Spain: MOH Statement On Ebola Infected Nurse & News Roundup

 

# 9155

 

In a follow up to yesterday’s report (see Nurse `Infected With Ebola’ In Madrid, Spain) we are seeing more details emerge, including demands from the EU for clarification on how this infection could have occurred (see AFP article EU demands explanation from Spain on Ebola case) in a modern hospital that knew they were receiving and treating an Ebola case.

 

ABC News is reporting that Spain Places Husband of Ebola Nurse in Quarantine – a reasonable precaution given his risks of exposure – and that the MOH is drawing up a list of others who may have had contact with this nurse so that they can be monitored.

 

Although we know how to protect against infection with the Ebola virus, the reality is, no system of infection control is infallible.  There are reports overnight in the media of complaints over `substandard PPEs’ provided by the Spanish hospital, although authorities are still insisting all proper infection control procedures were followed.

 

Quickly getting to the bottom of how this exposure occurred – and making adjustments to prevent it from happening again -  will be paramount to prevent a crisis of confidence in the ability of modern hospitals to take in, and care for Ebola cases,  without endangering their staff.  

 

For now, the Spanish MOH is being circumspect on releasing details of this nurse’s contacts, or travel history, during the six days after she began to feel unwell, but was not isolated.  A tactic that, unfortunately, may lead to more intense speculation online and in the media.

 

While it isn’t currently visible from the front page of Spain’s Ministry of Health website, there is now a brief press release posted under the  Actualidad (news)  banner.

 

Press Releases

Diagnosed a secondary case of Ebola virus infection

The patient was isolated at the Hospital La Paz Carlos III

The patient is a member of the medical staff who treated Manuel García Viejo

The Minister of Health, Social Services and Equality, Ana Mato, sends a message of calm and highlights the absolute coordination with health authorities both nationally and internationally

6 October 2014 The Minister of Health, Social Services and Equality, Ana Mato, today reported the detection of a secondary case of Ebola virus infection in our country. The minister, who appeared together with the Director General of Public Health, Mercedes Vinuesa, Director of Primary Care, Community of Madrid, Antonio Alemany and healthcare professionals of the Community, explained that this is a medical technician who treated the Manuel García patient Viejo. After the symptoms have been detected and confirmed infection, remains hospitalized in isolation at the La Paz Hospital Carlos III.

The minister explained that the Ministry and the public health authorities of the Community of Madrid are working in a coordinated and are taking every step to give the best care to the patient and to ensure the safety of the population and health personnel . It has also indicated that it is investigating the source of infection.

He also stressed the absolute international coordination and recalled that Spain collaborates with the World Health Organization (WHO). Finally, you have moved a message of reassurance to all citizens.

Japan: Locally Acquired Dengue Cases Rise To 34

Credit Wikipedia

 

# 9026

 

Less than a week ago, in Japan Reports 1st Locally Acquired Dengue Case In 60 Years, we learned of a teenage girl  (without recent travel history outside the country), living in Saitama prefecture (near Tokyo) who had been diagnosed with Dengue fever.

 

This marks Japan’s first locally acquired case of the mosquito-borne virus since the 1940s (although a German tourist came home from a trip to Japan with Dengue in 2013).

 

In less than six days the number of Dengue cases reported from Japan has jumped to 34, with nearly all of them associated with recent visits to the  popular Tokyo destination Yoyogi Park (once part of the 1964 Olympic Village) , which is adjacent to the Harajuku railway station and Meiji Shrine in Shibuya.

Dengue fever cases jump to 34 as outbreak spreads around Japan

September 02, 2014

THE ASAHI SHIMBUN

Health ministry officials announced on Sept. 2 that 12 more cases of dengue fever have been confirmed from mosquitoes at Tokyo's Yoyogi Park, with the outbreak spreading farther across the country.

The latest patients reside in Tokyo, Osaka, Aomori and Yamanashi prefectures. Like the 22 other cases already confirmed, the 12 individuals have not gone abroad recently, but have visited Yoyogi Park in Shibuya Ward and its vicinity.

(Continue . . . )

 

While having a common, geographically-limited source may make eradicating their infected mosquitoes easier, the danger exists that visitors to the park either have, or will carry the virus to infect other mosquito populations in Japan. 

 

We’ll know that has happened if cases not associated with Yoyogi Park begin to emerge. 

 

While dengue infected mosquitoes may not survive Japan’s winter, the yearly influx of millions of tourists – many from regions of the world where Dengue is endemic – all but assures the virus will be re-introduced to Japan’s mosquito population in the future.

 

The World Health Organization estimates 100 million people are infected with Dengue each year, and 500,000 are sickened enough to require hospitalization.  The WHO considers Dengue to be the most rapidly spreading mosquito borne viral disease in the world, and that increasingly it is posing a threat to both Europe and North America. 

Countries at risk for Dengue Transmission

For more on the spread of Dengue around the world you may wish to revisit these recent blogs:

 

PAHO/WHO: Epidemiological Alert On Chikungunya & Dengue In the Americas

Florida: Miami Reports 1st Locally Acquired Dengue Case Of 2014

Locally Acquired Dengue In New York City.

Florida: Miami Reports 1st Locally Acquired Dengue Case Of 2014

 

 

# 8819

 

Although details are scant at this time, and a press conference is promised for 1:30 this afternoon, local media in Miami Florida (and now the local health department) are reporting the first locally acquired case of Dengue in Florida for 2014.  First the report, from the local NBC News affiliate, followed by a link to the health department announcment:

 

Miami-Dade Dengue Fever Case is 1st of 2014

Wednesday, Jul 9, 2014  |  Updated 12:11 PM EDT The first locally acquired case of Dengue Fever in Miami-Dade in 2014 has been confirmed, state health officials said Wednesday.

The patient was diagnosed based on symptoms and confirmed by laboratory tests and has fully recovered from the illness, the Florida Department of Health said in a statement.

More details on the case will be given at an afternoon news conference.

(Continue . . . )

Press Releases

July 9, 2014

First Locally Acquired Case of Dengue Fever in Miami-Dade County in 2014

FOR IMMEDIATE RELEASE

MEDIA AVAILABILITY

First Locally Acquired Case of Dengue Fever in Miami-Dade County in 2014

(Miami, July 9, 2014) – Florida Department of Health in Miami-Dade County officials received confirmation of the first locally acquired case of Dengue Fever in Miami-Dade County in 2014.

The individual was diagnosed with Dengue Fever based on symptoms and confirmed by laboratory tests. The individual has fully recovered from this illness.

The Florida Department of Health in Miami-Dade County will hold media availability (information as follows).

Who: Lillian Rivera, RN, MSN, PhD

Administrator

Florida Department of Health in Miami-Dade County

Edhelene (Gigi) Rico, MPH

Epidemiologist

Florida Department of Health in Miami-Dade County

Chalmers Vasquez

Mosquito Control Operations Manager

Miami-Dade County Public Works and Waste Management Department

Date: Wednesday, July 9, 2014

Time: 1:30 p.m.

(Continue . . . )

Up until 2009, Florida had kept dengue at bay for  6 decades.  But one (or likely, more than one) infected international travelers arrived in Key West, and the virus seeded into the local mosquito population (see MMWR: Dengue Fever In Key West).

 

Since then, we’ve seen sporadic locally acquired dengue cases in south Florida(see Florida: Dengue Forces Suspension Of Blood Donations In Two Counties), likely due to repeated `reseeding’ of the virus among local mosquito populations.

 

In 2013, Florida recorded 120 imported cases of Dengue (plus 23 locally acquired cases).  

 

 

So far, in 2014, Florida has reported 24 imported cases of Dengue (see the most recent arbovirus surveillance report). 

Miami-Dade Announces 2nd Locally Acquired Dengue Case

 

 

 

# 5350

 

 

When it comes to mosquito activity in Florida, February is normally about as quiet as it gets.  The weather is cool – or sometimes cold – and we’ve usually been in droughty conditions for a couple of months.

 

Aedes aegypti

 

In fact, the latest Florida mosquito vector surveillance report, issued less than a week ago stated:

 

Florida Arbovirus Surveillance

Week 8: February, 20 – February 26, 2011

 

During the period February 20, – February 26, 2011, the following arboviral activity was recorded in Florida:

• DENV activity: No new cases of dengue associated with Key West were reported this week.
• EEEV activity: No EEEV activity was reported this week.
• WNV activity: No WNV activity was reported this week.
• SLEV activity: No SLEV activity was reported this week.
• HJV activity: No HJV activity was reported this week.

 

Not much activity, although Miami-Dade County was listed as being under a mosquito-borne illness advisory.

So it comes as a bit of a surprise that yesterday the Miami-Dade County Health department issued a statement confirming their second locally acquired case of Dengue in the past 50 years.

 

 

News
Press Releases

March 2, 2011

Second Locally Acquired Case of Dengue Fever in Miami-Dade County

 

(Miami, FL – March 2, 2011) – Miami-Dade County Health Department officials received confirmation of the second locally acquired case of Dengue Fever in Miami-Dade County.

 

The individual was diagnosed with Dengue Fever based on symptoms and confirmed by laboratory tests. The individual fully recovered from this illness.

 

Dengue Fever is a viral disease transmitted by a type of mosquito common to the southeastern United States and the tropics.  It is not spread from person to person.  The symptoms of Dengue Fever include, fever (over 101 degrees Fahrenheit), severe headache, severe pain behind the eyes, muscle, joint and bone pain, rash, loss of appetite, nausea and vomiting. There is no specific medication or vaccine for Dengue Fever.  If you are experiencing symptoms consistent with Dengue Fever, please call your healthcare provider to see if you need to be seen.

(Continue . . . )

 

Exactly when this individual was infected wasn’t disclosed, nor do we know which of the four serotypes of Dengue was involved. 

 

All we are told is that the patient recovered.

 

Each year usually see a couple of hundred imported cases of Dengue and/or Malaria among travelers who had recently visited areas where those viruses are endemic.

 

Two years ago – for the first time in more than 50 years – we started to a small number of locally acquired Dengue cases showing up in Key West (see MMWR: Dengue Fever In Key West), and in 2010 they totaled 65 cases in Key West and 1 each in Broward and Miami-Dade County.

 

Through aggressive mosquito control efforts during the 1940s, Dengue and Malaria were both eliminated from Florida – and remained so for nearly a half century. 

 

Since 1990 there have been a few scattered suspected (and confirmed) cases of locally acquired malaria in Florida, including one l reported on last December (see Florida: Locally Acquired Malaria Case Suspected).

 

But with millions of visitors arriving each year, many from regions where these diseases are endemic, it is basically only a matter of time before someone who is infected arrives – is bitten by a mosquito – and that mosquito manages to carry the virus on to someone else.

 

The CDC’s MMWR in a report last May on Locally Acquired Dengue in Key West, had this to say:

 

Cases of dengue in returning U.S. travelers have increased steadily during the past 20 years (8). Dengue is now the leading cause of acute febrile illness in U.S. travelers returning from the Caribbean, South America, and Asia (9).

 

Many of these travelers are still viremic upon return to the United States and potentially capable of introducing dengue virus into a community with competent mosquito vectors.

 

 

In truth, it may take many such introductions of Dengue or Malaria to an area before the right combination of weather, insect vectors, and ongoing transmission occur to enable it to get a foothold in a community.

 

But when it does, it can be very difficult to completely eradicate.

 

The explosive growth of Dengue around the world is well illustrated by the following graph from the World Health Organization.

 

What this graph doesn’t indicate is a doubling of dengue cases over the past 5 years.  

 

PAHO, in this pdf file, dated December 10th, showed more than 1.5 million cases reported during 2010 in the Americas alone (many more are likely undiagnosed).

 

 

 

For a fascinating podcast on the efforts of Florida’s mosquito control efforts, I would direct you to an episode of Vincent Racaniello’s TWiV taped last December with regulars Alan Dove & Rich Condit.

 

Joining them are Ed Fussell, Andrea Leal, and Amy Sargent of the Florida Keys Mosquito Control District at Florida Gulf Coast University (Ft. Myers) in a 105 minute show on Dengue in Florida and Mosquito control in the Florida Keys.

 

TWiV 111: Live at Florida Gulf Coast University

 

 

Although the overall risk of contracting a mosquito-borne illness in Florida remains very small, scattered cases of Dengue (along with West Nile, EEE, SLEV, and other rare arboviral threats) are why Florida health departments continue to urge people to remember to follow the `5 D’s’:

 

 

 

A few mosquito-disease centric posts from last year include:

 

Florida: Locally Acquired Malaria Case Suspected

 

ASTMH: Dengue and Insect-Borne EIDs In The US

 

Eastern Equine Encephalitis (EEE)

 

Making Themselves At Home

Update On The Florida Dengue Cases