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Vol. IV,
No. 08 ~ EINet News Briefs ~ May 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,
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To respond to the listserv, use the reply function.
In this edition:
- Infectious disease information
- Updates
- 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) AVIAN INFLUENZA VIRUS DETECTED IN GEESE
A strain related to the lethal H5N1 avian influenza has been detected
in samples taken
from geese at a market in Hong Kong. The strain, known as Goose 96–type
H5N1, is in
the same family as the Chicken 97–type H5N1 virus that resulted in the
death of 6
humans and the slaughter of over a million chickens in Hong Kong in
1997. Health
officials stated that the Goose 96–type virus generally infects ducks
and geese and has not
been known to cross to humans. Samples taken from geese in late February
were the first
to test positive for a H5N1 family virus in a retail market since the
outbreak in 1997. Of
28,000 tests conducted on fecal samples from geese and ducks in wholesale
markets as a
part of routine testing over the past year, 17 have tested positive
for the Goose 96–type
virus. The infected chickens were sold prior to the receipt of test
results.
[PROMED 4/20/01]
JAPAN
INFLUENZA A DIAGNOSED IN IMPORTED PARAKEETS
Scientists at the Japanese National Institute of Animal Health detected
influenza A H9N2
virus strains in imported parakeets that died subsequent to their arrival
in Japan.
According to authorities, these viruses were only known to infect chicken
and mice; this
is the first time that the H9N2 viruses have been diagnosed in domesticated
birds. The
H9N2 virus could pose a substantial health risk to humans if it mutated
or combined with
the more dangerous H5N1 virus, which was responsible for 18 infections
in humans,
including six deaths, and the mass killing of chickens in Hong Kong.
[PROMED 4/22/01]
AMERICAS
USA (OH) FIRST
U.S. CASE OF SEXUALLY TRANSMITTED TYPHOID
Health officials at the U.S. Centers for Disease Control (CDC) have
confirmed that a man
who contracted typhoid fever on a trip to Puerto Rico in May of
1999 spread the infection
to at least seven other men through oral and anal intercourse, in
what is considered the
first reported case of sexually transmitted typhoid in the U.S.
Typhoid is normally spread
through the consumption of food or water contaminated by infected
fecal matter. The
disease is characterized primarily by high fever and weakness, and
can be treated
successfully with antibiotics
[REUTERS HEALTH 4/26/01]
USA (CA) PRIMARY
AMEBIC MENINGOENCEPHALITIS
Two young children in California recently died of a rare encephalitis
caused by the
Balamuthia mandrillaris amoeba in March and April of this
year. State health officials
stated that these cases are isolated and do not suggest an outbreak
of the rare disease.
The infection is not well understood, but case studies in the literature
suggest that it
typically afflicts children less than 15 years of age and individuals
with compromised
immune systems. The infection has been diagnosed in approximately
100 people around
the world, including about 30 in the United States.
[SAN FRANCISCO CHRONICLE 4/21/01]
USA (AZ) – HANTAVIRUS PULMONARY SYNDROME DEATH
The Arizona Department of Health Services confirmed a fatal case
of Hantavirus
Pulmonary Syndrome (HPS) in a teenage resident in northern Arizona.
Health officials
are conducting an investigation to determine the potential source
of disease exposure.
This is the first confirmed case of HPS in Arizona this year. Nine
of the 33 reported
cases in Arizona since 1992 have been fatal. In the U.S., there
have been more than 280
cases of HPS reported, of which 38 percent were fatal, since the
virus was first
recognized in 1993.
HPS is transmitted when
people breathe in air contaminated with the virus, which is shed
in rodents urine, droppings, and saliva. Symptoms develop between
one and five weeks
following the exposure, and may include fatigue, fever, muscle aches,
coughing, and
shortness of breath. There is no specific treatment for HPS.
[PROMED 4/28/01; CDC, http://www.cdc.gov]
USA (CA) MYCOBACTERIOSIS
IN NAIL SALON
At least 110 customers of a California nail salon developed boils
and skin ulcers after
receiving a pedicure, during which they soaked their feet and calves
in a footbath for 10
to 15 minutes. The boils appeared between 10 days and 4 months following
the pedicure,
and in some cases, the infection was not responsive to antibiotics.
The infection was
caused by a fast–growing microbe, Mycobacterium fortuitum,
which was found in high
concentrations in the footbaths. The strains of M. fortuitum collected
from the footbaths
matched those of the infected customers. According to the epidemiologist
who led the
investigation of the outbreak, which occurred last fall, this was
the first spread of the
infection in a community. A subsequent spot check of other footbaths
throughout
California revealed that the bacteria were present in the majority
of them. California
officials are expected to develop regulations calling for thorough
cleaning and
disinfection of footbaths used in nail salons.
[PROMED 4/30/01]
OTHER
RUSSIA CRIMEAN–CONGO
FEVER
Two cases of Crimean–Congo hemorrhagic fever (CCHF), including one
death, have
been reported in the Stavropol and Dagestan territories. An additional
100 individuals
are under medical observation. CCHF is endemic throughout southern
Russia, and the
Stavropol region has experienced significant seasonal outbreaks
in recent years. Ticks are
the primary vectors of the infection, and epidemiologists suggest
that the local tick
population has grown over the years due to repeated warm and dry
winters. Three people
died of the infection last year, and about 1400 sought medical attention.
The Stavropol
government has approved measures to help control the disease, including
funds for the
disinfestation of ticks.
[PROMED 4/26/01, 5/3/01]
AFRICA MENINGITIS
OUTBREAK
An outbreak of meningitis that has spread across Africa has infected
about 38,000
individuals and killed at least 3,500. A statement by the International
Federation of Red
Cross and Red Crescent Societies claimed that it was the worst outbreak
of the disease in
the last decade and has resulted in a worldwide shortage of the
vaccine. Burkino Faso
and Benin are particularly affected, reporting 10,987 cases and
7,532 cases, respectively.
The federation and other international health organizations are
supplying vaccines to the
most affected areas. The emergency health coordinator of the federation
stated that the
infection is likely to spread without widespread vaccination until
the seasonal rains
arrive.
[ASSOCIATED PRESS 4/25/01, WHO, http://www.who.int/disease–outbreak–news]
2. UPDATES
U.S./MEXICO RESPIRATORY
ILLNESS INVESTIGATION
The Secretariat of Health of Mexico (SSA) and the CDC are collaborating
in the
investigation of an outbreak of acute febrile respiratory illness that
occurred among a
number of college students following their return from Acapulco, Mexico,
this past
March. Preliminary laboratory results suggested that the infection was
caused by
Histoplasma capsulatum, but the CDC also reported that some students
have tested
positive for infection with Mycoplasma pneumoniae. Investigations
of the hotel where
the students stayed and various nightclubs have not revealed obvious sources
of
exposure. There have been a few cases of acute febrile respiratory disease
among hotel
workers and Mexican guests who resided at the same hotel as the students,
but none of
these cases has tested positive for Histoplasma. The SSA is continuing
the investigation
and currently conducting a serological survey among hotel workers and
telephone inquiry
among Mexican guests.
[PROMED 4/28/01]
CHILE HANTAVIRUS PULMONARY
SYNDROME UPDATE
There have been 38 cases of HPS in Chile so far this year, of which 10
were fatal. The
Santiago Times stated that reported HPS cases have reached a record number
this year.
The infection is endemic in Chile, and health officials are urging residents
to adopt
sanitary measures to prevent the spread of infection.
[PROMED 4/19/01]
3. NOTICES
20TH APEC ISTWG MEETING
HANOI, VIETNAM
The APEC 20th Industrial Science and Technology Working Group (ISTWG)
side
meeting on emerging infectious diseases was held in Hanoi, Vietnam on
the 24th of April
2001. Eight economies were represented at the side meeting. A strategic
framework for
addressing emerging infections was reaffirmed by the group and will be
further revised
this year. A proposal for a Network of Networks meeting to be held later
this year
received enthusiastic support.
UNAIDS WARNS ASIA COULD
EXCEED AFRICA IN AIDS CASES
At a special session of the UN Economic and Social Commission for Asia
and the Pacific
(ESCAP) in Bangkok, UN officials warned that the number of HIV infections
in Asia
over the next 10 years could surpass those of Africa unless immediate
action is taken to
stem the spread of the virus. Kathleen Cravero, deputy executive director
of the Joint UN
Program on HIV/AIDS, stated that there were 900,000 new infections last
year in the
Asia–Pacific region, and 490,000 died of AIDS. In Africa, 3.9 million
people were
infected last year, and 2.4 million died. According to Cravero, South
Asia is the fastest
growing epidemic outside of sub–Saharan Africa, with an infection rate
of 5%. She also
stated that epidemics in Cambodia, Myanmar, Thailand, and parts of India
already have
spread beyond sex workers and intravenous drug users to the general population.
Cravero and other UN officials emphasized the pivotal roles of governments,
businesses,
and other sectors in helping to fight the spread of the disease at a national
level while the
epidemics are still in their early stages.
[UNWIRE 4/24/01,
http://www.unfoundation.org/unwire/archives/UNWIRE010424.cfm#3]
NEW TYPHOID VACCINE FOR
YOUNG CHILDREN
A new typhoid vaccine developed specifically for young children has been
demonstrated
to have an efficacy of greater than 90 percent in children two to five
years old. Dr. Feng
Ying C. Lin and colleagues conducted a double–blind, randomized trial
in children two to
five years old in 16 communes in Dong Thap Province, Vietnam, to evaluate
the safety,
immunogenicity, and efficacy of the vaccine relative to a saline placebo
over the course
of 27 months. Of 5,525 Vietnamese children who received two doses of the
vaccine six
weeks apart, four children developed typhoid. In comparison, 47 of the
5,566 who
received the placebo became infected. Furthermore, all of the children
who required
hospitalization were in the placebo group.
This finding has important
implications for the prevention and control of the disease in
areas where the infection is endemic, such as developing countries in
Asia, Africa, and
Latin America. Typhoid affects approximately 16 million people worldwide
and kills
about 600,000 each year. The infection is spread by human fecal contamination,
and has
become increasingly resistant to a number of antibiotics. Current typhoid
vaccines
provide about 70 percent immunity and are not recommended for children
under six years
of age, leaving many, particularly children, vulnerable to infection.
[NEW ENGLAND JOURNAL OF MEDICINE 2001;344:1263ץ MEDSCAPE,
http://www.medscape.com]
CANADA GROUND BEEF RECALL
The Canadian Food Inspection Agency (CFIA) is asking that consumers not
consume
ground beef products produced at the IBP–Lakeside facility in Brooks,
Alberta on March
1, as they may be contaminated with the E. coli bacteria. Cases
of reported illness in
Saskatchewan have been linked to this product. Potentially contaminated
ground beef
products have been sold to various retail outlets throughout Canada. As
it is unlikely that
any of the affected products are currently being sold, the CFIA is advising
consumers to
not consume ground beef products with the dates between March 1 and March
18, 2001,
that were bought at affected retail outlets. The CFIA is continuing with
the investigation
and advises consumers to cook all ground beef products to a minimum of
71 degrees
Celsius or 160 degrees Fahrenheit. For information on the recall or to
see the list of
affected retail outlets, visit the CFIAs website at http://www.cfia–
acia.agr.ca/english/corpaffr/recarapp/20010422e.shtml.
4. JOURNAL
ARTICLES
GLOBAL TRENDS IN RESISTANCE
TO ANTITUBERCULOSIS DRUGS
Researchers from the World Health Organization (WHO) and International
Union against
Tuberculosis and Lung Disease (IUATLD) expanded a WHO–IUATLD global survey
to
assess trends in resistance to antituberculosis drugs by surveying patients
in 58
geographic sites between 1996 and 1999. They found that among patients
with newly
diagnosed TB, the frequency of resistance to at least one anti–TB drug
ranged from 1.7
percent in Uruguay to 36.9 percent in Estonia. The prevalence of multidrug
resistance
among new cases ranged from 0 percent in eight sites to 14.1 percent in
Estonia. It was
also high in Henan Province, China (10.8 percent), Latvia (9.0 percent),
the Russian
oblasts of Ivanovo (9.0 percent) and Tomsk (6.5 percent), and Iran (5.0
percent). Among
countries that had data available for at least two years, the prevalence
of resistance to any
drug among new cases significantly increased in Estonia, Denmark, Peru,
New Zealand,
and Germany. Significant decreases were observed in Spain, Switzerland,
France, and
the United States. The authors state that multidrug–resistant TB continues
to be a serious
problem in countries of Eastern Europe as well as China and Iran, and
is likely a result of
inadequate TB control strategies.
[NEW ENGLAND JOURNAL OF MEDICINE 2001;344:1294�]
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 contactmailto:nwc@u.washington.edu. Further
information about the APEC Emerging Infections Network is available at
http://www.apec.org/infectious.
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