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Infectious disease surveillance update
Newsdesk
a public health issue, will there not be those deserving of punishment who escape justice? CPS guidelines point out that the consequences for the “victim” of contracting a sexually transmitted disease fit the criteria for grievous bodily harm. And what of those cases in which there is deliberate deception—an individual who explicitly claims to be negative and goes on to infect their partner? However, there is a risk that prosecutions will encourage the impression that precautions are the prerogative of the infected, eroding efforts to foment a culture of shared responsibility. “One unhelpful message is that HIV is spread only by people who know they have it, and that most people with diagnosed HIV will routinely tell you they have it”, says Azad. Most infections are attributable to the undiagnosed, and to suggest that a handful of criminally liable
people are to blame for the HIV/AIDS epidemic sidelines the responsibilities of the wider population. There are questions of justice. Is not the decision to have unprotected sex an implicit acceptance of the associated risks? What about cases where an HIV-positive defendant used a condom but it split? Or their antiretroviral regimen rendered their viral load undetectable? Weait points out that complaints have tended to be brought by aggrieved ex-partners, but many couples stay together after one infects the other, and no complaint is made. The number of potential criminals in the UK is likely to be several thousand. “There’s been a significant move towards criminalisation both in the UK and other countries”, Azad concludes, “but public health voices are beginning to be heard.” Prosecutorial guidelines demanding a high threshold of evidence have
reduced cases brought to court in England and Wales. Crucial to this is the burgeoning judicial awareness of the limitations of phylogenetic analysis, which cannot reliably establish the direction or source of HIV infection. New police guidelines, agreed with the National AIDS Trust, should prevent a recurrence of the circumstances surrounding the Porter case, and decrease the number and length of investigations. Still, it is hard to shake the idea that prosecutions reinforce stigma and create an impression of those living with HIV as being of especial threat to the general public. Azad believes this is counterproductive. “Stigma is the main reason people find it hard to declare their HIV status; we would do far better address this than to criminalise people.”
Talha Burki
Infectious disease surveillance update West Nile virus in Europe West Nile virus has been reported in several European countries since the initial outbreak in Greece reported on Aug 7. The Greek outbreak is largely limited to the central Macedonia region, with a few cases in the neighbouring district of Larissa. As of Sept 3, 173 cases (all laboratory confirmed) had been reported and there had been 15 deaths. In Romania, health authorities have reported 13 confirmed cases and two probable cases in the past 2 months. Two people with the infection, both older than 75 years, have died. The median age of the people infected was 50 years (range 18–79) and they were from 11 different districts. The Hungarian health authorities have confirmed three cases of infection: two people living in central Hungary and one close to the Romanian border. One case of infection has also been confirmed in the Veneto region of Italy www.thelancet.com/infection Vol 10 October 2010
and one probable case was identified in Portugal. Outside of the European Union, from July to August, 2010, 231 cases of West Nile fever were reported in Russia, including six deaths. On Aug 10, 24 confirmed cases were reported in Israel, with six further presumed cases. A more recent case was imported into Israel from the Netherlands. Most cases in Israel have been in the Central and Tel Aviv region, but there have also been isolated cases reported in the Haifa region.
Encephalitis in India On Sept 8, health officials in India confirmed that a further five people had died due to encephalitis, bringing the total number of deaths in Uttar Pradesh’s eastern region to 254 this year. The outbreak of encephalitis this year began unusually early, by mid-April 210 patients had already been treated in this region. In many
cases the cause has not been specified. Some of the cases are due to Japanese encephlitis virus (JEV) and others have been described as acute encephalitis of undefined aetiology but not due to JEV infection. In 2009, more than 500 cases of encephlitis were reported in the region. Again, only some of these cases were attributed to JEV.
Legionnaires disease in the UK As of Sept 12, 19 cases of legionnaires disease have been identified in Wales in the UK. All patients have needed treatment in hospital. A further four people are being investigated to establish if they are linked to the outbreak. Two of these four people have died: a 70-year-old man who died on Sept 8 and a 64-year-old woman on Sept 6. The source of the outbreak has not yet been identified.
For more on WNV in Europe see http://www.ecdc.europa.eu/en/ activities/sciadvice/Lists/ ECDC%20Reviews/ECDC_ DispForm.aspx?List=512ff74f77d4-4ad8-b6d6-bf0f23083f30 &ID=938&RootFolder=%2Fen%2 Factivities%2Fsciadvice%2FLists %2FECDC%20Reviews For ECDC’s WNV threat assessment see http://www. ecdc.europa.eu/en/healthtopics/ Documents/1009_Threat%20 assessment_West_Nile_Virus.pdf For more on legionnaires disease in Wales see http:// www.wales.nhs.uk/ sitesplus/888/news/17027
Onisillos Sekkides 667
a public health issue, will there not be those deserving of punishment who escape justice? CPS guidelines point out that the consequences for the “victim” of contracting a sexually transmitted disease fit the criteria for grievous bodily harm. And what of those cases in which there is deliberate deception—an individual who explicitly claims to be negative and goes on to infect their partner? However, there is a risk that prosecutions will encourage the impression that precautions are the prerogative of the infected, eroding efforts to foment a culture of shared responsibility. “One unhelpful message is that HIV is spread only by people who know they have it, and that most people with diagnosed HIV will routinely tell you they have it”, says Azad. Most infections are attributable to the undiagnosed, and to suggest that a handful of criminally liable
people are to blame for the HIV/AIDS epidemic sidelines the responsibilities of the wider population. There are questions of justice. Is not the decision to have unprotected sex an implicit acceptance of the associated risks? What about cases where an HIV-positive defendant used a condom but it split? Or their antiretroviral regimen rendered their viral load undetectable? Weait points out that complaints have tended to be brought by aggrieved ex-partners, but many couples stay together after one infects the other, and no complaint is made. The number of potential criminals in the UK is likely to be several thousand. “There’s been a significant move towards criminalisation both in the UK and other countries”, Azad concludes, “but public health voices are beginning to be heard.” Prosecutorial guidelines demanding a high threshold of evidence have
reduced cases brought to court in England and Wales. Crucial to this is the burgeoning judicial awareness of the limitations of phylogenetic analysis, which cannot reliably establish the direction or source of HIV infection. New police guidelines, agreed with the National AIDS Trust, should prevent a recurrence of the circumstances surrounding the Porter case, and decrease the number and length of investigations. Still, it is hard to shake the idea that prosecutions reinforce stigma and create an impression of those living with HIV as being of especial threat to the general public. Azad believes this is counterproductive. “Stigma is the main reason people find it hard to declare their HIV status; we would do far better address this than to criminalise people.”
Talha Burki
Infectious disease surveillance update West Nile virus in Europe West Nile virus has been reported in several European countries since the initial outbreak in Greece reported on Aug 7. The Greek outbreak is largely limited to the central Macedonia region, with a few cases in the neighbouring district of Larissa. As of Sept 3, 173 cases (all laboratory confirmed) had been reported and there had been 15 deaths. In Romania, health authorities have reported 13 confirmed cases and two probable cases in the past 2 months. Two people with the infection, both older than 75 years, have died. The median age of the people infected was 50 years (range 18–79) and they were from 11 different districts. The Hungarian health authorities have confirmed three cases of infection: two people living in central Hungary and one close to the Romanian border. One case of infection has also been confirmed in the Veneto region of Italy www.thelancet.com/infection Vol 10 October 2010
and one probable case was identified in Portugal. Outside of the European Union, from July to August, 2010, 231 cases of West Nile fever were reported in Russia, including six deaths. On Aug 10, 24 confirmed cases were reported in Israel, with six further presumed cases. A more recent case was imported into Israel from the Netherlands. Most cases in Israel have been in the Central and Tel Aviv region, but there have also been isolated cases reported in the Haifa region.
Encephalitis in India On Sept 8, health officials in India confirmed that a further five people had died due to encephalitis, bringing the total number of deaths in Uttar Pradesh’s eastern region to 254 this year. The outbreak of encephalitis this year began unusually early, by mid-April 210 patients had already been treated in this region. In many
cases the cause has not been specified. Some of the cases are due to Japanese encephlitis virus (JEV) and others have been described as acute encephalitis of undefined aetiology but not due to JEV infection. In 2009, more than 500 cases of encephlitis were reported in the region. Again, only some of these cases were attributed to JEV.
Legionnaires disease in the UK As of Sept 12, 19 cases of legionnaires disease have been identified in Wales in the UK. All patients have needed treatment in hospital. A further four people are being investigated to establish if they are linked to the outbreak. Two of these four people have died: a 70-year-old man who died on Sept 8 and a 64-year-old woman on Sept 6. The source of the outbreak has not yet been identified.
For more on WNV in Europe see http://www.ecdc.europa.eu/en/ activities/sciadvice/Lists/ ECDC%20Reviews/ECDC_ DispForm.aspx?List=512ff74f77d4-4ad8-b6d6-bf0f23083f30 &ID=938&RootFolder=%2Fen%2 Factivities%2Fsciadvice%2FLists %2FECDC%20Reviews For ECDC’s WNV threat assessment see http://www. ecdc.europa.eu/en/healthtopics/ Documents/1009_Threat%20 assessment_West_Nile_Virus.pdf For more on legionnaires disease in Wales see http:// www.wales.nhs.uk/ sitesplus/888/news/17027
Onisillos Sekkides 667