Date: Mon 23 Sep 2019
Source: Centers for Disease Control and Prevention (CDC) [edited]
<https://www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm>

Since March 2017, CDC's Division of Viral Hepatitis (DVH) has been assisting multiple state and local health departments with hepatitis A outbreaks, spread through person-to-person contact.

The hepatitis A vaccine is the best way to prevent HAV infection.

The following groups are at highest risk for acquiring HAV infection or developing serious complications from HAV infection in these outbreaks and should be offered the hepatitis A vaccine in order to prevent or control an outbreak:
- people who use drugs (injection or non-injection);
- people experiencing unstable housing or homelessness;
- men who have sex with men (MSM);
- people who are currently or were recently incarcerated; and
- people with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C.

One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A and provides up to 95% seroprotection in healthy individuals for up to 11 years.

Pre-vaccination serologic testing is not required to administer hepatitis A vaccine. Vaccinations should not be postponed if vaccination history cannot be obtained or records are unavailable.

State-reported hepatitis A cases and clinical outcomes
------------------------------------------------------

State / Case total / Hospitalizations n (%) / Deaths / Outbreak start / Current through / Av. weekly cases since last post
--------------------------------------------------------------------------------
Total / 26 013 / 15 643 (60%) / 262 / --- / --- /   265

States with an ongoing outbreak
--------------------------------
Alabama / 142 78 (55%) / NR / 1 Sep 2018 / 4 Sep 2019 / --
Arizona / 575 / 454 (79%) / 8 / 1 Nov 2018 / 19 Sep 2019 / 8
Arkansas / 412 / 209 (51%) / 3 / 7 Feb 2018 / 20 Sep 2019 / 3
Colorado / 173 / 126 (73%) / 1 / 1 Oct 2018 / 18 Sep 2019 / 12
Florida / 2903 / 2071 (71%) / 39 / 1 Jan 2018 / 31 Sep 2019 / --
Georgia / 656 / 450 (69%) / 4 / 1 Jun 2018 / 14 Sep 2019 / 14
Idaho / 59 / 30 (51%) / 0 / 1 Jan 2019 / 19 Sep 2019 / 2
Illinois / 157 / 104 (66%) / 1 / 1 Sep 2018 / 18 Sep 2019 / 2
Indiana / 2106 / 1163 (55%) / 4 / 1 Nov 2017 / 20 Sep 2019 / 24
Kentucky / 4902 / 2370 (48%) / 61 / 1 Aug 2017 / 7 Sep 2019 / 12
Louisiana / 541 / 308 (57%) / 1 / 1 Jan 2018 / 20 Sep 2019 / 9
Massachusetts / 502 / 405 (81%) / 7 / 1 Apr 2018 / 6 Sep 2019 / 0
Michigan / 920 / 738 (80%) / 30 / 1 Aug 2016 / 11 Sep 2019 / 1
Minnesota / 29 / 19 (66%) / 0 / 16 Dec 2018 / 13 Sep 2019 / 2
Mississippi / 49 / 31 (63%) / 0 / 1 Apr 2019 / 16 Sep 2019 / 4
Missouri / 453 / 255 (56%) / 2 / 1 Sep 2017 / 17 Sep 2019 / 14
Nevada / 89 / 77 (87%) / 1 / 1 Nov 2018 / 16 Sep 2019 / 1
New Hampshire / 209 / 126 (60%) / 1 / 1 Nov 2018 / 10 Sep 2019 / 10
New Jersey / 414 / 270 (65%) / 5 / 1 Dec 2018 / 14 Sep 2019 / 14
New Mexico / 145 / 114 (79%) / 2 / 8 Nov 2018 / 18 Sep 2019 / 3
North Carolina / 96 / 64 (67%) / 1 / 1 Nov 2018 / 20 Sep 2019 / 1
Ohio / 3327 / 2035 (61%) / 16 / 1 Jan 2018 / 16 Sep 2019 / 18
Pennsylvania / 516 / 390 (76%) / 7 / 1 Jan 2018 / 14 Sep 2019 / 25
South Carolina / 409 / 260 (64%) / 1 / 1 Nov 2018 / 13 Sep 2019 / 18
Tennessee / 2484 / 1493 (60%) / 20 / 1 Dec 2017 / 20 Sep 2019 / 52
Virginia / 177 / 110 (62%) / 0 / 1 Jan 2019 / 19 Sep 2019 / 7
Washington / 24 / 15 (63%) / 0 / 1 Apr 2019 / 11 Sep 2019 / 2
West Virginia 2555 / 1262 (49%) / 23 / 19 Mar 2018 / 13 Sep 2019 / 4

States with a declared end to their outbreak
----------------------------------------------------------
California / 708 / 464 (66%) / 21 / 1 Nov 2016 / 11 Apr 2018
Utah / 281 / 152 (54%) / 3 / 8 May 2017 / 12 Feb 2019

NR: not publicly reported
-"Outbreak-associated" status is currently determined at the state level in accordance with each state's respective outbreak case definition.
- Outbreak-related hepatitis A deaths are defined at the state level in accordance with each state's respective hepatitis A-related death definition. Some states are reviewing death certificates on a regular basis to actively find hepatitis A-related deaths, while other states are utilizing passive surveillance.
- Outbreak start date is defined at the state level and may represent the earliest onset date of an outbreak case (AR, AZ, UT), the left censor date for which cases are considered part of the outbreak based on the state outbreak case definition (AL, CA, CO, FL, GA, ID, IL, IN, KY, LA, MA, MI, MN, MO, MS, NV, NH, NJ, NC, OH, PA, SC, TN, VA, WA), or when a state declared a hepatitis A outbreak (NM, WV).
=======================
[Overall, the top 4 states for HAV cases remain Kentucky, Ohio, Florida and West Virginia.

As the numbers of cases continue to rise in a number of states and news of smaller (so far) outbreaks occur in others, the question at the end of ProMED-mail post http://promedmail.org/post/20190104.6241686 by a Kentucky official -- "This is a disease of developing countries. One has to ask: Why are we seeing it in the USA?" -- is more and more relevant. We are seeing these outbreaks because of the inability to deal with marginalized populations among our midst. The dramatic cutbacks in public health infrastructure in some of these states clearly feed the fire of these outbreaks. They must be addressed by bolstering public health resources and education and directly addressing the needs of these marginalized populations. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
United States: <http://healthmap.org/promed/p/106>]
Date: Thu 1 Oct 2019 5:02 AM EDT
Source: WXYZ [edited]
<https://www.wxyz.com/news/eee-confirmed-in-livingston-county-horse-that-was-euthanized>

The Livingston County Health Department said that they have confirmed the 17th case of eastern equine encephalitis in a horse from Hamburg Township.  The horse, an unvaccinated 3-year-old Paint gelding, had a sudden onset of neurological signs on [23 Sep 2019] and was euthanized. According to the health department, there have been no human cases of EEE reported in Livingston County. According to the state, there have been 9 cases of EEE confirmed in residents of Barry, Berrien, Calhoun, Cass, Kalamazoo, and Van Buren counties, including 3 deaths.

There have also been 17 animal cases of EEE confirmed; 15 equine and 2 canines, which were 2 wolf pups who both died at the Binder Park Zoo in Battle Creek.  EEE is very rare, but it is one of the most dangerous mosquito-borne diseases in the US, with a 33 percent fatality rate in people who become ill. The virus is transmitted to humans and other mammals through the bite of an infected mosquito. Severe cases of EEE infection begin with the sudden onset of headache, high fever, chills, and vomiting. The illness may then progress into disorientation, seizures, and coma. Anyone who thinks they may be experiencing these symptoms should contact a medical provider.

The state is reminding people that mosquitoes capable of transmitting the disease are assumed to be widespread throughout the region and will remain until the 1st hard frost reduces the mosquito population.  Michigan is also spraying in 14 counties for mosquitoes to stop thespread of EEE.

Residents should take these steps to avoid contracting EEE:
- avoid being outdoors between dusk and dawn when mosquitoes that carry EEE virus are most active;
- apply insect repellents that contain the active ingredient DEET, or other US Environmental Protection Agency-registered product to exposed skin or clothing, and always follow the manufacturer's directions for use;
- wear long-sleeved shirts and long pants when outdoors. Apply insect repellent to clothing to help prevent bites;
- maintain window and door screening to help keep mosquitoes outside;
- empty water from mosquito breeding sites around the home, such as buckets, unused kiddie pools, old tires, or similar sites where mosquitoes may lay eggs;
- use nets and/or fans over outdoor eating areas.
========================
[HealthMap/ProMED-mail map of Michigan:
<http://healthmap.org/promed/p/4213>
Michigan county map:
<https://www.mapsofworld.com/usa/states/michigan/michigan-county-map.html>]
Date: Wed, 2 Oct 2019 23:48:50 +0200 (METDST)

Washington, Oct 2, 2019 (AFP) - A freakish heat wave is making early autumn feel like the dog days of summer in much of the southern and eastern United States, with forecasters predicting that temperatures Wednesday could get close to triple digits.   Washington hit 97 degrees Fahrenheit (36 Celsius) late in the afternoon, according to the National Weather Service (NWS), surpassing the city's previous monthly record of 96 degrees on October 5, 1941.    The mercury rose into the 90s across much of the south, the NWS said, with Montgomery, Alabama reaching 98 degrees, Little Rock, Arkansas hitting 94 and Atlanta seeing 95 degrees in the mid-afternoon.

Temperature tracking in New York's Central Park recorded 92 degrees, just two degrees lower than the city's all-time October high in 1941.   Temperatures in some places could be as many as 30 degrees higher than normal, the NWS said, while a quarter of the country will reportedly experience temperatures above 90 degrees.   It's been so bad this week that some schools with no air conditioning in states like Ohio and Maryland are sending children home early or closing altogether.   In Tipp City, Ohio, teachers gave kids popsicles and held some classes in shady spots outdoors, NBC affiliate WDTN reported.

Records were set or tied Tuesday in more than a dozen cities including Cleveland, Ohio, New Orleans, Louisiana and Syracuse, New York, the Weather Channel reported.   Atlanta could break its all-time October record high of 95 degrees Wednesday or Thursday, it added.   Relief is expected late in the week as a cold front rushes in, sending temperatures way down.

Some in the Northeast could even see the first frost or freeze of the season.   The United States has already experienced extreme weather at the other end of the scale this week, as the northern state of Montana was blanketed with record snowfall -- four feet (1.20 meters) in the town of Browning.   And at 8:00 am Wednesday in Billings, Montana's most populous town, it was a lowly 34 degrees.
Date: Mon 30 Sep 2019 11:22 AM EDT
Source: Wicked Local Hamilton [edited]
<https://hamilton.wickedlocal.com/news/20190930/state-officials-announce-11th-human-case-of-eastern-equine-encephalitis>

The Massachusetts Department of Public Health announced the 11th human case of eastern equine encephalitis [EEE] virus infection, a man in his 70s from Worcester County.  As a result, the communities of Auburn, Charlton, Dudley, Leicester, Southbridge, and Spencer have been elevated to high risk.

The Department of Public Health has also been recently notified by a hospital of a death from the virus of an Essex County resident. It marks the 4th death from eastern equine encephalitis virus this year [2019] in Massachusetts.  "Although mosquito populations are declining at this time of year, risk from EEE will continue until the1st hard frost," said state epidemiologist Dr Catherine Brown.  "We continue to emphasize the need for people to protect themselves from mosquito bites."  There are 35 communities now at critical risk, 46 at high risk and 122 at moderate risk for the virus in Massachusetts. A map of the state's current eastern equine encephalitis risk levels can be found at <https://bit.ly/2mVNdnY>.

In addition to the 11 human cases of the virus this season in Massachusetts, there have also been 8 confirmed cases of in animals -- 7 horses and a goat.  State officials continue to remind residents to take personal precautions to prevent mosquito bites. Eastern equine encephalitis is a rare but serious and potentially fatal disease that can affect people of all ages. The virus occurs sporadically in Massachusetts, with the most recent outbreak years occurring from 2004 to 2006 and 2010 to 2012. There were 22 human cases of infection during those 2 outbreak periods, with 14 cases occurring among residents of Bristol and Plymouth counties.

The virus has been found in 422 mosquito samples this year [2019], many of them from species of mosquitoes capable of spreading the virus to people. An additional 83 mosquitos have tested positive for West Nile virus.

The Massachusetts Department of Agricultural Resources has now completed aerial spraying for mosquitoes for the season. Aerial spraying has been conducted in parts of Bristol, Plymouth, Middlesex, Norfolk, Worcester, Hampden, and Hampshire counties. Aerial spraying helps reduce risk of transmission, but some risk will continue to exist until there is a hard frost.
========================
[The number of human EEE cases in Massachusetts continues to increase, with the diagnosis of the 11th case this 2019 season, with 4 deaths. A 21 Sep 2019 report stated that a 2nd person in Massachusetts has died from EEE. The patient was a man in his 70's and was the 10th confirmed case of EEE in the state (see Eastern equine encephalitis - North America (25): USA (CT, MA, MI) human http://promedmail.org/post/20190923.6688701). Now, there is one additional case. Killing frosts should be coming in the next 2-3 weeks [<https://www.weather.gov/iwx/fallfrostinfo>}, which will bring the EEE transmission season to an end. Meanwhile, Massachusetts residents and visitors should heed the advice to avoid mosquito bites and horse owners should vaccinate their animals if they have not done so already. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Massachusetts:
<http://healthmap.org/promed/p/4527>
Massachusetts county map:
<https://www.mapsofworld.com/usa/states/massachusetts/massachusetts-county-map.html>]
Date: Mon 30 Sep 2019 04:26 PM CDT
Source: AgWeb [edited]
<https://www.agweb.com/article/cyclospora-outbreak-mexican-basil-over>

An outbreak of _Cyclospora_ illnesses linked to fresh basil appears to be over, according to the Food and Drug Administration [FDA] and the Centers for Disease Control and Prevention.

The FDA reported 241 illnesses were involved in the outbreak, including 6 cases that required hospitalization. No deaths were reported in connection to the outbreak.

The FDA first reported the outbreak on [25 Jul 2019], the day after Siga Logistics de RL de CV, a Morelos, Mexico, company, recalled fresh basil shipped to the US. The FDA's traceback investigation "confirmed that the fresh basil available at points of sale where some consumers became ill was exported" to the US by the company.

While the outbreak appears to be over, the FDA continues to investigate, according to a [30 Sep 209] update from the FDA. Siga Logistics de RL de CV has cooperated with the investigation, ceasing production and distribution of the basil, according to the FDA.

The last onset date for _Cyclospora_ was [26 Jul 2019]

Cases were reported in Connecticut, Florida, Georgia, Iowa, Massachusetts, Minnesota, New York, Ohio, Rhode Island, South Carolina and Wisconsin. Exposures were traced to restaurants in Florida, Minnesota, New York, Ohio, and Wisconsin.  [Byline: Chris Koger]
==========================
[HealthMap/ProMED-mail map of United States:
<http://healthmap.org/promed/p/106>]
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