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Vol. IV, No. 06 ~ EINet News Briefs ~ April 7, 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. How to join the EINet listserv

Below is a bi–monthly summary of Asia–Pacific emerging infectious diseases.


A Ford Motor Co. plant in Cleveland, OH, closed on March 14 for a five–day clean up of several water sources after three cases of Legionnaires’ disease were confirmed among the company’s 2500 employees. The total number of cases rose to four, two of whom have died of the disease. The plant has not been confirmed as the source of the infection. Tests on water samples from the plant revealed that 18 of 153 tested positive for some type of Legionella bacteria. Two of the samples showed growth of Legionella pneumophila 1, the isolate that is most commonly associated with Legionnaire’s disease. These samples were obtained from a stagnant water pool and a floor furnace tank. The Centers for Disease Control is continuing to test samples from the plant to see whether the bacteria in the water matches the strains found in the infected workers.
[ASSOCIATED PRESS 3/28/01, PROMED 3/16/01]

The Wyoming State Department of Health shut down the Big Horn Mountain Lodge in early March following reports from 64 visitors who complained of stomach illness between January 1st and March 6, 2001. According to the health Department Director, the order was issued because of concern that the water supply may have been contaminated with calicivirus. Caliciviruses are transmitted by fecal–oral contact, and can cause nausea, vomiting, diarrhea, and stomach cramps. The lodge was shut down because it was not clear whether the lodge would be able to comply with the Department of Health’s order requiring only bottled or boiled water be used. The Department of Environmental Quality’s Water Quality Division further stated that the lodge did not obtain the county or state permits needed to ensure the proper construction of its septic and water systems.
[PROMED 3/17/01]


Production and marketing were halted at a Novosibirsk meatpacking plant, the Siberian Food Company, following the suspicion that a former worker had contracted anthrax while at the plant. The 43–year–old worker was admitted to the “Vektor” Siberian Virology Centre, where blood tests came back negative for anthrax bacteria. Prior to the test results, emergency conditions were implemented, and staff who were in contact with the infected worker were examined. All workrooms were reported to have been disinfected.
[PROMED 3/19/01, 3/26/01, 3/31/01]


Indian scientists are attributing the mystery disease that has killed 45 people and made at least 66 others ill in February and March to a highly lethal measles–like virus that causes encephalitis in adults and children. Scientists investigating the outbreak told the Health Ministry in India that a mutant measles virus affecting the brain, lungs, or kidneys is responsible for the disease. Investigators were able to rule out vector–borne infections such as cerebral malaria, Japanese encephalitis, Hanta, West Nile, Nipah, and dengue viruses. Tests on tissue samples revealed that four of 21 samples tested positive for measles IgM antibodies, and 15 of 21 samples tested positive for IgG antibodies. According to epidemiologists, the spread of the infection has slowed, due in large part to adequate protection and barrier nursing methods.
[BMJ 2001;322:693, http://www.bmj.com/cgi/content/full/322/7288/693/a; MEDSCAPE 3/23/01 http://www.medscape.com]

The University Malaya Medical Centre confirmed that the 22–year–old livestock worker from Bukit Pelanduk who died of a form of encephalitis was infected with Nipah virus. The Health Ministry Parliamentary Secretary stated that this case was the result of a prior infection, as the worker had exhibited symptoms of Nipah virus while culling pigs in the previous outbreak. No new or recent cases of infection of either Japanese encephalitis virus or Nipah virus have been reported in the areas.
[PROMED 3/16/01]

The reported incidence rate of TB in the province of Kazakhstan has increased considerably from 122 per 100,000 in 1998 to 152 per 100,000 recently reported in the online news source, Russia Today. According to this report, 4000 people infected with TB died last year in Kazakhstan. The article suggests that the increasing incidence can be attributed in large part to the low socioeconomic status and lack of awareness among the Kazakh people.
[RUSSIA TODAY 3/27/01; PROMED 3/29/01]
Ed. comment: The lack of an adequate public health infrastructure and limited access to appropriate TB medication regimens likely play a role in the high incidence rates.


The 20th meeting of the APEC Industrial Science and Technology Working Group (ISTWG) scheduled for April 23rd–27th in Hanoi, Vietnam will include a side meeting on Health/Emerging Infections on Tuesday, April 24 at the Melia Hanoi Hotel. Interested persons should contact their APEC delegation for further information.

Tuberculosis (TB) is the world’s leading curable infectious killer, killing approximately two million people each year. Developing countries account for over 90 percent of TB cases worldwide, and the global TB epidemic increased six percent between 1997 and 1999, largely as a result of a 20 percent increase in African countries heavily affected by HIV/AIDS. The theme for this year’s World TB Day, commemorated annually on March 24, 2001, was “DOTS: TB Cure for All.” (DOTS is the World Health Organization’s approved strategy for TB control, and stands for directly observed therapy short course.) This theme underscores the importance of making treatment accessible to all people infected with TB. A recent report published by the WHO stated that only 23 percent of individuals with infectious TB were treated in DOTS programs. Drug shortages constitute one of the principal barriers to rapid DOTS expansion. The WHO and the global partnership to Stop TB announced a new initiative, the Global TB Drug Facility that aims to increase access to TB drugs for ten million patients, primarily in Africa, Asia, and Eastern Europe, over the next five years. To view the WHO’s press release, go to http://www.who.int/inf–pr�/en/pr2001㪥.html.

The WHO’s fifth annual report on Global TB Control can be downloaded in full or in parts from http://www.who.int/gtb/publications/globrep01/index.html. This report is based on case notifications and treatment outcome data provided to the WHO from national control programs. The focus of the report was to evaluate progress towards the 2005 designated targets of 70 percent case detection and 85 percent treatment success rates, and to assess the epidemiological effects of diagnosing and curing large numbers of people.

The WHO has also recently published “Guidelines for establishing DOTS–PLUS Pilot Projects for the Management of Multidrug–Resistant Tuberculosis,” which will be available online shortly at http://www.who.int/gtb/publications/TBCatalogue.htm.

The Global Polio Eradication Initiative, headed by WHO, Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), and the United Nations Children’s Fund (UNICEF), announced that the eradication of poliomyelitis is 99 percent complete. There were an estimated 350,000 annual cases in 1988 when the initiative began. In 1999, 7141 cases were reported, and this number was reduced by over half in 2000, during which there were no more than 3500 cases of polio reported worldwide. The reduction is attributed to the World Health Assembly’s directive in 1999 for more expeditious eradication activities, such as increased numbers of National Immunization Days (NIDs) and house–to–house vaccine delivery strategies. The poliovirus now circulates in no more than 20 countries, primarily in South Asia and sub–Saharan Africa. According to the Director–General of the WHO, the program’s principal challenges, acquiring access to all children, sufficient funding, and maintaining political commitment, still lie ahead.

The WHO and UNICEF announced a new initiative, the Global Measles Strategic Plan, that aims to reduce global measles deaths by one–half by 2005. Despite an effective and inexpensive vaccine that has been available for over 30 years, measles remains a leading childhood killer, with more than 30 million cases and approximately 900,000 annual deaths in recent years. The high incidence and mortality rates associated with measles are attributed to the low vaccination rates of infants. In conjunction with WHO and UNICEF, involved countries would evaluate progress on measles control, identify reasons for low routine coverage, develop a three to five year plan for measles mortality reduction, and fully implement the recommended strategies. According to Dr. Suomi Sakai, UNICEF’s Chief of Immunization Activities, vaccine coverage levels need to be above 90 percent in order to stop measles deaths, since a small percent of vaccinated individuals do not develop immunity. In 1999, fourteen countries reported measles coverage below 50 percent. To view the WHO’s press release, go to http://www.who.int/inf–pr�/en/pr2001㪨.html.

Similarly, the Global Alliance for Vaccines and Immunizations (GAVI) began its first round of a global schedule of vaccine delivery in Mozambique on April 6. GAVI, a coalition of public and private organizations including the Bill and Melinda Gates Children’s Vaccine Program, the WHO, the World Bank, and UNICEF, among others, was created in 1999 with the aim of increasing access to vaccines such as diphtheria, measles, tetanus, pertussis and hepatitis B among children in developing countries. Mozambique is one of 25 countries to secure support from GAVI subsequent to a review of country proposals.
[SEATTLE POST–INTELLIGENCER 4/6/01, http://www.seattlep–i.com; GAVI website, http://www.vaccinealliance.org]

An advisory panel appointed by South African President Thabo Mbeki to recommend approaches to the HIV/AIDS epidemic in South Africa released a divided report, reflecting disagreement among the council members. The council, created in 2000, was comprised of mainstream scientists and revisionist theorists, many of whom question whether the HIV virus causes AIDS, the effectiveness of AIDS medication, and whether AIDS really exists. As a result of the disagreement on the causes of AIDS, the report includes two different sets of recommendations. The theorists argue for the use of massage therapy, music therapy, yoga, and the use of supplements such as ginseng and Echinacea to help prevent AIDS. They urged that HIV testing and the use of current AIDS medications be stopped. Mainstream scientists called for increased HIV testing, use of anti–retroviral drugs, and increased emphasis on sex education. AIDS activists have criticized President Mbeki for involving the dissident theorists, arguing that their views have damaged prevention efforts. According to South Africa’s Health Minister, the government will maintain its current AIDS policy, which is based on the premise that HIV causes AIDS.
[TIMES OF INDIA 4/6/01, http://www.timesofindia.com]

The National Nutritional Foods Association (NNFA), the nation’s largest dietary supplements industry group, has issued recommendations for manufacturers, encouraging them to eliminate all neurological bovine materials from their products. The NNFA issued the recommendation in order to minimize the risk of transmission of bovine spongiform encephalopathy (BSE) to humans, which has been attributed to the consumption of brain and spinal cord tissue from infected cows. According to the association, about 200 dietary supplement products, which represent 0.5% of the total U.S. market, currently contain bovine glandular material.
Ed. comment: There have been no confirmed diagnoses to date of vCJD related to the ingestion of these products.

The Centers for Disease Control and Prevention (CDC) and Emory University’s Rollins School of Public Health will co–sponsor a course, “International Course in Applied Epidemiology” from September 24 through October 19, 2001, in Atlanta, Georgia. The course will include discussions of epidemiologic principles, basic statistical analysis, public health surveillance, field investigations, surveys and sampling, and discussions of the epidemiologic aspects of current major public health problems in international health. Preference will be given to applicants whose work focuses on international public health issues. For more information, visit Emory’s website at http://www.sph.emory.edu/EPICOURSES or email pvaleri@sph.emory.edu.

Note to Readers: In this newsletter we have included editorial comments from Dr. Carrie Horwitch, co–investigator on the APEC–EINet Project and a clinical instructor at the University of Washington School of Public Health.

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.

Nov. 7, 2000

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