Outbreak of gastroenteritis caused by Yersinia pestis in Afghanistan.

Plague, which is most often caused by the bite of Yersinia pestis-infected fleas, is a rapidly progressing, serious disease that can be fatal without prompt antibiotic treatment. In late December 2007, an outbreak of acute gastroenteritis occurred in Nimroz Province of southern Afghanistan. Of the 83 probable cases of illness, 17 died (case fatality 20·5%). Being a case was associated with consumption or handling of camel meat (adjusted odds ratio 4·4, 95% confidence interval 2·2-8·8, P<0·001). Molecular testing of patient clinical samples and of tissue from the camel using PCR/electrospray ionization-mass spectrometry revealed DNA signatures consistent with Yersinia pestis. Confirmatory testing using real-time PCR and immunological seroconversion of one of the patients confirmed that the outbreak was caused by plague, with a rare gastrointestinal presentation. The study highlights the challenges of identifying infectious agents in low-resource settings; it is the first reported occurrence of plague in Afghanistan.

Serological evidence of arboviral infection and self-reported febrile illness among U.S. troops deployed to Al Asad, Iraq.

Understanding the epidemiology of current health threats to deployed U.S. troops is important for medical assessment and planning. As part of a 2004 study among U.S. military personnel deployed to Al Asad Air Base, in the western Anbar Province of Iraq, over 500 subjects were enrolled, provided a blood specimen, and completed a questionnaire regarding history of febrile illness during this deployment (average approximately 4 months in country). This mid-deployment serum was compared to pre-deployment samples (collected approximately 3 months prior to deployment) and evaluated for seroconversion to a select panel of regional arboviral pathogens. At least one episode of febrile illness was reported in 84/504 (17%) of the troops surveyed. Seroconversion was documented in nine (2%) of deployed forces tested, with no association to febrile illness. Self-reported febrile illness was uncommon although often debilitating, and the risk of illness due to arbovirus infections was relatively low.

Influenza: the next pandemic?: A review.

OBJECTIVES: To examine existing information on the recent influenza outbreaks in order to create awareness of a possible influenza pandemic and to suggest future research areas in developing control strategies in Kenya. DATA SOURCES: Review of literature via Internet, articles, journals and un-refereed features from the media and personal communications. DATA SELECTION: Most published data from 1979 to March 2005 found to reveal cases of influenza outbreaks were included in the review. Also, selected articles on the recent outbreaks and professional guidance on influenza infections were critically examined and analyzed. DATA EXTRACTION: Abstracts and articles identified were accessed, read to establish relevance to this review. DATA SYNTHESIS: Important points were prioritised and then included as subtitles; below each subtitle, published works were included. Finally, a table of influenza outbreaks and the strains of the viruses involved were drawn as summary. CONCLUSION: Influenza is a highly contagious, acute respiratory disease that may spread rapidly and pervasively through a population. Due to the diversity of susceptible reservoirs of influenza viruses and the interspecies transmission recently reported, a mutated strain of the virus to which people have no immunity could cause an influenza pandemic once the virus gains efficient and sustained human-to-human transmission. The fear that avian influenza could be a precursor to the next pandemic is real and inevitable, given the extremely high case-fatality ratio among confirmed cases and that genetic sequencing of influenza A (H5N1) viruses from human cases in Thailand and Vietnam show resistance to the antiviral medication amantadine and rimantadine. This calls for a high level of preparedness to avoid a public health emergency. Nowhere is this paradigm more real than in Africa.

T cell immunity to brucellosis.

Brucellosis is an ancient disease of animals and man that still threatens the health and prosperity of many, primarily in the third world, who depend on animal agriculture for their livelihood. Further, its pathogenicity and the facts that it is zoonotic is effectively eradicated from many Western nations make it a dangerous bioterrorism threat. Targeted human vaccination may reduce the various threats brucellosis poses. Significant effort has been expended toward this goal and many candidate vaccines exist. However, the ideal vaccine would be a subunit vaccine that specifically targets only the critical aspects of the immune response necessary to induce immunity. Much about the immune response, in particular the T cell response, remains to be discovered in order to accomplish that goal. In this review we focus on T cell responses to brucellosis with particular attention to the specific roles of T cell subtypes. We also point out areas of research on T cell responses that may allow exploitation of cutting edge vaccine technologies for the next generation vaccine for brucellosis.