It seems that Mexico is a hotspot for Cyclospora infections. There is no known animal reservoir so the infection is most probably transmitted when human feces are used to fertilize greens for human consumption.
CYCLOSPORIASIS – UK: ex MEXICO
Published Date: 2016-07-30 13:11:32
Subject: PRO> Cyclosporiasis – UK: ex Mexico
Archive Number: 20160730.4381665
Date: Sat 23 Jul 2016
Source: Outbreak News Today [edited]
UK health officials are seeing an increase in the parasitic infection, cyclosporiasis, in travelers returning from Mexico, according to Travel Health Pro report.
The cluster has been seen since June  and many of the travelers stayed in Riviera Maya [Quintana Roo state], the same place where some 80 travelers contracted Cyclospora last summer.
_Cyclospora cayetanensis_ is a single celled coccidian parasite. Cyclosporiasis occurs in many countries, but it seems to be most common in tropical and subtropical regions. The parasite causes watery diarrhea, nausea, anorexia, abdominal cramps and weight loss. Fever is a rare symptom.
People get infected with Cyclospora through foodborne or waterborne means. Swimming in contaminated water is also a way someone can get infected.
Cyclospora has been implicated in numerous outbreaks with contaminated fruits and vegetables being the common culprits (raspberries, basil and lettuce all washed with contaminated water), especially those imported from developing nations.
All fruits and vegetables should be thoroughly washed before eating though this does not guarantee safety. Cyclospora is resistant to chlorination. Treatment is usually successful after a course of the antibiotic Septra [trimethoprim-sulfamethoxazole].
Patients with HIV or otherwise immunocompromised usually require higher dosages for a longer period of time. Untreated infections can last from a few days to over a month.
ProMED-mail from HealthMap Alerts
[A similar outbreak in UK travellers was reported in October 2015 where _Cyclospora cayetanensis_ was identified in 176 returned travellers from the Riviera Maya region of Mexico between 1 Jun and 22 Sep 2015, 79 in the United Kingdom (UK) and 97 in Canada. A nationwide outbreak of cyclosporiasis took place in the United States and Canada in June to August 2015 (see ProMED-mail reports below) and the source was suspected to be lettuce imported from Mexico.
It seems that Mexico is a hotspot for Cyclospora infections. There is no known animal reservoir so the infection is most probably transmitted when human feces are used to fertilise greens for human consumption. – Mod.EP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/14.]
Cyclosporiasis – UK, Canada: ex Mexico, RFI 20151101.3759380
Cyclosporiasis – USA (05): ex Mexico 20150827.3606898
Cyclosporiasis – USA (04): ex Mexico 20150813.3576519
Cyclosporiasis – Canada 20150810.3569701
Cyclosporiasis – USA (03) 20150802.3553403
Cyclosporiasis – USA (02): (TX) 20150702.3479116
Cyclosporiasis – USA: (TX) increase in cases 20150624.3462421
Cyclosporiasis – USA (14) 20130906.1926983
Cyclosporiasis – USA (02): background 20111002.2967
Cyclosporiasis – USA (FL)(03) 20050604.1564
Cyclosporiasis – USA (PA) 20040918.2584
Cyclosporiasis – USA (Missouri) 19990907.1574
Cyclosporiasis, basil – USA (Washington D.C.) (04) 19970730.1594
ANTHRAX – RUSSIA (04): (YAMAL-NENETS) REINDEER, HUMAN EXPOSURE
Published Date: 2016-07-30 12:37:26
Subject: PRO/AH/EDR> Anthrax – Russia (04): (YN) reindeer, human exposure
Archive Number: 20160730.4381564
Date: Saturday, 30 July 2016
Source: The Siberian Times [edited]
40 now hospitalised after anthrax outbreak in Yamal, more than half are children
Russian army biological protection troops called in amid warnings ‘utmost care’ needed to stop deadly infection spreading. The concern among experts is that global warming thawed a diseased animal carcass at least 75 years old, buried in the melting permafrost, so unleashing the disease.
A total of 40 people, the majority of them children, from nomadic herder families in northern Siberia, are under observation in hospital amid fears they may have contracted the anthrax. Doctors stress that so far there are NO confirmed cases. Up to 1200 reindeer were killed either by anthrax or a heatwave in the Arctic district where the infection spread.
Specialists from the Chemical, Radioactive and Biological Protection Corps were rushed to regional capital Salekhard on a military Il-76 aircraft. They were deployed by Defence Minister Sergei Shoigu to carry laboratory tests on the ground, detect and eliminate the focal point of the infection, and to dispose safely of dead animals. The move confirmed the seriousness with which the authorities view the anthrax outbreak, the 1st in this region since 1941. The army unit is equipped with military helicopters as well as off road vehicles for what Yamalo-Nenets governor Dmitry Kobylkin calls ‘an extremely challenging task of liquidating the consequences — and disinfecting the focus — of the infection. I think this perhaps will be the 1st in the world operation cleaning up a territory of mass deer mortality over such distances in the tundra.’
Eight new people were admitted to hospital in Salekhard early on Friday [29 Jul 2016], bringing the total to 40, said officials. Earlier it was reported that 13 were in hospital. ‘As of now, there is no single diagnosis of the dangerous infection,’ said a spokesman for the governor of Yamalo-Nenets, Dmitry Kobylkin. ‘Medics are taking preliminary measures even if there is the slightest doubt over the nomads’ state of health.’
The 40 are all from a total of 63 nomads belonging to a dozen families who were at the site of the outbreak at Tarko-Sale Faktoria camp. The remaining nomads have been evacuated some 60 kilometres [about 37 miles] from the focus of infection in Yamalsky district.
A prolonged period of exceptionally hot weather in an Arctic Siberian district — with temperatures of up to 35 degrees C — has led to melting of permafrost in Yamalo-Nenets and other regions. The outbreak of anthrax earlier this week is the 1st in this part of Russia since 1941. Officials say 1200 reindeer have died in recent days, evidently through a combination of infection from anthrax, and the heatwave — unprecedented in living memory. A major [animal] inoculation programme is also underway with a local state of emergency declared at Tarko-Sale Faktoria camp, above the Arctic Circle and close to the Yaro To lake, some 340 kilometres [about 210 miles] north-east of Salekhard.
Anna Popova, director of state health watchdog Rospotrebnadzor, flew to the region on Thursday [28 Jul 2016] and insisted ‘all measures are now being taken to minimise the risks’. She denied there was a risk of a spread to other regions of Russia. But she warned: ‘We need to be ready for any manifestations and return of infection. The (Yamalo-Nenets) territory, which has had no anthrax in animals or people since 1941, and which has been considered free from infection since 1968, demonstrates that this infection is subtle. ‘It’s not the 1st situation when anthrax returns to Russia.’
Sanitation of the territory and disposal of reindeer carcasses will begin in the district in the nearest future.
‘To increase lab control, scientists from 2 Rospotrebnadzor research institutes are doing all necessary research,’ Anna Popova said. ‘Additionally, a lab has been deployed on the ground, and work is being done in the (scientific) institutions in Moscow and other cities of Russia.’
The concern follows an outbreak of the bubonic plague in the Altai Mountains in southern Siberia earlier this month [July 2016].
It is already clear that the anthrax outbreak has come despite major precautions against the disease in a part of northern Russia which takes huge pride in its venison industry, with supplies sent to other regions of the country and abroad. Officials insisted that last year  almost half a million reindeer were vaccinated against anthrax.
One leading academic Professor Florian Stammler, of the Arctic Centre, University of Lapland, Finland, has warned of the serious risk of anthrax spreading around the Yamal Peninsula from this location, which he portrays as a reindeer junction. He told The Siberian Times: ‘I have myself moved together with private herders around the Yaro To lake. The location is an important pass way for many reindeer nomads, used in all seasons. The nomads with the furthest longest migration routes use it in early May, just before calving time, moving up North in spring towards their summer pastures.’
‘The 2nd “wave” of herders use this location as a summer site, where they group with several households uniting many small herds into a big one for withstanding mosquito harassment,’ Professor Florian Stammler said. ‘People stay close to the Yaro To lake for fishing there in summer. In autumn the site is again used as a pass way for herders returning from their summer pastures south heading towards the slaughtering sites in the south of the Yamal Peninsula. In winter, some private herders use the site and get supplies from the trading post in Tarko Sale. This shows that the place is very intensively used. Due to the high mobility of herders using this site, utmost care has to be taken for preventing of anthrax being spread all over the Yamal Peninsula.’
Experts believe that the reason of the outbreak is the unusually warm summer and the resulting thawing of the tundra. Anthrax has the potential to survive for a century or more. It appears that the frozen infection ‘was unlocked by the thawing of a diseased carcass from a long time ago’, The Siberian Times was told. ‘We have a significant change in our climate in this region. Global warming can be behind the return of anthrax.’ The reindeer here were weakened by the heat, and strong warm winds. The region has faced ‘hot days’ of temperatures in the range of 25 degrees C to 35 degrees C for around a month, it is reported.
The lethal anthrax bacteria turn into spores when frozen, but morph back into their dangerous state when temperatures warm. [Confusion here. The spores form in the soil in the summer heat. They survive well in the frozen permafrost. When this melts there is the potential for germination and vegetative cycling for a limited series before it resporulates. – Mod.MHJ] Potentially this process can unleash widespread old bacteria across regions with melting permafrost, as a number of scientists have warned.
The Sakha Republic, east of this region, has some 200 burial grounds of animals that succumbed to anthrax in the past.
The authorities insist the outbreak will not impact venison exports. They stress it was restricted to the site around Tarko-Sale camp, yet the warning of Professor Stammler that the location is a reindeer crossroads means there is no scope for complacency. A spokesman for the governor said: ‘This case won’t affect exports or the quality of meat.’ Most exports go to Germany, Sweden, Finland and the UK.
‘This case is local, it is about one centre — Yaro To lake in Yamalsky district. No other centres (of anthrax infection) have been discovered. Control and safety measures have been restricted across the whole region. There is no single chance that infected venison will make it to the slaughter complex: all of them, each and every patch is thoroughly checked in line with the highest standards. We’re interested in exporting high-quality venison just like it has always been. Our long-term history with foreign partners says that we are trusted and our reputation is precious. We’re hoping that this situation will not impact on attitudes towards Yamal products.’
[Many thanks, David.
The permafrost melting in the heat is clearly the received cause of this outbreak of anthrax, but the actual cause has yet to be determined, as well as why so many reindeer have died. A difficult problem, but they now have enough feet on the ground to sort it out. Plus a great opportunity for training. Note that though “anthrax” has been confirmed in one or more reindeer, they state that human anthrax has not been confirmed yet.
As the reporting has continued, the location of these afflicted reindeer has moved from report to report. It is now, from this report and its map, 340 km northeast of Salekhard. And while this area reported its last anthrax case in 1941, it was not declared clear until 1968. And elsewhere they have been vaccinating half a million reindeer each year. Well, it is claimed so. In my experience with Russian numbers, there tends to be a confusion between the numbers of vaccine doses provided and the actual number of animals vaccinated. How many actually get vaccinated can be uncertain. – Mod.MHJ
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/54485.]
Anthrax – Russia (03): (YN) reindeer, human exposure 20160728.4376306
Anthrax – Russia (02): (YN) reindeer, human exposure 20160727.4373872
Anthrax – Russia: (YN) reindeer, human exposure 20160726.4370736
Category A – Bioterrorism Agents
Category A pathogens are those organisms/biological agents that pose the highest risk to national security and public health because they can be easily disseminated or transmitted from person to person; result in high mortality rates and have the potential for major public health impact; might cause public panic and social disruption, and require special action for public health preparedness. — National Institutes of Health
Anthrax is a high-priority agent and poses a high risk to national security, it can be easily transmitted and disseminated, result in high mortality, has potential major public health impact, may cause public panic, or require special action for public health preparedness.
Bacillus anthracis (anthrax) is a non-contagious disease caused by the spore-forming bacterium Bacillus anthracis. An anthrax vaccine does exist but requires many injections for stable use. When discovered early, anthrax can be cured by administering antibiotics (such as ciprofloxacin). Its first modern incidence in biological warfare were when Scandinavian “freedom fighters” supplied by the German General Staff used anthrax with unknown results against the Imperial Russian Army in Finland in 1916. In 1993, the Aum Shinrikyo used anthrax in an unsuccessful attempt in Tokyo with zero fatalities. Anthrax was used in a series of attacks on the offices of several United States Senators in late 2001. The anthrax was in a powder form and it was delivered by the mail. Anthrax is one of the few biological agents that federal employees have been vaccinated for. The strain used in the 2001 anthrax attack was identical to the strain used by the USAMRIID. -–Wikipedia
VANCOMYCIN RESISTANCE – USA: (FLORIDA) ENTEROCOCCUS FAECIUM, SEWAGE SPILL, ENVIRONMENTAL CONTAMINATION, 2014
Published Date: 2016-07-28 15:40:52
Subject: PRO/AH/EDR> Vancomycin resistance – USA: (FL) E. faecium, sewage spill, envir. contam., 2014
Archive Number: 20160728.4376123
Date: Friday, 15 July 2016
Source: Applied and Environmental Microbiology [edited]
Citation: Young S, Nayak B, Sun S, Badgley B, Rohr J, Harwood VJ: Vancomycin resistant enterococci and bacterial community structure following a sewage spill into an aquatic environment. Appl Environ Microbiol. 2016; pii: AEM.01927-16. [Epub ahead of print]. DOI: 10.1128/AEM.01927-16
Sewage spills can release antibiotic resistant bacteria to surface waters, contributing to environmental reservoirs and potentially impacting human health. Vancomycin resistant enterococci (VRE) are nosocomial pathogens that have been detected in environmental habitats including soil, water, beach sands and wildlife feces. However, VRE harboring _vanA_ genes that confer high-level resistance have infrequently been found outside of clinical settings in the U.S. This study found culturable _Enterococcus faecium_ harboring the _vanA_ gene in water and sediment up to 3 days after a sewage spill, and the qPCR signal for _vanA_ persisted for an additional week. Culturable enterococci levels in water exceeded recreational water guidelines for 2 weeks following the spill, declining about 5 orders of magnitude in sediments and 2 orders of magnitude in the water column over 6 weeks. Analysis of bacterial taxa via 16S rRNA gene sequencing showed changes in community structure through time following the sewage spill in both sediment and water. The spread of opportunistic pathogens harboring high level vancomycin resistance genes beyond hospitals and into the broader community and associated habitats is a potential threat to public health, requiring further studies examining the persistence, occurrence and survival of VRE in different environmental matrices.
Significance of the study: vancomycin-resistant enterococci (VRE) are harmful bacteria that are resistant to the powerful antibiotic vancomycin, used as a last resort against many infections. This study followed the release of VRE in a major sewage spill, and their persistence over time. Such events can act as a means of spreading vancomycin-resistant bacteria in the environment, which can eventually impact human health.
USDA, Agricultural Research Service, retired
[Enterococci are Gram-positive cocci that normally inhabit the lower gastrointestinal tract of animals, including humans. They commonly cause both community-acquired and nosocomial infections, which include urinary tract infection, biliary sepsis, and other intra-abdominal infections, wound infections, bacteremia, and endocarditis. The most common enterococcal pathogens are _Enterococcus faecalis_ and _Enterococcus faecium_.
Vancomycin is a glycopeptide antibiotic that has been used to treat infections caused by antibiotic-resistant Gram-positive bacteria, including enterococci. However, vancomycin-resistant enterococci (VRE) have become increasingly common worldwide since they were 1st reported in 1988 in the UK and France. Although _E. faecalis_ is more common overall among clinical isolates, _E. faecium_ is more common than _E. faecalis_ among VRE.
Of the several genotypes of vancomycin resistance, _vanA_ and _vanB_ are most common as they are located on mobile genetic elements that can readily move between enterococci. _VanA_ strains have high MICs (minimum inhibitory concentrations) to both vancomycin and another related antibiotic teicoplanin; _vanB_ strains have moderate to high MICs to vancomycin and are susceptible to teicoplanin.
Avoparcin, a member of the class of antibiotics (glycopeptides) to which vancomycin belongs, had been used in some countries in animal feed as a growth promoter. Because avoparcin confers cross-resistance to vancomycin, the use of avoparcin can select for VRE. VRE, i.e. vancomycin-resistant _E. faecium_ carrying the _vanA_ genotype, was more common in the intestinal tract of farm animals and humans with no exposure to hospitals and in sewage in European countries that used avoparcin in animal feed for growth promotion than in European countries, Canada and the USA that never used avoparcin in animal husbandry.
In the USA, where use of glycopeptides had been restricted to use in hospitals, VRE has been much more common in hospitals, detected in fecal colonization or infections in people with hospital exposure and hospital sewage, and rarely found in humans in the community with no hospital exposure or in food animals (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020891/). Once the use of avoparcin was discontinued in European countries, the prevalence of VRE among farm animals decreased (http://jac.oxfordjournals.org/content/46/1/146.full). In China, where glycopeptides, including avoparcin, are banned in animal husbandry, VRE reportedly has been rarely found on farms (http://jac.oxfordjournals.org/content/early/2013/07/18/jac.dkt293.extract).
In the field study reported in the abstract above, culturable VRE and/or _vanA_ genes were transiently detected in sediment and water samples after a 3-day sewage spill released more than 500 000 gallons of untreated sewage in a residential neighborhood in 2014. The spill in this study was not in close proximity to any hospital; and sewage from the nearest hospital flowed away from the break site. The source of the VRE in this study was not explained. – Mod.ML
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/212.]
Staphylococcus aureus, MRSA – Brazil: (SP) vancomycin resistant (VRSA) update 20140422.2420131
Antibiotic resistance – USA (03): vancomycin, comment 20131125.2073470
Antibiotic resistance – USA (02): vancomycin, comment 20131118.2061191
Antibiotic resistance – USA: vancomycin, crow 20131111.2048866
Vancomycin resistant enterococci – China: (HK) E. faecium ST6/CC5 20130801.1858689
Staphylococcus aureus, MRSA – Brazil: (SP) vancomycin resistant (VRSA) 20130630.1800166
Vancomycin resistant enterococci – Sweden 20100727.2515
PERTUSSIS – USA (05): (MINNESOTA, OKLAHOMA) INCREASING INCIDENCE
Published Date: 2016-07-28 18:24:02
Subject: PRO/EDR> Pertussis – USA (05): (MN, OK) increasing incidence
Archive Number: 20160728.4377210
In this post:
Date: Wednesday, 27 July 2016
Source: Post-Bulletin [edited]
An additional 20 cases of pertussis were confirmed last week by Olmsted County Public Health, matching the highest weekly number since the local health department activated its emergency response team on [23 May 2016]. [The city of Rochester, Minnesota is the Olmsted County seat and home to Mayo Medical School and the Mayo Clinic.]
The new recent cases bring Olmsted County’s 2016 total to 173, which is by far the most in Minnesota and the highest local level since the 2012 outbreak. Hennepin County [where Minneapolis is located] had the 2nd highest annual total in the state with 62, according to the [30 Jun 2016] report from Minnesota Department of Health; a new state report is expected to be released next week.
While more than half of the state has reported zero pertussis cases, Olmsted County has nearly matched Hennepin’s total for 3 straight months, including 52 in May, 46 in June and 58 so far in July .
“Pertussis spreads through the air when a person who is contagious with pertussis coughs or sneezes and exposes others close[by],” said Pete Giesen, director of Olmsted County Public Health. “Although the cough can last more than 100 days, a person is no longer spreading it after the 3rd week or after 5 days of taking antibiotics, which is why it is so important to follow the guidance to prevent further transmission.”
The local health department says that the pertussis outbreak continues to impact day cares, youth camps and sporting groups. After just 7 cases were counted between [11-17 Jul 2016], that number nearly tripled to dash hopes that the outbreak was subsiding.
Pertussis, which is also called whooping cough, mimics the common cold for about a week before symptoms worsen. Coughing often comes in uncontrollable fits that can cause vomiting and is often marked by a whooping-like noise. It’s highly contagious and most commonly found in teenagers, but it’s considered especially dangerous for infants and the elderly.
[Byline: Brett Boese]
ProMED-mail from HealthMap Alerts
Date: Thursday, 28 July 2016
Source: Tulsa World [edited]
Oklahoma sees increase in whooping cough as vaccination rate declines. State health officials cite waning immunity and decisions to opt out of vaccinations.
Oklahoma has seen an increase this year  in the occurrence of pertussis, or whooping cough, a highly contagious respiratory disease that can cause serious illness in children and adults. Since [1 Jan 2016], Oklahoma has seen 70 confirmed cases of pertussis, compared to 86 confirmed cases for all of 2015, according to the state Health Department. “We don’t know how the rest of the year is going to play out, and if we might end up with the same number of cases, but certainly going through the halfway point of the year so far, we have noted that we have seen more cases this year,” said Laurence Burnsed, an epidemiologist at the Oklahoma Department of Health.
The agency’s investigations of recent cases have identified several case clusters across Oklahoma among household members and contacts within close-knit community groups, such as day cares and schools, Burnsed said.
[Byline: Jaclyn Cosgrove]
ProMED-mail from HealthMap Alerts
[Outbreaks tend to occur in roughly 3- to 5-year cycles. For discussions of pertussis, please see moderator’s comments in prior ProMED-mail posts below. – Mod.ML
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/238.]
Pertussis – USA (04): (CA) increasing incidence, corr 20160701.4318528
Pertussis – USA (04): (CA) increasing incidence 20160629.4315517
Pertussis – USA (03): (CA) fatal 20160504.4202149
Pertussis – New Zealand 20160426.4184540
Pertussis – USA (02): (NY) 20160403.4135723
Measles, pertussis – Nigeria: (JI) fatalities 20160317.4101954
Pertussis – Australia (03): (NS) 20160316.4097729
Pertussis – Australia (02): (NS) vaccine shortage 20160304.4068067
Pertussis – Spain: (CM) 20160214.4018889
Pertussis – Canada: (ON) 20160112.3930921
Pertussis – USA (01) 20160111.3927199
Pertussis – Australia: (WA) 20160111.3926728
Pertussis – Canada (04): (AB,SK) 20150918.3653562
Pertussis – USA (13): (OH,KY,IN) 20150910.3637867
Pertussis – French Polynesia 20150907.3628904
Pertussis – USA (12): (AZ) 20150902.3617491
Pertussis – USA (11): (KS) update 20150726.3537082
Pertussis – Canada (03): (ON) update 20150726.3537081
Pertussis – USA (10): (KS) fatal, update 20150618.3446509
Pertussis – UK: (England) increasing incidence, 2014 20150506.3344092
Pertussis – USA (08): (NC) 20150418.3305675
Pertussis – USA (05): (OR) 20150314.3229781
Pertussis – USA: (CA) fatal 20150115.3093551
Nuclear Event in USA on Monday, 18 July, 2016 at 12:30 [EDT]
AGREEMENT STATE REPORT – LOSS OR THEFT OF DEPLETED URANIUM OXIDE
The following report was received via e-mail:
“On Monday, July 18, Manufacturing Sciences Corp. [MSC] shipped five pallets (18 drums) of product containing depleted uranium oxide [DU] to a customer, Clariant, in Louisville, KY. On Wednesday, July 20, the customer contacted MSC to report only four pallets containing 14 drums were received by Clariant. When the bill of lading was examined by the customer, 5 and 18 had been marked through by hand and changed to 4 and 14. The carrier, was contacted and is conducting a thorough search of its terminal and investigating to locate the missing material. The carrier is routinely used by MSC for transport of product. Total activity of missing material: 271,285 microcuries DU.”
Tennessee Report: TN-16-100
THIS MATERIAL EVENT CONTAINS A “LESS THAN CAT 3” LEVEL OF RADIOACTIVE MATERIAL
Sources that are “Less than IAEA Category 3 sources,” are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly – although it is unlikely – temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf