Vol. IV, No. 01 ~ EINet News Briefs ~ January 12,
2001
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1. OVERVIEW OF INFECTIOUS–DISEASE INFORMATION
Below is a bi–monthly summary of Asia–Pacific emerging infectious diseases.
ASIA
SINGAPORE – HAND, FOOT AND MOUTH DISEASE DEATH
Researchers in the Department of Pathology at the Singapore General
Hospital identified Enterovirus 71 (EV71) as the virus associated with
the Hand, Foot and Mouth Disease (HFMD) infection that led to the death
of a four–year–old boy in Singapore on January 3, 2001. The boy's family
had traveled with two other families to Johor (Malaysia) from December
23 to December 26, 2000. After returning to Singapore, five of the children
who had traveled became ill with HFMD–like illness, including the four–year
old who died. In addition, two children in Johor became ill at about
the same time. The HFMD Taskforce believes that the initial infection
among these children could have occurred in either Singapore or Johor
based on the incubation period of HFMD.
Although the number of cases of HFMD is on the rise in
Singapore, the HFMD Taskforce states that the situation is stable and
under control at the present time. During the first week of January,
126 new cases were reported, whereas about 70 new cases per week were
reported in December. As a result, the Taskforce has intensified monitoring
and surveillance efforts, particularly in preschools.
[PROMED 01/05/01, STRAITS TIMES 01/10/01]
SINGAPORE – HEPATITIS INFECTIONS FROM KIDNEY TRANSPLANTS
ABROAD
Patients in Singapore who have received kidney transplants in China
or India exhibit high rates of blood–borne infections, such as hepatitis.
Of the 100 Singaporeans who had a kidney transplant in China since 1986,
42 percent are believed to have acquired hepatitis C, and ten percent
are believed to have acquired hepatitis B as a result of the procedures.
Likewise, of the 158 Singaporeans who received successful kidney transplants
in India during the decade prior to 1996, 27 percent acquired some type
of microbial infection, such as HIV, malaria, hepatitis B and/or C.
In addition to the infections, receiving a transplant abroad often results
in further difficulties. The drug commonly used to treat hepatitis C
infection, interferon, is inappropriate in transplant patients because
it will cause their bodies to reject the new kidney. In Singapore, patients
who receive transplants abroad are not eligible for the government subsidy
of 50 percent to help pay for necessary immuno–suppressive drugs. A
waiting period of about five and one–half years for a kidney transplant
in Singapore is believed to be the primary factor causing people to
seek transplants abroad. Health officials encourage patients with kidney
failure to persuade a relative to donate the kidney, as the risk to
the donor is minimal. [PROMED 12/22/00]
CHINA (HONG KONG) – ENCEPHALITIS DEATH FOLLOWING HIN1
INFECTION
A six–year old girl infected with the New Caledonian strain of H1N1
influenza died on December 24, 2000, of acute encephalitis, prompting
health authorities to investigate whether the two were related. According
to Dr. Lo Wing–lok, an infectious diseases expert, acute encephalitis
is not a common complication of influenza virus infection. While the
H1N1 viruses affect individuals of all ages, infection in young people
is more common. Those who are middle–aged or elderly are more likely
to have partial immunity due to a result of prior infection, as H1N1
viruses have been circulating in the area since about 1977. Between
January and November of 2000, 651 people were infected with the New
Caledonian strain of influenza in Hong Kong.
[SOUTH CHINA MORNING POST 01/04/01]
AMERICAS
USA – MULTISTATE OUTBREAK OF LISTERIOSIS LEADS TO TURKEY RECALL
An outbreak of Listeriosis since May 2000 has been responsible for
29 illnesses in ten states, including four deaths and three miscarriages/stillbirths.
Results from a case control study identified the consumption of deli
turkey meat as the primary risk factor for infection and implicated
Cargill Turkey Products as a potential source. On December 14, Cargill
Turkey Products voluntarily recalled 16.7 million pounds of ready–to–eat
poultry products that may have been contaminated. These products were
produced at the company's facility in Waco, Texas, and were distributed
to grocery stores, restaurants, and institutions across the United
States, Iceland, and Venezuela. Listeriosis is an infection caused
by eating food contaminated with the bacteria Listeria monocytogenes,
and primarily affects pregnant women, newborns, and those with weakened
immune systems. Symptoms are often flu–like and can include high fever,
severe headaches, nausea and neck stiffness. More information about
the recall is available at http://www.fsis.usda.gov/OA/recalls/rec_actv.htm.
[MMWR 49(50);2000:1129� ASSOCIATED PRESS 12/15/00]
USA – TB THREAT AMONG CAPTIVE ELEPHANTS
Captive Asian elephants in the United States are becoming increasingly
at risk for contracting tuberculosis. Eighteen active cases of the
human strain of Mycobacterium tuberculosis (3.3 percent of the captive
population) have been reported in elephants since 1996 in the U.S.
The majority of the cases have occurred among privately owned elephants;
only four occurred in elephants at zoos. Since the disease is unrecognized
in elephants in their native habitats, researchers believe that the
elephants contracted the infection from their handlers in either Asia
or North America. It is not known whether the animals can transmit
the infection to one another, or whether a human host is required
for transmission. Current means of diagnosing the disease involve
"trunk wash" cultures. These cultures, however, only indicate whether
the elephant has active TB; there is no reliable test to determine
if the animal is harboring the infection.
[HEALTHSCOUT 12/30/00 (http://www.healthscout.com);
THE SEATTLE TIMES 10/31/00]
OCEANIA
AUSTRALIA (MELBOURNE) – HOSPITAL–ASSOCIATED INFECTION OF LEGIONELLOSIS
Health authorities believe that contaminated air–conditioning towers
at the Royal Melbourne Hospital are responsible for the transmission
of Legionnaires' Disease to one patient and possibly others. The infected
patient, who was admitted for an unrelated illness and died on Dec.
12, was confirmed as having legionellosis on Dec. 15. He had been
in the hospital for over two weeks, and the maximum incubation period
for the infection is often ten days. The head of the Victorian Infectious
Diseases Service stated that the patient most likely contracted the
infection by inhaling contaminated airborne particles that were released
from the cooling towers to the outside of the hospital. Two of the
hospital's 12 towers tested positive for low levels of the bacteria,
and were subsequently cleaned with chlorine. Samples from the towers
revealed several strains of the Legionella bacteria, including the
one found in the patient. Two of the other three patients who tested
positive for legionellosis exhibited flu–like symptoms upon admission,
suggesting that they may have already been infected.
[PROMED 12/22/00, 01/08/01]
AUSTRALIA – ROSS RIVER VIRUS CONCERN
The Department of Human Services of South Australia reported an increase
in the number of reported cases of Ross River virus infection throughout
various regions of the state. Cases have been reported on the West
Coast, Kangaroo Island, and near Lake Albert. In addition, the Australian
Centre for Disease Control has issued a warning about the infection
in the Northern Territory, stating that there have been more cases
than usual. The affected areas include Katherine, Barkly, and Gove
regions. The virus is most often transmitted by mosquitoes and can
cause arthritic pain, fever, and a rash in about 2㪶 percent of those
infected. Mosquitoes are present in high numbers in these areas as
a result of recent flooding. Health officials are urging individuals
to take precautionary measures against mosquitoes by wearing protective
clothing, avoiding outdoor exposure at dawn and dusk, and using insect
repellent. While there is no cure, Ross River virus is a self–limiting
viral infection, and those infected will make a full recovery, although
recovery periods often vary.
[PRESS RELEASE 12/28/00, SOUTH AUSTRALIA DHS (http://www.health.sa.gov.au);
http://www.health.qld.gov.au/brochure/phs/ross_river.htm,
PROMED 01/08/01]
OTHER
RUSSIA – INFECTIOUS DISEASES ON THE RISE
Rates of infectious diseases in Russia have soared over the last several
years, driven by increasing poverty, alcoholism, overcrowding, intravenous
drug use, weak health programs, and scarce resources. This is particularly
apparent with tuberculosis, where the number of TB patients has nearly
doubled since 1993, and deaths due to TB alone rose 30 percent in 1999.
Escalating prison populations housed in overcrowded conditions and inadequate
health programs have essentially transformed prisons into breeding grounds
for the infection. According to a report issued by Harvard University
last year, as many as ten percent of Russia's million prisoners now have
active TB, and more than half of those cases are resistant to at least
one anti–TB drug, while 20 to 30 percent are resistant to several. Medicine
shortages and an intermittent supply of anti–TB drugs have fostered an
epidemic of drug–resistant TB in the prisons that has spread to communities
throughout the country.
In addition to the TB epidemic, Russia has one of the fastest growing
rates of HIV, and syphilis and hepatitis B and C cases rose dramatically
during the 1990's. The Moscow Committee of Health Care reported that morbidity
caused by hepatitis C and B has increased seven– and two–fold, respectively,
in Moscow over the last five years. Young people between the ages of 15
and 29 years make up 80 percent of those infected. These high infection
rates are attributed to an increasing use of intravenous drugs and an
increase in sexual transmission of hepatitis B.
[PROMED 12/18/00, NY TIMES 12/5/00]
2. UPDATES
USA – CONTINUED E. COLI INFECTIONS FROM GROUND BEEF IN MIDWEST The number of E. coli infections linked to the Wisconsin meat packer,
American Foods Group, Inc., has increased to 43, including 36 cases in
Minnesota. Two individuals in Minnesota, ages two and six years, remain
hospitalized as a result of severe kidney complications. Minnesota health
and agriculture officials issued a statement indicating that they are
confident that the ground beef produced at this establishment on November
2nd and 3rd can be linked to the E. coli infections in Minnesota. The
company voluntarily recalled 1.1 million pounds of ground beef produced
from its Greenbay, WI, site in early December.
[PROMED 12/19/00]
USA (PA) – ANIMALS AT PETTING ZOO TEST POSITIVE FOR E. COLI
Twenty–six cows and calves at a petting zoo in Pennsylvania tested positive
for the E. coli strain 0157:H7, which was responsible for an outbreak
among 16 children who visited the zoo. Bacteria of the same strain were
also found on a railing that separates the animals from the public at
the zoo. These results confirm the supposition that the cows at the zoo
were a likely source of the bacteria. According to a summary of a draft
report issued by the Centers for Disease Control and Prevention (CDC),
progress is being made towards the development of national guidelines
for operators of petting zoos, farms, and animal exhibits. Recommendations
include sufficient, on–site hand–washing facilities, eating areas for
people that are separate from animal facilities, and increased information
for visitors on the risks of infection of bacteria from the animals.
[PROMED 12/15/00]
3. NOTICES
INFLUENZA VACCINATION ADVISED
Health officials in the United States are urging individuals to be vaccinated
against the influenza virus, stating that the strain circulating this
year varies substantially from that of previous years. Recent tests conducted
on blood samples in Wisconsin suggest that only 12 percent of individuals
will have adequate protection from prior influenza vaccines or infections
to protect them against the new strain, A–New Caledonia. As a result,
there is a large susceptible population, and herd immunity is much lower
for the new strain than it has been for other strains in the past. While
influenza cases and deaths in the U.S. have been below epidemic levels
thus far for this season, the peak typically occurs in January. [MILWAUKEE
JOURNAL SENTINEL 12/20/00]
NATURE MEDICINE WEB FOCUS: TUBERCULOSIS AT THE MILLENIUM
The Nature Medicine Web Focus provides a wide array of information related
to tuberculosis, including commentaries by experts in the field, news,
summaries of current research, Nature Medicine papers, and web links.
It can be accessed at http://www.nature.com/nm/special_focus/tb/.
4.MMWR UPDATES
CDC RECOMMENDS INCREASED CONSIDERATION OF RABIES
The CDC reports that a diagnosis of rabies should be considered in any
patient with progressive encephalitis. In this report, the CDC describes
the five cases of rabies that occurred in the United States during the
months of September, October, and November, 2000. Four of the five cases
occurred as a result of contact with bats; however, only one of the patients
was known to have been bitten. The CDC states that while 74 percent of
the 32 cases of rabies reported since 1990 were attributed to bat associated
variants of the virus, a history of a bite was established in only two
of these cases. As the initial manifestations of rabies often vary, and
a history of animal contact is rarely taken, the CDC advises health care
providers to be more cognizant of the possibility of rabies as the cause
of progressive encephalitis in their patients.
[MMWR 49(49);2000:1111�]
RECOMMENDATIONS FOR IMPROVING GLOBAL MEASLES CONTROL
Members from the World Health Organization (WHO), the United Nations Children's
Fund (UNICEF), and the CDC met during May 2000 to review the status of
global measles control and to develop recommendations to facilitate the
implementation of control activities. The participants concluded that
vaccination coverage should be greater than 90 percent in order to achieve
measles control, and that a single–dose measles policy is inadequate,
as it leaves many children susceptible to infection. The recommendations
focused on improving routine and supplemental vaccinations, measles surveillance,
and vitamin A supplementation. Key recommendations include the incorporation
of an action plan to reduce measles mortality as a part of each country's
comprehensive long–term vaccination strategy, increased management of
vaccination services, the consideration of mass vaccination campaigns,
the establishment of defined surveillance methods, and the provision of
vitamin A supplements in appropriate countries. The full report can be
accessed at http://www.who.int/wer/75_27_52.html.
[MMWR 49(49);2000:1116�]
STUDIES SHOW INCREASING GONOCOCCI RESISTANCE IN U.S.
Reports from Hawaii and Missouri indicate that gonorrhea is becoming increasingly
resistant to various antibiotics used to treat the sexually transmitted
infection. While gonorrhea became resistant to penicillin and tetracycline
in the 1980's, only recently have strains shown signs of resistance to
fluoroquinolone antibiotics. This increase in resistance is particularly
apparent in Hawaii, where 9.5 percent of strains tested in 1999 were flouroquinolone–resistant,
compared with 1.4 percent in 1997. As a result, the CDC recommends that
health care providers attempt to determine if their patients or their
patients' sex partners could have contracted the infection in Hawaii,
other Pacific Islands, or Asia, where flouroquinolone–resistant gonorrhea
is common. Under these circumstances, patients should be treated with
other drugs that are recommended for gonorrhea treatment, such as cefixime
or ceftriaxone. Cases from Missouri also suggest that gonorrhea is becoming
resistant to another commonly used antibiotic, azithromycin. If not treated
successfully, gonorrhea infection can lead to pelvic inflammatory disease,
infertility, ectopic pregnancy, and chronic pelvic pain.
[MMWR 49(37);2000:833𤴵]
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