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Vol. IV, No. 17 ~ EINet News Briefs ~ Nov. 5, 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. Notices
  3. Journal articles
  4. How to join the EINet listserve

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


China – Chinese Army to Test New Recruits for HIV
China's People's Liberation Army will begin testing new recruits for HIV this year. The tests will begin in three districts of Beijing and expand to include all new recruits. According to unofficial estimates the number of HIV–infected people is near one million and according to state media reports, the annual increase in HIV infections have increased by 30 percent over the past several years. The government has issued a five–year plan to keep the annual increase in infections below 10 percent.
[Associated Press 10/24/01]


Canada – Botulism Food Contamination
The Canadian Food Inspection Agency (CFIA) and INDIANLife Food Corporation are cautioning the public about consumption of INDIANLife brand Roti Wraps and six varieties of Naan Breads. These products should not be consumed because it is possible that they may support growth of bacteria causing botulism in humans. The manufacturer, INDIANLife Food Corp., Burnaby, British Columbia, is voluntarily recalling the affected products from the market. The products have been distributed in British Columbia, Alberta, Saskatchewan, and Manitoba. At this time there have been no reported illnesses associated with the consumption of these products and the CFIA is monitoring the effectiveness of the recall.
[PROMED 10/30/01]

Australia– Vancomycin–resistant Enterococcus

A Vancomycin Resistant Enterococcus outbreak at Royal Perth Hospital in Western Australia involved 134 patients. Three were infected and screening established that 131 were colonized. According to a clinical microbiologist at the hospital, the outbreak has peaked and a small number of colonized patients are being detected after active infection control and antibiotic restriction program.
[PROMED 10/25/01]


World Bank and WHO Global Tuberculosis Plan
The World Health Organization (WHO) and the World Bank have launched a global plan to cut tuberculosis (TB) infection and death rates in 22 targeted countries that account for 80 percent of the eight million TB infections contracted worldwide. The plan is estimated to cost US$8.2 billion for implementation and US$10.2 over the next five years. Of the 34 million TB cases expected in the target countries by 2005, the plan is anticipated to detect and treat 21.5 million. The 22 countries would be responsible for developing their own anti–TB strategies with the help of international agencies. In particular, the target countries are urged to develop their own methods of instituting directly observed therapy short–course programs. Currently, the worldwide funding from governments and private donors provide only half the needed amount for fighting TB infections. Officials plan to find donors for the program among wealthy industrialized countries in Asia, Europe, and North America.
[Reuters Health 10/24/01, 10/23/01]


US (Florida, New York, Washington, D.C.) – Anthrax Cases
Beginning Oct. 3, 2001, the US Centers for Disease Control and Prevention (CDC) and state and local public health authorities have been investigating cases of bioterrorism–related anthrax. As of Nov. 2, 2001, the CDC has confirmed 17 cases of anthrax in the United States, including: two cases of inhalation anthrax in Florida; four cases of cutaneous anthrax and one case of inhalation anthrax in New York City; three cases of cutaneous anthrax and two cases of inhalation anthrax in New Jersey; and five cases of inhalation anthrax in Washington, DC. Suspected cases include three cutaneous cases in New York City and one cutaneous case in New Jersey. Case confirmation is based on a rigorous case definition that was published in the CDC's Morbidity and Mortality Weekly Report (MMWR) on Oct. 19, 2001. On Oct. 31, 2001 an additional suspected case of cutaneous anthrax in New Jersey was reported. Officials have said that anyone thought to have been at risk for anthrax exposure is being offered antibiotics. Current treatments of anthrax exposure include ciprofloxacin or doxycycline as initial therapy.

The source of the majority of the anthrax cases have been attributed to mail delivery to government or media organizations, however, there have been two anthrax cases detected in women with no connection to the postal service, government or media. These include a 51–year–old accountant in New Jersey and a 61–year–old hospital worker in New York.

Four persons have died from the bacteria. The 61–year–old hospital worker, Kathy T. Nguyen, who tested positive for inhalation anthrax in New York died Oct. 31, 2001. The woman worked in a hospital supply room, which may have shared space with or was in close proximity to the hospital mailroom. New York Mayor Rudolph W. Giuliani has said that environmental samples from the hospital have come back negative and no one else in the workplace is showing signs of the disease. In addition, two male postal workers in Washington, DC, aged 55 and 47, died on
Oct. 21 and Oct. 22, 2001, respectively. The fourth death, of a 63–year–old photo editor from Florida, was reported in the previous bulletin.

Traces of anthrax have been found in federal buildings, including congressional office buildings, the Supreme Court, the State Department and the health department as well as mail–processing facilities for the CIA, Department of Veterans Affairs Medical Center, and the White House. In addition, several postal facilities were found to be contaminated with anthrax. Investigations into the sources of anthrax contaminations are still being carried out.

On Oct. 27, 2001, the CDC posted recommendations for handling suspicious packages or envelopes.
[PROMED 10/19/01 – 10/30/01; CDC 10/30/01; Reuter 10/31/01; MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5041a1.htm]

As of Nov. 2, 2001 the total number of CDC laboratory confirmed cases of dengue fever contracted in Hawaii is 74. On Maui there have been 56 cases, four cases on Kauai, 13 cases on Oahu and one case on the Hawaii. Two suspected cases on Maui and three suspected cases on Oahu have tested positive on preliminary screening tests. In addition, there are 310 reports of illness under investigation.
[PROMED 11/03/2001]


A meeting organized by the APEC Emerging Infections Network, "The Network of Networks Meeting", will be held by invitation from Jan. 28, to Jan. 30, 2002 in Seattle, Washington, US. The meeting will include participation by key individuals working in electronic networking from around the region, representatives from the World Health Organization, and interested national partners identified at the APEC Industry, Science and Technology Working Group (ISTWG) meeting. Individuals will convene to discuss the development of an integrated disease surveillance and alert network in the Asia Pacific Region. Aims include enhancing geographic coverage of communication about infectious disease, assuring accuracy and completeness of content about emergent infectious disease, and assuring timeliness of information access about epidemic disease activity in the region. For more information please contact Alicia Silva at: apecein@u.washington.edu.

A side meeting on infectious diseases convened in Penang, Malaysia on Oct. 10, 2001 to review a recently completed APEC infectious disease strategy and to begin planning for its implementation. A total of 19 delegates from Australia, Canada, the United States, Hong Kong China, Chinese Taipei, Korea, and Malaysia as well as two invited World Health Organization (WHO) officials participated the meeting. The side meeting included an overview of the history of cooperation on emerging infectious diseases, a presentation from WHO, and a discussion about future actions. The meeting went well and will feed into future planning and action related to the APEC infectious disease strategy.

The World Health Organization (WHO) has stated that it is reconsidering the use of the smallpox vaccine in instances where smallpox virus is deliberately introduced to a population. However, the guidance on smallpox vaccination states that vaccination of entire populations is not recommended. This is due to the high incidence of adverse side–effects with the vaccine, including death, and the ability of the vaccine to prevent smallpox after viral exposure. WHO recommends the use of the vaccine for people who are at risk of exposure to smallpox, including health and civil workers. It would also be used in a search and containment exercise if an outbreak were to occur. In light of the recent anthrax cases in the US, WHO recommends that governments verify their level of preparedness to handle diseases, including smallpox. At present, there are no indications of possible intended use of smallpox virus.
[WHO http://www.who.int/inf–pr�/en/state2001㪨.html; PROMED 10/22/01]


Two Salmonella bacteria, S. typhi and S. typhimurium, have been sequenced recently. S. typhi causes typhoid in humans, a disease that infects 16 million people each year and kills 600,000, while S. typhimurium is a leading cause of human gastroenteritis. The team investigating S. typhi (CT18) sequenced its 4,809,037–base pair (bp) genome using an antibiotic resistant strain isolated from 9–year–old Vietnamese girl suffering from typhoid. Researchers investigating S. typhimurium strain LT2 sequenced the 4,857–kilobase (kb) chromosome and 94–kb virulence plasmid. Sequencing of the genomes may lead to new ways to diagnose, treat and vaccinate against both diseases. In addition, a comparison of sequences will most likely identify reasons that the closely related bugs behave so differently..
[Nature 413, 848𤵄(2001); Nature 413, 852𤵈(2001)]

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 apec–ein@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://www.apec.org/infectious.

Nov. 5, 2001

Contact us at apecein@u.washington.edu
© 2001, The University of Washington