Primary Syphilis Outbreak in Edmonton, July 2004 to April 2006: Alberta
Syphilis is a sexually transmitted infection (STI) that has been notifiable in Canada since the 1940s. Rates of syphilis began declining in Canada in the early1980s, and by 1997 syphilis rates had met the national goal of elimination (< 0.5/100,000). Unfortunately, the continued elimination of syphilis has been hampered by recent outbreaks in subpopulations across Canada, contributing to rising rates nationally. After a syphilis outbreak among sex trade workers in Vancouver in mid-1997, local outbreaks were reported in other areas of Canada among men having sex with men in Calgary, Montreal, Ottawa and Toronto, as well as among heterosexuals in the Yukon. Subsequently, the national rate reported in 2004 was nine times the reported rate in 1997 (3.5 vs. 0.4/100,000). The last syphilis outbreak in Edmonton occurred in the early 1980s when over 1,000 cases of infectious syphilis were identified over a 7-year period; 2003 marked the first significant rise in infectious syphilis cases since that time. Twenty-seven cases of infectious syphilis were reported in the Capital Health region (Edmonton and surrounding area). Each subsequent year has seen a rise in the number of reported cases: 52 cases in 2004, 106 cases in 2005 and 36 cases identified during the first 3 months of 2006. When analyzed by quarter, the epidemiologic curve depicts a smaller initial outbreak during 2003 and the first two quarters of 2004 followed by a second outbreak with a significant rise in cases beginning in the third quarter of 2004 and continuing to date. In addition, five babies born in 2005 had congenital syphilis, and one of the neonates died. To better understand the dynamics of the current outbreak, a case review was completed. The report is available online at:
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/07vol33/dr3306ea.html.
Source: Canada Communicable Disease Report, Volume 33, No. 6, 15 March 2007

Human Rabies: Indiana and California
Rabies is a viral infection that causes acute, progressive encephalitis and is considered to be universally fatal. However, during 2004, an unvaccinated Wisconsin patient received a new medical treatment and became the first documented survivor of rabies who had not received preexposure vaccination or postexposure prophylaxis (PEP), suggesting the possibility of successful future interventions. This report describes two patients in 2006 with rabies who were treated using therapy similar to that used for the Wisconsin patient; both treatments were unsuccessful. The report also describes the concomitant epidemiologic investigations by the Indiana State Department of Health, California Department of Health Services, and CDC, and the local public health responses in Indiana and California. The findings in this report underscore the continuing need for enhanced clinical awareness of possible rabies exposure to ensure prompt PEP and timely diagnosis of rabies, especially if treatment is attempted.
Source: Morbidity and Mortality Weekly Report, Volume 56, No. 15, 20 April 2007

Lymphogranuloma venereum (LGV), 2006-2007: Netherlands
As reported previously (Eurosurveillance Weekly, 2006;11(9):150-152), LGV has emerged as a significant public health problem in the Netherlands since an outbreak among mainly HIV-positive men having sex with men (MSM) in Rotterdam in 2004. As of March 2007, 232 confirmed cases of LGV had been reported in the Netherlands. The number of LGV notifications decreased in the first months of 2006, but there seems to have been an increase since summer 2006. As of January 2006, 179 confirmed cases were reported in the Netherlands. Cases were confirmed by the presence of Chlamydia and an LGV serovar (L1, L2, or L3) from genotyping or an LGV specific PCR. Between January 2006 and the end of February 2007, 53 new cases were reported with epidemiological information. Most of these (74%, n=39) were diagnosed at an STI clinic in Amsterdam. Preliminary results show that all these cases were MSM, 77% (n=41) were HIV-positive and all diagnoses were based on an anorectal sample, comparable to the results of 2004-2005.
Source: Eurosurveillance Weekly, Volume 12, Issue 4, 19 April 2007

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.