AVIAN INFLUENZA, HUMAN (98): CHINA (JIANGXI) H7N9

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A ProMED-mail post
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International Society for Infectious Diseases
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Date: Fri 1 May 2015
Source: Jiangxi Provincial Health and Family Planning Commission [in Chinese, machine trans., edited]
http://www.jxwst.gov.cn/cszw/wsyj/gzdt/201505/t20150501_365863.htm

On 1 May 2015, the Health and Family Planning Commission of Jiangxi Province confirmed one case of H7N9
[influenza virus infection]. Currently, the patient is in critical condition in a hospital in Jiujiang City.
The patient is a 39-year-old female, living in Jiujiang Hukou County. On 1 May 2015, Jiangxi Province Center for
Disease Control and Prevention, the patient's samples were sent for analysis and were confirmed as H7N9 virus
positive.
-Communicated by:
Michael Fraser RN (CNO)
<frasermdx@gmail.com>
[China now has reported a total of 659 cases of H7N9 since 2013, with 164 of them in 2015 alone (according to
FluTrackers;https://flutrackers.com/forum/forum/china-h7n9-outbreak-tracking/143874-flutrackers-2013-15human-case-list-of-provincial-ministry-of-health-government-confirmed-influenza-a-h7n9-cases-with-links).
The distribution of cases from the initiation of H7N9 activity in 2013 to 5 Apr 2015 (619 human cases of avian
influenza A(H7N9) reported by the Mainland health authorities -- note discrepancy with FluTrackers count),
include Guangdong (181 cases), Zhejiang (167 cases), Jiangsu (73 cases), Fujian (59 cases), Shanghai (46
cases), Hunan (26 cases), Anhui (24 cases), Xinjiang (10 cases), Jiangxi (10 cases), Shandong (6 cases),
Beijing (5 cases), Henan (4 cases), Guangxi (3 cases), Jilin (2 cases), Guizhou (2 cases), and Hebei (1 case).
With this new report, Jiangxi now has 11 cases.
Maps of China can be seen at http://www.china-mike.com/china-travel-tips/tourist-maps/china-provincesmap (with provinces) andhttp://healthmap.org/promed/p/33874. - Mod.LK]

------------------------------------------------------------------------------------------------------------HEPATITIS A - USA (02): ex MEXICO (QUNITANA ROO)

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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Sat 2 May 2015
Source: Outbreak News Today [edited]
http://outbreaknewstoday.com/cdc-warns-travelers-to-tulum-mexico-of-hepatitis-a-risk-68060/

According to the CDC, as of 1 May 2015, a total of 27 cases of hepatitis A have been reported in USA travelers
who went to Tulum, Mexico. All of the people traveled between the dates of 15 Feb 2015, and 20 Mar 2015.
CDC advises travelers to the area to get vaccinated against hepatitis A and follow all food and water precautions.
In addition, federal health authorities tell returning travelers from Tulum, Mexico during the last 14 days to talk to
your doctor about receiving a dose of hepatitis A vaccine, which can prevent or reduce the symptoms of hepatitis
A if given within 14 days of exposure.
Hepatitis A is a liver disease that results from infection with the hepatitis A virus. It can range in severity from a
mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread when a
person ingests fecal matter -- even in microscopic amounts -- from contact with objects, food, or drinks
contaminated by the feces or stool of an infected person.
The best way to prevent hepatitis A is by getting vaccinated.
[Byline: Robert Herriman]
-Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
[Tulum (http://en.m.wikipedia.org/wiki/Quintana_Roo) is the site of a Pre-Columbian Maya walled city. The ruins
are on 12-meter (39-foot) tall cliffs along the east coast of the Yucatan Peninsula on the Caribbean Sea in the
state of Quintana Roo, Mexico. Tulum was one of the last cities inhabited and built by the Mayas. - Mod.LL
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/14.]
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Thu 30 Apr 2015

Source: Times-Independent [edited]
http://www.moabtimes.com/view/full_story/26611417/article-Case-of-hantavirusconfirmed-in-Grand-County?instance=secondary_five_leftcolumn

A case of hantavirus pulmonary syndrome [HPS] has been reported in Grand

County [Utah], and while instances of HPS are rare, local health department
officials are reminding area residents to take precautions to help reduce the risk

of contracting the disease, which is only transmitted to humans through contact

with hantavirus-infected rodents or their urine, saliva and droppings.

"We had a confirmed case in Spanish Valley," Orion Rogers, environmental health
scientist for the Southeastern Utah District Health Department said on 22 Apr
[2015]. "A man had come into contact with deer mice."

The man was treated at St. Mary's Hospital in Grand Junction, Colorado, and
survived, Rogers said. "It's been years since we've seen a case in our region,"
Rogers said. "It's a very uncommon disease."

[Sin Nombre] hantavirus is not contagious and cannot be transmitted from one
person to another, according to the Centers for Disease Control (CDC). People
most often become infected with [a] hantavirus when they breathe in air
contaminated with the virus, such as in areas like storage sheds and root cellars,
where rodents and rodent droppings and urine might be found.

Hantavirus pulmonary syndrome has a fatality rate of 38 per cent, according to

the CDC, and symptoms may develop within 1-5 weeks after a person is exposed
to the virus. Early symptoms of the disease can include fatigue, fever and muscle
aches, especially in the thighs, hips, back and sometimes shoulders. Individuals
may also experience headaches, dizziness, chills, and nausea, vomiting, diarrhea
and abdominal pain. An individual may begin to experience coughing and
shortness of breath caused by the lungs filling with fluid 4-10 days after the
initial symptoms appear, the CDC website states.

According to a news release from the Southeastern Utah District Health

Department, several simple precautions should be taken to help prevent the
possibility of contracting the virus:

- When entering an outdoor shed or other area that has been closed up for a few
months, be sure to open the doors and windows to allow sunlight and fresh air
into the area for at least 30 minutes before entering. This will help inactivate the
virus. "The [ultraviolet light] from the sun kills the virus, so we're more worried
about darker, danker areas," Rogers said.

- Remove trash and debris [that might harbor deer mice] from around the home,
and move wood piles at least 100-feet from the home's living area.

- Seal any cracks or openings that lead into the home, and make sure doors and
screens are in good condition [to prevent mice from entering].

- Store food off the floor, and clean up food spills quickly [to avoid attracting
mice]. Campers should store food safely and keep it away from rodent
harborages.

"If you notice areas that have mouse droppings, do not vacuum them," the news
release states. "Put on rubber or latex gloves, and spray the area with a mixture
of 4 tablespoons [60 ml] of bleach to one gallon [3.8 l] of water. Then use a
paper towel to gently sweep up the mess, double bag it and throw it away."

Health officials also noted that just because a person sees a mouse does not
mean they are or will be infected with the virus. "It requires exposure to
something that is already contaminated," officials said. "If we take reasonable
precautions, we can go about our lives worry free."

-Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[This area is geographically close to and ecologically similar to the 4 Corners

area (where the states of Utah, Colorado, New Mexico and Arizona adjoin), where
the 1st recognized cases of HPS occurred and Sin Nombre virus was initially
detected. Although not stated in the report above, the specific hantavirus
involved in this case probably is Sin Nombre virus, which is endemic in deer mice
(_Peromyscus maniculatus_) in Utah. The nature of the patient's contact with the
deer mice is not specified, but would be of interest.

An image of the deer mouse, _P. maniculatus_, can be seen at the URL above and
at http://www.nsf.gov/news/mmg/media/images/mouse_f.jpg.

A map showing the location of the state of Utah and Grand county can be
accessed at http://en.wikipedia.org/wiki/Grand_County,_Utah and images of the
area showing the ecological setting of the county at
https://www.google.com/search?
q=grand+county+utah&biw=1165&bih=734&noj=1&site=webhp&tbm=isch&tb
o=u&source=univ&sa=X&ei=EKtGVbvyO8fRtQXBzoHgAQ&ved=0CEEQsAQ. Mod.TY

A HealthMap/ProMED-mail map can be accessed at:

http://healthmap.org/promed/p/246.]
------------------------------------------------------------------------------------------------------------UNDIAGNOSED ILLNESS - INDIA: (KARNATAKA) FEBRILE, REQUEST FOR INFORMATION
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Tue 28 Apr 2015
Source: The Hindu [edited]
http://www.thehindu.com/news/national/karnataka/mysterious-fever-breaks-out-in-shivamoggavillage/article7149279.ece

A mysterious fever has surfaced at Baalur, a village of over 500 population near Ripponpet in Shivamogga
[Shimoga] district [Karnataka state], as 35 persons are reported to have been infected with it since [Fri 24 Apr
2015].
It all began on [Fri 24 Apr 2015] when 8 persons in the village developed complaints of fever and pain in joints.
They underwent treatment at the primary health centre at Ripponpet. However, the number of infected persons
jumped to 32 by [Sun 26 Apr 2015] and another 3 complained of similar symptoms on [Mon 27 Apr 2015], District
Health Officer Nagaraj Naik told The Hindu. Blood samples of all the patients were subjected to medical
investigation, which tested negative for malaria, chikungunya, and dengue.
Meanwhile, a team of medical experts from a private hospital in Manipal visited the village on [Sun 26 Apr 2015]
and conducted medical examination.
Dr Naik said the medical experts suspected the symptoms to have been caused by a "droplet viral infection". The
blood samples were later sent to a private health establishment at Manipal for further tests and the results were
expected in 4 days' time.
A medical camp had been set up at Baalur and 2 doctors had been deputed to treat the patients. Those suffering
from serious health complications were treated at the general hospital in Sagar and Shivamogga Institute of
Medical Sciences.
Adequate stock of medicines was being maintained in the village, he said.
Kalagodu Ratnakar, president of the Shivamogga Zilla Panchayat [district government], has said that the local
gram panchayat had launched a drive to control mosquitoes at Baalur and the neighbouring Haalugudde villages.
Fogging operation had been conducted in places, which were potential breeding grounds for mosquitoes, he

said.
-Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
<roland.hubner@sante.belgique.be>
[There is not an adequate enough description of the disease to speculate what the etiology of these febrile cases
might be. The basis on which a "droplet virus infection" was based is not presented in the report above. The
emphasis on mosquito breeding sites and control suggests that vector mosquitoes are involved, although dengue
and chikungunya viruses were excluded. However, the tests used to exclude these 2 viruses were not given.
The results from the blood samples taken should be available by now. ProMED-mail would appreciate receiving
the results of those tests, and any addition information about this outbreak that may become available.
Maps of India can be seen at http://www.mapsofindia.com/maps/india/india-politicalmap.htm and http://healthmap.org/promed/p/1020. - Mod.TY]
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CHICKENPOX - NEPAL: (KATHMANDU), POST-EARTHQUAKE

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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Tue 5 May 2015

From: Sher Bahadur Pun <drsherbdr@yahoo.com> [edited]

Three patients who took shelter after the 2015 mega-earthquake (on 25 Apr
2015) visited our hospital with a history of fever, headache, lethargy and
vesicular rash appearing on the face, trunk, chest and whole body. All patients
spent at least 3 days in separate shelters together with other people.

1st case: A 17-year-old male, history of contact with his younger brother who had
been diagnosed with chickenpox. He is currently in a shelter together with

another approximately 19 people (including children). He is being treated on an

outpatient basis in our hospital.

2nd case: A 6-year-old girl, no history of contact with chickenpox

suspected/confirmed cases in the shelter. She was diagnosed with chickenpox
based on clinical signs and symptoms. She is currently being treated on an
outpatient basis in our hospital.

3rd case: A 26-year-old male visited the emergency department of our hospital a
week ago where he was diagnosed with chickenpox. He was treated with the
antiviral drug (acyclovir) and is now almost recovered from his illness.

Some medical doctors who have visited other shelters also found additional
chickenpox cases in Kathmandu, indicating that chickenpox could potentially
spread among people, especially to those who had not had been previously
infected or immunized, because the virus is highly contagious and spreads
quickly and easily through the respiratory route.

-Dr. Sher Bahadur Pun

Sukraraj Tropical and Infectious Disease Hospital
Kathmandu, Nepal
<drsherbdr@yahoo.com>

[ProMED thanks Dr. Pun for this firsthand report.

The incubation period of varicella is 14-21 days, averaging about 17 days, so

these individuals were exposed prior to the earthquake.

In a 1991 report on sero-epidemiology in Nepal (Kubo T, Rai SK, Nakanishi M,

Yamano T: Seroepidemiological study of herpes viruses in Nepal. Southeast Asian
J Trop Med Public Health. 1991;22:323-325), only 25 percent of children 1-4 years
old showed antibodies to VZV, but the number of positives increased rapidly with
age (82.9 percent in greater than 15 years age). This would suggest that most
Nepali adolescents and adults (a cohort with higher risk of more severe illness

from varicella) are likely to be immune, but overcrowding in shelters would

enhance the likelihood of increased cases. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at:

http://healthmap.org/promed/p/139.]