APEC EMERGING INFECTIONS NETWORK
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About EINet News Briefs Learning tools Data Library search Other links APEC ISTWG EINet home	Vol. III, No. 4~ EINet News Briefs ~ March 24, 2000 ****A free service of the APEC Emerging Infections Network***** The EINet listserv was created to foster discussion, networking, and collaboration in the area of emerging infectious diseases (EID's) among academicians, scientists, and policy makers in the Asia–Pacific region. We strongly encourage you to share their perspectives and experiences, as your participation directly contributes to the richness of the "electronic discussions" that occur. To respond to the listserv, use the reply function. In this edition: Infectious disease information from ProMED and other sources Notices How to join the EINet listserv 1. OVERVIEW OF INFECTIOUS–DISEASE INFORMATION FROM PROMED   Below is a bi–weekly summary of Asia–Pacific EID issues based on postings to the ProMED Electronic Network and other sources. ProMED is the prototype for a communications system that monitors emerging infectious diseases globally, an initiative of the Federation of American Scientists (FAS), and co–sponsored by WHO. ASIA INDONESIA – DENGUE Over the past 3 months, 1,526 cases of dengue, including 10 fatalities, have been recorded in Jakarta. A total of 161 cases were reported in Central Jakarta in January and February––three times the number of cases reported during the same time last year (46). In 1999, only 751 cases and 45 fatalities were recorded in the capital, compared to over 15,000 cases and 133 fatalities recorded in 1998. Health officials have asked the public to help prevent an outbreak situation by avoiding clean and still water where the Aedes aegypti mosquito, the carrier of the virus, lays its eggs. Experts believe that dengue can be eradicated by ending the life cycle of the mosquito. [JAKARTA POST 3/7/00] VIETNAM – MALARIA REBOUND The Health Ministry has predicted the return of malaria to the central coastal region and the central highlands, areas where mortality increased by 0.7% last year. Failure to eradicate the disease in these regions has been attributed to unorganized migration, poor popular awareness of malaria, and inadequate investment in grassroots–level medical networks. The Health Ministry has earmarked VNN25 billion for malaria prevention programs this year; this request is expected to lead to decreases in the malaria and mortality rates to 7 per 1000 and 0.7 per million, respectively, in these regions. Last year, the number of malaria patients in these regions decreased by 14.74% overall. [VIETNAM NEWS 3/10/00] KOREA – TUBERCULOSIS DEATH RATE According to the Ministry of Health and Welfare and the Korean Tuberculosis Association (KNTA), Korea had the highest tuberculosis (TB) death rate among the 29 member countries of the Organization for Economic Cooperation and Development (OECD) in 1998. The report indicated that a rate of 7.1 per 100,000 people fell to TB in Korea, followed by China (4.9 per 100,000) and Singapore (3.4 per 100,000). The nation reported a drop in TB cases from 52,000 in 1980 to 36,000 in 1999. However, a growing number of young people are becoming infected; last year, 8,000 cases reported were between the ages of 15 and 34. The health ministry and the government aim to develop control measures to cut the TB rate to 0.4%. [KOREA TIMES 3/23/00] OCEANIA PAPUA NEW GUINEA – TUBERCULOSIS According to national health statistics, 800 per 100,000 people in Papua New Guinea (PNG) are diagnosed with tuberculosis (TB). In the city of Port Moresby, the transmission rate of TB is six times higher than the country's average. The rapid spread of TB in PNG has been attributed to low immunity among residents, a high mobility of people, unhealthy living conditions, and overcrowding. Health officials believe that the disease can be eradicated with patient compliance to the short course directly observed treatment (DOTS) strategy and cooperation with the general community to control TB in workplaces and homes. The World Health Organization (WHO) recently declared a "TB crisis" in the Western Pacific, a region that includes PNG. [THE NATIONAL ONLINE 3/24/00] AMERICAS MEXICO – DRUG–RESISTANT TUBERCULOSIS According to two recently published reports, a substantial proportion of tuberculosis (TB) cases in Mexico are resistant to drugs used as first–line defense against the disease. The findings also suggest that the short–course directly observed treatment (DOTS) strategy may not be adequate to control TB, particularly in regions with high drug resistance; it has been inferred that these areas are not following the recommendations of the International Union Against Tuberculosis and Lung Disease (IUATLD) for proper implementation of DOTS. Among patients who were smear–positive for acid–fast bacilli (n=238), the overall resistance rate was 28.4%, with a rate of resistance to isoniazid and rifampin of 10.8%. Another study (n=460) showed resistance to at least one drug used as first–line defense of 12.9% in new cases, and 50.5% in retreatment cases. Researchers propose adopting a 4–drug regimen for patients with no history of treatment, and developing a national strategy to treatment patients with multi–drug resistant tuberculosis (MDR–TB) to improve cure rates and control further spread of drug resistant TB strains. Other "hot spots" of drug–resistant TB strains include Russia, Thailand, the Phillipines, Africa, India, Pakistan, Indonesia. [ARCH INTERN MED 2000; 160: 639𤱴 REUTERS 3/15/00; FOX NEWS.COM 3/14/00] USA (OHIO) – STREPTOCOCCUS GROUP A INVASIVE Health officials are currently investigating an outbreak of 23 cases of invasive Group A streptococcal disease in the Cincinnati area. The majority of the cases have led to toxic shock, and a few of the cases have developed into necrotizing fasciitis (flesh–eating disease). Two fatalities have been reported to date. Invasive Group A Streptococcal disease is transmitted through direct contact with mucus from the nose (or throat), or contact with an open wound of an infected person. Most people who are exposed to the bacteria develop mild skin infections or a sore throat; only a few who are infected develop serious illness. Typically, only 3 to 5 cases are expected in the greater Cincinnati area during the same time each year. The 63 cases that were reported statewide in January and February alone, exceeded the total number of cases (39) reported during 1999. [ProMED 3/7/00] USA – LISTERIA CONTAMINATION The U.S. Food and Drug Administration (FDA) has issued a nationwide consumer warning to avoid consumption of any cold–smoked fish products sold by Royal Baltic Ltd. (Brooklyn, NY), due to potential contamination with Listeria monocytogenes. The FDA has repeatedly discovered Listeria–contaminated batches of cold–smoked Royal Baltic products. This is the 4th FDA action against the company since November 1999; an order has also been issued to the company to cease manufacturing of all cold–smoked seafood. Listeria can cause fever, severe headaches, nausea, and diarrhea in healthy individuals, and may lead to serious and fatal infections in children, the elderly, and the immunocompromised. [FDA PRESS RELEASE 3/10/00] USA – SKIN–PREP PRODUCTS CONTAMINATED The U.S. Food and Drug Administration (FDA) has announced the voluntary recall of antiseptic sterile skin preparations by Clinipad Corporation (Rocky Hill, CT), due to potential bacterial contamination. The company has confirmed bacterial contamination in some lots of its sterile products, including one with Pseudomonas aeruginosa and Stenotrophomonas maltophilia (recalled in December 1999). The products, which include swabsticks, prep pads, towelettes, ointments, pouches, and protective dressings, are packaged in various institutional kits, or sold separately, to blood banks, hospitals, clinics, and retail pharmacies. The Clinipad sterile–products line are distributed under such names: Clinipad, Cliniswab, Clinipad, EZ Prep, and Cliniguard. [ProMED 3/15/00] USA – SMALL POX VACCINE The U.S. Centers for Disease Control and Prevention (CDC) has asked researchers at St. Louis University School of Medicine to study the safety and effectiveness of the smallpox vaccine, Dryvax. Researchers will measure the effectiveness of the vaccine at dilutions of 0, 10, and 100 times, to determine the number of doses that will be available in the event that smallpox is used in a bioterrorist attack. An estimated 7 million Dryvax doses are currently available in the U.S. The stocks are held in high–security laboratories at the CDC and at the Russian State Center for Research on Virology and Biotechnology (Novosibirsk). The World Health Organization (WHO) declared the world free of smallpox in 1980, after routine vaccinations eradicated the disease. [ProMED 3/15/00] USA (NEW YORK) – WEST NILE VIRUS THREAT Scientists at the U.S. Centers for Disease Control and Prevention (CDC) have evidence that supports the presence of the West Nile Virus in overwintering mosquitoes in New York City. A bird that that was found in February with the live virus suggests the possibility that the virus may also be able to overwinter in birds; although birds do not pose a direct threat to human, any mosquito that feeds off them can transmit the disease, and in turn, cause encephalitis. The CDC has recommended the development of larvicide and monitoring programs, due to potential transmission of the virus this spring. Larvaecidal pellets will be used in mosquito breeding grounds in New York City to kill insects before they take to the air in the spring. The West Nile Virus outbreak last year––the first of its kind in the Western Hemisphere––led to 7 fatalities and dozens of illnesses. [NEWSDAY 3/22/00; ProMED 3/14/00] OTHER RUSSIA – DYSENTERY Over 69 people have been hospitalized with symptoms of dysentery in the small town of Pavlohrad, in eastern Ukraine, due to contaminated well water. Residents were forced to use water from abandoned wells were polluted with sewage flows after a failure in the municipal water supply system at the end of February. Fourteen children have contracted a serious form of the illness after drinking the water. [AP WIRE 3/8/00] ARGENTINA – LEPROSY BATTLE Over 10,000 cases and 700 new cases of Leprosy are reported annually in Argentina. Although the mode of transmission is still unknown, Leprosy has been linked to areas of poor hygiene and malnutrition; the ailment is predominantly found among poor populations. In Brazil, the illness was renamed Hansen's disease, to deter potential discrimination of Leprosy patients. The World Health Organization (WHO) aims to eradicate Leprosy worldwide by 2005. [PAULA ANDALO, BUENOS AIRES CLARIN, 3/13/00, UN WIRE TRANSLATION] SPAIN – HEPATITIS C SINGLE SOURCE OUTBREAK An official investigation of surgical patients who acquired Hepatitis C in 1998 in one of 2 local hospitals (Valencia, Spain) suggests the source of the outbreak to be an anaesthetist. It is suspected that the anaesthetist, a morphine addict, injected himself with opiod analgesics in the immediate post–operative period, before injecting the rest to his patients using the same syringe. In April 1998, the Valencia Health Department reported that over 200 patients had been infected with HCV after surgery at one of the 2 local hospitals during the previous year. Subsequently, experts were commissioned to analyze the blood samples from more than 500 HCV carriers to determine the exact DNA sequence of their viruses. The findings revealed only a one nucleotide difference between the non–hypervariable region in the virus of 170 patients and that of the anaesthetist's. [LANCET 2000; 355: 816𤴢] U.K. – NEW VARIANT CREUTZFELD–JAKOB DISEASE The possibility of maternal transmission of new variant Creutzfeld–Jakob Disease (nvCJD) is currently being investigated in the U.K. A baby girl, who has been ill since birth last year, is being treated alongside her mother, a confirmed sufferer of nvCJD. The passing of nvCJD from mother to infant was previously considered unlikely. [THE GUARDIAN 2/29/00] 2. NOTICES OUTBREAK RESPONSE SURVEY An extensive survey of the APEC economies' collective capacity for emerging infectious disease surveillance and outbreak response under went a final review at the 18th Industrial Science and Technology Working Group Conference in Thailand, March 14㪩. It will be disseminated by electronic mail in early April. The survey design was discussed at a side meeting on Emerging Infectious Diseases and Environmental Health issues, chaired by Dr. Jean Larivière of Canada (jean_lariviere@hc–sc.gc.ca) on Monday, March 14. Representatives from Australia, Canada, Chinese Taipei, Indonesia, Japan, Korea, Malaysia, Thailand, the United States and Vietnam attended the meeting. Gathering information about the current status of computer capability, facilities, and staff is one of the first steps in a project approved at the 17th ISTWG in Seattle to improve networking on infectious diseases. For more information about the project contact Col. Patrick Kelley (Patrick.kelley@na.amedd.army.mil). Questions specifically about the survey may be sent to Nedra Floyd Pautler (pautler@u.washington.edu). 3. JOIN THE E–LIST AND RECEIVE EINet NEWS BRIEFS REGULARLY The APEC EINet listserv was established to enhance collaboration among academicians and public health professionals in the area of emerging infections surveillance and control. Subscribers are encouraged to share their material with colleagues in the Asia–Pacific Rim. To subscribe (or unsubscribe), please contact pautler@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://www.apec.org/infectious.
Revised: April 21, 1999	Contact us at apecein@u.washington.edu © 1998, The University of Washington