Date: Sat 7 Jul 2018
Source: Outbreak News Today [edited]

The Norway Institute of Public Health reports investigating an outbreak of gastrointestinal bacterium, _Yersinia enterocolitica_ O:9. To date [Sat 7 Jul 2018], 18 people from several counties have been diagnosed with the infection. The patients are between 13 and 60 years old and 60 percent of them are women. They are residents from Troms, Oslo, Akershus, Trøndelag, Vestfold, Rogaland, Nordland, Hordaland and Møre og Romsdal, and are tested in May and early June [2018]. Bacteria with similar DNA profiles have been detected in all 18 individuals. Health and Food Safety officials are trying to determine if there is a common source of infection.

Interviews are conducted with the patients, and samples from the homes are taken to find the source of infection, if possible. "Investigations can be complicated and take time, and in many cases you will not be able to find the source of infection or to clarify if there is a common source", says Solveig Jore Senior Adviser. The most common symptoms of yersiniosis are diarrhoea, fever and abdominal pain, usually of 1-3 weeks duration.

The reservoir for the bacterium is primarily pig. Dogs and cats can also be carriers of the bacterium. _Yersinia_ bacteria mainly contaminate food, usually via infected pork products, contaminated vegetables or salads, and the use of non-disinfected drinking water. Every year, between 40 and 80 cases are reported to the Public Health Institute of Yersiniosis.  Most cases are acquired domestically (70-75 percent of reported cases). [Byline: Robert Herriman]
[The 2 species of _Yersinia_ associated with food-borne disease are _pseudotuberculosis_ and _enterocolitica_. The latter species, can be associated with abdominal pain as a hallmark symptom. As a mesenteric lymphadenitis, yersiniosis can mimic appendicitis but may also cause infections of other sites such as wounds, joints, and the urinary tract.

As noted in the FDA "Bad Bug Book" <>, "Strains of _Y. enterocolitica_ can be found in meats (pork, beef, lamb, etc.), oysters, fish, and raw milk. The exact cause of the food contamination is unknown. However, the prevalence of this organism in the soil and water and in animals such as beavers, pigs, and squirrels, offers ample opportunities for it to enter our food supply.

Poor sanitation and improper sterilization techniques by food handlers, including improper storage, cannot be overlooked as contributing to contamination." Additionally, some strains of these organisms can be associated with blood transfusion-associated illnesses due to an ability to grow at refrigerator temperatures. - ProMED Mod.LL]

[HealthMap/ProMED map available at: Norway:
Date: Wed 29 Nov 2017 06:38
Source: Science Nordic [edited]

Norway is home to roughly 5 million people and nearly a million sheep. Sheep, which wander freely in the Norwegian forests and mountains in the summer, can be infected by _Anaplasma phagocytophilum_, a bacterium carried by ticks that can also infect humans and cattle.

Medical researchers have previously described the tick-borne infection caused by _A. phagocytophilum_ as the most widespread tick-borne infection in animals in Europe.

But its prevalence in Norway in humans is so poorly known that the discovery of a case of anaplasmosis in a man at Stavanger University Hospital merited a just-published report in the December 2017 issue of Lancet Infectious Disease [1]. "This was the 1st confirmed case we have seen in Rogaland County," said Ase Berg, chief attending physician at Stavanger University Hospital, where the infected man was seen.

Although this was the 1st report of the disease, Berg and others say that it is likely that many other people in the county have been infected. In late May 2016, a man came to Stavanger University Hospital reporting that he had experienced recurring attacks of high fever, headaches and achy muscles over the previous 10 days. The doctors who saw him were initially puzzled. They tested him for different blood diseases and cancers and for a number of infectious diseases, such as HIV and hepatitis, but without finding anything. But then the doctors learned that  the man often spent time camping in the woods. These are areas where ticks often infect sheep with _A. phagocytophilum_. The doctors took a sample from his bone marrow and found the bacteria there. The bacterium that causes anaplasmosis can be found by looking at white blood cells under a light microscope, as is shown in this picture. [Photo available at source URL.]

"Between 300,000 and 400,000 lambs are infected here every year," said Professor Snorre Stuen at the Norwegian University of Life Sciences (NMBU), who has studied anaplasmosis for 30 years. In sheep, anaplasmosis infection is called "sjodogg", which translates as tick-borne fever. It has been known for hundreds of years in Norway. The infection can make sheep very ill. Many animals die or are permanently weakened, primarily because the bacterium makes them vulnerable to other infections.

Although there are few reported cases in Norway, it is also known that ticks can transfer _A. phagocytophilum_ to people. The 1st case of anaplasmosis in humans was described in the United States in 1994 by the Norwegian researcher Johan Bakken, who is currently working at the University of Minnesota. It was 1st reported in a human in Europe in 1997. Since that time, more than 15 000 cases of anaplasmosis have been detected in the United States. The American experience means that we know a bit about the course of the disease in humans.

Like the more well-known Lyme disease, anaplasmosis mostly infects people only when the ticks have been attached to their human hosts for more than a day. Symptoms develop 7 to 10 days after the bite and are reminiscent of the flu, with fever, headache and muscle aches. In many cases, the disease clears up by itself, without the infected individual having any serious or lasting ailments. Bakken says the disease is so mild in many people that they think they have a summer cold. "I would estimate that maybe 2 out of 100 have strong enough symptoms that they go to the doctor," he said of his experience in the Midwestern United States.

However, the disease is not completely benign. In just under one of 100 cases reported, the disease is fatal. "As a rule, it's not anaplasmosis itself that kills people, but that the disease makes people more vulnerable to other infections," says Jens Vikse at Stavanger University Hospital.

Nevertheless, people are not routinely tested for anaplasmosis in Norway. The mildness of the symptoms means that few people go to the doctor, even if they have had a fever for several days. Both of these factors mean that health officials don't actually know how prevalent the disease is in Norway. Several surveys in different Norwegian counties found between 14 and 16 percent of those tested had antibodies to the disease, which suggests it is not uncommon.

Ase Berg at Stavanger University Hospital thinks it would be good to test people who work in the woods, as well as people who participate in the sport of orienteering, which involves running through areas that might have a lot of ticks. The researchers believe that it is important for both healthcare professionals and people to be aware that humans can be infected with this bacterium in areas with ticks. If the disease is detected, it can be treated with antibiotics.

But don't worry: The disease does not appear to be chronic, like Lyme disease. So if you are concerned that you might have had it in the past, you don't need to worry that you will have ongoing problems or that you will get it again.  [Byline: Nancy Bazilchuk]

[1. Vikse J, Klos J, Berg A. A travelling camper with a spiking fever, headache, myalgia, hepatitis, and intracellular inclusions, The Lancet Infectious Diseases 2017; 17 (12):1318. DOI: - ProMED Mod.ML ]
[_Anaplasma phagocytophilum_, the causative agent of anaplasmosis (also known as human granulocytic anaplasmosis or HGA), is transmitted to humans in northeastern United States by the same tick (_Ixodes scapularis_ in the northeastern and upper central U.S., _Ixodes pacificus_ in California, _Ixodes ricinus_ in Europe, and _Ixodes persulcatus_ in Europe and Asia). _Ixodes_ also transmit _Borrelia burgdorferi_, the causative agent of Lyme disease and _Babesia microti_, the causative agent of babesiosis, as well as Powassan virus the cause of meningoencephalitis. Typically, the nymph stage of the tick, which is about the size of a poppy seed, transmits these diseases. For a picture of the nymph, see <>. Patients may be concurrently co-infected by these pathogens.

Some individuals infected with _A. phagocytophilum_ do not become ill or experience only very mild symptoms and do not seek medical treatment. The symptoms tend to be most severe in aged or immunosuppressed people. In infected persons who are symptomatic with anaplasmosis, illness onset occurs 5-21 days after a bite from an infected tick. Initial presentation typically includes sudden onset of fever, headache, malaise, and myalgia, often accompanied by thrombocytopenia, leukopenia, and elevated liver transaminases. Approximately 5 to 7 percent of patients require intensive care, and the disease can be fatal. Severe infections can include prolonged fever, shock, confusion, seizures, pneumonitis, renal failure, hemorrhages, and death.

Because _A. phagocytophilum_ are found in the blood stream, infected blood can serve as a vehicle for person-to-person transmission (Centers for Disease Control and Prevention. _Anaplasma phagocytophilum_ Transmitted Through Blood Transfusion -- Minnesota, 2007. MMWR 2008; 57(42): 1145-8. October 2008 [date cited] Available from <>).

Treatment with doxycycline 100 mg twice daily orally or intravenously for 10 days for all symptomatic patients suspected of having anaplasmosis is recommended for a minimal total course of 10 days. This treatment regimen should be adequate therapy for patients with anaplasmosis alone and for patients who are co-infected with Lyme disease, but is not effective therapy for patients who are co-infected with _B. microti_.

Anaplasmosis has been reported in the past in Europe, including Norway
(<> and

Please also see prior ProMED-mail posts Ehrlichiosis, human granulocytic - Sweden

For a further discussion of anaplasmosis, please see my moderator comments in the prior ProMED-mail posts Anaplasmosis - China: (HL) new species, humans, goats, tick-borne and Anaplasmosis - USA: (ME) increased incidence

Rogaland, a coastal county located in southwestern Norway with fjords, beaches, and islands, is the center of the Norwegian petroleum industry (<>). Stavanger, where the patient described in the news report above was hospitalized, is the 3rd-largest urban zone in Norway and the administrative center of Rogaland county.

A map of Rogaland County can be found at
<,+Norway>. - ProMED Mod.ML]

[_Anaplasma phagocytophilum_ has for decades been known to cause the disease tick-borne fever (TBF) in domestic ruminants in _Ixodes ricinus_-infested areas in northern Europe. In recent years, the bacterium has been found associated with Ixodes-tick species more or less worldwide on the northern hemisphere. It has a broad host range, on top of humans; in several mammalian species severe disease may be observed. Fatal cases in animals have been, so far, reported in sheep, cattle, horses, reindeer, roe deer, moose and dogs.

The main disease problems associated with TBF in ruminants are seen in young animals, and individuals purchased from tick-free areas and placed on tick-infested pastures for the 1st time. The most characteristic symptoms in domestic ruminants are high fever, anorexia, dullness, and sudden drop in milk yield. The fever reaction may vary according to the age of the animals, the variant of _A. phagocytophilum_ involved, the host species and immunological status of the host. Abortion in ewes, reduced fertility in rams and reduced weight gain in infected lambs have been observed. For a review addressing _A. phagocytophilum_ in sheep. See ref 1.

1. Stuen S (2016) Tick-Borne Fever (Anaplasma phagocytophilum Infection) in Sheep - A Review. J Vet Med Res 3(5): 1062. - ProMED Mod.AS]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Fri, 25 Aug 2017 14:14:28 +0200

Oslo, Aug 25, 2017 (AFP) - Usually the humans are scared of the wild animals. But in the Norwegian far-north, an Arctic tourist guide has been fined 1,300 euros ($1,500) for scaring off a polar bear.   When a group of tourists on a snowmobile expedition in May spotted a bear standing still, 900 metres (2,950 ft) away, their guide decided to approach the predator to take a closer look.

The animal, spotted on the Norwegian archipelago of Svalbard, fled the scene.      "The regulations say that it is forbidden to approach polar bears in such a way that they are disturbed, regardless of the distance," the Svalbard governor's office said in a statement.   Located 1,000 miles (1,600 km) from the North Pole and twice the size of Belgium, Svalbard is, according to 2015 state figures, home to nearly 1,000 polar bears, a protected species since 1973.    Five deadly attacks on people have been recorded in about 40 years.
Date: Mon, 8 May 2017 16:28:40 +0200

Oslo, May 8, 2017 (AFP) - The Norwegian government on Monday authorised the slaughter of a herd of around 2,000 reindeer in a bid to eradicate a brain-destroying disease, after several cases were detected in Norway for the first time in Europe.   In chronic-wasting disease (CWD), a cousin of mad-cow disease and already present in North America, deer brains turn spongy, causing the animal to lose weight and die.   It is contagious among deer and reindeer but not known to pass from animals to humans.   The disease was detected for the first time in Europe last year in Norway, with three known cases of reindeer infected in a single herd and two other cases among moose -- though the latter cases were considered to be of less concern since moose do not live in herds.

To prevent the spread of the disease, the Norwegian Food Safety Authority -- which oversees animal health issues -- called for the slaughter of the affected herd, which has between 2,000 and 2,200 wild reindeer living in the southwestern mountainous region of Nordfjella.   In a letter sent Monday to the authority, the agriculture ministry gave the green light "based on the knowledge we have today and the unanimous recommendations of experts."   The herd, which represents about six percent of Norway's total reindeer population, is to be eradicated by May 1, 2018, the ministry said.   The Food Safety Authority has until June 15 to present an action plan.    Possibilities being considered include rounding up the animals for slaughter, or extending hunting in the region.
Date: Mon, 29 Aug 2016 11:43:25 +0200

Oslo, Aug 29, 2016 (AFP) - More than 300 wild reindeer have been killed by lightning in southern Norway, Norwegian officials said Monday, in the largest such incident known to date.   The 323 reindeer, including 70 young, were found on Friday by a gamekeeper on the Hardangervidda plateau, a national park where Europe's largest herd of some 10,000 wild reindeer roam freely.

Television footage showed the animals' dead bodies lying close together on the ground.   "There were very strong storms in the area on Friday. The animals stay close together in bad weather and these ones were hit by lightning," an official from the Norwegian Environment Agency, Kjartan Knutsen, told AFP.

Reindeer are social creatures and usually move in packs.   "It's unusual. We've never seen anything like this on this scale," Knutsen said.   Norwegian authorities have yet to decide what to do with the animals.   "We're going to decide soon whether to let nature run its own course or whether we will do something," he said.   Of the 323 reindeer killed, five had to be put down due to their injuries.   Thee are some 25,000 wild tundra reindeer in Norway, located in the southern mountain ranges, according to experts.
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