World’s largest gathering creates perfect storm for infectious disease

A tent city is rising near Allahabad, India, at the confluence of three of the country’s holiest rivers: the Ganges, Yamuna and Saraswati. Complete with running water and sparkling LED lights, the city will accommodate 150 million pilgrims — a crowd equivalent to nearly half the population of the United States — next February for the Kumbh Mela, the world’s largest bathing event.

But some experts worry that the iconic religious festival poses a major health concern. The last major gathering in 2015 altered the bacterial population of the Godavari River, increased the risk of waterborne disease outbreak and introduced drug-resistant “superbugs” according to a study published in October in Microbial Ecology.

This is not the first time the festival spurs health concerns. Experts have long recognized it as a major cause of cholera epidemics during the 18th and 19th centuries.

Researchers saw a 130-fold increase in the total number of bacteria following the festival. They also discovered that most of the naturally occurring bacteria in the river were replaced by microbes usually found in human skin and feces. There were also elevated levels of pathogens that cause salmonella, whooping cough, staph infections and tuberculosis.

Water is an open system. If the water is not treated, it goes to different areas, which may lead to bacteria swapping genetic material with one another without reproducing — that process is known to speed the proliferation of drug-resistant strains of bacteria. This could lead to antibiotic resistance spreading downstream through the river.

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Hepatitis A – Tennessee, USA

The Tennessee Department of Health continues to investigate and respond to a hepatitis A outbreak impacting the state with more than 400 cases of illness to date. One death associated with this hepatitis A outbreak has been reported. The outbreak in Tennessee most heavily affects Nashville and Chattanooga.


Measles – Thailand

Thailand health officials are working to contain a measles outbreak in the southern provinces, in which some 1,500 cases have been reported, including 12 deaths.

Dengue Fever – Senegal

As of 3 November 2018, the cumulative number of suspected cases is 2,123, of which 216 are confirmed. Six regions are currently reporting confirmed cases: Diourbel (169), Fatick (34), St Louis (6), Dakar (3), Louga (3) and Thiès (1). So far, six cases have been hospitalized. One death of a confirmed case has been reported in the city of Touba in Diourbel Region.

Cholera – Nigeria

Cholera cases have jumped in northeast Nigeria where Boko Haram violence has forced tens of thousands of people to seek refuge in crowded camps, the Norwegian Refugee Council said on Monday. The humanitarian group said 10 000 people have been affected by the fast-spreading cholera outbreak and 175 people have died in the northeast states of Adamawa, Borno and Yobe as of early November 2018.


African swine fever found in animal feed – China

Major Chinese animal feed maker Tangrenshen Group reported on Sunday that feed produced by one of its units had been contaminated with African swine fever, raising fears of its spread further across the country.

This is the first reported contamination of feed supplies in China and increases the concerns for pig farmers trying to avoid the disease. It also raises the economic pressure on feed manufacturers already struggling with low margins and slowing demand.

Ebola – DR Congo

As the official death toll reaches 200, authorities are describing the current ebola outbreak in the DR Congo as the worst in its history, since the disease was identified in 1976.


Malaria – Greece

Greek health officials have reported nine autochthonous non-Plasmodium falciparum malaria cases since August. In 2018, 47 total malaria cases have been reported in Greece as of late October, with the remainder being imported (37) or unclassified (1).

Rabies – Utah, USA

Utah public health officials have confirmed a Utah resident died from rabies earlier this month. It is suspected exposure to a bat was the source of infection. This is the first Utah resident to die from rabies since 1944.

Measles – Serbia

In an update on the ongoing measles outbreak in the Republic of Serbia, Institute of Public Health of Serbia reported 23 additional measles cases in October–17 in Belgrade and six in Pancevo. This brings the total to 5764 cases, including 2912 laboratory confirmed, since October 2017, with nearly 5000 cases occurring in 2018 .


Outbreak of Japanese Encephelatis in Bali

An outbreak of Japanese Encephalitis has emerged in Indonesia, and the tourist hotspot, Bali has the highest number of cases. The disease can be spread from human to human via mosquito bites, and bats, pigs and poultry can also carry the disease. Australian visitors to Bali are warned to stay in air-conditioned or screened rooms, and to avoid dirtier rural areas.

Japanese Encephelatis is a brain infection and can be deadly. One in four cases prove to be fatal. Symptoms can take up to 15 days to become noticeable, and include fever, headache, neck stiffness, tremors, convulsions in children and even paralysis.


Hand, Foot, Mouth Disease – Britain

A wave of hand, foot and mouth disease is sweeping across Britain, and parents are being urged to lookout for signs. The virus which can lead to painful symptoms, including red sores, for both children and adults. Several Somerset pre-schools have reported an increasing number of cases and other cases have also been reported in the popular Spanish holiday Island Majorca.


Ethiopia yellow fever outbreak

An outbreak of yellow fever has been confirmed in the Wolaita Zone of the Southern Nations, Nationalities, and Peoples’ (SNNP) Region of Ethiopia, located in the south-western part of the country.

Since the index case in late August, 35 suspected yellow fever cases have been reported in two woredas of Wolaita Zone in the SNNP Region. In addition, ten deaths were recorded (case fatality ratio 28.6%), including six in health facilities and four in the community.

African Swine Fever – China – Update

China confirmed a new case of African swine fever on Monday, in southern Hunan province, marking the 50th outbreak of the highly contagious disease in the world’s top pork producer. China’s agriculture ministry said the latest case was on a small farm of 119 pigs in Baojing county, near the border with Chongqing. It follows two cases reported over the weekend, one in Chongqing municipality, close to Baojing.

China linked feeding kitchen waste to pigs to the majority of the early cases of African swine fever in recent months, but it has not given a cause of the other cases. Analysts said the country’s feed sector might have been contaminated, suggesting risks were high that the disease would continue to spread quickly.


Plague – Madagascar

In an update on the plague situation in Madagascar, an additional case was reported in the district of Tsiroanomandidy in central-western part of the country. This brings the total plague cases to 38 since August 1.

Pneumonia Accounts for 10% of Deaths – Philippines

In the Philippines, authorities have released information indicating that 57,809 pneumonia deaths were reported in 2016, nearly 10 percent of 582,183 registered deaths in 2016. This made pneumonia the 3rd top killer behind ischemic heart disease and cancer.


Chagas disease reported in dogs working along the U.S.-Mexico border

More than 100 working dogs employed by the federal government across the United States have been infected with the parasite Trypanosoma cruzi, the cause of Chagas disease, which may lead to heart problems. Chagas disease is a tropical infection spread by a blood-sucking triatomine or “kissing bug” that may pose a growing threat in the United States. Once known only in Mexico, Central America and South America, Chagas is now making tentative incursions into the United States, infecting canines and humans.

Illinois: Hundreds of deer die

The Illinois Department of Natural Resources (IDNR) has received reports of 432 suspected cases of Epizootic Hemorrhagic Disease (EHD) in white-tailed deer so far in 2018.

EHD is a viral disease of white-tailed deer that can cause localized die-offs when conditions are favorable for transmission. Infected animals develop a high fever, and dead animals often are found near water sources. The virus is transmitted between deer by a midge that hatches from muddy areas along lakes/ponds and streams/rivers.


Measles – Israel – Update

In an update on the measles outbreak in Israel, health officials put the outbreak case tally at 1,150, up from nearly 900 cases a week ago. The majority of cases have been reported in Jerusalem. The Jerusalem Post reported today that a one-and a half year-old baby died from the measles on Thursday.

Ebola – DR Congo – Update

Since the last update (24–30 October), 32 new confirmed EVD cases were reported: 24 from Beni, and seven from Butembo and one from Vuhovi.

As of 30 October 2018, 279 EVD cases (244 confirmed and 35 probable), including 179 deaths (144 confirmed and 35 probable)1, have been reported in eight health zones in North Kivu Province and three health zones in Ituri Province (Figure 2). Over the past week, 14 additional surivours were discharged from Ebola treatment centres (ETCs) and reintegrated into their communities; 81 patients have recovered to date.


Swine Flu – Nepal

Two children in Kanchanrup Municipality of Saptari district died of an unidentified disease on October 23 and 24 respectively. The victims suffered from a fever, nausea, headache and blood vomiting before they died.

The case comes just two months after four persons, including two children, died and more than 2,000 fell ill due to an outbreak of an influenza that was later confirmed as Swine flu (H1N1) and Hong Kong flu (H3N2).


Leprosy – Russia

The director of the Research Institute for the Study of Leprosy reports seven Astrakhan patients being treated for leprosy. “Seven new cases have been identified in our region. Six are the sick for the first time, and the seventh is a relapse in a patient who is under observation”. All patients are elderly.

Dengue Fever – Bangladesh

In a follow-up on the record dengue fever season in Bangladesh, the Institute of Epidemiology, Disease Control, & Research reported an additional 600+ cases in the past ten days. This brings the total to 8,079, as of Oct. 24.


Monkeypox – Nigeria – Update

Nigeria health officials reported an additional 10 suspected monkeypox cases during the past month, according to the Nigeria Centre for Disease Control (NCDC). The ten new suspected cases of monkeypox were reported from Ebonyi (4), Rivers (2), Bayelsa (4) states. A total of 86 cases have been reported in 2018.