Eurosurveillance editorial team

Mihaela Lazar, Aurora Stănescu, Ana Raquel Penedos and Adriana Pistol

Background Since January 2016, a resurgence of measles in Romania has led to the third measles epidemic in the past 12 years; 64 deaths have been confirmed so far–the highest number of measles-related deaths since the measles-mumps-rubella (MMR) vaccine was introduced in 2004. Aim To provide an overview on the characterisation on measles in Romania after the introduction of the MMR vaccine with focus on the current outbreak, laboratory and molecular analysis. Methods We performed an analysis of measles incidence and mortality after the introduction of MMR vaccination and a retrospective study using serological and molecular data in three consecutive outbreaks with focus on the current outbreak. Results In the current outbreak, 17,533 measles cases were notified to the national surveillance system, 93% were unvaccinated. Measles virus was isolated from 429 samples and 283 were genotyped. Genotype B3 was predominant (n = 269) and sporadic measles cases associated with D8 genotype (n = 9) were also observed; genotype D4 and D8 were identified in the previous two measles outbreaks. The detection of several distinct measles virus B3 genotypes suggests multiple virus importations to Romania. Conclusion The current outbreak is a consequence of insufficient vaccine coverage. Control measures were implemented to improve uptake of MMR vaccine, including administering the first MMR dose at a younger age (9–11 months) and offering catch-up vaccination to children that have not followed the recommended dosing schedule. More measures are needed to improve the surveillance performance and to achieve high routine MMR vaccination coverage.…

Maite Aubry, Mihiau Mapotoeke, Anita Teissier, Tuterarii Paoaafaite, Elsa Dumas-Chastang, Marine Giard and Van-Mai Cao-Lormeau

In 1996–97, the last dengue virus serotype 2 (DENV-2) outbreak occurred in French Polynesia. In February 2019, DENV-2 infection was detected in a traveller from New Caledonia. In March, autochthonous DENV-2 infection was diagnosed in two residents. A DENV-2 outbreak was declared on 10 April with 106 cases as at 24 June. Most of the population is not immune to DENV-2; a large epidemic could occur with risk of imported cases in mainland France.…

Jukka-Pekka Pietilä, Taru Meri, Heli Siikamäki, Elisabet Tyyni, Anne-Marie Kerttula, Laura Pakarinen, T Sakari Jokiranta and Anu Kantele

Background Despite the global distribution of the intestinal protozoan Dientamoeba fragilis, its clinical picture remains unclear. This results from underdiagnosis: microscopic screening methods either lack sensitivity (wet preparation) or fail to reveal Dientamoeba (formalin-fixed sample). Aim In a retrospective study setting, we characterised the clinical picture of dientamoebiasis and compared it with giardiasis. In addition, we evaluated an improved approach to formalin-fixed samples for suitability in Dientamoeba diagnostics. Methods This study comprised four parts: (i) a descriptive part scrutinising rates of Dientamoeba findings; (ii) a methodological part analysing an approach to detect Dientamoeba-like structures in formalin samples; (iii) a clinical part comparing demographics and symptoms between patients with dientamoebiasis (n = 352) and giardiasis (n = 272), and (iv) a therapeutic part (n = 89 patients) investigating correlation between faecal eradication and clinical improvement. Results The rate of Dientamoeba findings increased 20-fold after introducing criteria for Dientamoeba-like structures in formalin-fixed samples (88.9% sensitivity and 83.3% specificity). A further increase was seen after implementing faecal PCR. Compared with patients with giardiasis, the symptoms in the Dientamoeba group lasted longer and more often included abdominal pain, cramping, faecal urgency and loose rather than watery stools. Resolved symptoms correlated with successful faecal eradication (p …

How ready is the United States to cope with Ebola again? The immediate threat is low, but that can change on a dime. …

Eurosurveillance Editorial team

The FDA approved the antibacterial drug trio imipenem, cilastatin, and relebactam for adults with complicated urinary tract infections and complicated intra-abdominal infections. …

Angeliki Stathi, Ioanna Loukou, Helen Kirikou, Argyri Petrocheilou, Maria Moustaki, Aristea Velegraki and Levantia Zachariadou

We report the first isolation of Candida auris in Greece from a sputum culture of a cystic fibrosis patient in their 20s under posaconazole treatment. The pathogen was identified as C. duobushaemulonii by VITEK2YST, but as C. auris by MALDI-TOF MS. This case underscores the need for species-level identification of all non-albicans Candida (NAC) isolates from cystic fibrosis patients and patients with predisposing factors to fungal infection.…

Angel Vila-Córcoles, Olga Ochoa-Gondar, Cinta de Diego, Eva Satué, Angel Vila-Rovira and Maria Aragón

Background Recent published data on pneumococcal vaccination coverages among adults are scarce. Aim To update on pneumococcal vaccination uptakes among middle-aged and older adults in Catalonia. Methods We conducted a population-based retrospective observational study including 2,057,656 individuals ≥ 50 years old assigned to primary care centres managed by the Catalonian Health Institute on 1 January 2017 (date of data collection). An institutional clinical research database (SIDIAP) was used to classify persons by vaccination status for both 23-valent pneumococcal polysaccharide (PPsV23) and 13-valent pneumococcal conjugate (PCV13) vaccines, as well as to identify underlying risk conditions. Results Overall, 796,879 individuals (38.7%) had received PPsV23 and 13,607 (0.7%) PCV13. PPsV23 coverage increased with age: 9.2% (95,409/1,039,872) in 50–64 year olds, 63.1% (434,408/688,786) in 65–79 year olds and 81.2% (267,062/328,998) in ≥ 80 year olds (p …

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Anthrax -- IndiaTwo people from Madagada village in Araku mandal who were admitted to King George Hospital with symptoms of cutaneous anthrax tested positive for the disease on Saturday [13 Jul 2019], sparking panic in the Agency area."In the case of Araku mandal, both persons who were affected with anthrax allegedly cut the meat which was purchased from a weekly shandy [street market]," said Mr Kalyan Prasad, an official from the Health Department and the nodal officer for swine flu. "After consuming…

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Anthrax -- KazakhstanThere is no threat of anthrax in the animal burial site in Arys, says the press service of the akim [mayor] of the Turkestan region. "No threat has been found in the animal burial site located on the territory of Arys connected with anthrax. There are 2 animal burial sites in Arys. One is located in Dermen; another one [is] in Kozhatogay rural county. Both of them are under control," said Omirkul Omaroc, head of Arys city territorial inspection.He said the burial sites have not been…

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Anthrax -- Kenya[A photograph of] a man who ate the meat of an infected cow displays a swelling, a symptom of anthrax, at Mowlem in Kisumu County on 12 Jul 2019. [Actually it is a typical necrotic ulcer on his left forefinger that is healing, indicating that he has had it for a couple of weeks, dating the outbreak. - Mod.MHJ]The anthrax outbreak in Kisumu County has been contained, county director of health Dickens Onyango said on Sunday [14 Jul 2019]. The disease has left one person dead and others…

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Anthrax -- United StatesSince the 9 Jul 2019 update, anthrax has been detected on 3 additional premises in southwest Sutton County and one premises in southcentral Crockett County. The Texas Animal Health Commission (TAHC) quarantined the premises after animals tested positive for the reportable disease.To date, 8 premises in 3 Texas counties have had animals confirmed with anthrax. Animals include the following species: antelope, goat, horses and cattle. Producers have been advised on vaccinating exposed animals…

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BSE -- SpainInformation received on 16 Jul 2019 from Dr Valentin Almansa, director general, [Health of Agricultural Production, Ministry of Agriculture, Fisheries, and Food], Madrid, Spain.SummaryReport type: immediate notification (final report)Date of start of the event: 3 Jul 2019Date of confirmation of the event: 10 Jul 2019Date of event resolved: 10 Jul 2019Reason for notification: reoccurrence of a listed diseaseDate of previous occurrence: 19 Feb 2019Manifestation of disease:…

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Hemorrhagic Fever -- BoliviaDelgado S, Erickson BR, Agudo R, et al. Chapare virus, a newly discovered arenavirus isolated from a fatal hemorrhagic fever case in Bolivia. PLoS Pathog. 2008; 4(4): e1000047; It is unfortunate that the rodent reservoir of Chapare virus is still unknown. - Mod.TYHealthMap/ProMED-mail map of Bolivia: ][See Also:Bolivian hemorrhagic fever - Bolivia: background http://promedmail.org/post/20190705.6553672Undiagnosed illness - Bolivia (02): (LP) Bolivian hemorrhagic fever conf…

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Chikungunya -- Worldwide/UnknownBackground: Since its 1st detection in the Caribbean in late 2013, chikungunya virus (CHIKV) has affected 51 countries in the Americas. The CHIKV epidemic in the Americas was caused by the CHIKV-Asian genotype. In August 2014, local transmission of the CHIKV-Asian genotype was detected in the Brazilian Amazon region. However, a distinct lineage, the CHIKV-East-Central-South-America (ECSA) genotype, was detected nearly simultaneously in Feira de Santana, Bahia state, northeast Brazil. The…

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Other Animal Disease -- RussiaThe crops that bring us most of our food provide for 35 per cent of calorie intake, as well as most minerals, vitamins, and antioxidants. Nuts, melons, and berries will not grow without pollinating insects. Bees also pollinate citrus fruits, apples, onions, broccoli cabbage, zucchini, beans, peppers, eggplants, cucumbers, tomatoes, beans, coffee, cocoa, avocados, and coconuts. The production of these crops belongs to most valuable segments of the global food industry. Thus, the disappearance…

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Crimean-Congo Hemorrhagic Fever -- IranThe Crimean-Congo hemorrhagic fever (CCHF) virus has been the cause of 100-plus human infections in Iran annually since it was first reported about a decade ago. This calendar year in Iran ([Iranian calendar] which begins in March), the Ministry of Health has reported 54 CCHF cases, including 5 deaths, The Tehran Times reports.Behzad Amiri, head of zoonotic diseases department at the Ministry of Health noted the disease incidence is especially high over warm seasons because the ticks…

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E. coli -- IcelandA total of 16 children have been diagnosed with the bacterial infection, and concerns have been raised that tourists may spread it further, RUV [the Icelandic National Broadcasting Service] reports. The outbreak is purported to have originated in Efstadal 2, a farm and restaurant near Laugarvatn, after a group of schoolchildren visited the place, with some of them contracting _Escherichia coli_ infection. To be clear: none of the food nor any of the employees tested positive for _E. coli_.

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E. coli -- IcelandAt least 3 children have developed kidney failure after being diagnosed with _Escherichia coli_ infections that are linked to eating ice cream from a farm. A cluster of infections due to Shiga toxin producing enterohemorrhagic _E. coli_ (EHEC) O26:H11 has been traced to the tourist attraction Efstidalur II farm in Blaskogabyggd in the south of Iceland.The 17 ill children are aged between 14 months and 12 years. At least 3 of them developed hemolytic uremic syndrome (HUS), a severe…

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E. coli -- United KingdomPublic Health England has issued a warning after almost 20 cases of Shiga toxin-producing _Escherichia coli_ infection [also called enterohemorrhagic _E. coli (EHEC)] were found in people returning from Egypt in 2019.All travelers had been to the Hurghada region [Red Sea governorate] of Egypt. A variety of different EHEC strains have been detected in visitors to Egypt with serotypes O157 and O26 identified among them. One person developed hemolytic uremic syndrome (HUS), a type of kidney…

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E. coli -- United StatesAn international investigation is under way as public health officials report more than 20 people have been infected with _Escherichia coli_ linked to ground bison, which is now under recall. "As of 16 Jul 2019, Northfork Bison Distributions Inc is voluntarily recalling its ground bison, referred to as Bison Ground, and its ground bison patties, referred to as Bison Burgers and/or Buffalo Burgers, produced between 22 Feb 2019, and 30 Apr 2019," according to a public alert posted today by the…

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Ebola -- DR Congo…

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Ebola -- DR Congo- Following the recommendations of the international expert committee, WHO declared on Wed 17 Jul 2019, that the Ebola epidemic in the DRC is a health emergency of international concern.- The Ministry of Health accepts the evaluation of the expert committee. The ministry hopes that this decision is not the result of the many pressures from different stakeholder groups who wanted to use this declaration as an opportunity to raise funds for humanitarian actors despite the potentially harmful…

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Ebola -- DR Congo- The minister of health, Dr Oly Ilunga Kalenga spent the day of Fri 19 Jul 2019 in Beni where he visited the various field teams and the transit center whose capacity will be increased in the coming days.- Following the resurgence of patients in Beni, Dr Oly Ilunga said that one of the key lessons learned in this 10th epidemic is to rely on the health system. "If we really want to solve this epidemic and have a lasting impact, we need to strengthen the health system by working with the…

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Equine Influenza -- NigerInformation received on 15 Jul 2019 from Dr Issiako Abdou, [director general of veterinary services, directorate of animal health, Ministry of Agriculture and Livestock], Niamey, NigerSummaryReport type: immediate notification (final report)Date of start of the event: 1 Oct 2018Date of confirmation of the event: 9 Jul 2019Report date: 14 Jul 2019Date event resolved: 30 Jan 2019Reason for notification: 1st occurrence of a listed diseaseCausal agent: equine influenza A…

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Poisoning -- FranceHolidaymakers heading to France have been warned about a green tide of potentially toxic sea lettuce possibly having killed 2 men in under a week. An 18 year old oyster farmer died in Morlaix Bay last Saturday [6 Jul 2019], and a 70 year old retiree passed away in Douarnenez Bay on Tuesday [9 Jul 2019].The Brittany beauty spots where the unidentified men apparently succumbed to heart attacks "in minutes" are hugely popular with tourists, including thousands who arrive from the UK at this…

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Japanese Encephalitis -- MalaysiaThe Japanese encephalitis (JE) virus has been detected in Tambunan [Sabah], about 100 km (62 mi) from [the state capital, Kota Kinabalu], says the state agriculture and food industries minister Datuk Junz Wong on [Tue 16 Jul 2019]. He said Health Department officials in Sabah had detected the virus in a pig farm in Kampung Lubang, Tambunan on [11 Jul 2019].On being informed, the Department of Veterinary Services started inspection at all 7 pig farms within the vicinity. "My officers are…

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Japanese Encephalitis -- IndiaAs many as 872 cases of acute encephalitis syndrome (AES) were reported in Bihar in the year 2019. Of 872 reported cases, 176 died of the disease, said [minister of] State Health and Family Welfare Ashwini Kumar Choubey in a reply to a question in Lok Sabha.Japanese encephalitis [JE] also claimed one life in Bihar; 16 cases of it were reported in the state."In a reply to an unstarred question raised by many parliamentarians on the issue of acute encephalitis syndrome, the government…

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Japanese Encephalitis -- IndiaWith the death of 5 more patients on Sunday [14 Jul 2019], the toll in Japanese encephalitis (JE) cases in Assam rose to 76, a National Health Mission (NHM) bulletin stated. The registered positive JE cases across the state also increased to 348 from 334 on Friday [12 Jul 2019]. The 5 deaths were reported from Darrang, Nalbari, Tinsukia, Kamrup and Udalguri districts, the bulletin said.Giving the cumulative figures for JE/AES (acute encephalitis syndrome), the bulletin said there [had…

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Japanese Encephalitis -- IndiaAs many as 11 positive cases of Japanese encephalitis (JE) have been detected in Arunachal Pradesh, a statement from the health department said on Monday [15 Jul 2019].JE is a flavivirus related to dengue, yellow fever and West Nile viruses, and is spread by mosquitoes. JE is the main cause of viral encephalitis in many countries of Asia with an estimated 68 000 clinical cases every year.Lobsang Jampa, the state's senior statistical officer for integrated disease surveillance programme…

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Japanese Encephalitis -- IndiaThe death toll from Japanese encephalitis (JE) in Assam reached 101 on Friday [19 Jul 2019] even as the state continues to battle flood fury caused by the monsoon rain. State health department officials said special measures are being taken in flood-affected areas to prevent the spread of the disease.On Friday [19 Jul 2019], the daily report from the National Health Mission (NHM) Assam noted 4 more JE deaths. It showed a total of 1569 cases of acute encephalitis syndrome cases, including…

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MERS -- Saudi ArabiaFrom 1-31 May 2019, the National International Health Regulations (IHR) Focal Point of Saudi Arabia reported 14 additional cases of Middle East respiratory syndrome (MERS-CoV) infection, including 5 deaths. Of the 14 cases reported, 4 cases were associated with 2 separate clusters. Cluster 1 involved 2 cases (case no. 6 and case no. 7) living in the same household in Alkharj, Riyadh, and cluster 2 involved one patient (case no. 9) and one healthcare worker (case no. 11) in Riyadh.MERS-CoV…

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Other Animal Disease -- United KingdomA new strain of a disease that is frequently fatal to rabbits has been confirmed for the 1st time in Jersey by New Era Vets. Rabbit viral hemorrhagic disease, also known as VHD [or RHD] is highly contagious for both domestic and wild rabbits and hares. The 2nd strain VHD2, is the one that has been found locally.The virus can be spread through flies, insects, or birds which act as indirect hosts. Humans can also pass it on if they can come into contact with an infected rabbit or…

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Rabies -- CanadaA British Columbia man has died of a rare viral rabies infection, the 1st such case in the province since 2003. Provincial health officer Dr Bonnie Henry says the man was in contact with a bat in mid-May [2019] and developed symptoms compatible with rabies 6 weeks later. She says in a news release that while the exposure in this case was on Vancouver Island, bats in all areas of BC are known to carry rabies.The Health Ministry is not releasing further information about the man to ensure…

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Poisoning -- NorwayTraditional rat poison causes small rodents to die from internal bleeding within a few days. The active substances prevent the blood from clotting. Norway banned the use of rat poison by private individuals in 2014. Yet researchers have found active substances from rodenticides in 54% of the red foxes they examined, according to a recent study."We were surprised how many of the foxes had consumed rat poison. The discovery worries us," says veterinarian and doctoral student Kristin Opdal…

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Salmonella -- FranceFrench authorities are investigating a suspected salmonella outbreak linked to a meat product from Italy. Officials did not reveal how many people were ill, but did say Coppa ham, which is a salted, seasoned, and dry-cured thinly cut pork shoulder or neck product, was thought to be the source.Consumer complaints led the French supermarket Intermarche to alert authorities and withdraw products from sale. The store started the withdrawal of implicated products on 8 Jul 2019. According to the…

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Scrapie -- CanadaTwo sheep flocks in central Alberta have been quarantined by the Canadian Food Inspection Agency (CFIA) for scrapie, a fatal disease affecting the central nervous system of both sheep and goats and is related to mad cow disease. The 2 flocks were quarantined due to scrapie being found in one sheep.The CFIA said in mid-June [2019] it confirmed a sheep had scrapie, and implemented disease-control measures at that farm. It found the diseased sheep had lived on multiple premises, which…

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Sheep/Goat Pox -- RussiaInformation received on [and dated] 12 Jul 2019 from Dr Nikolay Vlasov, deputy head, Federal Service for Veterinary and Phytosanitary Surveillance, Ministry of Agriculture, Moscow, RussiaSummaryReport type: immediate notificationDate of start of the event: 10 Jul 2019Date of confirmation of the event: 11 Jul 2019Reason for notification: recurrence of a listed diseaseDate of previous occurrence: 21 Mar 2019Manifestation of disease: clinical diseaseCausal agent: sheep pox and…

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Undiagnosed -- KenyaThe Baringo County government does not have drugs to treat an outbreak of a bacterial disease among camels, county veterinary director John Wameyo has said. "Going by the symptoms, we have identified the deadly disease as enterotoxaemia -- [a] bacterial disease spread as a result of animals drinking dirty water," he told the Star on Tuesday [9 Jul 2019] [see comment]. "The disease requires special antibiotics and vaccination. As a department, we don't have any stock of medication at the…

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Vesicular Stomatitis -- United StatesVesicular stomatitis is a viral disease that primarily affects horses and cattle and occasionally swine, sheep, goats, llamas, and alpacas. The transmission process of VSV is not completely understood but includes insect vectors such as black flies, sand flies, and biting midges.The incubation period ranges from 2-8 days. Clinical signs include vesicles, erosions, and sloughing of the skin on the muzzle, tongue, ears, teats, and coronary bands. Often excessive salivation is the 1st sign of…

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Vesicular Stomatitis -- Worldwide/UnknownDonaldson AI. Bats as possible maintenance hosts for vesicular stomatitis virus. Am J Epidemiol. 1970; 92(2): 132-6. doi: 10.1093/oxfordjournals.aje.a121185Dr Donaldson may have a point. This may be something the United States Department of Agriculture or a university might choose to pursue and verify.In Panama, vesicular stomatitis virus was found to infect members of 7 mammalian orders, including opossums, xenarthrans (sloths, anteaters, and armadillos), bats, primates, carnivores,…

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West Nile Virus -- GermanyInformation received on [and dated] 10 Jul 2019 from Dr Dietrich Rassow, director for animal health and animal welfare, chief veterinary officer, Directorate of Animal Health and Animal Welfare, Federal Ministry of Food and Agriculture, Berlin, GermanySummaryReport type: immediate notificationDate of start of the event: 3 Jul 2019Date of confirmation of the event: 9 Jul 2019Reason for notification: recurrence of a listed diseaseDate of previous occurrence: 18 Jul…

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West Nile Virus -- GreeceInformation received on [and dated] 15 Jul 2019 from Mrs Chrysoula Dile, head, Animal Health Directorate, Ministry of Rural Development and Food, Athens, GreeceSummaryReport type: immediate notificationDate of start of the event: 9 Jul 2019Date of confirmation of the event: 9 Jul 2019Reason for notification: recurrence of a listed diseaseDate of previous occurrence: 31 Dec 2019Manifestation of disease: sub-clinical infectionCausal agent: West Nile fever virusNature of…

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West Nile Virus -- HungaryBackground: During the 2018 West Nile virus (WNV) transmission season, similarly to other endemic areas in Europe, a large number of human WNV infections were reported in Hungary.Aims: We summarise the epidemiological and laboratory findings of the 2018 transmission season and expand experiences in flavivirus differential diagnostics.Methods: Every patient with clinical suspicion of acute WNV infection was in parallel tested for WNV, tickborne encephalitis virus and Usutu virus (USUV)…

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Equine Influenza -- United KingdomWe reiterate our major concerns regarding future scheduled events that do not require vaccination for attendance and as such our recommendations follow:1. Ensure all horses attending events are vaccinated. We would strongly advise events accept only horses that have had a booster within the past 6 months (rather than annual) and also enforcing the minimum 5-day rule post-vaccination (interval between last vaccine dose and competition entry to have some benefit from that vaccination).2.

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Other Animal Disease -- PolandInformation received on [and dated] 15 Jul 2019 from Dr Pawel Niemczuk, chief veterinary officer, Ministry of Agriculture and Rural Development, POL Ministry of Agriculture and Rural Development, Warsaw, PolandSummaryReport type: immediate notificationDate of start of the event: 23 Jun 2019Date of confirmation of the event: 26 Jun 2019Reason for notification: recurrence of a listed diseaseDate of previous occurrence: June 2010Manifestation of disease: clinical diseaseCausal…

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Botulism -- United StatesHealth officials have now confirmed 3 cases of infant botulism in East Texas, and a possible 4th case is under investigation. "We are certainly curious about where this originated from," said Russell Hopkins, with Northeast Texas Public Health District. According to Hopkins, 2 cases occurred in Troup, one in Mineola, and they are expecting a 4th case to be confirmed in Tyler."We're not really sure what the commonality is, because they are kind of spread out," Hopkins said. "You do have 2…

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Influenza H1N1, Influenza H3N2, Influenza -- MyanmarAt least 21 people have died in Myanmar due to swine flu [influenza A(H1N1)] in the past 2 weeks, according to a health ministry official on Tue [2 Jul 2019]. "Over the past few weeks, 21 including 4 children have died of seasonal H1N1 influenza," said Phyu Phyu Aye, information officer of health and sports ministry.The 1st death related to the H1N1 virus, widely known as swine flu, was reported on [19 Jun 2019]. A total of 99 out of more than 340 patients were tested positive for the…

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Legionnaires' -- United StatesOfficials said 5 guests who stayed at a prominent downtown Atlanta hotel have become sick with legionnaires' disease, prompting an investigation of the hotel on [Mon 15 Jul 2019]. "Based on epidemiological evidence we have an outbreak among people who stayed at the [Sheraton Atlanta] during the same time period," said Nancy Nydam, director of communications at Georgia Department of Public Health, on [Tue 16 Jul 2019].Legionnaires' is a serious form of pneumonia that is non-contagious.