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LEISHMANIASIS, CUTANEOUS - ISRAEL
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Date: Sat, 1 Sep 2012
Source: http://www.jpost.com/Health/Article.aspx?id=283337


Cutaneous leishmaniasis spreads from Tiberias to Dimona, Israel
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"Rose of Jericho" skin disease has recently spread westward to cities and
towns from Tiberias to Dimona, along the Jordan Valley.The Environmental
Protection Ministry, together with the Health Ministry, will launch a
program to fight the spread of the serious skin disease leishmaniasis, which
has recently spread westward to cities and towns from Tiberias to Dimona,
along the Jordan Valley.

Dubbed "Rose of Jericho," the disease is caused by protozoan parasites that
belong to the genus Leishmania and is transmitted by the bite of female sand
fly that bite infected rodents called rock hyraxes.

The cabinet approved the program this week. Cutaneous leishmaniasis is the
most common form of leishmaniasis, while visceral leishmaniasis is a severe
form in which the parasites have migrated to the vital organs. The infection
appears as red sores (hence its nickname) on the skin a few weeks or months
after being bitten by the sand fly that erupt weeks to months after the
person affected is bitten by sand flies. The infection can also damage the
liver and spleen and cause anemia. The sores can cause permanent, ugly scars
if untreated.

The government decided to invest NIS 10 million [2 489 000 US dollars] in the effort, with municipalities and local authorities where the sand flies have spread to receive money to buy fly traps and run public information campaigns to
minimize infection.

Localities that are known to have infected hyraxes will be surrounded with
fences to bar their entry. In the past decade, more than 1650 Israelis from
50 communities have been diagnosed with the disease.

Environmental Protection Minister Gilad Erdan said leishmaniasis affects
children and adults and can leave them with disfigurement and worse.
Infected sandflies have been identified in hot areas around Lake Kinneret
(the Sea of Galilee), on the hills of Judea and Samaria, and in central
Galilee, the Beit She'an Valley, Gush Etzion, Elkana, the Ramat Hanegev and
the Arava.

The money will be spent over three years. Individuals can purchase sand
flies repellants, install screens on windows and wear long, light clothing
to protect the skin from bites.


[Byline:
Judy Siegel-Itzkovich]

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NOVEL CORONAVIRUS - SAUDI ARABIA: HUMAN ISOLATE
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Date: Sat 15 Sep 2012
From: Ali Mohamed Zaki [edited]


A new human coronavirus was isolated from a patient with pneumonia by Dr Ali Mohamed Zaki at the Virology Laboratory of Dr Soliman Fakeeh Hospital Jeddah Saudi Arabia.

The virus was isolated from sputum of a male patient aged 60 years old presenting with pneumonia associated with acute renal failure. The virus grows readily on Vero cells and LLC-MK2 cells producing CPE in the form of rounding and syncetia formation.

[The clinical isolate] was initially tested for influenza virus A, influenza virus B, parainfluenza virus, enterovirus and adenovirus, with negative results. Testing with a pancoronavirus RT-PCR yielded a band at a molecular weight appropriate for a coronavirus. The virus RNA was tested also in Dr. Ron Fouchier's laboratory in the Netherlands and was confirmed to be a new member of the beta group of corononaviruses, closely related to bat coronaviruses. Further analysis is being carried out in the Netherlands.

The Virology Laboratory at the Dr Fakeeh Hospital will be happy to collaborate with others in studies of this virus.

--
Ali Mohamed Zaki
Professor of Microbiology
Dr Fakeeh hospital Jeddah Saudi Arabia


[ProMED-mail welcomes the opportunity to communicate Dr Ali Mohamed Zaki's invitation.

Human coronaviruses were 1st isolated in the mid 1960's from volunteers at the Medical Research Council Common Cold Unit in Salisbury, England. The family _Coronaviridae_ is comprised of a group of RNA-containing viruses that are associated with respiratory infections in humans and animals, including pigs, cats, dogs, mice and chickens. The group was so named because of the crown-like projections on its surfaces. Coronaviruses are enveloped viruses with a positive-sense RNA genome and with a nucleocapsid of helical symmetry. The genomic size of coronaviruses ranges from approximately 26 to 32 kilobases.

The classification of the coronaviruses is complex and subject to progressive revision. There are at least 3 genera: The genus _Alphacoronavirus_, which includes bat, human and porcine viruses; the genus _Betacoronavirus_, which includes a murine species; and the genus _Gamacoronavirus_, which includes avian and marine mammal coronaviruses. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1HAJ.]

NOVEL CORONAVIRUS - SAUDI ARABIA (02): ADDITIONAL CASES, REQUEST FOR INFORMATION
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[1]

Date: 23 Sep 2012
Source: Bahrain News Agency
http://www.bna.bh/portal/en/news/525747


Saudi Health Ministry Announces Diagnosis of New Form of Coronavirus
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Saudi Ministry of Health announced Sunday that a new form of the coronavirus was diagnosed in 3 people causing the death of 2 of them; the 3rd is still undergoing treatment. The Ministry explained that, with the rapidly changing weather at this time of the year and with the start of the Hajj season a new strain of coronavirus has been recovered from 3 patients.

Coronaviruses are considered to be one of the common etiological agents of the common cold. The 1rst case was a Saudi patient diagnosed in one of the hospitals in Jeddah; the 2nd was a Saudi patient and the 3rd a Gulf State patient both diagnosed in London, England. Two of the patients passed away and the 3rd patient is still under treatment. The Ministry said that the coronaviruses are well known and most of those who are diagnosed with it recover completely with no complications after receiving the needed supportive therapy.

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[2]
Date: 23 Sep 2012
Source: Arab News / Saudi Arabia Ministry of Health Press Release [edited]
http://www.arabnews.com/saudi-ministry- ... oronavirus


Saudi Ministry of Health announcement on Coronavirus
-----------------
Saudi Ministry of Health announced Sunday [23 Sep 2012] that a new form of the coronavirus was diagnosed in 3 people causing the death of 2 of them; the 3rd is still undergoing treatment.

The Ministry explained that, with the rapidly changing weather at this time of the year and with the start of the Hajj season a new strain of coronavirus has been recovered from 3 patients. Coronaviruses are considered to be one of the common etiological agents of the common cold. The 1st case was a Saudi patient diagnosed in one of the hospitals in Jeddah; the 2nd was a Saudi patient and the 3rd a Gulf State patient both diagnosed in London, England. Two of the patients passed away and the 3rd patient is still under treatment.

The Ministry said that the coronaviruses are well known and most of those who are diagnosed with it recover completely with no complications after receiving the needed supportive therapy. In minority of the patients who are infected with this novel strain; complications can develop affecting the respiratory system and the kidneys and can cause death especially among the elderly and in patients with chronic respiratory & cardiac conditions and among immunocompromised patients.

The ministry assured the public that such occurrences are rare and the overall health conditions are stable and there are no reasons for concern. And encourages those who would like to perform Hajj and Umra from within the kingdom or from abroad to take the necessary precautions and recommended vaccines recommended by the government of Saudi Arabia and pay special attention to personal hygiene, and hand cleansing, to wear masks in crowded places and change them frequently.

The Ministry would like to affirm that it will continue to monitor the situation locally, regionally and globally in close coordination with concerned departments and the international health authorities.

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[As mentioned by Mod.CP, in the 1st post on this novel coronavirus in Saudi Arabia "The family _Coronaviridae_ is comprised of a group of RNA-containing viruses that are associated with respiratory infections in humans and animals, including pigs, cats, dogs, mice and chickens." (see prior ProMED-mail post Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733).

The coronavirus family has been identified as the etiology of many of the varieties of upper respiratory illnesses in humans referred to as the common cold. Oftentimes 1st reports of novel diseases are associated with severe clinical presentations including fatalities. Upon further community based studies, new diseases with severe early presentations are found to be less severe as studies reveal the overwhelming majority of infected individuals have had either subclinical infections (no disease) or very mild clinical presentations (i.e. "the common cold"). Concern is raised when there are reports of severe illness in otherwise healthy individuals when infected by a novel organism.

One question that arises here is whether these 3 individuals had predisposing illnesses which would lead to more severe disease with organisms usually associated with mild disease. Another question is whether community based studies are underway to determine how widespread transmission of this organism is, and what might be the "true" case fatality rate (CFR) -- right now the information available suggests the CFR is 67 percent (2 out of 3 known cases), but if there are many infected individuals with mild disease, that would significantly lower the CFR. Another observation/clarification that Mod.CP raised is that it is not entirely certain that this virus is the same one described in the 1st report. That virus (from the 1st report) was sent to the Netherlands, whereas diagnosis and the identification of some of these 3 isolates seems to have been done in London.

Given the rapid identification of new cases shortly following the identification of the 1st case, it strongly supports an observation that the Saudi MoH is monitoring the situation closely and appropriately with a focus on the upcoming mass gathering of the Hajj in Saudi Arabia.

For the HealthMap/ProMED-mail interactive map of Saudi Arabia and the Gulf States, see http://healthmap.org/r/1HAJ. - Mod.MPP]

NOVEL CORONAVIRUS - SAUDI ARABIA (03): UNITED KINGDOM HEALTH PROTECTION AGENCY, WHO, QATAR
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In this report:
[1] HPA press release
[2] HPA notice for professionals
[3] WHO GAR



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[1] HPA press release

Date: 23 Sep 2012
Source: Health Protection Agency UK press release [edited]
http://www.hpa.org.uk/NewsCentre/Nation ... dentified/


The Health Protection Agency (HPA) can confirm the diagnosis of one laboratory confirmed case of severe respiratory illness associated with a new type of coronavirus. The patient, who is from the Middle East and recently arrived in the UK, is receiving intensive care treatment in a London hospital.

In recent months, this new human coronavirus was also identified in a patient with acute respiratory illness in Saudi Arabia, who subsequently died.

Coronaviruses are causes of the common cold but can also include more severe illness, such as the virus responsible for SARS (Severe Acute Respiratory Syndrome). This new virus, however, is different from any that have previously been identified in humans. Preliminary enquiries have revealed no evidence of illness in contacts of these 2 cases, including healthcare workers. Based on what we know about other coronaviruses, many of these contacts will already have passed the period when they could have caught the virus from the infected person.

We are also aware of a small number of other cases of serious respiratory illness in the Middle East in the past 3 months, one of whom was treated in the UK but has since died. This person's illness is also being investigated although there is no evidence at present to suggest that it is caused by the same virus or linked to the other 2 cases. No other confirmed cases have been identified to date in the UK.

Professor John Watson, head of the respiratory diseases department at the HPA, said: "The HPA is providing advice to healthcare workers to ensure the patient under investigation is being treated appropriately.

"In the light of the severity of the illness that has been identified in the 2 confirmed cases, immediate steps have been taken to ensure that people who have been in contact with the UK case have not been infected, and there is no evidence to suggest that they have.

"Further information about these cases is being developed for healthcare workers in the UK, as well as advice to help maintain increased vigilance for this virus. This information is also being shared with national and international authorities including the World Health Organization and the European Centre for Disease Control.

"As we are aware of only 2 cases worldwide and there is no specific evidence of ongoing transmission, at present there is no specific advice for the public or returning travellers to take but we will share any further advice with the public as soon as more information becomes available."

Notes for editors:

Laboratory confirmed cases to date
Saudi Arabia:1
UK: 1

For further information, see the Q&A that has been developed on this topic. [see http://www.hpa.org.uk/webw/HPAweb&HPAwe ... 7136202755]
Further information has also been produced for health professionals. [see [2] below]

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[2] HPA notice for professionals
Date: 23 Sep 2012
Source: Health Protection Agency UK (HPA) release for Health Professionals [edited]
http://www.hpa.org.uk/webw/HPAweb&HPAwe ... 7136202801


Information for professionals: novel corona virus
On [21 Sep 2012] a novel corona virus was identified in lower respiratory tract specimens of a Qatari national who was receiving treatment for a severe respiratory illness in London. The virus is the same as a novel corona virus recently identifed by Dutch researchers in lung tissue from a national from Saudi Arabia who was ill previously with pneumonia. These are currently the only 2 known cases where this virus has been isolated.

There are a variety of corona viruses and these include viruses causing common cold symptoms and other types causing the much more serious illness of SARS. In light of the seriousness of the illness in these 2 patients and the unknown nature of the novel coronavirus, the current patient is being managed in strict respiratory isolation and any staff caring for them must wear full personal protective equipment - FFP3 respirator (staff should be fit tested), goggles, gown and gloves. Anyone who was in close contact with the patient while the patient was ill is being followed up - this includes healthcare workers who provided direct clinical or personal care or examination of the case while they were symptomatic.

The incubation period is currently considered to be up to 7 days and therefore any respiratory illness occuring in the 7 days following last contact with this case is considered relevant and staff should alert their manager / occupational health service as soon as possible. Symptoms would include fever, cough, or other respiratory symptoms.

At the current time any person recently returning from Saudi Arabia or Qatar with a serious respiratory illness should be managed in strict respiratory isolation (ideally a negative pressure room) and all staff should wear PPE as described above.

Clinicians who think they may have a patient meeting the above criteria should call the fever service on 0844 7788990.

Individuals with health concerns or queries should contact their occupational health department.

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[3] WHO GAR
Date: 23 Sep 2012
Source: WHO Global Alert and Response [edited]
http://www.who.int/csr/don/2012_09_23/en/index.html


On [22 Sep 2012], the United Kingdom (UK) informed WHO of a case of acute respiratory syndrome with renal failure with travel history to the Kingdom of Saudi Arabia (KSA) and Qatar.

The case is a previously healthy, 49-year-old male Qatari national that presented with symptoms on [3 Sep 2012] with travel history to the KSA prior to onset of illness. On [7 Sep 2012], he was admitted to an intensive care unit (ICU) in Doha, Qatar. On [11 Sep 2012], he was transferred to the UK by air ambulance from Qatar. The Health Protection Agency of the UK (HPA) conducted laboratory testing and has confirmed the presence of a novel coronavirus.

The HPA has compared the sequencing of the virus isolate from the 49-year-old Qatari national with that of a virus sequenced previously by the Erasmus University Medical Centre, Netherlands. This latter isolate was obtained from lung tissue of a fatal case earlier this year [2012] in a 60-year-old Saudi national. This comparison indicated 99.5 percent identity, with one nucleotide mismatch over the regions compared.

Coronaviruses are a large family of viruses which includes viruses that cause the common cold and SARS. Given that this is a novel coronavirus, WHO is currently in the process of obtaining further information to determine the public health implications of these 2 confirmed cases.

With respect to these findings, WHO does not recommend any travel restrictions. Information regarding requirements and recommendations for the Hajj season in 2012 can be found at http://www.who.int/ith/updates/20120730/en/index.html.

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[The above reports from the Health Protection Agency (HPA) of the UK and WHO provide a bit more information on the background of the tested cases reported in the previous post (see Novel coronavirus - Saudi Arabia (02): additional cases, RFI 20120923.1305931) and addresses the question raised by Mod.CP concerning the viral identifications. According to the HPA report, there have been only 2 confirmed cases with severe disease associated with this novel coronavirus, the 1st from a Saudi Arabian national (see Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733) and the 2nd from a Qatari national treated in the UK. Apparently, the 3rd case mentioned in the previous ProMED-mail report today [23 Sep 2012] is a suspected case under investigation but not as yet confirmed to have been infected with this coronavirus. Information from the WHO report includes information that the 2nd case (the Qatari national) was a previously healthy 49-year-old male with a history of travel to Saudi Arabia prior to onset of illness, raising the possibility that infection may have taken place in Saudi Arabia.

From the information provided above it is clear there is a heightened level of awareness on the international level for the need for a rapid investigation on the possible implications of a novel coronavirus associated with severe disease. Concerns regarding the upcoming mass gathering in a region where this virus has been identified are clearly present, and the approach of implementing "active surveillance" (actively searching for cases) is highly appropriate to better define the epidemiology of this newly identified novel coronavirus.

For the HealthMap/ProMED map of the middle east region showing Saudi Arabia and Qatar, see http://healthmap.org/r/1HAJ. - Mod.MPP]

NOVEL CORONAVIRUS - SAUDI ARABIA (04): REQUEST FOR INFORMATION, JORDAN, APRIL 2012
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Date: Sun 23 Sep 2012
From: Irene Lai [edited]


I would be interested to know whether the outbreak of severe respiratory disease of unknown origin in Jordan in April [2012] is now being reviewed for evidence of this new coronavirus.

The HPA UK reports (http://www.hpa.org.uk/NewsCentre/Nation ... dentified/) seem to indicate that the cases under review were only those that occurred since July [2012]. "We are also aware of a small number of other cases of serious respiratory illness in the Middle East in the past 3 months."

This ECDC report from May [2012] (http://ecdc.europa.eu/en/publications/P ... 202012.pdf):
Severe respiratory disease of unknown origin - Jordan - Outbreak in ICU
Opening date: [26 Apr 2012] Latest update: 3 May 2012

Epidemiological summary
-----------------------
An outbreak of a respiratory illness was reported on [19 Apr 2012] by the Ministry of Health in an intensive care unit in a hospital in Zarqa, Jordan. 7 nurses and one doctor were among the 11 affected. One of the nurses died. Jordan's Ministry of Health acknowledges the fatal case specifying she had underlying conditions and all cases had high fever and lower respiratory symptoms. According to the Ministry, the origin of the infection is likely to be viral. However, laboratory results are not available to date.

ECDC assessment
---------------
ECDC is following this event due to its severity including one fatality and the unusualness of the disease affecting healthcare staff. These cases drew high media attention this week [week of 3 May 2012].

Actions
-------
ECDC contacted both Episouth, WHO, and US CDC for further information. Both WHO and US CDC are following this event.

--
Communicated by:
Irene Lai MD
Medical Director
Medical Information and Analysis
International SOS
Level 3, 45 Clarence Street
Sydney NSW 2000


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[2]
Date: Sun 22 Apr 2012
Source: Jordan Times [edited]
http://jordantimes.com/Infectious+disea ... ikat-47253


Emergency team searching for cause of unidentified illness
----------------------------------------------------------
The disease that broke out in the Intensive Care Unit of Zarqa Public Hospital late last week [week of 19 Apr 2012] has not yet been identified, but the outbreak is under control, Minster of Health Abdul Latif Wreikat said on Sunday [22 Apr 2012].

The ministry on Friday [20 Apr 2012] closed the hospital's ICU after an unknown illness believed to be pneumonia affected 7 nurses, one of whom died on Thursday [19 Apr 2012], one doctor, and the brother of one of the nurses.

The minister said that so far, only 11 people have been confirmed infected with the disease, 4 of whom are receiving treatment and responding positively to medication, while 6 others have already been discharged from the hospital.

The ministry has set up an emergency team from its Communicable Diseases Directorate to investigate the cause of the illness, he said.

"The ministry's team took samples from the infected citizens, who also underwent intensive care measures to identify the cause," Wreikat told reporters at a press conference on Sunday [22 Apr 2012], noting that the infected patients' symptoms are similar to those of pneumonia.

The minister, who visited the Zarqa hospital on Saturday [21 Apr 2012], said the ministry has confirmed that the outbreak has been brought under control and that the infected individuals are not in danger of spreading the disease to others.

Meanwhile, the minister said, the hospital has been sterilised 3 times over the past 3 days as a precautionary measure, while its employees have received a short, intensive training course on preventing the disease from spreading.

He also urged the media to be cautious and objective in reporting on the outbreak.

[Byline: Hani Hazaimeh]

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[ProMED-mail would like to thank Dr Lai for raising this very astute query and for alerting us to this prior report of an earlier outbreak of severe respiratory disease in the region. This moderator has checked the WHO archives and the ProMED-mail archives and could not find reports on the above mentioned outbreak. The ECDC report is the only formal report on this outbreak. A retrospective search of HealthMap Alerts from 2 Apr 2012 through 25 Apr 2012 looking for reports of pneumonia outbreaks that might be related to this current event only identified a report on the above mentioned outbreak in Jordan in April 2012.

There are a series of newswire reports in the Jordanian Times on this event at the time of the outbreak -- the report above in [2] is a comprehensive discussion of the event. Another report the preceding day (21 Apr 2012) highlighted the fact that after the 1st severe case, staff were not using adequate infection control measures, especially an absence of use of masks (see http://jordantimes.com/zarqa-hospital-i ... -infection). From these reports, it appears as though the outbreak in Jordan was a nosocomial outbreak involving healthcare personnel working in an ICU where presumably a patient with a severe pneumonia had been hospitalized -- quite possibly related to deficiencies in respiratory infection control measures.

It would be of interest to know if the etiology of the outbreak was ever identified, along with more information on the epidemiologic studies conducted at the time. Information on the index case in that outbreak would be of interest as well.

The interactive HealthMap/ProMED map of the region can be found at http://healthmap.org/r/1HAJ. As can be seen on the map, Jordan shares borders with Saudi Arabia to the east and southeast, Iraq to the northeast, Syria to the north, and the West Bank and Israel to the west. - Mod.MPP]

LEISHMANIASIS, CUTANEOUS, VISCERAL - ISRAEL (02)
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Date: Thu 20 Sep 2012
Source: Ynetnews http://www.ynetnews.com/articles/0,7340 ... 21,00.html [edited]


The Environmental Protection Ministry expressed concern over the growing number of cutaneous leishmaniasis cases reported in over the past year, and has been able to obtain NIS 10 million (roughly USD 2.6 million) in government funds to curb a potential outbreak. The funds are to be allocated across 3 years.

The Health Ministry has reports of 293 patients in 2011 -- double the number of cases reported in 2010.

According to the Environmental Protection Ministry's data, over 1650 people in 50 communities is Israel have contracted the Oriental sore over the past decade, especially around the Sea of Galilee, the Judea Mountains, the western Negev, the Arava, and the Beit Shean Valley.

Cutaneous leishmaniasis, commonly known as "Oriental sore," or "Aleppo boil," is a skin infection caused by a single-celled parasite. It is usually transmitted by sandflies.

The ministry appealed to the cabinet for funds meant to help at-risk communities, in the form of setting up sandfly traps and building fences to keep the rock hyrax -- which is a known carrier -- out.

"This is a difficult disease that has inflicted many and left them scarred, literally," Environmental Protection Minister Gilad Erdan said. "After years of ignoring this hazard, the government is taking on dealing with this national infliction."

[Byline: Itay Gal]

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[_Leishmania tropica_ and _L. major_ causing cutaneous leishmaniasis (CL) have been identified in jackals, foxes, and rock hyrax throughout Israel (Talmi-Frank D et al: _Leishmania tropica_ infection in golden jackals and red foxes, Israel. Emerg Infect Dis. 2010; 16(12): 1973-5; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294571/ and Talmi-Frank D et al: _Leishmania tropica_ in rock hyraxes (_Procavia capensis_) in a focus of human cutaneous leishmaniasis. Am J Trop Med Hyg. 2010; 82(5): 814-8; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861385/).

CL has been slowly increasing in Israel at least over the past decade (Vinitsky O et al: Geographic and epidemiologic analysis of the cutaneous Leishmaniasis outbreak in northern Israel, 2000-2003. Isr Med Assoc J. 2010; 12(11): 652-6; http://www.ncbi.nlm.nih.gov/pubmed/21243862).

Visceral leishmaniasis, VL, caused by _Leishmania infantum_ has also returned to Israel after being absent for 30 years, with dogs as the main reservoir (Nasereddin A et al: Molecular fingerprinting of _Leishmania infantum_ strains following an outbreak of visceral leishmaniasis in central Israel. J Clin Microbiol. 2005; 43(12): 6054-9; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317210/ and Hamarsheh O et al: Serological and molecular survey of _Leishmania_ parasites in apparently healthy dogs in the West Bank, Palestine. Parasit Vectors. 2012; 5(1): 183; http://www.ncbi.nlm.nih.gov/pubmed/22937916). - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1z-1.]

CHIKUNGUNYA (16): YEMEN (TAIZ)
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Date: Mon 1 Oct 2012
Source: News Yemen [In Arabic trans. Corr.SB; edited]
http://www.newsyemen.net/contents/News/ ... 0/7391.htm


The Governor has directed the implementation of a joint campaign of the Office of Health and Optimization and localities to combat (dengue/chikungunya) in the Villages of Sharhab, Alrona, Taiz (Governorate) who have complained of the disease "almkrvs" said the Director of Health: recorded 36 cases ere recorded up to Thursday [27 Sep 2012]. [In Yemen, they use the word "almkrvs," bone-breaker, as the local expression for chikungunya virus infections. The term for dengue is actually "damal Dank." - Corr.SB]

Local residents said that dozens of families have been hit by chikungunya disease "almkrvs," (bone-breaker) in the Directorate Sharhab Alrona in Taiz, demanding the governor of Taiz give guidance to the Office of Health and Epidemiological Surveillance and to rapidly disembark field and medical teams to treat the injured.

The population call chikungunya virus infections "almkrvs," which spread 2 weeks ago in a lot of villages which lack government health centers.

A spokesman told News Yemen that workers in the health sector in the region to were reporting a transmissible disease similar to "dengue fever and malaria," where the sick patients movements are paralyzed and they can not get up. [Pain from the acute arthralgia in acute chikungunya virus infections makes individuals unwilling to move. - Mod.TY]

He said patients in Mamedan and Amuallamh villages and its neighboring villages have symptoms that are "severe pain in the joints, have combined symptoms, in addition to severe headache, fever, and fatigue and muscle pain and other symptoms."

The Sheikh Qurashi circuit 54 said, in a press statement, that dengue [chikungunya?] fever has swept many areas and the numbers of casualties continue to rise and the poor sanitary conditions in the district and poverty contributed greatly to the spread of the disease where it is difficult for citizens to find even a Band-Aid [adhesive plaster] in the health units in addition [to the fact that] areas city of Taiz are infested, [presumably with mosquitos. - Corr.SB], which makes people succumb to the disease.

He expressed rising fears that the disease epidemic was not being contained and is continuing to spread as health authorities in the province have not yet done their duty.

The Director General of the Office of Health and Population in Taiz, Dr. Abdul Nasser, said that dengue [chikungunya?] cases [had been reported] in the province of Taiz since 1994, noting that the official cases registered up to last Thursday reached 36 cases and compared to last year is very modest.

The Director General issued directives of the governor of the province Shawki for a massive implementation of a joint campaign of the Office of Health and the Office of optimization and directorates city leadership starting on Tuesday to fight dengue fever in the city.

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[Although the word "almkrvs" is the local term for chikungunya virus infections, it is possible that dengue virus is also circulating there. There have been several previous outbreaks of dengue in Yemen, some relatively recently (June 2012, see ProMED archive no. 20120704.1189075).

It will be helpful to know if laboratory tests have confirmed chikungunya virus as the etiological agent in this outbreak, or if a mixed chikungunya-dengue outbreak is occurring. - Mod.TY

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3BOT.]

NOVEL CORONAVIRUS - SAUDI ARABIA (15): NEW CASE
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Date: Nov 4, 2012 12:11 PM
From: Ziad Memish

Subject: Re: A new Saudi novel coronavirus case diagnosed in KSA (Kingdom of Saudi Arabia)

Attached is a report we would like for you to consider releasing in ProMED-mail:

In accordance with Ministry of Health's (MoH) responsibilities for disease prevention and control, and in keeping with our practice to inform the public and the media about significant findings that result from MoH disease surveillance activities, we are announcing today [4 Nov 2012] that one of our hospitalized citizens has been confirmed to have pneumonia caused by novel Coronavirus (nCoV). This case had no epidemiological links to the 2 documented novel coronavirus cases to date. When this individual was first admitted to hospital, he was evaluated for usual respiratory agents including influenza viruses. When none of these tests were positive, additional specimens were collected and tested by one of our regional MoH laboratories and an international reference centre. Both labs report RT-PCR positive results for nCoV upE target. Today MoH press agents released this information in English and Arabic to local and regional television and newspapers. WHO has been contacted in accordance with our IHR 2005 duties.

With regard to the patient's current status, he is recovering and out of intensive care. We have done preliminary investigations of family members and contacts including health care workers. There are no apparent secondary cases at this time, however these investigations are on-going. This man has no significant travel history, in fact had not been out of Riyadh. One week prior to disease onset he reports having visited a farm. Additional details will be reported as they become available.


--
Ziad A Memish, MD, FRCP(Can), FRCP(Edin), FRCP(Lond), FACP
Deputy Minister for Public Health
Director WHO Collaborating Center for Mass Gathering Medicine
Ministry of Health
Professor, College of Medicine
Alfaisal University
Riyadh 11176
Kingdom of Saudi Arabia

[ProMED-mail would like to thank Dr. Memish for the above report on the additional novel coronavirus (nCoV) case recently diagnosed in KSA. It is noteworthy that this case as well as one of the 2 prior confirmed cases of respiratory illness associated with this novel coronavirus both had a history of contact with farm animals in the week or 2 prior to onset of their illness.

A comparison of the sequencing of the virus isolates from both prior cases indicated 99.5 percent identity, with one nucleotide mismatch over the regions compared, suggesting the 2 isolates were strongly related. The virus was identified as belonging to the genus beta-coronavirus, with closest relationship to bat coronaviruses (see Novel coronavirus - Saudi Arabia (03): UK HPA, WHO, Qatar 20120923.1305982 and Bermingham A, Chand MA, Brown CS, Aarons E, Tong C, Langrish C, et al. Severe respiratory illness caused by a novel coronavirus, in a patient transferred to the United Kingdom from the Middle East, September 2012. Euro Surveill. 2012;17(40):pii=20290. Available from: http://www.eurosurveillance.org/ViewArt ... leId=20290). The extent of sequence identity of this latest isolate is not yet available.

As a reminder, investigations to date have not shown person-to-person transmission as close contacts of the 2 prior cases including both medical staff and other contacts did not have evidence of infection with this novel coronavirus.

We await further information on investigations of this new case.

For the HealthMap/ProMED map of Saudi Arabia showing the location of Riyahd, see http://healthmap.org/r/3_0m. - Mod.MPP]

HEPATITIS A - KUWAIT: (KUWAIT CITY) FOODBORNE SUSPECTED, REQUEST FOR INFORMATION
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Date: Sun 4 Nov 2012
Source: Arab Times [edited]
http://www.arabtimesonline.com/NewsDeta ... fault.aspx


The Infectious Diseases Hospital allegedly received more than 30 hepatitis A patients within a short period, according to Annahar [newspaper]. Sources revealed that the Preventive Medicine Department has been trying to find reasons behind the spread of the disease for 3 weeks but until now no result has been announced.

Meanwhile, health experts have advised the public to refrain from eating fast-food meals to prevent further spread of the disease. They believe the epidemic is local as it might have started amongst some patients who probably consumed contaminated food.

The experts said hepatitis A symptoms include feeling cold at the beginning, followed by a sudden rise in temperature and liver enzyme levels, in addition to yellowish eyes.

--
Communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

[Hepatitis A is a liver disease caused by hepatitis A virus, transmitted primarily by the faecal-oral route. Hepatitis A virus is one of the most frequent causes of foodborne infection. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water. The virus can also be transmitted through close physical contact with an infectious person, although casual contact among people does not spread the virus.

Although this outbreak of 30 cases of hepatitis A virus infection is being attributed to foodborne transmission of infection, earlier in the year (see ProMED-mail post: Hepatitis A, B & C - Kuwait 20120828.1268627), a larger outbreak of 245 cases of hepatitis A virus infection was reported to involve both the resident and non-resident population, with no suggestion of foodborne transmission.

Further information concerning the hepatitis A situation in Kuwait would be welcome.
- Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3bNo.]

WEST NILE VIRUS - EURASIA (15): ISRAEL, HUMAN, EQUINE
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Date: Tue 13 Nov 2012 (accessed)
Source: Israel Veterinary Services, Ministry of Agriculture [in Hebrew, trans., summ. Mod.AS, edited]
http://www.vetserv.moag.gov.il/NR/rdonl ... 211012.pdf


Map: West Nile fever activity in Israel, as of 21 Oct 2012
----------------------------------------------------------
The map legend at the source URL above, is in Hebrew; for subscribers' convenience, the following interpretation:

Red star - mosquitoes
Green triangle - horses
Blue circles - human (suspected)
Rose circles - human (laboratory confirmed)

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[The West Nile fever map cited above is accompanied, on the website, by the following comment of the Veterinary Services (in Hebrew):
"Owners in the affected areas are advised to have their horses vaccinated."

Clinical cases of West Nile fever have been reported periodically from Israel since the late 1950s. Initially from humans, later also from avians (domestic geese) and equines. The virus was demonstrated in migratory birds. During recent decades the disease reappears every summer. 46 human cases were reported earlier this year (2012; see ProMED-mail archive no 20121025.1364837). - Mod.AS

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1z-1, http://healthmap.org/r/1z-1.]

LEISHMANIASIS, TUBERCULOSIS - SYRIA
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Date: Tue 25 Dec 2012
SOURCE: Washington Post [edited]
http://www.washingtonpost.com/world/mid ... _headlines


Leishmaniasis and tuberculosis increasing in Syria
--------------------------------------------------
Inevitably, disease is spreading among people whose immune systems have been weakened by hunger, in a city [Aleppo] where sanitation has broken down. Tuberculosis is ravaging some neighborhoods, and there have been hundreds of cases of leishmaniasis, a skin disease transmitted by sand flies, which are multiplying amid the heaps of uncollected trash, said Saad Wafai, who serves on the crisis committee of the Aleppo council.

At a small clinic in an abandoned shopping arcade -- set up by doctors driven out of a hospital destroyed in an air strike -- the number of patients has surged recently, to about 150 a day. For the 1st time, physician Izzat al-Mizyad said, most show up not with injuries from the war but infectious diseases, including hepatitis, respiratory infections and scabies.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Leishmaniasis is transmitted by sand flies (_Phlebotomus_ spp.) and the incubation period can be weeks to months. Cutaneous leishmaniasis is caused by _Leishmania tropica_ and 30 000 cases were reported in 2008 (Alvar J et al. and the WHO Leishmaniasis Control Team. Leishmaniasis Worldwide and Global Estimates of Its Incidence. PLoS One. 2012; 7(5): e35671). Visceral leishmaniasis is rare but is found from Aleoppo and towards the Turkish border. The reservoir for _L.tropica_ is small rodents and for _L.infantium_ it is dogs.

It is no surprise that the incidence is increasing. Rodent and vector control activities most probably no longer exist and leishmania infected dogs are not captured and killed.

It it no surprise either that tuberculosis in on the increase. Syria was in 2009 estimated to have 26 (range 22-31) new cases of tuberculosis per 100 000 population (WHO World Tuberculosis Report 2012;
http://www.who.int/tb/publications/glob ... annex4.pdf). - Mod.EP]

[[Cutaneous lesions on a leg:
http://www.leishrisk.net/Leishrisk/User ... 201(1).jpg
on a dog's ear:
http://www.vetnext.com/fotos/Lm1.jpg
Sandfly biting finger
http://upload.wikimedia.org/wikipedia/e ... andfly.jpg
Life cycle:
http://www.uni-tuebingen.de/modeling/im ... _cycle.jpg
- Mod.JW]

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ.]

.................................................ep/ejp/jw

LEISHMANIASIS, TUBERCULOSIS - SYRIA (02): COMMENT
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Date: 26 Dec 2012
From: Merritt Clifton <anmlpepl@whidbey.com> [edited]


The moderator comment of ProMED-mail post "Leishmaniasis, tuberculosis - Syria 20121226.1470184" overlooks the reality that in much of the developing world, probably including Syria, street dogs ARE the primary rodent control entities, assisted by feral cats, scavenging birds, and miscellaneous other urban wildlife including street pigs and monkeys, neither of which inhabit Syria.

The role of street dogs in rodent control differs significantly from the roles of feral and domestic cats, hawks, owls, and other rodent predators, in that the dogs consume edible waste which would otherwise feed rodents, as well as hunting rodents themselves. Thus, against rats in particular, who often become too big and dangerous for most cats to attack, dogs do double duty.

Conversely, pigs and monkeys consume edible refuse but do not hunt rats and mice. (Monkeys may grab a rodent if they can, but do not go actively searching for them, unlike dogs, who will nose every wrapping in a pile in hopes a rodent will run out from under it, and will swiftly crunch in their jaws almost every rodent who bolts.)

Accordingly, in practically any developing world context, if you kill off the dogs before instituting reliable waste collection and disposal, you will get far more rodents, along with any diseases that the rodents may carry. In war zones in particular, dogs and other urban wildlife may be the only rodent control that exists, or is likely to, until the return of a stable peace.

--
Merritt Clifton
Editor, Animal People
P.O. Box 960
Clinton, WA 98236
http://www.animalpeoplenews.org
<anmlpepl@whidbey.com>

[ProMED thanks Merritt Clifton for his valuable comment and hopes the situation in Syria will improve to allow proper control of the vector and the reservoir of both cutaneous and visceral leishmaniasis. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ.]

DENGUE/DHF UPDATE (01): MIDDLE EAST
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*****

- Saudi Arabia (Makkah [Mecca] province). 3 Jan 2013. Dengue 47 cases.
http://www.saudigazette.com.sa/index.cf ... 0103147959

[A HealthMap/ProMED-mail interactive map showing the location of Makkah province on the Red Sea can be accessed at http://healthmap.org/r/4Jp9. - Mod.TY]

LEISHMANIASIS - SYRIA: REQUEST FOR INFORMATION
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Date: Sun 24 Feb 2013
Source: WHO Emergency preparedness and humanitarian action [edited]
http://www.emro.who.int/emergency/eha-n ... itrep.html


Reports indicate an increase in the numbers of suspected cases of typhoid fever and cutaneous leishmaniasis in the Syrian Arab Republic.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[Leishmaniasis is endemic in Syria.

A recent review of the global distribution of leishmaniasis (Alvar J, V.ID, Bern C, Herrero M, Desjeux P, Cano J, Jannin J, den Boer M; WHO Leishmaniasis Control Team; Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012;7(5):e35671) cites national reports from 2004 to 2008 showing that 14 cases of visceral leishmaniasis (VL) were reported during that period, with the true incidence being between 30 and 60 cases. In the same period, 22 882 cases of cutaneous leishmaniasis (CL) were reported, with the estimated range being between 64 100 and 105 300 CL cases.

CL caused by _L. tropica_ is still endemic in its traditional home of Aleppo but also in Edlib, Lattakia, Tortous, Hama, and the city of Damascus. CL caused by _L. major_ is found in and around Damascus. VL caused by _L. infantum_ is found in the northwest in the provinces of Al Ladhiqiyah, Idlib, and Halab.

The reservoirs for _L. tropica_ are humans, and not all cases are treated, and the study by Alvar et al. estimated that the human reservoir is increasing. The reservoirs for _L. major_ are small rodents and for _L. infantum_, dogs.

Leishmaniasis is transmitted to humans by the sandfly, _Phlebotomus_, and it was expected that the number of cases would increase during the civil war. Breakdown of vector control programmes, an expected decrease in the number of human cases treated, and general poor housing conditions and crowding will increase transmission.

With the increasing numbers of refugees in Turkey, Lebanon, and Jordan, cases can be expected in these countries as well. ProMED will be happy to post any further information on the number of cases.

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ. - Mod.EP]

LEISHMANIASIS - SYRIA (02)
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Date: Thu 28 Mar 2013
Source: Today's Zaman [edited]
http://www.todayszaman.com/news-310925- ... order.html


Approximately 100 000 people have been infected with the leishmaniasis parasitic disease in the past 2 years after civil war broke out in Syria, compared with before the conflict when the number of cases in Syria had been reduced to 3000-4000 as a result of joint efforts by Turkish and Syrian authorities.

The increase in the number of patients suffering from the disease is alarming not only for Syria but for Turkey as well, since leishmaniasis has also reached Turkey.

Opposition forces who have been leading an uprising against Syrian President Bashar al-Assad's rule have asked Turkey to deliver 10 000 boxes of Glucantin [supposedly the meglumine antimoniate Glucantime], a medicine used to treat leishmaniasis, which amounts to one month's treatment of 20 000 people.

However, there has been no positive response from the Turkish side yet. Fake Glucantin is being produced and sold for 50 percent less than the normal price for the medicine in Aleppo.

Dr. Kerem Kinik, coordinator of the Association of Earth Doctors, told Today's Zaman that his organization has been working to help the Syrians fight the disease. "We'll provide assistance to fight the disease, starting with sending medicine. This step is also important to protect our country [Turkey] from the disease," he said.

The number of doctors in Syria has dropped dramatically from 30 000 to 5000, and 57 percent of the hospitals have been damaged in the conflict, according to Kinik.

Before the civil war in Syria, the number of leshmaniasis patients had been reduced to a great extent after studies carried out in 45 centers in 14 provinces across the nation. After a Syrian health official fled to Canada following the start of the conflict in the country, the battle against the disease was halted.

Experts argue that the nation also faces typhoid, cholera and tuberculosis epidemics.

Turkey imports leshmaniasis medicine via the Turkish Pharmacists' Association (TEB). TEB Secretary General Harun Kizilay told Today's Zaman that Turkey could bring the drugs to combat the disease for Syrians should the Turkish Prime Ministry's Disaster and Emergency Management Directorate (AFAD) submit a request at the Health Ministry.

Professor Fatih Koksal, from Cukurova University's department of microbiology and clinical microbiology, said _Leishmania infantum_, a parasite that causes leshmaniasis, has been more common in Turkey in the recent years. "There was one case each in 2005 and 2010. But now, 30 out of every 100 cases are caused by this parasite. Measures need to be taken," he urged.

Koksal said he visited the buffer zone between the Cilvegozu and Bab al-Hawa border gates and observed poor conditions there that might lead to other epidemics. "The passage of people [from Syria] to Turkey has increased the frequency of diseases in Turkey."

The symptoms of leshmaniasis are skin sores, fever and anemia and may result in spleen and liver problems. The disease can be fatal if not treated. The disease is transmitted by certain species of sandfly and later passes on to humans from animals, including dogs.

[Byline: Caglar Avci]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[This is probably cutaneous leishmaniasis, which is the most common form of leishmaniasis in Syria.

It is difficult to confirm the numbers, but as ProMED commented in our 26 Dec 2012 posting on leishmaniasis in Syria, the infection will increase. It will be interesting to get numbers of cases in Syrian refugees in Turkey, Lebanon and Jordan. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ.]