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         Valley Fever:     more books (99)
  1. Rift Valley fever outbreak with East-Central African virus lineage in Mauritania, 2003.(RESEARCH): An article from: Emerging Infectious Diseases by Ousmane Faye, Mawlouth Diallo, et all 2007-07-01
  2. Rift Valley fever, Mayotte, 2007-2008.(DISPATCHES)(Report): An article from: Emerging Infectious Diseases by Daouda Sissoko, Claude Giry, et all 2009-04-01
  3. Rift Valley fever during rainy seasons, Madagascar, 2008 and 2009.(RESEARCH)(Report): An article from: Emerging Infectious Diseases by Soa Fy Andriamandimby, Armand Eugene Randrianarivo-Solofoniaina, et all 2010-06-01
  4. Rift Valley fever in small ruminants, Senegal, 2003.(RESEARCH): An article from: Emerging Infectious Diseases by Veronique Chevalier, Renaud Lancelot, et all 2005-11-01
  5. Rift Valley fever outbreak--Kenya, November 2006-January 2007.(Disease/Disorder overview): An article from: Morbidity and Mortality Weekly Report by P. Nguku, S. Sharif, et all 2007-02-02
  6. Rift Valley fever potential, Arabian Peninsula.(Letter to the editor): An article from: Emerging Infectious Diseases by Assaf Anyamba, Jean-Paul Chretien, et all 2006-03-01
  7. Silicon Valley Fever
  8. Rift Valley Fever: An Emerging Human and Animal Problem (Offset Publications) by World Health Organization, 1982-08
  9. Doomsday Journals: Fireball, Fibal Warning, Bedford Fever, Lost Valley, and Comet by Dudley Bromley, 1982-01-01
  10. Slam Book Fever (Sweet Valley High) by Francine Pascal, 1988-09
  11. Rift valley fever (enzootic hepatitis) =: Febra vaii Rift (Rift valley fever) (Hepatita enzootica) by I Cirstet, 1986
  12. Valley Fever Task Force report on the control of Coccidioides immitis by B. A Jinadu, 1995
  13. Presence of Rift Valley fever antibodies in the blood of Africans =: Presence d'anticorps contre la fièvre de la Vallée du Rift dans le sang des Africains by G. J Findlay, 1984
  14. Rift valley fever, a veterinary and medical problem =: Rift Valley fever, een veterinair en medisch probleem by H. A. E. van Tongeren, 1980

41. MDTravel Health - Rift Valley Fever
MDTravel Health complete travel health information, updated daily, for physicians and travelers.
http://www.mdtravelhealth.com/infectious/rift_valley_fever.html
Rift Valley Fever insect protection measures and to wear gloves and protective garments when handling animal tissues or caring for infected patients. Strict barrier and respiratory precautions are essential when patients with suspected Rift Valley fever are admitted to the hospital. From the World Health Organization (WHO) Rift Valley Fever Fact Sheet From the Centers for Disease Control (CDC) Travelers' Health Information on Viral Hemorrhagic Fevers Fact Sheet on Rift Valley Fever Rift Valley Fever Fact Sheet Rift Valley Fever Distribution Maps ...
- Back to Infectious Diseases -

42. RIFT VALLEY FEVER
Rift valley fever is caused by a threestranded RNA virus in the Phlebovirus Rift valley fever virus in aerosols has a half-life in excess of 77 minutes
http://www.vet.uga.edu/vpp/gray_book/FAD/rvf.htm
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FOREIGN ANIMAL DISEASES RIFT VALLEY FEVER
(Infectious enzootic hepatitis of sheep and cattle) Definition Rift Valley fever (RVF) is an arthropod-borne (primarily mosquito), acute, febrile, viral disease of sheep, cattle, and goats (4). The disease in these species is characterized by high abortion rates, high mortality in neonates, and hepatic necrosis (6). Humans are highly susceptible. Symptoms in humans in most cases are those of an acute undifferentiated febrile disease; severe cases (about 1 percent) resemble a dengue-like disease (18) accompanied by hemorrhage, meningoencephalitis, retinopathy, and sometimes death (10). Etiology Rift Valley fever is caused by a three-stranded RNA virus in the Phlebovirus genus of the family Bunyaviridae (11). All isolates are serologically similar. Detection of differences between isolates requires RNA fingerprinting. Rift Valley fever virus is inactivated by lipid solvents, detergents, and low pH. At neutral or alkaline pH in the presence of protein such as serum, the virus can remain viable for up to 4 months at 4 o C. Specimens stored below

43. RIFT VALLEY FEVER
Rift valley fever is caused by a threestranded RNA virus in the Rift valley fever virus is inactivated by lipid solvents, detergents, and low pH.
http://www.vet.uga.edu/vpp/gray_book/Handheld/rvf.htm
RIFT VALLEY FEVER
(Infectious enzootic hepatitis of sheep and cattle) Definition top Rift Valley fever (RVF) is an arthropod-borne (primarily mosquito), acute, febrile, viral disease of sheep, cattle, and goats (4). The disease in these species is characterized by high abortion rates, high mortality in neonates, and hepatic necrosis (6). Humans are highly susceptible. Symptoms in humans in most cases are those of an acute undifferentiated febrile disease; severe cases (about 1 percent) resemble a dengue-like disease (18) accompanied by hemorrhage, meningoencephalitis, retinopathy, and sometimes death (10). Etiology top Rift Valley fever is caused by a three-stranded RNA virus in the Phlebovirus genus of the family Bunyaviridae (11). All isolates are serologically similar. Detection of differences between isolates requires RNA fingerprinting. Rift Valley fever virus is inactivated by lipid solvents, detergents, and low pH. At neutral or alkaline pH in the presence of protein such as serum, the virus can remain viable for up to 4 months at 4 o C. Specimens stored below

44. Valley Fever
valley fever is not contagious to other pets or family members! Early symptoms often seen in the initial stages of valley fever are dry, harsh cough,
http://www.dlrrphoenix.org/VF.html
What's Valley Fever?
Valley Fever (VF), or Coccidioidomycosis, is reaching epidemic proportions in Arizona, affecting both people and dogs. Dogs, in fact, are even more susceptible than humans, by virtue of their closer proximity to the ground where Valley Fever spores live. VF is a fungal infection contracted by inhaling soil-dwelling spores. When soils containing the fungus are disturbed and dust is raised, spores may be inhaled with the dust. Soil is disturbed by things like construction, digging (by dogs or humans), and wind. Dogs, known to dig and to stick their noses right into the dirt, have potential to breathe in many, many spores at a time. The microscopically small spores are found in the arid soils of the low desert regions of the southwestern U.S. In recent years, we've seen explosive population growth in Arizona and an associated increase in new home construction and extreme disturbance of the soil. The increase in the number of cases of VF seems to closely correspond to the increase in population. VF infections are more likely to occur during certain seasons. In Arizona, the highest prevalence of infections occurs June through July and from October through November. Many dogs in this part of the country become infected with VF, but do not become visibly ill. In most cases, only a mild respiratory inflammation occurs as the dogs’ defense mechanisms wall off the organisms. However, very young puppies, older dogs, or dogs with weakened immune systems are at much higher risk to develop a more serious case of VF. In severe cases, the disease can spread throughout the lungs and invade other organs with the fungal infection. Once the spore has been breathed into the lungs, the spore transforms itself into a larger, multi-cellular structure called a spherule. The spherule grows and will eventually burst, releasing lots of small endospores. These develop into new spherules, and the cycle repeats again and again. This is how the fungus can be spread from the lungs through the bloodstream to other organs.

45. Coccidioidomycosis - Valley Fever - Mesa Veterinary Hospital
Coccidioidomycosis valley fever. What it is valley fever Coccidioidomycosis, or valley fever, is a disease caused by the fungus coccidioides imminia,
http://www.mesavet.com/library/coccidi.htm

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Coccidioidomycosis - Valley Fever
What it is Valley Fever
Coccidioidomycosis, or valley fever, is a disease caused by the fungus coccidioides imminia, which exists as a mold found in the soil. The highest incidence of this disease occurs in the desert areas of the southwestern United States. The environmental conditions necessary for survival of the fungus include a warm, arid climate, low elevations with small amounts of rainfall, and relatively alkaline soil. The disease occurs in most species of domestic animals, many exotic animals, and in man. It is usually not considered contagious from one animal to another or from animal to man. The disease occurs as a result of the inhalation of fungal spores directly from the soil or from dust in the air.

46. Rift Valley Fever - Vads Corner
Information and links on the recent outbreak of Rift valley fever and haemorrhagic disease Origin of 199798 Rift valley fever outbreak in East Africa.
http://www.vadscorner.com/rvf.html
Rift Valley Fever
Vads Corner - Rift Valley Fever Information and links on the recent outbreak of Rift Valley fever and haemorrhagic disease in Kenya, Somalia,?Tanzania, Yemen, Saudi Arabia and around the world. This page will be updated when information is available. You are welcome to suggest links or comments related to this site by e-mailing directly to me or mentioning the link in the guestbook. I however have the right to moderate these links. Please read the If you appreciate this site do sign my guestbook View comments. See comments of previous guestbook ....also guestbook recent Suggest for updates, see links in italics. Thank you for visiting this site. Last updated on 27 January 2001. Home Software Hindu Malaysian ... email me Updates- When available

47. Coccidioidomycosis Fact Sheet
Coccidioidomycosis(valley fever) The primary disease may produce no symptoms at all or may produce a fever, chills, and cough.
http://health.utah.gov/els/epidemiology/epifacts/cocci.html

DELS Home Page
Communicable Disease Control Epidemiology Utah Public Health Lab
C occidioidomycosis (Valley fever)
(*PDF version)
for printing.
What is coccidioidomycosis?
Coccidioidomycosis is an infectious disease caused by inhaling spores of a fungus called Coccidioides immitis . The disease starts out as a respiratory illness and may progress to a persistent infection. Disseminated coccidioidomycosis is the most severe form of the disease and is often fatal. Who gets coccidioidomycosis? Anyone who is present near dust-producing activities where soil or other materials contaminated with C. immitis are present can get coccidioidomycosis if enough spores are inhaled. People of African or Asian descent, pregnant women and people who are immunocompromised are at increased risk for developing disseminated coccidioidomycosis. C. immitis

48. AllRefer Health - Coccidioidomycosis (Coccidiosis, San Joaquin Valley Fever, Val
Coccidioidomycosis (Coccidiosis, San Joaquin valley fever, valley fever) information center covers causes, prevention, symptoms, diagnosis, treatment,
http://health.allrefer.com/health/coccidioidomycosis-info.html

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Web health.allrefer.com You are here : AllRefer.com Health Coccidioidomycosis
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Alternate Names : Coccidiosis, San Joaquin Valley Fever, Valley Fever Definition Coccidiodomycosis is a disease caused by the spores of the fungus, Coccidioides immitis
Coccidioidomycosis - Chest X-Ray
Pulmonary Nodule - Front View Chest X-Ray Infection is caused by inhalation of the spores of the fungus, Coccidioides immitis , which is often found in desert regions. About 60% of infections cause no symptoms and are only recognized later by a positive coccidioidin skin test In the remaining 40% of cases, symptoms range from mild to severe. People with a compromised immune system tend to have more serious infections. Individuals with

49. AllRefer Health - Histoplasmosis (Ohio River Valley Fever)
Histoplasmosis (Ohio River valley fever) information center covers causes, prevention, symptoms, diagnosis, treatment, incidence, risk factors, signs,
http://health.allrefer.com/health/histoplasmosis-info.html

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Web health.allrefer.com You are here : AllRefer.com Health Histoplasmosis
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Alternate Names : Ohio River Valley Fever Definition Histoplasmosis is a fungal infection caused by Histoplasma capsulatum which primarily affects the lungs but may spread to other organs.
Lungs
Acute Histoplasmosis
Disseminated Histoplasmosis
Histoplasmosis, Disseminated in HIV Patient Histoplasmosis is a fungal infection that can occur almost anywhere in the world. In the United States, it is most common in the southeastern, mid-Atlantic, and central states. The lungs are the portal of entry for this infection. Histoplasma grows as a mold in soil and infection results from inhalation of airborne fungal particles. Soil contaminated with bird or bat droppings may have a higher concentration of mold.

50. Golden Retrievers: Rescue A Golden Of Arizona: Valley Fever Information
RAGofAZ rescues Golden Retrievers in need and finds new, permanent homes for them. We spend considerable time and resources on educating the public about
http://www.golden-retriever.org/valleyfever.asp
For the Love of Goldens
Valley Fever Information
Walker came to us on Nov. 30, 2003. He had valley fever. Walker did not fit his name....he couldn't walk. The valley fever had ravaged his body, and disseminated into his bone. His left hind leg had a kind of paralysis and he could not "rest" it, and it remain fixed close to the side of his body. Walker's valley fever titer at intake was 1:32. He now, walks, runs, plays in the pool (but doesn't swim), his titer is now 1:16. Walker will always be on valley fever medication because of the bone lesions throughout his legs, but we see improvement in him everyday. The lesions have significantly reduced, and has much less pain in his bones. He says "thanks" every single day, and this family loves him very much. Valley Fever Coccidioides immitis, which grows in soils in areas of low rainfall, high summer temperatures, and moderate winter temperatures. These fungal spores become airborne when the soil is disturbed by winds, construction, farming and other activities. In animals, infection occurs when a spore is inhaled. Valley Fever is not a "contagious" disease.

Valley Fever Information and Links
Valley Fever (Coccidioidomycosis) is primarily a disease of the lungs that is common in the southwestern United States and northwestern Mexico. It is caused by the fungus Coccidioides immitis, which grows in soils in areas of low rainfall, high summer temperatures, and moderate winter temperatures. These fungal spores become airborne when the soil is disturbed by winds, construction, farming and other activities. In susceptible people and animals, infection occurs when a spore is inhaled. Within the lung, the spore changes into a larger, multicellular structure called a spherule. The spherule grows and bursts, releasing endospores which develop into spherules. Valley Fever symptoms generally occur within three weeks of exposure. Valley Fever is not a "contagious" disease, meaning it is not passed from person to person or dog to dog. Secondary infections are rare.

51. Facts About Valley Fever
What you need to know • valley fever which gets its name from California s San Joaquin Valley, not Arizona s Valley of the Sun - is a non-contagious lung
http://www.azcentral.com/health/wellness/articles/0830valleyfever31facts.html
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Facts about valley fever Aug. 31, 2004 12:00 AM
What you need to know
• Valley fever - which gets its name from California's San Joaquin Valley, not Arizona's Valley of the Sun - is a non-contagious lung infection common in the southwestern United States and northwestern Mexico. The largest number of cases occurs in Maricopa County.
• In the rarer disseminated form, the disease moves through the bloodstream from the lungs to other parts of the body. advertisement OAS_AD('BoxAd')
• The fungus that causes valley fever grows in alkaline soils in areas with little rainfall, high summer temperatures and moderate winter temperatures.
• In Arizona, the number of cases typically rises after the monsoon season and after winter storms.
• Visitors who notice symptoms after returning home should tell their doctor they have been in an area with high rates of valley fever.
AT RISK FOR VALLEY FEVER • Construction workers, farmers, archaeologists and others working in dry, dusty conditions.

52. Information About Valley Fever
This site contains information about valley fever what is it, treatment options.
http://www.mamashealth.com/infect/valley.asp

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Links Email Mama What is Valley Fever?
Valley fever is a type of fungus infection. Valley fever usually affects the lungs. In severe cases, it can cause death. Valley fever is also called coccidioidomycosis and disseminated valley fever. What causes Valley Fever? Valley fever is caused by the fungus called Coccidioides immitis. It lives in soil and is spread via inhalation of airborne spores. If soil containing the valley fever fungus is disturbed by construction, natural disasters, or wind, the fungus spores get into the air. When people breathe in the spores, they can develop valley fever. Valley fever is not spread from person to person. The fungus that causes valley fever is commonly found in the soil of the southwestern United States, Mexico, and parts of Central and South America. Symptoms of Valley Fever? In most cases, symptoms are not present. When symptoms are present, the most common symptoms are:
  • fever fatigue cough rash loss of appetite night sweating chest pain muscle aches and pains
Who is at risk for Developing Valley Fever?

53. A080 - RIFT VALLEY FEVER
Rift valley fever. Aetiology Epidemiology Diagnosis Prevention and control References. AETIOLOGY. Classification of the causative agent
http://www.oie.int/eng/maladies/fiches/a_A080.htm
var code_langue1='f';var code_langue2='e';var rep_l='/maladies/fiches/';var lc='en';var code_page='a080.htm';var titre_p1='Animal'; var titre_p2=' diseases data'; document.write(ent); document.write(ent2); Updated: 22/04/2002 Rift Valley fever Aetiology Epidemiology Diagnosis Prevention and control ... References AETIOLOGY Classification of the causative agent
Virus family Bunyaviridae, genus Phlebovirus Resistance to physical and chemical action
Temperature: Survives several months at 4°C. In serum, inactivated by 56°C for 120 minutes pH: Chemicals: Inactivated by ether and chloroform Disinfectants: Inactivated by strong solutions of sodium or calcium hypochlorite (residual chlorine should exceed 5000 ppm) Survival: Survives in dried discharges and multiplies in some arthropod vectors. Can survive contact with 0.5% phenol at 4°C for 6 months
EPIDEMIOLOGY
  • High mortality rate in young animals High abortion rate in ruminants
Hosts
  • Cattle, sheep, goats, dromedaries, several rodents Wild ruminants, buffaloes, antelopes, wildebeest, etc. Humans are very susceptible (major zoonosis) African monkeys and domestic carnivores present a transitory viraemia
Transmission
  • Haematophagous mosquitoes of many genera Aedes Anopheles, Culex, Eretmapodites

54. Valley Fever-- Complete Article
valley fever Sneaky fungus that can make you very sick. valley fever Task Force report on the control of Coccidioides immitis.
http://www.balaams-ass.com/journal/theworld/valfever.htm
Valley Fever Sneaky fungus that can make you very sick.
Synopses
Coccidioidomycosis: A Reemerging Infectious Disease
Theo N. Kirkland, M.D., and Joshua Fierer, M.D. Departments of Pathology and Medicine, University of California, San Diego School of Medicine Department of Veterans Affairs Medical Center, San Diego, California, USA - Coccidioides immitis, the primary pathogenic fungus that causes coccidioidomycosis, is most commonly found in the deserts of the southwestern United States and Central and South America. During the early 1990s, the incidence of coccidioidomycosis in California increased dramatically. Even though most infections are subclinical or self-limited, the outbreak is estimated to have cost more than $66 million in direct medical expenses and time lost from work in Kern County, California, alone. In addition to the financial loss, this pathogen causes serious and life-threatening disseminated infections, especially among the immunosuppressed, including AIDS patients. This article discusses factors that may be responsible for the increased incidence of coccidioidomycosis (e.g., climatic and demographic changes and the clinical problems of coccidioidomycosis in the immunocompromised) and new approaches to therapy and prevention.
Etiology
Epidemiology
C. immitis is primarily found in desert soil. It is present in highest numbers in the San Joaquin Valley in California, southern Arizona, southern New Mexico, west Texas, and the desert areas of northern Mexico (Figure 2) [Figures not available in ASCII]. The organism is also found in scattered foci in coastal southern California, southern Nevada, and Utah (7) and is endemic in a few areas in Central and South America, especially in Venezuela (7). C. immitis is distributed unevenly in the soil and seems to be concentrated around animal burrows and ancient Indian burial sites (8,9); it is usually found 4 to 12 inches below the surface of the soil (7).

55. Rift Valley Fever
“To say that Rift valley fever makes West Nile look like a hiccup is an Like West Nile, Rift valley fever spreads rapidly in the warm weather mosquitoes
http://www.comosquitocontrol.com/Rift Valley Fever.htm
Rift Valley Fever
Reprinted From Discover Magazine, Vol. 26 No. 03
Page 14, By Jocelyn Selim
The deadly Rift Valley fever virus is on the move. First detected during the 1930s in southern Africa, the mosquito-borne pathogen had crossed the Sahara into Egypt by 1977 and by 1999 had traversed the Red Sea into Yemen and Saudi Arabia. Now it seems poised to enter the United States—and the results could be devastating. “To say that Rift Valley fever makes West Nile look like a hiccup is an understatement,” says Mike Turell, a specialist at the U.S. Army Medical Research Institute in Fort Detrick, Maryland. Like West Nile, Rift Valley fever spreads rapidly in the warm weather mosquitoes favor. But Rift Valley fever is much more devastating. Most people who get West Nile don’t even know it, but 90 percent of those infected with the Rift Valley fever virus become demonstrably ill. Symptoms range from weakness and feverish illness to blindness and Ebola-like hemorrhaging. Victims are 10 times more likely to die from it than West Nile.

56. Entrez PubMed
Rift valley fever virus (RVFV), a phlebovirus of the Bunyaviridae family, is an arthropodborne virus which emerges periodically throughout Africa,
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1

57. Entrez PubMed
Detection of Rift valley fever viral activity in Kenya by satellite remote sensing imagery. Linthicum KJ, Bailey CL, Davies FG, Tucker CJ.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3

58. My Free Web Site On FreeServers
Aug 06, 2005 This free personal web site belongs to Project Canine valley fever. This page is a placeholder while the site is under construction.
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This free personal web site belongs to Project Canine Valley Fever. This page is a placeholder while the site is under construction. Looking for ideas for your new website? You can start by posting photos of your family and friends like we've done here. Log in to your site now or sign up for a new web site. This web page has been online for 80 weeks. It's had visits. Visit Site Stats in your Member Area to get more detail! This free website is hosted by FreeServers. Host your website with us and enjoy...
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  • 59. Rift Valley Fever: Information From Answers.com
    Rift valley fever A viral disease that is acute, causes fever in domestic animals (such as cattle, buffalo, sheep, goats, and camels) and humans, and.
    http://www.answers.com/topic/rift-valley-fever-2
    showHide_TellMeAbout2('false'); Business Entertainment Games Health ... More... On this page: Medical Term Wikipedia Mentioned In Or search: - The Web - Images - News - Blogs - Shopping Rift Valley fever Medical Term Rift Valley fever A viral disease that is acute, causes fever in domestic animals (such as cattle, buffalo, sheep, goats, and camels) and humans, and is associated with mosquito-borne epidemics during years of heavy rainfall. Rift Valley fever is more deadly than West Nile virus. Rift Valley fever has not occurred in the United States (through 2003). However, there has been concern that it could become permanently established in the US if it does enter the country. People with Rift Valley fever usually have flu-like symptoms but may develop complications such as kidney or liver disease. In outbreaks, the death rate has been about 15% for those seriously ill with Rift Valley fever. Rift Valley fever is caused by the RVF virus. It is found mainly in regions of eastern and southern Africa where sheep and cattle are raised. RVF primarily affects livestock and can cause disease in a large number of domestic animals (a situation referred to as an "epizootic"). An RVF epizootic can lead to an epidemic among people exposed to animals with RFV. The most notable epizootic of RVF to date occurred in Kenya in 1950-1951 and resulted in the death of an estimated 100,000 sheep. The first epidemic of RVF in West Africa was reported in 1987. Epizootics of RVF tend to occur during years in which there is heavy rainfall and localized flooding. The excessive rain allows mosquito eggs, usually of the genus Aedes, to hatch. The mosquito eggs are infected with the RVF virus, and the resulting mosquitoes transfer the virus to the livestock on which they feed. Once the livestock are infected, other species of mosquitoes can become infected from the animals and spread the disease.

    60. Rift Valley Fever
    IScientists are learning that the key to predicting certain epidemics like Rift valley fever in Africa or Hanta virus in the US - lies in an unexpected
    http://www.firstscience.com/SITE/ARTICLES/fever.asp
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    Scientists are learning that the key to predicting certain epidemics - like Rift Valley fever in Africa or Hanta virus in the U.S. - lies in an unexpected place: the ocean.
    by Karen Miller On the dusty savannahs of eastern Africa, where livestock sustain the economy, about twice a decade an epidemic whips through to decimate the herds. Nearly all of the pregnant animals spontaneously lose their fetuses. Among those already born - the lambs and kids - the mortality rate can reach 90 percent. It's called Rift Valley fever. Humans can be infected as well, either through mosquitoes that carry the disease, or by handling infected tissue. Few die, but the illness can cause serious complications: meningoencephalitis, an inflammation of the brain, and lesions of the retina, which leave victims with at least some permanent loss of vision. During the most recent and devastating outbreak in 1997-98, an embargo banned exports of East African meat for one and a half years. While no easy treatment exists for the disease, Rift Valley fever can be controlled. Animals can be vaccinated, insecticides can be spread into the soil to keep infected mosquitoes from hatching. But the disease's unpredictability has been a sticking point: without knowing when and where the disease will strike, it's hard to know how to use those controls efficiently.

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