www.cdc.go.kr/phwr Outbreak and surveillance of hand foot and mouth disease associated with severe complication 273 277 279 282 Public Health Weekly Report, KCDC 273
Table 1. Outbreaks associated with EV71 Geographic location, year No. of cases No. of fatalities Clinical manifestations Aseptic meningitis(m) New York, 1972 11 None Encephalitis(s) HFMD(s) Sweden, 1973 195 None Aseptic meningitis(m) HFMD(s) 68 Aseptic meningitis(m) Bulgaria, 1975 705 (bulbar Paralytic disease(s) encephalitis) Encephalitis(s) Hungary, 1978 Aseptic meningitis(m) 45 1,550 Encephalitis(s) (encephalitis) Flaccid paralysis(s) HFMD(m) Japan, 1973 3,296 Some Brain stem encephalitis(s) Paralysis(s) Japan, 1978 36,301 Aseptic meningitis(s) New York, 1977 12 None HFMD(s) Paralysis(s) HFMD(m) Austrailia 114 None Aseptic meningitis Respratory disease Encephalitis Acute respiratory France, 1979 5 None disease CNS complications Philadelphia, 1987 5 None Flaccid paralysis(all) Aseptic meningitis(s) USA, 1987 45 None Paralysis(s) Encephalitis(s) HFMD Malaysia, 1997 5,999 31 Brain stem encephalitis Pulmonary edema HFMD or HA Brain stem encephalitis Encephalitis Taiwan, 1998 129,106 78 Pulmonary edema/hemorrhage Myocarditis Flaccid paralysis Abbreviations: EV= enterovirus; HFMD = hand, foot and mouth disease; CNS = central nervous system; HA = herpangina; m = most(>50%); s = minority(<50%) Source: Ho M. et al., J Microbiol Immunol Infect 2000;33:208 274 Public Health Weekly Report, KCDC
Table 2. Neurologic complications associated with EV71 Sign or symptom Pathology Nuchal rigidity Aseptic meningitis Kernig sign Aseptic meningitis Headache Aseptic meningitis, encephalitis Vomiting Aseptic meningitis, encephalitis Irritability Encephalitis Drowsiness Encephalitis Reduced consciousness Encephalitis Flaccid paralysis Motor neuron death Tremor Brain stem encephalitis Ataxia Brain stem encephalitis Myoclonus Brain stem encephalitis Pulmonary edema/hemorrhage Brain stem encephalitis Source: Ho M. et al., J Microbiol Immunol Infect 2000;33:208 Table 3. Demographic and clinical comparison of enterovirus infection with severe complications accompanied by hand-foot and mouth disease in 2009, N(%) Characteristics Age (months), mean SD 3.9 4.0 Gender, male 70 (61.4%) Clinical complicated presentation Encephalitis 19 (16.7%) Meningitis 83 (72.8%) Others 12 (10.5%) Presenting symptoms Fever > 37 53 (46.5%) Headache 36 (31.6%) Vomiting 29 (25.4%) Neck stiffness 12 (10.5%) Seizure 9 (7.9%) Sore throat 2 (1.5%) Decreased mentality 2 (1.5%) Table 4. Prevalence of enterovirus genotype identified in patients with hand-foot-mouth disease or herpangina in Korea, 2009 Genotype Number of Cases (%) CB 14 (3.9%) CA 22 (2.0%) CA 161 (1.0%) EV7 192 (90.2%) Other EV 3 (2.9%) Total 102 CA: coxsackie virus A; CB: coxsackie virus B; EV: enterovirus Public Health Weekly Report, KCDC 275
Current status and laboratory diagnosis of melioidosis 276 Public Health Weekly Report, KCDC
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Figure 1. Global map showing the categories of distribution of melioidosis and Burkholderia pseudomallei [1] Morphology : Gram-negative rod, small, straight or silghtly curved, may Demonstrate bipolar morphology at 24h and peripheral staining, like endospores, when cultures are older. Growth : Poor rowth at 24h, good growth of white colonies at 48h on SBN, May develop wrinkled colonies in time, nonpimented. Often demonstrates strong characteristic musty, earthy odor. Reactions : Oxidase-positive, growth on MacConkey in 48h, indole negative Growth : MacConkey agar, Asdown s medium, SBA medium Morphological diagnosis Biochemical diagnosis - Bipolar staining - API20E(or VITEK) - Multiplex PCR Burkholderi pseudomallei Genetic diagnosis Figure 2. Scheme of meliodiosis laboratory diagnosis[5] 278 Public Health Weekly Report, KCDC
Impact of the routine varicella vaccination programme on varicella epidemiology in Germany Public Health Weekly Report, KCDC 279
Figure 1. Number of varicella cases and reporting units by physician group, sentinel data, Germany, April 2005-March 2009 280 Public Health Weekly Report, KCDC
Public Health Weekly Report, KCDC 281
Figure 1. The weekly proportion of influenza-like illness visits per 1,000 patients, 2005-2006 season - 2009-2010 season Figure 2. The number of influenza virus isolates, 2009-2010 season 2010 No. of No. of detected cases (detection rate, %) (week) tested cases ADV PIV RSV IFV H1N1pdm hcov hrv hbov hev Weekly total 14 515 21 (4.1) 0 (0.0) 5 (1.0) 323 (62.7) 8 (1.6) 8 (1.6) 35 (6.8) 6 (1.2) 6 (1.2) 412 (80.0) 15 487 24 (4.9) 0 (0.0) 8 (1.6) 296 (60.8) 20 (4.1) 8 (1.6) 25 (5.1) 6 (1.2) 5 (1.0) 392 (80.5) 16 425 18 (4.2) 2 (0.3) 9 (2.1) 202 (47.5) 19 (4.5) 12 (2.8) 29 (6.8) 15 (3.5) 18 (4.2) 324 (76.2) 17 332 12 (3.6) 0 (0.0) 8 (2.4) 169 (50.9) 8 (2.4) 17 (5.1) 30 (9.0) 4 (1.2) 6 (1.8) 254 (76.5) Cum. * 5,136 225 (4.4) 14 (0.3) 215 (4.2) 1,456 (28.3) 774 (15.1) 276 (5.4) 408 (7.9) 49 (1.0) 62 (1.2) 3,479 (67.7) - ADV : adenovirus, PIV : parainfluenzavirus, RSV : respiratory syncytial virus, IFV : influenza virus (except for pandemic influenza virus) - H1N1pdm: pandemic influenza virus, hcov : coronavirus, hrv : rhinovirus, hbov : human bocavirus, hev : enterovirus * Com. 2010 : the total No. of tested cases between Dec. 27. 2009 - Apr. 24. 2010 influenza detection was 169(influenza B viruses) in week 17. All Causes 396* 10 5 64 153 164 P&I 18* 0 0 2 7 9 * Mortality data in this table are voluntarily reported from 40 hospitals, which of total discharged patients in 16 th week, 2010 are 14,746. A causes of death are defined from death certificates. Fetal deaths are not included. Pneumonia and influenza (KCD code J09-J18). 282 Public Health Weekly Report, KCDC
Cholera - - - - 5 7 5 16 Plague - - - - - - - - Typhoid fever 2 43 4 168 188 223 200 190 Paratyphoid fever - 12 1 36 44 45 50 31 Shigellosis 10 64 3 180 209 131 389 317 Africa(1), Vietnam(1) EHEC - 2 1 62 58 41 37 43 Diphtheria - - - - - - - - Pertussis 1 13-66 9 14 17 11 Tetanus - 5-17 16 8 10 11 Measles 1 7 1 17 2 194 28 7 Mumps 90 1,084 86 6,399 4,542 4,557 2,089 1,863 Rubella 1 12 1 36 30 35 18 12 Poliomyelitis - - - - - - - - Japanese encephalitis - - - 6 6 7-6 Varicella 327 4,687 449 25,194 22,849 20,284 11,027 1,934 Malaria 5 23 8 1,343 1,052 2,227 2,051 1,369 Scarlet fever 2 42 3 127 151 146 108 87 Meningococcal meningitis - 2-3 1 4 11 7 Legionellosis - 8 1 24 21 19 20 6 Vibrio vulnificus sepsis - - - 24 49 59 88 57 Epidemic typhus - - - - - - - - Murine typhus - 11-29 87 61 73 35 Scrub typhus 3 69 2 4,992 6,057 6,022 6,480 6,780 Leptospirosis 1 3-62 100 208 119 83 Brucellosis - 6 3 24 58 101 215 158 Anthrax - - - - - - - - Rabies - - - - - - - - HFRS 5 50 2 334 375 450 422 421 Dengue fever - 21 1 59 51 97 35 34 Leishmaniasis - 1 - - - - - - Babesiosis - - - - - - - 1 Cryptosporidiosis - - - - - - - 1 Botulism - - - 1 - - 1 - Q fever - 9-14 19 12 6 - Tuberculosis 821 11,981 618 35,845 34,157 34,710 35,361 35,269 HIV/AIDS 18 191 17 771 797 744 750 680 -: No reported cases. N : Not notifiable. Cum: Cumulative counts of the year from 1st week to current week. EHEC : Enterohemorrhagic Escherichia coli. HFRS : Hemorrhagic fever with renal syndrome. * Incidence data for reporting years 2009 and 2010 are provisional, whereas data for 2004, 2005, 2006, 2007 and 2008 are finalized. * Reported cases contain all case classifications(confirmed, Suspected, Asymptomatic carrier) of the disease respectively. Excluding Hansen's disease and diseases reported through the Laboratory Surveillance System and Sentinel Surveillance System(Data for Sentinel Surveillance System are available in Table III) and no case reported since 2003(Yellow fever, Marburg fever, Ebola fever, Lassa fever, African Trypanosomiasis, Schistosomiasis, Yaws, Pinta, Smallpox, Severe Acute Respiratory Syndrome, Avian influenza infection and humans, Tularemia, and Newly everging infectious disease syndrome) Calculated by summing the incidence counts for the current week, the 2 weeks preceding the current week, and the 2 weeks following the current week, for a total of 5 preceding years.(in case of Varicella, used data for 4 years-2006, 2007, 2008 and 2009 because of being designated as of July 13, 2005) HIV/AIDS is infected cases but not disease cases. Public Health Weekly Report, KCDC 283
-: No reported cases. Cum: Cumulative counts of the year from 1st week to current week. * Incidence data for reporting years 2009 and 2010 are provisional, whereas data for 2005, 2006, 2007, and 2008 are finalized. Reported cases contain all case classifications (Confirmed, Suspected, Asymptomatic carrier) of the disease, respectively. Calculated by averaging the cumulative counts from 1st week to current week, for a total of 5 preceding years. Public Health Weekly Report, KCDC 284
--: No reported cases. Cum: Cumulative counts of the year from 1st week to current week. * Incidence data for reporting years 2009 and 2010 are provisional, whereas data for 2005, 2006, 2007, and 2008 are finalized. Reported cases contain all case classifications (Confirmed, Suspected, Asymptomatic carrier) of the disease, respectively. Calculated by averaging the cumulative counts from 1st week to current week, for a total of 5 preceding years. (In case of Varicella, used data for 4 years - 2006, 2007, 2008 and 2009, because of being designated as of July 13, 2005) Public Health Weekly Report, KCDC 285
-: No reported cases. Cum: Cumulative counts of the year from 1st week to current week. * Incidence data for reporting years 2009, 2010 are provisional, whereas data for 2004, 2005, 2006, 2007 and 2008 are finalized. Reported cases contain all case classifications (Confirmed, Suspected, Asymptomatic carrier) of the disease, respectively. Calculated by averaging the cumulative cou nts from 1st week to current week, for a total of 5 preceding years. Public Health Weekly Report, KCDC 286
2.6 11.2 7.3 1.9 7.8 6.2 1.6 3.5 3.3 2.1 6.0 7.7 2.5 10.4 11.6 2.7 8.5 8.3 0.232 0.092 0.033 -: No reported cases. Cum: Cumulative counts of the year from 1st week to current week. * Incidence data for reporting years 2008 and 2009 are provisional. Reported cases contains all case classifications (Confirmed, Suspected, Asymptomatic carrier) of the disease, respectively. Calculated by averaging the cumulative counts from 1st week to current week, for a total of 5 preceding years. Public Health Weekly Report, KCDC 287