CDC Alert Issued Concerning Outbreak of Human Salmonella Typhimurium Infections Associated with Contact with Water Frogs

African Dwarf Frog

CDC is collaborating with public health officials in many states to investigate a multistate outbreak of human Salmonella serotype Typhimurium infections due to contact with water frogs including African Dwarf Frogs. Water frogs commonly live in aquariums or fish tanks. Amphibians such as frogs and reptiles such as turtles, are recognized as a source of human Salmonella infections.  In the course of routine assessment, a number of cases with the same strain have been identified over many months.

As of 12pm EST on December 7, 2009, 48 individuals infected with the outbreak strain of Salmonella Typhimurium have been reported from 25 states.  The number of ill persons identified in each state is as follows: Arizona (1), California (2), Colorado (2), Florida (1), Georgia (1), Idaho (1), Illinois (5), Kentucky (1), Louisiana (1), Massachusetts (2), Maryland (2), Michigan (3), Minnesota (1), Missouri (2), Mississippi (1), New Jersey (2), New Mexico (1), New York (1), Ohio (2), Pennsylvania (3), Tennessee (2), Texas (3), Utah (6), Virginia (1), and Washington (1).

Among the persons with reported dates available, illnesses began between June 24, 2009 and November 14, 2009.  Infected individuals range in age from <1 year old to 54 years old. Seventy-seven percent (77%) of patients are younger than 10 years old and the median age is 4 years.  Fifty-five percent (55%) of patients are female.  No deaths have been reported.

Map of human Salmonella cases

For further details see < http://www.cdc.gov/salmonella/typh1209/ > .

Recent rabies reports

New York  12/08/09  cbs2.com:  The New York City health department has issued a rabies warning for the very heart of Manhattan.  Two rabid raccoons discovered this week in Central Park brings the annual citywide total of cases to 20, reported CBS station WCBS-TV. The infected animals are dead, but the emerging pattern has the Health Department on alert.  “With the finding of these racoons within a fairly short time frame, it suggests the virus is being transmitted from raccoon to raccoon, which also suggests that we can expect to find more,” said the Health Department’s Sally Slavinsky.

South Carolina  12/08/09  wyff4.com:  Six people are under the care of a physician after an incident in Williamston involving a dog that has tested positive for rabies, said the S.C. Department of Health and Environmental Control.  “The dog was a pet but it was not vaccinated against rabies,” said Sue Ferguson of DHEC’s Bureau of Environmental Health. “The dog attacked two people at a residence, and four other people have been potentially exposed to the dog in recent days.”  This is the fifth confirmed rabid dog in the state this year and the eighth confirmed rabid animal in Anderson County in 2009.

New York  12/08/09  wktv.com:  Otsego County Health officials have confirmed that a raccoon tested positive for rabies on December 7th. The raccoon was found fighting with a dog in Unadilla on December 2nd. The dog did not have a rabies vaccination and was put to sleep. This is the seventh animal to test positive for rabies in Otsego County this year.

West Virginia  12/07/09  register-herald.com:  Last week in downtown Lewisburg, Greenbrier County Animal Control Officer Robert McClung shot and killed a raccoon that later tested positive for the rabies virus.  Saying this was the first rabid raccoon he has heard of in the city limits during his three-year tenure with the county, McClung shot the animal only about 6 to 8 feet from the entrance to the True Value hardware store on Court Street at around 9:20 a.m. Thursday.  Greenbrier County has been plagued by a rabies outbreak this year, with well over 40 cases confirmed since the first of the year, with most occurring in the Frankford/ Renick and White Sulphur Springs areas.

Connecticut  12/07/09  courant.com:  A rabid skunk was discovered in a yard on Woodlawn Avenue (in the town of Enfield) on Sunday afternoon, police said, one of several recent incidents involving rabid animals.  State labs confirmed rabies in the skunk, police said.  In other cases, a girl was scratched by a rabid raccoon that was chasing people on Elm Street, a sick skunk was found in a yard on Post Office Road and two rabid raccoons were killed in the southern portion of town.

Rhode Island  12/03/09  warwickonline.com:  The Department of Environmental Management has received positive confirmation of rabies in a raccoon that was found in Roger Williams Park in Providence last week. A veterinarian who works near the park retrieved the already deceased animal and brought it to the Department of Health Laboratory for testing. There have been no reports of human or animal contact with this raccoon. Finding rabies in this location is a public health concern due to the large number of people who use the park.

Florida  12/03/09  nflaonline.com:  The Suwannee County Health Department issued a rabies alert for Suwannee County Wednesday, according to department officials.  “The alert is in response to a positive laboratory result from a cat,” wrote Pamela Blackmon, Suwannee County Health Department administrator, in a formal notice. The alert ends 60 days from the release date unless another incident occurs within the area.

West Virginia  12/03/09  cbs59.com:  The Greenbrier County Health Department said an animal control officer and the White Sulphur Springs police chief were called about a raccoon staggering in the street on Dry Creek Road in White Sulphur Springs on Monday.  When the officers responded, they found the raccoon and shot it. A second raccoon ran out from beneath concrete and charged the men. It was also shot, but it was damaged in such a way that rabies testing was impossible. The other raccoon did test positive for rabies. Five of the last 10 rabies cases in Greenbrier County have been in the White Sulphur Springs area in neighborhoods along Howard’s Creek.

South Carolina  12/03/09  wyff4.com:  A woman who was bitten by a fox near U.S. Highway 25 south of the city of Greenwood Dec. 1 is under the care of a physician after the animal tested positive for rabies, the S.C. Department of Health and Environmental Control said Thursday. “The woman was walking to her truck when she was attacked and bitten by the fox,” said Sue Ferguson of DHEC’s Bureau of Environmental Health.  This is the ninth confirmed rabid animal in Greenwood County in 2009. Last year, there were nine rabid animals confirmed in the county. In 2008, there were 166 confirmed cases of rabies in animals in South Carolina. So far this year, there have been 142 confirmed cases in animals in the state.

North Carolina  12/03/09  mooresvilletribune.com:  Iredell County Animal Services has confirmed a skunk that recently bit a dog in northern Iredell County had rabies — the 17th confirmed case of the disease this year.  The number of rabies cases in Iredell in 2009 is nearly double the 2008 total of 10. Iredell County ranks sixth in the state in the number of cases, she said.  The cases in Iredell this year involved cows, raccoons, skunks and foxes, Royal said. Most cases, more than half, involve skunks.

Domestic cat in California tests positive for bubonic plague

California 12/04/09  turnto23.com:  The Kern County Department of Public Health has confirmed a test result positive for Y. pestis, the bacteria that causes plague, conducted on a domesticated cat from Hart Flat, (between Bakersfield and Edwards AFB) California.  A test on another cat in the same household is pending. The Vector Control Section of the California Department of Health Services and the Kern County Environmental Health, which is now part of Public Health, are collaborating to investigate these cases. There is no evidence of human infection at this time, Kim Rodriguez with the KCDPH said. One of the symptomatic cats is responding well to antibiotics, but one of the cats has died, Rodriguez said. Plague, infection with the bacteria Y. pestis, is endemic throughout the southwest United States, including much of Kern County. Each year numerous mammals, including domestic cats, are identified with evidence of infection with Y. pestis, Rodriguez said.  Cats are believed to be the domestic species most susceptible to plague.

CDC study confirms need for broader educational outreach to bear hunters concerning the risk of trichinellosis

Kodiak Bear

Problem/Condition: Trichinellosis is a parasitic disease caused by roundworms of the Trichinella genus. Humans are incidental hosts who become infected after ingestion of raw or undercooked meat containing encysted larvae of Trichinella spp.

 

Polar Bear

Description of System: Trichinellosis is a reportable disease in 48 states and has been a nationally notifiable disease since 1966. Cases are defined by clinical characteristics and the results of laboratory testing for evidence of Trichinella infection. States report cases to CDC through the National Notifiable Diseases Surveillance System.

Results: During 2002–2007, a total of 18 states reported 66 cases of trichinellosis to CDC. Of these 66 cases, 12 (18%) were excluded from analysis; eight did not meet the case definition, two were unaccompanied by case report forms, and two had been included previously in the 1997–2001 surveillance summary. Four states accounted for 31 (57%) cases: California (11 cases), Alaska (10 cases), New York (five cases), and Pennsylvania (five cases). Three states in the West (Alaska, California, and Washington) reported 21 (39%) cases, seven states in the Northeast (Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont ) reported 17 (31%) cases, four states in the Midwest (Michigan, Minnesota, North Dakota, and Ohio) reported 10 (19%) cases, and three states in the South (Florida, Maryland, and Tennessee) reported six (11%) cases. (One case reported in Illinois was excluded.) Of the 54 cases that were analyzed, 35 (66%) occurred in males and 19 in females. For the

Black Bear

53 (98%) patients whose age was known, the median age was 39 years (range: 2–73 years). Date of illness onset was known for 42 (78%) patients. Five cases occurred in the winter, 16 in the spring, nine in the summer, and 12 in the fall; for 10 cases, the onset date was known, but the associated meat product was unknown.

The source of infection was identified for 43 (80%) patients. Of the 43 cases with known source of infection, pork was associated with 10 (23%) cases: seven with commercial pork, two with noncommercial pork, and one with an unknown type of pork. Of the seven cases associated with commercial pork, five were linked to U.S. commercial pork and two to pork consumed while traveling in Asia. The two cases associated with noncommercial pork were linked to wild boar meat: one with wild boar meat from a farm and one with wild boar meat from a farmers’ market. Of the 43 cases for which a suspected meat product was identified, non-pork products were associated with 27 (63%) cases; bear meat was associated with 21 (78%) of these cases. Of the six cases not associated with bear meat, two were attributed to consumption of U.S. commercial beef and one each to cougar meat, deer meat, either walrus or seal meat, and either bear or deer meat. Six patients reported consuming both pork and non-pork products, but the infected meat product could not be distinguished.

 

Grizzly Bear

Interpretation:

The number of reported trichinellosis cases attributed to commercial pork consumption remains low. The greatest number of cases continues to be associated with consumption of meat other than pork, especially bear meat.

Public Health Action: For the incidence of trichinellosis in the United States to be reduced further, education regarding safe food preparation practices and prevention of trichinellosis should be targeted toward hunters and other consumers of wild game meat, especially bear.

To read complete surveillance report go to

< http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5809a1.htm?s_cid=ss5809a1_e >.

Florida’s Sarasota County reports first case of Rocky Mountain Spotted Fever since 2005

CDC Map of American Dog (aka Wood) Tick Range in US

Florida  11/07/09  examiner.com:  A 52 year old Sarasota man recently contracted Rocky Mountain Spotted Fever (RMSF) while clearing brush, but has since fully recovered. This is the first case of RMSF seen in Sarasota County since 2005.  RMSF is a tick borne disease caused by the organism, Rickettsia rickettsii. The most common vector is the American Dog Tick, also known as the Wood Tick.  Typically, the

Dog Tick aka Wood Tick

progress of the disease is a sudden onset of high fever, deep muscle pain, severe headache and chills.  A rash usually appears on the extremities within 5 days then spreads to the palms, soles and finally the torso.  Fatalities have been seen in more than 20% of untreated cases. Death is uncommon with prompt recognition and treatment. Still approximately 3-5% of cases seen in the U.S. are fatal.

Texan dies of West Nile Virus infection, while North Dakota records lowest number of human cases in seven years

 

CDC Final map of Human West Nile Virus cases in the U.S. 2008

Texas  12/01/09  dallasnews.com:  A 66-year-old Denton man died Sunday from the West Nile virus, his family said.  Charlie Mac Sweatman had been sick for nine weeks, said his son, Gary Sweatman. Doctors first believed he had the flu and then meningitis, Gary Sweatman said. Twenty days after the elder Sweatman became ill, doctors diagnosed him with West Nile virus.  Denton County officials would not confirm a name but did confirm a West Nile death of a person with underlying medical conditions.

North Dakota  11/30/09  inforum.com:  North Dakota has recorded its lowest summer count of human West Nile cases since the virus was found in the state seven years ago. Only one human case was confirmed by the state Health Department, and the West Nile threat is over because freezing temperatures this fall have killed the mosquitoes that transmit the disease. Michelle Feist is the Health Department’s West Nile virus surveillance coordinator. She says having only one human case of West Nile is unusual. She says there likely were several reasons, including the weather and people taking more precautions. The highest human case total in North Dakota was 617 in 2003.

Columbia Study Finds That One Deer Tick Bite Can Lead to Multiple Infections

National  11/18/09  prweb.com:  According to a recent study conducted at the Columbia University Center for Infection and Immunity in New York City, as many as 70% of deer ticks are capable of passing on conditions like Lyme disease and recurring fevers to the humans they bite.  The results corroborate what many have feared; more ticks are carrying more pathogens.

Deer Tick

Published in the September issue of the peer-reviewed Vector-Borne and Zoonotic Diseases, the study describes deer ticks as carriers of a “plethora of pathogens” potentially dangerous to humans. The most common disease-producing bacterium found in the roughly 300 New York deer ticks examined was Borrelia burgdorferi—the infectious organism that causes Lyme disease.

Researchers additionally found some deer ticks (2%) to be carriers of the Powassan virus, which can lead to a severe central nervous infection, along with life-threatening brain swelling and inflammation caused by encephalitis.

Although Lyme disease is most common in the Northeast, it’s been found in all 50 states. Those who live, or spend time, in grassy or wooded areas are most at risk. According to the Centers for Disease Control (CDC), more than 20,000 cases of Lyme disease are reported each year. Yet because most doctors do not report new cases of Lyme disease to the CDC, the actual number of new Lyme disease cases each year has been estimated to be as high as 200,000, says Connecticut-based neurologist Harriet Kotsoris, M.D., medical director of Time for Lyme—a non-profit organization working to eliminate tick-borne diseases through research, education and both state and national legislation.

“Couple the study results with these statistics, and it’s no wonder the CDC has classified Lyme disease as a health epidemic,” Dr. Kotsoris continues, adding that since 1991 the number of those infected with Lyme disease has doubled.

Because deer ticks can carry multiple disease-producing bacteria and microorganisms, it’s also possible for a human to develop two or more infections from one bite, researchers say. The Columbia study found that in addition to the bacteria that leads to Lyme disease, it is common for deer ticks (scientifically known as Ixodes scapularis ticks) also to carry:

• Babesia microti, a parasite that can infect red blood cells causing a condition known as Babesiosis.  Some people with the infection never experience symptoms.  In others, the flu-like symptoms can be life threatening;
• Anaplasma phagocytophilum, a bacterium that can lead to an infectious disease called anaplasmosis.  Threated with antibiotics, symptoms are flu-like and generally range from mild to moderate; and
• Borrelia miyamotoi, a bacterium that is similar to the Borrelia lonestari, but has not yet proven to cause disease in human, though it is found in about 2% of ticks.

This study was made possible by a grant funded in part by Time for Lyme and the Columbia Lyme Center to support a fellowship to the lead investigator, microbiologist and Columbia postdoctoral research scientist Rafal Tokarz, Ph.D., an expert on tick-borne illnesses in humans.

“The results corroborate what many have feared—that more ticks are carrying more pathogens, and that without physician and public education, we could have a skyrocketing health crisis on our hands,” Dr. Kotsoris adds.

Congress is currently considering legislation that would mandate the U.S. Department of Health and Human Services to create a Tick-Borne Diseases Advisory Committee to coordinate efforts and improve communication between the federal government, medical experts, physicians and the public.

About Time for Lyme
Time for Lyme is an organization dedicated to eliminating the devastating effects of Lyme disease and other tick-borne illness. Its mission is to prevent the spread of disease, develop definitive diagnostic tools and effective treatments, and to ultimately find a cure for tick-borne illness by supporting research, education, and the acquisition and dissemination of information. In addition, TFL continues to act as an advocate for Lyme disease sufferers and their families through support of legislative reform on the federal, state and local levels. www.timeforlyme.org.

Connecticut study shows significant increase in % of ticks infected with Lyme Disease and Babesiosis

Blacklegged Tick

Connecticut  11/27/09  connpost.com:  The percentage of black-legged ticks in the area infected with at least two disease-causing microbes — the bacteria that cause Lyme disease and the parasite that causes babesiosis (see posts dated Nov 5^th and 6^th) — may be much higher than previously thought.   A new study, performed by Dr. Eva Sapi of the University of New Haven, collected ticks in four towns in northern Fairfield County — Bethel, Newtown, Redding, and Ridgefield.  It found that in 2009, about 90 percent of the ticks tested had the Lyme disease bacteria. The same study showed about 30 percent of ticks tested had babesia, the parasite that causes the malaria-like illness babesiosis.

Range of blacklegged tick

“To be honest, it doesn’t surprise me at all,” said Maggie Shaw, of the Newtown Tick-borne Disease Committee, Friday. “I’ve had babesiosis. My daughter has had babesiosis.”  Dr. Gary Schleiter, chief of infectious diseases at Danbury Hospital, said that the hospital also has seen an increase in cases of people with babesiosis recently.  “It’s been around here for years, but in the past two or three years it seems to be increasing,” he said. “This study confirms what we’ve been seeing.”  The study, done in coordination with the Fairfield County Municipal Deer Management Alliance, is in the second year of a three-year project.

Kirby Stafford of the Connecticut Agricultural Experiment Station in New Haven has tested the blood of engorged ticks sent to the station and found much lower rates of Lyme infection in the state — as low as 13.6 percent in Newtown and 23 percent statewide in 2008.  At the same time, the number of Lyme disease cases in the state is rising, according to the state Department of Public Health. The state reported 3,896 confirmed cases of Lyme disease reported in Connecticut in 2008, compared to 3,058 in 2007.  By most accounts, that number under-counts the actual number of Lyme cases by a factor of 10.