Wüstenschiff

Blutsauger mit Fieber im Gepäck

Neustes "Schmuckstück" im östlichen Mittelmeerraum ist das ursprünglich aus Zaire stammende Krim-Kongo hämorrhagische Fieber (CCHF). Mehr als 150 Erkrankungen mit 27 Todesfällen wurden in der Türkei allein in diesem Jahr bis Ende Juni registriert. Im gesamten vorigen Jahr waren es 438. Der zu den Bunyaviridae gehörende Erreger ist in der Türkei endemisch, mit sporadischen Fällen und Clustern ist im Frühjahr und Sommer landesweit zu rechnen. Schwerpunkte haben sich, nachdem die Krankheit erst seit 2002 in der Türkei bekannt ist, im zentralen Anatolien mit den Provinzen Corum und Yozgat gebildet. Die Übertragung erfolgt gewöhnlich durch Zecken, gelegentlich aber auch von Mensch zu Mensch, z.B. nosokomial.

Wer in diese Region reist, sollte in jedem Fall über die Gefahren aufgeklärt werden. Patienten sollten den Schutz vor Zeckenstichen beachten und den Kontakt mit Kranken meiden.

Quelle: Doc-Check

Zecken töteten schon fast 20 Menschen in Zentralanatolien
04.07.2007

In Zentralanatolien geht die Angst um. Fast 20 Menschen sind in diesem Jahr bereits an der Folge von Zeckenbissen gestorben. Auch am Dienstag starb wieder ein Mann am so genannten Krim-Kongo-Fieber, ausgelöst durch Zecken.

Der 68-jährige Bauer Ahmet Iseri, der am Dienstag in der Klinik der zentralanatolischen Stadt Tokat starb, war wie die meisten anderen 16 Zeckenopfer dieses Jahres bei der Arbeit auf dem Feld mit den kleinen Insekten in Berührung gekommen. Türkische Experten haben seit Beginn des Sommers in der Region viele Zecken gefunden und unschädlich gemacht. Dennoch breitet sich das Krim-Kongo-Fieber weiter aus. Wie beim berüchtigten Ebola-Virus werden die Patienten beim Krim-Kongo-Fieber von heftigen Blutungen heimgesucht, jeder zweite Kranke stirbt. Es gibt weder Impfstoff noch Gegenmittel.

Kein Wunder, dass viele Menschen in Zentralanatolien und am Schwarzen Meer verängstigt sind. Selbst die Profifußballer des türkischen Erstligisten Trabzonspor rennen vor den Zecken davon: Der Mannschaftsarzt forderte die Spieler im Trainingslager in der Nähe des Schwarzen Meeres auf, die festgelegte Trimmstrecke durch den Wald nicht zu verlassen. Normalbürgern in der Gegend geht es nicht anders. In einem Krankenhaus in dem betroffenen Gebiet melden sich jede Nacht 60 bis 70 Personen, die um ihr Leben fürchten.

Inzwischen ist das Krim-Kongo-Fieber bereits in Edirne an der nordwesttürkischen Grenze zu Bulgarien angekommen. Auch in der Metropole Istanbul wurden infizierte Zecken schon gesichtet. Besonders auf Picknickplätzen in den Parks und in der Umgebung der Metropole gilt Zeckenalarm - und das ausgerechnet in jener Zeit des Jahres, in der vor allem ärmere Istanbuler an den Wochenenden mit der ganzen Familie den heißen Stadtvierteln entfliehen und im Grünen den Grill anfeuern.

Dabei ist das durch Viren übertragene Krim-Kongo-Fieber in der Türkei nicht neu. Schon vor vier Jahren wurde die Krankheit im Land registriert. Die Krankheit war Mitte des 20. Jahrhunderts zunächst auf der Krim und dann in Afrika entdeckt worden und ist seitdem von China bis zum Balkan aufgetreten. In der Türkei starben seit dem Jahr 2003 nach offiziellen Angaben etwa 60 Menschen an der Krankheit.

Um sich vor der Gefahr zu schützen, werden die Bewohner der besonders gefährdeten Provinzen in Zentralanatolien von Experten aufgerufen, sich an einfache Verhaltensregeln zu halten. So könne man das Risiko eines Zeckenbisses schon dadurch stark reduzieren, dass man sich bei der Feldarbeit und im Wald die Hosenbeine in die Strümpfe stopfe. Wie schon bei der Vogelgrippe tritt die Krankheit besonders häufig dort auf, wo Menschen und Stalltiere eng zusammenleben, denn die Zecken und damit das gefährliche Virus befallen auch die Tiere. In Ankara erklärte das Gesundheitsministerium, die Lage sei unter Kontrolle. In den betroffenen Gegenden werden Pestizide versprüht, um möglichst viele Zecken zu töten. Die Insekten ganz auszurotten, sei aber unmöglich, warnte das Ministerium.

Wegen der Hartnäckigkeit der Zeckenplage tauchten bereits Gerüchte auf, beim Krim-Kongo-Fieber handle es sich nicht um eine natürliche Krankheit, sondern um einen künstlich hergestellten chemischen Kampfstoff. Bei dem Gerede spielen mitunter politische und religiöse Feindbilder eine große Rolle: Als im vergangenen Sommer israelische Touristen in Zentralanatolien Urlaub machten, wurde ihnen von islamistischen Politikern vorgeworfen, sie hätten in der Gegend die gefährlichen Zecken ausgesetzt.

Quelle: Vorarlberg Online

E. COLI O157 - UNITED KINGDOM (SCOTLAND) EX TÜKEI: ALERT
*********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 11 Aug 2007
Source: The Herald [edited]
<http://www.theherald.co.uk/news/news/di ... 71.0.0.php>


[So far,] 2 people from Fife have been confirmed with the potentially
fatal _E. coli_ O157 infection, while a 3rd is suspected to have
contracted the bug. NHS [National Health Service] Fife confirmed that
a 12-year-old girl and 2 35-year-old women were thought to have
caught the infection in the Turkish resort of Marmaris in July 2007.
The health board said investigations were continuing as it was
possible other people may have been affected.

The incubation period for the infection is usually about one to 14
days. Dr. Mike Roworth, consultant in public health medicine, said:
"_E. coli_ O157 can spread easily. By taking some simple precautions
people can help reduce the risk of catching the infection. Careful
hand washing, especially before eating, after using the toilet, and
before and after handling food, is one of the most effective methods
people can avoid the infection."

--
Communicated by:
ProMED-mail
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[It has been unusual for _E. coli_ O157 postings on ProMED-mail to
reflect travel-related cases. If this is indeed the case, other
infections may occur in visitors to Marmaris returning to different
countries. No information is given regarding the potential vehicle of
transmission.

Fife (<http://en.wikipedia.org/wiki/Fife>) is a council area of
Scotland, situated between the Firth of Tay and the Firth of Forth.
It was originally one of the Pictish kingdoms, known as Fib, and is
still commonly known as the Kingdom of Fife within Scotland.

Turkey's resort of Marmaris, on the Aegean Sea, can be found on a map at:
<http://www.turkeytravelplanner.com/Asse ... ticMap.jpg>.
- Mod.LL]

KRIM-KONGO-HÄMMORHAGISCHES FIEBER - TÜRKEI
****************************************
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International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 7 May 2008
Source: Turkish Daily News [edited]
<http://www.turkishdailynews.com.tr/arti ... sid=103801>


On Monday [5 May 2008], 3 more people died from Crimean-Congo
hemorrhagic fever (CCHF), raising the death toll to 5 in the past week.

In Samsun province 2 people died from CCHF and another 4 with similar
symptoms have been in medical care since then [? 5 May 2008].

A 57-year old man was bitten by a tick 3 weeks ago and died at the
Ankara Education and Research Hospital. His family said they had
taken him to a hospital a few days after the tick bite, which
occurred in the garden of their home in the village of Kirecoca in
Corum province.

In the central Anatolian city of Sivas 6 children were placed under
observation on suspicion of CCHF.

People should be aware of tick bites and should never try to take out
the ticks that have stuck to their skin, said Davut Vecdi Ersoz,
medical superintendent of the Sivas State Hospital. The Health
Ministry also issued a statement warning people against tick bites.
In case of a tick bite the skin should be covered with the proper
medicine [antiseptic?]. The tick should be removed using tweezers
with great care and iodine should be applied to the bite. Health
Ministry officials said ticks should never be killed by hand.
Moreover, those people touched by any tick should be kept under
medical treatment for 10 days and go to the nearest hospital if they
have symptoms such as fever, headache, nausea, vomiting, or diarrhea,
officials from the Health Ministry said.

CCHF mainly affects animals. Ticks, which live on sheep and cattle,
can sometimes pass the virus to people. It is an Ebola-like [that is,
haemorrhagic] fever where patients can bleed to death if they are not
treated quickly. Those infected can transmit the virus through their
blood or saliva. The disease is endemic in parts of Africa, Asia, and
Europe. Health authorities said a warmer climate, which Turkey has
experienced in recent years, could mean a larger tick population that
could in turn infect more people with the disease.

--
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[CCHF is caused by a an RNA virus with a tri-segmented genome
classified in the genus _Nairovirus_ of the family _Bunyaviridae_.
CCHF virus can be transmitted to humans directly by tick-bite, by
nosocomial spread in hospitals, or by blood-borne transmission during
the slaughter of domestic animals, and rarely via unpasteurised milk.

Cases arising by transmission from ticks are usually sporadic,
whereas clusters of cases can be indicative of blood-borne
transmission associated with the slaughter of animals (mainly sheep
which themselves do not exhibit signs of disease).

A map of the provinces of Turkey can be accessed at
<http://en.wikipedia.org/wiki/Provinces_of_Turkey>. - Mod.CP]

Türkei - Krim-Kongo hämorrhagisches Fieber CCHF
09.05.2008

Mehrere dieser mit Fieber, schweren Allgemeinerscheinungen und gelegentlich Blutungen einhergehenden Erkrankung wurden auch diesmal nach Einbruch der warmen Jahreszeit wieder bekannt. Der Erreger, ein Virus, kommt vor allem im nördlichen und zentralen Anatolien vor; die Urlaubsgebiete im Süden der Türkei sind bisher nicht befallen. Die Übertragung erfolgt gewöhnlich durch Zecken, gelegentlich aber auch von Mensch zu Mensch. Schutz vor Zeckenstichen beachten, Kontakt mit Kranken meiden. / Quelle: crm

KRIM-KONGO-HÄMORRHAGISCHES FIEBER - TÜRKEI (02)
***********************************************
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International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 11 May 2008
Source: Today's Zaman [edited]
<http://www.todayszaman.com/tz-web/detay ... ink=141414>


A woman from the Central Anatolian province of Sivas died on Thursday
[8 May 2008] at an Ankara hospital where she was being treated for
Crimean-Congo hemorrhagic fever, a viral disease contracted from a
tick bite which can be fatal.

The woman, who herself had removed the tick that bit her 10 days ago
as she grazed her cattle, died on Thursday [8 May 2008] at Ankara
Numune Hospital, where she had been transferred from a Karabuk
provincial hospital that she initially checked into after falling ill
a few days after the bite. She was buried in her home district of
Eflani in Karabuk. She is survived by her 2 children.

Meanwhile, in the Central Anatolian city of Sivas, 10 children with
tick bites were taken to the Sivas State Hospital in the past 2 days.
The ticks on the children's bodies were removed by medical staff at
the hospital. One of the children's tick bites was noticed by the
child's teacher, who immediately notified the parents. Their
hospitalization follows that of 6 other children, also taken to the
hospital in Sivas on Wednesday [7 May 2008] with symptoms of
Crimean-Congo hemorrhagic fever.

Officials at the Sivas State Hospital repeated their warning against
trying to remove a tick from the body oneself, advising instead that
people go to the nearest hospital or clinic for medical staff to
remove the tick.

In the past 5 years, 94 people have died in Turkey of Crimean-Congo
hemorrhagic fever. People who have come into contact with a tick
should be monitored for 10 days following contact and seek
professional medical care if symptoms of fever, headache, nausea,
vomiting or diarrhea present themselves.

Turkish Clinical Microbiology and Infectious Disease Foundation
(KLIMIK) President Haluk Eraksoy pointed out that ticks become active
in spring and summer, so necessary measures should be taken now.
Eraksoy said we must learn to live with ticks, accepting them as a
reality of life in this geography.

"This is the most active period for ticks. As we cannot completely
eradicate ticks, we must take preventive measures at once. They
multiply in spring, and this increases the possibility of their
contact with human beings. We expect this to continue also in summer," he said.

As to the reason why tick bite cases have surged in recent years,
Eraksoy said: "Some put the blame on global warming or environmental
pollution. Some suggest that the ticks are carried by migratory birds
to Turkey. Yet, there is no generally accepted explanation for its
origins." He indicated that in regions where tick bite cases are
frequent, doctors should be briefed about the illness and that people
engaged in animal breeding should be trained about how to safeguard
against ticks, such as wearing apparel that will not allow ticks to
attach to the body.

Eraksoy noted that Crimean-Congo hemorrhagic fever is known under
different names around the world and that it is hosted by arthropods
such as ticks. He stated that they are planning to organize an
international conference in Istanbul in June [2008] in cooperation
with the European Society of Clinical Microbiology and Infectious
Diseases to discuss all viral hemorrhagic fever diseases. "This will
be a great opportunity to exchange experiences on this subject. This
is a first of its kind. Many authorities in the field will attend the
conference from the US, the EU, Iran, Nigeria and South Africa," he said.

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

[Crimean-Congo hemorrhagic fever (CCHF) is caused by infection with a
tick-borne virus classified in the genus _Nairovirus_ of the family
_Bunyaviridae_. CCHF virus is found in Eastern Europe, particularly
in the former Soviet Union. It is also distributed throughout the
Mediterranean, in northwestern China, central Asia, southern Europe,
Africa, the Middle East, and the Indian subcontinent. In fact, its
range coincides with that of its tick vector.

Ixodid (hard) ticks, especially those of the genus, _Hyalomma_, are
both a reservoir and a vector for the CCHF virus. A representation of
a _Hyalomma_ tick can be found either at
<http://www.cdc.gov/ncidod/dvrd/Spb/mnpa ... s/cchf.htm>, or by
accessing the press report at the URL above. Numerous wild and
domestic animals, such as cattle, goats, sheep and hares, serve as
amplifying hosts for the virus. Transmission to humans occurs through
contact with infected animal blood or ticks. CCHF can be transmitted
from one infected human to another by contact with infectious blood
or body fluids. Nosocomial spread of CCHF has also occurred in
hospitals due to improper sterilization of medical equipment, reuse
of injection needles, and contamination of medical supplies.

Immature _Hyalomma_ ticks (nymphs and larvae) feed on small mammals
and birds and adults ticks on the larger mammals and livestock as
well as birds. Infected ticks become carriers of the virus and can
pass on the virus to the next generation of ticks as well as to
mammals, birds and humans when the ticks seek a blood meal.
Fortunately, ticks prefer feeding on animals and birds rather than on humans.

A map of the provinces of Turkey can be accessed at
<http://en.wikipedia.org/wiki/Provinces_of_Turkey>, and a map of the
central province of Sivas is available at
<http://www.map-of-turkey.co.uk/map-of-sivas.htm>. - Mod.CP]

BRUCELLOSIS, LIVESTOCK, HUMAN - AZERBAIJAN
**************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 14 May 2008
Source: IA Trend [translated by Mod.NP, edited]
<http://news.trendaz.com/index.shtml?sho ... 199394〈=RU>


Brucellosis revealed in humans and animals in the Khachmazskiy district
-----------------------------------------------------------------------
Brucellosis has been revealed in the village Niyazabad in the Khachmazskiy
district in cattle and small ruminants; 14 inhabitants of the village have
been infected.

Mugeddes Takhaev, deputy chief physician of the outpatient department in
the village of Niyazabad, has stated that the disease was first detected on
15 Mar 2008 in 4 persons. Further investigations, carried out on 8 May
2008, have led to the discovery of 10 additional patients.

The human patients have been treated. Animals had not been vaccinated, said
Takhaev [see comment].

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

[According to Azerbaijan's annual report to the OIE (2007), _Brucella
melitensis_ and B. abortus_ are endemic in the local animals (cattle,
sheep, and goats). The control measures include targeted surveillance and
stamping out; reportedly, no vaccinations have been applied against either
of the above agents, in the respective target animal populations. It would
be interesting to note how many animals have been found infected in the
village Niyazabad, their species, the agent identified (_B. abortus_ and/or
_B. melitensis_), and how many of the said animals have been slaughtered according to the official stamping out policy. - Mod.AS]

Mongolei - Hand-Fuß- und Mundkrankheit (HFMD)
19.05.2008

Wie im benachbarten China ist die Erkrankung jetzt auch in 5 Provinzen der Mongolei aufgetreten, vor allem in der Hauptstadt Ulaanbaatar. Betroffen sind vorwiegend Kleinkinder aus sozial schwachen Schichten. Der Erreger, ein sog. "Enterovirus", ist sowohl durch verunreinigte Nahrung und Trinkwasser wie auch durch Tröpfchen übertragbar. Die HFMD tritt in asiatischen, zumeist tropischen Ländern (Städten) bisweilen periodisch mit mehrjährigen Unterbrechungen auf. Bei entsprechender Hygiene und Vermeidung von Kontakten mit Erkrankten ist mit einer erhöhten Gefährdung von Reisenden (Kindern) nicht zu rechnen. Ein Zusammenhang mit der Maul- und Klauenseuche der Tiere besteht nicht. / Quelle: crm

KRIM-KONGO-HÄMORRHAGISCHES FIEBER - TURKEY (03)
*********************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 20 May 2008
Source: United Press International (UPI) [edited]
<http://www.upi.com/NewsTrack/Top_News/2 ... tals/5920/>


Tick bite disease scare floods hospitals
----------------------------------------
Istanbul, Turkey, hospital workers said hundreds of the city's
residents have flocked to hospitals after a Crimean-Congo hemorrhagic
fever [CCHF] scare. Hospitals including Haseki, Okmeydani, and
Haydarpasa Numune said more than 500 residents sought treatment
during the weekend [17-18 May 2008] for tick bites after a woman died
of Crimean-Congo hemorrhagic fever that was thought to have been
transmitted by a tick bite in the town of Sivas, Today's Zaman
[newspaper] reported Tuesday [20 May 2008].

Doctors said they performed tests on the patients and told them to
return if they suffer fever, headache, nausea, vomiting, or diarrhea.
Istanbul Provincial Health director Mehmet Bakar said Monday [19 May
2008] that citizens should avoid contact with ticks whenever
possible. "There has never been a CCHF incident in Istanbul. But this
does not mean that there won't be one in the future," he noted.

--
Communicated by:
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[The woman at the centre of this incident died on Thu 8 May 2008 at
Ankara Numune Hospital, where she had been transferred from a Karabuk
provincial hospital, hence the concern in Istanbul despite the
absence of cases in Istanbul.

In the past 5 years, 94 people have died in Turkey of Crimean-Congo
hemorrhagic fever. People who come into contact with ticks have been
advised to seek medical treatment if symptoms of illness develop. The
local advice has been to warn against trying to remove a tick from
the body oneself, recommending instead that people go to the nearest
hospital or clinic for medical staff to remove the tick. - Mod.CP]

Mongolei - Hand-Fuß- und Mundkrankheit (HFMD)
26.05.2008

Wie im benachbarten China sind die Fallzahlen jetzt auch in der Mongolei angestiegen. Bis zum 22. Mai wurden etwa 1.000 Erkrankungen aus 11 Provinzen gemeldet, die meisten aus der Hauptstadt Ulaanbaatar. Alle Kindergärten und die unteren Klassen der Grundschulen wurden vorsorglich geschlossen. Betroffen sind vorwiegend Kleinkinder aus sozial schwachen Schichten. Der Erreger, ein sog. "Enterovirus", ist sowohl durch verunreinigte Nahrung und Trinkwasser wie auch durch Tröpfchen übertragbar. Die HFMD tritt in asiatischen, zumeist tropischen Ländern (Städten) bisweilen periodisch mit mehrjährigen Unterbrechungen auf. Bei entsprechender Hygiene und Vermeidung von Kontakten mit Erkrankten ist mit einer erhöhten Gefährdung von Reisenden (Kindern) nicht zu rechnen. Ein Zusammenhang mit der Maul- und Klauenseuche der Tiere besteht nicht. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (27)
**********************************************
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ProMED-mail is a program of the
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In this update:
Asia
[1] Diarrhea - Turkey (Aksaray)
[2] Cholera - Pakistan (Sindh)

******
[1] Diarrhea - Turkey (Aksaray)
Date: Wed 21 May 2008
Source: Today's Zaman [edited]
<http://www.todayszaman.com/tz-web/detay ... ink=142420>


Health officials have stated that the source of more than 4000 cases
of diarrhea seen since last week [12-18 May 2008] in the central
Anatolian city of Aksaray and the town of Sereflikochisar was
contaminated water.

A statement by the Ministry of Health yesterday [20 May 2008]
indicated that after the appearance of the diarrhea cases, which
started on 13 May 2008 in Aksaray and on 16 May 2008 in
Sereflikochisar, the ministry sent a team of specialists to the
region to take water samples from drinking water sources and blood
samples from the patients.

"According to the results of the tests, various viruses including
adenovirus, rotavirus, and norovirus, plus some _E. coli_ bacteria
caused the diarrhea. The outbreak started due to contamination in the
water and grew with person-to-person and other types of
transmission," officials stated.

The statement also noted that in Aksaray water contamination occurred
during repair work on the local pipe system and in Sereflikochisar
the cause was inadequate chlorine levels. "In both regions, chlorine
levels were checked and brought to the required levels," an official
stated.

Hospitals saw more than 4000 people admitted with complaints of
diarrhea, vomiting, and stomach pains early last week [12-18 May
2008]. Aksaray governor Sebati Buyuran said the cases only require
outpatient treatment and that the number of people coming to the
hospitals with similar complaints has gradually been decreasing.

Meanwhile, health teams started taking water samples in the eastern
city of Siirt because of several cases of diarrhea. Officials said
water contamination in the city most likely occurred due to ongoing
replacement of water and sewer pipes. Water quality specialists will
check the levels of chlorine more often in the area and increase it
when necessary, they noted.

After the outbreak in Aksaray, experts from the Health Ministry
advised people to wash fruit and vegetables well before eating them
and to boil water that will be used for drinking purposes. They also
said basic rules of hygiene, including washing hands, should be
observed.

A health official in Konya has said approximately 400 people were
seen in hospitals in the central Anatolian city with symptoms of
diarrhea. Bahaattin Akyurek, deputy manager of Konya City Health
Office, indicated in a written statement that 393 patients applied to
Konya hospitals with diarrhea symptoms and 8 have been hospitalized.
Almost all of the patients had abdominal pain, diarrhea, and
low-grade fever.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

The province and city of Aksaray in central Turkey can be located on a map at
<http://en.wikipedia.org/wiki/Aksaray>. - Mod.LL]

******
[2] Cholera - Pakistan (Sindh)
Date: Tue 20 May 2008
Source: The Nation (Pakistan) [edited]
<http://www.nation.com.pk/pakistan-news- ... irpur-Khas>


Scientists at the University of Health Sciences (UHS) have discovered
the outbreak of cholera in Mirpur Khas, a district of Sindh province.
Addressing a press conference [in Lahore] on Monday [19 May 2008],
UHS Microbiology Department's head Prof Dr Maj Gen (R) Abdul Hannan
claimed that according to the research carried out in this regard,
the district Mirpur Khas was affected by cholera instead of
gastroenteritis. He said that the authorities concerned should pay
special attention towards the outbreak of cholera, which could spread
to the other areas of the province.

Prof Dr Maj Gen (R) Abdul Hannan has claimed that he has studied
stool samples of 18 patients from Mirpur Khas district of Sindh who
were supposed to be suffering from gastroenteritis. "8 out of 18
samples of feces are found to be infected with _Vibrio cholerae_, the
cause of cholera," he disclosed.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Sindh province is one of the 4 provinces in Pakistan and is located
in the southeastern part of the country. It can be found on a map at
<http://en.wikipedia.org/wiki/Sindh>. - Mod.LL]

KRIM-KONGO-HÄMMORGAGISCHES FIEBER - TÜRKEI (04)
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] CCHF death in Yozgat province
[2] CCHF-free regions
[3] CCHF death in Samsun province

******
[1] CCHF death in Yozgat province
Date: Sat 24 May 2008
Source: Today's Zaman online [edited]
<http://www.todayszaman.com/tz-web/detay ... ink=142542>


Woman dies from tick-transmitted disease in Yozgat
--------------------------------------------------
A woman from the central Anatolian province of Yozgat died Wednesday [21
May 2008] at an Ankara hospital where she was being treated for
Crimean-Congo hemorrhagic fever, a viral disease contracted from a tick
bite which can be fatal.

Cekerek District Governor Ahmet Odabaui talked to the Anatolia news agency
about the incident, saying that the 28 year old woman, who was living in
the Bayindirhoyuk village of Cekerek, was sent to Yozgat State Hospital
last week after she was bitten by a tick. She was later transferred to
Ankara Numune Hospital when her condition deteriorated and died yesterday
at this hospital.

The woman's death is the 6th fatal case of Crimean-Congo hemorrhagic fever
in the country this year [2008]. The number of tick bite cases increase as
the weather gets warmer and people engage in more activities outdoors. In
the past 5 years 94 people have died in Turkey from Crimean-Congo
hemorrhagic fever. People who have come into contact with a tick should be
monitored for 10 days following contact and seek professional medical care
if symptoms of fever, headache, nausea, vomiting or diarrhea present
themselves.

--
communicated by:
ProMED-mail rapporteur A-Lan Banks

******
[2] CCHF-free regions
Date: Wed 28 May 2008
Source: Today's Zaman online [edited]
<http://www.todayszaman.com/tz-web/detay ... ink=143195>


Istanbul's ticks do not transmit CCHF, says expert
--------------------------------------------------
Infectious diseases expert Dr Hurrem Bodur has said people with tick bites
should go to the hospital, but that there was no need for Istanbulites to
panic. An expert in infectious diseases has said there is no reason to
panic over ticks in Istanbul since they do not carry Crimean-Congo
hemorrhagic fever (CCHF), which has recently sparked fears throughout the
country.

"There is no need to panic. Scientific studies have proven that the ticks
in Istanbul do not carry Crimean-Congo hemorrhagic fever. You should go to
a hospital if ticks bite you, but there is no need to worry," said Dr
Bodur, the head of the Infectious Diseases Clinic at Ankara's Numune Hospital.

Istanbulites have recently begun to fear for their pastime of picnicking
because of a number of reported CCHF cases in Turkey. CCHF is transmitted
by tick bites and can be fatal. More than 1200 people went to emergency
rooms in hospitals throughout Istanbul over the weekend [24-25 May 2008]
because of tick bites. However, none of these people were infected with
CCHF. There were 4 CCHF incidents in Istanbul last year [2007], but these
people were infected by the CCHF virus during visits to other cities.

Bodur said the ticks that carry the CCHF virus are primarily found in the
provinces of Sivas, Tokat, Gumushane, Bayburt, Amasya, Cankin, Corum,
Yozgat, Samsun, Karabuk and Kastamonu. She added that people bitten by
ticks should go directly to a hospital no matter which city they are living
in. Bodur also added there was no need for panic as long as one does not
take the tick out of his/her body themselves and added that the rumors that
ticks carrying CCHF had come to big cities like Istanbul and Ankara were
not true.

Bodur said [since] ticks cannot fly they cannot spread to other cities as
long as animals or human beings do not carry them. "People buying animals
from cities in which there have been CCHF incidents should check these
animals for ticks. In this way we can prevent the circulation of ticks
carrying the CCHF virus," she explained. Answering a question about whether
these ticks could spread to all of Turkey, Bodur said: "Theoretically this
is possible. But practically the living spaces of [CCHF-carrying] ticks are
restricted to rice planting basins and around these places. The species
transmitting CCHF cannot live out of these places. We have not seen any new
CCHF incidents in cities other than those we saw them in last year."

Universities in Turkey are trying to develop a vaccine against CCHF. In
Central Europe, people are vaccinated against another illness [tickborne
encephalitis - Mod.CP] that ticks are transmitting again. Aykut Darendeli,
an instructor at the veterinary school at Elazig's Firat University, said
they have been conducting studies to develop a vaccine against CCHF for
four years with support from the Scientific and Technological Research
Council of Turkey (TUBITAK), adding: "We are developing this vaccine
project to immunize people against CCHF. We have not conducted our
experiments on animals yet, so I cannot claim we will definitely succeed."

[byline: Hasan Bozkurt]

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

******
[3] CCHF death in Samsun province
Date: Thu 5 Jun 2008
Source: Today's Zaman online [edited]
<http://www.todayszaman.com/tz-web/detay ... ink=143951>


TAEK tries tick sterilization to prevent further tickborne disease
------------------------------------------------------------------
The Turkish Atomic Energy Agency (TAEK) has taken a step to prevent a rise
in the tick population through a male sterilization and release program, a
method scientists expect will help prevent further cases of
tick-transmitted disease. TAEK officials announced that they have started
sterilizing ticks collected from regions where people have died from
Crimean-Congo hemorrhagic fever (CCHF) -- a tickborne viral disease that
often proves fatal -- in order to control the number of ticks that spread
CCHF and other infectious diseases. The technique utilizes a form of
irradiation to destroy or seriously debilitate the testes of the male insects.

"We have collected many ticks from regions where there have been incidents
of CCHF-related deaths. We have sterilized them and then released them back
to the wild. These sterilized ticks will continue to copulate, but will not
be able to reproduce or will produce nonviable larvae. With this method, we
expect to see a significant decrease in the number of ticks carrying CCHF,"
said a TAEK official.

The same official noted that using insecticides against ticks is not an
effective way of curbing their population in the long term. "These insects
often develop resistance to such insecticides over time," he added.

Meanwhile, a man from northern Samsun province died on Tuesday [4 Jun 2008]
at a hospital where he was being treated for CCHF. The man, who was living
in the Armutlu village of Asarcik district, was sent to Ondokuz Mayis
University Hospital last week after he was bitten by a tick while working
in his garden. His death is the 17th fatal case of CCHF in four Turkish
provinces, namely Samsun, Corum, Tokat and Amasya, this year [2008]. The
number of tick bite cases increase as the weather gets warmer and people
engage in more activities outdoors. In the past 5 years, 94 people have
died in Turkey from CCHF. People who have come into contact with a tick
should be monitored for 10 days following contact and seek professional
medical care if symptoms of fever, headache, nausea, vomiting, or diarrhea
present themselves.

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

[ProMED-mail thanks A-Lan Banks for drawing attention to these recent
reports of CCHF deaths in the Turkish provinces of Yozgat and Samsun and
the novel initiatives to combat the spread of tickborne disease.

The HealthMap/ProMED-mail interactive map of Turkey is available at
<http://healthmap.org/promed?v=39.1,35.2,5>, and a map delineating the
administrative provinces of Turkey can be accessed at
<http://www.mapsofworld.com/turkey/turke ... l-map.html>. - Mod.CP]

MILZBRAND, HUMAN, EQUINE - KIRGISISTAN
***********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 9 Jun 2008
Source: Novosti Russian News & Information Agency [edited]
<http://en.rian.ru/world/20080609/109575426.html>


An anthrax outbreak has hit south Kyrgyzstan, where 2 people are reported
to have died of the disease, and 6 others are being treated in hospital
with similar symptoms, health officials in the Central Asian state said on
Monday [9 Jun 2008].

Anthrax has been confirmed in the 2 fatal cases, who were from the village
of Beshinchi. Further tests are being carried out on the 6 people, who are
currently being treated in isolation wards, officials said. Health
officials said the victims may have contracted the disease when they
slaughtered a horse for its meat in late May 2008.

There are effective vaccines against the disease. Authorities have
temporarily shut the local livestock market.

--
communicated by
ProMED-mail rapporteur Dan Silver

[I have searched for this village in south Kyrgyzstan but as yet have been
unable to find it. I am asking my contacts in Bishkek for more information,
and when it comes through, it and the location can be posted.

Unfortunately, this is not an unusual outbreak for Kyrgyzstan. The puzzle
is that it is claimed to have started with a presumably sick horse. People
eat horses in Central Asia. Horses can get infected from grazing but also
by horseflies with contaminated mouthparts, which is what I suspect in this
instance, as horses are not aggressive grazers as are cattle. And, if so,
there will have been prior livestock cases to contaminate the flies'
mouthparts. That the local livestock market has been closed would hint that
the authorities suspect that more might be happening than they are party to.

To find the location of Kyrgyzstan, go to
<http://encarta.msn.com/encnet/features/ ... ckCheck=on>.
- Mod.MHJ]

MILZBRAND, HUMAN, EQUINE - KIRGISISTAN (02): (OSH)
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Wed 11 Jun 2008
From: Asankadyr Junushov <junushov@mail.ru>


Kyrgyzstan: human anthrax cases
-------------------------------
Data on anthrax human cases in the Uzgen region in Osh oblast, for 2008
(according to the report of the Republican Center for Quarantine &
Especially Hazardous Diseases of Health Ministry KR)

1. [18 year old unemployed male], from Iyrisuu Rural Council, Taktagai site
(Beshinchi) who fell ill on 16 May 2008. He was involved in the cooking and
meat cutting of a forced-slaughtered horse. Five persons were involved in
the horse slaughter. 200 kg (441 lb) of meat were distributed among 42
families. In total, 175 people consumed the meat. There were no meat
remainders, so skin and soil samples were tested. The test on 21 May 2008
confirmed the presence of the anthrax agent, _Bacillus anthracis_.

2. [42 year old male], in Makarenko village, Turt-kul Rural Council, Uzgen
region, Osh oblast, who fell ill on 16 May 2008. He was involved in cattle
slaughter. The diagnosis of [cutaneous] anthrax was confirmed by laboratory.

3. [42 year old male], in Makarenko village, Turt-kul Rural Council, Uzgen
region, Osh oblast. He was involved in cattle slaughter. His diagnosis of
[cutaneous] anthrax was fixed clinically.

All the necessary antiepidemic and antiepizootic [measures] are being
implemented.

--
Asankadyr Junushov
D/Biotechnology Institute
National Academy of Sciences of Kyrgyzstan
265 Chui ave.
Bishkek
Kyrgyzstan
<junushov@mail.ru>

******
[2]
Date: Tue 10 Jun 2008
From: ProMED-RUS <promed@promedmail.org>
Source: IA Medportal [translated by Corr.ATS, edited]
<http://www.medportal.ru/mednovosti/news ... 0/anthrax/>


The number of infected with anthrax has increased in Kyrgyzstan
---------------------------------------------------------------
The 3rd case of confirmed human anthrax has been registered in Osh region
of Kyrgyzstan. This information came from the director of Republican Center
for Particularly Dangerous Infections. There was information about 8 cases
of anthrax admitted to the hospitals and in 5 of them the infection has not
been confirmed yet. The cases are with skin lesions, which are treated with
grater success, the representative of the Ministry of Health said. The
doctors say that the infections are due to consumption of contaminated beef.

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

[Our thanks to Asankadyr for the information in [1], which, yet again,
reiterates the importance of our informed members in filling out the
details of the events ProMED-mail reports. The coincidence of the 2
incidents, in the ongoing absence of the location of Beshinchi village,
would reinforce the speculation that the horse case may have been
associated with the cattle outbreak in Makarenko, site also unknown for the
present.

To find Uzgen, go to <http://www.fallingrain.com/world/KG/0/Ozgon.html>.
According to Google Earth Turt-kul is immediately north of Uzgen (capital
of Uzgen district). There is, however, a town named Irisu in the mountains
well north of Uzgen. See
<http://www.traveljournals.net/explore/k ... irisu.html>
which if the same as Irisuu would suggest two very separate outbreaks. -
Mod.MHJ]

KRIM-KONGO-HÄMMORHAGISCHES FIEBER - TÜRKEI (05)
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 6 Jun 2008
Source: TurkishPress.com [edited]
<http://www.turkishpress.com/news.asp?id=234933>


Fifteen people have died of Crimean-Congo hemorrhagic fever (CCHF) in
Turkey since the beginning of the year [2008]. More than 300 people were
hospitalized after being bitten by ticks.

CCHF is a viral haemorrhagic fever with a high mortality rate caused by
tick bite.

--
communicated by:
Claudio Po
<ClPo@regione.emilia-romagna.it>

[ProMED-mail thanks Claudio Po for this update on the the CCHF situation in
Turkey. - Mod.CP]