Re: Henan/Shangdong Province: Ticks kill 21 in hushed-up outbreak
Re: Henan/Shangdong Province: Ticks kill 21 in hushed-up outbreak
http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,84746
Archive Number 20100910.3274
Published Date 10-SEP-2010
Subject PRO/EDR> Anaplasmosis, human granulocytic - China: (HE) susp, RFI
ANAPLASMOSIS, HUMAN GRANULOCYTIC - CHINA: (HENAN) SUSPECTED, REQUEST FOR
INFORMATION
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[1]
Date: Thu 9 Sep 2010
Source: Shanghai Daily [edited]
<http://www.shanghaidaily.com/article/?id=448793&type=National>
Health authorities in central China's Henan Province said last night [8 Sep
2010] that 18 people had died of infection from a series of tick bites that
have been kept secret. Another 3 fatalities were reported in Penglai City,
east China's Shandong Province.
The 18 victims were among 557 reported cases of suspected human
granulocytic anaplasmosis [HGA] since the 1st case was reported in Xinyang
City of Henan in May 2007, Xinhua news agency reported. Most of the cases
were found in Xinyang's Shangcheng and Guangshan counties and Shihe and
Pingqiao districts, the provincial Public Health Department said.
The disease is often reported from May to August and most people infected
are between ages 40 to 70, according to officials. The cases mainly were
reported in rural areas where hygiene conditions are questionable, SINA.com
quoted Yu Xinbing, a parasite expert at Guangzhou-based Sun Yat-sen University.
Pets in urban areas rarely have the ticks because the owners regularly
clean them, Yu said.
HGA reduces white blood cell and platelet counts in the blood, leading to
organ failure and death. [The case fatality rate in HGA is quite low. Most
patients with HGA recover uneventfully. However, HGA can be severe and even
life threatening if untreated or initiation of antibiotic therapy is
delayed in elderly and in immunocompromised patients. - Mod.ML]
People in close contact with the patient can also be infected if no
precautions are taken. [Exposure to blood or bloody body fluids from a
patient with HGA has been implicated in person to person transmission --
see ProMED-mail post Anaplasmosis, nosocomial transmission - China: (AH)
20081120.3661. _Anaplasma phagocytophilum_ can survive in refrigerated
blood and anaplasmosis has also been transmitted through blood transfusion
(CDC. _Anaplasma phagocytophilum_ transmitted through blood transfusion --
Minnesota, 2007. MMWR 2008; 57(42): 1145-8. October 2008 [date cited];
available from <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5742a1.htm>). -
Mod.ML] The disease is curable if treated soon enough.
An outbreak of tick bite infection was reported last year [2009] in Henan,
according to state radio. Besides Henan, tick bite cases have been reported
in 5 other provincial regions, all mountainous areas or areas with large
waterways. Among them were 3 villagers who were killed in July [2009] in
Penglai City, Shandong Province, according to the radio station.
Tick attacks first appeared in Xinyang in 2007 when several people reported
a skin rash after being bitten by the ticks. [Except for redness at the
site of the tick bite, skin rashes are rare in HGA]. The number of victims
started to climb up in 2009 when a few deaths were reported. This year's
[2010] situation has been the worst, Yang Fu, a village official in
Shangcheng County, told The Beijing News.
For most patients in Shangcheng, the 1st symptom was fever -- something
easily misdiagnosed by local village doctors.
[byline: Meng Tiexia]
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[2]
Date: Thu 9 Sep 2010
Source: China.org.cn, CNTV report [edited]
<http://www.china.org.cn/video/2010-09/09/content_20897240.htm>
In Central China's Henan province, the health department has reported that
18 deaths were likely caused by a tickborne disease. So far 557 cases have
been reported, with most occurring in Shangcheng County of the province.
Local authorities in Henan say tickborne diseases, which mostly occur in
the summer, are believed to be the cause of a string of deaths. Most
patients who fall ill have been middle aged and the elderly.
Xu Bianli, vice director of Henan Disease Control Center, said, "It is an
acute disease with the symptoms of fever, nausea, and can lead to multiple
organ failure."
But Xu says it still cannot be confirmed if the disease was directly caused
by tick bites. Meanwhile experts from China's disease control center, the
US and Australia are in Henan, trying to find the cause of the disease. Xu
Bianli said, "We have not found the direct cause of the disease. It is
difficult to diagnose it now." However, he also noted that tickborne
diseases could be fully cured if people get immediate and necessary medical
treatment, including antibiotics. Local authorities have dispatched experts
in the disease-hit regions, and have also stepped up efforts in disease
prevention, including thorough sterilization and quarantines.
Ticks are known to carry various diseases, transmitting them from animal to
animal. In China, tickborne disease have been confined most to rural areas
in Henan and Guangdong provinces and the Guangxi Zhuang Autonomous Region.
--
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ProMED-mail
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[Human granulocytic anaplasmosis (HGA), formerly known as human
granulocytic ehrlichiosis, is a tickborne disease caused by a
rickettsia-like bacterium, called _Anaplasma phagocytophilum_. Many people
with HGA experience headaches, fever, chills, and muscle aches that can be
confused with other common infections. The symptoms tend to be most severe
in aged and immunosuppressed people. Some individuals who become infected
with _A. phagocytophilum_ do not become ill or experience only very mild
symptoms and do not seek medical treatment.
However, it is clear from the
2nd news release above that there is uncertainty concerning the diagnosis
in these fatalities in Henan, China. We await further clarification. A
detailed discussion of HGA can be found in the moderator's comments in the
prior ProMED-mail post, Anaplasmosis, nosocomial transmission - China: (AH)
20081120.3661.
Henan province is located in the eastern central part of China and is the
2nd most populated province of China after Guangdong
(<http://en.wikipedia.org/wiki/Henan>). Xinyang is subtropical and
mountainous and is the southernmost administrative division in Henan
province; Xinyang administers 2 districts and 8 counties
(<http://en.wikipedia.org/wiki/Xinyang>).
For a map of China with geographic divisions see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/china_pol01.jpg>. Of
note, Henan province is adjacent to Shandong province to the north east and
Anhui province to the east, where other cases of HGA have been reported.
The HealthMap/ProMED-mail interactive map of China is available at
<http://healthmap.org/r/06JJ>.
Additional information on ticks, including pictures, is available at
<http://www.lib.uiowa.edu/haRDIN/MD/cdc/ticks.html>. - Mod.ML]
[see also:
Anaplasmosis, ehrlichiosis - USA: (WI, MN) Alert 20100515.1593
2009
---
Anaplasmosis - USA: (WI) 20090909.3186
2008
---
Anaplasmosis, nosocomial transmission - China: (AH) 20081120.3661
Anaplasmosis, human granulocytic - USA: (MN), ex transfusion 2007
20081024.3362
Undiagnosed hem. disease - China (02): (SD), anaplasmosis 20080805.2400
Anaplasmosis, human granulocytic - Canada: 1st rep., (AB) 20080731.2352
2007
---
Ehrlichiosis, fatal - USA (MO) 20070607.1849
2003
---
Ehrlichiosis, human granulocytic - USA (MA) 20030903.2211
Ehrlichiosis, human monocytic - USA (NC) 20030625.1571
1999
---
Ehrlichiosis, human - Mexico 19990713.1173
1998
---
Ehrlichiosis, human granulocytic - USA (Connecticut) 19980713.1318
Ehrlichiosis, human granulocytic - Sweden 19980418.0719
1995
---
Human granulocytic ehrlichiosis (5) 19950802.0625
Human granulocytic ehrlichiosis - Europe? 19950723.0581]
.................ml/mj/sh