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Denmark SSI: Marked Increase In Parrot Fever Cases - WHO Update & Risk Assessment

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  • Denmark SSI: Marked Increase In Parrot Fever Cases - WHO Update & Risk Assessment

    Denmark SSI: Marked Increase In Parrot Fever Cases Over the Past 60 Days






    #17,933

    Psittacosis - often called parrot fever - is a rarely reported, atypical bacterial pneumonia caused by Chlamydia psittaci. The CDC cites an average of 10 cases of Psittacosis reported each year in the US, although many others may go undiagnosed.

    The CDC also reports:

    Since 1988, there has been a decline in reported psittacosis cases. This decline may be the result of improved diagnostic tests that distinguish Chlamydia psittaci from more common Chlamydia pneumoniae infections.


    From time to time we see small outbreaks reported, usually in Asia (Japan Report 2 Fatal Cases of Parrot Fever (Psittacosis) In Pregnant Women) or in Europe (see 2007's To You, My Heart Cries Out Chlamydiaabout a small outbreak that occurred at a Bird lovers Society show in Weurt, Norway).

    Until fairly recently, human infection has been solely attributed to direct or indirect contact with infected birds.


    But in 2012, the journal Eurosurveillance carried a report called Psittacosis outbreak in Tayside, Scotland, December 2011 to February 2012, involving four family members and a health-care worker, which suggested human-to-human transmission.

    The following year, in Sweden Reports Rare Outbreak Of Parrot Fever,we saw a credible report of human transmission of parrot fever, where a 75 year old man who died in Kronoberg appeared to have spread the infection to at least 8 close contacts, including healthcare personnel.

    In 2014, the ECDC's Eurosurveillance Journal carried a follow up report called:

    Eurosurveillance, Volume 19, Issue 42, 23 October 2014
    Surveillance and outbreak reports
    Proven transmission of Chlamydia psittaci between humans has been described on only one occasion previously. We describe an outbreak which occurred in Sweden in early 2013, where the epidemiological and serological investigation suggests that one patient, severely ill with psittacosis after exposure to wild bird droppings, transmitted the disease to ten others: Two family members, one hospital roommate and seven hospital caregivers. Three cases also provided respiratory samples that could be analysed by PCR. All the obtained C. psittaci sequences were indistinguishable and clustered within genotype A.
    The finding has implications for the management of severely ill patients with atypical pneumonia, because these patients may be more contagious than was previously thought. In order to prevent nosocomial person-to-person transmission of C. psittaci, stricter hygiene measures may need to be applied.


    And in 2018 we saw another example, in PLoS Currents: A Psittacosis Outbreak Among Office Workers With Little Or No Bird Contact - UK. In 2022 the Lancet published a correspondence (see Gestational psittacosis: an emerging infection) that called:

    `Human-to-human transmission of psittacosis is an emerging public health risk to medical workers and other close contacts, including pregnant women.'


    While H-2-H transmission of C. psittaci now appears possible, contact with infected birds remains the primary suspected route of transmission.

    Today Denmark's SSI is reporting an uptick in Psittacosis cases (n=23 since December 20th), which is roughly as many as they see in an average year. Notably, most of these cases report no known contact with birds.


    This report mentions other European countries reporting cases (see Health alert after parrot fever infects humans in Sweden). I'll have a bit more after the (translated) statement.

    Several cases of parrot disease/ornithosis in Denmark

    During the past two months, there have been more cases of parrot disease in Denmark than usual. The disease spreads from birds to humans. SSI therefore encourages doctors to be aware of the disease.
    Last edited on March 1, 2024

    Since 20 December 2023, 23 cases of parrot disease in humans have been detected in Denmark. Normally we register around 15-30 cases in a whole year.

    "We are currently experiencing more cases than usual, and we hear the same message from other colleagues around Europe. That is why we ask doctors in practice and in hospitals to pay particular attention to the disease," says senior researcher Søren Uldum from the Statens Serum Institut.

    Parrot disease is also called ornithosis (bird disease), as it is not only parrots that can infect humans. It is a bacterial respiratory infection caused by the bacterium Chlamydia psittaci. The bacterium can be transmitted from infected birds to humans through close contact, but can also be transmitted by inhaling atomized particles from feathers or excrement. People are most often infected from domestic birds or various hobby birds such as ring pigeons. Most of the patients infected this winter report no or unknown contact with birds, while some report having fed birds at bird trays or automatic feeders.

    "We suspect that the main cause of the infection must be found among wild birds, and we have several measures underway to examine samples from wild birds in an attempt to clarify this."Søren Uldum, senior researcher, Statens Serum Institut.

    Parrot disease is in most cases a mild disease, and most often presents with flu-like symptoms such as fever, muscle aches and headaches. In some people, it can develop into a severe pneumonia affecting several organs. The disease can be treated with antibiotics.

    In general, you should not be afraid to feed the birds in the garden, but you can follow these tips:
    • Do not touch dead birds. If you find several dead or sick wild birds within a small area, it can be reported to the Danish Veterinary and Food Administration, primarily because of the risk of bird flu.
    • If you have to clean (sweep/rake) where there have been birds at feeding places, in outbuildings and the like, you should wet the surface beforehand so that it does not create dust.
    • If you find dead or sick birds in the garden, you must stop feeding them.
    • You must then scald the places where there has been feed and water.
    • Wash hands after contact with wild birds, feeding area or droppings.

    (Continue . . . )

    Fourteen years ago, in How Parrot Fever Changed Public Health In America, I wrote about the 1929 Parrot Fever epidemic which briefly revived fears of a new pandemic 10 years after the Spanish Flu.

    While overblown by the newspapers eager for something other than the stock market crash to focus on, at least 169 people were diagnosed with the illness across several states, and 33 died.


    Among the dead were 3 members of the public health team investigating the outbreak (Dr. Daniel S. Hatfield and Dr. William Stokes of the Baltimore Health Department, and Henry (Shorty) Anderson of the Hygienic Lab).

    The outbreak was finally quashed, but out of it (and concerns over the recent rise in flu) came funding from Congress for a new, better staffed and equipped laboratory to replace the old Hygienic Lab.

    They also gave it a new name: The National Institute of Health.


    Today, treatment of Psittacosis is much easier than it was in 1930, as it generally responds well to Tetracyclines.


     #17,933 Psittacosis - often called parrot fever - is a rarely reported, atypical bacterial pneumonia caused by  Chlamydia   psittaci . Th...
    Last edited by Michael Coston; March 6, 2024, 06:52 AM.
    All medical discussions are for educational purposes. I am not a doctor, just a retired paramedic. Nothing I post should be construed as specific medical advice. If you have a medical problem, see your physician.

  • #2
    WHO DON Update & Risk Assessment On Psittacosis In Europe




    5 Nations reporting Psittacosis Uptick


    #17,938

    Last week, in Denmark SSI: Marked Increase In Parrot Fever Cases Over the Past 60 Days, we looked at reports of an unusual number of Psittacosis cases being reported by Denmark's SSI, along with similar media reports from Sweden.

    Psittacosis - often called parrot fever - is a rarely reported, atypical bacterial pneumonia caused by Chlamydia psittaci, which is often carried by wild or captive birds.

    Most infections are mild, and usually respond to antibiotic treatment, although untreated it can progress to cause substantial morbidity and mortality. While likely under-reported, the U.S. reports roughly 10 cases per year.

    Psittacosis (aka `Parrot Fever') has occasionally sparked small outbreaks around the wolrd, such as the following CDC report on an outbreak at two U.S. poultry plants in 2018.



    In 1929, before the advent of modern antibiotics, the United States experienced a short-lived `Parrot Fever Epidemic', spread by infected birds sold by a pet store in Maryland. By the time it was over, at least 169 cases were reported across several states, along with 33 deaths.

    While normally spread by (direct or indirect) bird-to-human transmission, in recent years we've seen a few documented instances strongly suggesting human-to-human transmission.
    Late yesterday afternoon the World Health Organization published a DON (Disease Outbreak News) update and risk assessment on the recent rise in Psittacosis reported by at least five European nations (Austria, Denmark, Germany, Sweden, and the Netherlands).

    Due to its length, I've only posted some excerpts. Follow the link to read the full report.

    Situation at a Glance
    In February 2024, Austria, Denmark, Germany, Sweden and The Netherlands reported through the Early Warning and Response System (EWRS) of the European Union, an increase in psittacosis cases observed in 2023 and at the beginning of 2024, particularly marked since November-December 2023. Five deaths were also reported.

    Exposure to wild and/or domestic birds was reported in most of the cases. Psittacosis is a respiratory infection caused by Chlamydophila psittaci (C. psittaci), a bacteria that often infects birds. Human infections occur mainly through contact with secretions from infected birds and are mostly associated with those who work with pet birds, poultry workers, veterinarians, pet bird owners, and gardeners in areas where C. psittaci is epizootic in the native bird population.

    The concerned countries have implemented epidemiological investigations to identify potential exposures and clusters of cases. Additionally, implemented measures include the analysis of samples from wild birds submitted for avian influenza testing to verify the prevalence of C. psittaci among wild birds. The World Health Organization continues to monitor the situation and, based on the available information, assesses the risk posed by this event as low.

    (SNIP)

    Epidemiology

    Chlamydophila psittaci is a bacterium that causes the zoonotic disease of psittacosis in humans. Human infections are generally associated with those who work with pet birds, poultry workers, veterinarians, pet bird owners, and gardeners in areas where C. psittaci is epizootic in the native bird population.

    C. psittaci is associated with more than 450 avian species and has also been found in various mammalian species, including dogs, cats, horses, large and small ruminants, swine, and reptiles. However, birds, especially pet birds (psittacine birds, finches, canaries, and pigeons), are most frequently involved in causing human psittacosis. Disease transmission to humans occurs mainly through inhalation of airborne particles from respiratory secretions, dried faeces, or feather dust. Direct contact with birds is not required for infection to occur.

    In general, psittacosis is a mild illness, with symptoms including fever and chills, headache, muscle aches and dry cough. Most people begin developing signs and symptoms within 5 to 14 days after exposure to the bacteria. Prompt antibiotic treatment is effective and allows avoiding complications such as pneumonia. With appropriate antibiotic treatment, psittacosis rarely (less than 1 in 100 cases) results in death.

    WHO Risk Assessment

    Overall, five countries in the WHO European region reported an unusual and unexpected increase in reports of cases of C. psittaci. Some of the reported cases developed pneumonia and resulted in hospitalization, and fatal cases were also reported.

    Sweden has reported a general increase in psittacosis cases since 2017, which could be associated with the increased use of more sensitive polymerase chain reaction (PCR) panels. The increase in reported psittacosis cases across all countries requires additional investigation to determine whether it is a true increase in cases or an increase due to more sensitive surveillance or diagnostic techniques.

    While birds that carry this disease could be crossing international borders, there is currently no indication of this disease being spread by humans nationally or internationally. Generally, people do not spread the bacteria that causes psittacosis to other people, so there is a low likelihood of further human-to-human transmission of the disease. If correctly diagnosed, this pathogen is treatable by antibiotics.

    WHO continues to monitor the situation, and based on the available information, assesses the risk posed by this event as low.

    WHO Advice

    WHO recommends the following measures for the prevention and control of psittacosis:
    • increasing the awareness of clinicians to test suspected cases of C. psittaci for diagnosis using RT-PCR.
    • increasing awareness among caged or domestic bird owners, especially psittacines, that the pathogen can be carried without apparent illness.
    • quarantining newly acquired birds. If any bird is sick, contact the veterinarian for an examination and treatment.
    • conducting surveillance of C. psittaci in wild birds, potentially including existing specimens collected for other reasons.
    • encouraging people with pet birds to keep cages clean, position cages so that droppings cannot spread among them and avoid over-crowded cages.
    • promoting good hygiene, including frequent hand washing, when handling birds, their faeces, and their environments.
    • standard infection-control practices and droplet transmission precautions should be implemented for hospitalized patients.

    5 Nations reporting Psittacosis Uptick #17,938 Last week, in  Denmark SSI: Marked Increase In Parrot Fever Cases Over the Past 60 Days , we ...
    All medical discussions are for educational purposes. I am not a doctor, just a retired paramedic. Nothing I post should be construed as specific medical advice. If you have a medical problem, see your physician.

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