Thursday, June 30, 2011

Bangladesh: Conflicting Bird Flu Reports

 

 


# 5564

 

 

We’ve a curious report today in the Financial Express – the only English language financial daily in Bangladesh – on the level of bird flu activity in that country.

 

Since 2007 we’ve often heard of outbreaks of the H5N1 bird flu virus on poultry farms, and the OIE (to whom reporting of H5 & H7 avian flu is mandatory) lists 34 reports totaling 514 outbreaks since May of that year.

 

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(Photo Credit – OIE Bangladesh H5N1)

The last OIE notification was on May 12th of 2011, which noted 3 recent outbreaks,  and the total number of poultry affected since 2007 is listed as just under 640,000.

 

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(Photo Credit – OIE Bangladesh H5N1 Stats)

 

Which makes the following story in the Financial Express - wherein an Industry leader puts the number of outbreaks at 20 times higher – a bit hard to reconcile.

 

A hat tip to Carol@SC on the Flu Wiki for this link.

 

 

Bird flu wreaks havoc in poultry industry: official

 

Dhaka, Friday July 1 2011

Doulot Akter Mala


A third of the country's farm-raised chicken has been decimated by the latest outbreak of the bird-flu, a top poultry farmer has said Thursday, demanding compensation for the affected farms.

 

He told the FE the government needed to roll up its sleeve and help the affected farms with compensation and vaccines in an effort to prevent Avian Influenza from inflicting a mortal blow to the key industry.

 

"We've estimated that 10,000 to 15,000 poultry firms have been affected by bird-flu. Unfortunately the government shows it only 153," said Syed Abu Siddique, president of the Bangladesh Poultry Industries Association,

(Continue . . . )


 

This makes for a sizeable discrepancy between the claims made by the President of the Bangladesh Poultry Industries Association and what has been officially reported to the OIE.

 

The accuracy of either number is difficult to verify, since the OIE can only report what is voluntarily submitted to them.

 

And between this report, and others, there is obviously a good deal of political pressure being exerted in Bangladesh over current and future tax breaks for the poultry Industry, compensation for culled birds, and the importation of vaccine.

 

A cause that would be bolstered by higher poultry losses.

 

There is also the possibility that Siddique is including LPAI outbreaks – such as H9N2 – in his numbers, although only H5N1 is mentioned in the article.

 

We are left with a bit of a mystery it seems.

 

And while I am a bit skeptical that 95% of the outbreaks in Bangladesh are going unreported - that country remains one of the hotspots for bird flu activity in the world - and so it deserves our continued attention.

Minnesota: Powassan Virus Fatality

 

 

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(Photo Credit- CDC)

# 5663

 

 

News today of the first known death in the state of Minnesota from the Powassan Virus (POW), a rare but sometimes deadly Flavivirus  in the same family of arboviruses  as West Nile Virus (WNV), Dengue Fever, St. Louis Encephalitis, and Yellow Fever.

 

Minnesota’s  Department of Health has details on this fatality in the press release below, after which I’ll return with more on this rare infection.

 

 

News Release
June 29, 2011


Minnesota records first death from tick-borne Powassan virus

State health officials emphasize the importance of preventing tick bites

 

A woman in her 60s from northern Minnesota has died from a brain infection due to Powassan (POW) virus. This is the first death in the state attributed to the disease. One other likely POW case has been identified this year in Minnesota, in an Anoka County man in his 60s who was hospitalized with a brain infection and is now recovering at home. POW virus is transmitted through the bite of an infected tick.

 

Both 2011 cases became ill in May after spending time outdoors and noticing tick bites. The fatal case was likely exposed to ticks near her home. The case from Anoka County might have been exposed near his home or at a cabin in northern Minnesota.

 

Health officials say this death serves as a reminder of the vital importance of preventing tick bites. “Although Powassan cases are rarely identified, it is a severe disease which is fatal in about 10 percent of cases nationwide, and survivors may have long-term neurological problems” said Dr. Ruth Lynfield, state epidemiologist with the Minnesota Department of Health (MDH).

 

“Powassan disease is caused by a virus and is not treatable with antibiotics, so preventing tick bites is crucial.”

(Continue . . . )

 

The Powassan Virus (POW) was first identified in 1958 in Powassan, Ontario following the death of a child from the infection.  Later, a species of ticks (Dermacentor andersoni) collected in Colorado in 1952 were shown to carry the same virus.

 

The virus can be transmitted by the same species of ticks that carry Lyme disease, anaplasmosis, and babesiosis (bacterial or parasitic infections).

 

The animal reservoir for the virus appears to encompass a wide range of mammals. According to the Canadian Cooperative Wildlife Health Center the virus has been identified with:

 

. . . the Woodchuck (Marmota monax) and the tick Ixodes cookei seem to be particularly important, but infection rates can be high in Red Squirrels (Tamiasciurus hudsonicus), Grey Squirrels (Sciurus carolinensis), Eastern Chipmunks (Tamias striatus), Porcupines (Erethizon dorsatum), Deer Mice (Peromyscus maniculatus), voles (Microtus sp.), Snowshoe Hares (Lepus americanus), Striped Skunks (Mephitis mephitis) and Raccoons (Procyon lotor).

 

Human POW infection appears to be very rare, but difficulties in testing, the variability of illness severity, and similarity of symptoms to other illnesses may be clouding that picture.

 

The Minnesota Department of Health advises:

 

How common is POW disease?

Physician-diagnosed POW disease is very rare. Fewer than 60 cases have been identified in the U.S. and Canada since 1958. From 2008-2010, six cases of POW encephalitis or meningitis have been reported in Minnesota. These cases lived in or had visited wooded areas in north central or east central counties (Cass, Carlton, Hubbard, Itasca, or Kanabec).

 

It is possible that other cases of suspected viral encephalitis or meningitis during times of peak tick-borne disease transmission (May to October) are due to POW virus.

 

 

In light of this fatality, the Minnesota Health Department is advising health providers:

 

  • Medical providers should consider the possibility of POW virus infection in patients with central nervous system disease who have recent histories of activities in wooded areas (with or without known tick bites) during Minnesota’s warm weather months.
  • The only laboratories that offer testing for POW virus are at state health departments (including MDH) and CDC. At this time, no commercial laboratories offer serologic testing for the virus.
  • Serum or CSF specimens from patients with central nervous system disease can be submitted directly to the MDH Public Health Laboratory for arboviral disease testing, including POW virus.

 

Complicating matters, the state of Minnesota is facing a potential shutdown of government services at midnight tonight due to a budget impasse that could adversely affect state laboratory testing services.

 

Admittedly, the odds of contracting the Powassan virus are exceedingly low. More people are struck and killed by lightning each year or killed by bee stings.

 

But when you consider the wide panoply of tickborne diseases found in the United States;

 

Lyme disease, anaplasmosis, babesiosis, TBE (tick borne encephalitis), Rocky Mountain Spotted Fever, Ehrlichiosis, STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Rickettsiosis, and Tularemia . . . 

 

. . .  well, the odds of getting sick from a tick bite go up considerably. 

 

Lyme disease alone is considered responsible for 20,000+ infections each year (MMWR  Lyme Disease --- United States, 2003—2005).

 

Which means that preventing tick bites, and looking for and removing ticks as quickly as possible, are important steps to take after visiting tick-endemic areas.

 

Since it is summer, and tick season, a few timely reminders:

 

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Lastly, the CDC offers the following advice:

 

Preventing Tick Bites

While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September) when ticks are most active.

Avoid Direct Contact with Ticks

  • Avoid wooded and bushy areas with high grass and leaf litter.
  • Walk in the center of trails.

Repel Ticks with DEET or Permethrin

  • Use repellents that contain 20% or more DEET (N, N-diethyl-m-toluamide) on the exposed skin for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.
  • Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents. It remains protective through several washings. Pre-treated clothing is available and remains protective for up to 70 washings.
  • Other repellents registered by the Environmental Protection Agency (EPA) may be found at http://cfpub.epa.gov/oppref/insect/.

Find and Remove Ticks from Your Body

  • Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.
  • Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
  • Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs. Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.

Wednesday, June 29, 2011

Arlene: First Tropical Storm of the 2011 Atlantic Season

 

 

# 5662

 

With only a short distance of open water to traverse before reaching the Mexican coastline, T.S. Arlene (named last night) is unlikely to reach hurricane intensity before it makes landfall tomorrow.

 

It should, however, prove to be a significant rainmaker as it slowly moves westward.

 

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Some excerpts from the NATIONAL HURRICANE CENTER’s  7am (CST) advisory:

 

WTNT31 KNHC 291147
TCPAT1

BULLETIN
TROPICAL STORM ARLENE INTERMEDIATE ADVISORY NUMBER   3A
NWS NATIONAL HURRICANE CENTER MIAMI FL       AL012011
700 AM CDT WED JUN 29 2011

...ARLENE EXPECTED TO MAKE LANDFALL IN NORTHEASTERN MEXICO EARLY
TOMORROW...

SUMMARY OF 700 AM CDT...1200 UTC...INFORMATION
----------------------------------------------
LOCATION...21.8N 95.2W
ABOUT 175 MI...280 KM E OF TAMPICO MEXICO

MAXIMUM SUSTAINED WINDS...40 MPH...65 KM/H
PRESENT MOVEMENT...WNW OR 300 DEGREES AT 8 MPH...13 KM/H


MINIMUM CENTRAL PRESSURE...1002 MB...29.59 INCHES

<SNIP>

DISCUSSION AND 48-HOUR OUTLOOK
------------------------------
AT 700 AM CDT...1200 UTC...THE CENTER OF TROPICAL STORM ARLENE WAS LOCATED NEAR LATITUDE 21.8 NORTH...LONGITUDE 95.2 WEST.  ARLENE IS MOVING TOWARD THE WEST-NORTHWEST NEAR 8 MPH...13 KM/H.  A TURN TOWARD THE WEST IS FORECAST LATER TODAY.  ON THE FORECAST TRACK...


ARLENE IS EXPECTED TO MAKE LANDFALL ALONG THE NORTHEASTERN COAST OF MEXICO WITHIN THE WARNING AREA EARLY ON THURSDAY.

 

MAXIMUM SUSTAINED WINDS ARE NEAR 40 MPH...65 KM/H...WITH HIGHER GUSTS.  SOME STRENGTHENING IS FORECAST UNTIL LANDFALL ON THURSDAY.

 

TROPICAL STORM FORCE WINDS EXTEND OUTWARD UP TO 115 MILES...185 KM FROM THE CENTER.

 

 

While posing a minimal threat to the residents along the Mexican coastline, Arlene is a solid reminder that the tropical season is upon us.

 

All residents living within several hundred miles of the Atlantic and Gulf coasts should make advance preparations to deal with these storms.

 

For more on Hurricane Preparedness you may wish to revisit:

 

National Hurricane Preparedness Week 2011

Hurricane Preparedness Week: Inland Flooding

How Not To Be Gone With The Wind

Getting SLOSHed For Hurricane Season

Referral: BFIC on Human Influenza In Indonesia

 

 

 

# 5661

 

 

Ida posting on the Bird Flu Information Corner - a joint project of Kobe University in Japan and the Institute of Tropical Disease, Airlangga University, Indonesia – has been an invaluable source of information on influenza activity in Indonesia for several years.

 

Today, via the BFIC, Ida has an excellent summary (with maps, graphs, & charts) of an article published in the Journal Microbiology and Immunology yesterday titled:

 

Virological surveillance of human influenza in Indonesia, October 2008-March 2010

Masaoki Yamaoka, Justinus F. Palilingan, Jusuf Wibisono, Resti Yudhawati, Reviany V. Nidom, Muhamad Y. Alamudi, Teridah E. Ginting, Akiko Makino, Chairul A. Nidom, Kyoko Shinya, Yoshihiro Kawaoka

Article first published online: 28 JUN 2011

DOI: 10.1111/j.1348-0421.2011.00344.x

 

 

This study is based on a collaborative work between Kobe University and Institute of Tropical Disease, Airlangga University that conducted surveillance in Surabaya from October 2008 to March 2010. 

 

Surveillance of Human Influenza in Indonesia, October 2008-March 2010

Posted by Ida on June 29, 2011

 

Since only the abstract to the study is freely available on the journal site, this summation is highly welcome.

Dr. York Chow Questioned On HK Scarlet Fever Outbreak

 

 

 

# 5660

 

Dr. York Chow, who is an orthopedic surgeon by profession, has been the Secretary for Food and Health in Hong Kong since 2007.  

 

Today (June 29th), the Health Secretary has responded at some length to two urgent questions posed by members of Hong Kong’s LC (Legislative Council) on the ongoing Scarlet Fever outbreak.

 

Under normal rules of procedure, members of the LC must give notice of a question 7 `clear days’ in advance of a public meeting, but under Rule 24(4) a member may ask permission to pose a question if it is `of an urgent character and relates to a matter of public importance’.

 

Both questions, submitted by Hon Chan Hak-kan and Hon Cheung Man-kwong, had some overlap – particularly in regards to the level of SF (Scarlet Fever) activity being reported on the Chinese mainland and in neighboring countries.

 

York Chow conceded that the current outbreak is likely a`regional phenomenon’ - and that the Hong Kong Centre for Health Protection (CHP) is in contact with other health departments in the region and is aware of `a simultaneous increase of SF cases in Mainland China and Macao’

 

But beyond that, he was unable to offer any specifics, noting that scarlet fever is not a notifiable disease in many neighboring countries.

 

When asked to characterize the genetic changes to the bacterium, along with changes to treatment due to antibiotic resistance, he replied:

 

As of June 28, there have been four SF cases with complications and two fatal cases of SF in Hong Kong. Details are set out in the Annex.

 

Laboratory investigation of the two fatal cases showed that two different strains of Group A Streptococcus were involved (emm type 1 and emm type 12).

 

CHP, the Hospital Authority and the University of Hong Kong (HKU) have been working in collaboration on laboratory testing for the bacterium causing SF, including tests on antimicrobial resistance, serotypes, virulence genes and the new gene fragment reported by HKU. Further studies will be done to characterise the role and prevalence of the new genetic change and to project the outlook of the outbreak over time.

 

So far, all the Group A Streptococcus isolates detected are sensitive to penicillin, meaning that all antibiotics belonging to the penicillin group or first generation cephalosporins can effectively treat SF.

 

Local antibiotic resistance surveillance data showed that around 50-60% of Group A Streptococcus isolated in 2011 are resistant to erythromycin (which also predicts resistance to azithromycin and clarithromycin). As a result, antibiotics belonging to the macrolide group (e.g. erythromycin) should not be used as empirical treatment for SF. 

 

 

The health secretary warned that this outbreak was expected to persist into the summer, and that the CHP has stepped up publicity and health education efforts.

 

The complete Q&A’s may be viewed in press releases from the Hong Kong government.

 

LC Urgent Q1: Scarlet fever

LC Urgent Q2: Scarlet fever in Hong Kong and neighbouring areas

 

 

In his remarks, York Chow stated that:

 

Health authorities of Guangdong, Hong Kong and Macao have exchanged the surveillance data and the analysis of SF in view of the rising number of cases this year.

 

Unlike Hong Kong, mainland Chinese officials have a history of holding infectious disease information close to the vest. 

 

So it is disappointing, but not entirely unexpected, that we are not getting any specific numbers from the mainland.

 

Hong Kong, meanwhile, has released their latest daily update, indicating 17 new cases and 1 new outbreak in the last 24 hours.

 

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Tuesday, June 28, 2011

Sweden: First Domestic EHEC Case

 

 

# 5659

 

 

Today, the Smittskyddsinstitutet (Swedish Institute for Communicable Disease Control) announced their first locally acquired case of EHEC due to the same enterohemorrhagic E. coli strain that has recently sickened thousands, and killed dozens, across Germany and parts of Europe.

 

Exactly how this patient Рa middle-aged man from Sk̴ne (southern Sweden) with no history of travel to Germany and no known contact with anyone returning from the region Рcame to acquire the infection is unknown.

 

Of particular concern would be if this virulent strain of E. Coli has managed to get into Sweden’s food supply.  There are other possibilities, of course, including acquiring the bacteria indirectly from contact with another person.

 

Tracking down the source of this infection is now a top priority for local health officials. 

 

This from The Local.se.

 

 

Sweden reports first domestic EHEC case

Published: 28 Jun 11 16:24 CET |

For the first time, a Swede with no connections to Germany has been infected with the virulent enterohaemorrhagic E. coli (EHEC) bacteria that has claimed dozens of lives across Europe, Swedish health authorities reported on Tuesday.

 

“This means that the source of the infection is in Sweden, which is a lot worse, because it might mean that there is some form of infected food product in circulation that we haven’t yet identified, “ said Sofie Ivarsson, epidemiologist at the institute to news agency TT.

(Continue . . . )

 


Meanwhile the latest ECDC update shows roughly 4,000 cases in Germany and 48 related deaths.

 

image

 

Separately, another much smaller outbreak featuring the same E. coli O104:H4 strain has been detected in Bordeaux, France, hospitalizing at least 9 people. 

 

ECDC update on outbreak in Germany and cluster in France

27 Jun 2011

ECDC

On Friday 24 June, France reported a cluster of eight patients with bloody diarrhoea, after having participated in an event in the commune of Bègles around Bordeaux on 8 June. Of these, seven have developed HUS, a severe complication of E. coli infection. In three of the patients, infection with E. coli O104:H4 has been confirmed.

 

The French authorities are investigating this new cluster of STEC - the suspected vehicle of infection for the cases and whether there is any link between that cluster and the large outbreak reported from Germany.

 

Since 25 June in the EU/EEA, 880 HUS cases, including 31 deaths, and 3 039 non-HUS cases, including 16 deaths have so far been reported. ECDC is continuously monitoring the enterohaemorrhagic E. coli (EHEC) and Shiga toxin-producing E. coli (STEC) oubreak in Germany and other EU Member States.

 

 

While the original outbreak in Germany is winding down, two fresh foci of infection – seemingly unrelated to the main outbreak – leave us with many unanswered questions.

 

And so the epidemiological investigation continues.

Referral: McKenna On Drug Resistant E. Coli And Chickens

 

 


# 5658

 

 

Maryn McKenna writing on her Superbug Blog today has the details of a new study out of the Netherlands which appears in the June edition of the CDC’s EID Journal  that takes close look at the genetic make up of drug resistant E. Coli carried by chickens and that carried by humans.

 

As Maryn tells us – assuming this study is correct – this research would appear to provide additional support to many scientist’s concerns over a link between the use of antibiotics in agriculture and the emergence of resistant pathogens in humans.

 

The study may be read at:

 

Volume 17, Number 7–July 2011
Research

Extended-Spectrum β-Lactamase Genes of Escherichia coli in Chicken Meat and Humans, the Netherlands

Ilse Overdevest, Ina Willemsen, Martine Rijnsburger, Andrew Eustace, Li Xu, Peter Hawkey, Max Heck, Paul Savelkoul, Christina Vandenbroucke-Grauls, Kim van der Zwaluw, Xander Huijsdens, and Jan Kluytmans

 

 

But for the short course, by a writer well-versed in the subject, I would refer you to Maryn’s article today.

 

 

Is Drug Resistance in Humans Coming From Chickens?

The Ripple Effect

 

 

# 5657

 

image

 

In a bit of a follow up to yesterday’s blog OECD Report: Future Global Shocks and one from last week called Estimating The Economic Impact Of A San Andreas Quake we’ve a report out of New Zealand (h/t Sally Furniss, Managing Editor of FluTrackers) on the nationwide economic impact of the three recent Christchurch earthquakes.

 

The article, by Marta Steeman of BusinessDay.co.nz, describes how 2/3rds of all businesses in New Zealand have been economically impacted by these quakes – even those well beyond the damaged areas.

 

Quakes affect two-thirds of NZ businesses

MARTA STEEMAN

Last updated 11:22 28/06/2011

The September and February earthquakes have affected nearly two-thirds of New Zealand businesses, according to a 2011 Grant Thornton international survey.

 

The survey indicated 18 per cent of businesses had suffered long-term impacts, 26 per cent medium-term impacts and 20 per cent a short-term hit.

(Continue . . . )

 

 

Businesses in Christchurch, at the center of the quake damage, are the most severely affected with 18% of business establishments destroyed.  Half of businesses cited a fall in demand for their goods and services as being the most significant impact.

 

Another concern - as we saw in New Orleans after Hurricane Katrina – is that many skilled workers have left the Christchurch area since the quakes, further hindering the recovery.

 

But the repercussions have been felt across New Zealand.

 

While not in the category of a `future global shock’, the Christchurch quakes demonstrate how a local disaster can economically impact a much larger area.

 

Just as individuals and families need to be prepared for the immediate impact of a disaster, businesses need to have a robust and practical disaster plan that will keep them functioning during, or shortly after, a crisis.

 

While fortune 500 companies spend big bucks on disaster preparedness and recovery, Small businessesthose with fewer than 20 employees – make up nearly 90% of the companies (that have employees) in the United States.  

 

In 2004 they numbered over 5.2 million firms, which employed nearly 25 million people.In addition, there are nearly 22 million non-employer firms (as of 2007) – essentially self-employed individuals.

 

And these are the business enterprises that are the least likely to be prepared for a local, or global, disaster.

 

Ready.gov, the Small Business Administration,  and the American Red Cross are just a few of the agencies working to help small businesses prepare to survive the next disaster.

 

If you value your job, or your business, you owe it to yourself, and your employees to visit:

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And

image

 

And to avail yourself of the free 123 point assessment survey at the American Red Cross’s Ready Rating Program.

 

image

 

And of course, National Preparedness Month isn’t just for agencies, families, and individuals.

 

It is for businesses as well.

 

image

 

Like death and taxes, disasters are inevitable. 

 

We may not always be able to prevent them, but we can be better prepared to deal with them when they happen.  


And that can make all the difference whether your business ultimately survives or fails.

CHP: Scientific Committee Statement On Scarlet Fever

 

 

# 5656

 

image

Photo Credit – CDC PHIL : Photomicrograph of Streptococcus pyogenes bacteria, 900x Mag.

 


From their Centre For Health Protection we have a consensus view statement issued by the Scientific Committee (SC) on Emerging and Zoonotic Diseases and Scientific Committee on Advanced Data Analysis and Disease Modelling on the ongoing Scarlet Fever outbreak in Hong Kong.

 

You can find previous reports on this outbreak at:

Updating Hong Kong’s Scarlet Fever Outbreak
More On Hong Kong's Scarlet Fever Outbreak
When Old Bacteria Learns New Tricks

 

 

This latest statement, dated 6/27/2011 can be found at:

 

Statement of the Scientific Committee on Emerging and Zoonotic Diseases and the Scientific Committee of Advanced Data Analysis and Disease Modelling on Scarlet Fever

 

Excerpts:

  • The rise of scarlet fever (SF) cases in Hong Kong is likely a regional phenomenon.

 

  • The overall epidemiologic and clinical characteristics of SF cases  in this outbreak  resemble  those  in  the past, although  infrequently some cases may have atypical clinical presentation.

 

  • The case fatality rate so far  is not significantly higher than historical or international figures.

 

  • A number of different Group A Streptococcus (GAS) strains causing SF are circulating in the community.

 

  • The  underlying  reasons  for  the  SF  upsurge  are  being  further investigated,  including  a  new  genetic  fragment  inserted  in  the bacterial genome, clone shuffling effects and others.

 

  • The  contribution  of  new  GAS  clone(s)  with  altered  genetic characteristics  causing  this  outbreak  remains  to  be  further investigated.

  • For patients with  suspected SF,  the penicillin group of  antibiotics  is the treatment of choice and should be given for at least 10 days.

  • Judicious  use  of  antibiotics  is  important  in  preventing  the development  of  bacterial  resistance.    Microbiological  testing  by antigen  testing  and  culture  should  be  considered  to  guide antimicrobial  therapy.    Patients with  only  runny  nose without  fever should not be considered for antimicrobial therapy unless the clinical condition changes or the microbiological test is positive for GAS.

  • High  SF  activity will  probably  persist  for  a  period  of  time  into  the summer.  The situation needs to be closely monitored to guide public health measures.  

The Committee recommends:

  • studies  be  done  to  characterize  the  role  and  prevalence  of  new genetic  changes  and  to  project  the  outlook  of  the  outbreak  over time

  • continued  intensive  surveillance  for  SF  and  invasive  GAS infections including acute rheumatic fever and glomerulonephritis

  • strengthening  publicity  and  education  on  the  appropriate  use  of antibiotics 

  • close  communications  with  healthcare  professionals  on  the progression of  the outbreak and  information pertaining  to clinical diagnosis and management of SF patients

 

 

These views are also summarized in a press release issued today (6/28) from the Centre For Health Protection (CHP):

 

Update on scarlet fever in Hong Kong 

The Scientific Committee (SC) on Emerging and Zoonotic Diseases and Scientific Committee on Advanced Data Analysis and Disease Modelling under the Centre for Health Protection (CHP) of the Department of Health (DH) held a joint meeting today (June 27) to review and discuss the upsurge of scarlet fever (SF) in Hong Kong.

(Continue . . . )

 

As of this writing (0530 EST), the CHP website had not updated their daily tally of Scarlet Fever Cases.  As of yesterday, more than 600 cases had been reported in Hong Kong, and there are reports of thousands more on the mainland.

Monday, June 27, 2011

OECD Report: Future Global Shocks

 

 

 

# 5655

 

 

Now in its 50th year, the OECD (The Organisation for Economic Co-operation and Development) – with 34 Member States – works to stimulate economic progress and world trade.  

image

Today, in a 139 page report, they provide a warning that - as the world becomes more interconnected and interdependent - that `Global Shocks’ to the world economy become more likely.

 

In the report, they define a Global Shock as: a rapid onset event with severely disruptive consequences covering at least two continents.

They write:

Extremely disruptive events, such as earthquakes, volcanoes, financial crises and political revolutions destabilize critical systems of supply, producing economic spillovers that reach far beyond
their geographical point of origin.

 

While such extreme events have been relatively rare in the past, they seem poised to occur with greater frequency in the future. Global interconnections accompanying economic integration enable some risks to propagate rapidly around the world.

 

 

While discussing a wide range of future shock scenarios, the authors concentrated most of their attention on five highly disruptive future shock events.

 

  • A Pandemic
  • A Cyber Attack
  • A Financial Crisis
  • A Geomagnetic Storm
  • Social Unrest/Revolution

 

They also make special note of the risks of increased antibiotic resistance, and the need for new antibiotics to be developed.

 

Although I’ve not yet had time to read the entire 139 page report (or the six background papers and case studies on: Systemic Financial Risk; Pandemics; Cyber Risks; Geomagnetic Storms; Social Unrest and Anticipating Extreme Events) what I have briefly skimmed makes for fascinating reading.

 

For those who want the condensed  version, the OECD has put out a press release, which read at the link below.

 

 

Economy: Global shocks to become more frequent, says OECD

27/06/2011 - Disruptive shocks to the global economy are likely to become more frequent and cause greater economic and societal hardship. The economic spill-over effect of events like the financial crisis or a potential pandemic will grow due to the increasing interconnectivity of the global economy and speed with which people, goods and data travel, according to a new OECD report.

 

Future Global Shocks” analyses five potential major risks in the years ahead: a pandemic, a cyber attack disrupting critical infrastructure, a financial crisis, socio-economic unrest and a geomagnetic storm.

 

The growing threat of a pandemic was highlighted by the SARS outbreak in 2002, which spread quickly from Hong Kong around the world as travellers caught the virus and then flew home. The increasing number of heavily populated megacities, notably in Asia, exacerbates the risk, particularly in business travel, tourism and migration hubs like Dhaka, Manila and New Delhi.

(Continue . . . )

 

 

Today, when a volcano spews ash in Iceland, it can disrupt airline traffic and commerce a thousand miles away in Europe, costing hundreds of millions of dollars.

 

A financial crisis in Greece or Spain can cause economic, social, and political reverberations felt around the world.

 

As we saw in 2003 with SARS – the outbreak of a novel virus in rural China can quickly end up being a public health crisis around the world.

 

And as this report points out, wildfires last year in Russia consumed 20% of their Wheat crop, reducing grain exports and fueling a spike in global food prices, which led to social unrest and revolution in the Middle East this Spring.

 

The point being, that it doesn’t take a disaster to directly hit your community for it to eventually impact your life.

 

Large disasters have ripple effects that can be felt around the globe.

 

Today, it is hard to know what will be the next trigger event that will spark a future global shock.   The world is full of so-called `unknown unknowns’.  

 

Four months ago, few people would have seriously concerned themselves that a 9.0 earthquake, and a 100 foot tsunami, would soon devastate northern Japan, disable four nuclear reactors, and change the view of nuclear energy in many countries around the world.

 

 

But regardless of the source of the next future global shock, being prepared to deal with it is of paramount importance. 

 

For governments, international organizations, and multinational corporations that means detailed risk analysis, contingency planning, and developing a higher order of international cooperation.

 

While you and I can do little about governmental and international preparedness, there is also a role and responsibility for individuals, families, small businesses, and their communities.

 

That’s something that FEMA, Ready.gov, and many other agencies remind us of constantly. That we owe it to ourselves, our families, and our communities to be better prepared do deal with future emergencies and disasters.

 

A nation’s resilience in the face of a major crisis –whether it be local or global - truly comes from the bottom up, not from the top down. 

 

For more on individual and community preparedness, you may wish to revisit:

 

When 72 Hours Isn’t Enough
Planning To Survive
An Appropriate Level Of Preparedness
In An Emergency, Who Has Your Back?
The Gift Of Preparedness

WHO: EHEC Update

 

# 5654

 

 

From the World Health Organization this morning, an update on the EHEC (E. Coli) in Germany, and a few details on the similar outbreak now reported in Bordeaux, France.

 

The good news is that the number of new cases has declined significantly over the past couple of weeks in the German outbreak, and so far, the outbreak in France has been limited to just 8 cases.

 

 

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EHEC outbreaks: Update 24, France reports 8 cases in new outbreak

27-06-2011

Since week 23/2011, the number of reported cases of haemolytic uraemic syndrome (HUS) enterohaemorrhagic Escherichia coli (EHEC) has declined significantly. In Germany, the daily numbers of reported cases have steadily decreased since they peaked on 22 May. Nevertheless, the cumulative numbers of cases from Germany continue to rise, primarily owing to delays in notification.

 

Investigations by the German authorities indicate that the vehicle of the bacterium responsible for the outbreak, enteroaggregative verocytotoxin-producing E. coli (EAggEC VTEC) O104:H4, is bean and seed sprouts, and the Robert Koch Institute has warned people in Germany not to eat raw sprouts of any origin.

 

On 24 June, France reported an outbreak of verocytotoxin-producing E. coli (VTEC)/HUS with 8 cases in adults (6 women and 2 men). E. coli O104:H4 has been confirmed in 3 cases. Investigations are ongoing, but the first findings suggest that locally grown sprouts might be involved. Intensive traceback is under way to identify a possible common source of the German and French sprout seeds. Other potential vehicles are also under investigation.

 

The table shows the reported cases of and deaths from HUS and EHEC infection as of 24 June at 15:00 CET. It does not include the 8 cases reported by France on 24 June, as these are considered a separate outbreak.

 

In Germany, the latest date of onset of diarrhoea is 22 June for HUS cases and 20 June for EHEC cases. All but 5 of the above HUS and EHEC cases were in people who had travelled to or lived in Germany during the incubation period for infection, typically 3–4 days after exposure (range: 2–10 days). The remaining 5 cases can also be linked to the outbreak in Germany.

Note

EHEC and HUS have exclusive notification categories, so case numbers should not overlap. The figures in any rapidly evolving outbreak, however, are provisional and subject to change for a variety of reasons.

 

In providing the above information, WHO wishes to recognize the contribution of its Member States, and technical partners such as the European Commission, the European Centre for Disease Prevention and Control and a number of WHO collaborating centres.

PTSD Awareness Day

 

 

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# 5653

 

Today, June 27th, has been designated National PTSD Awareness Day by the Congress of the United States.

 

PTSD (Post Traumatic Stress Disorder) is a stress response that some people experience after a traumatic event that may include anxiety, depression, suicide, and may lead to drug and alcohol-related disorders.

 

The United States Department of Veterans Affairs has taken the lead in PTSD awareness and research, but the victims of PTSD are far more widespread than just military personnel returning from war zones.

 

Victims of personal violence, rescue and medical workers, victims of disasters, terrorism, physical or psychological trauma, and/or a combat zone are all at risk of PTSD.

 

From the National Center For PTSD today, some resources including videos on how to conduct Psychological First Aid.

 

 

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Psychological First Aid: Field Operations Guide

Psychological First Aid

For disaster responders

Developed jointly with the National Child Traumatic Stress Network, PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short and long-term adaptive functioning. It is for use by first responders, incident command systems, primary and emergency health care providers, school crisis response teams, faith-based organizations, disaster relief organizations, Community Emergency Response Teams, Medical Reserve Corps, and the Citizens Corps in diverse settings. The 5th appendix consists of Handouts for Survivors (PDF).

Online training on how to provide Psychological First Aid is available from http://learn.nctsn.org/, and you can view a series of videos about the process that are available on the PFAOnlinevideos Channel of Youtube.

 

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Updating Hong Kong’s Scarlet Fever Outbreak

 

 


# 5652

 

 

From Hong Kong’s Centre For Health Protection (CHP) this morning, we’ve updated numbers as of mid-day Monday on their Scarlet Fever outbreak.

 


Over the 72 hours of the weekend, 71 new cases have been reported. The number of fatalities (2) remains unchanged from last week.

 

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While accurate numbers have been impossible to come by, local reporting indicates that scarlet fever is spreading on the mainland of China as well.

 

The number being reported in the media today (9,000 cases) is the same as we heard early last week, suggesting that surveillance and reporting from the mainland is less than robust.

 

In a long and informative Associated Press report by Margie Mason, we learn some new details regarding the two antibiotic resistant strains circulating in this outbreak.

 

Mutated scarlet fever fuels Hong Kong outbreak

By MARGIE MASON , 06.27.11, 03:30 AM EDT

 

 

The gist being that two mutated strains of group A Streptococcus that are causing this outbreak both show signs of increased resistance to erythromycin and clindamycin, long considered the standard treatment for the illness. 

 

Fortunately, they remain susceptible to penicillin and some newer drugs of last resort. 

 

Once a common scourge of children, scarlet fever has been largely controlled by the use of modern antibiotics. What happens should this new strain develop penicillin resistance as well is a major concern of scientists.

 

 

According to Kwok-yung Yuen - head of Hong Kong University's microbiology department -  the more dominant of the two strains has undergone a genetic mutation that appears to make it more contagious as well.

 

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(Source CDC Scarlet Fever Webpage)

For some background on Scarlet Fever this morning, we’ve a 5 minute CDC Podcast on the illness from last February.

 

Scarlet Fever

Katherine Fleming-Dutra, pediatrician, discusses scarlet fever, its cause, how to treat it, and how to prevent its spread.

Katherine Fleming-Dutra, pediatrician, discusses scarlet fever, its cause, how to treat it, and how to prevent its spread. Created: 6/9/2011 by National Center for Immunization and Respiratory Diseases (NCIRD). Date Released: 6/9/2011. Series Name: CDC Featured Podcasts.

More info on this topic

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(click image to load page)

Running time = 5:09

To save the Podcast, right click the "Save this file" link below and select the "Save Target As..." option.

save Save This File (5MB) [right click]

 


For now, even with the availability of antibiotics, prevention of the disease is the best course of action.  To that end, the CDC recommends:

 

Preventing Infection: Wash Those Hands

The best way to keep from getting infected is to wash your hands often and avoid sharing eating utensils, linens, towels or other personal items. It is especially important for anyone with a sore throat to wash his or her hands often. There is no vaccine to prevent strep throat or scarlet fever.

Sunday, June 26, 2011

UK: Updated Sprout Safety Statement

 

 


# 5651

 

Even as the sprout-linked  EHEC outbreak in Germany drags on, a new (and similar) outbreak has been reported in Bordeaux, France - with seven people hospitalized.

 

This report from Deutsche Presse-Agentur.

 

French E coli outbreak likened to deadly German drama

Jun 26, 2011, 10:05 GMT

Paris - This week's outbreak of E Coli in the south-western French city of Bordeaux bears the hallmarks of the outbreak that claimed dozens of lives in Germany, French media reports said Sunday.

(Continue . . . )

 

 

As a possible link to a UK supplier of sprout seeds has been mentioned (but not confirmed), the UK’s Food Standards Agency has issued a revised safety statement on the preparing and handling of sprout seeds.

 

 

Updated sprouted beans statement

Saturday 25 June 2011

About us forks

Following further cases of E. coli in France, the Food Standards Agency is revising its guidance on the consumption of sprouted seeds such as alfalfa, mung beans (usually known as beansprouts) and fenugreek.

 

As a precaution, the Agency is advising that sprouted seeds should only be eaten if they have been cooked thoroughly until steaming hot throughout; they should not be eaten raw.

 

The investigations into the outbreak of E. coli in France have suggested a possible link to sprouting seeds from a company based in the UK. To date, no cases of food poisoning have been reported in the UK linked to the outbreak in France. We are in close contact with the Health Protection Agency who is actively monitoring the situation.

 

The Agency also advises that equipment which has been used for sprouting seeds should be cleaned thoroughly after use. You should always wash your hands after handling seeds intended for planting or sprouting.

Saturday, June 25, 2011

Just A Matter Of Time

 

 

"Time Is What Prevents Everything From Happening At Once.." - John Wheeler, Theoretical Physicist (1911-2008)

 

 

# 5650

 

 

Just over 311 years ago an earthquake and tsunami – likely on par with this year’s disastrous quake in Japan - struck the coastline of the Pacific Northwest.

 

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While there were no contemporaneous local records kept of the event, roughly 10 hours later an `orphan tsunami’ spawned by this quake struck Japan, where records of such events have been kept for centuries.


Scientists today, looking at sediment levels and tree growth rings, can easily see some of the impact of this great quake.

 

And if you go back through the geological record, you’ll find massive quakes have struck the region at least 7 times over the past 3500 years. Given enough time, another is sure to strike sometime in the future.

 

Perhaps tomorrow, or perhaps not for hundreds of years.  

 

Fortunately, the last great event occurred at a time when that region of the world was sparsely inhabited – more than a hundred years before the celebrated Lewis & Clarke expedition.

 

Little was known about that part of the world at the time, and cartographers left that portion of the map blank. The map below was drawn roughly 20 years after this last great quake.

 

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But today, millions of people live along the coastline that runs from Vancouver Island to Northern California, and another megathrust quake could kill thousands, injure tens of thousands, and deliver a terrible economic blow.

 

While Southern California gets most of the press when it comes to earthquake concerns, the potential for a truly great quake (8.0+ mag.) is actually higher in Seattle.

 

After the recent Ring Of Fire earthquakes in Chile, New Zealand, and Japan – and the devastating Indonesian earthquake and Tsunami of 2004 – earthquake researchers are speaking with renewed urgency about the potential for seismic destruction and the need to prepare.

 

An Active Ring of Fire

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Original Map – USGS

 

 

This week geologists met in Portland, Oregon to discuss what they consider to be an inevitable event – another megathrust earthquake along the Cascadian fault line.

 

Details of that meeting, and an interview with Oregon State University Professor Chris Goldfinger, appear in yesterday’s Oregonian.

 

Experts say an earthquake surely will devastate the Northwest

Published: Friday, June 24, 2011, 9:26 PM     By Richard Read, The Oregonian 

 

A brief tour this morning of some videos on the Cascadian earthquake threat, and a referral to a couple of preparedness sites.

 

First stop, a short demonstration of an earthquake model by University of Washington Seismologist William Steele in this KOMO News feature.

 

 

Next stop, a simulation from the Washington State Department of Transportation that shows the likely effects on the Alaskan Way Viaduct, part of Washington's State Route 99, and adjacent seawall from a 7.0 earthquake.

 

 

A bit less dramatic perhaps, but extremely informative, is the 35 minute science lecture by Geologist Brian Atwater, PhD, of the USGS and University of Washington, who discusses the 1700 Cascadian earthquake and the `orphan tsunami’ that struck Japan.

 

 

Dr. Atwater is also one of the authors of the 140 page USGS paper :

 

The Orphan Tsunami of 1700—Japanese Clues to a Parent Earthquake in North America

 

Since we can’t prevent earthquakes, and accurate prediction of when they will occur is beyond our technology, our only recourse is to prepare for them.

 
And that means upgrading building codes, improving emergency services infrastructure and surge capacity, and promoting individual, family, and business preparedness.

 

Last January I profiled a Washington state based preparedness educator Carol Dunn, who maintains an excellent website on the hazards faced by those living in the Pacific Northwest called 2Resilience.

You’ll find numerous resources geared for professional first responders, citizen volunteers, and families, individuals, and businesses looking to improve their level of knowledge and preparedness.

 

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Many of us who follow @Caroldn on Twitter find her dedication and enthusiasm on preparedness issues to be quite contagious.  And if your interests lie in that direction I’d certainly recommend you include her feed.

 

Another resource I strongly recommend is Shakeout.org, which promotes yearly earthquake drills and education around the country.

 

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Upcoming drills include:

 

Future ShakeOuts (new and repeating):
The Great British Columbia ShakeOut, October 20, 2011, with 780 participants currently (2010: 470,000)
The Great California ShakeOut, October 20, 2011, with 6.4 million participants currently (2010: 7.9 million)
The Great Nevada ShakeOut, October 20, 2011, with 389 participants currently (2010: 110,000)
The Great Guam ShakeOut, October 20, 2011, with 21 participants currently (2010: 38,000)
The Great Utah ShakeOut, April 17, 2012, with over 110,000 participants

 

For more on how you can prepare for `the big one’ (even if you live someplace other than Los Angeles), I would recommend you download, read, and implement the advice provided by the The L. A. County Emergency Survival Guide.

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To become better prepared as an individual, family, business owner, or community to deal with these types of disasters: visit the following preparedness sites.

 

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

 

Because no matter where you live, its just a matter of time before the next disaster strikes.

Friday, June 24, 2011

Referral: McKenna On E. Coli

 

 

 

# 5649

 

This week we’ve seen a number of new journal articles on Germany’s EHEC outbreak, appearing in The Lancet , Eurosurveillance Journal, and the NEJM.

 

Maryn McKenna gives us an excellent walk-thru of their findings this morning in her SUPERBUG BLOG post:

 

E. coli: Some Answers, Many Questions Still

 

Highly Recommended.

 

And for a terrific (ongoing) multi-part series on HUS (Hemolytic Uremic Syndrome) – a devastating complication in some toxic E. Coli infections - I would refer you to Tara C. Smith’s Aetiology Blog.

Pssst! Immunity . . . Pass it On

 

 

 

# 5648

 

 

Two related stories today involving expectant mothers and vaccines that have been in the news over the past 48 hours.

 

Both suggest that one of the best ways to protect a newborn baby against influenza and pertussis is to vaccinate the mother before she gives birth.

 

In both cases, newborn infants are too young to receive vaccines during the first months out of the womb, but may acquire limited immunity from antibodies passed on from the mother.

 

First from the Advisory Committee On Immunization Practices (ACIP) meeting this week, a recommendation that pregnant women and other adults who will be in close contacts with a soon-to-be born infant receive the Pertussis vaccine.

 

CIDRAP has the details in last night’s news scan. 

 

 

ACIP recommends pertussis vaccine for pregnant women


To protect infants in a time of increasing pertussis cases, pregnant women as well as teens and other adults in close contact with newborns should receive pertussis (whooping cough) vaccine, an advisory group to the US Centers for Disease Control and Prevention (CDC) said yesterday. The panel, the Advisory Committee on Immunization Practices (ACIP), also recommended meningococcal vaccine for high-risk infants at 9 months, according to MSNBC. The CDC still needs to decide on the recommendations but often follows ACIP guidance.

(Continue . . . )

 

 

A second report, this time from Wake Forest Baptist Medical Center, revolves around a study that appears this month in American Journal of Obstetrics & Gynecology.

 

Impact of maternal immunization on influenza hospitalizations in infants

American Journal of Obstetrics and Gynecology, 2011; 204 (6): S141 DOI:

Katherine A. Poehling, Peter G. Szilagyi, Mary A. Staat, Beverly M. Snively, Daniel C. Payne, Carolyn B. Bridges, Susan Y. Chu, Laney S. Light, Mila M. Prill, Lyn Finelli, Marie R. Griffin, Kathryn M. Edwards.

 

It found that by analyzing data collected by CDC and the New Vaccine Surveillance Network between 2002 and 2009 (before the H1N1 pandemic), that infants born to mothers who had received the flu vaccine during pregnancy were more than 45% less likely to be hospitalized with laboratory confirmed influenza.

 

This isn’t the first time that studies have shown the benefits to the newborn child derived from maternal vaccination.  

 

Last October, in Study: Protecting Two With One Shot I blogged on Lisa Schnirring’s CIDRAP News story regarding a study that showed that babies born to mothers who received the flu vaccination experienced fewer infections and hospitalizations during their first six months than babies whose mothers did not.

 

And two years before that, we had a study conducted in Bangladesh (see CIDRAP’s Study: Flu shots in pregnant women benefit newborns) that offered pretty much the same conclusion.

 

Pregnant women (and their unborn child) are at particularly high risk from influenza due to changes in the mother’s immune system during pregnancy.  This is something I’ve written about often, mostly recently in BMJ: Perinatal Outcomes After Maternal 2009/H1N1 Infection.

 

Which is why the CDC encourages pregnant women to get the flu vaccine.

 

Pregnant Women Need a Flu Shot!

Photo: A woman with her healthcare professional.

Photo Credit – CDC

If you're pregnant, a flu shot is your best protection against serious illness from the flu. A flu shot can protect pregnant women, their unborn babies, and even their babies after birth.

 

(Continue . . .)

 

 

 

While the importance of maternal flu vaccination has been stressed in pediatric journals in the past, this most recent study is geared for the OB/GYN audience, which will hopefully induce them to recommend flu shots to their patients.

 

For more on this, here is a link to the Press Release.

 

Wake Forest Baptist Medical Center

Influenza vaccination during pregnancy protects newborns

WINSTON-SALEM, N.C. – June 23, 2011 – Infants born to mothers who received the influenza (flu) vaccine while pregnant are nearly 50 percent less likely to be hospitalized for the flu than infants born to mothers who did not receive the vaccine while pregnant, according to a new collaborative study by researchers at Wake Forest Baptist Medical Center and colleagues.

(Continue . . . )

 

 

And for more on the re-emergence of Pertussis in this country, you may wish to read:

 

California Reports 9th Pertussis Fatality of 2010
California Whooping Cough (Pertussis) Update
California: Pertussis Epidemic