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Emerging Infections Update: January to June 2008

Monthly summaries of notable events and developments of potential public health importance are produced by the Emerging Infections and Zoonoses Department, for circulation to recipients including the Chair and members of the National Expert Panel on New and Emerging Infections (http://www.advisorybodies.doh.gov.uk/nationalexpertpanel/index.htm). Incidents reported over recent months are shown in the table below. Events are identified through horizon scanning activities and then logged and systematically followed up. Multiple sources are scanned including: ProMED online (http://www.promedmail.org); World Health Organization sources (Disease Outbreak News,http://www.who.int/csr/don/en/); Weekly Epidemiological Record (Outbreak Verification List, http://www.who.int/wer/en/); Eurosurveillance (http://www.eurosurveillance.org/index-02.asp); the Global Public Health Intelligence Network (GPHIN) early warning system; CIDRAP online (http://www.cidrap.umn.edu/index.html); CDC Morbidity and Mortality Weekly Report (http://www.cdc.gov/ncidod/EID/index.htm) and the wider scientific literature.

Table 1 notable events/incidents of potential public health significance: January to June 2008

Progressive Inflammatory Neuropathy (PIN)
Investigations have continued into the cluster of cases of neurological illness reported in workers at a pork processing plant in Minnesota in early January 2008. A survey of swine slaughterhouses in the US found that only three use the compressed air technique to harvest brain tissue, and following intense investigations cases of PIN have now been identified at all three plants. A total of 24 cases of PIN have now been confirmed, including 18 among workers at the plant in Minnesota, five in Indiana, and one at a plant in Nebraska . The working hypothesis remains that the workers were exposed to a fine mist of brain tissue, leading to the development of an autoimmune response which caused nerve damage.

The compressed air technique is not used for removal of livestock brains at meat processing plants in the UK and no similar cases have been identified here to date.
See: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm57e131a1.htm

Rabies
Imported rabid dog from Gambia to Belgium and France
Rabies was identified in a dog imported from the Gambia into France and Belgium. The dog was found injured in the Gambia by a Belgian woman, where it was treated by a vet and given a first dose of rabies vaccine. The woman adopted the dog and brought it back to Belgium on 7 April, and then to Var region in SE France on 13 April. The dog developed rabies symptoms on 16 April and died on 21 April.
See: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18856

Chapare virus
A recent paper describes a newly identified arenavirus, named Chapare virus, which was isolated from the serum of a 22 year old man who died of haemorrhagic fever in Bolivia in January 2004. The patient was part of a small cluster of haemorrhagic fever cases which occurred near Cochabamba, Bolivia, between December 2003 and January 2004. Details of the cluster were sparse and samples were only available from one of the cases, who worked as a tailor and a farmer. The man reported no history of travel and no contact with any case with compatible illness for at least four weeks prior to his disease onset. Clinical signs included fever, headache, arthralgia, myalgia and vomiting with subsequent deterioration and multiple haemorrhagic signs. Sequence analysis of the virus indicated that it was a unique member of the Clade B New World arenaviruses, most closely related to Sabia virus.
See: Delgado et al (2008) PLOS Pathogens, vol 4, issue 4, e1000047