Vol. IV, No. 03 ~ EINet News Briefs ~ February 13,
****A free service of the APEC Emerging Infections Network*****
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In this edition:
- Infectious disease information
- Journal Articles
- How to join the EINet listserv
1. OVERVIEW OF INFECTIOUSDISEASE INFORMATION
Below is a bimonthly summary of AsiaPacific emerging infectious diseases.
CHINA (HONG KONG) – VANCOMYCIN RESISTANT ENTEROCOCCI
Two kidney dialysis patients who died at the Tuen Mun Hospital in Hong
Kong last month were found to carry vancomycinresistant Enteroccocus
(VRE). The patients were believed to have shared a ward. The hospital
planned to conduct a review of antibiotic use to determine whether the
vancomycin had been used properly. Patients on continuous ambulatory
peritoneal dialysis (CAPD) are susceptible to peritonitis, which is
treated with antibiotics, allowing the potential for the routine use
of vancomycin to select for VRE. While the emergence of VRE was not
surprising, a doctor from the Kidney Patients Trust Fund believed that
the patients on CAPD had become infected while inside the hospital.
A spokesman for the College of Pathologists called for more stringent
control measures including the isolation of VRE carriers.
AUSTRALIA – KUNJIN AND MURRAY VALLEY VIRUSES
Early warning signs of a potential Kunjin virus outbreak prompted
Territory Health Services to issue a warning to residents and visitors
of the Northern Territory and northwest Western Australia to take
precautions to avoid mosquito bites. Kunjin virus has been detected
in sentinel chickens, which are part of an early warning system that
can signal increased risk of the infection. Tests on the sentinel
chickens in December 2000 also indicated the presence of Murray Valley
encephalitis virus in Western Australia. Both viruses are transmitted
by the common banded mosquito, Culex annulirostris, which is
most prevalent during and just following the wet season. Individuals
camping near swamp and river systems are at particularly high risk.
Kunjin virus disease is generally nonfatal and can have symptoms
of fever and severe headache. Australian encephalitis, caused by the
Murray Valley encephalitis virus, is potentially fatal, with typical
symptoms including a severe headache, stiff neck, high fever, and
in some cases, delirium and coma. It is estimated that about one person
in 1000 bitten by infected mosquitoes will actually develop an infection.
100 NATIONS MAY BE AT RISK OF BSE
The United Nations Food and Agriculture Organization (FAO) warned
that up to 100 countries may be at risk of bovine spongiform encephelopathy
(BSE) as a result of importing cattle and/or meat and bone meal
(MBM) from Western European countries, particularly the United Kingdom,
between 1988 and 1996. The director of the FAO, Jacques Diouf, stated
that the regions that imported substantial quantities of MBM from
the UK include the Near East, Eastern Europe, and Asia. The European
Union has implemented a number of measures to prevent further spread
of BSE among cattle, including the slaughter of infected animals
and a ban on feeding MBM to cattle, sheep, and goats. The FAO urges
countries that may be at risk of BSE to adopt similar measures and
to institute safe procedures for slaughtering infected animals and
processing offal and byproduct parts.
[REUTERS 2/7/01; PROMED 1/27/01]
SOUTH AFRICA – CHOLERA OUTBREAK
As of February 4, the KwazuluNatal Department of Health reported
37,204 confirmed cases of cholera in the province, including 85
deaths, since the start of the epidemic in August of 2000. The case
fatality rate of 0.4 percent is unusually low, and has been attributed
to the KwaZulu Health Department’s efforts that helped educate people
about the disease. Cases of cholera have also been reported in Swaziland,
Malawi, Mozambique, Zambia, and Zimbabwe, although the infection
rates have not been nearly as high as in South Africa. This outbreak
is South Africa’s largest since the early 1980’s, when more than
105,400 people were infected and 342 died in four consecutive epidemics.
[WHO DISEASE OUTBREAKS REPORT 2/5/01 http://www.who.int/diseaseoutbreaknews/;
ASSOCIATED PRESS 1/29/01]
SINGAPORE – Stable HFMD SITUATION
A press release issued by the Hand foot, and mouth disease (HFMD) taskforce
on Jan. 20, 2001, reports that the HFMD situation in Singapore is now
under control. The average number of cases reported daily to the Ministry
of the Environment during the week of Jan. 20 was 25. At the time of this
press release, there were five cases still hospitalized, all of whom were
in stable condition.
[PRESS RELEASE – HFMD TASKFORCE 1/20/01; http://www.env.gov.sg/info/press/index.html]
NORTHERN AUSTRALIA – ROSS RIVER VIRUS ACTIVITY CONTINUES
The number of reported cases of Ross River virus (RRV) in the Northern
Territory of Australia continues to exceed the usual counts. There were
75 territorywide cases in January, with 26, 25, and 20 cases in the Darwin,
Barkly, and Katherine districts, respectively. This compares to 46 cases
in January of last year, and 153 cases for 2000 overall. The increase
has been attributed to heavy rain in the Top End and Central Australia,
which has resulted in an increased number of mosquitoes. No travel restrictions
to the Northern Territory have been advised.
UPDATED APEC WEBSITE
The APEC website, http://www.apec.org/infectious,
has been updated to provide current information click on “other
links” to access healthrelated websites from APEC economies and information
on various important infectious diseases. We also wanted to remind everyone
about the updated distance learning materials on emerging infections that
are available at http://www.hscer.washington.edu/em_inf/index.html.
The information on this website is drawn from a course taught at the University
of Washington, and includes lectures and audiovisual materials produced
by international experts.
20TH APEC ISTWG MEETING – VIETNAM
This is to confirm that the APEC Industrial Science and Technology Working
Group (ISTWG) side meeting on health will take place on April 24th, 2001
in Hanoi, Vietnam, as part of the ISTWG’s biannual meeting.
LISTERIA RISK ASSESSMENT AND ACTION PLAN RELEASED
The U.S. Department of Health and Human Services/Food and Drug Administration
(HHS/FDA) and the U.S. Department of Agriculture/Food Safety and Inspection
Service (USDA/FSIS) have released a draft risk assessment of the potential
relative risk of listeriosis from consuming specific readytoeat foods,
as well as an action plan to help reduce the risk of listeriosis caused
by the bacteria Listeria monocytogenes. Listeriosis causes an estimated
2500 serious illnesses and 500 deaths each year. The illness primarily
affects pregnant women, older adults, and those with weakened immune systems.
The risk assessment was conducted in order to predict the potential relative
risk of listeriosis among three agebased groups – perinatal, elderly,
and intermediate age – from eating certain readytoeat foods. The assessment
examined foods within 20 categories believed to be the principal sources
of the bacteria. The action plan provides a number of guidelines for those
involved in the manufacturing, inspection, and distribution of readytoeat
foods, and for those monitoring outbreaks, and conducting related research.
The draft risk assessment and the action plan can be viewed at http://www.foodsafety.gov/~dms/lmrisk.html.
RECENT UNAIDS PUBLICATIONS
A number of recent UNAIDS publications that are relevant to the Asian
Pacific are available on the UNAIDS website. A publication from January
entitled, “Drug use and HIV Vulnerability: A Policy Research Study in
Asia” focuses on policies and strategies related to drug use and HIV,
and how they may hinder or facilitate efforts to reduce HIV risks among
drug users and their sex partners. View this and other publications at
PUBLIC HEALTH ACTION PLAN TO COMBAT ANTIMICROBIAL RESISTANCE
The U.S. Interagency Task Force on Antimicrobial Resistance has released
an action plan to address the growing threat of antimicrobial resistance.
The Centers for Disease Control and Prevention, the Food and Drug Administration,
and the National Institutes of Health oversee the task force, which is
made up of members from a number of federal agencies and departments.
The action plan focuses on four principal areas: surveillance, prevention
and control, research, and product development. A brief overview of the
top priorities include delineating local, state, and federal surveillance
responsibilities, initiating a national public education campaign to improve
antibiotic use in health care systems, researching new information and
technologies to assist with new diagnostics, treatments, and vaccines,
and forming an Interagency Antimicrobial Product Development Working Group
to identify and publicize priority health needs for new products that
prevent or treat resistant infections. The plan can be accessed online
6TH INTERNATIONAL CONGRESS ON AIDS IN ASIA AND THE PACIFIC
The 6th International Congress on AIDS in Asia and the Pacific (ICAAP)
will be held this year in Melbourne, Australia, from October 5㪢, 2001.
The theme of this year’s Congress will be "Breaking Down Barriers.” To
promote crossdisciplinary dialogue, the Congress will focus on four principal
themes: treatment and care, prevention, socio economic determinants,
and sexuality and gender. Submitted abstracts that address these topics
will be given priority for oral presentations. The deadline for submitting
abstracts is May 1, 2001. Submissions may be completed online at the
ICAAP website. For more
information, see http://www.icaap.conf.au
or email firstname.lastname@example.org.
4. JOURNAL ARTICLES
LETHAL MOUSEPOX VIRUS CREATED
The February issue of the Journal of Virology describes how Australian
researchers, led by Dr. Ronald J. Jackson, inadvertently created a lethal
recombinant ectromelia virus (mousepox) by inserting a gene that controls
the expression of interleukinנ. While the researchers intended for the
interleukinנ enhanced virus to boost the immune response in mice to the
extent that reproduction could not occur, they observed that both mousepoxresistant
and mousepoxsensitive strains of mice died within a week, on average.
Genetically resistant strains of mice are not susceptible to mousepox,
but in this case the recombinant virus proved to have increased virulence.
Even mice who had been recently vaccinated against mousepox displayed
a mortality rate of about 60 percent. This is unusual in that genetically
engineered viruses tend to exhibit reduced virulence. Although the mousepox
virus does not present a threat to humans, the findings from this study
have led to concern that similar methods could be adopted to produce lethal
forms of human viruses. However, similar instances in the past where lethal
pathogens were accidentally created have not resulted in any known increase
in harm or biological weapons.
[J VIROL 2001;75:1205 NEW YORK TIMES 1/22/01]
JAPAN – RECENT TRENDS IN TB
Toru Mori, of the Research Institute of Tuberculosis in Japan, reports
on the epidemiologic patterns of tuberculosis (TB) in Japan since WWII
in a recent issue of Emerging Infectious Diseases. Prior to WWII, TB was
highly prevalent in Japan. Control measures implemented during the postwar
period helped to decrease the incidence and death rates, although they
still remained higher than those of other developed countries. Epidemiologic
data suggest that infection is currently disproportionately concentrated
in the elderly, partly as a result of the aging of the war time population.
While more than half of adolescents = 20 years of age were estimated
to have been infected in 1950, that figure dropped to 1 percent in 1995.
Similarly, individuals >/=40 years of age comprised 53 percent of newly
reported infections in 1950 and 82 percent in 1998. The declining trend
in incident cases that has been apparent since the 1950s has reversed
slightly and is evident in all age groups. As a result of the recent increase
in TB rates, the Japanese minister of health and welfare has declared
a TB emergency, calling for the public and the medical community to be
increasingly cognizant of the situation.
[EMERG INFECT DIS 6(6), 2000. Available at URL: http://www.cdc.gov/eid]
PREVENTING AND CONTROLLING TB ALONG USMEXICO BORDER
TB among foreignborn individuals living in the United States is increasing.
As Mexico was the country of origin for 23 percent of all foreign born
individuals infected with TB in 1999, prevention and control efforts that
focus on the challenges of working with bordercrossing populations are
needed. Reducing TB rates in the border areas is reliant on diagnosing
and treating infected individuals on both sides of the border. In June
of 1999, the CDC organized a meeting of TB control officials from the
four U.S. states that border Mexico California, Arizona, New Mexico,
and Texas to address issues related to TB prevention and control along
the border. The working group focused on four main areas: surveillance
needs, case management and therapy completion, performance indicators
and program evaluation, and research needs. The working group identified
the following actions for federal agencies and state and local TB control
- Establishing a consensus case definition for a binational TB case
and assessing the need for a registry of binational cases
- Improving the clinical care of binational TB patients and their
- Creating evaluation tools for TB prevention and control efforts
- Setting research priorities
Areas for additional research include binational TB case surveillance,
delayed treatment, treatment completion, drug resistance, contact investigation,
and targeted testing. The full report of the work group’s proposals can
be viewed at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5001a1.htm.
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