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ProMED Digest      Wednesday, November 10 2004      Volume 2004 : Number 432



In this issue:
 
        PRO/AH/EDR> Bluetongue, domestic ruminants - Spain  (02)
        PRO/AH/EDR> Tularemia, pneumonic - USA (NYC)
        PRO/AH/EDR> CJD (new var.) - Ireland (02): conf.
        PRO/AH/EDR> Plague, tularemia, rodents, human - USA (CO)
        PRO/EDR> Malaria & dengue fever - Dominican Republic: RFI

See the end of the digest for information on how to retrieve back issues.

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Date: Tue, 9 Nov 2004 22:51:29 -0500 (EST)
From: ProMED-mail <
promed@promed.isid.harvard.edu>
Subject: PRO/AH/EDR> Bluetongue, domestic ruminants - Spain  (02)

BLUETONGUE, DOMESTIC RUMINANTS - SPAIN (02)
*******************************************
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Date: Tue, 9 Nov 2004
From: Chris Griot <
Christian.Griot@ivi.admin.ch>
Source: The Herald, 9 Nov 2004 [edited]
<
http://www.theherald.co.uk/business/27581.html>


SAC warns blue tongue disease is on move
- -----------------------------------------
Global warming and the growth of international travel pose increasing
threats to animal health. The expansion of the European Union is another
factor which could allow the spread of diseases, including blue tongue.

This disease, which primarily affects sheep but can occur in all ruminants,
has been spreading throughout much of southern Europe and North Africa and
there are fears it may spread further north, according to Brian Hosie, of
the Scottish Agricultural College.

Hosie, who is also president of the British Sheep Veterinary Association,
said: "Blue tongue is a viral disease spread by a midge. It has in the past
normally been associated with the tropics but in recent years has been
quite common in the former Yugoslavia, Romania and Hungary [According to
the OIE data, Bluetongue has never been recorded in Romania nor Hungary. -
Mod. AS]. "What is more worrying is Italian scientists have discovered the
disease is now being spread by another species of midge common in that part
of Europe."

Typical symptoms include nasal congestion, breathing problems, lameness and
a reluctance to move. There can also be reproductive problems. Fatality
rates are normally in excess of 30 percent and animals which recover tend
to remain unhealthy.

The disease has also been found in northern Australia. However, in the
European context the major concern has been an outbreak in southern Spain
which has now spread to Morocco [It seems that the direction of spread
might have been the opposite one. - Mod.AS]. More than 1000 cases have been
reported, with 13 000 animals at risk within 142 separate outbreaks. The EU
has imposed import and movement restrictions on infected areas.

Tropical breeds of sheep tend to have a higher resistance. However, there
are fears that if the disease spreads into northern Europe the casualty
rate could be high.

Hosie explained: "There is no doubt the threat of blue tongue is real. Our
generally warmer climate means there is a possibility we could see some
exotic diseases not normally associated with northern latitudes. Midges
could easily be blown north or carried by thermals."

There is a vaccine, but in the event of a UK outbreak it is probable the
government would adopt a slaughter policy, with quarantine and movement
restrictions [see comment].

The BSVA, in conjunction with the department of the environment, food and
rural affairs, held a course 18 months ago to alert the profession to the
dangers. Some research has been conducted at the government's animal
disease centre at Pirbright in Surrey. Should farmers observe suspicious
symptoms they should contact their veterinary surgeon.

The message from the veterinary profession is that every effort must be
made to keep blue tongue out of the country.

[Byline: Dan Douglass]

- --
ProMED-mail
<
promed@promedmail.org>

[Killing affected or exposed sheep for the control of bluetongue is
unlikely to be an effective, or scientifically justifiable policy. The
disease spreads with infected, wind-bourne midges (notably _Culicoides
imicola_, and according to some recent investigations, potentially also
other species such as _C. obsoletus_ and _C. pulicaris_), while bovines
serve as the reservoir or rather amplifier of the virus. Viraemic cattle
generally do not show clinical symptoms, while the duration of their
viraemia is generally longer than in sheep. The value of quarantine and
movement restrictions in sheep is also questionable.

Further reading:

Sellers RF, 1980. Weather, host and vector-- their interplay in the spread
of insect-borne animal virus diseases.J Hyg (Lond) (1980) 85(1):
65-102.Tatem AJ et al, 2003. Prediction of bluetongue vector distribution
in Europe and north Africa using satellite imagery.  Vet Microbiol (2003)
97(1-2):13-29. - Mod.AS]

[see also:Bluetongue, cattle - Spain (02)                        20041018.2823
Bluetongue, cattle - Spain (Andalucia): OIE            20041015.2811
Bluetongue, domestic ruminants - Spain                 20041107.3013
Bluetongue, ruminants - Morocco                        20040918.2582
Bluetongue, ruminants - Morocco (02)                   20040925.2649]
.....................arn/mpp

------------------------------

Date: Wed, 10 Nov 2004 13:42:17 -0500 (EST)
From: ProMED-mail <
promed@promed.isid.harvard.edu>
Subject: PRO/AH/EDR> Tularemia, pneumonic - USA (NYC)

TULAREMIA, PNEUMONIC - USA (NEW YORK CITY)
*****************************************
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Date: Wed 10 Nov 2004
From: ProMED-mail <
promed@promedmail.org>
Source: New York Daily News [edited]
<
http://www.nydailynews.com/boroughs/story/251139p-215035c.html>


Rabbit-fever concern has officials hopping
- -----------------------------------------
New York City health officials are watching for a recurrence of a
potentially deadly disease transmitted by wild rabbits that hospitalized a
Staten Island resident this summer [2004]. After the 21-year-old woman was
diagnosed with pneumonia in mid-August 2004, Health Department officials
confirmed she had contracted tularemia, a rare disease caused by the
bacterium _Francisella tularensis_, which infects both animals and people.

The woman reportedly contracted the disease -- also known as rabbit fever
- -- from her dog, after it captured an infected wild rabbit and then licked
her on the face. The woman survived, and no other cases have since been
reported.

Tularemia is on the list of potential biological agents that can be used by
terrorists. As a biological weapon, tularemia-causing bacteria could be
dispersed through the air and inhaled. Still, health officials say there is
no reason to believe the incident is linked to terrorism.

"This woman had [a] clear risk factor for naturally occurring tularemia,"
said Health Department epidemiologist Annie Fine. "We think it's an
isolated case, but we're keeping our eyes open." Despite the optimism, a
number of rabbits collected for data tested positive. However, health
officials deny there is any evidence of risk to human beings beyond this case.

There are only about 100 cases reported per year in the USA, usually less
than 2 percent of which are fatal. Since 1965, there have been 13 other
cases in the city; the last occurred in 1998. Cases have been reported in
every borough except the Bronx.

Humans can acquire the illness by coming into contact with the blood or
bodily fluids of infected animals, from the bite of a fly or tick that
carries blood from an infected animal, or from contaminated food or water.
Rabbits and rodents are the animals most likely to be infected. Signs and
symptoms vary but include fever, headache, chills, weakness, enlarged lymph
nodes, or, an ulcerated sore if bitten by an infected fly or tick.

Symptoms usually appear 3 to 5 days after exposure to the bacteria, but can
take as long as 14 days to manifest. The disease can be effectively treated
with antimicrobial agents.

[Byline: Amy Sacks]

- --
ProMED-mail
<
promed@promedmail.org>

[Although not thought of in association with an urban environment,
tularemia (a category B bio-terrorism disease) is occasionally acquired
naturally in New York. Primary pneumonia, due to _F. tularensis_, is
usually transmitted by aerosol as shown by the landscaper cases on Martha's
Vineyard, MA, USA. Upper respiratory infection manifesting as a pharyngitis
can occur with inoculation at that site. There is no information regarding
whether this young woman had a pharyngitis as well.

Despite a low inoculum needed to cause pneumonic tularemia, human-to-human
cases are not generally recognized. In pneumonic plague, however, this form
of transmission is of major concern.

The last case of reported infection in New York City was in the borough of
Brooklyn in 1998 (see below), a fatal case of pneumonia diagnosed by
positive blood culture after the person had died. Of note, this case was
reported to ProMED-mail by this moderator, which was his 1st contact with
this often real-time reporting system. - Mod.LL]

[see also:
Tularemia, landscaper - USA (MA) 20040713.1882
2003
- ----
Tularemia, human - USA (Wyoming) 20030902.2204
Tularemia, tick - USA (San Diego): alert 20030814.2027
Tularemia - USA (Nebraska) (02): comments 20030626.1572
Tularemia - USA (Nebraska) 20030625.1562
2002
- ----
Tularemia - USA (Martha's Vineyard, MA) (02) 20020613.4490
Tularemia - USA (Martha's Vineyard, Massachusetts) 20020611.4465
2001
- ----
Tularemia, wildlife - USA (Colorado): alert 20010924.2326
Tularemia - USA (Wyoming): alert 20010731.1498
Tularemia - USA (Massachusetts) (06) 20010717.1378
Tularemia - USA (Massachusetts) 20010609.1129
2000
- ----
Tularemia - USA (Martha's Vineyard, Massachusetts) 20000901.1465
1998
- ----
Tularemia - USA (New York City) (03) 19980804.1490
Tularemia - USA (New York City): RFI 19980724.1405]
......................ll/msp/mpp

------------------------------

Date: Wed, 10 Nov 2004 13:45:16 -0500 (EST)
From: ProMED-mail <
promed@promed.isid.harvard.edu>
Subject: PRO/AH/EDR> CJD (new var.) - Ireland (02): conf.

CJD (NEW VARIANT) - IRELAND (02): CONFIRMED
*****************************************
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Date: Wed 10 Nov 2004
From: ProMED-mail <
promed@promedmail.org>
Source: The Scotsman newspaper, Wed 10 Nov 2004 [edited]
<
http://news.scotsman.com/latest.cfm?id=3740723>


Ireland: variant Creutzfeldt-Jakob case confirmed
- -----------------------------------------------
Irish premier Bertie Ahern moved quickly to quell public fears today [Wed
10 Nov 2004], after the country's 1st case of the fatal brain disease
variant Creutzfeldt-Jakob disease [abbreviated in ProMED-mail as CJD (new
var.) or vCJD] was diagnosed in a Dublin hospital. He said he was confident
state controls on beef production were rigorous and met international
standards. "Ireland's controls to eradicate BSE [bovine spongiform
encephalopathy] are deemed to be optimum stable from 1998 onwards," he
said. "We will continue to take all necessary precautions. Both the CJD
advisory group and Food Safety Authority of Ireland (FSAI) have indicated
there should not be public concern for the safety of Irish beef."

The patient, believed to be in his early 20s, has never received a blood
transfusion or made a blood donation. Given that he has never undergone an
operation, it is understood that doctors are investigating the possibility
that he contracted the disease by eating infected beef. Mr. Ahern said the
worrying issue was that, even though all precautions have been taken, the
incubation period for the disease is not yet known. "There is a possibility
that the man became infected prior to the introduction of the more rigorous
food safety controls," he said.

A statement released by the hospital said: "The patient is seriously ill
and is being provided with all of the appropriate care by the hospital. All
of the necessary precautions are being taken, and the relevant authorities
have been updated."

The government was made aware of the potential case on Thu 21 Oct 2004,
when Health Minister Mary Harney was briefed by the chief medical officer,
Dr. Jim Kiely, and the chairman of the national vCJD advisory committee,
Prof. William Hall. Mr. Ahern said he was assured that the measures in
place to protect public health, particularly in relation to blood supply,
reflect international best practice standards.

The hospital confirmed the conclusive test involved a tonsillar biopsy of
the patient. "In the interests of patient confidentiality, further
information on the patient's condition will not be issued, and we ask that
the privacy of the patient and family be respected during this difficult
time," the statement added. There is no definitive blood test to diagnose
vCJD, but the presence of prion in immune system tissue in the tonsils, and
the specific appearance of the brain on an MRI scan, is understood to have
put the diagnosis beyond doubt. The national CJD advisory board will
continue to monitor all developments nationally and internationally. The
Taoiseach (Prime Minister) said the government's thoughts and prayers were
with the victim, his family, and friends.

[Byline: Victoria Ward]

- --
ProMED-mail
<
promed@promedmail.org>

[A previous case of vCJD in Ireland was reported in the Lancet in 1999
(see: CJD (new var.), human - Ireland 19990715.1192). St. Vincent's
Hospital in Dublin reported that a patient, who had undergone a gastroscopy
earlier in 1999, was diagnosed with vCJD on 31 May 1999. The scope used on
the vCJD-infected patient was subsequently used on 49 other patients.
Although the patient was not identified by the hospital, she was a mother
in her 30s who had been resident in England during the high-risk bovine
spongiform encephalopathy period. Although CJD has been shown to be
transmitted from one infected patient to another via certain neurosurgical
procedures, there was no subsequent report of transmission of vCJD to other
patients in this case. The current vCJD case in Dublin is the 1st case in
which exposure outside of Ireland is unlikely. - Mod.CP]

[see also:
CJD (new var.) - Ireland: susp. 20041029.2922
CJD (new var.) - UK: update 2004 (13) 20041103.2977
CJD (new var.) - UK: update 2004 (01) 20040106.0064
CJD (new var.) - France: 8th case 20041022.2864
CJD (new var.), blood supply - UK 20040318.0758
CJD (new var.), carrier frequency study - UK 20040521.1365
2003
- ----
CJD (new var.) - UK: update 2003 (13) 20031216.3072
CJD (new var.) - New Zealand: suspected (04) 20030817.2057
CJD (new var.) - Italy (05): death 20030809.1969
CJD (new var.) - New Zealand: suspected 20030807.1941
CJD (new var.) - Czech Republic: suspected 20030711.1707
CJD (new var.) - Spain (Madrid): suspected 20030208.0333
CJD (new var.) - UK: update 2003 (01) 20030108.0057
2002
- ----
CJD (new var.) - UK: update Dec 2002 20021207.5997
CJD, possible association with BSE 20021129.5921
CJD (new var), susp. case - Italy (Sicily) (04):conf 20020927.5418
CJD (new var.) - Canada (SK) ex UK (02) 20020809.5010
CJD (new var.), suspected - USA (FL) ex UK 20020419.3989
CJD (new var.) - France: sixth case 20020418.3983
CJD (new var.) - China (Hong Kong): confirmed 20020222.3604
CJD (new var.) - UK: update Jan 2002 20020111.3223
2001
- ----
CJD (new var.), incidence & trends - UK (02) 20011124.2875
CJD (new var.), incidence & trends - UK 20011115.2816
CJD (new var.) - UK: reassessment 20011029.2671
CJD (new var.) - UK: update Oct 2001 20011005.2419
CJD (new var.) - UK: regional variation (02) 20010907.2145
CJD (new var.) - UK: update Sep 2001 20010906.2134
CJD (new var.) - UK: update Aug 2001 20010808.1872
CJD (new var.) - UK: 9th Annual Report 20010628.1231
CJD (new var.) - UK: update June 2001 20010622.1188
CJD (new var.) - UK: update 3 Jan 2001 20010104.0025
1999
- ----
CJD (new var.), human - Ireland 19990715.1192]
.........................mpp/cp/msp/mpp

------------------------------

Date: Wed, 10 Nov 2004 13:47:32 -0500 (EST)
From: ProMED-mail <
promed@promed.isid.harvard.edu>
Subject: PRO/AH/EDR> Plague, tularemia, rodents, human - USA (CO)

PLAGUE, TULAREMIA, RODENTS, HUMANS - USA (COLORADO)
**************************************************
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Date: 9 Nov 2004
From: ProMED-mail <
promed@promedmail.org>
Source: The Rocky Mountain Collegian 9 Nov 2004 [edited]
<
http://www.collegian.com/vnews/display.v/ART/2004/11/09/419067c0089df>


Health officials find dead animals infected with the plague
- -------------------------------------
Local health officials have found evidence that the plague and tularemia
have been found in dead animals and pets and are alerting the public to use
preventative measures to avoid the diseases.

2 pet cats have been diagnosed with the plague [caused by the
bacterium  _Yersinia pestis_] in the past 2 weeks, and a woman died from
the plague while visiting the Red Feather Lakes area in August 2004.

The Centers for Disease Control and Prevention have jointly been working
with the Larimer County Department of Health and Environment in monitoring
the plague and other infectious diseases.

"Plague has always been endemic to this area," said LeeAnn Kempton, an
environmental specialist at the health and environment department.

So far, 4 feline plague cases have been reported this year. In 1999, a
woman died from the plague in the same area that this year's human case
occurred.

Ann Watson, public information specialist with the health and environment
department, said it is rare to find humans infected with the plague and
said those people that are infected come from contact with their pets.

"Most of our human cases come from cats. We have had so few cases it is
hard to make generalizations," Watson said.

Cats and other animals can be infected with the plague when they kill and
eat infected rodents that are riddled with infected fleas. From that point,
pets can transmit the disease to humans through bites, scratches or
droplets from their coughs. The bacteria can also be transmitted via the
infected fleas themselves, which pets can also bring into domesticated areas.

Bubonic plague, the more common form of the plague, occurs when extreme
pain and swelling of the lymph nodes strikes a victim. The groin and armpit
region are the most common fleabite locations in humans, according to a
press release from the health and environment department.  The bubonic
plague is not transmitted person-to-person, but it can spread to the lungs
to form pneumonic plague, and the victim's close contacts can be infected.

Though the plague may be rare in humans, rodent populations carry it often,
such as in mice or rats, Kempton said.

Recently, another bacterium, [_Francisella tularensis, the cause of ]
tularemia, has been traced in Larimer County in a dead beaver and mouse. A
man from Loveland was struck with pneumonia caused by tularemia in August.

Tularemia is another rare occurrence in Larimer County and infects humans
who handle infected animals such as rodents or rabbits or humans who are
bit by infected insects, especially ticks and deer flies.  Tularemia is a
bacterial disease that can affect humans or animals from insects that have
the disease.

Health officials say to take precautions to prevent infections from these
diseases. Using insect repellents, avoiding sick or dead rodents, keeping
pets leashed while camping or hiking, and keeping close attention to a
pet's health are all preventative measures.

Adrienne LeBaily, the county's heath department director, said, "Although
these bacteria are potential bioterror agents, we are convinced that these
human cases were naturally occurring."

[Byline: James Baetke]

- --
ProMED-mail
<
promed@promedmail.org

[Prairie dogs are often considered the most sensitive sentinel to plague.
Generally monitoring prairie dog activity can give one a clue as to when
the rodent cycle of plague may be spilling over into other
populations.  Cats may be one of our most sensitive domestic sentinels.

Plague generally has 2 forms: pneumonic and bubonic. Pneumonic form can
spread between people if the contact is relatively close.

While fleas carry plague, ticks carry tularemia.

Tularemia may be acquired from ticks, or from handling an infected carcass,
from inhalation of the bacteria, and from consumption of contaminated food
or water.  Tularemia is not known to spread from person to person.

Both of these bacterial diseases can be treated, in pets as well as in
human beings. - Mod.TG]

[see also:
Plague, fatal - China (Qinghai)    20041101.2948
Plague, squirrels - USA (CO)(03) 20041022.2863
Plague, squirrels - USA (CO) (02) 20041022.2858
Plague, squirrels - USA (CO) 20041021.2851
Plague, feline - USA (CO) 20040901.2440
Plague, bubonic, human - USA (CO)(02) 20040826.2380
Plague, bubonic, human - USA (CO) 20040825.2370
Plague, prairie dogs - USA (CO): alert  20040614.1600
Plague, prairie dogs - USA (TX) 20040520.1355]
..........tg/pg/mpp

------------------------------

Date: Wed, 10 Nov 2004 14:35:15 -0500 (EST)
From: ProMED-mail <
promed@promed.isid.harvard.edu>
Subject: PRO/EDR> Malaria & dengue fever - Dominican Republic: RFI

MALARIA & DENGUE FEVER - DOMINICAN REPUBLIC: REQUEST FOR INFORMATION
***********************************************
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Date: Wed 10 Nov 2004
From: Neville Clynes <
clynesn@yahoo.com>


Malaria and dengue in the Dominican Republic
- -----------------------------------------------
In the past week [1st week of November 2004], I have seen one patient with
dengue and one patient with malaria (an older woman visiting San Francisco
de Marcolis), both having returned from the Dominican Republic. I doubt
that this is simply coincidental and suspect that conditions (such as
increased construction) are related to an upturn. Are any others seeing an
increase in cases?

- --
Neville Clynes
Associate Professor
Department of Medicine
Department of Epidemiology
Columbia University, NY
<
clynesn@yahoo.com>

[There has been a previous outbreak of malaria in the Dominican Republic.
In this previous outbreak, malaria was introduced by construction workers
from Haiti and transmitted locally. ProMED-mail would appreciate any
information on dengue fever and malaria from the Dominican Republic,
including, for instance, similar observations. - Mod.EP]

[As of 7 Nov last year, 2003, 4430 cases of dengue fever were reported --
twice as many as in 2002; reported cases of hemorrhagic dengue also rose
from 78 to 189 with 73 deaths -- see 1st dengue references below.  I have
no information on dengue in the DR in 2004. - Mod.JW]


[see also:
2003
- ----
Dengue/DHF update 2003 (44) 20031113.2814
Dengue/DHF update 2003 (40) 20031013.2585
Dengue/DHF update 2003 (01) 20030106.0044
2001
- ----
Malaria - Italy ex Dominican Republic 20010604.1101
2000
- ----
Dengue - Dominican Republic: RFI 20000829.1450
Malaria - Dominican Republic: update 20000223.0242
Malaria - Dominican Republic: update (02) 20000310.0326
Malaria - Dominican Republic: update: CORRECTION 20000224.0251
1999
- ----
Malaria, imported - Europe ex Dominican Rep.(02) 19991213.2160
Malaria, imported - Europe ex Dominican Rep. (03) 19991217.2173
Malaria, imported - Europe ex Dominican Rep. (04) 19991221.2189
Malaria, imported - Europe ex Dominican Rep. (05) 19991223.2201
Malaria, imported - Europe ex Dominican Rep.: alert 19991212.2152
Malaria, imported - Europe ex Dominican Rep.: CDC ... 19991223.2200]
...................ep/msp/jw/mpp

------------------------------

End of ProMED Digest V2004 #432
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