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Vol. IV, No. 03 ~ EINet News Briefs ~ February 13, 2001


****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:

  1. Infectious disease information
  2. Updates
  3. Notices
  4. Journal Articles
  5. 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) – VANCOMYCIN RESISTANT ENTEROCOCCI
Two kidney dialysis patients who died at the Tuen Mun Hospital in Hong Kong last month were found to carry vancomycin–resistant 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.
[PROMED 1/23/01]


OCEANIA



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 non–fatal 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.
[PROMED 2/6/01]


OTHER


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 Kwazulu–Natal 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/disease–outbreak–news/; ASSOCIATED PRESS 1/29/01]



2. UPDATES

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 territory–wide 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.
[PROMED2/5/01]


3. NOTICES

UPDATED APEC WEBSITE
The APEC website, http://www.apec.org/infectious, has been updated to provide current information – click on “other links” to access health–related 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 bi–annual 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 ready–to–eat 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 age–based groups – perinatal, elderly, and intermediate age – from eating certain ready–to–eat 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 ready–to–eat 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 http://www.unaids.org/publications/documents/health.

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 at http://www.cdc.gov/drugresistance/.

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 cross–disciplinary 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 on–line at the ICAAP website. For more information, see http://www.icaap.conf.au or email 6icaap@icms.com.au.


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 mousepox–resistant and mousepox–sensitive 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 post–war 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 /=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 US–MEXICO BORDER
TB among foreign–born 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 border–crossing 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 programs:

  • 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 close contacts
  • 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.


5. 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.

Revised:
Nov. 7, 2000

Contact us at apecein@u.washington.edu
© 2000, The University of Washington