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Disease Outbreaks - Top 30 Publications

Disease surveillance in England and Wales, May 2017.

 Current and emerging issues: potentially toxic blue-green algal blooms Highlights from the scanning surveillance network Update on international disease threats Focus on topical issues and recent cases relating to wildlifeThese are among matters discussed in the Animal and Plant Health Agency's (APHA's) disease surveillance report for May 2017.

The Other Victims of the Opioid Epidemic.

Fact sheet on Ebola virus disease (updated May 2017).

Toxic Anterior Segment Syndrome Outbreak after Cataract Surgery Triggered by Viscoelastic Substance.

The purpose of this study is to present toxic anterior segment syndrome (TASS) outbreak at our clinic and discuss possible causes of TASS.

Notes from the Field: Measles Outbreak at a United States Immigration and Customs Enforcement Facility - Arizona, May-June 2016.

Changes of Global Infectious Disease Governance in 2000s: Rise of Global Health Security and Transformation of Infectious Disease Control System in South Korea.

This paper focus upon the changes of global infectious disease governance in 2000s and the transformation of infectious disease control system in South Korea. Traditionally, infectious disease was globally governed by the quarantine regulated by the international conventions. When an infectious disease outbreak occurred in one country, each country prevented transmission of the disease through the standardized quarantine since the installation of international sanitary convention in 1892. Republic of Korea also organized the infectious disease control system with quarantine and disease report procedure after the establishment of government. Additionally, Korea National Health Institute(KNIH) was founded as research and training institute for infectious disease. However, traditional international health regulation system faced a serious challenge by the appearance of emerging and re-emerging infectious disease in 1990s. As a result, global infectious disease governance was rapidly changed under the demand to global disease surveillance and response. Moreover, global health security frame became important after 2001 bioterror and 2003 SARS outbreak. Consequently, international health regulation was fully revised in 2005, which included not only infectious disease but also public health emergency. The new international health regime was differently characterized in several aspects; reinforcement of global cooperation and surveillance, enlargement of the role of supranational and international agencies, and reorganization of national capacity. KNIH was reorganized with epidemic control and research since late 1990s. However, in 2004 Korea Center for Disease Control and Prevention(KCDC) was established as a disease control institution with combining quarantine and other functions after 2003 SARS outbreak. KCDC unified national function against infectious disease including prevention, protection, response and research, as a national representative in disease control. The establishment of KCDC can be understood as the adoption of new international health regulation system based upon SARS experience.

Northern Ireland disease surveillance report, January to March 2017.

 Pneumonia in cattle Malignant catarrhal fever in cattle Tumours in sheep Pneumonia in pigs Histomonosis in chickensThese are among matters discussed in the Northern Ireland animal disease surveillance quarterly report for January to March 2017.

Using Molecular Characterization to Support Investigations of Aquatic Facility-Associated Outbreaks of Cryptosporidiosis - Alabama, Arizona, and Ohio, 2016.

Cryptosporidiosis is a nationally notifiable gastrointestinal illness caused by parasitic protozoa of the genus Cryptosporidium, which can cause profuse, watery diarrhea that can last up to 2-3 weeks in immunocompetent patients and can lead to life-threatening wasting and malabsorption in immunocompromised patients. Fecal-oral transmission of Cryptosporidium oocysts, the parasite's infectious life stage, occurs via ingestion of contaminated recreational water, drinking water, or food, or following contact with infected persons or animals, particularly preweaned bovine calves (1). The typical incubation period is 2-10 days. Since 2004, the annual incidence of nationally notified cryptosporidiosis has risen approximately threefold in the United States (1). Cryptosporidium also has emerged as the leading etiology of nationally notified recreational water-associated outbreaks, particularly those associated with aquatic facilities (i.e., physical places that contain one or more aquatic venues [e.g., pools] and support infrastructure) (2). As of February 24, 2017, a total of 13 (54%) of 24 states reporting provisional data detected at least 32 aquatic facility-associated cryptosporidiosis outbreaks in 2016. In comparison, 20 such outbreaks were voluntarily reported to CDC via the National Outbreak Reporting System for 2011, 16 for 2012, 13 for 2013, and 16 for 2014. This report highlights cryptosporidiosis outbreaks associated with aquatic facilities in three states (Alabama, Arizona, and Ohio) in 2016. This report also illustrates the use of CryptoNet, the first U.S. molecularly based surveillance system for a parasitic disease, to further elucidate Cryptosporidium chains of transmission and cryptosporidiosis epidemiology. CryptoNet data can be used to optimize evidence-based prevention strategies. Not swimming when ill with diarrhea is key to preventing and controlling aquatic facility-associated cryptosporidiosis outbreaks (

Bordetella parapertussis outbreak in Southeastern Minnesota and the United States, 2014.

Whooping cough is traditionally ascribed to Bordetella pertussis; however, Bordetella parapertussis can cause a similar clinical syndrome. This study describes an outbreak of B. parapertussis in Southeastern Minnesota and the United States (US) in 2014. This was a retrospective analysis of Mayo Clinic and Mayo Medical Laboratories patients who tested positive for B. parapertussis from 2012 to 2014. The medical records of Mayo Clinic patients who tested positive in 2014 were reviewed for demographic information, presenting symptoms, disease course, and vaccination history. In Southeast Minnesota, 81% of the 31 patients who tested positive for B. parapertussis in 2014 were found to be positive from October through December. Their mean age was 5.9 years. Five reported "exposure to pertussis." Two pairs of siblings were affected. Patients reported having had symptoms for an average of 2.6 weeks before nasopharyngeal specimen collection for B. parapertussis testing. Cough was the primary symptom reported. Forty percent reported posttussive vomiting, 40% coryza, 32% apnea/sleep disturbance, and 12% sore throat. All were current with pertussis vaccination. Based on the review of national data, an outbreak occurred nationally in the Northeast and Midwest US over the same time period. In 2014, there was an outbreak of B. parapertussis in Southeastern Minnesota and likely other parts of the US. The presenting illness was similar to that of B. pertussis. All patients were vaccinated against pertussis, suggesting that pertussis vaccination is ineffective against B. parapertussis.

Ebola exposure, illness experience, and Ebola antibody prevalence in international responders to the West African Ebola epidemic 2014-2016: A cross-sectional study.

Healthcare and other front-line workers are at particular risk of infection with Ebola virus (EBOV). Despite the large-scale deployment of international responders, few cases of Ebola virus disease have been diagnosed in this group. Since asymptomatic or pauci-symptomatic infection has been described, it is plausible that infections have occurred in healthcare workers but have escaped being diagnosed. We aimed to assess the prevalence of asymptomatic or pauci-symptomatic infection, and of exposure events, among returned responders to the West African Ebola epidemic 2014-2016.

MSMA PRESIDENT'S PAGE. The Fight Continues.

Klebsiella pneumoniae septicaemia in preweaned pigs.

This article has been prepared by Susanna Williamson and colleagues of the APHA Pig Expert Group.

Disease surveillance in England and Wales, April 2017.

▪ Current and emerging issues: update on Schmallenberg virus▪ Highlights from the scanning surveillance network▪ Update on international disease threats▪ Focus on Klebsiella pneumoniae septicaemia in preweaned pigsThese are among matters discussed in the Animal and Plant Health Agency's (APHA's) disease surveillance report for April 2017.

Infectious diarrheal disease caused by contaminated well water in Chinese schools: A systematic review and meta-analysis.

In China, waterborne outbreaks of infectious diarrheal disease mainly occur in schools, and contaminated well water is a common source of pathogens. The objective of this review was to present the attack rates, durations of outbreak, pathogens of infectious diarrheal disease, and sanitary conditions of wells in primary and secondary schools in China, and to analyze risk factors and susceptibility of school children.

Outbreak of toe tip necrosis syndrome in calves.

Toe tip necrosis syndrome in calvesAbortions in embryo recipient gimmers associated with Paecilomyces variotiiAmyloidosis secondary to dosing gun injury in a eweRhinitis and middle ear infection in pigsFungal pneumonia in a duckThese are among matters discussed in the disease surveillance report for January 2017 from SAC Consulting: Veterinary Services (SAC C VS).

Environmental sampling coupled with real-time PCR and genotyping to investigate the source of a Q fever outbreak in a work setting.

A Q fever outbreak was declared in February 2016 in a company that manufactures hoists and chains and therefore with no apparent occupational-associated risk. Coxiella burnetii infection was diagnosed by serology in eight of the 29 workers of the company; seven of them had fever or flu-like signs and five had pneumonia, one requiring hospitalisation. A further case of C. burnetii pneumonia was diagnosed in a local resident. Real-time PCR (RTi-PCR) showed a widespread distribution of C. burnetii DNA in dust samples collected from the plant facilities, thus confirming the exposure of workers to the infection inside the factory. Epidemiological investigations identified a goat flock with high C. burnetii seroprevalence and active shedding which was owned and managed by one of the workers of the company as possible source of infection. Genotyping by multispacer sequence typing (MST) and a 10-loci single-nucleotide polymorphism (SNP) discrimination using RTi-PCR identified the same genotype (MST18 and SNP type 8, respectively) in the farm and the factory. These results confirmed the link between the goat farm and the outbreak and allowed the identification of the source of infection. The circumstances and possible vehicles for the bacteria entering the factory are discussed.

Eliminate Yellow fever Epidemics (EYE): a global strategy, 2017–2026.

Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017.

When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions ( Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (

The Zika Virus Outbreak in Brazil: Knowledge Gaps and Challenges for Risk Reduction.

We analyzed uncertainties and complexities of the Zika virus outbreak in Brazil, and we discuss risk reduction for future emergencies. We present the public health situation in Brazil and concurrent determinants of the epidemic and the knowledge gaps that persist despite building evidence from research, making public health decisions difficult. Brazil has adopted active measures, but producing desired outcomes may be uncertain because of partial or unavailable information. Reducing population group vulnerabilities and acting on environmental issues are medium- to long-term measures. Simultaneously dealing with information gaps, uncontrolled disease spread, and vulnerabilities is a new risk scenario and must be approached decisively to face emerging biothreats.

A Public Health Approach to Hepatitis C in an Urban Setting.

The clinical consequences of HCV infection are increasing because the population with the highest prevalence of the infection, persons born between 1945 and 1965, is aging. As a result, health care expenditures are expected to increase. Now that a cure for HCV infection is the norm, a public health approach is necessary to identify, link to care, and treat infected persons and prevent new infections. We believe that the success of public health interventions, such as those for tuberculosis, can be translated to HCV infection. New York City has many HCV-infected residents and has developed a public health approach to controlling the HCV epidemic. It encompasses surveillance and monitoring, case finding, linkage to care, care coordination, increasing clinical provider capacity for screening and treatment, increasing public awareness, and primary prevention.

"Zombie" Outbreak Caused by Synthetic Cannabinoid.

Yellow fever from Angola and Congo: a storm gathers.

In common with Zika, Chikungunya and Dengue, Yellow Fever (YF) is an arthropod-borne flavivirus. It is transmitted between humans and from monkeys by mosquitoes of the Aedes aegypti (its principal vector), haemogogus and albopictus varieties. Three cycles of transmission may occur: urban; sylvatic; and intermediate. Recently, sub-Saharan Africa has seen the resurgence of this neglected disease. The current YF outbreak in Angola began in December 2015 in the capital Luanda and by October 2016 there had been > 4300 suspected cases, with 376 deaths (case fatality rate = 8.8%). A total of 884 were laboratory confirmed but it is likely that case numbers may be seriously underestimated. YF has subsequently quickly spread to neighbouring Congo and further afield to Kenya and also China, this being of grave concern as this was a first introduction of YF to Asia. YF has recently hit Brazil, with 555 suspected cases and 107 deaths reported by the end of January 2017. Extremely rapid unplanned urban migration in Africa by non-immune rural populations to already densely populated cities, where high densities of mosquitoes co-exist with city dwellers in makeshift flimsy accommodation, poses a ready recipe for an epidemic of massive proportion. In such conditions, with enormously strained public services existing among the most needy and vulnerable populations, mosquito control programmes are nearly impossible. YF in Congo is a tempest barely restrained. However, it is one that can be controlled by focused and committed international collaboration, by intense and united political will and by the marriage of old and trusted techniques: a vaccine almost a century old and some of the most modern technologies available to man.

"Zombie" Outbreak Caused by Synthetic Cannabinoid.

"Zombie" Outbreak Caused by Synthetic Cannabinoid.

Addressing the Opioid Epidemic - Opportunities in the Postmarketing Setting.

Early outbreak detection by linking health advice line calls to water distribution areas retrospectively demonstrated in a large waterborne outbreak of cryptosporidiosis in Sweden.

In the winter and spring of 2011 a large outbreak of cryptosporidiosis occurred in Skellefteå municipality, Sweden. This study summarizes the outbreak investigation in terms of outbreak size, duration, clinical characteristics, possible source(s) and the potential for earlier detection using calls to a health advice line.

Meningococci of Serogroup X Clonal Complex 181 in Refugee Camps, Italy.

Four cases of infection with serogroup X meningococci (MenX) (1 in 2015 and 3 in 2016) occurred in migrants living in refugee camps or reception centers in Italy. All MenX isolates were identified as clonal complex 181. Our report suggests that serogroup X represents an emerging health threat for persons arriving from African countries.

Community-based survey during rabies outbreaks in Rangjung town, Trashigang, eastern Bhutan, 2016.

Rabies is a highly fatal disease transmitted through the bite of a rabid animal. Human deaths can be prevented by prompt administering of rabies vaccine and rabies immunoglobulin following the exposure. An assessment of community knowledge, awareness and practices on rabies is important during outbreak to understand their preparedness and target educational messages and response activities by the rapid response team.

Land altitude, slope, and coverage as risk factors for Porcine Reproductive and Respiratory Syndrome (PRRS) outbreaks in the United States.

Porcine reproductive and respiratory syndrome (PRRS) is, arguably, the most impactful disease on the North American swine industry. The Swine Health Monitoring Project (SHMP) is a national volunteer initiative aimed at monitoring incidence and, ultimately, supporting swine disease control, including PRRS. Data collected through the SHMP currently represents approximately 42% of the sow population of the United States. The objective of the study here was to investigate the association between geographical factors (including land elevation, and land coverage) and PRRS incidence as recorded in the SHMP. Weekly PRRS status data from sites participating in the SHMP from 2009 to 2016 (n = 706) was assessed. Number of PRRS outbreaks, years of participation in the SHMP, and site location were collected from the SHMP database. Environmental features hypothesized to influence PRRS risk included land coverage (cultivated areas, shrubs and trees), land altitude (in meters above sea level) and land slope (in degrees compared to surrounding areas). Other risk factors considered included region, production system to which the site belonged, herd size, and swine density in the area in which the site was located. Land-related variables and pig density were captured in raster format from a number of sources and extracted to points (farm locations). A mixed-effects Poisson regression model was built; and dependence among sites that belonged to a given production system was accounted for using a random effect at the system level. The annual mean and median number of outbreaks per farm was 1.38 (SD: 1.6), and 1 (IQR: 2.0), respectively. The maximum annual number of outbreaks per farm was 9, and approximately 40% of the farms did not report any outbreak. Results from the final multivariable model suggested that increments of swine density and herd size increased the risk for PRRS outbreaks (P < 0.01). Even though altitude (meters above sea level) was not significant in the final model, farms located in terrains with a slope of 9% or higher had lower rates of PRRS outbreaks compared to farms located in terrains with slopes lower than 2% (P < 0.01). Finally, being located in an area of shrubs/ herbaceous cover and trees lowered the incidence rate of PRRS outbreaks compared to being located in cultivated/ managed areas (P < 0.05). In conclusion, highly inclined terrains were associated with fewer PRRS outbreaks in US sow farms, as was the presence of shrubs and trees when compared to cultivated/ managed areas. Influence of terrain characteristics on spread of airborne diseases, such as PRRS, may help to predicting disease risk, and effective planning of measures intended to mitigate and prevent risk of infection.

Zika virus: an epidemiological update.