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Vol. III, No. 12 ~ EINet News Briefs ~
September 21, 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
- Updates from previous bulletins
- 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
MALAYSIA––LEPTOSPIROSIS OUTBREAK
According to the U.S. Centers for Disease Control and Prevention (CDC),
leptospirosis infection is the probable cause of acute febrile illness
among participants of the EcoChallenge Sabah 2000 Expedition Race (August
20–September 3, 2000)*. GeoSentinel, a global surveillance network of
the International Society of Travel Medicine, has reported 9 potential
cases, and has indicated at least 15 other participants with similar
illness.
Leptospirosis is usually transmitted after exposure to
water contaminated with urine from infected animals. The disease has
an incubation period between a few days to one month. Symptoms include
fever, chills, diarrhea, myalagia, and clinical stigmata. CDC has issued
an alert advisory about the suspected leptospirosis outbreak associated
with the event. The World Health Organization (WHO) is also working
with relevant national authorities to notify participants.
*EcoChallenge Adventure Race This year,
over 75 4–person teams from 22 countries spent between 6 to 12 days
to complete the course on the coast of Sabah Malaysia. The annual event
involves jungle trekking, river and ocean paddling, mountain biking,
canyoneering, and open water swimming.
[MMWR 9/15/00; WHO 9/15/00; GEOSENTINEL 9/11/00]
THAILAND––LEPTOSPIROSIS OUTBREAK
Since July 1, 2000, 100 fatalities linked to leptospirosis infection
have been registered in Thailand. The rise in cases has been attributed
to the increase of torrential rainfalls. Most of the cases involve farmers
who contracted disease through cuts or wounds exposed to contaminated
water, and children who played in ponds and rivers. It is possible that
the number of reported infections will increase with unabated rains
in towns that are currently submerged in record levels of water.
Health authorities have been dispatched to villages to
identify victims, and to educate and provide gloves and boots to farmers
and villagers. The Livestock Department has also carried out a large–scale
vaccination campaign on cows and buffaloes, who are potential carriers
of the disease.
An estimated 6,000 people are currently infected with
Leptospirosis in Thailand.
[STRAITS TIME INTERACTIVE 9/2/00]
SINGAPORE––HAND, FOOT AND MOUTH DISEASE
To date, a total of 24 cases of hand, foot, and mouth disease have been
reported by at least 2 childcare centers. It is suspected that the fatality
of a 2–year old earlier this month was a result of these outbreaks;
it is thought that the toddler contracted the disease at a childcare
center in Sengkang.
Hand, foot, and mouth disease is a highly contagious viral
infection that usually affects children >10 years. Mild illness occurs
between 7 to 10 days after infection. In rare cases, damage in the brain
or heart, or death can result. Incidentally, hand, foot, and mouth disease
will be included in the Singapore's list of compulsory notified infectious
diseases commencing October 1, 2000. The Commissioner of Public Health
hopes that notification will strengthen efforts to discover the norm
of people with disease.
Singapore has never registered a fatality or serious infection
from hand, foot and mouth disease.
[PROMED 9/15/00; THE STRAITS TIME 9/14/00]
VIETNAM––FLOODS THREATEN HEALTH
Over the past couple of months, the risk of waterborne disease has heightened
among residents of the Mekong Delta, as heavy rains have swollen the
Mekong and other nearby rivers. There is currently little fresh water
and no sewage system. No disease outbreaks have been reported. This
is the worst flooding in Vietnam in 40 years.
An estimated 150,000 people have been displaced; over
3 million have lost homes, land, livestock, or loved ones. Health officials
fear that the worst is yet to come, as the water begins to recede and
animal carcasses start to rot. The Red Cross has appealed $1.5 million
for aid.
The Mekong, which is still rising an average of 2נ inches
a day, will probably peak in early October, thereby approaching the
17–foot record of 1961.
[AP WIRE 9/20/00]
AMERICAS
CANADA––MALARIA OUTBREAK
Quebec public health officials have registered 12 cases of malaria in
the last month; they are currently awaiting confirmation of disease
in an additional 3 cases. All of the cases involve refugees from central
Africa who were on a flight that also transported 240 Rwandans and others
from a refugee camp in Burundi; the flight arrived in Quebec on August
9, 2000. Federal authorities are currently investigating the outbreak.
Current policy only calls for routine screening of immigrants
for tuberculosis (TB) and syphilis.
[PROMED 9/13/00; TORONTO STAR 9/13/00]
USA–SALMONELLA OUTBREAK LINKED TO ORANGE JUICE
Over 80 cases of Salmonella enteritidis infection across 8 states became
ill after drinking the same brand of unpasteurized orange juice. The
onset of illness was between March 12 and April 21, 2000. Thirteen cases
were hospitalized; no fatalities were reported. This is the 2nd salmonella
outbreak linked to consumption of unpasteurized orange juice during
the last year.
The orange juice implicated in the recent outbreak was
processed under a newer system that sanitizes the outside of the fruit,
and subsequently, squeezes the juice. Since the juice undergoes a process
that significantly reduces the potential of bacterial contamination,
the juice is not considered raw. The juice has been recalled; however,
the U.S. Food and Drug Administration (FDA) continues to investigate
the source of infection.
Consumers have been advised to avoid juices that are
"freshly squeezed" or "unpasteurized"; FDA regulations require that
manufacturers of unpasteurized juices place warning labels on their
packaging.
[REUTERS HEALTH 9/12/00]
USA––LEGIONNAIRE'S DISEASE CONTRACTED THROUGH POTTING
SOIL
The U.S. Centers for Disease Control and Prevention (CDC) have registered
2 Legionella cases linked to potting soil. These are the first such
cases reported in the U.S. Legionella longbeachae was isolated in the
soil used by each case. Potting soil has been implicated in Legionella
outbreaks in Australia and Japan. To date, no warning that involves
potting soil has been issued in the U.S.
Legionnnaire's Disease is usually contracted after exposure
to water from shower heads, humidifiers, cooling towers, and aerosol
sprays. Symptoms include fever, respiratory problems, and disorientation.
Each year, an estimated 8,000㪢,000 cases of Legionnaire's are reported
in the U.S.; 5㪶% of these cases are fatal.
[MMWR 49 (34): 777פ SEATTLE TIMES 9/2/00]
OTHER
POSSIBLE IN UTERO TRANSMISSION OF NEW VARIANT
CREUTZFELD–JAKOB DISEASE (nvCJD)
Britain physicians believe that an infant may have contracted "mad cow"
disease in the womb. The infant, who was 7 months when her mother died,
currently suffers from brain damage, fits, and convulsions. An accurate
diagnosis can only occur with a post–mortem examination. Upon confirmation,
this will be the first reported case of nvCJD transmitted from mother
to infant.
In recent years, surgically related small clusters of this new illness
have been reported in Japan and Thailand. The primary source of transmission
was dura mater transplants, related specifically to one company.
[PROMED 9/17/00; REUTERS ONLINE 9/16/00]
WORLD BANK RECOMMENDATIONS TO IMPROVE HEALTH
According to the World Development Report 2000/2001, only 10% of the $50㫔
billion spent each year on health research globally is used on diseases
that affect 90% of the people. Recommendations to address risk particularly
in the poor include: preventing economic crises, introducing public health
campaigns to prevent ill health and communicable disease, and reducing
vulnerability to natural disasters.
The World Bank notes that there are over 30 million people worldwide
who are infected with HIV; 90% of these cases are in the developing world.
[WORLD DEVELOPMENT REPORT 2000/2001]
2. UPDATES FROM PREVIOUS
BULLETINS
USA (WISCONSIN)––E.COLI OUTBREAK TRACED TO MEAT
Genetic fingerprinting analysis has traced the source of the recent E.coli
outbreak to a raw sirloin meat product at Sizzler Restaurant. Health officials
have suggested improper handling of food by Sizzler employees as the likely
mode of cross–contamination between the uncooked meat and foods served
at the buffet and salad bar.
[REUTERS HEALTH 9/1/00]
CANADA––E.COLI OUTBREAK IN WALKERTON
According to health officials, 3 different types of bacteria plagued 2000
residents during the E.coli outbreak in Walkerton in May. An estimated
40% of the cases were infected with Campylobacter; the other cases were
infected with E.Coli or Salmonella. The town's water supply was contaminated
with E.Coli 0157:H7, Campylobacter, Salmonella, and other bacteria during
extensive flooding.
All 6 fatalities reported during the outbreak were linked to E.Coli.
[PROMED 9/12/00; TORONTO STAR 9/12/00]
3. NOTICES
HEMOPHILUS VACCINE RECALL
Wyeth–Ayerst (Radnor, Pennsylvania) has recalled 5 cartons of its HibTITER
hemophilus b conjugate vaccine because of improper shipping. Evidently,
shipment occurred by airfreight without a documented freeze indicator.
Each carton contained 80 multi–dose vials of the vaccine. They originated
from Lot 613803A, and were labeled with a January 2002 expiration date.
The vaccine was "inadvertently distributed" in a single insulated container
between July 19 and August 17.
HibTITER is used to prevent invasive bacterial diseases in young children,
particularly among those who are 2 to 71 months.
[REUTERS HEALTH 9/6/00]
NEW ZEALAND––ECHOVIRUS TYPE 33
The New Zealand Ministry of Health has advised physicians to be on alert
for a new and potentially dangerous virus, Echovirus Type 33 (ECHO 33).
Approximately 50 people have been infected to date. Symptoms of ECHO 33
include diarrhea, headache, fever, rash, and potentially fatal aseptic
meningitis.
ECHO 33 is transmitted with poor hygiene.
[PROMED 9/5/00; XIN HUA NEWSAGENCY 9/4/00]
CANADA––BLOOD DONOR RESTRICTIONS
Health officials have issued a blood donor restriction on Canadians who
have spent 6 months or more in France between 1980 and 1986 because of
fear that they may introduce "mad cow" disease to Canada. Last year, Health
Canada issued a similar ban on blood donors who had spent 6 months or
more in Britain during the same period.
"Mad cow" disease, which is responsible for the new variant of Creutfeldt–Jakob
Disease (nvCJD), has never been confirmed in Canada.
[SYMPATICO NEWSEXPRESS 9/1/00; REUTERS HEALTH 9/1/00]
BALI––REGIONAL SURVEILLANCE CONFERENCE
One hundred fifty delegates from Pacific Rim Countries and Southeast Asia
met in Bali, Indonesia to design an action framework for enhanced surveillance
of Emerging Infections. The deliberations were very successful, and this
initiative will set the stage for increased international cooperation
in international surveillance throughout the region. Further details will
be shared in future EINET bulletins. Publication of results is anticipated
shortly, and a report will be made to the upcoming ISTWG/APEC side meeting
in Health in Brunei next month.
The Conference was sponsored by the Indonesian Ministry of Health and
USNAMRU, and cosponsored by World Health Organization (WHO), The World
Bank, Asia Pacific Economic Cooperation (APEC).
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REGULARLY
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