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Vol.
IV, No. 15 ~ EINet News Briefs ~ September
24 , 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:
- Infectious disease information
- 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.
APEC
ECONOMIES
CHINA (JILIN) – CONTAMINATED SOY MILK SICKENS
SCHOOLKIDS
Nearly 1200 schoolchildren became ill in northeast China after consuming
soy milk that was contaminated with a form of Dysentery bacillus. The
Jilin Wanfang Scientific, Industrial, and Trade Ltd. Co. recently began
producing the soy milk and provided it to students at eleven different
schools in Jilin city free of charge. After consuming the drink, the
students experienced fever, stomach cramps, and vomiting. PROMED suggested
that the outbreak may have resulted from fecal contamination of water
used to prepare the soy milk or contamination by a food handler during
the production process.
[PROMED 9/10/01]
KOREA – CHOLERA OUTBREAK
Over 100 people have become infected with cholera in the first outbreak
in the country since 1999. Cases were first reported in late August
in the city of Yeongcheon in the North Kyongsang Province, where several
people became ill after eating at the same restaurant. The Korean National
Institutes of Health (NIH) has performed tests on 593 blood and fecal
samples out of 1252 collected from individuals. Of these 593, 106 were
confirmed to be infected with cholera bacilli. The NIH also confirmed
four cases of secondary infections from family members and four cases
that are believed to have contracted the infection from a source other
than the restaurant. An NIH official stated that they have identified
the majority of infections associated with the restaurant in Yeongcheon
and suggested that the infection rate among the remaining samples is
likely to decrease.
[KOREAN HERALD 9/10/01]
TAIWAN – FIRST E. COLI 0157:H7 CASE
A six–year–old Chinese–American boy is reported to have contracted the
first confirmed case of E. coli 0157:H7 infection in Taiwan.
As a result of the infection, the boy developed hemolytic uremic syndrome,
a condition in which red blood cells are destroyed and the kidneys fail.
It is not clear how the boy became infected. Health officials are certain
that he acquired the infection while in Taiwan, as the boy had spent
more than six weeks there prior to developing symptoms. Nineteen suspected
cases of E. coli 0157:H7 have been reported in Taiwan, but none
was Confirmed.
[PROMED 9/1/01]
JAPAN – FIRST CONFIRMED CASE OF BSE REPORTED
Japan’s government announced on September 10 that it had likely
identified the country’s first case of Bovine Spongiform Encephalopathy
(BSE), also known as mad cow disease. Health officials stated that the
cow, a five–year–old Holstein from a dairy farm in the Chiba prefecture,
had exhibited symptoms typical of BSE, such as difficulty standing,
in mid–August. Initial tests did not suggest infection, but tests performed
following the slaughter of the cow revealed signs of the disease. Britain’s
Veterinary Laboratories Agency confirmed the diagnosis on September
21 after performing additional tests. Conflicting reports reveal that
it is not clear whether the remains of the cow were destroyed or processed
into meat and bone meal. The Associated Press reported an Agriculture
Ministry spokesman stating that the cow’s meat and bones were sent
to be processed into meal prior to the receipt of test results. According
to this report, the ministry ordered the tainted meal to be destroyed.
Earlier reports on PROMED stated that the animal was destroyed and burned.
In response to the suspected case, the Ministry of Agriculture,
Forestry and Fisheries ordered a nationwide investigation, involving
a probe of 4.5 million cows at 140,000 farms throughout Japan. The source
of the infection has not been identified, but health officials presume
that it may have come from imports of feed from Europe. Although the
majority of imported feed in Japan comes from the United States, Canada,
and Australia,
Japan received some shipments from European countries prior to instituting
a ban on European feed this year. Several Asian countries responded
to the announcement by banning imports of Japanese beef. The United
States also placed import restrictions on Japanese ruminants and ruminant
products.
[ASSOCIATED PRESS 9/10/01; PROMED 9/12/01, 9/15/01, 9/20/01, 922/01]
AUSTRALIA, SINGAPORE, U.S. – ECHOVIRUS TYPE 13,
30 AND ASEPTIC MENINGITIS OUTBREAKS
Health officials in several countries, including Australia, Singapore,
and the United States, have reported how previously rare echoviruses
have become increasingly associated with outbreaks of aseptic meningitis
over the past few years. According to the CDC, echoviruses comprise
one of the major groups of the genus Enterovirus and are associated
with illnesses such as aseptic meningitis, nonspecific rashes, encephalitis,
and myositis. Echovirus 13 is an enterovirus that up until 2001, had
rarely been observed in the U.S. However, between March and August of
2001, echovirus 13 had been isolated in samples from 76 patients in
13 states. Of 52 clinical diagnoses reported for the patients, 50 included
patients with aseptic meningitis. Findings reported by the CDC suggest
that aseptic meningitis is the predominant illness associated with recent
echovirus 13 activity in the U.S.
Similarly, in Australia, echoviruses 13 and 30 had rarely
been detected in cases of aseptic meningitis prior to 2001. Between
March and July 2001, a community enterovirus surveillance project in
Western Australia found that of 150 healthy children, 15 yielded an
enterovirus isolate from a throat swab, and seven of these (46 percent)
were echovirus 13. During a concurrent outbreak of aseptic meningitis,
echovirus 13 and 30 were
isolated from 57 percent and 19 percent of cases, respectively.
Echovirus 30 caused a meningitis outbreak in a neonatal
nursery in Singapore in May 1997, which was Singapore’s first recorded
isolation of Echovirus 30. Echovirus 30 has subsequently been isolated
each year in similar outbreaks among infants.
[MMWR 2001;50:777𤳼, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5036a1.htm;
PROMED 9/17/01, 9/18/01]
RELATED
NEWS
COSTA RICA – RED TIDE POISONING CONTINUES
Since December 2000, a phenomenon known as Red Tide has appeared
along Costa Rica’s Pacific coast, and has recently appeared
along the Guatemalan and Salvadoran coasts. “Red tide”
refers to the proliferation of toxic algae that can affect mollusks,
and subsequently humans through the food chain. Individuals who
consume infected mollusks may experience paralysis and even death
as a result. Fifty–one individuals in Costa Rica have been affected
by this toxin since December 2000. Experts in Costa Rica have warned
that the mollusks in the region are currently exhibiting “dangerous
levels of toxins.” Changes in the salinity, temperature, or
nutrients in the water can cause the red tide by favoring the rapid
reproduction of algae that produce these toxins.
[PROMED 9/7/01]
2. NOTICES
21ST APEC ISTWG MEETING
The 21st meeting of the APEC Industrial Science and Technology Working
Group (ISTWG) will convene in Penang, Malaysia from October 8㪤, 2001.
A side meeting on infectious diseases will be held on Wednesday, October
10, from 9:00㪤:30. Participants will review the evolution of the APEC
EID (Emerging Infectious Diseases) agenda, including the paper developed
for delivery to APEC Leaders in Shanghai; hear about WHO's programs in
this area; and discuss the new proposed strategy, focusing on planning
for action around the main pillars of this strategy. New infectious disease
project proposals may be submitted up to four weeks before each ISTWG.
The two APEC EID co–chairs enthusiastically welcome ideas, project proposals,
and other contributions to the overall APEC infectious disease agenda
from all APEC economies. Those interested should contact their APEC ISTWG
delegate.
NEW WPRO/SEARO REPORT ON HIV/AIDS IN ASIA PACIFIC
The World Health Organization for the Western Pacific Region (WPRO) and
the Southeast Asian Region (SEARO) have produced a joint report on HIV/AIDS
in Asia and the Pacific during 2001. The report describes regional trends
of the disease, major HIV risk behavior groups, the projected impact of
the epidemic, and current and future challenges to HIV/AIDS prevention
in the Asia Pacific. The report also provides
country–specific information, including each country’s status as
a low, moderate, or high HIV prevalence country. The report indicates
that Cambodia, Myanmar, and Thailand are all high HIV prevalence countries.
The report can be viewed online at http://www.whosea.org/aids/hiv_aids.htm
or
http://www.wpro.who.int/themes_focuses/theme1/focus4/pub_doc.asp.
AIDS LEADING CAUSE OF DEATH IN THAILAND
Thailand’s Health Ministry announced that AIDS and related complications
accounted for 16 percent of all deaths in 1998, making it the leading
cause of death in Thailand. AIDS surpassed accidents, high blood pressure,
and cancer, which were other main causes of death. Approximately one million
people out of Thailand’s 61.2 million have been infected with HIV
since the beginning of the epidemic, and 300,000 of them have died. According
to the Health Minister, AIDS may have been the leading cause of death
in Thailand for years, but underreporting and a flawed system of recording
data led to inaccurate estimates. He also stated that relatives of victims
in rural areas were reluctant to report the true cause of death, and that
most non–accidental deaths had been reported as heart failure.
[ASSOCIATED PRESS 8/31/01]
AUSTRALIA – PEANUT RECALL DUE TO POSSIBLE SALMONELLA CONTAMINATION
Le Kiu Importing Co. Ltd. Of Vancouver has voluntarily recalled several
kinds of Farmer Brand peanuts due to possible contamination with Salmonella
bacteria. The products had been distributed in British Columbia, Alberta,
Saskatchewan, Manitoba, and the Yukon.
[PROMED 9/19/01]
U.S. –– RECALL OF GROUND BEEF IN 35 STATES BECAUSE OF E. COLI CONCERNS
IBP Inc., the nation’s largest processor of beef, recalled 500,000
pounds of ground beef from 35 states and the District of Columbia because
of possible contamination with E. coli O157:H7. E. coli was detected
from samples collected by the Agriculture Department’s Food Safety
and Inspection Service, prompting the company to issue a voluntary recall.
The beef was produced August 7 and was distributed in 5– and 10– pound
packages.
[ASSOCIATED PRESS 8/30/01]
3. JOURNAL ARTICLES
BASIS OF AVIAN INFLUENZA VIRULENCE IDENTIFIED
Researchers at the University of Wisconsin have identified a specific
gene that appears to influence the virulence of the avian influenza virus
that killed six people in Hong Kong in 1997. The virus, known as H5N1,
spread among live chickens at poultry markets, killing them rapidly, and
infecting humans. This was the first documentation of an influenza virus
spreading directly from chickens to humans. That outbreak prompted the
slaughter of all chickens, and when the virus reappeared in chickens this
summer, more than one million were slaughtered. To determine what allowed
the virus to infect humans and how it became so virulent, researchers,
led by Dr. Yoshihiro Kawaoka, infected mice with human isolates of the
1997 H5N1 virus. There were two distinct virulence groups among these
human isolates – one that caused the mice to die and one that made
the mice ill. Using a technique known as reverse genetics, the researchers
swapped genes between the viruses to identify which genes influenced the
level of virulence. They found that a mutation on the PB2 gene played
a pivotal role in determining the virus’s lethality in mice. These
findings suggest that a few specific changes in the PB2 gene can have
a dramatic effect on the virus’s mortality rate in humans.
[SCIENCE 2001;293:1840� NEW YORK TIMES 9/7/01; ASSOCIATED
PRESS 9/6/01]
HPV16 AND RISK FOR CERVICAL CANCER IN MEXICAN WOMEN
Mexico has one of the highest rates of cervical cancer, with an estimated
16,000 new cases each year. Research conducted at the Universidad del
Ejercito y Fuerza Aerea in Mexico suggests that this may related to the
high frequency of a particular variant of the sexually transmitted virus,
human Papillomavirus 16 (HPV16). The Asian–American (AA) variants are
found primarily in Central and South America, Mexico, and Spain. Dr. Jaime
Berumen and colleagues conducted a case control study among women in Mexico
to examine the frequency of the HPV16 virus and the AA variant in cervical
cells from 181 women with cancer and 181 women without cancer. The researchers
detected HPV16 in 51 percent of cervical cells from cases and in 11 percent
of cervical cells from controls. They also found that the frequency of
the AA variant was 21 times higher in cases than controls, and that the
odds ratio for cervical cancer associated with AA variants was 27. These
findings led the authors to conclude that the high frequency of HPV16
AA variants may contribute to the high incidence of cervical cancer in
Mexico.
[JOURNAL OF THE NATIONAL CANCER INSTITUTE 2001;93:1325� REUTERS
HEALTH 9/5/01]
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