Vol. IV, No.
09 ~ EINet News Briefs ~ May 31, 2001
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In this edition:
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OF INFECTIOUSDISEASE INFORMATION
Below is a bimonthly summary of AsiaPacific emerging infectious diseases.
KONG) INFLUENZA A (H5N1) VIRUS IN POULTRY
Following the detection of avian influenza A (H5N1) virus in chickens
at ten poultry markets in Hong Kong, health officials ordered the slaughter
of approximately two million chickens at markets and farms throughout
the territory. Hong Kong has also requested that mainland China halt
exports of live birds to the territory. No human cases have been detected,
but the influenza was highly virulent among chickens, killing almost
all of the infected chickens within days. The virus strains isolated
from the chickens differ genetically from the H5N1 virus that spread
to humans and killed six people in 1997. Since that outbreak, Hong Kong
has conducted routine testing for the H5N1 virus in poultry at retail
markets. In April, officials detected an H5N1 virus similar to the current
strain, but it did not cause death in chickens, as the current strain
does. The ten infected markets have been shut down and, following the
destruction of the chickens, will be thoroughly disinfected. According
to Lily Yam, the Secretary for the Environment and Food in Hong Kong,
the vast majority of H5N1 strains do not affect humans; however, there
is always the possibility that the strains may combine with other viruses
to produce a strain that could infect humans.
[WHO 5/17/01, 5/18/01, http://www.who.int/diseaseoutbreaknews/n2001/may/17may2001.html;
THE NEW YORK TIMES 5/16/01, http://www.nytimes.com]
(KUALA LUMPUR) CHOLERA OUTBREAK
Health authorities stated that the outbreak of cholera near Kuala Lumpur
that killed one person and is believed to have affected 146 others has
been contained and is under control. Officials ordered the closure of
132 food stalls, restaurants, and factory canteens in the western Malaysian
state of Selangor. The source of the outbreak has not yet been identified.
[ASSOCIATED PRESS 5/13/01, 5/15/01]
E. COLI 026 INFECTION
A man was diagnosed with E. coli 026 bacterial infection after
being hospitalized as a result of food poisoning. This strain is similar
to E. coli 0157, which was first found in the U.S. in 1982. This
case represents the second E. coli 026 patient diagnosed in Korea
since 1999, when the infection was designated a communicable disease.
Additional information on this, such as the source of the infection,
would be helpful and can be sent to firstname.lastname@example.org.
POSSIBLE SURGICAL CJD TRANSMISSION
A woman who was operated on at the HotelDieu Grace Hospital in
Windsor on March 11, 2001, later tested positive for CreutzfeldtJakob
Disease (CJD). Neurosurgeons at the hospital learned of the test
result, which is about 85 percent accurate, on May 7. The hospital
subsequently suspended all surgery and disinfected the operating
rooms and surgical equipment. The hospital has begun contacting
patients who have undergone neurosurgery since March. While the
risk of iatrogenic transmission is very small, normal sterilization
protocols reduce, but do not eliminate that risk, as the infectious
agent is resistant to standard sterilization procedures. Iatrogenic
transmission of CJD from contaminated surgical instruments such
as dura mater grafts has been reported previously in Japan and Thailand.
As of November 1997, approximately 43 patients were believed to
have contracted the infection in this manner in Japan. CJD is extremely
rare and leads to progressive dementia and loss of physical functions,
inevitably resulting in death.
[PROMED 5/14/01, 11/20/97]
More than 100 flulike illnesses in the town of North Battleford
in westcentral Saskatchewan are believed to be the result of a
contaminated water supply. The parasite, Cryptosporidium parvum,
was found in a watertreatment plant that serves the town, and
is presumed to have entered the water supply through a faulty filtration
system. Health officials stated that 36 cases of cryptosporidiosis
have been confirmed through laboratory testing, and may have been
responsible for one death. The Environment Department recently released
the names of 119 communities in Saskatchewan that have problems
with their water treatment facilities. According to the Environment
Minister, nearly a third of these lack minimum treatment standards.
[REUTERS 5/7/01; PROMED 5/6/01, CANADIAN PRESS 5/16/01]
METHICILLINRESISTANT STAPHYLOCOCCUS AUREUS OUTBREAK IN HOSPITALS
Ottawa hospitals have treated about 50 cases of methicillinresistant
Staphylococcus aureus (MRSA) following its introduction into
a hospital by a patient from the United Kingdom. The director of
the Ottawa Hospitals Infection Prevention and Control Program emphasized
that the community is not at risk and that this particular bacteria
is not particularly dangerous as it can be successfully treated
with antibiotics. The hospitals have had to respond to MRSA outbreaks
since 1990. Nonetheless, hospital officials state that they are
following strict procedures such as isolating infected patients.
In a hospital outbreak, patients with weak immune systems are those
most susceptible to the infection.
[OTTAWA CITIZEN 5/17/01, http://www.ottawacitizen.com]
CALICIVIRUS OUTBREAK IN SCHOOL
An outbreak of viral gastroenteritis affected 163 children and 16
teachers at an elementary school in Calgary on May 2. The virus
has been identified as belonging to the calicivirus family, and
samples have been sent to the Centers for Disease Control and Prevention
(CDC) for further testing. Caliciviruses are commonly spread through
the consumption of contaminated food or beverages, and can cause
nausea, diarrhea, vomiting, abdominal pain, fever, and malaise.
While the source of the infection is not clear, the schools water
has been ruled out as a possible source. The school has disinfected
the walls, floors, and handrails in order to minimize the risk of
[CANADIAN PRESS 5/16/01; PROMED 5/17/01]
U.S. (NJ) WEST
NILE VIRUS DETECTED IN CROWS
As of May 20, five crows found dead in two counties of New Jersey
have tested positive for the West Nile Virus (WNV). Both of these
counties exhibited high crow mortality last year. Most counties
in New Jersey have been conducting surveillance activities since
March, but these are the first reports of WNV in the country in
2001. Testing dead birds has proven to be an effective earlywarning
system, as the virus can infect birds before it infects people.
Such increased awareness can alert health officials to the need
to increase surveillance and control measures of mosquito populations.
WNV first appeared in
New York two years ago. Since then, it has infected tens of thousands
of birds and at least 81 people, including nine deaths. The most
effective way to prevent infection is to take precautions to reduce
the risk of being bitten by a mosquito.
[NJ WNV WEB SITE, http://www.state.nj.us/governor/westnile/index.html;
5/7/01, 5/8/01, 5/15/01, 5/20/01]
MEXICO SUSPECTED IMPORTED MEASLES
A small outbreak of measles in the Benito Juarez Municipality in
Mexico occurred in a 33yearold male of U.S. nationality and his
wife and daughter. The index case was the 33yearold male, whose
illness began on April 13. He had recently had contact with some
Koreans on March 15, and had traveled to a convention in Dallas
on March 22. According to the Texas Department of Health, there
has been only one reported case of measles in the state, which occurred
in an adoptee exposed in China with onset on February 14. The CDC
confirmed that there were no reported cases that may have traveled
through Dallas or Houston during the relevant time period in March.
While there has been an outbreak in Korea with approximately 40,000
cases, the date of contact with the Koreans is outside of the average
14day exposure period. It is not known whether any specimens for
viral isolation were obtained from the index case.
[PROMED 5/4/01, 5/5/01]
EL SALVADOR SUSPECTED
The El Salvador Ministry of Health confirmed the first two cases
of measles in the country since eradication of the disease in 1996.
The cases occurred in two brothers who recently returned from Europe.
The cases are thought to be imported. In response, health authorities
announced plans to vaccinate university students, and to establish
sanitary cordons in the international airport and at overland border
crossings. Neighboring countries have also enhanced prevention measures
by increasing vaccinations and notifying residents of border regions.
The Guatemalan government sent 200,000 doses of measles vaccine
to the El Salvadoran Ministry of Health.
[PROMED 5/14/01, 5/17/01]
RUSSIA (KALUGA and
UDMURTSKAYA) SHIGELLOSIS OUTBREAK
Two outbreaks of acute dysentery occurred in late April and early
May in the Kaluga province and the Udmurtskaya Republic in Russia.
In Kaluga, 158 cases of acute dysentery were reported at a psychiatric
hospital between April 29 and May 3. Isolation of the bacteria from
66 cases identified the Shigella flexneri 2a strain to be
the cause of the infection. The outbreak was associated with the
consumption of curd pudding. The cook was found to carry the infection,
and is presumed to be the source of the outbreak. In the Udmurtskaya
Republic, 93 cases of acute dysentery were reported between April
24 andMay 1. This outbreak has been attributed to the water supply
system, which became contaminated with sewage on April 23. The bacteriological
strain, Shigella sonnei, was isolated from samples of 71
A recent ProMED report describes a case involving a 23yearold
patient who developed an acute aseptic meningoencephalitis shortly
after his return to Germany on April 27 after a sixmonth stay in
Australia. The patient initially developed fever followed by evident
behavioral changes and a persistent headache. He became comatose
on May 4 and is currently under intensive care. The patient had
been residing primarily in the Northern Territories and Queensland,
where health officials have noted elevated risks of both Kunjin
and Murray Valley Encephalitis, which are transmitted by the common
banded mosquito, Culex annulirostris. Further test results are being
ACUTE FEBRILE ILLNESS AMONG
TRAVELERS TO MEXICO
The CDC and the Mexico Ministry of Health are continuing a joint investigation
of the source of the outbreak of acute febrile illness that occurred in
college students who recently visited Acapulco in March. Initial laboratory
testing suggested that most of the students had histoplasmosis, an infection
caused by the fungus Histoplasma capsulatum. The majority of students
with the infection resided at the Calinda Beach Hotel in Acapulco. The
CDC reports that as of May 1, 2001, 44 colleges in 22 states and the District
of Columbia have reported 229 students with acute febrile respiratory
illness who met a specified case definition. A cohort study of 109 randomly
selected students who stayed at 3 different hotels in Acapulco during
the first two weeks of March found that having stayed at the Calinda Beach
Hotel was significantly associated with illness in univariate analysis.
An investigation of the hotel and nearby areas in April did not identify
any sources of the fungus. Another cohort study is currently being conducted
among college students who stayed at the hotel during March to identify
specific sources of infection. Reports of illness among travelers residing
at the hotel in April are continuing to be received by the CDC, suggesting
ongoing transmission associated with the hotel.
U.S. (CT) SALMONELLOSIS
LINKED TO CHEESE IN THE NORTHEAST
Fresh Italianstyle cheese made by Liuzzi Cheese Co. in North Haven, CT,
has been linked to at least 12 of 15 cases of Salmonellosis caused by
the Salmonella newport strain. The Department of Public Health
issued a recall on May 3 for basket cheese, ricotta cheese, and mozzarella
cheese, all of which were made with unpasteurized milk. These cheeses
were distributed throughout Connecticut and surrounding states and sold
with a Liuzzi label beginning on approximately March 20. Consumers who
bought the specified fresh cheese since March 20 are advised not to eat
it and to inform the Department of Public Health if they still have some
left. Salmonellosis is generally a selflimited infection, although it
may become lifethreatening in those at high risk, such as infants, the
elderly, and immunocompromised individuals.
U.S. SALMONELLOSIS OUTBREAK
NATIONWIDE FROM CANTELOUPES
An outbreak of Salmonellosis that has occurred in a number of states throughout
the country has been attributed to cantaloupes that are thought to have
been imported. The infection, caused by the rare strain Salmonella
poona, killed a 78yearold woman in California and caused illness
in about 30 others in Arizona, Missouri, New Mexico, New York, Oregon,
Tennessee, and Washington. All of the illnesses occurred between April
6 and April 24. Health officials have not identified the source of contamination
that led to this outbreak, but an investigation is ongoing. Consumers
are advised to wash their hands before and after preparing foods, and
to rinse fruits and vegetables to remove bacteria.
[WA DEPT OF HEALTH 5/18/01; PROMED 5/16/01]
U.S. GROUND BEEF RECALL
According to the Agriculture Department, Emmpack Foods Inc., of Milwaukee,
WI, is recalling 471,000 pounds of ground beef as a result of possible
contamination with the E. coli 0157:H7 bacteria. The meat was distributed
across the country for retail use in fivepound tubes and for institutional
purposes in boxes. Both bear a sellby date of 3㪮㪙.
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