Outbreaks repored in 2016

In the year 2016, several major out-breaks from emerging and re-emerging diseases including cholera in Somalia and Yemen; MERS-CoV in Saudi Arabia; Chikungunya in Somalia, Pakistan and Crimean– Congo Haemorrhagic fever in Pakistan were reported in the Eastern Mediterranean Region [EMR]

Unknown VHF in Sudan

An outbreak of Viral Haemorrhagic Fever [VHF] of unknown illness has been reported from Darfur in Sudan. Between 30 August to 27 November 2015, a total of 469 suspected cases of VHF including 120 deaths [CFR: 26%] were reported from 27 localities in Greater Darfur

Report: strategic approach to control of viral haemorrhagic fever outbreaks in the Eastern Mediterranean Region: report from a regional consultation

The viral haemorrhagic fevers [VHF] are a growing public health threat in the Eastern Mediterranean Region. Nearly all of them are of zoonotic origin. VHF often cause outbreaks with high fatalities and, except for yellow fever, currently there are no specific treatment or vaccination options available. In response to this growing threat, the Regional Office for the Eastern Mediterranean of the World Health Organization convened a technical consultation in Tehran on 27-30 November 2011 to review the current gaps in prevention and control of VHF outbreaks in the Region. The meeting recommended a number of strategic public health approaches for prevention and control of VHF outbreaks through synergizing effective collaboration between the human and animal health sectors on areas that involve better preparedness, early detection and rapid response. Implementation of these approaches would require working together with vision, commitment and a sense of purpose involving partnerships and cooperation from all relevant sectors

Chikungunya infection in children.

Chikungunya fever is caused by Chikungunya virus (CHIK) and spread by Aedes aegypti and Aedes albopictus. The median incubation period is 2 to 4 days. Vertical transmission of disease from mother to child has also been documented. Clinical manifestations are very variable, from asymptomatic illness to severe debilitating disease. Children are among the group at maximum risk for severe manifestations of the disease and some clinical features in this group are distinct from those seen in adults. Common clinical features include: abrupt onset high grade fever, skin rashes, minor hemorrhagic manifestations, arthralgia/ arthritis, lymphadenopathy, conjunctival injection, swelling of eyelids and pharyngitis. Unusual clinical features include: neurological manifestations including seizures, altered level of consciousness, blindness due to retrobulbar neuritis and acute flaccid paralysis. Watery stools may be seen in infants. Treatment is symptomatic. Generally non- steroidal anti-inflammatory drugs are avoided. Paracetamol may be used for pain and fever. However, NSAIDS may be required for relief of severe arthralgia during convalescent phase.

Suspected viral haemorrhagic fever in southern Sudan

Following an unconfirmed report of an outbreak of acute viral haemorrhagic fever in some remote and inaccessible areas of Western Bahar El Gazal State of southern Sudan, a joint field investigation was carried out by WHO and the officials of the Ministry of Health of the Government of southern Sudan [GoSS]. The investigation was carried out between 05 to 13 October in both the areas from where these unconfirmed reports spread. The investigation team did not find any active case with bleeding manifestations suspected to be of acute viral haemorrhagic fever. However, a blood sample collected from a 35 year old lady who was jaundiced and had a history of epistaxis and vaginal bleeding was tested positive for Hepatitis-E as well as for Ebola IgG

Febres hemorrágicas por vírus no Brasil / Viral hemorrhagic fevers in Brazil

Chamando a atencão para as febres hemorrágicas por vírus, que em sua maioria tem escassa informacão divulgada e provavelmente são subnotificadas, mostra-se neste artigo casos clínicos das 4 doencas deste tipo que ocorrem no Brasil: febre amarela, dengue hemorrágico/síndrome de choque do dengue, febre hemorrágica por arenavírus e síndrome pulmonar e cardiovascular por hantavírus. Também, relevantes aspectos clínicos, laboratoriais e epidemiológicos destas viroses são aqui abordados. São doencas que têm alta letalidade e induzem extravasamento capilar e coagulopatia, que podem ser evidenciados pela elevacão do hematócrito e plaquetopenia. A suspeita clínica e o tratamento precoce são fundamentais à sobrevida dos pacientes.

Epidemiology of the ebola virus: facts and hypotheses

Marburg and Ebola viruses are emerging pathogens recognized since 1967, and in 1976, when they were first identified. These viruses are the only members of the Filoviridae family. They cause severe, frequently fatal, hemorrhagic fever. Each genus includes some serotypes with the distinctive characteristics to cause high mortality rate during outbreaks. The Ebola-Zaire subtype is the most lethal variant. The epidemiology of human pathogenic filovirus is reviewed in this paper considering the most relevant facts. Primary human cases arise probably through close contact with infected primates. This point may be the key to preventing the introduction of these viruses in human populations. Once introduced in humans, the infection may spread through close contact with infected individuals or their body fluids, particularly in hospital environments. A main feature of filovirus outbreaks is the occurrence of cycles of secondary infection.

Fiebre hemorrágica Venozolana: ocho anos de observacion / Venezuelan hemorrhagic fever: eight of observation

La fiebre hemorrágica Venezolana (FHV) es una enfermedad severa, caracterizada por fiebre, malestar general, dolor de cabeza dolor de garganta, seguida por dolor abdominal, diarrea, una variedad de manifestaciones hemorrágicas y convulsiones. El agente causal es el arenavirus Guanarito, el cual es mantenido en la naturaleza por el roedor de la especie Zygodontomys brevicauda: ratón de la caña de azúcar. La enfermedad afecta principalmente a agricultores del sexo masculino, en edades comprendidas entre 14- 54 años, procedentes del Municipio Guanarito del estado Portuguesa y áreas adyacentes del Estado Barinas. Desde la emergencia de la FHV en 1989 hasta 1997, se han reportado 220 casos con una letalidad del 33 por ciento. Tiene un comportamiento epidemiológico cíclico, registrándose periodos epidémicos cada 4-5 años, e interepidémicos con un numero reducido de casos.

The investigation of emerging and re-emerging viral diseases: a paradign

Emerging virus infections are defined as previously nonthreatening viruses that can decimate new populations by finding fresh hosts and vectors--often with the help of humans who introduce new species into virgen environment, Several etiologic agents of these diseases, some of the interacting factors that contribute to their development and the role of molecular medicine in their understanding is discussed

Dengue haemorrhagic fever/dengue shock syndrome: an unwelcome arrival in Trinidad

This is the first report of dengue haemorrhagic fever and dengue shock syndrome in Trinidad. Dengue infection was confirmed serologically or by viral isolation in five patients, aged 15 to 33 years, who presented with fever, thrombocytopenia and haemoconcentration. Three patients developed dengue shock syndrome, which was fatal; although there was no haemorrhagic tendency among these patients, bleeding occurred shortly before death in one of them. Two patients who had dengue haemorrhagic fever survived. The co-circulation of dengue virus serotypes 1, 2 and 4 in the Caribbean facilitates the development of dengue shock syndrome (DSS) or dengue haemorrhagic fever (DHF). Clinicans should therefore be aware of their clinical features, laboratory diagnosis and clinical management. Appropriate public health interventions and improved surveillance should be implemented to reduce the risk of DHS/DSS associated mortality in Trinidad and Tobago.

Cartilla del brigadista para la lucha contra el dengue

Cartilla popular dirigida a la población para orientar acerca del dengue y dengue hemorrágico producido por el Aedes aegypti que desde 1985 ha causado la enferemdad a más de 17,000 personas. Orienta acerca de la transmisión del virus, la inoculación, los síntomas de la enfermedad y cómo tratarla. También informa sobre la manera de combatir y eliminar el mosquito y las medidas de prevención que debe desarrollar la población para evitar la propagación del aedes.

O vírus Ébola e sua infecçäo / The ebola virus and its infection

As propriedades epidemiológicas, ecológicas, biológicas, patogenéticas e o diagnóstico do vírus Ébola e sua infecçåo, bem como seu controle såo apresentadas neste artigo. Embora seja um vírus endêmico em certas regiöes da Africa, o risco de disseminaçåo deste vírus para fora do continente africano tem despertado a atençåo e o interesse da comunidade médica mundial, e acionado a vigilåncia sanitária internacional para este vírus

Dengue haemorrhagic fever in Burma.

Although sporadic from 1965 to 1969, a major outbreak of dengue haemorrhagic fever (DHF) occurred for the first time in Rangoon in 1970. Since then the disease has occurred every year in Rangoon and is now observed to be expanding to other urban areas in the country. The clinical diagnosis of DHF was confused by concurrent outbreaks of influenza A in 1971 and influenza A and B in 1972. A laboratory study of 3,447 clinically diagnosed haemorrhagic fever cases showed that 1643 cases (47.8%) were due to dengue and chikungunya, 296 (8.6%) to influenza A, 85(2.5%) to influenza B, 12(0.3%) to measles and 1411(40.8%) were of unknown aetiology during the 5 year period 1970-1974. Ae. aegypti mosquitoes are widely distributed in the country up to and including 900 meters above sea level but breeding is not found above that altitude. The absolute larval population which is highest in July as well as landing rate correlated with the peak incidence of DHF cases.

Epidemiological features of dengue and chikungunya infections in Burma.

A serological survey for antibody to dengue and chikungunya was carried out in all 14 divisions and states and 2 border towns in Burma during 1973-74. Dengue HI antibody prevalence rate of less than 10% was observed in Arakan and Shan States, 10 to 30% in the Irrawaddy, Pegu, Mandalay Divisions and Kachin, Mon and Karen States, 31 to 60% in Sagaing Division, and over 60% in Rangoon, Magwe and Tenasserim Divisions. Similarly, chikungunya HI antibody prevalence rate of less than 10% was observed in Arakan State, 10 to 30% in the Irrawaddy, Pegu, Mandalay and Sagaing Divisions and Kachin State, 31 to 60% in Rangoon Division and Mon State. Both dengue and chikungunya antibodies were detected where Aedes aegypti mosquitoes were prevalent but the antibody prevalent rates were not directly proportional to the premises index. No HI antibody to dengue nor chikungunya was detected in Aedes aegypti free hilly areas, Chin and Kayah States, but was detected in the Shan State, Dengue and chikungunya infections were observed both in rural and urban populations. Dengue and chikungunya infections affected all socioeconomic classes in Rangoon equally but in Mandalay high socioeconomic class was nearly 3 times less affected than lower socioeconomic class. The infrequencies of dengue and chikungunya infections were observed to be 2 to 3 times higher in residents of Rangoon City than those of other towns. In Rangoon the antibody prevalence rates to dengue increased progressively with age while in other towns no appreciable increase in rates with age was observed. Both sexes were equally affected. This study provides strong circumstantial evidence that dengue and chikungunya viruses are highly and widely distributed throughout Burma, and that new outbreaks of haemorrhagic fever could occur in previously free areas following introduction of dengue viruses into populations previously exposed to one type of dengue.