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Infectious disease threatens New Zealand
Newsdesk Infectious disease surveillance update
294
additional deaths in the Arua district. Plague is known to be endemic in this part of the country with occasional human outbreaks. “Nebbi and Arua District, both on the north-western part of Uganda, are geographically contiguous and cover an area bordering with the Democratic Republic of Congo where a similar outbreak is currently in progress and Sudan; so it is plausible to assume a
common origin”, explains Jaime Torres (Promed). Rodent control is undoubtedly key to alter the course of the epidemic pattern. Additionally, measures should be taken to ensure that sick people who die are buried immediately and not transported from one place to another. The latter appears to be related to the early spread of the outbreak. Pam Das
Infectious disease threatens New Zealand Flightless birds are not the only legacy that the “ecologically privileged of New Zealand’s longstanding status” of Crump’s native New geographical isolation. Because of its Zealand has contributed to the unusual and sparse indigenous fauna, country’s inadequate support for geographic isolation, and relatively communicable-disease control and recent exposure to man and exotic research. animals, the country provides “a unique But how long will New Zealand, model for the study of emerging be able to sustain its “isolation”? infectious diseases”, according to John According to Andrew Cliff Crump (Centers for Disease Control (University of Cambridge, UK), who and Prevention, Atlanta, GA, USA) and specialises in modelling geographical colleagues (Emerg spread of infectInfect Dis 2001; 7: ious diseases, 767–72). agrees. “InterNew Zealand national travel does not have times have collrecognised interapsed exponmediate hosts entially over the for human last 200 years, pathogens. The and individual first, Polynesian, mobility has settlers arrive only Not the only unusual thing on the island. increased by a 700 years ago, but factor of some epidemic disease and zoonoses seem to 10 000 over the same period”. This arrive with European (mostly British) increase in flux implies that migrants and their animals in the 18th “individuals incubating diseases can century. Even so, say Crump and easily and unwittingly bypass colleagues, the long sea voyage to New quarantine barriers as they journey Zealand provided a form of enforced round the world”. quarantine, and only infections that The possible introduction of could persist in crowded conditions or arboviruses from Australia in a chronic state in man or animals exemplifies the potential threat to were imported. Today, says Crump, New Zealand’s public health. “The new pathogens, including shiga-toxin- climate of northern New Zealand is producing strains of Escherichia coli and receptive to several vector mosquito a number of multidrug-resistant species”, says Crump. A competent bacteria, con-sistently emerge up to 10 vector of dengue (Aedes albopictus) years later there than in other made an incursion in 1993, and a industrialised countries. “This puts New competent vector of Ross River fever Zealand in a unique position to test, (Aedes camptorhynchus) has recently early in an epidemic, recommendations become established but has yet to drawn up in other countries”, he adds. meet up with the relevant viruses. On the down side, the authors suggest Dorothy Bonn Dorothy Bonn
The dengue outbreak in Hawaii continues to take its toll with the number of cases reaching 74 and confirmation of the first case of the illness on the island of Hawaii as of November 3. 56 cases have been confirmed on Maui with more than 300 reports of illness still under investigation across the state. An outbreak of vancomycinresistant enterococcus (VRE), at the Royal Perth Hospital in Western Australia, has been described as the worst outbreak of VRE in the country, and even led to the partial closure of the intensive care unit (ICU) of Perth’s leading teaching hospital. “We have had 151 patients from whom we have isolated VRE with the vanB genotype. Of these, only three had infections—the rest are colonised only”, said Keryn Christiansen (Royal Perth Hospital). The outbreak began in September, and although the origins are unknown, the index patient was identified from the ICU. Stringent control measures have meant the epidemic is now under control. For the first time since the 1970s Crimean-Congo haemorrhagic fever (CCHF) has been reported in Iran. From June 2000 to early November 2001, 71 people tested IgM positive with 11 fatalities. “There is no explanation so far as to why the disease has appeared now after a long period of silence. It might be due to an absence of circulation of the virus amongst human populations during this period, or to a deficiency of surveillance systems. It is likely that the disease is transmitted by tick bites as well as direct contact with blood or liver from freshly slaughtered sheep as many of the infected patients are butchers”, explained Marie-Francoise Saron (WHO, Dakar, Senegal). The Iranian government was quick to react to the situation distributing insecticides for animals and cattle sheds, providing quarantine bases in certain provinces for animal importation, and information to the public and workers at risk. An outbreak of bubonic plague in Uganda has left 17 people dead in the Nebbi district and caused three
THE LANCET Infectious Diseases Vol 1 December 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
294
additional deaths in the Arua district. Plague is known to be endemic in this part of the country with occasional human outbreaks. “Nebbi and Arua District, both on the north-western part of Uganda, are geographically contiguous and cover an area bordering with the Democratic Republic of Congo where a similar outbreak is currently in progress and Sudan; so it is plausible to assume a
common origin”, explains Jaime Torres (Promed). Rodent control is undoubtedly key to alter the course of the epidemic pattern. Additionally, measures should be taken to ensure that sick people who die are buried immediately and not transported from one place to another. The latter appears to be related to the early spread of the outbreak. Pam Das
Infectious disease threatens New Zealand Flightless birds are not the only legacy that the “ecologically privileged of New Zealand’s longstanding status” of Crump’s native New geographical isolation. Because of its Zealand has contributed to the unusual and sparse indigenous fauna, country’s inadequate support for geographic isolation, and relatively communicable-disease control and recent exposure to man and exotic research. animals, the country provides “a unique But how long will New Zealand, model for the study of emerging be able to sustain its “isolation”? infectious diseases”, according to John According to Andrew Cliff Crump (Centers for Disease Control (University of Cambridge, UK), who and Prevention, Atlanta, GA, USA) and specialises in modelling geographical colleagues (Emerg spread of infectInfect Dis 2001; 7: ious diseases, 767–72). agrees. “InterNew Zealand national travel does not have times have collrecognised interapsed exponmediate hosts entially over the for human last 200 years, pathogens. The and individual first, Polynesian, mobility has settlers arrive only Not the only unusual thing on the island. increased by a 700 years ago, but factor of some epidemic disease and zoonoses seem to 10 000 over the same period”. This arrive with European (mostly British) increase in flux implies that migrants and their animals in the 18th “individuals incubating diseases can century. Even so, say Crump and easily and unwittingly bypass colleagues, the long sea voyage to New quarantine barriers as they journey Zealand provided a form of enforced round the world”. quarantine, and only infections that The possible introduction of could persist in crowded conditions or arboviruses from Australia in a chronic state in man or animals exemplifies the potential threat to were imported. Today, says Crump, New Zealand’s public health. “The new pathogens, including shiga-toxin- climate of northern New Zealand is producing strains of Escherichia coli and receptive to several vector mosquito a number of multidrug-resistant species”, says Crump. A competent bacteria, con-sistently emerge up to 10 vector of dengue (Aedes albopictus) years later there than in other made an incursion in 1993, and a industrialised countries. “This puts New competent vector of Ross River fever Zealand in a unique position to test, (Aedes camptorhynchus) has recently early in an epidemic, recommendations become established but has yet to drawn up in other countries”, he adds. meet up with the relevant viruses. On the down side, the authors suggest Dorothy Bonn Dorothy Bonn
The dengue outbreak in Hawaii continues to take its toll with the number of cases reaching 74 and confirmation of the first case of the illness on the island of Hawaii as of November 3. 56 cases have been confirmed on Maui with more than 300 reports of illness still under investigation across the state. An outbreak of vancomycinresistant enterococcus (VRE), at the Royal Perth Hospital in Western Australia, has been described as the worst outbreak of VRE in the country, and even led to the partial closure of the intensive care unit (ICU) of Perth’s leading teaching hospital. “We have had 151 patients from whom we have isolated VRE with the vanB genotype. Of these, only three had infections—the rest are colonised only”, said Keryn Christiansen (Royal Perth Hospital). The outbreak began in September, and although the origins are unknown, the index patient was identified from the ICU. Stringent control measures have meant the epidemic is now under control. For the first time since the 1970s Crimean-Congo haemorrhagic fever (CCHF) has been reported in Iran. From June 2000 to early November 2001, 71 people tested IgM positive with 11 fatalities. “There is no explanation so far as to why the disease has appeared now after a long period of silence. It might be due to an absence of circulation of the virus amongst human populations during this period, or to a deficiency of surveillance systems. It is likely that the disease is transmitted by tick bites as well as direct contact with blood or liver from freshly slaughtered sheep as many of the infected patients are butchers”, explained Marie-Francoise Saron (WHO, Dakar, Senegal). The Iranian government was quick to react to the situation distributing insecticides for animals and cattle sheds, providing quarantine bases in certain provinces for animal importation, and information to the public and workers at risk. An outbreak of bubonic plague in Uganda has left 17 people dead in the Nebbi district and caused three
THE LANCET Infectious Diseases Vol 1 December 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.