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Vol. III, No. 16 ~ EINet News Briefs ~ December
15, 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
- Notices
- Journal Articles
- How to join the EINet listserv
1. OVERVIEW OF INFECTIOUS–DISEASE INFORMATION
Below is a bi–monthly summary of Asia–Pacific emerging infectious diseases.
ASIA
CHINA (HONG KONG) – NO EVIDENCE OF AVIAN INFLUENZA
VIRUS ON CHICKEN FARM
Health inspectors in Hong Kong certified that the chicken farm in Yuen
Long is free of the haemagglutinin type 5 (H5) avian influenza virus.
This virus is similar to the avian influenza virus that led to the infection
of 18 people, including six deaths, and the slaughter of one million
chickens in 1997. In October, 24 of 52 blood samples from chickens at
this farm showed traces of antibodies to H5, raising concerns over a
possible new outbreak. However, blood tests on 3000 chickens and 1700
samples collected from the farm showed no evidence of the avian influenza
virus. The presence of antibodies in the chickens may be indicative
of a past exposure to the H5 virus rather than a potential health threat.
[PROMED 11/22/00, 10/22/00]
CHINA – HANTAVIRUS HFRS CONCERNS
Epidemic patterns suggest that an outbreak of hantavirus–related hemorrhagic
fever with renal syndrome (HFRS) may occur this year in the Chongqing
province of China. Current surveillance records, however, have not revealed
a substantial increase in cases compared to the usual number expected
for this time of year. The last epidemic in this region was in 1990,
and had an incidence of 350 cases per 100,000 and a mortality rate between
30 and 50 percent. Fall and early winter represent the high season for
spread of the Hantaan virus in this region. At this point, only those
who are likely to come in contact with mouse– and/or rat–infested areas
are considered at high risk for contracting the virus.
Approximately 95% of hantavirus–related HFRS cases in
China are linked to rodents, as infected rodents shed the virus in their
urine, droppings, and saliva. People acquire the virus by breathing
in contaminated air. In China, the majority of HFRS cases are attributed
to either the Hantaan or the Seoul virus, which are serologically distinct
and differ with regards to the seasonality of epidemics.
[PROMED 11/18/00, 11/21/00, HEALTHANSWERS ASIA ONE 11/28/00]
AMERICAS
DOMINICAN REPUBLIC, HAITI – VACCINE–DERIVED POLIO OUTBREAK
Epidemiologists from the Pan American Health Organization (PAHO) are
investigating a recent outbreak of vaccine–derived poliomyelitis in
the Dominican Republic and Haiti. The identified virus is an unusual
derivative of the Sabin type 1 oral poliovirus vaccine (OPV), that
has 97 percent genetic similarity to the parental OPV strain, and
exhibits comparable degrees of neurovirulence and transmissibility
as the wild poliovirus type 1. Six cases have been confirmed in the
Dominican Republic, with at least ten additional suspected cases that
are clinically compatible with poliomyelitis. Both confirmed and suspected
cases are regionally concentrated and all but one are epidemiologically
linked. One confirmed case has been reported in Haiti.
The outbreak occurred in areas with low vaccination rates, and all
of the infected individuals either had not been vaccinated or had
not received their complete doses. Although wild poliovirus was eradicated
from the Western Hemisphere in 1991, this outbreak emphasizes the
need for high vaccine coverage to prevent infection from imported
wild polioviruses as well as person–to–person transmission of OPV–derived
strains. Mass vaccination campaigns have been initiated in the Dominican
Republic, and nationwide vaccination efforts are planned for Haiti
in early 2001.
[PAHO PRESS RELEASE 12/14/00, 12/8/00; http://www.paho.org]
OCEANIA
NEW ZEALAND – HIGH RATES OF STDS AND TEENAGE PREGANCY
The Ministry of Health in New Zealand reported escalating rates of sexually
transmitted diseases (STDs) and teenage pregnancy. Sexual health clinics
reported an increase of approximately 80 percent in the number of gonorrhea
cases and a fifteen percent increase in the number of chlamydia cases
diagnosed nationwide in the April to June quarter of 2000, compared with
the same time period in 1999. Recent figures from the regions of Auckland,
Waikato, and Bay of Plenty estimate the incidence of chlamydia among 15
to 19 year old women to be 4466 per 100,000. Additionally, teenage pregnancy
rates ranked as the second–highest in the developed world. While the government
had planned to implement measures in September of 2001 to address sexual
and reproductive health, these recent estimates may call for a more prompt
initiation of strategies.
[THE NEW ZEALAND HERALD 11/28/00;
http://www.moh.govt.nz]
OTHER
RUSSIA – SUSPECTED DEATH OF vCJD IN YOUNG MAN
A 29–year–old Russian merchant seaman is suspected to have died from the
human form of bovine spongiform encephalopathy (BSE), also known as new
variant Creutzfeldt– Jakob disease (vCJD). While vCJD is linked to the consumption
of beef carrying the BSE agent, CJD is often the result of iatrogenic transmission
or genetic factors. CJD has occurred previously in Russia, but there have
not been any known cases of vCJD. The young age of this victim may implicate
vCJD as the cause of death. According to the Murmansk Region’s Chief Medical
Officer, the average age of people who have died of CJD is often much older.
As the victim was a sailor, it is possible that he acquired vCJD from consuming
contaminated meat while abroad.
[PROMED 12/4/00]
2. NOTICES
DISTANCE LEARNING WEBSITE – EMERGING INFECTIONS OF INTERNATIONAL PUBLIC
HEALTH IMPORTANCE
Updated distance learning materials on Emerging Infections of International
Public Health Importance are now available at http://www.hscer.washington.edu/em_inf/index.html.
The information on this site is drawn from a course at the University
of Washington. The materials provided include recent lectures and audiovisual
materials by international experts, and are being made available by the
APEC EINET project. Comments are encouraged, and an evaluation form is
provided on the website. This distance learning course can also be accessed
from our homepage.
NEW APEC EINET EDITORIAL MANAGER – LARKIN STRONG
Greetings to all APEC EINET recipients – I would like to introduce myself
as the new editorial manager for the project. I am a graduate student
at the University of Washington’s School of Public Health pursuing my
MPH degree. Please feel free to send any comments you may have about the
newsletter to the apecein email address, as well as any relevant information
that you would like to see posted. Thank you.
BEEF RECALL AFTER E. COLI OUTBREAK
The meatpacking company, American Foods Group Inc., is recalling 1.1 million
pounds of ground beef distributed to stores in early November after an
E. coli outbreak. The outbreak has affected 31 people in three states,
with 27 confirmed cases in Minnesota, three in Wisconsin, and one in Iowa.
Although tests have not confirmed that the company’s meat was the source,
epidemiologic evidence traced the contaminated ground beef to the company’s
location in Green Bay, WI. While the Minnesota Health Department is investigating
the cases, epidemiologists expect the number of confirmed infections to
increase. Stores that are involved in the recall include Cub Foods, Supervalu,
County Markets, Kowalski’s, Jerry’s, and Driskills.
[NANDO TIMES 12/5/00, 12/7/00]
GLOBAL AIDS UPDATE
UNAIDS reported that the scope of the current AIDS epidemic is far more
extensive than previously thought, with cases of HIV and AIDS 50 percent
higher than medical experts in 1991 had predicted for the year 2000. Currently,
36.1 million people are estimated to be living with the AIDS virus, with
5.3 million new infections in the past year. An estimated 25.3 million
cases are in Sub–Saharan Africa, which is home to 70 percent of the adults
and 80 percent of the children living with HIV.
Infection rates are soaring in Eastern Europe, where an estimated 700,000
people are infected with HIV, compared to 420,000 a year ago. Increasing
rates of injection drug use are thought to be the driving force behind
this epidemic. The rapid spread of HIV is particularly evident in the
Russian Federation, where new HIV infections are greater this year than
in all previous years combined. By the end of 2000, an estimated 300,000
people will be living with HIV. Despite the rapid increase, health officials
believe that a window of opportunity exists to reduce transmission through
appropriate interventions while the epidemic is largely contained to the
drug–using populations.
Additional information is available from the WHO’s website, http://www.who.int/wer,
in Part II of the Global AIDS Surveillance Report. This presents a detailed
analysis of the distribution of reported AIDS cases for selected countries
by age, sex, and assumed mode of transmission.
This year’s World AIDS Campaign, “Men Make a Difference,” focused on
men’s potential to reduce HIV transmission, care for infected individuals,
and look after orphans of the epidemic. More information is available
at http://www.who.org.ph/pdf/WAD_00.pdf
[UNAIDS – http://www.unaids.org]
3. JOURNAL ARTICLES
EBOLA NON–HUMAN PRIMATE VACCINE
Researchers from the National Institutes of Health and the Centers for
Disease Control and Prevention report on the development of a non–human
primate vaccine against the Zaire subtype of the Ebola virus. In this
study, Dr. Gary Nabel and others exposed eight macaques to a lethal dose
of the Ebola Zaire virus. The four controls all developed the infection
and died in less than one week. In contrast, the four vaccinated macaques
remained asymptomatic for more than six months, with no detectable virus
following the initial exposure. The vaccinated animals had received a
combination of DNA immunization and boosting with adenoviral vectors encoding
viral proteins that produced cellular and humoral immunity in the macaques.
As the Zaire subtype of the Ebola virus is the most lethal, with a case
fatality rate of up to 90%, the development of an effective vaccine for
humans has a significant potential to protect exposed individuals from
infection and limit the spread of the virus.
[NATURE 408;2000:605𤱑]
PERTUSSIS INFECTION IN FULLY VACCINATED CHILDREN
While Pertussis, also known as “whooping cough,” is considered a preventable
infection, evidence suggests that fully vaccinated children and adults
may act as asymptomatic reservoirs for the infection. Researchers in Israel
examined the family of a 4–month–old infant who died of Pertussis as well
as children at two different day care centers where the siblings of the
infected infant attended. All family members of the infant were fully
vaccinated with four doses of diphtheria–tetanus toxoid pertussis (DTP)
as were the children in the day care centers. Despite full vaccination,
four of the five members of the index family tested positive by polymerase
chain reaction (PCR) assays and three siblings and the mother reported
paroxysmal coughs for at least 4 to 5 weeks. Eleven percent of the children
at the day care centers were also positive by PCR. As the vaccine protects
against clinical disease but not infection, a vaccinated person may become
infected and show only nonspecific symptoms. As a result, these individuals,
including young and recently vaccinated children, may potentially transmit
the infection to unprotected infants. [EMERGING INFECTIOUS DISEASES 6;2000:526𤰁]
TB OUTBREAK AMONG HIV INFECTED INMATES
A report by the CDC underscores the need for vigilant monitoring of Tuberculosis
(TB) when HIV infected individuals are housed together in settings such
as prisons, hospital wards, group residences, and homeless shelters. This
report described the investigation of a TB outbreak among HIV positive
inmates in a state correctional facility in South Carolina. The correctional
facility conducts mandatory HIV testing of all inmates at the time of
incarceration and places those who are positive in segregated dormitories.
The source case–patient had had latent TB infection since 1984, and was
diagnosed with active TB during August of 1999, which was more than six
weeks subsequent to the appearance of symptoms. The exposure period was
identified as May through September, 1999. By November 2000, 31 current
or former HIV infected inmates, all of whom had resided in close proximity
to the source patient, had been diagnosed with TB. Nineteen of the cases
had DNA isolates that matched that of the source patient. This outbreak
illustrates the rapidity with which TB can spread when HIV infected individuals
are housed together. The report recommends thorough screening for TB infection
and disease in HIV positive inmates, with the consideration of an infectious
TB diagnosis in those with respiratory symptoms, even in the absence of
a positive chest radiograph.
[MMWR 49;2000(46):1041�]
4. 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 nwc@u.washington.edu.
Further information about the APEC Emerging Infections Network is available
at http://www.apec.org/infectious.
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