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  • Archive, EpiSouth Weekly Epidemiological Bulletin (2010)

    EpiSouth Weekly Epi Bulletin – N°123 - 21 July 2010 – 27 July 2010 (Extracts, edited)

    [Source: Epi-South, Full PDF Document, (LINK). Extracts, edited.]

    EpiSouth Weekly Epi Bulletin – N°123 - 21 July 2010 – 27 July 2010


    The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


    INDEX e-WEB n°123

    • A(H5N1) Human influenza – Egypt
    • A(H5N1) Avian influenza – Vietnam
    • “INSIDE” Events:
      • Rabies - Italy, Ukraine
    • “OUTSIDE” Events:
      • Review of the 500 A(H5N1) human cases - World


    Location: Egypt
    Event: A(H5N1) – Human

    Comments
    • On 24 July 2010, Egyptian sources reported a 110th case of A(H5N1) infection. The case is:
      • A 20 year-old woman from Qalyubia governorate (cf. map 1)
      • Admitted on 21 July 2010 in a critical condition,
      • The patient received tamiflu traitment but died on 27th July.
      • Since the beginning of the 1st bird flu occurrence in Egypt. To date, the total rises 110 cases and 35 deaths.
      • (...)
      • In Egypt, the last human case was reported in March 2010 in Cairo governorate (cf. eWEB n°107).
      • The available information does not indicate a change in the epidemiology of the virus in either country.


    Location: Vietnam
    Event: A(H5N1) – Epizootic

    Comments
    • On 26 July 2010, Vietnamese health authorities reported clusters of A(H5N1) influenza infecting poultry in the province of Gia Lai (cf. map 2).
    • In Vietnam, the last epizootic was reported on June 19th 2010 in the province of province of Thai Nguyen (cf. eWEB n°119).
    • The available information does not indicate a change in the epidemiology of the virus in Vietnam or Egypt.


    REPORT OF NEW HEALTH EVENTS OCCURRING OUTSIDE THE EPISOUTH AREA (not occurring in one or several EpiSouth countries)

    Comments:
    • Since 2008, the North-Eastern Italy experimented a large increase of rabies cases.
      • From 9 cases in 2008 to 68 in 2009 and 202 in the first half of 2010 (cf. table 1).
      • Most of the affected animals were foxes, but some deer and badger were also involved. It is suspected that virus-carrying foxes wandered into Italy from Eastern Europe, where rabies is common.
      • In 2010, the most affected regions were Veneto region with 176 cases of rabies, followed by Friuli regions with 14 cases: cf. map 3.
    • Other countries
      • In Switzerland.
        • In Switzerland, the rabies outbreak which occurred in Northern Italy is a cause for concern for the Federal veterinary Office. While the affected area is around 100 km from the Swiss border, officials are keeping a close eye on the situation. Switzerland has been free of rabies virus since 1998.
        • The Veterinary authorities do not exclude that rabies could be re-introduced by foxes in Switzerland.
        • Local authorities are now preparing in case of rabies virus spread and have increased observation in canton Graubünden’s Münster and lower Engadin valleys, which serve as natural gateways to Italy.
      • In Ukraine
        • Since, last June 2010, an epidemic of rabies is ongoing in Zhytomyr Oblast region. It is estimated that about 7000 foxes are present in the oblast.
        • It is considered that if the fox population is not reduced a rabies epidemic will be unavoidable. Rabid foxes have already infected more than 2 dozen household pets.
        • Local authorities


    REPORT OF NEW HEALTH EVENTS OCCURRING OUTSIDE THE EPISOUTH AREA (not occurring in one or several EpiSouth countries)

    Location: World
    Event: The A(H5N1) influenza pandemic: 500 notified cases

    • On June 2010, Indonesia reported the world’s 500th case of A(H5N1) influenza infection. Although the overall annual number of cases reported worldwide has decreased since 2003, the virus continues to circulate intensively in some countries.
    • Epizootic
      • From the end of 2003 to 1st July 2010, 63 countries or territories on the Asian, African or European continents have notified A(H5N1) influenza infections in poultry or wild birds to OIE.
      • In 2009, a total of 9 countries notified outbreaks in poultry or were considered enzootic by OIE.
      • In 2010, 12 countries have been affected to date.
      • Many other countries, notably in Sub-Saharan Africa, have suspected transmission in predominantly backyard flocks, but lack surveillance systems to document it.
    • Human epidemic
      • From Nov. 2003 to 1st July 2010, a total of 500 confirmed human cases of A(H5N1) influenza, including 296 deaths (case fatality rate CFR, 59%) were notified to WHO by 15 countries (cf. table 2)
      • Since Nov. 2003, reported human cases seem to follow a decreasing trend. Cases occur mostly between November and April, a period corresponding to seasonal patterns described also in poultry.
      • During the period from Jan. to July 2009, 41 confirmed human cases including 12 deaths (CFR 29%) were notified by China, Egypt and Vietnam. A total of 32 cases were reported for the same period in 2010.
    • Conclusion
      • Some countries which were heavily affected before 2007 (such as Thailand and Turkey) seem to have controlled the situation and reduced risks to humans.
      • The A(H5N1) virus is one of several which could hypothetically give rise to a pandemic in the future.
      • Human cases will continue to occur as long as the situation in animals is not brought under control especially in Egypt, Indonesia and Bangladesh.

    (...)
    -
    ------

  • #2
    EpiSouth Weekly Epi Bulletin – N°124 - 28 July 2010 – 3 August 2010 (Extracts, edited)

    EpiSouth Weekly Epi Bulletin – N°124 - 28 July 2010 – 3 August 2010 (Extracts, edited)

    [Source: Epi-South, full PDF Document (LINK). Extracts, edited.]

    EpiSouth Weekly Epi Bulletin – N°124 - 28 July 2010 – 3 August 2010

    The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information.Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


    INDEX e-WEB n°124

    • A(H5N1) Human influenza – Indonesia
    • A(H5N1) Avian influenza – None
    • “INSIDE” Events: - None
    • “OUTSIDE” Events:
      • Dengue outbreak - Yemen


    Location: Indonesia Event: A(H5N1) – Human Comments

    On 3rd of August 2010, Indonesian health authorities reported a human case of A(H5N1) influenza in the province of Banten (cf. map 1). The case is :
    • A 34 year-old woman from Tangerand district.
    • Admitted on 4 July 2010 in a critical condition,
    • She died on 7 July.
    • Since the beginning of 2010, 6 cases including 4 deaths due to A(H5N1) influenza have been reported by Indonesian health authorities and WHO.


    In Indonesia, the last human case was reported in July 2010 in (cf. eWEB n°120).

    The available information does not indicate a change in the epidemiology of the virus in either country.


    Location: World Event: A(H5N1) – Epizootic Comments

    No influenza A(H5N1) epizootic reported this week


    REPORT of NEW HEALTH EVENTS OCCURING OUTSIDE THE EPISOUTH AREA (Not occurring in one or several EpiSouth countries)

    Area: Yemen Event: Dengue

    For at least 3-4 months, outbreaks of dengue fever are reported in Yemen, in the southern and eastern Governorates of Hadhramout, Taiz, Aden and Abyan (cf. map. 2). Those areas recorded dozens of deaths in the past few months .
    • On 13th July, the head of the Ministry of Public Health & Population’s office in Hadhramout Governorate confirmed that dengue was spreading rapidly in various districts of Al Mukalla, the provincial capital :
      • 12 people had died since April and 1,442 people had been infected in Mukalla city.
      • Many people died at home as they were unable to cover the cost of treatment in hospitals.
      • In Aden Governorate, dozens of slum residents in the governorate died from dengue over the past few months and more than 150 had been infected.
    • According to a survey performed in November 2009 by the Central Lab of the Republican Hospital in Taiz Governorate:
      • 490,000 people (82 % of the governorate’s urban population) were living in environments that exposed them to dengue infection.
      • And 2,000 people had been infected.
    • In the southern Abyan governorate hundreds dengue infections had been discovered in recent weeks; it was suspected that hundreds of other cases had gone undiagnosed.
    • The most important outbreak reported in Yemen, since 1994 occurred in 2000: 653 suspected cases were reported, including 80 deaths. In September 2009 (cf. eWeb n° 85) and in May 2008 (cf. eWeb n° 11), important outbreaks were reported but without any details regarding serotypes.
    • Last month, the ministry of public health had carried out large vector control campaigns in the different governorates.


    Comments

    Dengue fever was first detected in Yemen in the early 1990s and there have been intermittent outbreaks over the years.
    • According to health authorities, the four primary factors behind those repeated outbreaks of dengue in those water-scarce governorates are present: “The fertile environment for mosquito breeding, lack of early diagnosis systems, poor health awareness among citizens and poverty”.
    • In the absence of solid dengue surveillance system, the scope of the outbreaks is likely to be underestimated.
    • According to health authorities, control measures have been taken in Yemen but people need to be educated and aware of how to behave with the water storage. Situation should be monitored in coordination with the public health Ministry.
    • In 2010, Dengue outbreaks have been documented in the east part of Indian Ocean: Madagascar, the republic of Comoros, Mayotte, Tanzania (cf. eWeb n° 121), Saudi Arabia and Soudan near Port Soudan (cf. eWeb n°110).

    -
    -----

    Comment


    • #3
      EpiSouth Weekly Epi Bulletin – N°125 - 4 August 2010 – 11 August 2010 (edited)

      EpiSouth Weekly Epi Bulletin – N°125 - 4 August 2010 – 11 August 2010 (edited)

      [Source: Epi-South, full PDF Document (LINK). Edited.]

      EpiSouth Weekly Epi Bulletin – N°125 - 4 August 2010 – 11 August 2010

      The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


      INDEX e-WEB n°125

      • A(H5N1) Human influenza – Egypt
      • A(H5N1) Avian influenza – None
      • “INSIDE” Events: - West Nile virus review
      • “OUTSIDE” Events: Heat-wave-wildfires - Russia


      Location: Egypt Event: A(H5N1) – Human

      On 3rd of August 2010, Egyptian health authorities reported a human case of A(H5N1) influenza in Cairo Governorate (cf. map 1).

      The case is :
      • A 2 year-old girl.
      • She presented 1st symptoms on 2nd August and was admitted the same day.
      • She is on a stable condition,
      • Contacts with sick/dead poultry have been documented
      • Since 2006, a total of 111 A(H5N1) influenza cases including 35 deaths have been reported by Egyptian health authorities, of which, 21 cases and 8 deaths reported 2010 .


      Comments

      In Egypt, the last human case was reported in July 2010 (cf. eWEB n°123).
      • Available information does not indicate a change in the epidemiology of the virus.


      Location: World Event: A(H5N1) – Epizootic

      No influenza A(H5N1) epizootic reported this week


      REPORT of NEW HEALTH EVENTS OCCURING INSIDE THE EPISOUTH AREA (Occurring in one or several EpiSouth countries)

      Location: EpiSouth Event: West Nile Infection

      Since 2005,
      • Epizooties were reported in Austria, France, Israel, Italy, Spain and Russia
      • Human cases were reported in, Hungary, Italy, Israel, Palestine, Romania, Russia and Czech Republic and more recently in Greece, See Map 1
      • (see eweb 29, 32 76, 78)


      Comments

      The diagnosis of sporadic human symptomatic infections underlines viral circulation in the area. However, in regards to the high proportion of asymptomatic human infections the scope of this circulation cannot be determined precisely.
      • Severe forms (mainly encephalitis and meningitis) occur in less than 1% of human infections.
      • Case fatality rate of these severe infection ranges from 3 à 15%.


      REPORT of NEW HEALTH EVENTS OCCURING OUTSIDE THE EPISOUTH AREA (Not occurring in one or several EpiSouth countries)

      Location Russia Event: Heat-wave Wildfires

      Since the beginning of August 2010, Russia is affected by a severe heat-wave and major wildfires. Over 26 000 wildfires have been reported in 22 provinces of the Russian Federation (cf. Map 2).
      • To date, specific data are scarces, but the Russian Civil Status Service has already reported a 30 to 35% increased mortality in Moscow (data for the rest of the country are not available). According to the Federal Service on Surveillance of Consumers’ Rights Protection and Human Welfare (rospotrebnadzor), reported pollutants largely exceed the WHO recommended maximum allowable level :

      [Hazardous substances - Average Reported values for Moscow - WHO recommended maximum allowable level]
      • Suspended solids (particles’ size not available) - 0.35 to 2.33mg/m3 - PM2.5μm: 0,025 mg/m3 in 24h, (do not exceed 3 days per year) - PM10μm : 0,05 mg/m3 for 24h
      • Nitrogen dioxide - 0.06 to 0,38 mg/m3 - 0,2 mg/m3 in 1h
      • Carbon monoxide - 4.89 to 20.27mg/m3 - 100 mg/m3 for 15 mn, 10 mg/m3 for 8h


      Comments

      Wildfires generates significant amount of particles and pollutants (carbon monoxide, nitrogen oxides, sulphur dioxide, organic compounds, etc.) that can have adverse health effects ranging from mild eyes and respiratory tract irritations to more serious disorders (including premature death).
      • According to WHO, exposure to small particles (<2.5 μm) is the main public health threat from short-term exposures to wildfire smoke.
      • Heat-waves are also know increase mortality in the at risk groups (elderly, people with chronic diseases, etc.)
      • The combined effect of the heat-wave and the wildfires smokes is likely to have a significant impact on mortality and morbidity in the affected areas.
      • For more information refer to WHO EURO Wildfires and heat-wave in the Russian Federation – Public health advice

      (...)
      -
      ------

      Comment


      • #4
        EpiSouth Weekly Epi Bulletin – N°126 (11 August 2010 – 17 August 2010) (edited)

        EpiSouth Weekly Epi Bulletin – N°126 (11 August 2010 – 17 August 2010) (edited)


        [Source: EpiSouth.org, full PDF Document (LINK). Edited.]

        EpiSouth Weekly Epi Bulletin – N°126 (11 August 2010 – 17 August 2010)

        The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


        INDEX e-WEB n°126
        • A(H5N1) Human influenza – none
        • A(H5N1) Avian influenza – none
        • “INSIDE” Events:
          • West Nile virus – Greece, Morocco
          • Aseptic Meningitis - Serbia, Latvia
        • “OUTSIDE” Events:
          • Extensively antibiotic-resistant Enterobacteriaceae- Europe
          • Dengue – Florida


        Location: World - Event: A(H5N1) – Human

        No human cases reported this week.


        Location: world - Event: A(H5N1) – Epizootic

        No influenza A(H5N1) epizootic reported this week .


        REPORT OF NEW HEALTH EVENTS OCCURRING OUTSIDE THE EPISOUTH AREA (not occurring in one or several EpiSouth countries)

        Location: Europe - Event: Extensively resistant enterobacteriaceae

        The emergence of a resistant strain to carbapenems, called NDM-1 (New Delhi metallo-β-lactamase,) was identified in Southeast Asia (India, Pakistan) and is now the subject of an alert. Several European countries and other parts of the world reported an increase in the antibiotic resistance in Enterobacteriaceae bacteria. Imported cases have been reported in Belgium, France, Sweden and UK.
        • These extensively antibiotic-resistant Enterobacteriaceae still remain relatively an uncommon cause of human infection in Europe. Bacteria epidemic could spread internationally by patient transfers between hospitals from different countries.
        • The potential expansion of this resistance is a major concern for public health. The situation is following with attention both internationally. More information on ECDC website.


        Comments

        This new NDM-1 enzyme was first detected in 2008 in a patient repatriated to Sweden after being treated in a hospital in New-Delhi, India.


        REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occurring in one or several EpiSouth countries)

        Location: Greece, Morocco - Event: West Nile virus

        • CONTEXT:
          • In recent months, infections related to West Nile viruses were reported in Greece, Italy and Israel: cf. eWEB n°125.
        • In Greece:
          • On August 7, 2010, the Greek health authorities have reported indigenous cases of West Nile infection in the province of Central Macedonia (see Map 2).
          • On 17 August, 60 cases were reported with 4 deaths (13 cases and 1 death biologically confirmed).
          • Most patients are patients aged over 70 years and presented meningitis or encephalitis.
          • According to the Greek authorities, the veterinary and vector surveillance were enhanced in this province. Blood centers have been alerted and a public awareness has been initiated.


        Table1. Number of laboratory diagnosed West Nile virus infections and deaths, 17 August 2010. (source: KEELPNO)

        [Number of cases with central nervous system manifestation - Number of cases without central nervous system manifestation - Total number of cases - Number of deaths]
        • 58 - 2 - 60 - 4

        • In Morrocco
          • On 18 August 2010, the Ministry of Agriculture and Fisheries of Morocco reported to OIE a West Nile outbreak located in Ben-Slimane province (cf. map 4) among equines:
            • The first infection started on 20th July 2010.
            • To date, a total of 17 cases, 8 deaths were reported to OIE.
            • A total of 16 outbreaks were detected in Ben-Slimane province.
          • Until now, no human case infected by the West Nile virus has been reported.
          • Recently, the region benefit for a vector eradication campaign which minimise the risk of transmission.
          • At local level, all the regional health centres are alerted to detect any suspect case.
          • In Morocco, the last West Nile outbreak among equines was reported in 2003.


        COMMENTS:
        • West Nile virus had never been reported so far in Greece.
        • A seroprevalence study in 1980 indicated the presence of serum antibodies to West Nile at 1% of the population of Central Macedonia.
        • West Nile virus is endemo-epidemic in Eastern Europe and the Mediterranean with epidemics regularly reported.
        • In North Africa, Tunisia has experienced two outbreaks of West Nile fever: in 1997 and 2003 (source: Epireg Maghreb) and Algeria in 1994.


        REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occurring in one or several EpiSouth countries)

        Location: Serbia, Latvia - Event: Aseptic meningitis

        • Serbia:
          • Since June 2010, incidence of aseptic meningitis has increased in the city of Novi Sad, in the autonomous province of Vojvodina.
          • From 2 June to 25 July 2010, 80 aseptic meningitis cases were reported to the Institute of Public Health in Vojvodina: cf. figure1.
          • The cumulative incidence for the period was 30 per 100,000 population, compared with 2 per 100,000 pop. in 2009 and 4 per 100,000 pop. in 2008.
          • The incidence rate ranged from 10 to 366 per 100,000 pop. in different local communities.
          • The majority of cases (n=64) were aged between 2 and 15 years: cf. figure 2.
          • The Echovirus 30 was isolated in 2 specimens.
        • Latvia
          • Since the end of June 2010, an outbreak of aseptic meningitis is ongoing in several areas of Latgale region, South-Eastern of Latvia.
          • From 30 June to 9 August 2010, 136 aseptic meningitis cases were registered in Latvia (6 cases per 100,000 pop.), 114 of whom were reported from Latgale region (33 cases per 100,000 pop.)
          • Most of the cases were registered in the city and neighbouring municipalities of Daugavpils.
          • The 2 causative agents identified were coxsackie A-9 and echovirus 30.
          • The majority of cases (82%) were children and adolescents (aged 2 to 19 years): cf. figure 4.
          • The previous largest aseptic meningitis outbreak in Latvia occurred in August to November 2006, due to echovirus 30 infection, with 408 cases.
          • A substantial increase of aseptic meningitis was observed in 2007 but echovirus 6 and 18 were the dominants: cf. figure 3.


        REPORT OF NEW HEALTH EVENTS OCCURRING OUTSIDE THE EPISOUTH AREA (not occurring in one or several EpiSouth countries)

        Location: USA - Event: Dengue

        On 13 August 2010, Florida health authorities reported an autochthonous case of Dengue in the Broward County (South of the state, cf. map 5):
        • The DEN-3 serotype was identified.


        Comments :
        • Until 2009, no indigenous cases had been reported in Florida during the previous 40 years.
        • In 2009, 27 autochthones cases were reported in Key West (Florida) in the Monroe County (cf. eWEB n°79).
        • Since the beginning of 2010, 26 new indigenous cases of dengue were reported by health authorities in Florida, including 25 acquired in Key West in Monroe County.
        • The 26 case detected in Broward County being (DEN-3), is the first confirmed case in thFlorida acquired outside of Monroe County, showing a geographical extension of the disease transmission in that state. Furthermore, the identification of a new serotype indicates a new introduction.
        • Considering the presence of Aedes aegypti and Albopictus vectors and the large number of cases of dengue imported into Florida, the extension of a transmission cycle could be a major risk.

        -
        -----

        Comment


        • #5
          EpiSouth Weekly Epi Bulletin – N°127 - 18 August 2010 – 24 August 2010 (edited): Unusual simultaneaous WNV transmission in both nesting and migratory bird routes.

          EpiSouth Weekly Epi Bulletin – N°127 - 18 August 2010 – 24 August 2010 (edited)


          [Source: EpiSouth.org, full PDF Document (LINK). Edited.]

          EpiSouth Weekly Epi Bulletin – N°127 - 18 August 2010 – 24 August 2010

          The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


          INDEX e-WEB n°127
          • A(H5N1) Human influenza – none
          • A(H5N1) Avian influenza – none
          • “INSIDE” Events:
            • Mumps – Gaza strip
          • “OUTSIDE” Events:
            • Rift Valley fever – Saudi Arabia
            • West Nile virus – Russia, Euro-Mediterranean area


          Location: World - Event: A(H5N1) – Human

          No human cases reported this week.


          Location: world - Event: A(H5N1) – Epizootic

          No influenza A(H5N1) epizootic reported this week .


          REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occurring in one or several EpiSouth countries)

          Location: Gaza Strip - Event: Mumps

          During week 28 to 31, 19 cases of mumps were reported in the Gaza strip.
          • The mumps cases are twice higher than in the same period in 2009 and most of them were from Gaza and North areas (cf. map 1):
            • 7 from Gaza city, 3 from Zaiton, 1 from Beach, 3 from Beit Hanoun, 4 from Middle area and 1 from Khan Younis.
          • The age of affected cases ranged between 3 years to 47 years.
          • All were previously immunized by MMR except for the oldest female case who was 47 years and came from Beit Hanoun (immunization status undermined)
          • The male/female ratio was 12.7
          • Control measures were implemented in coordination with the Ministry of Health: massive health education and isolation of cases and biological confirmation of cases.
          • More information available from the Epidemiological Bulletin for Gaza Strip.


          Comments

          In the region, Israel experiments also an ongoing outbreak of Mumps.


          REPORT of NEW HEALTH EVENTS OCCURING OUTSIDE THE EPISOUTH AREA (Not occurring in one or several EpiSouth countries)

          Location Saudi Arabia - Event: Rift valley fever

          On 23 August 2010, the Ministry of Agriculture of Saudi Arabia reported retrospectively to OIE an outbreak of Rift Valley fever (RVF) in the Jizan province (South West of the country, cf. map 2) among cattle and sheep.
          • The first infection started in 10th March 2010 and was confirmed on 15th March 2010.
          • To date, among 101 susceptible cases, 1 cattle and 5 sheep were confirmed. All confirmed cases were destroyed.
          • The Laboratory diagnosis was performed by the local Jazan laboratory.
          • Serological survey in the affected region showed that the local animals have adequate protective immune antibodies titters.
          • No human case associated with this outbreak has been reported.
          • However, in Saudi Arabia, several provinces are endemic to Rift Valley fever and documented RVF cases: Asir, Jizan and Najran.


          Comments
          • The last documented outbreak with RVF cases was reported in 2000 with 884 cases including 124 deaths, mainly in Jizan provinces of Jizan, Asir and Quenfadah.
          • In December 2008, the Asir Agriculture department in Saudi Arabia communicated a suspicion of Rift Valley Fever outbreak among cattle in Asir region (cf. eWEB 38).
          • Regarding human cases, 3 suspect cases were reported in May 2010 and 1 confirmed human case in April 2010 (cf. eWEB n°112), in Najran province which is west neighbouring province of Jizan.


          REPORT of NEW HEALTH EVENTS OCCURING OUTSIDE THE EPISOUTH AREA (Not occurring in one or several EpiSouth countries)

          Location Russia - Event: West Nile

          From July 16 to August 23, 2010, 116 cases of West Nile virus (WN) infections with 5 deaths were reported by health authorities of the Volgograd Region (southwest of the country), including 101 in the district of Volgograd (Map 3).
          • According to health authorities:
            • All age groups are affected with a predominance in those over 60 years
            • About 80% of infections are related to outdoor activities.
            • Currently, between six and 10 new cases are diagnosed daily.
          • The vector control measures have been stepped up as well as human cases surveillance. (especially surveillance area has been enlarged).
          • The period of transmission to human in this region typically begins in July. This year, the increase in the number of cases occurred one month earlier than previous years.
          • A large increase in the number of mosquitoes due to the large rainfalls in May and June was observed not only in the Volgograd region but also in neighbouring regions and other further North.
          • The vector density found this year compared to previous years is on average 10 times higher in the Volgograd region and 20-30 times in the floodplain of the Volga


          Comments

          In Russia, Volgograd region has become endemic for WN virus since 1999, when the largest documented outbreak in the countries of the former Soviet Union occured : 826 suspected cases and 40 deaths had been reported
          • Natural conditions and climate characteristics of the Volgograd region provide ideal conditions for migratory birds that gather in large numbers to nest in the Volga delta.


          REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occurring in one or several EpiSouth countries)

          Location: Euro-Mediterranean - Event: West Nile
          • The notification this week of a large West Nile outbreak in Russia should be placed in the broader intensification of the WN circulation in Mediterranean area
          • In the on cette semaine de foyers de WN au Maroc et en Russie s’inscrit dans un contexte plus large d’intensification de la circulation du virus dans le Bassin ainsi :
            • In Greece, The first ever reported outbreak is on going (Eweb N° 126 ), with 106 cases including 9 deaths reported on 24 August 2010.
            • In Israel, At least 12 human cases have been reported early August
            • In Morocco, 17 cases in horses were reported on 18th August (Eweb N° 126),.
            • Note :Birds are the main WN virus reservoir (Human and horses are only accidental hosts )


          Comments
          • West Nile is endemo-epidemic in most of the recently affected zones, However, the simultaneous occurrence of active transmission flocci in both nesting areas (Volga delta) and on the main birds migratory routes crossing Europe an Near East is an unusual event (See map 4).
          • Beside, the detection of the active transmission flocci on the main migratory routes (Greece, Israel and Morocco) takes place very early in the season as only very few species have started their autumn migration.
          • The combination of the viral circulation on both nesting area and migratory routes (map 4) could lead to an intensification of the final circulation in the coming weeks (main autumn migration period

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          Comment


          • #6
            EpiSouth Weekly Epi Bulletin – N°128 - 25 August 2010 – 31 August 2010 (9/02/10, edited)

            EpiSouth Weekly Epi Bulletin – N°128 - 25 August 2010 – 31 August 2010 (9/02/10, edited)


            [Source: EpiSouth.org, full PDF Document (LINK). Edited.]

            EpiSouth Weekly Epi Bulletin – N°128 - 25 August 2010 – 31 August 2010

            The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


            INDEX e-WEB n°128
            • A(H5N1) Human influenza – Egypt
            • A(H5N1) Avian influenza – None
            • “INSIDE” Events:
              • West Nile – Greece, Morocco, Romania, Hungary, EpiSouth Countries
            • “OUTSIDE” Events: none


            Location: Egypt - Event: A(H5N1) – Human

            • On 26 August 2010, the Egyptian Ministry of Health reported the 112th case of A(H5N1) infection. The case is:
              • A 33 year-old woman from Qalyubia governorate (cf. map 1)
              • She developed symptoms on 17 August and was hospitalised on 24 August 2010.
              • The patient received tamiflu traitment but died on 26th August.
              • Investigations indicate exposure with sick and dead poultry.
              • Since the 1st case of bird flu in Egypt, to date the case count is 112 cases including 36 deaths.

            (...)


            Comments
            • In Egypt, the last human case was reported in August 2010 in Cairo governorate (cf. eWEB n°125).
            • The available information does not indicate a change in the epidemiology of the virus in Egypt.


            Location: World - Event: A(H5N1) – Epizootic

            No influenza A(H5N1) epizootic reported this week .


            REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occurring in one or several EpiSouth countries)

            Location: Greece, Morocco Romania, Hungary - Event: West Nile

            • Greece
              • On August 27, 2010, the Greek Ministry of Rural Development and Food notified to the OIE 6 cases of equine West Nile in five foci in the province of Central Macedonia, where an outbreak began on August 7, 2010.
              • With regards to human cases situation, on 31/08/2010, Greek public health authorities reported a total of 150 human cases of West Nile virus infections including 11 deaths.
            • Morocco
              • On August 27, 2010, the Moroccan authorities have notified 3 new equine outbreaks to the OIE:
                • 1 in the province of Benslimane where outbreaks were reported on August 18, 2010;
                • 2 in the province of Khemisset in the region of Rabat-Salé, bordering the Chaouia-Ouardigha region where the Benslimane province is localised (cf. map 2).
                • No human case infected by the West Nile virus has been reported yet.


            HUMAN cases: (only new countries reporting human cases of WN)
            • Romania
              • On August 30, 2010, Romanian health authorities reported two confirmed fatal cases (old patients) of WN infection. At least, 80 suspected cases are under investigation in nine departments including the one of Bucharest, the capital of the country (cf. map 3.)
            • Hungary
              • On August 31st, 2010, Hungarian health authorities reported two human cases of WN infection that were treated in hospitals.
              • No death due to WN virus has been registered.
              • The disease uses to emerge in Hungary each year since 2003, mostly in regions where migrant birds circulate.
              • The last human cases were reported October 2008 with 12 confirmed cases (cf. e-WEB n°32 )


            Comments
            • The identification of equine outbreaks in Greece and Morocco as well as human cases in Romania highlighted the increased circulation of WN Europe and the Mediterranean (cf. eWEB n°127).
            • Viral circulation (human and animal morbidity, mortality and geographical extension) in Europe and Mediterranean countries should be carefully monitored.
            • Other countries of the region affected by the migration of birds currently have launched investigation for suspected cases of WN. Countries such as Italy and Turkey are currently investigating suspect cases.
            • In Romania, active surveillance of human and animal cases of WN infections cases was implemented in the South of the country in 1997. Between 1997and 2009, 4 human cases were confirmed in the district of Brail and in Bucharest (cf. e-WEB n°32 ) and in Dolj district (cf. eWEB n°76).
            • Neighboring countries (Balkans and others) where no disease or no human cases have been detected or reported to date could be considered at risk.

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            Comment


            • #7
              EpiSouth Weekly Epi Bulletin – N°129 - 1st September 2010 – 7 September 2010 (EpiSouth, edited)

              EpiSouth Weekly Epi Bulletin – N°129 - 1st September 2010 – 7 September 2010 (EpiSouth, edited)


              [Source: EpiSouth.org, full PDF Document (LINK). Edited.]

              EpiSouth Weekly Epi Bulletin – N°129 - 1st September 2010 – 7 September 2010


              The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


              INDEX e-WEB n°129
              • A(H5N1) Human influenza – None
              • A(H5N1) Avian influenza – None
              • “INSIDE” Events:
                • West Nile – Morocco, Italy, Turkey
              • “OUTSIDE” Events: none


              Location: world - Event: A(H5N1) – Human

              No influenza A(H5N1) human case reported this week


              Location: World - Event: A(H5N1) – Epizootic

              No influenza A(H5N1) epizootic reported this week .


              Location: Morocco, Italy, Turkey - Event: West Nile (WN)

              EQUINE cases
              • Italy
                • On September 7, 2010, Italian health authorities have reported to OIE 4 equine cases of West Nile in the Sicilian province of Trapani (West Island).
                • Human and veterinary surveillance has been strengthened and control measures have been implemented by health authorities.
                • These are the first WN cases to be reported in this region of Italy.
              • Morocco
                • On September 7, 2010, Moroccan authorities have notified 4 new equine WN outbreaks to OIE (see map 1):
                  • 2 in the province of Khemisset, region of Rabat-Salé : in Rommani and Marchouch,
                  • 1 in the province of Benslimane,
                  • 1 in Casablanca (in the equestrian club of Anfa).
                  • No human WN virus case has been reported.


              HUMAN cases: (only new countries reporting human cases of WN)
              • Turkey
                • As of September 8, 2010, Turkish ministry of health reported seven human cases of WN infection including 3 deaths.
                • All the patients originate from five western Turkish provinces: Sakarya, İzmir, Isparta, Aydin and Manisa (see map 2 below).


              Comments

              The equine cases in Sicily suggest that transmission also occurs outside the regions of Veneto and Emilia-Romagna where outbreaks of equine West Nile fever have been reported regularly since 1998 (eWEB n°29 and n° 32), and where the last outbreak was reported in September 2009 (eWEB n°78).
              • Since the past few weeks, changes in the number of cases in affected countries in Europe and the Mediterranean are carefully monitored. (eWEB n° 128).
              • Other countries of the region affected by the migration of birds are currently actively searching for suspected cases of WN.
              • Neighboring countries (Balkans and others) where no disease or no human cases have been detected or reported to date could be considered at risk.

              (...)
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              Comment


              • #8
                EpiSouth Weekly Epi Bulletin – N°130 - 07 September 2010 – 14 September 2010 (extracts, edited)

                EpiSouth Weekly Epi Bulletin – N°130 - 07 September 2010 – 14 September 2010 (extracts, edited)


                [Source: EpiSouth.org, full PDF Document (LINK). Extracts, edited.]

                EpiSouth Weekly Epi Bulletin – N°130 - 07 September 2010 – 14 September 2010

                The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


                INDEX e-WEB n°130
                • A(H5N1) Human influenza – None
                • A(H5N1) Avian influenza – None
                • “INSIDE” Events:
                  • Dengue – France
                  • West Nile – Mediterranean countries: Italy, Spain, Turkey
                • “OUTSIDE” Events: none


                Location: World - Event: A(H5N1) – Human

                No human cases reported this week.


                Location: world - Event: A(H5N1) – Epizootic

                No influenza A(H5N1) epizootic reported this week .


                REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occuring in one or several EpiSouth countries)

                Location: France - Event: Dengue

                On 13 September, the French Ministry of Health confirmed the presence of the 1st indigenous case of dengue fever in France, Nice (Alpes-Maritimes, cf. map 1). This is an isolated case and no further cases have been reported to date.
                • The case is a 64 years old man who developed suddenly fever, myalgia and asthenia on August 23rd:
                  • He has neither history of recent international travel nor recent history of blood transfusion.
                  • The serotype is currently unknown.
                  • The patient is cured and healthy.
                • Investigations detected in Nice 6 recent imported cases of dengue from the 24th July to 23rd August 2010. Within these 6 cases, four were confirmed PCR positive.
                • The patient is living in Nice, located in a French department (Alpes-Maritimes) where Aedes albopictus is established and active during this season (1st May to 30 November).
                • This case has been reported by the enhanced surveillance system implemented in this area (French South East) during this season.
                • To prevent any further spread of the virus, the epidemiological surveillance and control measures will be strengthened. Mosquito control actions have been implemented around the area of the residence of the person who was affected.


                Comments

                Even if some elements are still under investigation, this patient has been considered as a confirmed autochthonous case of Dengue.
                • The risk of development of an epidemic is considered limited, but can not be excluded, due to the significant presence of the tiger and other imported virus. In recent weeks, many cases have been imported from French West indies.


                REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occurring in one or several EpiSouth countries)

                Location: Turkey, Spain, Italy - Event: West Nile

                Turkey, human cases
                • On September 8, 2010, the Turkish Ministry of Health has confirmed seven human cases of West Nile with 3 deaths in five provinces (west of the country): Aydin, Isparta, Izmir, Manisa, and Sakarya


                Spain, Equine cases
                • On September 10, 2010, the Spanish Ministry of Agriculture and Fisheries has notified to the OIE two outbreaks of equine West Nile virus which occurred in late August (two horses), in Cadiz in Andalusia province (south of the country, cf. map 3).


                Italy, Equine cases
                • On September 14, 2010, the Italian health authorities have notified to the OIE an additional outbreak of equine West Nile virus in Trapani in Sicilia province, Italy (cf. map 4)


                Comments

                In Turkey, this is the first time that human cases are officially reported. However, various serological studies provided evidence of WN virus circulation in different regions of the country since the 1970s.
                • In Spain, no equine outbreak was never officially reported to OIE before.
                • However, seroprevalence studies in the Delta del Ebro (2001) and south of Spain (2007) indicated the presence of WN specific antibodies in serum with respective seroprevalence of 3.8% and 0.6%.
                • In recent weeks, there has been an intensification of the West Nile virus circulation in Europe and the Mediterranean region (cf. eWEB n°125, n°126, n°127, n°128 and n°129).
                • To date, nine countries reported cases (human or equine) in this region (cf. table 1 and map 4)
                • Changes in the West Nile virus dynamic (number of cases and geographical extension) is closely monitored as an epidemic spread to other countries with migratory flows can not be excluded.


                (...)
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                Comment


                • #9
                  Archive, EpiSouth Weekly Epidemiological Bulletin (2010)

                  This archive contains the most recent EpiSouth bulletins.

                  Comment


                  • #10
                    EpiSouth Weekly Epi Bulletin – N°131 - 15 September 2010–21 September 2010 (9/25/10, edited)

                    EpiSouth Weekly Epi Bulletin – N°131 - 15 September 2010–21 September 2010 (9/25/10, edited)


                    [Source: EpiSouth, full PDF Document (LINK). Edited.]

                    EpiSouth Weekly Epi Bulletin – N°131 - 15 September 2010–21 September 2010

                    The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


                    INDEX e-WEB n°131
                    • A(H5N1) Human influenza – None
                    • A(H5N1) Avian influenza – None
                    • “INSIDE” Events:
                      • Dengue – France
                      • Plague – Algeria (article)
                    • “OUTSIDE” Events: none


                    Location: World - Event: A(H5N1) – Human

                    No human cases reported this week.


                    Location: world - Event: A(H5N1) – Epizootic

                    No influenza A(H5N1) epizootic reported this week .


                    REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occuring in one or several EpiSouth countries)

                    Location: France - Event: Dengue
                    • Following the confirmation of the 1st indigenous case of dengue fever in France, Nice (Alpes-Maritimes, cf. map 1) last 10th September 2010 (cf. eWEB n°130), the French Ministry of Health reported on 19th September 2010, a second autochthonous case of dengue fever.
                    • This second case has been reported by the enhanced surveillance system implemented in this area (French South East) during this season (1st May to 30 November).
                    • Both patients recovered.
                    • To date, the number raise is limited and cases are located in a defined geographical area. Nevertheless, the state services are mobilized to prevent the spread of the virus.
                    • It was decided to strengthen the measures already in place (epidemiological and entomological surveillance and mosquito control measures) around the area of residence of affected individuals.
                    • A careful search for other cases in the vicinity of the first patient aims to identify those potentially affected.
                    • The mosquito bit trip (25-50 feet around his place of birth). Therefore, health authorities call on residents in and around Nice to adopt a number of preventive measures.


                    Comments

                    The risk of development of an epidemic is considered limited, but can not be excluded, due to the significant presence of the tiger [mosquitoes] and the touristic area of the Côte d’Azur region.


                    REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occurring in one or several EpiSouth countries)

                    Location: Algeria - Event: Plague

                    An article published in the Emerging Infectious Diseases Journal (17th September 2010) by the Pasteur Institute of Algiers, the Mediterranean University of Marseille and the University hospital of Laghouat, describes retrospectively several cases of plague diagnosed in July 2008 in the province of Laghouat (550 km southwest of Algiers, cf. map 2).
                    • In July 2008, 4 patients in total were admitted to Laghouat University hospital (included one death).
                    • All were nomads living in a 24-person camp in Thait El Maa in the Laghouat area.
                    • No patients reported contact with sick animals.
                    • These cases were officially communicated to WHO.
                    • In Algeria, the last human plague re-emergence was reported in 2003 in Oran area.


                    Comments

                    Plague is often perceived as a sensitive issue and is regularly a cause of false alerts (cf. eWEB n°44).
                    • Plague is endemic among wild rodent in several areas of North Africa and sporadic human cases may occur in regions where plague circulated among wildlife (cf. map 3).
                    • In recent years, several foci linked with wild rodent have reappeared.
                    • More recently, on 14th June 2009, Libya Arab Jamahiriya reported 12 bubonic plague cases (including 1 death) in the North East coast of the country (cf. eWEB n°65). This outbreak occurred in a semi-nomadic setting.
                    • The occurrence of sporadic plague cases or small cluster in rural areas in not an unexpected event. This event does not to be considered as an alert.

                    (...)
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                    Comment


                    • #11
                      EpiSouth Weekly Epi Bulletin – N°132 - 22 September 2010 – 28 September 2010 (Edited)

                      EpiSouth Weekly Epi Bulletin – N°132 - 22 September 2010 – 28 September 2010 (Edited)


                      [Source: EpiShouth, full PDF Document: (LINK). Edited.]

                      EpiSouth Weekly Epi Bulletin – N°132 - 22 September 2010 – 28 September 2010

                      The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


                      INDEX e-WEB n°132
                      • A(H5N1) Human influenza – None
                      • A(H5N1) Avian influenza – None
                      • “INSIDE” Events:
                        • Chikungunya – France
                        • West Nile – Mediterranean countries: Morocco, Spain
                      • “OUTSIDE” Events: none


                      Location: World - Event: A(H5N1) – Human

                      No human cases reported this week.


                      Location: world - Event: A(H5N1) – Epizootic

                      No influenza A(H5N1) epizootic reported this week .


                      REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occuring in one or several EpiSouth countries)

                      Location: France - Event: Chikungunya

                      On 24 September, the French authorities confirmed the occurrence of the 1st indigenous case of chikungunya fever in France, Frejus (Var district cf. map 1). On 27 September a 2nd autochthonous case, epidemiologically linked to the index case has been confirmed.
                      • The cases are:
                        • Two 12-year old girls, both symptomatic on 18 September including fever, arthralgia, myalgia, rash and headache.
                        • They are both resident in Frejus, living in the same neighbourhood and frequenting the same school.
                        • The serotype is currently unknown.
                      • Var is a French district (South-east of France) where Aedes albopictus is established since 2004.
                      • Enhanced seasonal surveillance system of chikungunya and dengue fever has been implemented in this area of France since 1st January 2006 from May to November. Both cases have been detected through this system.
                      • To prevent any further spread of the virus, the epidemiological surveillance and control measures have been strengthened, including entomological investigations, active case finding around the cases and public information.


                      Comments

                      Although the risk of widespread epidemic is considered limited it cannot be excluded. The detection of new autochthonous cases is likely to happen until November, end of the mosquito season.
                      • The detection of 2 autochthonous cases of dengue fever 10 days prior to this event in South East of France, emphasizes the need to closely follow-up the situation of arboviruses in the region.
                      • Map 1. Frejus, city in Var district, France.


                      REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occurring in one or several EpiSouth countries)

                      Location: Turkey, Spain, Italy - Event: West Nile

                      Morrocco, equine cases
                      • On 28 September 2010, the Moroccan Institute for Food Safety (ONSSA) has reported an outbreak of equine West Nile fever in a newly affected region; Grand Casablanca.
                      • Since 17 September 2010, a total of 24 equine cases including 10 deaths in 23 foci has been reported in 3 regions: Rabat-Salé, Chaouia-Ouardigha and Grand Casablanca (cf. map 2).
                      • Grand Casablanca is the most populated region of Morocco.


                      Spain, human case
                      • On 27 September 2010, Spanish health authorities have reported a case of WN fever in Cadiz, Andalusia.10 foci of equine WN fever have been reported in Andalousia from 10 to 24 September 2010 (9 in Cadiz, 1 in Sevilla) (cf.map 3)


                      Comments

                      In Morocco, the active case finding around equine foci has not found any human cases.
                      • In Spain, the last human case reported was in 2004.
                      • The epidemiological situation in other countries of the euro-mediterranean area remains unchanged (cf. map 4, EpiSouth Thematic Note ).



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                      Comment


                      • #12
                        EpiSouth Weekly Epi Bulletin – N°133 - 29 September 2010 – 05 October 2010 (10/08/10, edited)

                        EpiSouth Weekly Epi Bulletin – N°133 - 29 September 2010 – 05 October 2010 (10/08/10, edited)


                        [Source: EpiSouth, full PDF Document (LINK). Extracts, edited.]

                        EpiSouth Weekly Epi Bulletin – N°133 - 29 September 2010 – 05 October 2010

                        The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


                        INDEX e-WEB n°133
                        • A(H5N1) Human and avian influenza – None
                        • “INSIDE” Events:
                          • Dengue – Croatia
                          • West Nile – Mediterranean area: update
                        • “OUTSIDE” Events:
                          • Chikungunya - China
                          • Toxic Flood - Hungary


                        Location: World - Event: A(H5N1) – Human and Epizootic

                        No human cases reported this week.
                        No influenza A(H5N1) epizootic reported this week .


                        REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occuring in one or several EpiSouth countries)

                        Location: Croatia - Event: Dengue

                        On 30 September, German health authorities have reported a case of dengue fever virus infection imported from Croatia.
                        • The case is:
                          • a German tourist 72 years old
                          • Having traveled in the south-east of Croatia on the Adriatic Sea coast, from 1 to 15 August 2010 (see Map 1);
                          • He was symptomatic on 16th August 2010;
                          • He has no history of vaccination against yellow fever and tick-borne encephalitis.
                          • To date, the serotype is unknown
                        • Control measures, information and sensitization of clinicians and active case finding have been implemented. To date, no other suspect cases have been detected neither in the above mentioned area nor in the rest of the country
                        • Aedes albopictus, as the potential dengue vector is well established in Croatia but also in several Mediterranean countries (cf. Map2).


                        Comments

                        This is the first confirmed case of dengue fever acquired in Croatia. At this stage, the probable source of infection (index case) remains unknown, investigations are ongoing
                        • The detection of autochthonous dengue fever cases both in France (cf. eWEB n°130, 131) and Croatia constitutes a significant public health event although not unexpected due to the presence of A. albopictus in these 2 countries.
                        • At this stage, the risk of implantation of a sustained cycle of transmission appears limited.
                        • This has also to be put in perspective with the recent detection of indigenous chikungunya in southern France (eWEB n°132) as it illustrates the risk of autochthonous transmission in all Mediterranean countries where A. albopictus is present.
                        • The evolution of these two arboviruses in southern Europe is closely monitored.


                        REPORT OF NEW HEALTH EVENTS OCCURRING OUTSIDE THE EPISOUTH AREA (occurring in one or several EpiSouth countries)

                        Location: China - Event: Chikungunya

                        On October 3, 2010, Chinese authorities have confirmed several cases of chikungunya in Guangdong province (South of the country (see Map 3)
                        • The cases’ details were not disclosed.


                        Comments

                        This is the first indigenous cases of chikungunya reported in China.
                        • The chikungunya virus has been detected in China in the 1980s:
                          • among bats of Culex mosquitoes in the provinces of Yunnan and Hainan Island;
                          • well as in samples taken from humans in these two provinces and Guangdong.
                        • Guangdong is the most populous province of China (80M). Imported cases have been described repeatedly in the capital, Guangzhou (Canton).


                        Location: Hungary - Event: Pollution (toxic flood)

                        After the break of a dike surrounding a pool of waste water in an aluminum plant, the Hungarian authorities have declared on October 05, 2010, a state of emergency in the departments of Veszprem, Győr-Moson-Sopron and Vas - located in the North West of the country (close to Slovak and Austrian Border) and upstream Budapest (see Map 4).
                        • Approximately 1 million cubic meters of toxic sludge containing heavy metals has flooded several villages.
                        • To date, 120 people were injured and 4 died.
                        • The flow caused by toxic red mud that spread after this industrial accident reached the Danube, threatening the ecosystem of the River.
                        • Water samples collected at the confluence of the Raab River and Danube revealed a rate slightly more alkaline than normal, between 8.96 and 9.07 (normal is 8).
                        • Measures of restraint of toxic flood have been implemented by the authorities.


                        Comments

                        Investigations are underway to determine the ecological consequences for the fauna and flora of the region.
                        • This event may constitute a public health emergency of international concern. The risk remains to be assessed for people living downstream on the Danube, especially in Croatia, Romania and Serbia


                        REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA + NEIGHBOURING COUNTRIES

                        West Nile Update – 07th October 2010.
                        • Except the increase number of human and equine cases in already affected countries, the main new features regarding WNV are
                          • BULGARIA
                            • On 04th October 2010, the Bulgarian Health authorities has notified to the OIE about West Nile fever virus infections in 5 donkeys, in the North-East part of Bulgaria. These are the first equine cases ever reported to OIE by Bulgaria.
                          • SPAIN
                            • On 06th October 2010, the Spanish Ministry of health has confirmed a 2nd human case of West Nile in the Cadiz province: a 77 years old man from Benalup-casas viejas.
                            • He was hospitalised on 28th September 2010 and recovered.
                            • This case is the second WN human case in Cadiz which already reported in September equine cases (cf. eWEB n°130) and a 1st human case (cf. eWEB n° 132)
                            • For more details regarding other countries, please refer to the West Nile thematic note posted on 6th October 2010.

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                        Comment


                        • #13
                          EpiSouth Weekly Epi Bulletin – N°134 - 06 October 2010 – 12 October 2010 (Extracts, edited)

                          EpiSouth Weekly Epi Bulletin – N°134 - 06 October 2010 – 12 October 2010 (Extracts, edited)


                          [Source: EpiSouth, full PDF Document (LINK). Extracts, edited.]

                          EpiSouth Weekly Epi Bulletin – N°134 - 06 October 2010 – 12 October 2010

                          The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


                          INDEX e-WEB n°134
                          • A(H5N1) Human and avian influenza – None
                          • “INSIDE” Events:
                            • Malaria – Spain, Morocco
                            • West Nile – Mediterranean area: update
                          • “OUTSIDE” Events:
                            • Polio - Kazakhstan


                          Location: World - Event: A(H5N1) – Human and Epizootic

                          No human cases reported this week.

                          No influenza A(H5N1) epizootic reported this week .


                          REPORT OF NEW HEALTH EVENTS OCCURRING OUTSIDE THE EPISOUTH AREA (not occurring in one or several EpiSouth countries)

                          Location: Kazakhstan - Event: Polio

                          On 11 October 2010, the Kazakh health authorities have reported a case of indigenous poliomyelitis in a child of 7 years in the South Kazakhstan. 5 other cases are suspected.
                          • The child did not leave Kazakhstan.
                          • Vaccination campaigns have recently been performed in the country. This child was out of the targeted age group.
                          • Further campaigns are planned in this region, targeting children aged 0-15 years in the border regions of Kazakhstan and Almaty, Zhambyl, Kyzylorda and Mangistau.


                          Comments

                          On April 23, 2010, an outbreak of wild poliovirus (type 1) began in Tajikistan, while the European WHO region did not reported cases since 2002 (cf. eWEB n°110).
                          • The last WHO update, on 30 September 2010, reported 458 confirmed cases including 26 deaths (polio update in Tajikistan).
                          • Indigenous cases were reported in Russia (cf. eWEB n°113) and Turkmenistan.
                          • Given the location of the epidemic in Tajikistan and the frequency of asymptomatic infection by wild polio virus, a virus circulation in areas bordering Uzbekistan, Kyrgyzstan and Kazakhstan can not be excluded.


                          REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (occuring in one or several EpiSouth countries)

                          Location: Spain - Event: Malaria

                          On October 8, 2010, a case of Plasmodium vivax has been reported by Spanish health authorities.
                          • The case is:
                            • a 48 year old woman living in Huesca, Aragon (cf. map 2)
                            • She never travelled outside the country, has not received recent treatment (transfusion), and does not live near an airport.
                            • The samples were sent to the Institute Carlos III (Madrid), which confirmed the diagnosis of malaria on 1st October 2010.
                            • The patient was treated and she’s in stable condition.
                          • The Anopheles atroparvus vector is present in all over Spain.
                          • To date, the origin of the contamination was not identified.


                          Comments

                          In Spain, the last indigenous cases were reported during the 1950s. Spain was declared malaria free by the WHO in September 1964.
                          • As in Spain, isolated cases of autochthonous malaria were reported in Greece (2009-2010), Albania (2010), France (Corsica - 2006) and Italy (1997, 2009).
                          • Such cases are due to local transmission from imported cases, unidentified, back from an endemic area in the presence of a competent vector.


                          Location: Morocco - Event: Malaria

                          On 22 September 2010, the Moroccan Ministry of Health confirmed two cases of indigenous malaria Plasmodium falciparum in the district of Hay Hassani, Casablanca (North West, cf. map 3).
                          • To date, investigations have not identified other suspected cases.
                          • The origin of the contamination could be identified.
                          • Control measures have been taken by health authorities.


                          Comments

                          In Morocco, the last cases of malaria due to P. falciparum were reported in 1963.
                          • The last cases of malaria due to P. vivax were reported in the years 1973-80.
                          • Since May 2010, Morocco was declared malaria-free by WHO.
                          • To date, consequences for France are limited due to the absence of evidence of an active cycle of transmission.


                          Location: Mediterranean - Event: West Nile

                          Greece: On October 8, 2010, 5 new outbreaks (5 horses) were reported to the OIE, all located in Central Macedonia (an area already affected, cf. map 4).


                          Comments

                          The epidemiological situation in other Euro-Mediterranean countries remains unchanged.

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                          Comment


                          • #14
                            EpiSouth Weekly Epi Bulletin – N°137 - 27 October 2010 – 02 November 2010 (Extract, edited)

                            EpiSouth Weekly Epi Bulletin – N°137 - 27 October 2010 – 02 November 2010 (Extract, edited)


                            [Source: EpiSouth, full PDF document, (LINK). Extract, edited.]

                            EpiSouth Weekly Epi Bulletin – N°137 - 27 October 2010 – 02 November 2010

                            The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. Neither the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


                            INDEX e-WEB n°137
                            • A(H5N1) Human influenza – None
                            • A(H5N1) Avian influenza – Japan
                            • “INSIDE” Events: none
                            • “OUTSIDE” Events: none


                            Location: World - Event: A(H5N1) – Human

                            No human cases reported this week.


                            Location: Japan - Event: A(H5N1) – Epizootic

                            On October 29, 2010, Japanese authorities reported to the FAO a positive environmental sample of A (H5N1) HPAI in the prefecture of Hokkaido (northern Japan, cf. map 1).
                            • These are samples of faeces from wild birds collected on October 14, 2010.
                            • The identification of the virus does not mean the existence of local virus circulation: the island of Hokkaido is located along the routes followed by migratory birds.
                            • Other locations within the same prefecture were inspected.
                            • To date, no outbreak or animal human cases have been reported.


                            Comments

                            Japan is among the first affected Asian countries in 2003.
                            • In Japan, the last outbreak was reported in June 2008 in the province of Aomori (cf. eWEB n°12).

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                            Comment


                            • #15
                              EpiSouth Weekly Epi Bulletin – N°138 - 03 November 2010 – 10 November 2010 (11/14/10, edited)

                              EpiSouth Weekly Epi Bulletin – N°138 - 03 November 2010 – 10 November 2010 (11/14/10, edited)


                              [Source: EpiSouth, full PDF document (LINK). Extract, edited.]

                              EpiSouth Weekly Epi Bulletin – N°138 - 03 November 2010 – 10 November 2010

                              The objective of the bulletin is to report new heath events occurring outside and inside EpiSouth area that have potential implications on EpiSouth population. It does not aim to provide an exhaustive review of international alerts. Since 2006, The French public health Institute (InVS) is issuing an online epidemic intelligence bulletin (Bulletin hebdomadaire International - BHI). In order to limit duplication and to make this already verified information available to a larger audience, information relating to health events of interest for EpiSouth population are translated and integrated in the relevant e-web sections. Despite all verifications, WP6 team would not be responsible for potential errors. The recipient is responsible for the cautious use of this information. either the European Commission nor any person acting on behalf of the Commission is liable for the use that may be made of the information contained in this report. Data maps and commentary used in this document do not imply any opinion of EpiSouth countries or its partners on the legal status of the countries and territories shown or concerning their borders.


                              INDEX e-WEB n°138
                              • A(H5N1) Human and avian influenza – None
                              • “INSIDE” Events:
                                • West Nile – Italy, Bulgaria and Greece
                              • “OUTSIDE” Events:
                                • Poliomyelitis- Congo


                              Location: World Event: A(H5N1) – Human and Epizootic

                              No human cases reported this week

                              No influenza A(H5N1) epizootic reported this week


                              REPORT OF NEW HEALTH EVENTS OCCURRING INSIDE THE EPISOUTH AREA (not occurring in one or several EpiSouth countries)

                              Location: Bulgaria, Italy, and Greece - Event: West Nile
                              • Bulgaria
                                • On 3d of November, ministry of agriculture of Bulgaria reported to the OIE a West Nile equine outbreak (3 horses) in the village of Staro Oriahovo, located in Dolni Chiflik, in the Varna oblast (North-East part of Bulgaria)(cf. map 1).
                                • Last outbreak was reported in October 2010 in Dobrich, first equine cases ever reported to OIE by Bulgaria (cf. Eweb n°133).
                              • Italy
                                • On 4 November 2010, Italian health authorities reported new foci of West Nile virus infection in province of Compobasso, in Molise region (2 horses):
                                  • To date, regarding West Nile outbreaks in animals, health authorities reported:
                                    • 53 clusters in horses in the provinces of Trapani, Venice, Treviso, Campobasso, and Bologna.
                              • Greece
                                • As of 12 November 2010, 261 human cases and 34 deaths have been reported (Greek MoH, Keel data).
                                • Furthermore, on 4 November 2010, Greek health authorities reported 2 new equine West Nile outbreaks, located in Central Macedonia.


                              REPORT OF NEW HEALTH EVENTS OCCURRING OUTSIDE THE EPISOUTH AREA (NOT occurring in one or several EpiSouth countries)

                              Location: Congo - Event: Poliomyelitis
                              • On 3 November 2010, Health authorities of the Republic of Congo have reported 120 suspected cases of poliomyelitis (acute flaccid paralysis) including 58 deaths.
                              • On November 9, 184 suspected cases including 85 deaths have been reported.
                                • A wild poliovirus type 1 (WP1) has been isolated from four patients.
                                • Almost all cases are reported in Pointe Noire, the economic capital of the country, in Kouilou region on the Atlantic coast. Other suspected cases were reported in southern regions (Niari, Bouenza Kouilou) and in Brazzaville, capital of the Congo (see Map 2).
                              • The first case occurred early October. Half of the cases were reported within 15 days.
                              • Most cases and deaths are young adults. Of 42 cases for which information is available:
                                • 1 is less than 5 years;
                                • 3 are between 7 and 13 years;
                                • 33 are between 15 and 25;
                                • 5 are between 26 and 58 years.
                              • As a response to this epidemic:
                                • Surveillance of acute flaccid paralysis has been strengthened;
                                • A vaccination campaign against polio is expected to begin November 12, 2010 in the regions of Kouilou and Cabinda, Angola border region. Other campaigns to cover the entire Congolese population are expected to begin November 18, 2010.


                              Comments

                              The last case of indigenous polio in the country dates back to 2000.
                              • According to preliminary results of epidemiological investigations and virus typing, it seems that the virus strain comes from Angola.
                              • In regard to the large number of reported cases, the unusual age distribution of cases the speed of the epidemic spread, the situation should be monitored carefully. Pointe Noire, the second largest city, has substantial international trade with African and European cities. The exportation of cases is possible, especially in this unusual age group (young adults).

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                              Comment

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