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Vol. IV, No. 16 ~ EINet News Briefs ~ October 17 , 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–weekly summary of Asia–Pacific emerging infectious disease reports.


China (Macau, Hong Kong) – Dengue Fever
The Health Services Bureau reports that the number of confirmed cases of dengue fever in Macau has escalated to 415 since the first cases were reported on Aug. 30. The 415 confirmed reports occurred between Aug. 30 to Sept. 17. This has been the first official record of dengue fever in that area. The Health Services Bureau director, Dr. Koi Kuok–ieng, has said the situation is currently under control and that the government has not released daily updates so as not to "... alarm the population". Sixty–one people are still being treated at Macau's two hospitals.

As of Aug. 30, no locally contracted case of dengue fever has been recorded in Hong Kong. The Department of Health has said that the eight cases reported were all imported. Mosquito breeding grounds have been targeted in a campaign that will run until Nov. 3.
[[PROMED 09/22/01]

Philippines—Acute Flaccid Paralysis
Three cases of Acute Flaccid Paralysis (AFP) associated with circulating vaccine–derived poliovirus (cVDPV) isolates were reported in the Philippines between March 15 to July 26. The three cases include an 8–year–old child from northern Mindanao Island who had onset of paralysis on March 15; a 3–year–old child from Laguna province who had signs of meningitis on July 23, but no paralysis; and a 14–month–old child from Cavite province who had onset of paralysis on July 26. None of the children had traveled outside of their residence since birth. Isolates from the three children showed Type 1 polioviruses derived from Sabin vaccine strain type 1.

As a result of the AFP cases, the Department of Health in the Philippines has: begun an active record review for AFP cases in health–care facilities in the affected and neighboring provinces; established surveillance to investigate aseptic meningitis at major health–care facilities; collected stools from healthy contacts of cases; conducted field investigations of grouped AFP cases; and evaluated polio vaccination coverage in these communities. As of yet there are no unreported AFP cases. However, some AFP cases are still under investigation. A mass OPV vaccination campaign is planned in order to disrupt cVDPV circulation.
[PROMED 10/12/01; MMWR 50(40); 874ס]


US (Florida, New York, Nevada)—Anthrax
Robert Stevens of Lantana, Florida died of Anthrax on Friday, Oct. 5 after checking into Lake Worth Hospital on Tuesday, Oct. 2. The 63–year–old man, a photo editor of The Sun, was the first person in 25 years to catch a case of the rare inhalation form of anthrax. A co–worker, Ernesto Blanco, was found to have anthrax bacteria in his nasal passages and traces of anthrax were found on a computer keyboard in the building.

According to health officials, the co–worker was in stable condition the following Monday at an unidentified Miami–Dade County hospital. David Pecker, chief executive of the tabloid's publisher, American Media Inc. (AMI), said Ernest Blanco worked in the mailroom. For this reason, officials believe the anthrax was spread through the mail. As a preventative measure, public health officials began to contact the 300 personnel who worked in the building and anyone who visited the building for more than an hour since Aug. 1, to test for the bacteria and to provide antibiotics. In addition, the FBI sealed off the office building and combed it for clues. Results of the tests on AMI personnel revealed that six employees were exposed to the anthrax bacterium. On Oct.10 a 35–year–old woman tested positive for anthrax exposure and on Oct.
13 it was announced that five more AMI employees had tested positive for exposure to anthrax. All employees are in good health, have begun treatment, and are not expected to develop the disease.

Officials reported on Oct.13 that preliminary tests on letters mailed to NBC News in New York indicated the presence of anthrax. The personal assistant to NBC news anchor Tom Brokaw contracted cutaneous, or "skin," anthrax, which is less dangerous than inhaled anthrax and rarely fatal if treated. On Sept. 25, the assistant opened a piece of suspicious mail with powder inside. The letter, postmarked Sept.18 from Trenton, New Jersey, has tested positive for anthrax. In addition, on Oct. 14 the Mayor of New York, Rudolph Giuliani, stated that anthrax spores were found on a police officer and two lab technicians involved in detecting the case of anthrax at NBC. All of those who are known to have been exposed are being treated with antibiotics and are in good health.

In Nevada, state officials said that tests have shown that pictures contained in a letter sent to a Microsoft office in Reno from Malaysia were contaminated with anthrax. As of yet, no one has tested positive for exposure.

U.S. Attorney General John Ashcroft has said that the FBI has started a criminal investigation, but does not yet know if the anthrax is related to the Sept.11 terrorist attacks.
[[PROMED 10/04/01 10/08/01 10/09/01 10/14/01; REUTERS 10/10/01; NEW YORK
TIMES 10/14/01]

US (Hawai'i)—Dengue Fever Outbreak
The dengue fever outbreak in Hawai'i is the first in 50 years. As of Oct. 12, the U.S. Center for Disease Control and Prevention has confirmed cases of dengue fever in 45 Maui residents, two Kauai residents, and one Oahu resident. In addition to the confirmed cases, 20 suspected cases have tested positive on preliminary screening tests and another 222 reports of illness are under investigation. The state Health Director Bruce Anderson has stated that the problem is largely confined to East Maui and a few areas on other islands. In another statement Anderson has said that the virus has most likely been introduced from American Samoa, Tahiti, and other parts of Polynesia, where the disease is epidemic. The Department of Health in Hawai'i and the Center for Disease Control have jointly implemented an extensive, statewide mosquito control program. All islands are involved in the aggressive mosquito control measures with intensive activity focused on the island of Maui. In addition, the state is urging residents to help by using insect repellent and eliminating breeding grounds for mosquitoes.
[PROMED 10/06/01; ASSOCIATED PRESS 10/09/01; HAWAI'I DEPARTMENT OF HEALTH 10/09/01 http://www.state.hi.us/health/dengue/press.html]

US (North Carolina)—A Possible Case of West Nile Infection
In early September a 66–year–old Florida man traveling with his wife through North Carolina in a recreational vehicle (RV) was treated for a possible West Nile virus infection. It is not certain where the man may have contracted the virus, but the man noticed a dead bird under his RV and noticed many mosquitoes when he stayed several nights in Greenville. Tests performed by a private laboratory indicate that the man may have contracted the virus, but the State Public Health Laboratory will conduct further tests to confirm the preliminary results.

On Oct. 9 the North Carolina Public Health Laboratory reported that five new cases of West Nile virus have been found in animals. The cases include three crows and two horses found in four of the state's counties. West Nile virus was first detected in the state a year ago on Sept.17. The virus is transmitted to humans when a mosquito bites an infected bird and then bites a human. It is not known to pass directly from birds to humans or from human to human.

Chile—Girl Dies of Hantavirus Infection
A 4–year–old girl from Llico Bajo, Chile died of hantavirus infection after being admitted to the local hospital on Sept. 18 with a severe fever. The following Thursday a team from the Department of Environmental Programs visited the area in which the girl resided in order to collect samples and establish a possible zone of contagion.
[PROMED 09/29/01]


Vietnam—Dengue Hemorrhagic Fever
According to the Vietnamese Ministry of Health, the number of reported cases of dengue hemorrhagic fever (DHF) has increased considerably. As of mid–August over 18,700 people have been infected and 44 persons have died from the disease. Health officials have said that this is a 57 percent increase from the same time period last year. Most of the reported cases are from southern Vietnam, but the disease has spread to the central and northern provinces of Quang Binh and Nghe An. There have been 12 deaths of 2300 reported cases in An Giang province, 2200 cases reported in Binh Thuan province and 2170 cases reported in Phu Yen province. There is no vaccine or cure for dengue fever and the high death toll among reported cases is most likely due to the delay in seeking medical treatment.
[PROMED 09/24/01]

Japan—BSE Confirmed
On Sept. 13, the Veterinary Laboratories Agency (VLA), located in the United Kingdom, confirmed the National Institute of Animal Health (NIAH) diagnosis of bovine spongiform encephalopathy (BSE) in a dairy cow in Shiroi City, Chiba Prefecture. The source of infection is under investigation and the dairy farm where the case of BSE was found has been placed under supervision by Chiba Livestock Hygiene Service Center. Investigators are tracing animals kept with the infected cow and examining the feed used on the farm. Officials are also visiting feed mills and cattle farms in Japan to investigate practices in feed preparation and to examine other cattle for clinical signs of BSE infection.
[PROMED 10/02/01]

Australia—Echovirus Types 9, 13, and 30
The virus isolation laboratory at Westmead Hospital in Sydney, Australia reports an increase of echovirus types 9, 13, and 30. The lab has detected echovirus type 13 in 12 samples in the first seven months of 2001 when, previously, the virus was rarely isolated. Within the first six months of 2001, the lab has received 168 non–polio isolates, of which Echovirus type 9 was identified most frequently (32 percent of the isolates). In comparison, the highest number of isolations within a calendar year was 258. Additionally, but to a lesser extent, echovirus type 30 has increased in activity.
[PROMED 09/26/01]


Cambodia—Increase in Suicide Among Young Aids Patients
According to the Cambodian Aids Authority, approximately 170,000 people in Cambodia are infected with HIV. Government officials in Phnom Penh reported that the suicide rate among young AIDS patients has risen during the last three years such that the number of suicides during the first half of this year nearly match the total number of recorded suicides for 1999. This year 105 HIV positive men and women have committed suicide. Officials with the Cambodian Aids Authority have begun a public appeal to HIV infected persons in order to stop the suicides.
[PROMED 09/19/01]

UK—Plague Bacterium Genes Mapped
Scientists at Britain’s Wellcome Trust Sanger Center in Cambridge have mapped the 4,012 genes of the plague bacterium, Yersinia pestis strain CO92. Y. pestis has been responsible for three human pandemics and still poses a threat to human health due to drug resistant strains and its potential use as a biological weapon. In addition, up to 3,000 cases of bubonic plague are reported each year to the World Health Organization.

The researchers mapped a strain isolated from a US veterinarian who died of pneumonic plague when he contracted the bacterium from an infected cat in 1992. Julian Parkhill, the head of the research team, said in a telephone interview with Reuters that, “Having this data will without a doubt accelerate and facilitate subsequent research of the organism in terms of new drugs or vaccines.” The sequence of Y. pestis CO92 was
determined with collaboration from the London School of Hygiene and Tropical Medicine, The Imperial College, the London School of Medicine and Dentistry, and the Defense Science and Technology Laboratory in Porton Down.
[NATURE 2001;413:523𤯿 http://www.sanger.ac.uk/Projects/Y_pestis/; REUTERS 10/09/01]

2002 APEC Emerging Infections Network Meeting
A meeting organized by the APEC Emerging Infections Network will be held by invitation in winter, 2002 in Seattle. The meeting will bring disease alert and surveillance networks from the APEC community together to discuss possible cooperation among networks. Details on the meeting will appear in following bulletins.

2002 CDC Conference on Emerging Infectious Disease
The Center for Disease Control and Prevention (CDC) is hosting the International Conference on Emerging Infectious Diseases (ICEID) March 24—27, 2002 in Atlanta, Georgia. At the conference 2,500 public health professionals will come together to exchange scientific and public health information on global emerging infectious disease issues. The program will include plenary sessions and symposia with invited speakers,
presentations on emerging infections, and oral poster presentations. Featured topics include: surveillance, epidemiology, research, communication and training, bioterrorism, and prevention and control of emerging infectious diseases, both in the United States and abroad.
[CDC http://www.cdc.gov/iceid/]

4. Join the E–List and Receive EINet News Briefs Regularly
The APEC EINet list serve 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 emerging infections and the APEC Emerging Infections Network is available at http://www.apec.org/infectious.

Oct. 19, 2001

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