- 08 Jun 2017 Legionellosis - USA (04): (AZ) neonatal, underwater birthing
- 08 Jun 2017 Poliomyelitis update (09): Syria (DY), conf. cVDPV
- 08 Jun 2017 Scrub typhus - Nepal (03): (BA)
- 08 Jun 2017 Conjunctivitis - French Caribbean territories: (Guadeloupe, Martinique)
- 08 Jun 2017 Crimean-Congo hem. fever - Iran (02): update
- 08 Jun 2017 MERS-CoV (35): Saudi Arabia (RI), nosocomial and household transmission
- 08 Jun 2017 Peste des petits ruminants - Israel (02): (HD) ovine, OIE
- 08 Jun 2017 Rocky Mountain spotted fever - USA (02): (IN) fatal
- 08 Jun 2017 Cholera, diarrhea & dysentery update (49): Asia (Yemen)
- 08 Jun 2017 Stripe rust, wheat - Canada, USA
- 08 Jun 2017 Foodborne illness - Japan (03): (IB) school students, milk, RFI
- 08 Jun 2017 Rubella - Taiwan: ex Philippines
- 08 Jun 2017 Salmonellosis - Australia (03): (WA) eggs
- 08 Jun 2017 Drug abuse - USA: (GA) pot. lethal unknown substance, RFI
- 08 Jun 2017 Foot & mouth disease - Israel (04): (HA) bovine, OIE, st O
- 07 Jun 2017 Falsified polysaccharide meningococcal ACWY vaccine - West Africa: WHO, alert
- 07 Jun 2017 Ebola update (28): DR Congo, Uganda, research
- 07 Jun 2017 Anthrax - Bangladesh (03): (RS) bovine, more human cases
- 07 Jun 2017 White nose syndrome, bats - North America (07): (AL) southeastern bat, 1st rep.
- 07 Jun 2017 Cholera, diarrhea & dysentery update (48): Asia (Yemen)
- 07 Jun 2017 Anthrax - Nigeria: (KE) livestock vaccination program
- 07 Jun 2017 Cholera, diarrhea & dysentery update (47): Africa
- 07 Jun 2017 Invasive mosquito - USA (02): (NE)
- 07 Jun 2017 Hepatitis A - Australia: frozen berries, link to 2015 cluster, alert, recall
- 07 Jun 2017 Lassa fever - West Africa (20): Nigeria
- 06 Jun 2017 Plague - USA (06): (NM)
- 06 Jun 2017 Dengue/DHF update (06): Americas, observations, research
- 06 Jun 2017 Cholera, diarrhea & dysentery update (46): Asia (Yemen)
- 06 Jun 2017 Avian influenza (112): Luxembourg, poultry, HPAI H5N8 conf. spread
- 06 Jun 2017 Measles update (31)
- 06 Jun 2017 MERS-CoV (34): Saudi Arabia, UAE, Qatar, WHO
- 06 Jun 2017 Avian influenza, human (56): China, H7N9
- 06 Jun 2017 Kyasanur Forest disease - India (11): (MH) update
- 06 Jun 2017 Undiagnosed illness - Pakistan (02): (NW) Crimean-Congo hem. fever CCHF conf.
- 06 Jun 2017 Foodborne illness - Philippines (05): (MM) prisoners, fatal, culture results
- 06 Jun 2017 Avian influenza (112): France (CN) poultry, LPAI H7, OIE
- 06 Jun 2017 Hepatitis A - USA (07): (CA) fatal
- 06 Jun 2017 Vibrio vulnificus - USA (03): (TX) fatal, tattoo site entry
- 06 Jun 2017 Shigellosis - Viet Nam: (LI)
- 06 Jun 2017 Undiagnosed disease, multiple crops - Ecuador: (MN)
- 05 Jun 2017 Undiagnosed illness - Pakistan: (NW) Crimean-Congo hem. fever susp, RFI
- 05 Jun 2017 MERS-CoV (33): Saudi Arabia (RI), nosocomial transmission
- 05 Jun 2017 Anthrax - Bangladesh (02): (RS) bovine, human death
- 05 Jun 2017 Pertussis (05): New Zealand, USA, Australia, Spain
- 05 Jun 2017 Cholera, diarrhea & dysentery update (45): Asia (Yemen)
- 05 Jun 2017 Meningitis, meningococcal - Nigeria (10): fatal, serogroup C
- 05 Jun 2017 Rift Valley fever - Mauritania: RFI
- 05 Jun 2017 Anthrax - Bangladesh: (RS) bovine, human
- 05 Jun 2017 Tilapia syncytial hepatitis - Israel (02): (HZ) emerging disease, OIE, follow-up
- 05 Jun 2017 Ebola update (27): news, vaccine
- 05 Jun 2017 Avian influenza (111): South Korea, poultry, HPAI H5N8, spread
- 04 Jun 2017 Zika virus (11): Americas, research, observations
- 04 Jun 2017 Avian influenza (110): UK, England poultry, backyard, HPAI H5N8
- 04 Jun 2017 MERS-CoV (32): Saudi Arabia (RI,MD)
- 04 Jun 2017 African swine fever - Europe (10): Ukraine (ZK) wild boar, OIE
- 04 Jun 2017 Foodborne illness - Philippines (04): (MM) prisoners, fatal, susp shigella
- 04 Jun 2017 Mushroom poisoning - USA: (CA)
- 04 Jun 2017 Japanese encephalitis & other - India (04): (OR)
- 04 Jun 2017 Anthrax - India (06): (JH) elephant
- 04 Jun 2017 Japanese encephalitis - Australia ex Thailand
- 04 Jun 2017 MERS-CoV (31): Saudi Arabia (MK,RI) nosocomial transmission
- 04 Jun 2017 Lassa fever - West Africa (19): Nigeria
- 04 Jun 2017 Hantavirus - Americas (35): Chile (BI)
- 04 Jun 2017 Veillonella - USA: (ID) tularemia not
- 03 Jun 2017 Avian influenza (109): Belgium (LX) phasianidae, HPAI H5N8, OIE
- 03 Jun 2017 Cholera, diarrhea & dysentery update (44): Asia (Yemen)
- 03 Jun 2017 Avian influenza (108): Zimbabwe (ME) poultry, HPAI H5N8, OIE
- 03 Jun 2017 Schistosomiasis - Philippines: risk, spread
- 03 Jun 2017 Avian influenza, human (55): China, H7N9
- 03 Jun 2017 Dengue/DHF update (05): Asia, Pacific, Africa, diagn, vacc, res, correction
- 03 Jun 2017 Measles update (30)
- 03 Jun 2017 Mumps update (19): Europe (UK), USA (HI,PA,CA)
- 02 Jun 2017 Avian influenza (107): Europe (Luxembourg) poultry
- 02 Jun 2017 Cholera, diarrhea & dysentery update (43): Africa
- 02 Jun 2017 Leishmaniasis - Colombia (02): (NS) visceral, alert
- 02 Jun 2017 Foodborne illness - Philippines (03): (MM) prisoners, fatal
- 02 Jun 2017 Legionellosis - Europe: ex United Arab Emirates (Dubai)
- 02 Jun 2017 Invasive mosquito - USA: (NV,CT)
- 02 Jun 2017 Salmonellosis - USA (04): live poultry, multiple serotypes
- 02 Jun 2017 MERS-CoV (30): Saudi Arabia (RI,MD,MK)
- 01 Jun 2017 Classical swine fever - China: new subgenotype
- 01 Jun 2017 Meningitis, meningococcal - Nigeria (09): fatal, serogroup C
- 01 Jun 2017 Powassan virus encephalitis - USA (04): (ME)
- 01 Jun 2017 Avian influenza (106): Netherlands, wildfowl, HPAI H5N5, OIE
- 01 Jun 2017 Vibrio vulnificus - USA (02): (MS)
- 01 Jun 2017 Tuberculosis - Syria: IDP
- 01 Jun 2017 Foodborne illness - Philippines (02): (MM) prisoners, fatal
- 01 Jun 2017 Cholera, diarrhea & dysentery update (42): Africa
- 01 Jun 2017 Bacterial black spot, mango - Ghana: (BA)
- 01 Jun 2017 Rabies (24): Americas (Brazil) vampire bat, human exp, fatal
- 01 Jun 2017 Brucellosis - Russia: (VR) livestock, human
- 31 May 2017 European foulbrood, apis - Europe (03): Romania (GJ) OIE
- 31 May 2017 Cholera, diarrhea & dysentery update (41): Asia (Yemen)
- 31 May 2017 Salmonellosis - Turkey: (MN) barracks
- 31 May 2017 Foodborne illness - Philippines: (MM) prisoners, RFI
- 31 May 2017 Dengue/DHF update (06): Israel ex Seychelles
- 31 May 2017 Avian influenza (105): Netherlands, wildfowl, HPAI H5N5
- 31 May 2017 Avian influenza (104): Congo DR (IT) poultry, HPAI H5, 1st rep, OIE
- 31 May 2017 Hantavirus - Americas (34): Uruguay (SO)
- 31 May 2017 Transboundary animal diseases - status recognition, members: OIE
- 31 May 2017 Dickeya blackleg, potato - Morocco: 1st rep
- 31 May 2017 Porcine epidemic diarrhea - North America (02): Canada (MB)
- 30 May 2017 Cholera, diarrhea & dysentery update (40): Africa
- 30 May 2017 Yellow fever - Americas (47): Brazil, PAHO/WHO
- 30 May 2017 Crimean-Congo hem. fever - Iran: fatal
- 30 May 2017 Avian influenza, human (54): CHINA, H7N9, WHO
- 30 May 2017 Rabies (23): Americas (USA)
- 30 May 2017 White nose syndrome, bats - North America (06): (NC) surveys
- 30 May 2017 Salmonellosis - Ireland: (Dublin) caterer, poultry
- 30 May 2017 Hepatitis - Iraq (02): (AN) RFI
- 30 May 2017 Cholera, diarrhea & dysentery update (39): Asia (Yemen)
- 30 May 2017 Foodborne illness - Uruguay: (MO) RFI
- 30 May 2017 Lassa fever - West Africa (18): Nigeria
- 29 May 2017 Prion disease update: CJD
- 29 May 2017 Zika virus (10): Americas, Asia, Middle East, research
- 29 May 2017 Leishmaniasis, cutaneous - Nepal (02)
- 29 May 2017 Hepatitis E - Niger (04): (DF) fatal, pregnant women
- 29 May 2017 Ebola update (26): news, research
- 28 May 2017 Dengue/DHF update (05): Asia, Pacific, Africa, diagnosis, vaccine, research
- 28 May 2017 Tilapia syncytial hepatitis - worldwide: FAO, alert
- 28 May 2017 Canine influenza - USA (02): (FL)
- 28 May 2017 Canine distemper - USA: (SC)
- 27 May 2017 Antibiotic resistance (05): China, colistin, mcr-1, hospital outbreak
- 27 May 2017 Bluetongue - Europe (02): (France) bovine, st 8, spread susp, assessment
- 27 May 2017 Hantavirus - Americas (33): Argentina (BA)
- 27 May 2017 MERS-CoV (29): Qatar, animal reservoir, camels
- 27 May 2017 Measles update (29)
- 26 May 2017 Poliomyelitis update (08): global (Congo DR cVDPV)
- 26 May 2017 Hendra virus, equine - Australia (04): (QL)
- 26 May 2017 Norovirus - USA (05): (CA)
- 26 May 2017 Jaundice - India: (HP)
- 26 May 2017 Influenza (12): India (HP), H1N1pdm09, ass. fatal cases
- 26 May 2017 Cholera, diarrhea & dysentery update (38): Asia (Yemen)
- 26 May 2017 Seal finger - Canada (02): (BC) comment
- 26 May 2017 Wheat viruses - USA: (KS)
- 26 May 2017 Foodborne illness - Nepal: (DH) religious ceremony
- 26 May 2017 Leishmaniasis, cutaneous - Nepal
- 26 May 2017 Foot & mouth disease - Israel (03): (HZ) bovine, st A, spread, OIE
- 25 May 2017 Bovine tuberculosis - UK (02): (England) bovine
- 25 May 2017 Antibiotic resistance (04): Canada, Fosfomycin, fosA7 gene, Salmonella, chickens
- 25 May 2017 Seal finger - Canada: (BC)
- 25 May 2017 Cholera, diarrhea & dysentery update (37): Africa
- 25 May 2017 Contagious ecthyma, human - UK: (Wales)
- 25 May 2017 E. coli EHEC - Germany: O157, sorbitol-fermenting, packaged minced meat
- 25 May 2017 Rocky Mountain spotted fever - Mexico: (BC) fatalities
- 25 May 2017 Foot & mouth disease - China (03): (XJ) st A, bovine, OIE
- 25 May 2017 Cholera, diarrhea & dysentery update (36): Czech Republic ex Tanzania
- 25 May 2017 Botulism - USA (10): (CA) nacho cheese, type A toxin, unrelated 2nd death
- 25 May 2017 Poliomyelitis update (07): Mozambique, Congo DR, VDPV, RFI
- 24 May 2017 Tilapia syncytial hepatitis - Israel: (HZ) emerging disease, OIE
- 24 May 2017 Typhoid fever - Zambia: (LS)
- 24 May 2017 Rabies (22): Americas (Bolivia)
- 24 May 2017 MERS-CoV (28): Qatar, Saudi Arabia (HA)
- 24 May 2017 Salmonellosis - Australia (02): (NSW) sandboxes, bandicoot droppings
- 24 May 2017 Cholera, diarrhea & dysentery update (35): Africa, Asia
- 24 May 2017 Febrile rhabdomyolysis - Italy (02): ex West Africa, commentary
- 24 May 2017 Typhoid fever - New Zealand (04): (MW)
- 24 May 2017 Vaccine-preventable diseases - Pakistan: (SD), varicella, measles, RFI
- 24 May 2017 Lumpy skin disease - Europe (05): FYR Macedonia, bovine, OIE
- 24 May 2017 Equine infectious anemia - USA (03): (CO)
- 24 May 2017 Ebola update (25): news, research, vaccine
- 24 May 2017 Varroosis, apis - France: (Reunion Island), 1st report, OIE
- 24 May 2017 European foulbrood, apis - Europe (02): Liechtenstein (BA) OIE
- 23 May 2017 Cholera, diarrhea & dysentery update (34): Asia (Yemen)
- 23 May 2017 Undiagnosed disease - Liberia (08): fatal, meningitis diagnosed
- 23 May 2017 Tick-borne encephalitis virus - Latvia (02): comment
- 23 May 2017 Febrile rhabdomyolysis - Italy: ex West Africa, RFI
- 23 May 2017 Typhoid fever - Syria: (HL)
- 23 May 2017 Hepatitis E - UK (02): EU pork products, commentary
- 23 May 2017 Avian influenza, human (53): China, H7N9
- 23 May 2017 Hepatitis C - USA (08): (TN) pregnant women, 2009-2014
- 23 May 2017 Hepatitis C - USA (07): injection drug use
- 23 May 2017 Cholera, diarrhea & dysentery update (33): Africa
- 23 May 2017 Botulism - USA (09): (CA) gas station food, nacho cheese conf, fatal
- 23 May 2017 Crayfish plague - Ireland: white-clawed crayfish
- 23 May 2017 Avian influenza (103): Libya (JG) poultry, LPAI H7, OIE
- 23 May 2017 Lyme disease - USA (03): (WV) canine
- 23 May 2017 Measles update (28)
- 22 May 2017 Undiagnosed disease - Angola: (HL) fatalities, RFI
- 22 May 2017 Sheep pox & goat pox - Egypt: (WJ) ovine, 1st rep, OIE
- 22 May 2017 Tick-borne encephalitis virus - Latvia
- 22 May 2017 Antibiotic resistance (03): USA (TX) MDR K. pneumoniae, CG307 predominant clone
- 22 May 2017 Hepatitis E - UK: EU pork products
- 22 May 2017 West Nile virus - Americas: USA (MI)
- 22 May 2017 Rotavirus - UK: (England) hospital outbreak
- 22 May 2017 Cholera, diarrhea & dysentery update (32): Asia (Yemen)
- 22 May 2017 Chikungunya (18): Asia (Pakistan)
- 21 May 2017 Hantavirus - Americas (32): Chile (LL)
- 21 May 2017 Undiagnosed illness - Zimbabwe: (MN) RFI
- 21 May 2017 Undiagnosed deaths, bovine, caprine - India: (GJ)castor plant poisoning susp,RFI
- 21 May 2017 Porcine epidemic diarrhea - North America: Canada (MB)
- 21 May 2017 Ebola update (24): news, research, vaccine
- 21 May 2017 Lyme disease - USA (02): (WV) canine
- 20 May 2017 Phosphine gas poisoning - Spain: (Burgos) fatalities
- 20 May 2017 Avian influenza (102): Congo DR (IT), poultry, HPAI, RFI
- 20 May 2017 Hepatitis A - UK (03): (Scotland) bakery
- 20 May 2017 Trypanosomiasis (Chagas disease) - Brazil: under reported
- 20 May 2017 Cryptosporidiosis - USA (02)
- 20 May 2017 E. coli EHEC - Canada (10): (BC) O121, flour
- 20 May 2017 Candida auris - USA (04): nosocomial, epidemiology, drug resistance
- 20 May 2017 Hand, foot & mouth disease update (04): Australia (VI)
- 20 May 2017 Mumps update (18): USA
- 20 May 2017 Cholera, diarrhea & dysentery update (31): Africa
- 19 May 2017 MERS-CoV (27): Saudi Arabia (RI,AS,QS) nosocomial transmission
- 19 May 2017 Hantavirus - Americas (31): Panama (LS)
- 19 May 2017 Pertussis (04): Canada, USA
- 19 May 2017 Meningitis, meningococcal - Niger: fatal
- 19 May 2017 Varicella - Pakistan (03): (PB) RFI
- 19 May 2017 Norovirus - Spain: (CT) hospital staff
- 19 May 2017 Anthrax - Switzerland (03): (JU) second bovine
- 19 May 2017 Botulism - USA (08): (CA) gas station food, nacho cheese
- 19 May 2017 Malaria - South Africa (04): (LP, MP) Kruger National Park
- 19 May 2017 Cholera, diarrhea & dysentery update (30): Asia (Yemen)
- 19 May 2017 Trypanosomiasis - The Netherlands (02): ex Tanzania, comment
- 19 May 2017 Undiagnosed die-off, fish - USA (03): (CA) shark, update
- 19 May 2017 Ebola update (23): Congo DR, news, vaccine
- 18 May 2017 Foot & mouth disease - Jordan (02): livestock, st. O, genotype O/ME-SA/Ind-2001d
- 18 May 2017 Marteilia refringens - United Kingdom: (Northern Ireland) mussels, 1st rep, OIE
- 18 May 2017 Chikungunya (17): Asia (Bangladesh)
- 18 May 2017 Ebola update (22): WHO sit rep, news, research, vaccine
- 18 May 2017 Trypanosomiasis - The Netherlands: ex Tanzania
- 17 May 2017 Venomous snake bites - Nepal: (Kathmandu) incidence increase
- 17 May 2017 Zika virus (09): Americas, Asia, Europe, research, observations
- 17 May 2017 Whirling disease - Canada: (AB) fish removal
- 17 May 2017 Cholera, diarrhea & dysentery update (29): Asia (Yemen)
- 17 May 2017 Anthrax - Niger: (TL) livestock, OIE
- 17 May 2017 Varicella - Pakistan (02): (PB)
- 17 May 2017 Hepatitis C - Taiwan: nosocomial, reused needles
- 17 May 2017 Hepatitis E - France (03): rabbit source
- 17 May 2017 Ebola update (21): Congo DR, Nigeria, news, research, vaccine
- 17 May 2017 Anthrax - Kenya (05): (KB) human recovery
- 17 May 2017 Avian influenza, human (52): China, H7N9
- 17 May 2017 African swine fever - Europe (09): Ukraine (CK, PL) domestic swine, spread
- 17 May 2017 Kyasanur Forest disease - India (10): (MH), update
- 17 May 2017 Chronic wasting disease, cervid - USA (05): (PA)
- 17 May 2017 Blight, sweet chestnut - Germany: (BY)
- 17 May 2017 Cholera, diarrhea & dysentery update (28): Africa (Horn of Africa)
- 16 May 2017 European foulbrood, apis - Europe: Liechtenstein (SN) OIE
- 16 May 2017 Cutaneous & renal glomerular vasculopathy, canine - UK (05): England, spread
- 16 May 2017 Yellow fever - Americas (46): Brazil, virus mutations
- 16 May 2017 Foot & mouth disease - Palestinian Auth (03): (WE) bovine,ovine, st pending, OIE
- 16 May 2017 Measles update (27)
- 16 May 2017 Pepino mosaic virus, tomato - UK
- 15 May 2017 Leaf rust, coffee - Honduras: new strain susp.
- 15 May 2017 Anisakiasis - Portugal: raw fish dishes
- 15 May 2017 Ebola update (20): Congo DR, news, vaccine, update
- 15 May 2017 Avian influenza (101): South Korea, poultry, HPAI H5N8, OIE
- 15 May 2017 Chikungunya (16): Asia (Bangladesh)
- 15 May 2017 Kyasanur Forest disease - India (09): (GA) susp. fatal case
- 15 May 2017 Cholera, diarrhea & dysentery update (27): Asia (Yemen)
- 15 May 2017 Powassan virus encephalitis - USA (03): (NH) Alert
- 15 May 2017 Hepatitis A - Spain: (MD) MSM
- 14 May 2017 Anthrax - Kenya (04): (KB) official response
- 14 May 2017 Ebola update (19): Congo DR, Nigeria preparedness
- 14 May 2017 Angiostrongylus cantonensis - USA (03): (HI)
- 14 May 2017 MERS-COV (26): Saudi Arabia, EMRO update, RFI
- 14 May 2017 Cholera, diarrhea & dysentery update (26): Asia (Yemen)
- 14 May 2017 Avian influenza, human (51): China, H7N9
- 13 May 2017 Kunjin virus - Australia: (WA)
- 13 May 2017 Scrub typhus - Australia: (NT) national park, tourists
- 13 May 2017 Hepatitis C - USA (06): injection drug use, state policies
- 13 May 2017 Yellow fever - Americas (45): Brazil
- 13 May 2017 Cholera, diarrhea & dysentery update (25): Asia (Yemen)
- 13 May 2017 Avian influenza (100): Russia (TT) poultry, H5, RFI
- 13 May 2017 Norovirus - USA (04): (CA)
- 13 May 2017 Legionellosis - Australia (02): (VI, SA)
- 13 May 2017 Ebola update (18): Congo DR, vaccine
- 13 May 2017 Lassa fever - West Africa (17): Nigeria
- 13 May 2017 BSE, bovine - Spain (02): (CB) atypical L-type, OIE
- 13 May 2017 Hantavirus - Americas (30): Chile (LG, AR), USA (WA, CO)
- 12 May 2017 Poliomyelitis update (06): Syria (DY), cVDPV susp
- 12 May 2017 Equine infectious anemia, equine herpesvirus - USA: (CO) equine
- 12 May 2017 Meningitis, meningococcal - Nigeria (08): fatal, sg C
- 12 May 2017 Anthrax - Kenya (03): (KB) bovine, human
- 12 May 2017 Tularemia - Australia: (NS) possum
- 12 May 2017 Salmonellosis - USA (03): (MT) live poultry
- 12 May 2017 Clostridium perfringens foodborne illness - USA: (IN) restaurant, fatal, 2016
- 12 May 2017 Botulism - USA (07): (CA) gas station food, nacho cheese
- 12 May 2017 Hepatitis A - USA (06): (CO) MSM
- 12 May 2017 Ebola update (17): Congo DR, vaccine, research
- 12 May 2017 Brucellosis - Israel: camel milk, unpasteurized, melitensis, human, update
- 12 May 2017 Coccidioidomycosis - USA (02): (CA) increased cases
- 12 May 2017 Measles update (26)
- 11 May 2017 Foot & mouth disease - Tunisia (02): (BZ) bovine, serotype A, vaccination, OIE
- 11 May 2017 Foot & mouth disease - Israel (02): bovine, st A, Palestinian Auth, st pending
- 11 May 2017 Announcements (03): ProMED-MENA seeks infectious disease moderator
- 11 May 2017 Hepatitis A - USA (05): (CA) fatal
- 11 May 2017 Bird die-off, murre - USA: (AK) delayed recovery
- 11 May 2017 E. coli EHEC - USA (11): O157, deer droppings, water exposure, 2016
- 11 May 2017 Lumpy skin disease - Europe (04): Russia, vaccine
- 11 May 2017 Anthrax - Zimbabwe (06): (MN) human, wildlife
- 11 May 2017 Scombroid fish poisoning - Europe: spanish tuna, alert, recall
- 11 May 2017 Hepatitis C - India (02): (PB) thalassemia patients
- 11 May 2017 Chikungunya (15): Asia (Pakistan)
- 11 May 2017 Anthrax - Switzerland (02): (JU) bovine
- 10 May 2017 Meningitis, meningococcal - Nigeria (07): fatal, sg. C
- 10 May 2017 TB, MDR: Russia, India, Philippines, S. Africa, primary, predicted incidence
- 10 May 2017 Hepatitis D - USA
- 10 May 2017 Cholera, diarrhea & dysentery update (24): Africa, Asia
- 10 May 2017 Hepatitis A - Portugal (02): MSM
- 10 May 2017 Equine infectious anemia - USA (02): (CO)
- 09 May 2017 Cholera, diarrhea & dysentery update (23): Asia (Yemen)
- 09 May 2017 Anthrax - Guinea: (KB) human, bovine, susp
- 09 May 2017 Botulism - Germany: imported salted fish, alert, recall
- 09 May 2017 Avian influenza, human (50): China, H7N9
- 09 May 2017 Foot & mouth disease - Israel: (HZ) bovine, st pending, OIE
- 09 May 2017 Winter tick - Canada, USA: expanding distribution
- 09 May 2017 Undiagnosed disease - Liberia (07): fatal, meningitis
- 09 May 2017 Undiagnosed fungus, mango - Bangladesh: (RP)
- 09 May 2017 Bacterial black rot, cabbage - USA: (TX)
Published Date: 2017-06-08 20:21:08
Subject: PRO/EDR> Legionellosis - USA (04): (AZ) neonatal, underwater birthing
Archive Number: 20170608.5093537
Subject: PRO/EDR> Legionellosis - USA (04): (AZ) neonatal, underwater birthing
Archive Number: 20170608.5093537
LEGIONELLOSIS - USA (04): (ARIZONA) NEONATAL, UNDERWATER BIRTHING
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A ProMED-mail post
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International Society for Infectious Diseases
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Date: Tue 6 Jun 2017
Source: Morbidity and Mortality Weekly Report (MMWR) Weekly 66(22);590-591, posted online [edited]
https://www.cdc.gov/mmwr/volumes/66/wr/mm6622a4.htm?s_cid=mm6622a4_e
Notes from the Field. Two Cases of Legionnaires' Disease in Newborns After Water Births -- Arizona, 2016
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Granseth G, Bhattarai R, Sylvester T, Prasai S, Livar E.
Legionnaires' disease is a severe, sometimes fatal disease characterized by fever, myalgia, cough, and clinical or radiographic pneumonia, caused by inhaling or aspirating small droplets of water containing Legionella bacteria.* In 2015, approximately 6000 cases of Legionnaires' disease were reported in the United States (1). Nearly 10 percent of cases are fatal (2). The number of reported cases of Legionnaires' disease in Arizona has increased in recent years. Surveillance data from Arizona's Medical Electronic Disease Surveillance Intelligence System (MEDSIS) identified 46 reported cases in 2011 and 93 in 2015 (3), representing more than a 100 percent increase. During 2011-2015, only one case was reported in an infant aged <1 month; however, during the 1st 4 months of 2016, 2 cases were reported in infants, both of whom were delivered at home in a birthing tub (water births).
The 1st case was reported to the Maricopa County Department of Public Health (MCDPH) during January 2016. The infant was delivered at home by a midwife on January 6, 2016 in a tub filled with tap water. The 1-and 5-minute Apgar scores were 5/10 and 9/10, respectively. The following day the infant was taken to a local emergency department with severe respiratory distress, tachypnea, and hypoxemia, where a diagnosis of congenital heart disease was made; the infant was transferred to children's hospital A. An initial chest radiograph showed a confluent opacity in the lower left lobe, which was initially thought to represent atelectasis, although pneumonia could not be excluded. During the hospital stay, serial chest radiograph revealed persisting bilateral pulmonary infiltrates with possible cavitary lesions.
The infant was later transferred to children's hospital B where a bronchoscopy was performed, and a bronchoalveolar lavage culture tested positive for _Legionella pneumophila_, later identified at CDC as serogroup 1. The patient was treated with a 10-day course of azithromycin, but remained hospitalized for more than 2 months, primarily because of the congenital heart disease.
MCDPH conducted an epidemiologic investigation to identify the etiology of Legionnaires' disease and provide recommendations based on potentially remediable transmission routes. The investigation revealed that a newly purchased birthing tub had been cleaned with vinegar and water before being filled with municipal tap water using a new drinking water hose immediately before the delivery. The mother delivered the child within an hour of entering the tub, and no aspiration by the infant was noted. No other risk factors for _Legionella_ transmission were identified.
The 2nd case was reported to MCDPH on April 18, 2016. The infant had been delivered by water birth at home on April 5 [2017] by a different, independently operating midwife, at home. Three days after delivery, the infant developed a fever reported to be as high as 101.0°F (38.3°C); the fever recurred the following day, at which time the baby was brought to the emergency department of hospital A for evaluation; the infant's temperature was 102.6°F (39.2°C) and a chest radiograph showed fluffy nodular opacities. The infant was admitted for treatment of neonatal sepsis and suspected pneumonia. On April 12, upper respiratory tract secretions and a urine specimen were collected. The urinary antigen test was positive for _Legionella pneumophila_ antigen, and culture of the respiratory tract secretions was positive for _Legionella pneumophila_, later identified at CDC as serogroup 6.† The patient was started on a 10-day course of azithromycin and later discharged on April 16.
An infection preventionist at hospital A familiar with the 1st case reported the 2nd case to MCDPH after inquiring about the delivery method and learning of the home water birth. Investigation of this case revealed that the water birth had taken place in a rented jetted Jacuzzi hot tub. The tub had been filled with municipal tap water using a newly purchased hose and maintained at 98.0°F (36.7°C) in the bedroom for a week before the delivery. During the birth, the mother labored outside the tub and entered the tub for delivery only. No aspiration by the infant was noted.
Investigation of these 2 cases identified numerous gaps in infection prevention for water births, including use of a jetted Jacuzzi rather than a disposable birthing tub, and allowing the water to remain for a week at 98.0°F (36.7°C), which is within the optimum range for _Legionella_ growth 77.0°F-108.0°F (25.0°C-42.2°C). Although the tub for delivery in the 1st case was filled immediately before the birth, tap water is not sterile, and Legionella can grow and spread in man-made water systems, such as plumbing systems. Because both tubs were emptied immediately after the births, no environmental sampling was performed.
During the follow-up investigation, a report of a legionellosis death in an infant after a water birth in Texas in 2014 was identified (4). On the basis of subsequent guidelines developed by the Texas Department of State Health Services to assist licensed midwives conducting water births, the Arizona Department of Health Services (ADHS) and MCDPH, with support and guidance of the Arizona Healthcare-Associated Infection and Midwife Advisory Committees, developed educational resources and guidelines in November 2016.§,¶ These resources aim to increase knowledge about the risk for _Legionella_ infection and maximize the safety for women choosing water immersion for labor or birth by providing a review of information on labor and birth in water. For example, although the risk for _Legionella_ infection cannot be eliminated because of the need for warm tap water to fill the tub, it can be reduced by running hot water through the hose for 3 minutes before filling the tub to clear the hose and pipes of stagnant water and sediment. These materials have been distributed to a listserv of >1300 Healthcare-Associated Infection contacts, shared with the local Association for Professionals in Infection Control and Epidemiology Chapter, and disseminated to all licensed midwives in the state. The materials are public and posted on the ADHS website at http://www.azdhs.gov/licensing/special/midwives/index.php#training.
* https://www.cdc.gov/legionella/about/index.html.
† The urine antigen is only designed to detect serogroup 1; however, cross reactions with other serogroups have been documented.
§ http://www.azdhs.gov/documents/licensing/special/midwives/training/guidelines-for-water-immersion-water-birth.pdf.
http://www.azdhs.gov/documents/licensing/special/midwives/training/legionella-infographic.pdf.
[The full article is available at the source URL.]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Legionnaires' disease is uncommon in children and exceedingly rare in neonates. Infected children have usually had many of the same risk factors for legionellosis as have adults. Most reported cases have involved children with malignancies, severe combined immunodeficiency, chronic granulomatous disease, organ transplantation, and prolonged treatment with corticosteroids, or who have preexisting respiratory disease (1,2).
ProMED-mail previously reported aspiration of _Legionella_-contaminated water was the source for neonatal legionnaires' disease that occurred following use of a home birthing pool in the UK (ProMED-mail post Legionellosis - UK: (England) neonatal, underwater birthing 20140708.2594991). The type of _Legionella_ bacteria found in the birthing pool was found to be the same strain that caused legionnaires' disease in the baby. _Legionella_ neonatal infection after birth in birthing pools had previously been reported from Italy and Japan (3,4).
Neonates with legionellosis may develop necrotizing pneumonia with signs of sepsis and multisystemic involvement that may progress rapidly to respiratory failure and death (5).
1. http://emedicine.medscape.com/article/965492-overview
2. Greenberg D, Chiou CC, Famigilleti R, Lee TC, Yu VL. Problem pathogens: paediatric legionellosis--implications for improved diagnosis. Lancet Infect Dis. 2006; 6:529-35.
3. Franzin, L, Scolfaro C, Cabodi D, Valera M, Tovo PA. _Legionella pneumophila_ Pneumonia in a Newborn after Water Birth: A New Mode of Transmission. [Nosocomial _L. pneumophila_ serogroup 1] Clin. Infect. Dis. 33:e103-e104. Available at: http://cid.oxfordjournals.org/content/33/9/e103.long.
4. Nagai T, Sobajima H, Iwasa M, Tsuzuki T, et al. Neonatal Sudden Death Due to _Legionella_ Pneumonia Associated with Water Birth in a Domestic Spa Bath [Community-acquired, _Legionella pneumophila_ serogroup 6] J Clin Microbiol. May 2003; 41(5): 2227-2229. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC154682.
5. Holmberg RE Jr, Pavia AT, Montgomery D, et al. Nosocomial _Legionella_ pneumonia in the neonate. Pediatrics. 1993; 92:450-3. - Mod.ML
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/207.]
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International Society for Infectious Diseases
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Date: Tue 6 Jun 2017
Source: Morbidity and Mortality Weekly Report (MMWR) Weekly 66(22);590-591, posted online [edited]
https://www.cdc.gov/mmwr/volumes/66/wr/mm6622a4.htm?s_cid=mm6622a4_e
Notes from the Field. Two Cases of Legionnaires' Disease in Newborns After Water Births -- Arizona, 2016
--------------------------------------------------------------------------------------------------------
Granseth G, Bhattarai R, Sylvester T, Prasai S, Livar E.
Legionnaires' disease is a severe, sometimes fatal disease characterized by fever, myalgia, cough, and clinical or radiographic pneumonia, caused by inhaling or aspirating small droplets of water containing Legionella bacteria.* In 2015, approximately 6000 cases of Legionnaires' disease were reported in the United States (1). Nearly 10 percent of cases are fatal (2). The number of reported cases of Legionnaires' disease in Arizona has increased in recent years. Surveillance data from Arizona's Medical Electronic Disease Surveillance Intelligence System (MEDSIS) identified 46 reported cases in 2011 and 93 in 2015 (3), representing more than a 100 percent increase. During 2011-2015, only one case was reported in an infant aged <1 month; however, during the 1st 4 months of 2016, 2 cases were reported in infants, both of whom were delivered at home in a birthing tub (water births).
The 1st case was reported to the Maricopa County Department of Public Health (MCDPH) during January 2016. The infant was delivered at home by a midwife on January 6, 2016 in a tub filled with tap water. The 1-and 5-minute Apgar scores were 5/10 and 9/10, respectively. The following day the infant was taken to a local emergency department with severe respiratory distress, tachypnea, and hypoxemia, where a diagnosis of congenital heart disease was made; the infant was transferred to children's hospital A. An initial chest radiograph showed a confluent opacity in the lower left lobe, which was initially thought to represent atelectasis, although pneumonia could not be excluded. During the hospital stay, serial chest radiograph revealed persisting bilateral pulmonary infiltrates with possible cavitary lesions.
The infant was later transferred to children's hospital B where a bronchoscopy was performed, and a bronchoalveolar lavage culture tested positive for _Legionella pneumophila_, later identified at CDC as serogroup 1. The patient was treated with a 10-day course of azithromycin, but remained hospitalized for more than 2 months, primarily because of the congenital heart disease.
MCDPH conducted an epidemiologic investigation to identify the etiology of Legionnaires' disease and provide recommendations based on potentially remediable transmission routes. The investigation revealed that a newly purchased birthing tub had been cleaned with vinegar and water before being filled with municipal tap water using a new drinking water hose immediately before the delivery. The mother delivered the child within an hour of entering the tub, and no aspiration by the infant was noted. No other risk factors for _Legionella_ transmission were identified.
The 2nd case was reported to MCDPH on April 18, 2016. The infant had been delivered by water birth at home on April 5 [2017] by a different, independently operating midwife, at home. Three days after delivery, the infant developed a fever reported to be as high as 101.0°F (38.3°C); the fever recurred the following day, at which time the baby was brought to the emergency department of hospital A for evaluation; the infant's temperature was 102.6°F (39.2°C) and a chest radiograph showed fluffy nodular opacities. The infant was admitted for treatment of neonatal sepsis and suspected pneumonia. On April 12, upper respiratory tract secretions and a urine specimen were collected. The urinary antigen test was positive for _Legionella pneumophila_ antigen, and culture of the respiratory tract secretions was positive for _Legionella pneumophila_, later identified at CDC as serogroup 6.† The patient was started on a 10-day course of azithromycin and later discharged on April 16.
An infection preventionist at hospital A familiar with the 1st case reported the 2nd case to MCDPH after inquiring about the delivery method and learning of the home water birth. Investigation of this case revealed that the water birth had taken place in a rented jetted Jacuzzi hot tub. The tub had been filled with municipal tap water using a newly purchased hose and maintained at 98.0°F (36.7°C) in the bedroom for a week before the delivery. During the birth, the mother labored outside the tub and entered the tub for delivery only. No aspiration by the infant was noted.
Investigation of these 2 cases identified numerous gaps in infection prevention for water births, including use of a jetted Jacuzzi rather than a disposable birthing tub, and allowing the water to remain for a week at 98.0°F (36.7°C), which is within the optimum range for _Legionella_ growth 77.0°F-108.0°F (25.0°C-42.2°C). Although the tub for delivery in the 1st case was filled immediately before the birth, tap water is not sterile, and Legionella can grow and spread in man-made water systems, such as plumbing systems. Because both tubs were emptied immediately after the births, no environmental sampling was performed.
During the follow-up investigation, a report of a legionellosis death in an infant after a water birth in Texas in 2014 was identified (4). On the basis of subsequent guidelines developed by the Texas Department of State Health Services to assist licensed midwives conducting water births, the Arizona Department of Health Services (ADHS) and MCDPH, with support and guidance of the Arizona Healthcare-Associated Infection and Midwife Advisory Committees, developed educational resources and guidelines in November 2016.§,¶ These resources aim to increase knowledge about the risk for _Legionella_ infection and maximize the safety for women choosing water immersion for labor or birth by providing a review of information on labor and birth in water. For example, although the risk for _Legionella_ infection cannot be eliminated because of the need for warm tap water to fill the tub, it can be reduced by running hot water through the hose for 3 minutes before filling the tub to clear the hose and pipes of stagnant water and sediment. These materials have been distributed to a listserv of >1300 Healthcare-Associated Infection contacts, shared with the local Association for Professionals in Infection Control and Epidemiology Chapter, and disseminated to all licensed midwives in the state. The materials are public and posted on the ADHS website at http://www.azdhs.gov/licensing/special/midwives/index.php#training.
* https://www.cdc.gov/legionella/about/index.html.
† The urine antigen is only designed to detect serogroup 1; however, cross reactions with other serogroups have been documented.
§ http://www.azdhs.gov/documents/licensing/special/midwives/training/guidelines-for-water-immersion-water-birth.pdf.
http://www.azdhs.gov/documents/licensing/special/midwives/training/legionella-infographic.pdf.
[The full article is available at the source URL.]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Legionnaires' disease is uncommon in children and exceedingly rare in neonates. Infected children have usually had many of the same risk factors for legionellosis as have adults. Most reported cases have involved children with malignancies, severe combined immunodeficiency, chronic granulomatous disease, organ transplantation, and prolonged treatment with corticosteroids, or who have preexisting respiratory disease (1,2).
ProMED-mail previously reported aspiration of _Legionella_-contaminated water was the source for neonatal legionnaires' disease that occurred following use of a home birthing pool in the UK (ProMED-mail post Legionellosis - UK: (England) neonatal, underwater birthing 20140708.2594991). The type of _Legionella_ bacteria found in the birthing pool was found to be the same strain that caused legionnaires' disease in the baby. _Legionella_ neonatal infection after birth in birthing pools had previously been reported from Italy and Japan (3,4).
Neonates with legionellosis may develop necrotizing pneumonia with signs of sepsis and multisystemic involvement that may progress rapidly to respiratory failure and death (5).
1. http://emedicine.medscape.com/article/965492-overview
2. Greenberg D, Chiou CC, Famigilleti R, Lee TC, Yu VL. Problem pathogens: paediatric legionellosis--implications for improved diagnosis. Lancet Infect Dis. 2006; 6:529-35.
3. Franzin, L, Scolfaro C, Cabodi D, Valera M, Tovo PA. _Legionella pneumophila_ Pneumonia in a Newborn after Water Birth: A New Mode of Transmission. [Nosocomial _L. pneumophila_ serogroup 1] Clin. Infect. Dis. 33:e103-e104. Available at: http://cid.oxfordjournals.org/content/33/9/e103.long.
4. Nagai T, Sobajima H, Iwasa M, Tsuzuki T, et al. Neonatal Sudden Death Due to _Legionella_ Pneumonia Associated with Water Birth in a Domestic Spa Bath [Community-acquired, _Legionella pneumophila_ serogroup 6] J Clin Microbiol. May 2003; 41(5): 2227-2229. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC154682.
5. Holmberg RE Jr, Pavia AT, Montgomery D, et al. Nosocomial _Legionella_ pneumonia in the neonate. Pediatrics. 1993; 92:450-3. - Mod.ML
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/207.]
See Also
2014----
Legionellosis - UK: (England) neonatal, underwater birthing 20140708.2594991
.................................................mpp/ml/ec/mpp
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