid, a person can be infected with as little as 10 organisms.

After being infected, symptoms usually appear 1-3 days later. It can be transmitted during the acute phase of infection until approximately four weeks after illness when the organism is no longer present in the feces. Asymptomatic carriers can also infect others.

Diagnosis is confirmed through bacteriological culture of feces. Treatment of shigellosis may include fluid and electrolyte replacement if there are signs of dehydration.

Antibiotics can shorten the course of infection, the severity of illness and the period of time a person may excrete the pathogen. Because of some antibiotic resistance, an antibiotic susceptibility test should be performed to determine which antibiotic would be effective (Examiner, 2012).

Title: University Of Zurich Microbiologists Confirm The Existence Of Another Tick Disease In Switzerland – Neoehrlichiosis
November 1, 2012
Global Dispatch

Microbiologists from the University of Zurich have detected a new disease transmitted via tick bites, and thanks to a newly developed PCR test, the bacterial infection can be detected within a day, according to a University of Zurich press release (translated) Oct. 31.

University microbiologists say that the new tick borne disease, neoehrlichiosis, is the third found in Switzerland- borreliosis and the early-summer-meningoencephalitis virus being the other two.

The findings of the Swiss, Swedish and German researchers can be found in their article, “Close geographic association of human neoehrlichiosis and tick populations carrying Candidatus Neoehrlichia mikurensis in Eastern Switzerland”, in latest issue of the Journal of Clinical Microbiology.

According to the release:

The pathogenic bacteria Candidatus Neoehrlichia mikurensis was first discovered in ticks and rodents in Europe and Asia in 1999. In 2010, Head of Molecular Diagnostics at the Institute of Medical Microbiology Guido Bloemberg and colleagues from Sweden and Germany diagnosed the world’s first infections in humans and dubbed the disease “neoehrlichiosis”, by detection of the bacterium in the patients blood. Two more cases were identified at the University of Zurich’s Institute of Medical Microbiology between October 2011 and January 2012. So far, a total of eight patients have been described in Europe, three of whom come from the Zurich area. They suffered from relapsing fevers of up to 40 degrees, weight loss and general malaise.

Bloemberg’s team studied around 2,000 ticks from the neighborhood of the three Swiss patients, who often spent time in forests and fields. The result: A large number of ticks in the Zurich area – five to ten percent – carry Candidatus Neoehrlichia mikurensis. “Our study shows that the greater Zurich region is a risk area for neoehrlichiosis, especially for immunocompromised people,” explains Florian Maurer from the University of Zurich’s Institute of Medical Microbiology. 

“Because the bacteria that cause neoehrlichiosis couldn’t be bred in the lab until now and thus no rapid tests were available, many infections might have remained undetected,” says Guido Bloemberg. However, help is now at hand with the new DNA test the researchers have developed: It can detect an infection definitively within one working day and also be used for larger test series.

The Swiss patients could be cured fully with a course of antibiotics. Within only a few weeks of beginning the treatment, the microorganism responsible could no longer be detected in their blood (Global Dispatch, 2012).

Title: Afghanistan: Large Increases In Measles Prompt Nationwide Measles Vaccination Campaign
November 2, 2012
Global Dispatch

A reduction in immunization coverage in recent years in Afghanistan has resulted in sharp increases in the vaccine preventable disease, measles in the strife-torn country, according to an Integrated Regional Information Networks (IRIN), the humanitarian news and analysis service of the United Nations Office for the Coordination of Humanitarian Affairs report Nov. 1.

The report states since the start of the last Afghan winter, in November 2011, 9,000 measles cases were reported across almost every province in the country, as compared to 3,000 cases over the same period the year before.

In addition, more than 300 children have died from the viral, respiratory disease during to this period.

Vaccination coverage in Afghanistan has been a challenge due to many factors – rising insecurity, decreased access, difficult terrain and harsh winters that cut off thousands of villages, to name a few.

“Day by day, the security situation becomes worse and our access to the people for providing health services becomes more limited,” said Sayed Zubair Sadat, with the Afghan Red Crescent Society.

Experts say nearly 30 percent of the population has no or very poor access to primary health care, including immunization, and the percentage is estimated to be as high as 70 percent in areas of conflict in the south.

In an effort to get Afghanis vaccinated, the World Health Organization-Afghanistan will join  the Afghanistan Ministry of Health National Immunization Programme to launch a second nationwide measles vaccination campaign in November.

This campaign will target 18 provinces and reach approximately 5 million children (nine months–10 years); thus ensuring a country-wide outreach: last July, more than 6 million received measles vaccine in the other 16 provinces (Global Dispatch, 2012).

Title: Oxford Heroin User Is The Latest Anthrax Case In The U.K.
November 2, 2012

An injectable heroin user from Oxford is the fifth and latest anthrax case to be reported from the United Kingdom this year, according to a Health Protection Agency (HPA) press release Nov. 2.

Health officials say the patient is recovering.

The HPA says the Oxford case brings the total number affected in the UK to five – three in England (two fatal, one recovering), one in Scotland and one in Wales (both recovering).

Two heroin users from Blackpool died from anthrax in a span of three weeks this late summer.
This case also brings the total in the European
anthrax outbreak to 12 since June, according to health officials

Health officials are still trying to determine if the U.K. cases are linked to cases elsewhere in Europe.

HPA expert in infections among drug users, Dr. Fortune Ncube said: “Anthrax can be cured with antibiotics, if treatment is started early. It is therefore important for medical professionals to be alert to the possibly of anthrax infection in heroin users presenting with signs and symptoms – which include severe soft tissue infections or blood poisoning – to prevent any delays in providing treatment.”

Dr Éamonn O’Moore, director of the HPA’s Thames Valley Health Protection Unit said, “Injecting drug users often experience skin infection but we strongly advise them not to ignore signs such as redness or excessive swelling around injection sites, or other symptoms of general illness such a high temperature, chills, severe headaches or breathing difficulties. They should seek medical advice quickly in such circumstances generally but particularly now because we have concerns that some batches of heroin in circulation in Oxfordshire and the wider Thames Valley may be contaminated with anthrax. Early treatment with antibiotics is essential for a successful recovery.”

The European Centre for Disease Prevention and Control says anthrax is a zoonotic disease caused by the spore-producing bacterium Bacillus anthracis. The disease is endemic in several regions of the world, including southern and Eastern Europe.

Humans may acquire the infection after exposure to spores, and symptoms appear one to seven days (up to 60 days) later. Clinical presentations include skin anthrax, lung anthrax, (with 75% death rate) and gastrointestinal forms (that may progress to blood infection and death). Antibiotic treatment is effective if given at an early stage (Examiner, 2012).

Title: Thirty Hippos Die In Anthrax Outbreak At Kruger National Park
November 5, 2012

An anthrax outbreak in the South African park has claimed the lives of 30 hippopotami in the past two weeks, according to a South African National Parks (SANParks) media release Nov. 5.

The outbreak north of Kruger National Park, which initially began in August, has killed dozens of hippos in the Letaba and Olifants Rivers recently.

Park officials are closely monitoring the situation.

“Members of the public are urged to report any sightings to the nearest camp and not to touch the carcases. The State Veterinarians are busy examining six carcases that were found over the weekend and will issue the results as soon as they’re available”, according to SANParks spokesperson, Reynold Thakhuli.

Thakhuli said that anthrax is a natural occurrence in the area.

Since 1960, eight major anthrax outbreaks have occurred in the Kruger National Park (1960, 1970, 1990, 1991, 1993, 1999, 2010 and 2012).

Anthrax is a pathogen in livestock and wild animals. Some of the more common herbivores are cattle, sheep, goats, horses, camels and deers.

It infects humans primarily through occupational or incidental exposure with infected animals of their skins.

Anthrax is caused by the bacterium, Bacillus anthracis. This spore forming bacteria can survive in the environment for years because of its ability to resist heat, cold, drying, etc. this is usually the infectious stage of anthrax.

When conditions become favorable, the spores germinate into colonies of bacteria. An example would be a grazing cow ingests spores that in the cow, germinate, grow spread and eventually kill the animal.

The bacteria will form spores in the carcass and then return to the soil to infect other animals.

The vegetative form is rarely implicated in transmission.

There are no reports of person-to-person transmission of anthrax. People get anthrax by handling contaminated animal or animal products, consuming undercooked meat of infected animals and more recently, intentional release of spores.

There are three types of anthrax with differing degrees of seriousness: cutaneous, gastrointestinal and inhalation (Examiner, 2012).

Title: Norovirus On Celebrity Cruises' Ship Constellation
November 6, 2012

A cruise ship delayed its departure from Southampton after a suspected outbreak of norovirus on board.

Celebrity Cruises' vessel Constellation arrived in the city's port at 06:00 GMT at the end of a 12-night cruise.

Southampton's Port Health Authority said about 350 passengers had fallen ill with the vomiting and diarrhoea bug.

Its departure was delayed until 20:00 while deep cleaning took place.

The authority's Rosie Zambra confirmed it was informed of "concerns over an increased levels of what appeared to be norovirus" several days before the ship's arrival.

'Bad sanitation'

About 2,200 and 900 crew had been on a wine cruise around the coasts of France and Spain.

A representative of the health authority has since been on board and verified the affected cabins and public areas had been deep cleaned.

Passenger David Mattey said his holiday had been "completely ruined" when he went down with severe vomiting and diarrhoea.

He said: "The sanitation on that ship is bad."

A statement from Celebrity Cruises said the crew was conducting "extra cleaning and sanitising on board the ship and within the cruise terminal as preventative measures."

It added its hygiene procedures on board were "comprehensive and always strictly adhered to" (BBC, 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)

Title: Hepatitis Hits More Than 1,000 Refugees In South Sudan: UNHCR
November 9, 2012

An outbreak of hepatitis E has infected at least 1,050 Sudanese refugees in South Sudan, killing 26 and threatening to spread further among people still arriving in crowded camps, the United Nations said on Friday.

About 175,000 people have already fled to South Sudan to escape fighting in Sudan's South Kordofan and Blue Nile states, the U.N. High Commissioner for Refugees said. Thousands more are expected to cross in coming weeks after the rainy season ends, it added.

"To date, 26 refugees have died in camps in Upper Nile (state)," UNHCR spokesman Adrian Edwards told a news briefing in Geneva.

"The capacity to contain an outbreak of hepatitis E among the refugee population is increasingly jeopardized. The risks will grow if, as currently anticipated, we see fresh inflows of refugees from South Kordofan and Blue Nile states," he said.

The death toll was up from 16 on September 13.

The virus, contracted and spread through contaminated food and water, damages the liver and can be fatal.

To counter spread of the disease, the UNHCR was struggling to provide 15 to 20 liters of safe drinking water per refugee per day and building enough latrines so that each unit is shared by no more than 20 refugees, said Edwards.

The agency needs at least $20 million by the end of the year for its South Sudan operation as only 40 percent of its appeal for $186 million has been received, he added (Reuters, 2012).

Title: Nestle Recalls Nesquik Due To Salmonella Risk
November 9, 2012
Fox News

Nestle USA is recalling some of its Nesquik chocolate powder because of a possible salmonella risk.

The food maker said Thursday that the Nesquik involved was in 10.9-, 21.8- and 40.7-ounce canisters produced in early October and sold at retailers across the country.

Nestle says it is issuing the recall after its ingredient supplier, Omaya Inc., decided to recall some of the calcium carbonate used in the product due to possible Salmonella contamination. The company says there are no reported illnesses associated with the product.

Salmonella can cause diarrhea, abdominal cramps and fever. It can be life-threatening in infants, the elderly, pregnant women and those with weakened immune systems.

The affected products have a "Best if sold by" date of October 2014.The recall includes the following products and unit production codes, which are located on the bottom of the canister.

-40.7 ounce powder with UPC 0 28000 68230 9 2282574810 2282574820

-21.8 ounce powder with UPC 0 28000 68090 9 2278574810 2278574820 2279574810 2279574820 2284574820 2284574830 2285574810 2285574820 2287574820 2289574810 2289574820

-10.9 ounce powder with UPC 0 28000 67990 3 2278574810

No other varieties of Nesquik powder are in the recall.

Nestle said that consumers who bought the affected Nesquik products should not use it and can return it for a refund or contact Nestle Consumer Services at(800) 628-7679.

Salmonella recalls are not uncommon in the food industry. Most recently a salmonella outbreak at the country's largest organic peanut processing plant lead to a major recall of peanut butter and other nut products over the past two months (Fox News, 2012).

Title: New York Style Nova Lox Recalled Due To Listeria Fears, May Be Linked To Two Infections
November 12, 2012
Global Dispatch

Brockton MA company, Spence & Co Ltd is recalling New York-Style Nova Lox, 4oz, Code/Lot: 9720704 due to an abundance of caution because of possible contamination by Listeria monocytogenes, according to an Food and Drug Administration (FDA) Firm Press Release Friday.

The bacterium was detected during routine microbial sampling.

The affected product,  1,563 packs of Spence & co Ltd New York Style Nova Lox, was distributed to IL, MO, NJ, MA and in the Detroit area between 9.26.12 and 10.5.12

The potentially tainted product was distributed to the following retail outlets:

Earthfare: AL, NC, GA, SC, TN, FL & OH between 9.28.12 and 10.5.12.

Shaws Supermarkets: New England on 9.28.12. (expiration date 10.21.12)

Roche Bros: MA on 9.26.12 (expiration date 10.19.12).

Fresh Markets: In FL,GA,KY,IL,AL,AZ,OH,TN,SC,VA,IN,MI,OK & KS.

The FDA says that 2 possible product related illnesses have been reported.

Listeriosis, a serious infection usually caused by eating food contaminated with the bacterium Listeria monocytogenes, is an important public health problem. . The disease primarily affects older adults, pregnant women, newborns, and adults with weakened immune systems. However, rarely, persons without these risk factors can also be affected.

Food contaminated with Listeria monocytogenes may not look or smell spoiled. Listeriosis can cause high fever, severe headache, neck stiffness and nausea. Pregnant women, the elderly and people with weakened immune systems are particularly at risk. Infected pregnant women may experience only a mild, flu-like illness, however, infections during pregnancy can lead to premature delivery, infection of the newborn, or even stillbirth (Global Dispatch, 2012).

Title: Outbreak Of Yellow Fever Kills 107 In Darfur, Sudan
November 13, 2012
Fox News

A yellow fever outbreak in Sudan's Darfur region has killed 107 people in the last six weeks, the World Health Organization reported Tuesday, warning that the disease could spread all over the country.

The number of deaths from the outbreak is steadily rising, and Sudan is working on an emergency vaccination drive. Officials reported last week that 67 people had died in the outbreak.

There is no medicinal cure for yellow fever, which is spread by mosquitoes. Doctors treat the main symptoms -- dehydration, fever, bleeding and vomiting -- and wait for the viral infection to pass.

The WHO estimates that more than 500 million people in 32 countries in Africa are at risk of yellow fever infection.

As part of the emergency response program, 2.4 million doses of the yellow fever vaccine are scheduled to arrive in the Sudanese capital next week, Dr. Anshu Banerjee of the WHO office in Sudan told The Associated Press by phone on Tuesday.

More than 350 suspected cases of yellow fever have been reported in Darfur since late September, and more than 30 percent of people showing symptoms have died, according to a WHO statement.

Around 70 percent are under 29 years old, according to a statement released Monday by the Sudanese Health Ministry and the WHO.

 Banerjee warned that yellow fever cases are "definitely spreading" to new areas of the remote region of Darfur, where Sudan's government has been battling rebel groups since 2003. More than 300,000 people have been killed in the conflict, and health care services are not available to many residents as a result of the turmoil.

He said that while no yellow fever cases have been found outside Darfur, the WHO is planning a risk assessment in the next two weeks on the assumption that all areas in Sudan may be at risk of infection.

Banerjee said that Darfur's heavy rainy season this year created additional breeding sites for the disease-carrying mosquitos.

Sudan's last outbreak of yellow fever killed 160 people in the South Kordofan region in 2005 (Fox News, 2012).

Title: Signs Of Drug-Resistant Malaria Emerge In Vietnam And Myanmar
November 14, 2012

Last spring, the global health community got some alarming news about its last, best treatment for malaria. The artemisinin-based drugs were losing their potency at two different places in Southeast Asia: in western Cambodia and along the border between Thailand and Myanmar.

Health workers feared that it was only a matter of time before the resistant malaria would show up elsewhere.

Now there are signs that artemisinin-resistant malaria is cropping up in Vietnam and central Myanmar, researchers reported Tuesday at the annual meeting of the American Society of Tropical Medicine and Hygiene in Atlanta.

"Showing that resistance is emerging outside of western Cambodia is a game changer," says Dr. Rick Fairhurst, an infectious disease specialist from the National Institute of Allergy and Infectious Diseases, who co-chaired the study. "There are other places, up and coming, that we'll have to be deal with now."

For the past year and a half, Fairhurst and a team of doctors from Oxford University have closely monitored 883 malaria patients at 12 locations in Cambodia, Thailand, Myanmar, Bangladesh, Vietnam and Laos. The researchers have been measuring how quickly the Plasmodium parasite leaves patients' blood after they're given artemisinin.

Patients in the drug-resistant hot spots of western Cambodia took the longest time to recover from malaria infections, as researchers expected. But at clinics more than 300 miles away in Vietnam, the results were mixed. Some patients wiped out the infections fast, but others were quite slow to recover. The team saw the same split at clinics in central Myanmar.

Some researchers at the meeting were hesitant to label this slow clearance of the parasite drug resistance because several factors can influence how fast the drug works, including a patient's age and the malaria species. Plus, artemisinin still kills the parasite, eventually. It just takes longer.

This is good news, Fairhurst says, because it means doctors can still use the drug to treat malaria in these locations. They probably just have to be extra careful, and perhaps add another medication to make sure they wipe out all forms of the parasite.

"We may need to get more serious about using a second drug to kill the gametocytes [one stage of the parasite]," he tells Shots. "The guidelines say to do this, but it is not in widespread use."

Although the study is still ongoing, the team hasn't found any signs of sluggish recovery in Laos or Bangladesh With careful surveillance and mapping of malaria infections, Fairhurst says he's hopeful that health workers will be able to stay ahead of artemisinin resistance before it spreads to other parts of Southeast Asia (KVNF News, 2012).

Title: Health Officials Isolate Scores After Ebola Kills At Least 2 In Uganda
  November 15, 2012
Fox News

Scores of Ugandans were isolated on Thursday to prevent the spread of a new outbreak of Ebola in Uganda, the scene of increasingly regular outbreaks of deadly hemorrhagic fevers that have left health officials grappling for answers.

The new Ebola outbreak was confirmed Wednesday in a district 40 miles from the Ugandan capital, Kampala. The outbreak comes roughly a month after Uganda declared itself Ebola-free following an earlier outbreak in a remote district of western Uganda. Last month at least five people in a southwestern district of Uganda were killed by Marburg, a hemorrhagic fever similar to Ebola.

The latest Ebola outbreak, officials say, is of the Sudan strain of Ebola and not linked to the previous one, of the Congo variety, which killed at least 16 villagers in July and August in the western district of Kibaale. At least three people have died in the latest outbreak, and up to 15 are being monitored for signs of the disease, officials said. They advised against panic after it was revealed that two possible Ebola patients had since checked into Kampala's main referral hospital.

"The Ministry of Health once again calls upon the public to stay calm as all possible measures are being undertaken to control the situation," Christine Ondoa, Uganda's minister of health, said.

Ebola is especially feared in Uganda, where multiple outbreaks have occurred over the years, and news of it can cause patients to flee hospitals to avoid infection. In 2000, in one of the world's worst Ebola outbreaks, the disease infected 425 Ugandans and killed more than half of them in the country's north. Another outbreak in 2007 killed 37 people in Bundibugyo, a remote district close to the Congolese border.

Ebola is highly infectious and kills quickly.

Denis Lwamafa, the director-general of health services in Uganda's Ministry of Health, suggested that there were more reported cases of Ebola in Uganda than other countries because "our diagnostic capability" has increased. But a World Health Organization official in Kampala said there were progressively more cases of Ebola because of an increase in "the interaction between man and the forests."

Investigators believe the first victim of Ebola in any outbreak acquires the disease after coming into contact with a "reservoir," an infected animal that is often a monkey.

"Whenever there is contact between man and the reservoir of Ebola then you get the first case," said Miriam Nanyunja of the World Health Organization.

Ebola was first reported in 1976 in Congo and is named for the river where it was recognized. There is no cure or vaccine for it. Ebola is "characterized by fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. A rash, red eyes, hiccups and internal and external bleeding may be seen in some patients," according to a factsheet by the U.S.-based Centers for Disease Control and Prevention.

The virus can be transmitted through direct contact with the blood or secretions of an infected person, or objects that have been contaminated with infected secretions. During communal funerals, for example, when the bereaved come into contact with an Ebola victim, the virus can be contracted, officials said, warning against unnecessary contact with suspected cases of Ebola.

Nanyunja of WHO said Ugandans near the Ebola epicenter should practice what she called "social distancing," avoiding things such as handshakes and similar contact (Fox News, 2012).

Title: Far Rockaway Cough Post Sandy
November 15, 2012
My Fox NY

Abstract: A bad cough is going around Far Rockaway, Queens. It is just one example of the post-storm health problems resident of hard-hit areas are exposed to in the aftermath.

Brett Scudder, a community activist, says he has come across many people who have a cough and migraine headaches.

Dr. Manny Alvarez of Fox News says migraines and respiratory problems could be signs of toxic exposure.

The city's Department of Health says recent testing shows outdoor air quality is good. But officials warn about indoor air quality.

Airborne toxins could come from mold in a flooded basement. We saw mold covering the walls of one basement. Health officials warn people to wear gloves and masks when cleaning out the debris.

Both my photographer and I started getting dizzy; we were down in the basement for just a few minutes.

Volunteers with Heart to Heart, a mobile medical unit in Far Rockaway, say respiratory illness has been the second biggest problem with people who have come in for help, right behind high blood pressure from stress (My Fox NY, 2012).

Title: Costa Rica Health Officials Warn The Public After Recent Dengue Fever Surge
November 15, 2012
Global Dispatch

Health officials are advising the public to be on the alert for dengue fever after a recent surge in cases in Guanacaste during the past three weeks, according to a Inside Costa Rica report today.

They say the areas most affected by the mosquito borne disease include  Liberia, Santa Cruz, Abangares, Nicoya and Carillo.

The health ministry reports that Santa Cruz was the hardest hit area reporting at least 75  new cases.

Thirty-four of the 200 cases were considered “severe” , where the patients required hospitalization.

Besides the Guanacaste cases, infections have also been reported in Puntarenas, Limon, Pococí, Sarapiqui and San Pablo de Heredia.

The report notes that the Ministry of Health has confirmed 505 infections of the dengue virus across the country this week. There have been just over 15,000 people infected so far this year.

Dengue fever is a disease caused by any one of four closely related dengue viruses (DENV 1, DENV 2, DENV 3, or DENV 4). The viruses are transmitted to humans by the bite of an infected Aedes mosquito.

The principal symptoms of dengue fever are high fever that lasts from 2 to 7 days, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash, and mild bleeding.

More serious and life threatening forms of dengue include dengue hemorrhagic fever (DHS) and dengue shock syndrome (DSS).

There is no vaccine for prevention of dengue fever and no specific medication for treatment of a dengue infection (Global Dispatch, 2012).

Title: Publix Recalls 45 Bakery Cake Products For Possible Listeria Contamination
November 16, 2012

Publix Super Markets Inc. (PUSH) is voluntarily recalling 45 bakery cake products because they may be contaminated with the food-borne bacteria Listeria monocytogenes.

"No illnesses have been reported to date in connection with the [seven-inch] chocolate layer cake used to make these desserts," said Maria Brous, media and community-relations director.

The company said it was notified of the possible contamination by its supplier, Maplehurst. The recalled cakes were distributed to Publix stores in several Florida counties between Nov. 11 and Nov. 15.

Consumers who bought the cakes can return them to their local store for a full refund.

Publix operates 1,065 grocery stores in Florida, Georgia, South Carolina, Alabama and Tennessee. Earlier this month, the employee-owned company reported its third-quarter earnings rose 18% as total sales climbed 4.4% and same-store sales increased 2.5% (WSJ, 2012).

Title: Plague Outbreak Kills Six In Madagascar
November 19, 2012
Global Dispatch

An outbreak of the dangerous bacterial disease on the Big Island marks the beginning of plague season on the island nation in the Indian Ocean.

The epidemiology and surveillance section of the Madagascar Ministry of Health reports 43 cases of pneumonic plague in the past month , which includes 6 fatalities in the Bongolava region alone.

While the vast majority of the cases where seen in Bongolava, other cases were reported in Mandoto and Ambalavao districts where at least one fatality was recorded.

“The plague victims sometimes live in remote areas and they self-medicate before going to a health center when the disease worsens. However, all health centers are equipped with rapid diagnostic test and medications to treat this disease immediately,” said Alain Marcel Rahetilahy, head of epidemic and neglected diseases within the Ministry of Health, reports L’Express de Madagascar.

Health authorities say the people must remain vigilant as the heat, rain and brush fires have forced rats to flee to the villages.

Madagascar sees up to 500 suspected plague cases annually.

Plague is an infectious disease caused by the bacterium, Yersinia pestis. It is found in animals throughout the world, most commonly rats but other rodents like ground squirrels, prairie dogs, chipmunks, rabbits and voles. Fleas typically serve as the vector of plague.

People can also get infected through direct contact with an infected animal, through inhalation and in the case of pneumonic plague, person to person.

Pneumonic plague is probably the most serious form of plague, here the bacteria infect the lungs and cause pneumonia. It is contracted when the bacteria is inhaled (primary) or develops when bubonic or septicemic plague spreads to the lungs.

Pneumonic plague is contagious and can be transmitted person to person. It is highly communicable under appropriate climate conditions, overcrowding and cool temperatures. Untreated pneumonic plague is frequently fatal (Global Dispatch, 2012).

Title: Pumpkin Butter Recalled Due To Botulism Risk
November 20, 2012

Woodstock, Ontario company, Birtch Farms and Estate Winery is voluntarily recalling their own brand of Pumpkin Butter because it may be contaminated with the bacterium that causes botulism, Clostridium botulinum, according to a Canadian Food Inspection Agency health hazard alert Nov. 19.

In addition, Birtch Farms and Estate Winery is warning the public not to consume the affected product.

All lots of the 110 ml and 250 ml jars of Birtch Farms and Estate Winery brand Pumpkin Butter are affected by the recall, which was distributed throughout Ontario.

To date, there have been no reported illnesses associated with the consumption of this product.

Food borne botulism occurs when the bacterium Clostridium botulinum is allowed to grow and produce toxin in food that is later eaten without sufficient heating or cooking to inactivate the toxin. Botulinum toxin is one of the most potent neurotoxins known.

Growth of this anaerobic bacteria and the formation of the toxin tend to happen in products with low acidity and oxygen content and low salt and sugar content. Inadequately processed, home-canned foods like asparagus, green beans, beets, and corn have commonly been implicated.

However, there have been outbreaks of botulism from more unusual sources such as chopped garlic in oil, chili peppers, improperly handled baked potatoes wrapped in aluminum foil and home-canned or fermented fish. Garden foods like tomatoes, which used to be considered too acidic for the growth of Clostridium botulinum, is now considered a potentially hazardous food in home canning.

Though more common in home-canned foods, it does happen occasionally in commercially prepared foods.

Typically in a few hours to several days after you eat the contaminated food you will start to show the classic symptoms; blurred vision, dry mouth, and difficulty in swallowing. Gastrointestinal symptoms may or may not occur. If untreated, the paralysis always descends through the body starting at the shoulders and working its way down.

The most serious complication of botulism is respiratory failure where it is fatal in up to 10% of people. It may take months before recovery is complete.

If the disease is caught early enough it can be treated with antitoxin. If paralysis and respiratory failure happen, the person may be on a ventilator for several weeks (Examiner, 2012).

Title: Priority Total Pet Care All Natural Bullstrips Recalled Due To Salmonella Risk
November 22, 2012
Global Dispatch

  Lenoir, NC dog treat company, Carolina Prime Pet Inc. announced the voluntary recall of Priority Total Pet Care All Natural Bullstrips in a 5-count package due to possible Salmonella contamination, according to a Food and Drug Administration (FDA) Firm Press Release Nov. 20.

The lot of dog treats tested positive during routine microbial testing by the Colorado Dept. of Agriculture.

Priority Total Pet Care All Natural Bullstrips are sold in Safeway stores in Arizona, California, Colorado, Delaware, Hawaii, Maryland, Nebraska, Nevada, New Mexico, South Dakota, Virginia, Washington DC and Wyoming as well as Vons, Pavilions and Pak ‘N Save stores in California; Randalls and Tom Thumb stores in Texas; Genuardi’s stores in Pennsylvania and New Jersey, and Dominick’s stores in Illinois. This product was distributed from about the first of September until now.

There is no reported cases of illness related to this product.

Salmonella is a pathogen to both humans and animals. There is a risk for humans handling the contaminated dog food if poor hand washing techniques are not performed or surfaces in contact with the dog food are not properly cleaned.

In humans, Salmonella can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain.

In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

Pets, including dogs, with Salmonella can become lethargic and have diarrhea or bloody diarrhea, fever and vomiting. The clinical features of canine salmonellosis vary on strain, amount ingested and dog host factors.

Many dogs however are asymptomatic carriers of the bacteria and may shed Salmonella for up to 100 days after being infected. This can become a risk for family members and anyone with confirmed salmonellosis without a known risk of exposure, the family pet should be tested regardless of symptoms.

Customers who purchased the recalled dog treats should discontinue use immediately, and return items to the purchase location for replacement, refund, or discard (Global Dispatch, 2012).

Title: North Sea Norovirus Outbreak: Five Oilworkers Quarantined As 55 Others Show Symptoms
November 22, 2012

A total of five oilworkers are now being kept in isolation on the North Sea installation at the centre of a suspected norovirus outbreak.

And the oil service company which operates the Heather platform today revealed that a further 55 personal had shown symptoms of being infected with the winter vomiting bug over the last month.

Yesterday non essential personnel were evacuated from the platform, 100 miles North east of the Shetland Islands, as a precautionary measure because of concerns of a potential norovirus outbreak, leaving 70 oilworkers still on board.

The platform is operated on behalf of EnQuest by Aberdeen-based oil service company Petrofac.

A spokesman for Petrofac said yesterday that two oil workers had been placed in quarantine and isolated on the installation as a precautionary measure. But he revealed today:: “Petrofac, as duty holder of the Heather installation on behalf of EnQuest, can confirm that there are currently three suspected cases of norovirus on the installation with an additional two who are clear of symptoms but still in isolation.

“Over the course of the last month 55 personnel have shown symptoms of the virus and have been provided with medical support as required and isolated in designated cabins.”

He added: “All reasonable steps have been taken to contain the spread of the virus including personnel being isolated for an additional 48 hours once clear of any symptoms. Guidance is also being provided by onshore occupational health medical professionals.

“As an additional precautionary measure we have reduced the number of non-essential personnel on the installation, including reducing mobilisation of personnel to the installation, to limit further spread of the virus on board. The platform continues to operate safely and efficiently and has 70 personnel currently on board” (Scotsman.com, 2012).

Title: Indiana Chickenpox Outbreak Largest In US, Official Says
November 23, 2012
Fox News

The chief medical officer of the Indiana State Department of Health says western Indiana's Vigo County is experiencing the largest known current outbreak of chickenpox in the U.S.

Dr. Joan Duwve (DUH'-vee) told the Terre Haute Tribune-Star for a story this week that Vigo County usually has fewer than 10 cases per year but had had 84 since September. The Vigo County health Department has scaled back the number of cases after reporting more than 100 cases earlier in the week.

Duwve says it's not clear why the county is having such a large outbreak. Neighboring Parke County has had cases at one school.

Vigo County School Corp. officials excluded 230 students from school last week because of the outbreak (Fox News, 2012).

Title: Norovirus Outbreak Sickens 140 On Royal Caribbean's ‘Voyager Of The Seas’
November 23, 2012

Approximately 140 passengers and crew on board Royal Caribbean's Voyager of the Seas developed gastrointestinal symptoms resembling norovirus upon returning from New Zealand to Sydney, according to a Royal Caribbean blog report Nov. 23.

According to the cruise line statement, those infected with the stomach bug responded well to over-the-counter medications administered on board the ship.

Cruise officials notified passengers today that they would begin cleaning and sanitizing guest rooms per Centers for Disease Control and Prevention (CDC) recommendations.

Because of these events, big lines were formed at the Overseas Passenger Terminal in Circular Quay, which stretched hundred of meters, frustrating passengers.

The Voyager of the Seas can hold 3,138 passengers and over 1,100 crew members.

Noroviruses are a group of viruses that cause the “stomach flu,” or gastroenteritis in people.

The symptoms include nausea, vomiting, diarrhea, and some stomach cramping. Sometimes people additionally have a low-grade fever, chills, headache, muscle aches, and a general sense of tiredness. The illness often begins suddenly, and the infected person may feel very sick. In most people, the illness is self-limiting with symptoms lasting for about 1 or 2 days. In general, children experience more vomiting than adults do.

Norovirus is spread person to person particularly in crowded, closed places. Norovirus is typically spread through contaminated food and water, touching surfaces or objects contaminated with norovirus and then putting your hand or fingers in your mouth and close contact with someone who is vomiting or has diarrhea (Examiner, 2012).

Title: WHO Reports Four New Confirmed Cases Of Novel Coronavirus
November 23, 2012

In a follow-up to a story in September, UN health officials have received reports of four additional cases and one death due to the novel coronavirus, according to a World Health Organization (WHO) Global Alert and Response released Nov. 23.

According to the WHO, the newly reported cases are from Saudi Arabia (3 cases and 1 death) and Qatar. This brings the total of laboratory confirmed cases to six. Of the six laboratory confirmed cases reported to WHO, 4 cases (including 2 deaths) are from Saudi Arabia and 2 cases are from Qatar.

Close contacts of the above patients have been identified, followed-up and the investigation into the source of the infection continues.

To date, only two of the recent confirmed cases from Saudi Arabia have been linked—being family members from the same household.

The WHO is encouraging continued surveillance for severe acute respiratory infections (SARI) and is reviewing the case definition for the disease (Examiner, 2012).

Title: German Lab: Qatar Man Suffered From New Virus
November 23, 2012
Yahoo News

A patient from Qatar has been confirmed with a new virus related to SARS, while health officials are investigating whether it may have spread between humans after close contact in Saudi Arabia.

Germany's Robert Koch Institute said Friday that the Qatari patient fell ill in October with severe respiratory problems. He was brought to Germany for treatment in a specialty clinic, recovered after a month and was released this week.

As a precaution, the World Health Organization advised medical authorities around the world to test any patients with unexplained pneumonias for the new coronavirus, from a family of viruses that cause the common cold as well as SARS. Previously, WHO had only advised testing patients who had been to either Qatar or Saudi Arabia — the two countries with all six reported cases.

"Until more information is available, it is prudent to consider that the virus is likely more widely distributed than just the two countries which have identified cases," WHO said.

WHO reported a cluster of four cases in October in a family living in the same household in Saudi Arabia, in which a father and son both fell ill with symptoms including pneumonia, fever and respiratory problems. The father, 70, died after developing renal failure. His son was hospitalized shortly afterwards and died four days later after multi-organ failure. The son was confirmed with the coronavirus while the father's results are pending.

Two other people in the same family got sick but both recovered. One was confirmed with the coronavirus while the other tested negative.

Health officials always keep a close eye on any clusters of unusual viruses within families, since they may suggest the possibility of human-to-human spread. Still, that is usually due to close contact in which family members are looking after sick loved ones and does not suggest the virus can be easily transmitted.

Experts aren't sure how the virus is spreading but suspect it may be jumping directly to humans from animals like bats, camels or goats. In the latest case from Qatar, however, the patient had no known links to animals.

WHO said Saudi officials were currently examining how its last cases got infected. "Investigations are ongoing to look at all sorts of exposure, including the possibility of human-to-human transmission," said spokeswoman Fadela Chaib. So far, there is no evidence the virus can spread easily between people.

The Koch institute says there is no evidence the Qatari patient treated in Germany infected anyone else in the country. "The Robert Koch Institute's assessment of the risk remains that the possibility of becoming infected in Germany is very low," the institute said.

About 8,500 people worldwide were affected by SARS, or Severe Acute Respiratory Syndrome, in 2003 and about 900 died (Yahoo News, 2012).

Title: Dengue Fever Cases Increase 25 Percent In The Philippines
November 24, 2012

The Philippines has seen a significant increase in cases of the mosquito borne virus, dengue, so far in 2012, reports The Manila Standard Today on Nov. 24.

From January to October this year, the Philippines reported 132,046 cases, up 25 percent versus the 105,702 logged in the same 10-month period in 2011.

This has prompted the Philippines universal health coverage program, The Philippine Health Insurance Corp. or PhilHealth president to assure the public that the program will continue to cover dengue fever.

According to an Inquirer News report Friday, Doctor Eduardo Banzon, PhilHealth president and chief executive officer, said the agency provides P8,000 ( about $195 US) for each case of dengue fever or simple dengue hemorrhagic fever and P16,000 for every case of dengue hemorrhagic fever with presence of shock.

“We are constantly helping to pay for the hospitalization and treatment of every member or dependent admitted due to dengue fever,” said Banzon.

Concerning treatment of this potentially life-threatening disease, the World Health Organization (WHO) says there is no specific treatment for dengue fever. Severe dengue is a potentially lethal complication but early clinical diagnosis and careful clinical management by experienced physicians and nurses often save lives.

There is also no vaccine against the virus to prevent the infection (Examiner, 2012).

Title: Ham Sausages Recalled Due To Listeria Risk, Company Has License Suspended
November 24, 2012

Edmonton, AB food manufacturer, Capital Packers Inc., is voluntarily recalling two ham sausage products because of a possible health risk of Listeria monocytogenes contamination, according to a Canadian Food Inspection Agency (CFIA) health hazard alert Nov. 22.

The company and the CFIA is advising the public not to eat the following affected products: Capital brand Ham Sausages, 300 g size, with UPC code 0 64946 51100 6 2012 DE 26 and Compliments brand Ham Sausages in the 375 g size, with UPC code 0 68820 10061 4 2012 DE 26.

These products may have been distributed nationally.

There have been no reported illnesses associated with the consumption of these products.

In addition, on the same day, the CFIA suspended Capital Packers Inc. license to operate effective immediately.

According to the news release, The CFIA has determined that adequate controls for food safety are not being reliably implemented in the facility on a consistent basis. The company has failed to correct deficiencies previously identified through CFIA inspections.

All products currently at this plant are under CFIA detention and control. In addition, the CFIA is conducting a food safety investigation to determine if products shipped from the plant pose potential risks to consumers, particularly related to Listeria monocytogenes contamination. The CFIA will immediately alert the public if unsafe food could be in the marketplace.

Capital Packers, Inc. will have to fully implement the necessary corrective actions and demonstrate to the CFIA’s satisfaction that they can effectively manage food safety risks.

Listeriosis, a serious infection usually caused by eating food contaminated with the bacterium Listeria monocytogenes, is an important public health problem. . The disease primarily affects older adults, pregnant women, newborns, and adults with weakened immune systems. However, rarely, persons without these risk factors can also be affected.

Food contaminated with Listeria monocytogenes may not look or smell spoiled. Listeriosis can cause high fever, severe headache, neck stiffness and nausea. Pregnant women, the elderly and people with weakened immune systems are particularly at risk. Infected pregnant women may experience only a mild, flu-like illness, however, infections during pregnancy can lead to premature delivery, infection of the newborn, or even stillbirth (Examiner, 2012).

Title: China Reports Small Outbreak Of Foot-And-Mouth Disease
November 25, 2012

Chinese agriculture officials are confirming a small outbreak of the highly contagious viral disease of cattle and swine, foot-and-mouth disease (FMD) in the northeast province of Liaoning, according to a China Daily report Nov. 25.

Forty-three pigs from a farm in Dalian City of Liaoning showed symptoms of the illness early last week.

Samples from the pigs were tested by The National Foot-and-Mouth Disease Reference Laboratory and were confirmed positive for type O foot-and-mouth disease.

Provincial health authorities have sealed off and began sanitizing of the affected area.

According to the USDA, foot-and-mouth disease is a severe, highly contagious viral disease of cattle and swine. It also affects sheep, goats, deer, and other cloven-hooved ruminants. FMD is not recognized as a zoonotic disease.

The disease is characterized by fever and blister like lesions followed by erosions on the tongue and lips, in the mouth, on the teats, and between the hooves. Most affected animals recover, but the disease leaves them debilitated. It causes severe losses in the production of meat and milk.

Since it spreads widely and rapidly and because it has grave economic as well as clinical consequences, FMD is one of the animal diseases that livestock owners dread most (Examiner, 2012).