Cholera in Haiti
As of 20 November 2010, the Haitian Ministry of Public Health and Population (MSPP) reported 60,240 cumulative cholera cases including 1,415 deaths at the national level. The case fatality rate in hospitals at the national level is 2.3%, with 67% of the deaths occurring at health services level and 33% at community level.
To see more from the WHO please go here http://www.who.int/csr/don/2010_11_24/en/
Information on cholera from HPSC is available here http://www.hpsc.ie/hpsc/A-Z/Gastroenteric/Cholera/Factsheet/
Update on Polio outbreak in European region - no time for complacency regarding polio immunisation
In April 2010 the WHO European Region experienced the first importation of wild poliovirus since it was certified polio free in 2002. The WHO European office has issued an update on the polio situation in the region. Please click here to access the report.
As of 30 September 2010, polio has been reported in three European countries and cases are under investigation in an additional 3 countries;
• Tajikistan (458 laboratory‐confirmed cases of wild poliovirus type 1, including 26 deaths)
• The Russian Federation (12 cases)
• Turkmenistan (3 polio cases)
• Kyrgyzstan (50 cases investigated, laboratory results pending on 13)
• Uzbekistan(99 cases under investigation)
• Kazakhstan(54 cases under investigation)
Polio vaccination is part of the routine immunization programme in Ireland.
1. Vaccination to protect against polio is included in the 6-in-1 vaccine given to infants at 2, 4, 6 months of age. An additional booster dose is given at 4-5 years of age (as part of the 4-in-1 vaccine).
2. All individuals, of all ages, regardless of whether they intend to travel, should ensure that they have completed appropriate immunisation against polio.
3. Travellers of any age to areas where polio is epidemic or endemic should ensure that they are appropriately immunised.
Note for clinicians:
4. All cases of acute flaccid paralysis (AFP)*, particularly in children < 15 years of age, should be investigated and 2 stool samples should be sent to the National Virus Reference Laboratory (NVRL) for testing indicating reason for investigation†.
*Acute flaccid paralysis has been defined as any case of new onset of hypotonic weakness in a child aged less than 15 years of age. This includes possible illness due to Guillain-Barré Syndrome, transverse myelitis, traumatic neuritis, viral infections such as Enterovirus 71, Echovirus, Coxsackie virus, toxins and tumours. All these causes of acute flaccid paralysis should be investigated. The non-Polio acute flaccid paralysis rate should be at least 1 per 100,000 children under 15. *Isolated facial paralysis is not included in the case definition of acute flaccid paralysis and does not require to be reported.
†It is strongly recommended to contact the National Virus Reference Laboratory in UCD for advice regarding the transfer of appropriate specimens immediately on admission of any child with acute flaccid paralysis, regardless of the cause of the AFP. Non-infectious causes of AFP are included in the surveillance required by the WHO.
In all cases of acute flaccid paralysis it is essential that two specimens of stool are collected taken 24 hours apart and within 14 days of the on set of paralysis. These stool specimens must be sent to the National Virus Reference Laboratory.
Vaccination recommendations for Saudi Arabia - Hajj 2010
Requirements and recommendations for entry visas for the Hajj seasons in 2010 have been published in the latest issue of the Saudi Arabian "Journal of Infectious Diseases and Public Health".2
The Hajj, is the annual Muslim pilgrimage to Mecca and Medina in Saudi Arabia. The exact dates of Islamic holidays cannot be determined in advance, due to the nature of the Islamic lunar but it is expected to fall in mid November, 2010.
During the Hajj, more than 2 million Muslims from all over the world congregate to perform their religious rituals. The potential for spread of infectious diseases associated with this pilgrimage has long been recognized. Throughout its 14-century history, the Hajj has been witness to a series of major health issues: historical records document outbreaks of plague and cholera, involving large numbers of pilgrims, when quarantine was the prime means of control.3
Overcrowding contributes to the potential dissemination of airborne infectious diseases or infections associated with person-to-person transmission. Extensive outbreaks of meningococcal disease among pilgrims have prompted the Saudi Arabian health authorities to introduce mandatory vaccination.3
Recommended vaccinations for pilgrims travelling from Ireland:
- Routine vaccinations (such as measles, mumps, poliomyelitis, tetanus, diphtheria and hepatitis B) should be up to date
- Quadrivalent meningococcal vaccine (A, C, Y and W135). All adults and children over the age of 2 years are required to demonstrate vaccination with 1 dose of quadrivalent meningococcal vaccine (ACYW135) issued not more than 3 years previously and not less than 10 days before arrival in Saudi Arabia.
- Seasonal influenza vaccine is recommended, particularly for those with pre-existing conditions (e.g. the elderly, people with chronic chest or heart diseases or cardiac, hepatic or renal failure)
- Pneumococcal vaccination for those aged over 65 years and those who would benefit from it because of underlying medical conditions
- Hepatitis A vaccination is recommended for non-immune pilgrims
- WHO update. Hajj 2010 available at http://www.who.int/ith/updates/20100930/en/
- Memish ZA. Health conditions for travelers to Saudi Arabia for (Hajj) for the year 1431H/2010. JIPH (2010) 3, 92—94, available at http://download.journals.elsevierhealth.com/pdfs/journals/1876-0341/PIIS1876034110000717.pdf
- WHO's International Travel and Health book, Chapter 9. Special groups of travelers available at http://www.who.int/ith/ITH2010chapter9.pdf
Measles outbreaks in Ireland, Europe, Africa - Measles vaccination recommended in addition to other travel vaccines
The large measles outbreak reported in Ireland earlier this year is decreasing but is not gone.
Since the beginning of 2010, 389 measles cases have been reported to the HPSC; most (52%) cases are less than 5 years of age and from the Dublin area (30%); with 22% less than 1 year of age, too young to have the vaccine usually. Most cases were preventable; of the 230 cases 12 months of age or older, for whom information on vaccination was known, 97% were either unvaccinated or had only one dose of MMR (73% unvaccinated, 24% one dose).
Measles can only be prevented with the MMR vaccine. It is very infectious, and is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. Symptoms usually appear 8–12 days after infection and include high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards.
Complications are more common in children under the age of five, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia.
Other countries are also reporting an upsurge in measles cases, and as in Ireland, this is occurring among unvaccinated.
• France has reported 2,000 cases since the beginning of the year
• Germany has reported a measles outbreak in the Essen area
• WHO has reported large measles outbreaks in Eastern and Southern Africa
Reminder about need for MMR vaccination for those travelling and resident in Ireland
• Measles outbreaks whether in Ireland or overseas pose a risk to non-vaccinated Irish children and adults
• All children need two doses of MMR vaccine; at 12-15 months and at age 4-5 years
• Older children and young adults who have not received at least two doses of MMR should contact their GP for this vaccine.
• Further details on measles can be found on the HPSC website at http://www.hpsc.ie/hpsc/A-Z/VaccinePreventable/Measles/
HPSC publishes HIV and AIDS figures for 2009
New figures released by the HSE’s Health Protection Surveillance Centre show 395 newly diagnosed case of HIV in Ireland during 2009 – a 2.2% decrease compared with 2008 – and 33 new cases of AIDS.
The cumulative number of AIDS cases reported up the end of 2009 is 1038, with 414 deaths reported among AIDS cases. There were two deaths among AIDS cases reported in 2009. The total number of HIV infections reported up to the end of 2009 is 5,637.
156 of the newly diagnosed HIV cases were heterosexually acquired, 138 new infections were among men who have sex with men (MSM) and 30 were among injecting drug users (IDUs). However, this data must be interpreted with caution as information on risk group is not available for 65 cases, making analysis of trends difficult.
258 of those diagnosed with HIV in 2009 were male, and 137 were female.
There were five new diagnoses of HIV infection in children during 2009. All are likely to have been infected through mother to child transmission (MCT). Of these, one was born in Ireland and the remaining four were older children who were born in Sub-Saharan Africa.
Of the 307 HIV cases where geographic origin is known, 141 were born in Ireland, 96 were born in sub-Saharan Africa, 21 were born in Western Europe, 13 were born in Central Europe, 15 were born in Eastern Europe and 14 were born in South America.
HPSC specialist in public health medicine, Dr Aidan O’Hora, said that the one of the key findings of this year’s report was the number of MSM who have been newly diagnosed with HIV.
“The number rose from 97 in 2008 to 138 in 2009 – a 42.3% increase in twelve months. The majority of these men – 63% - were born in Ireland and most likely acquired their infection here. Young men under 30 years of age accounted for 35% of new diagnoses. This trend is consistent with what is being seen in many other western industrialized countries.
“The overall drop in HIV cases is welcome. The number of people living with HIV is growing and given the increases in sexually transmitted diseases which facilitate the transmission of HIV infection, people should heed the safe sex message. Anyone engaging in sexual activity should practice safe sex. A properly used condom provides effective protection from HIV.
“The epidemiology of HIV in Ireland is complex and due to the voluntary nature of the reporting system, it is likely that the number of case reports is an underestimate,” added Dr O’Hora.
The full report is available here.
'Don't lick spoon' when cooking or baking with duck eggs warns HPSC as children fall ill with salmonella
The HSE Health Protection Surveillance Centre today (Tuesday) warned parents not to let children lick the spoon used in baking or cooking with duck eggs as an investigation continues into a salmonella outbreak.
So far in 2010, seven cases of Salmonella Typhimurium DT8 have been identified by HPSC and the National Salmonella Reference Laboratory, and have been linked to duck eggs by a public health investigation. At least three have occurred in children who licked the spoon used by their parents in food preparation, says HPSC specialist in public health medicine, Dr Paul McKeown.
"Many children love to lick the cake or food mixture from the spoon during baking and unfortunately in this outbreak it has probably resulted in some falling ill. As yet, the precise location and extent of the problem is not sufficiently clear for us to offer guidance on food distribution or recall so the only way to stay safe is by thoroughly cooking all duck eggs and by preventing cross-contamination between any raw egg and ready-to-eat foods. People should also wash their hands, any preparation surfaces and cooking utensils after handling or using duck eggs.
"The symptoms of Salmonella Typhimurium DT8 infection can include diarrhoea, stomach cramps, vomiting and fever. Occasionally, the illness can be severe, especially in children and the elderly. Anyone who may have these symptoms after recently eating duck eggs or products made with duck eggs, should contact their doctor for advice.
"The investigation into the outbreak is ongoing. HPSC is continuing to work closely with the Food Safety Authority of Ireland, the Department of Agriculture, Fisheries and Food and public health colleagues to control this outbreak and to prevent further cases," said Dr McKeown.
Polio outbreak in the south-west of Tajikistan
A polio outbreak in the south-west of Tajikistan, in the area bordering Afghanistan and Uzbekistan.
As of 22 April, 128 AFP cases have been reported and 10 children have died. All cases are in the south-west of the country, in an area bordering Afghanistan and Uzbekistan. Poliovirus has been isolated in diagnostic specimens from seven of these cases. Genetic sequencing of the virus is being done to further characterize the virus. Uzbekistan has also reported three AFP cases, which are under investigation.
Poliovirus travels long distances easily and polio-free regions will continue to be at risk until poliovirus transmission is stopped in the remaining endemic countries. The WHO European Region was certified polio-free in 2002, following over three years without transmission of indigenous wild poliovirus in the presence of certification-standard surveillance. The outbreak in Tajikistan has no immediate implications for the European Region’s certification.
This outbreak, however, demonstrates the need to maintain high population immunity until transmission of polio has been interrupted worldwide. The outbreak coincides with the annual European Immunization Week campaign which begins on 24 April 2010 to raise awareness of vaccine-preventable diseases and the importance of immunization.
Please click here to access the WHO press release http://www.euro.who.int/communicablediseases/outbreaks/20100423_1
World TB Day 2010
World Tuberculosis (TB) Day is held on March 24th each year and provides an opportunity to raise awareness about the international health threat presented by TB. It is a day to recognise the collaborative efforts of all countries involved in fighting TB.
March 24th commemorates the day in 1882 when Dr Robert Koch announced that he had discovered the cause of tuberculosis, the TB bacillus. Koch's discovery opened the way toward diagnosing and curing TB. TB can be cured, controlled, and with diligent efforts and sufficient resources, eventually eliminated.
“On the Move against Tuberculosis, Innovate to Accelerate Action” is the theme for World TB Day 2010. This theme underlines the worldwide plan to Stop TB (Global Plan to Stop TB-2006-2015 at http://www.stoptb.org/global/plan/) by promoting better efforts and innovative ways in order to achieve the 2006-2015 targets. The year 2010 marks the halfway point for the Global Plan. It is clearer than ever that all countries must scale up efforts and continue to seek new and innovative ways to stop TB if we are to achieve the targets outlined in the plan as follows:
1. By 2015: To reduce the prevalence of and death due to TB by 50% relative to 1990
2. By 2050: The global incidence of active TB will be less than 1 case per million
population (i.e. elimination of TB as a global public health problem)
Such innovations include finding new and better tools to fight tuberculosis e.g. drugs for treatment, vaccines and diagnostics and new innovative approaches for reaching people with TB care.
Though considerable achievements have been made, evidence shows that we need to speed up our efforts to achieve better results. The theme of innovation calls for a different way of thinking, as well as learning from the experiences of successful TB campaigns around the world.
TB –The Facts
TB remains a leading cause of death worldwide. In 2008, 1.8 million people died from TB including 500,000 people who were also co-infected with HIV. There were 9.4 million new cases of TB globally in 2008 including 1.4 million cases among people living with HIV. It is a disease closely related to poverty and more than 80% of the infected cases live in developing countries. The vast majority of TB deaths are in developing countries and more than half of all deaths occur in Asia. Multidrug-resistant TB remains a threat and extensively drug-resistant TB has become an emerging threat.
Across the WHO European Region, over 450,000 TB cases were reported in 2008, representing approximately 6% of TB cases reported to WHO worldwide. After an increase in overall TB notification rates between 2004 and 2007, the WHO European Region has reported a decrease of 2.6% since 2007. The age group with the highest number (42.0%) of newly detected TB cases in the Region is the 25–44 year olds.
In 2007, (the latest validated figures) there were 480 cases of TB reported in Ireland, a notification rate of 11.3 cases per 100,000 population. This is a slight increase in TB cases notified compared to 2006 when 465 cases were notified and the notification rate was 11.0 per 100,000. In 2008, 470 cases of TB have been provisionally reported giving a notification rate of 11.1 per 100,000. Full details are available here in the Annual TB Report 2007 (including provisional 2008 TB data).
In 2007, the notification rate for TB in the indigenous population was 8.0 per 100,000 while the rate in foreign-born persons was 31.3 per 100,000. The number of TB cases reported in Ireland has declined since the 1990s with 612 cases reported in 1991, a rate of 18.2 per 100,000. The decline has been even more considerable since the early 1950s when 7,000 cases of TB were notified annually.
More information on TB is available at:
Joint ECDC/WHO report on tuberculosis surveillance in Europe in 2008
WHO Euro website
Stop TB Partnership World TB Day 2010
WHO Global TB Report 2009
WHO TB website
The Global Plan to Stop TB 2006-2015
CDC website for World TB Day, 2010
Health Protection Agency UK
Epidemiology of Clostridium difficile in Ireland: May 2008 - Dec 2009
There were 3538 notifications of C. difficile associated disease (CDAD) from May 2008, when it first became notifiable, and December 2009 giving a national crude incidence rate (CIR) of 56.9 cases per 100,000 population in 2008 and 45.1 cases per 100,000 population in 2009. For further information view the March edition of Epi-Insight.
Indigenous salmonellosis low in Ireland
In 2008, there were 449 cases of salmonellosis notified, equating to a national crude incidence rate (CIR) of 10.6/100,000.
For the last eight years, the incidence of salmonellosis in Ireland has remained reasonably steady with around 350-450 cases reported per annum. This is a decrease from the number of cases that were reported in the late 1990s, when the number of cases peaked at 1257 cases in 1998. For further information view the March edition of Epi-Insight.
Applicants sought for ECDC training programme
The European Centre for Disease Prevention and Control (ECDC) is seeking applicants for its European Programme for Intervention Epidemiology Training (EPIET) programme, which starts on 16th September 2010.
This two year fellowship training programme provides training and practical experience in intervention epidemiology. The programme is aimed at EU and EEA/EFTA medical practitioners, public health nurses, microbiologists, veterinarians and other health professionals with previous experience in public health and a keen interest in epidemiology. Fellows are recruited for a two year period.
Full details are available here.
BonSoy Soy milk recall
BonSoy Soy milk recall: Information for medical Practitioners and Information for the Public may be found here
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