Wüstenschiff

Israel - Mumps
16.08.2010

Seit Januar ist es in Israel zu einem Mumps-Ausbruch mit bisher offiziell 4.190 Fällen gekommen. Die meisten Erkrankungen werden aus ultraorthodoxen Gemeinschaften gemeldet, in denen Kinder nur sehr unvollständig geimpft werden. Laut dem Gesundheitsministerium nehmen die Fälle seit April ab, dies wird jedoch von inoffizieller Seite angezweifelt. Impfschutz beachten. / Quelle: crm

DENGUE/DHF UPDATE 2010 (44)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>



******
Middle East
Yemen
Date: Thu 19 Aug 2010
Source: Yemen Times [edited]
<http://www.yementimes.com/defaultdet.aspx?SUB_ID=34617>


Over 2000 suspected cases of dengue fever have been reported in
Shabwa governorate, 474 km [295 mi] east of the capital Sana'a, a
source from the health office in the governorate told local press on
Sunday [15 Aug 2010]. The source said that one of the cases had
passed away, while 309 out of 2200 suspected cases were confirmed
positive. Many Yemeni governorates are witnessing the spread of this
epidemic including Taiz, Aden, Abyan, Lahj, and Shabwa, according to
a June 2010 report issued by the ministry.

Marshes resulting from rain and the leakage of sewage are the main
causes for the spread of mosquitoes that are transmitting the
epidemic, according to the heath official. [_Aedes aegypti_
mosquitoes, the dengue virus vectors, do not breed in marshes or in
sewage The rains likely produced clean water catchments in which the
dengue virus vector mosquitoes were reproducing, as mentioned below
in this report. - Mod.TY]

In July [2010], the government reported that dengue fever had claimed
the lives of 12 people in Hadramout and 1142 were infected with the
disease [virus]. A Saudi medical team visited Hadramout in June
[2010] and said the lack of modern testing equipment complicated
diagnostic efforts.

Dengue fever is transmitted by mosquitoes and education campaigns
should highlight the danger of stagnant water, open containers of
liquid, and standing rainfall in areas where mosquitoes breed.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[A map showing the administrative divisions of Yemen can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... n_2002.jpg>.
A HealthMap/ProMED-mail interactive map of Yemen can be accessed at
<http://healthmap.org/r/01fw>. - Mod.TY]

WEST NILE VIRUS - NETHERLANDS EX ISRAEL
***********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 26 Aug 2010
Source: Eurosurveillance, Volume 15, Issue 34 [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19649>


We report about West Nile virus (WNV) infections
in a symptomatic traveller returning from Israel
and in her asymptomatic travel companion.
Knowledge of the current epidemiological
situation in Israel from where WNV cases were
reported recently enabled a rapid diagnosis. The
described cases serve as a reminder for
physicians to consider WNV in the diagnosis of
patients returning from areas with potential circulation of the virus.

At the end of July 2010, a Dutch woman in her
early 30s presented to our 1st aid department
with fever, retro-orbital headache and a macular
rash. The day before she had returned from a
10-day holiday to Israel where she noticed
several mosquito bites during a camping trip at
the Sea of Galilee. There was no history of tick
bites. 5 days before presentation, she had
suddenly fallen ill with extreme fatigue,
myalgia, fever and an increasingly severe
headache. Movement of the eyes had been painful.
The next day she had developed a burning
sensation of the skin that was followed by a skin
eruption. The rash started on the trunk and spread to arms and legs.

Upon presentation in the 1st aid department she
did not appear ill. Body temperature was 36.4°C
[97.5 F]. There was a generalised macular rash,
sparing hands and feet, and no petechiae or
eschars were present. Neurological examination
revealed no abnormalities. Potential infection
with West-Nile virus was suspected because of the
clinical picture and recent reports of West Nile virus cases in Israel.

Laboratory examination showed a leukopenia of
1.8x109/L with a predominance of large granular
lymphocytes; thrombocyte count was 92x109/L.
Infection with Epstein Barr virus,
cytomegalovirus, dengue virus, enterovirus and
parechovirus was excluded by serology and antigen
test or PCR. A lumbar punction was not performed
due to missing neurological symptoms. West Nile
virus RNA could not be detected in the EDTA
plasma sample taken on day 5 after onset of
disease by a TaqMan reverse transcriptase-PCR
assay, using a probe for the WN3&#146;NC. However, in
a 2nd blood sample obtained 15 days later,
seroconversion for both serum IgG and IgM
antibodies against West Nile virus was detected
with an indirect qualitative enzyme-linked
immunosorbent assay (ELISA) (Focus Diagnostics,
Cypress, California). This assay uses antibody
capture technique for the detection of IgM antibodies.

Once the diagnosis was confirmed, serology was
performed in the patient&#146;s travel companion who
reported having had similar complaints, but who
had already recovered by the time he returned to
the Netherlands. The laboratory results showed
that he was seropositive for WNV IgG and IgM.
Recovery was uneventful in both patients.

West-Nile virus is endemic in Israel. The largest
recent outbreak in humans in Israel occurred in
the year 2000 with more than 400 reported cases.
Recently, 12 cases of West Nile fever have been
reported, centered around the Tel Aviv area.
_Culex perexiguus_, _Cx. pipiens_, and _Aedes
caspius_ are the vectors of West Nile virus in
Israel where most cases of West Nile fever occur
between August and October. The seasonal
occurrence of human cases reaches a peak one month after the mosquito peak.

Reference:

Aboutaleb N, Beersma MF, Wunderink HF, Vossen AC,
Visser LG. Case report: West-Nile virus infection
in two Dutch travellers returning from Israel.
Euro Surveill. 2010;15(34):pii=19649. Available
online: <http://www.eurosurveillance.org/ViewArt ... leId=19649>

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[West Nile virus has been identified previously
in clinical human and equine cases and in mosquitoes and birds in Israel.

A HealthMap/ProMED-mail interactive map of Israel
can be accessed at <http://healthmap.org/r/00JC>. - Mod.TY]

Israel - West Nile-Fieber
31.08.2010

Vor Kurzem wurden 12 Erkrankungen aus der Gegend um Tel Aviv gemeldet. Die meisten Fälle treten zwischen August und Oktober auf. Ende August erkrankte eine holländische Reiserückkehrerin. Sie hatte während eines 10-tägigen Campingtrips am See Genezareth Ende Juli mehrere Mückenstiche erlitten. Der letzte große Ausbruch mit mehr als 400 Fällen wurde im Jahr 2000 registriert. Mückenschutz beachten. / Quelle: crm
___________________________

Griechenland - West Nile-Fieber
07.09.2010

Seit Anfang August sind im Norden Griechenlands (Zentralmakedonien) 150 Patienten mit Zeichen einer Enzephalitis stationär aufgenommen worden. Elf Patienten sind verstorben, zehn weitere befinden sich auf Intensivstationen. Seitens der Behörden bestand früh der „starke Verdacht“ auf einen Ausbruch von West Nile-Fieber, dies ist nun im Labor bestätigt. In der betroffenen Region sind Blutspenden eingestellt worden, Transfusionen werden auf ein Minimum beschränkt. West Nile-Virus verursacht eine Enzephalitis bei Pferden und Menschen. Eine Impfung existiert nicht. Mückenschutz beachten, insbesondere nachts. / Quelle: crm

UNDIAGNOSED DISEASE - YEMEN: (AL HUDAYDAH), REQUEST FOR INFORMATION
*******************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Mon 22 Nov 2010
Source: Yemeni Times [edited]
<http://www.yementimes.com/defaultdet.aspx?SUB_ID=35093>


An unknown disease causing bouts of severe fever has spread across several
districts of Hodeida [Al Hudaydah], 200 km west of the capital Sana'a, a
local doctor told the Yemen Times. "It's an epidemic which is now rampant,
especially in the rural areas of Hodeida," Dr Mohamed Abdul Rahman Al-Qadi,
a doctor in Al-Marawa' district of Hodeida told the Yemen Times.

He explained that the disease, aided by falling temperatures at night, is
seriously affecting Hodeida's rural areas, which are more exposed and
vulnerable to the cold. Adults, especially those over 30, are more
susceptible to contracting the disease.

A similar disease hit the same area last year [2009], but this year, its
prevalence has been much higher, hitting around 40 per cent of Hodeida's
population compared to the one per cent of those infected in 2009,
according to Al-Qadi.

No deaths have yet been reported, but the disease can cause paralysis. The
fever causes an acute inflammation of the joints as well as severe
headaches, the doctor told the Yemen Times. He added that those with
already weak immune systems are particularly vulnerable.

Locals from Hodeida are reportedly alarmed by the disease, which has yet to
be officially classified by doctors. However, officials from the Ministry
of Health in Hodeida have told the Yemen Times that it is only a normal
fever and that there is no need to panic.

"It is only a normal fever caused by the cold," said Dr Othman Al-Baidani,
director of the Ministry of Health Office in the governorate. "Not a single
death has been recorded yet." The director said that the Ministry of Health
has recently formed a medical team and sent them to some of the affected areas.

In addition, the Health Office in the governorate has formed an operation
team in all of Hodeida's districts to follow up on the strange epidemic,
according to Al-Baidani. Those suffering from the disease, which is known
amongst locals as Al-Kritis fever, do not recover until given a strong dose
of antibiotics and vitamin injections, Dr. Al-Qadi said.

But many of those living in the infected areas of Al-Marawa', Al-Jarahi,
Zabeed, Bait Al-Faqih, Al-Mansoorya and Hais are unable to afford the
medication which costs more than YR 2000 (USD 10). In addition to disease,
Hodeida, Yemen's poorest governorate, suffers from rampant levels of poverty.

More than half of Hodeida's 2.5 million people live in traditional houses
built from wood, mud bricks, and straw. Their main source of income is
derived from agriculture and livestock.

The director of the Health Office in Hodeida advised families to take care
of hygiene in their houses and to cover water pools and swamps.

--
communicated by:
ProMED-mail <promed@promedmail.org>

******
[2]
Date: Sun, 21 Nov 2010
Source: <http://bit.ly/eGzAOv> (translated from Arabic by SB)


Strange epidemic ravaging western Yemen
---------------------------------------
A number of cities villages and districts of the province of Hodeidah,
western Yemen have been hit by strange outbreaks, the causes and sources of
which are unknown.

The outbreaks have so far resulted in the deaths of 5 people and infected
thousands of others from different age groups. Local sources say that the
epidemic started about a month ago and has now spread to the "Zabid -- Beit
al-Faqih --Nectarine".

The outbreak has so far killed 5 people in the Nectarine city and infected
thousands of others, many of whom are in a coma. There is a state of panic
and terror among the citizens because of the rapid spread of infection,
which has prompted a large numbers of students to leave school, especially
after the discovery of infections among students and teachers.

It is believed that there are deaths and infected people in many other
villages in remote and distant districts, where the inhabitants lack most
of the basic services and health infrastructure.

The sources confirmed that the epidemic, which is known to the inhabitants
of those areas as "Almkrvs". The disease begins with a very high
temperature, without without treatments leading to a sustained coma. In
addition to flulike symptoms [cough, fever, and muscle and joint pains],
headache, swelling of the face and joints, and trembling of the body have
been reported. Bleeding from the mouth and nose, and skin rash "bleeding
under the skin", diarrhea and vomiting, and inability to stand or walk have
also been described.

The sources said that the results of medical examinations conducted in the
patients affected by the epidemic, were all infections in the blood. The
treatment has been limited to giving the patient a dose of "glucose" with
some vitamins and painkillers.

A large number of the local population are being infected by the epidemic,
which appeared to infect in all the houses of the affected areas where the
number of patients in each family is between 4 and 5 people. It is a
serious threat to all county residents, who numbered over 2.1 million
according to the 2004 Census.

A large proportion of the population are experiencing difficult and
miserarable living conditions making them more susceptible to infection. It
is believed to be caused by bacteria transmitted by the wind resulting from
the bodies of dead animals.

A number of local residents have condemmed and rejected what they called
the "ignorance" shown by the concerned authorities and local councils in
the province. Citizens are demanding that the government, led by the
Ministry of Health and local authorities in the province to assume their
responsibilities and hasten to send medical teams to the areas where the
epidemic has spread and undertake the examination of infected cases to
identify the causes of the disease.

In addition to the transfer of patients from villages and neighborhoods,
isolating them in special places outside the population centers and
providing treatment and other actions that would protect the population
against infection and limit the spread as they consider that the epidemic
is spread by the air and move with the wind.

The need is stressed to provide the necessary treatment for patients free
of charge as some families cannot pay the costs of treatment. Local press
sources confirmed by mid-August that a strange epidemic was killing
children in rural villages directorate "Alemrauap" Hodeidah province, which
has resulted in the deaths of five children and infecting dozens of cases
of diarrhea and vomiting.

The Office of Health, the Government and an anti-epidemiological
surveillance group in addition to a committee from the Ministry of Health
visited the region in an attempt to control the epidemic, but they did not
identify what the disease is. In late October, other press sources said
that the disease had alos been identified in the Directorate of "Beit al-
Faqih -- and the Nectarine.

--
communicated by:
ProMED-mail <promed@promedmail.org>

[The two reports differ in both detail and tone, which makes it hard to
assess what the cause is likely to be. Both agree that many cases of
something have occurred. Deaths appear to have been absent or relatively
rare. The following commentaries are based on the first and second reports,
respectively. Authoritative information from the region would be
appreciated. - Mod.SH

From the limited description of symptoms, it is difficult to make a
precise diagnosis. This seems to be a recurrent non-lethal disease
associated with poverty and lack of basic resources. In recent years, there
have been extensive outbreaks of malaria, dengue haemorrhagic fever, and
influenza in Yemen, any of which might be responsible for the current
outbreak. - Mod.CP

The newspaper message translated above says that thousands have been
infected but only 5 people have died. A picture of a patient published in
the newspaper article showed ecchymosis, a sign of subcutaneous bleeding.

Given that it seems to be large outbreak in a limited geographical area
within a short time span (few months?), vectorborne zoonoses like Crimean
Congo haemorrhagic fever, hantavirus, or Rift Valley fever seem unlikely.
Dengue haemorrhagic fever is another possibility and a large number of less
severe cases in a situation with an introduction of a new serotype could
explain the outbreak. Meningococcal infection would cause a clinical
picture of septicemia, disseminated intravascular coagulation, with
cutaneous bleeding, but a large community wide outbreak would be unusual
outside the meningitis belt in tropical Africa, and a higher case fatality
rate would be expected. Leptospira may cause DIC, but large outbreaks are
usually linked to exposure to surface water and a widespread outbreak like
this would have to be explained by contanmination of drinking water sources
in all of the affected areas.

Anthrax spread by airborne spores would probably more cause sporadic cases
and the zoonotic Alkhurma virus is rare and probably spread by direct
contact with infected animals, which cannot explain the large number of
cases including many children seen here. &#150; Mod.EP

A map of the provinces and cities of Yemen can be accessed at
<http://www.citypopulation.de/Yemen.html#Land>. The HealthMap/ProMED-mail
interactive map of Yemen is available at <http://healthmap.org/r/01fw>. -
Mod.CP]

DENGUE/DHF UPDATE 2010 (63)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


******
Saudi Arabia (Jeddah)
21 Dec 2010

New cases of dengue fever have
been reported at Jeddah's King Abdul Aziz Hospital, with instances
emerging predominantly from the eastern district of Quwaizah, a
medical source has said. While unwilling to disclose the exact number
of cases, the source said that all afflicted persons were in stable
condition and receiving proper medical care
<http://biomedme.com/general/new-cases-o ... 26608.html>.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

RABIES, YEMEN: (DHAMAR), CANINE, HUMAN
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 8 Jan 2011
Source: Yemen Observer [edited]
<http://www.yobserver.com/local-news/10020548.html>


Ten deaths and 1751 rabies cases [see comment below] were caused by
stray dogs that were widespread throughout Dhamar governorate in
2010, said Mohammed Siylan, Rabies Programme Coordinator in Dhamar.
"1273 of those cases are males and 478 females," he added.

Siylan noted that this increasing number of rabies cases is due to an
increased number of stray dogs in the streets. "There is no more
treatment of this serious problem that threatens our families and
children," he said.

Children are the most affected group by these dogs [with] 854 rabies
cases and 4 deaths, according to statistics from the Rabies Program
[of] the Health Ministry. The problem is growing and a cause of
concern. "Many people [have died as a result of bites by
rabies-infected dogs]," he added. People have stopped walking at
night in streets and alleys fearing [attack by] the stray dogs roaming freely.

The programme receives dozens of people every day from outside the
province (such as the cities of Rada'a, Yarim, Al-Naderah, Bani Omar,
Al-Arsh) to receive [post-exposure vaccination and anti-rabies
immunoglobulin treatment].

According to Siylan, animals with rabies may act differently from
healthy animals. "Wild animals may move slowly or may act as if they
are tame. A pet that is usually friendly may snap at a person or try to bite."

Some signs of rabies in animals are: changes in an animal's behavior,
general sickness, problems swallowing, increased drooling, and
aggression. Rabies will kill if it is not treated. Once signs of the
disease appear in an animal or in a human, they usually die within 10
days. It is possible to get anti-rabies shots to fight off the disease.

[Byline: Fares Anam]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[The text does not clearly indicate whether the number of cases
indicates the number of people receiving post-exposure prophylactic
treatment or simply the number of people bitten by stray dogs
presumed to be rabid. Whatever the meaning, the number of fatalities
in Dhamar province is alarming.

A map of the administrative districts of Yemen showing the location
of Dhamar governorate can be accessed at
<http://www.lib.utexas.edu/maps/atlas_mi ... isions.jpg>.
Dhamar lies in the central highlands of Yemen, south-southeast of the
capital Sana'a, a region likely to lack resources and adequate
veterinary surveillance to undertake vaccination of the canine
population. The HealthMap/ProMED-mail interactive map of Yemen is
available at: <http://healthmap.org/r/01Gk>. - Mod.CP]

Israel - Tollwut
11.01.2011

2010 wurden wieder vermehrt Tollwut-Fälle bei Tieren gemeldet: darunter 23 Hunde, außerdem Katzen, Rinder, Schafe, ein Wolf und ein Fuchs. Risikoreisende sollten geimpft sein. Nach verdächtigen Tierkontakten ist umgehend eine Postexpositionsprophylaxe einzuleiten. / Quelle: crm

DENGUE/DHF UPDATE 2011 (03)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
Yemen (dengue suspected; request for information)
Date: Fri 14 Jan 2011
Source: Sabanews.net [in Arabic, trans. Corr.SB, edited & summ.]
<http://www.sabanews.net/ar/news233216.htm>


Since October of last year (2010) a number of directorates in
Hodeidah province [have expressed] great concern due to the spread of
the epidemic known popularly as "Almkrvs" [translated from the Arabic
as "the crunching" - Corr.SB] in relation to symptoms associated with
joint pain and inability to walk, high fever and severe cases of
diarrhea and vomiting in some infections and others with slight [light] rashes.

"Al Siyasiat" [a local Arabic language newspaper - Corr.SB] has
explored the views of academics and specialists on this epidemic.
Specialists affirm that there is no disease [officially] called
"Almkrvs," but there are cases with clinical signs of dengue fever
and a professor of physiology and nutrition at the University of
Hodeidah, Dr. Hazza El Jebel, says that the dengue virus is spread by
a female mosquito "_Aedes aegypti_," which transmits the virus from
an infected persons to healthy ones. The incubation period lasts for
a period of 5 days and [mosquitos] multiply in sewage, garbage and
breed in the winter period. [_Ae. aegypti_ breeds in fresh water in
water catchments in and around buildings, but not in sewage or
garbage. - Mod.TY]

He confirms that the virus, when its attacks a person, leads to a
significant decrease in white blood cells and platelets, and if not
addressed at the beginning of the disease progresses to bleeding and
may cause the patient to bleed to death.There is no disease called
"Almkrvs," but it is a name derived from the symptoms of the disease
in a patient, one of vulnerability and malnutrition, hygiene, housing
and others due to poverty and ignorance, and causes [conditions for]
dengue fever.

The symptoms associated with the disease are muscle weakness, joint
pain, high fever, headache, and eye pain, in addition to a rash. In
addition to the lack of awareness by the patient, [there is]
ignorance about disease states that have been transferred to us from
the affected countries such as South and East Africa. He also refers
to the lack of awareness by media and the competent authorities on
the reasons for the transfer of the virus from infected individuals
to non-infected persons.

He points out that a committee of the University of Hodeidah and the
Office of Health will visit the affected districts and will be taking
samples and a study on the causes of infection.

Dr. Bandar, of the al-Faqih military hospital in Hodeidah, said that
the disease is a viral infection and [based on] the epidemiology [of
the disease], the most important symptoms associated with the
disease are very high temperature and runny nose and pain of the
joints. The disease is confirmed as dengue fever after conducting
tests such as general blood [complete blood count?] giving the
percentage of platelets. The results provide [data on] the proportion
of white blood cells and platelets in particular.

It is confirmed that the clinical situation is evolving with the
progress to bleeding from the nose, which indicates that a critical
situation [exists] due to lack of blood platelets that may lead to
the death of the patient from to internal bleeding if the disease is
not treated in its early stages. Antibiotics are given if the disease
progresses in the patient and when there is inflammation due to
secondary bacterial infections as a result of HIV in the patient
infected with dengue fever.

He says that the symptoms of "Almkrvs" are similar to the symptoms of
dengue fever, with the same and pain associated with this disease,
and can be confirmed by the presence of dengue virus when tested.
Many cases have reached the hospital and have been processed and
given the necessary treatment. If a case has reached the bleeding
stage, it may may cause complications for the patient.

In advanced cases, transfusions may be given to the bleeding patient,
which saves the patient from internal bleeding that causes the
patient's death. Dr Abdullah Al-Hariri, head of laboratory at the
military hospital in Hodeidah, said that complete blood counts are
done on samples that come to the laboratory for diagnosis.

Dr. Abdu-Zeid, head of nursing at the military hospital, says that of
the number of patients examined in December, more than 400 cases have
been tested [by what means?] and were serious.

--
Communicated by:
HealthMap Alerts vis ProMED-mail
<promed@promedmail.org>

[This outbreak is a continuation of the undiagnosed "Almkrvs" disease
reported from western Yemen in November 2010 (see ProMED-mail archive
number 20101125.4246). Although the above report indicates that the
cases are dengue and DHF, it is difficult to conclude that these are
indeed cases of dengue fever or DHF from this report.

Medical authorities indicate that these are dengue virus infections,
with reduction in platelet counts as the diagnostic criterion. No
mention is made of virus detection or serological diagnosis of dengue
virus infections.

The term "crunching" makes one wonder if chikungunya virus infections
might be involved as well. The dengue and chikungunya virus vector
mosquito, _Aedes aegypti_, is present in this area in Yemen (see
ProMED-mail archive no. 20050308.0685). Dengue has been reported in
other parts of Yemen in August 2010, with 309 out of 2200 suspected
dengue cases confirmed positive and many Yemeni governorates
reporting the spread of this epidemic, according to a June 2010
report issued by the Ministry of Health (see ProMED-mail archive
number 20100826.3010). Additional information about this current
outbreak and laboratory testing that has been done would be appreciated.

A map of the provinces and cities of Yemen can be accessed at
<http://www.citypopulation.de/Yemen.html#Land>.
A HealthMap/ProMED-mail interactive map of Yemen can be accessed at
<http://healthmap.org/promed/index.php?v=15.9,47.6,5>. - Mod.TY]

Jemen - Dengue
21.01.2011

Aus dem Westen des Landes wird über einen Ausbruch mit über 400 Erkrankten berichtet, bei dem es sich wahrscheinlich um Dengue-Fieber handelt. Die Bestätigungen stehen aber noch aus. Bereits im August 2010 wurden bei einem ähnlichen Ausbruch 309 Proben positiv auf Dengue getestet. Schutz vor tagaktiven Mücken beachten! / Quelle: crm

LEISHMANIASIS, CUTANEOUS - ISRAEL
**********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 20 Jan 2011
Source: Yediot Aharonot Daily [trans. Mod.AS, summarised, edited]
<http://www.ynet.co.il/articles/0,7340,L-4016665,00.html>


Dozens of residents of the Eshkol region and Gaza perimeter have been
recently bitten by sand flies and suffer from infection and wounds
which leave ugly scars. The sores are locally known as the "Rose of
Jericho" (leishmaniasis).

In Kibbutz Urim alone [map at
<http://www.fallingrain.com/world/IS/01/Urim.html>], 27 members have
been infected. "I feel like a leper," said a resident of the area,
both she and her daughters having been bitten. "It started last month
[December 2010], causing hard, red, itching sores. I waited a few days
for it to disappear, but it did not. The pain was really strong, like
the stabbing of needles. Colleagues at work told me it sounds like the
Rose of Jericho, so I went to the clinic."

Eshkol residents are not alone. Even in the Jerusalem area, the number
of bitten persons recently increased. Several children from
Maale-Edomim have been hospitalized in recent days in Shaare Zedek
Hospital in Jerusalem after severe lesions were discovered on them as
a result of fly bites. At the same time, the phenomenon spread to the
Beth-Shean Valley area [northeast Israel].

Israel has always been considered a country with a high incidence of
[cutaneous] leishmaniasis, but in recent years, its spread has
increased. "Leishmania is big trouble, and control efforts are
insufficient," says Professor Eli Schwartz, director of the travellers
clinic and tropical disease specialist in the Sheba Medical Center.
"It is not fatal, but no doubt it is very disturbing and causes
serious aesthetic problems. Vast areas throughout the country are
infected, from north to south. In some places, the situation is really
terrible. We see people bitten dozens of times, showing 30 and 40
lesions on the body."

The disease is transmitted by the bite of the female sand fly. The
flies bite an infected animal, often the rock hyrax [but in several
parts of Israel, other rodents], and transmit the disease to people
they bite. The red ulcers will appear after the incubation time,
several weeks after the bite. It is not life-threatening, but painful
and unaesthetic. "A friend showed me online photos of the scars. I
thought she was crazy," says a bitten woman. "But today, I see that
it's worse than that on the Internet. It looked awful."

Disease management is carried out by drugs: in mild cases, an ointment
that kills the parasite; in severe cases, intravenous application may
be required. Recovery takes a long time, sometimes more than a year.
In any case, the drug does not prevent the ugly scars left behind by
the wounds.

Authorities, as it turns out, do not rush to eradicate the fly. For
example, Eshkol residents who approached the Department of the
Environment in the Regional Council were told that so far, fly
eradication measures could [not] be applied since by law the
authorities are committed to eradicating mosquitoes only.

Until the authorities find a solution, the only way to protect oneself
against the fly is by wearing suitable (long sleeved) clothing after
sunset and applying insect repellent. Nets on the windows will not
help in this case, since the sandfly is very small, and in any event,
pest control measures have a limited effect.

"We are investing great effort to study new methods in order to
control the phenomenon, but there is no magic solution," said Prof.
Itamar Grotto, head of the Public Health Services in the Ministry of
Health, yesterday [19 Jan 2011]. Prof. Schwartz added: "Anyone who has
had an unhealed wound for a week to 2 weeks, and who has stayed in
affected areas, should contact the doctor to check for possible
infection."

[Byline: Sarit Rosenblum, Yaron Sasson]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[Cutaneous leishmaniasis (CL), caused by _Leishmania major_, is known
to be present in Israel in low-lying arid and semiarid deserts,
particularly and traditionally in the Jordan valley, where it acquired
its vernacular name "Rose of Jericho," (synonyms: Aleppo boil,
Oriental sore, Delhi boil, Baghdad sore, etc). Throughout the 1990s it
remained at a relatively stable 0.5-2.5 cases/100 000, but since the
late 1990s, spread into and within areas hitherto not known to be
infected, such as the Jerusalem area (see ref. 1), northern Israel and
the Gaza perimeter, where the Eshkol regional council is located,
including Kibbutz Urim. The total population (all ages) of Urim, where
27 CL cases have allegedly been reported now, is 493 (December 2009
figures).

Ref. 1.
Singer SR, Abramson N, Shoob H, Zaken O, Zentner G, Stein-Zamir
C.(2008). Ecoepidemiology of Cutaneous Leishmaniasis Outbreak, Israel.
Emerg Infect Dis. 14(9): 1424-1426. - Mod.AS]

[Leishmaniasis is increasing in the Mediterranean area (Ready PD.
Leishmaniasis emergence in Europe. Euro Surveill. 2010;15:19505), and
the spread in Italy to northern Italy is especially well documented
(Maroli M et al. The northward spread of leishmaniasis in Italy:
evidence from retrospective and ongoing studies on the canine
reservoir and phlebotomine vectors. Trop Med Int Health.
2008;13:256-64. Ferroglio E et al. Distribution of _Phlebotomus
perniciosus_ in North-Italy: a study on 18S rDNA of phlebotomine sand
flies. Vet Parasitol. 2010;170:127-30). - Mod.EP]


[Location map of Israel:
<http://www.mapsofworld.com/israel/maps/ ... on-map.jpg>
Land use map of Israel showing desert areas:
<http://www.mapcruzin.com/free-maps-them ... l_land.jpg>
Some rather disturbing photos of the lesions at:
<http://dermatology.cdlib.org/102/case_p ... sis2/1.jpg>
<http://dermatology.cdlib.org/132/case_p ... asis/2.jpg>
<http://www.nature.com/jidsp/journal/v6/ ... 0053f2.gif>
<http://pathmicro.med.sc.edu/parasitology/lei16.jpg>
- Mod.JW]

Israel - Cutane Leishmaniase
01.02.2011

In den letzten Jahren hat die Zahl der Erkrankungen deutlich zugenommen. Jüngst wurden Fälle aus Jerusalem, aus dem Norden und aus der Region nahe des Gaza-Streifens gemeldet. Von öffentlicher Seite gibt es bisher keine Maßnahmen zur Vektorkontrolle. Schutz vor nachtaktiven Überträgermücken (Phlebotomen, sandflies) beachten. Bei nicht abheilenden Wunden sollte ein Arzt aufgesucht werden. / Quelle: crm

UNDIAGNOSED DISEASE - YEMEN: (AL HUDAYDAH), REQUEST FOR INFORMATION
*******************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 1 Mar 2011
Source: Arab News [edited]
<http://arabnews.com/saudiarabia/article293369.ece>


At least 65 deaths have been reported in Yemen's western coastal
province of Hodeidah. The disease is thought to be chikungunya, though
some medical officers dispute it. Symptoms of chikungunya include
kidney failure, high temperature, diarrhea and vomiting [This is
inaccurate. The US CDC states that, "chikungunya virus infection can
cause a debilitating illness, most often characterized by fever,
headache, fatigue, nausea, vomiting, muscle pain, rash, and joint
pain. ... Additionally, some patients have reported incapacitating
joint pain, or arthritis which may last for weeks or months. ...
Fatalities related to chikungunya virus are rare."
(<http://www.cdc.gov/ncidod/dvbid/Chikung ... tment.html>).
- Mod. TY].

Yemen's President Ali Abdullah Saleh has formed a committee to
monitor the spread of the disease, and the country's authorities are
working hard to keep it in check.

Dr. Mohsen Al-Tobaiki, director of health in Jazan, said the Saudi
authorities have been following developments across the border. Dr.
Khaled Al-Mirghalani, spokesman for the Ministry of Health, and Dr.
Ziyad Mishmish, undersecretary for preventive medicine, were
unavailable for comment.

A number of medical and environmental experts in Jazan said there is
a possibility of the disease entering the kingdom through unregistered
migrants who do not carry health certificates proving they have taken
necessary vaccinations [No vaccine is available for chikungunya virus.
- Mod.TY]. They added that, at the moment, the border provinces in the
south of the kingdom are free from the disease.

According to Yemeni media, people in the Hodeidah area were shocked
at the loss of life. Arafat Maki, a local journalist who contracted
the illness, said the disease has caused panic in the area.

"Lots of people are thought to have died. The health facilities in
Hodeidah and hospitals are working overtime to cope with the influx of
patients," he said. The disease is locally known as Al-Mukarfess.

Dr. Abdul Hakim Al-Khohlaini, manager of the epidemiological
surveillance department at the Yemeni Ministry of Health, said that
samples sent to Cairo for tests showed that the disease is
chikungunya. He added that local doctors have also found other
diseases in the area. "45 per cent of the cases are chikungunya, 10
percent malaria, and the rest dengue fever," he said.

According to Al-Khohlaini, 61 people have died so far. "Some of the
dead are very old, and most of the cases haven't been verified by
laboratories," he said. "Saudi health officials called us and inquired
about the spread of a disease in the border provinces. We told them
that it is chikungunya and assured them that the disease is under
control and far away from the Saudi border," he said.

However, another medical source gave a different assessment of the
situation. Dr. Najeeb Molha, head of the Hodeidah doctors' syndicate
who is also working with disease-fighting teams, said the disease is
not chikungunya. "Chikungunya doesn't claim this high a number of
lives. Chikungunya sprang up in the area in the last 3 months of 2010
and does not exist anymore," he said.

Molha said the symptoms of the disease are fever, diarrhea, renal
failure and sudden increase in the number of white blood cells and
granulocytes. "To my knowledge, 65 people have died because of the
disease, and 250 people are in hospitals. I think it is a kind of
hemorrhagic fever. Our interference has helped in bringing down the
number of victims and lessening the panic," he said.

The director of Hodeidah's provincial health office refused to
comment on the matter, saying he is waiting for the minister of health
to complete his investigations.

Chikungunya, a mosquito-borne disease with symptoms similar to dengue
fever, occurs mainly in Africa, Asia and the Indian subcontinent.

[Byline: Muhammad Humaidan, Saeed Al-Batati]

--
Communicated by:
John T. Cathey
Senior Editor
Annals of Saudi Medicine
Hematology/Oncology and Stem Cell Therapy
Scientific Publications Office
King Faisal Specialist Hospital and Research Centre (MBC 36)
PO BOX 3354
Riyadh 11211 Saudi Arabia
http://www.saudiannals.net

http://www.hemoncstem.net

<jtcathey@kfshrc.edu.sa>

[It is difficult to determine whether this outbreak is a totally new
one or a partial continuation of an outbreak reported in November 2010
(see ProMED-mail archive number 20101125.4246). The November 2010
outbreak reported low mortality and arthritis, much more compatible
with symptoms of chikungunya virus infections than the current report
above. The current outbreak may be one of mixed etiologies, but the
fatalities are extremely unlikely to have been caused by chikungunya
virus infection. One wonders whether the cases diagnosed by the
laboratory in Egypt were fatal ones or just febrile patients.
Curiously, no mention is made of arthralgia in the current report,
which is a key feature of chikungunya virus infections, leading one to
wonder whether the laboratory diagnoses of chikungunya virus infection
were made on serological grounds and reflect past rather than current
infections. Further information would be appreciated.

A HealthMap/ProMED-mail interactive map of Yemen showing the location
of Al Hodeidah on the west coast can be accessed at
<http://healthmap.org/r/0xiP>. - Mod.TY]

LEISHMANIASIS, CUTANEOUS - SAUDI ARABIA: (AL QASIM)
***************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 27 Mar 2011
Source: Saudi Gazette [edited]
<http://www.saudigazette.com.sa/index.cf ... 1032696748>


30 workers of a cleaning company in Albadaye'a governorate of Qassim
were found to have cutaneous leishmaniasis.

The company said the infected workers worked near farms and swamps.
It said the unavailability of medication led to the disease spreading
among the workers.

Infections can be treated in many ways if the sores do not heal on
their own, which happens often, said Abdullah Al-Suqair, Assistant
general director of the Primary Healthcare department. He said the
disease is transmitted by the 2 millimeter-sized sand fly from
infected animals to humans. He said it "is hard to eradicate, but the
healthcare efforts to combat the disease are continuing. The disease
in the Kingdom can be found in the regions of Qassim, Madina and
Riyadh. However, it is present particularly in Qassim, given the
agriculture and grazing activities which can provide an environment
for the parasites."

He said infections in Qassim are determined annually by the weather
because the sand fly is more active in hot and mild weather, and also
because people are more involved in outdoor activities during these
periods.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Leishmaniasis is endemic in Saudi Arabia, and the workers could have
been infected from a common source. A recent study from the area
(Shalaby I et al. Genotypic Characterization of Cutaneous
Leishmaniasis at al Baha and Al Qasim Provinces (Saudi Arabia). Vector
Borne Zoonotic Dis. 2011 Mar 21. [Epub ahead of print]) found both _L.
tropica_ and _L. major_ in biopsies from skin lesions.

The occurrence of leishmaniasis in the region has recently been
reviewed (Postigo JA. Leishmaniasis in the World Health Organization
Eastern Mediterranean Region. Int J Antimicrob Agents. 2010;36(Suppl
1):S62-5). For the HealthMap/ProMED map of Saudi Arabia, see
<http://healthmap.org/r/0CQY>. - Mod.EP]

DENGUE/DHF UPDATE 2011 (17)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

- Saudi Arabia (Jeddah). 20 Apr 2011.

Dengue fever is at epidemic
proportions in Jeddah and will be hard to eradicate, according to Dr.
Sami Eid, Assistant Director General of Health Affairs in Jeddah for
Primary Health Care. There has been a 50 per cent drop in infected
patients so far this year [2011], compared to the same period last
year [2010].
<http://www.saudigazette.com.sa/index.cf ... 1042198818>

[A HealthMap/ProMED-mail interactive map of Jeddah, Saudi Arabia can
be accessed at
<http://healthmap.org/r/011Z> & click once on the + sign. -
Mod.TY/JW]