Date: Sun, 24 Aug 2014 17:44:32 +0200 (METDST)

WASHINGTON, Aug 24, 2014 (AFP) - Tropical storm Cristobal headed toward the Bahamas Sunday after leaving one person missing in the Dominican Republic, US weather forecasters said.   The storm, which was upgraded from a tropical depression, had maximum sustained winds of 45 miles (75 kilometres) an hour, the National Hurricane Center in Miami said.   It predicted heavy rainfall of four to eight inches -- "with isolated amounts of 12 inches possible" -- for the Turks and Caicos islands and south-eastern and central Bahamas, it said.

In the Dominican Republic, authorities said a man was swept away when he tried to cross a rain-swollen river in his van.   Flooding near rivers and in cities also damaged more than 800 homes and cut off 23 towns, the emergency centre said in its latest update. Some 4,105 people went to take refuge in the homes of family and friends, it added.   A hospital in the country's east, where the rains were heaviest, also experienced flooding on the ground floor and "patients were moving to dry places," the bulletin said.
Date: Mon, 4 Aug 2014 12:16:18 +0200 (METDST)

MIAMI, Aug 04, 2014 (AFP) - Tropical Storm Bertha picked up strength Monday and was forecast to become a hurricane as it moved north from the Bahamas, US monitors said.   The National Hurricane Center reported in its 0900 GMT bulletin that the centre of Bertha was located about 220 miles (350 kilometres) east of Great Abaco Island, in the northern Bahamas.

The storm was moving towards the north at around 16 miles (26 kilometres) per hour packing winds of nearly 70 miles (110 kilometres) per hour, with higher gusts.   "Additional strengthening is expected ... and Bertha is forecast to become a hurricane later today," the NHC said.   While the outer bands of Bertha might brush the US coast, it was not expected to make landfall.

On its forecast track, Bertha "will continue to move away from the Bahamas ... and pass about midway between the US east coast and Bermuda on Tuesday," the NHC said.   The NHC earlier said Bertha was expected to drop up to five inches (13 centimetres) of rain across eastern portions of the Dominican Republic, as well as the Turks and Caicos through Monday.

Dominican authorities on Sunday declared a red-alert emergency after heavy rains triggered by Bertha toppled trees and flooded the banks of many rivers in the mountainous nation. No injuries were immediately reported.
Date: Wed 16 Jul 2014
Source: Bay News 9 [summ., edited]
<http://www.baynews9.com/content/news/baynews9/news/article.html/content/news/articles/bn9/2014/7/16/manatee_teens_get_fi.html>

Two Manatee County teens contracted a potentially deadly illness while on a fishing trip in the Bahamas. One of the teens is home now and the other is still in a Miami hospital. Their symptoms included hallucinations, seizures, vomiting, and shaking, all from eating some bad fish.

A 14-year-old and a 15-year-old, the older boy's mother along with her boyfriend were supposed to be on a fun trip to the Bahamas last week [week of 7 Jul 2014]. It was until they decided to go on a fishing trip. "We were just going to go down there and do some spear fishing and diving." The 2 boys dove along a coral reef and harpooned 2 large fish, which they ate the next day. "We fried it and just ate it with some tartar sauce," he said.

Unfortunately, it was a meal the boys will never forget. The next day the younger boy started feeling sick and started vomiting. Then everyone got sick. The whole group ended up at the hospital. One of the boys was even having hallucinations. "I remember being really scared," he said. His parents say doctors didn't know what was wrong. "They didn't have a treatment or a game plan so we felt kind of helpless," said [his father]. That's when it was decided to bring his son back to Florida. It was a doctor in Miami who diagnosed the symptoms as ciguatera poisoning, a deadly disease that you can get from eating fish that have ingested toxins from algae.

The boy is doing better now however, his doctor told the father that he could have health problems in the future because of the poisoning. The other boy had a more severe case and is still in the Miami hospital. His sister said it was scary to see him so ill. "He wasn't able to eat for about 6 days and he was already pretty skinny as it was and he is still a little shaky," said the sister.

A marine biologist from the Florida Aquarium says that there is about a 1 in 50 chance of contracting ciguatera poisoning around the Gulf but it is best to avoid eating large fish.  [Byline: Randi Nissenbaum]
===========================
[The following is taken from CDC: Cluster of ciguatera fish poisoning -- North Carolina, 2007. MMWR 2009; 58(11): 283-5 (<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5811a3.htm>; edited; original citation numbering retained):

"Ciguatoxins are lipid-soluble cyclic polyether compounds and are the most potent sodium channel toxins known (3). Carnivorous tropical and semitropical fish, such as barracuda, amberjack, red snapper, and grouper, become contaminated with ciguatoxins by feeding on plant-eating fish that have ingested _Gambierdiscus toxicus_ or another member of the _Gambierdiscus_ genus, a group of large dinoflagellates commonly found in coral reef waters (4). Gambiertoxins from _Gambierdiscus_ spp. are converted into more potent lipid-soluble ciguatoxins. Spoilage of fish that have been caught is not a factor in toxin development, and cooking does not deactivate the toxin. Humans who eat contaminated predatory fish are exposed to variable concentrations of ciguatoxin, depending on the fish size, age, and part consumed (toxins concentrate more in the viscera, especially liver, spleen, gonads, and roe). The attack rate can be as high as 80 to 90 per cent in persons who eat affected fish, depending on the amount of toxin in the fish.
"Persistence or recurrence of neurologic symptoms are hallmarks of CFP [ciguatera fish poisoning]. 3 of the 9 patients in this cluster had recurrences of one or more symptoms for more than 6 months after their initial illness. If these patients are again exposed to fish (either ciguatoxin-contaminated or even non-contaminated fish), their symptoms likely will be more severe than those experienced with their initial episodes of CFP (3).

"Variations in the geographic distribution of the various ciguatoxins might explain regional differences in symptom patterns. CFP symptoms associated with eating fish from the Pacific Ocean are primarily neurologic, and symptoms associated with eating fish from the Caribbean Sea are more commonly gastrointestinal (4). Amberjack of en
is linked to CFP cases in the Caribbean. Although the amberjack fish responsible for this cluster of CFP cases tested positive for C-CTX-1, it was not tested for the presence of other ciguatoxins, which also might have been present and could have altered disease presentation (7).

"CFP has been associated almost exclusively with eating fish caught in tropical or semitropical waters, but increased global marketing of these species has increased the possibility that persons in temperate zones might become ill with CFP (4). Moreover, warming seawaters might expand the ranges of ciguatoxin-contaminated fish (8). In the USA, such fish have been found as far north as the coastal waters of North Carolina. Despite underreporting, CFP now is considered one of the most common illnesses related to fish consumption in the USA (9).

"Any level of Caribbean ciguatoxin 0.1 ppb [parts per billion] or more of fish tissue is thought to pose a health risk (3). As this illness becomes more common in nontropical areas of the world, clinicians need to be aware of its manifestations and how to manage it. Although opinions vary on the most effective course of treatment, intravenous mannitol has been a mainstay of management of neurologic symptoms for more than 20 years. Early mannitol treatment is considered more effective, but anecdotal evidence suggests that even delayed therapy benefits some patients. Amitriptyline also has been useful in relieving some of the neurologic symptoms of CFP (10). If evaluating a possible case, clinicians should consult their local poison control center for the latest treatment guidelines.

References
----------
3. Pearn J: Neurology of ciguatera. J Neurol Neurosurg Psychiatry 2001; 70(1): 4-8 [available at <http://jnnp.bmj.com/content/70/1/4.long>].
4. Lewis RJ: The changing face of ciguatera. Toxicon 2001; 39(1): 97-106 [abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/10936626>].
5. Lange WR, Lipkin KM, Yang GC: Can ciguatera be a sexually transmitted disease? Clin Toxicol 1989; 27(3): 193-7 [abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/2810444>].
7. Lewis RJ, Jones A: Characterization of ciguatoxins and ciguatoxin congeners present in ciguateric fish by gradient reverse-phase high-performance liquid chromatography/mass spectrometry. Toxicon 1997; 35(2): 159-68 [abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/9080572>].
8. Chateau-Defat ML, Chinain M, Cerf N, et al: Seawater temperature, _Gambierdiscus_ spp. Variability and incidence of ciguatera poisoning in French Polynesia. Harmful Algae 2005; 4: 1053-62 [abstract available at <http://www.ilm.pf/node/1356>].
9. CDC. Surveillance for foodborne-disease outbreaks - United States, 1998-2002. MMWR 2006; 55(SS-10): 1-34 [available at <http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5510a1.htm>].
10. Lewis R, Ruff T: Ciguatera: ecological, clinical, and socioeconomic perspectives. Crit Rev Environ Sci Technol 1993; 23(2): 137-56 [abstract available at <http://www.tandfonline.com/doi/abs/10.1080/10643389309388447>]." - ProMed Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/5274>.]
19th April 2012
Center for Disease Control and Prevention: Update, Malaria, Bahamas, April 17, 2012

In March 2012, the Centers for Disease Control and Prevention (CDC) had received an official report of a confirmed case of malaria in a U.S. traveler to the island of Great Exuma, Bahamas. Since then, there have been no other reports of malaria in travelers to the Bahamas.

Additionally, the Bahamas Department of Public Health has found no new cases of locally transmitted malaria in Great Exuma after conducting active case finding and reviewing their Enhanced Malaria Surveillance Program.

Based on this information, CDC no longer recommends malaria prophylaxis for Great Exuma, Bahamas
.

Malaria is not endemic to the Bahamas. An outbreak of malaria previously occurred on Great Exuma Island, Bahamas in 2006, and the last documented case on the island was in 2008.
Date: Tue 27 Mar 2012
Source: CDC [edited]
<http://www.cdc.gov/malaria/new_info/2012/malariabahamas.html>

The Centers for Disease Control and Prevention (CDC) have recently received an official report of a confirmed case of malaria in a U.S. traveler to the island of Great Exuma, Bahamas. The traveler visited the island between February and March 2012 and reported no additional recent travel outside of the U.S.

An outbreak of malaria previously occurred on Great Exuma island, Bahamas in 2006, and the last documented case on the island was in 2008. Malaria is not endemic to the Bahamas, and no malaria cases have been reported from the country since then.

Malaria control measures have been implemented; environmental controls have been put into operation, and on-island surveillance has been enhanced. Officials will report any new cases of malaria if they are discovered.

Travelers should monitor their health during travel and for up to one year after return from the Bahamas for any symptoms of malaria, which are flu-like, such as fever and chills. If symptoms occur, the traveler should seek immediate medical care and inform their health-care provider of their travel to an area currently experiencing a malaria outbreak.

More information about malaria can be found at the CDC Malaria homepage. General health information for travel to the Bahamas can be found at the CDC Travelers' Health website. Health-care providers needing assistance with diagnosis or management of suspected cases of malaria should call the CDC Malaria Hotline: 770-488-7788 or toll-free at 855-856-4713 (M-F, 9 am-5:00 pm, Eastern Time). For consultation after hours, call 770-488-7100 and ask to speak with a CDC Malaria Branch clinician.
========================
[The outbreaks in Great Exuma in 2006-2008 were most probably due to local transmission from refugees from Haiti, being asymptomatic carriers of malaria parasites. - ProMed Mod.EP]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/1n1q>.]
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