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Vol. IV, No. 19 ~ EINet News Briefs ~ Nov. 30, 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. Journal articles
  5. How to join the EINet listserve

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


Japan — Bovine Spongiform Encephalopathy
According to the Japanese government, the second case of bovine spongiform encephalopathy (BSE) in the country has been confirmed. The infected cow was discovered during a nationwide screening of all cows at a meat inspection center in Hokkaido, northeastern Japan. Japan's first case of BSE, found in Chiba Prefecture, was confirmed by the Ministry of Agriculture, Forestry and Fisheries on 22 Sept 2001. Beginning 18 Oct 2001, the Health Ministry began a nationwide screening of all cows for human consumption.
[Promed 11/23/01]

China (Guangzhou) — Pork Poisoning
The biggest pork–poisoning incident of South China's Guangdong Province took place in Heyuanon on 7 Nov 2001. About 500 people were suspected to have eaten poisonous pork purchased from local bazaars. Symptoms of the poisoning included vomiting, headache, and a rapid heartbeat. The illness is only life–threatening if hospital treatment is not received in time. Victims are said to be in stable condition or recovering in local hospitals and no deaths related to the cases have been reported.

Heyuan government banned sales of pork in the whole city for three days, set up a task force in order to investigate the cause of the poisoning, and secured all pork suspected of being poisonous. On 11 Nov 2001, six suspects who were accused of producing or selling poisonous pork in Heyuan, China's Guangdong Province, were arrested and questioned by local police. Three of the suspects were owners of private pig–raising companies and were found to have fed their pigs with poisonous feedstuff. Farmers used the poisonous feedstuff in order to increase the percentage pig muscle, but it is dangerous to human health. Three other suspects were accused of knowingly selling pork raised on the poisonous feedstuff.

Health Minister Zhang Wenkang has urged for improvements in the inspection system and pushed for frequent checks on every part of the food production process, including planting, breeding, production, processing, storage, transportation and sale.
[Promed 11/17/01, Associated Press 11/09/01]

Philippines —– Anthrax
According to the Department of Health in the Philippines, two separate incidents of human anthrax involving nine human cases are being monitored in Barangay Matibag Banna, Ilocos Norte. The National Epidemiology Center and Research Institute for Tropical Medicine determined that the cases became ill on 2 Oct 2001 and 7 Nov 2001.

On 2 Oct 2001, six people developed signs consistent with cutaneous anthrax after a dead carabao was butchered and eaten by townsfolk. On 7 Nov 2001 three more people developed skin lesions after another dead carabao was butchered and eaten. A third carabao died on 19 Nov 2001 and was not butchered, but was dehorned. The horns of the third carabao were tested for anthrax and preliminary test results indicate the presence of Bacillus anthracis. At the time of investigation, all nine patients had self–medicated with various antibiotics and the skin lesions had healed.
[Promed 11/24/01]


Canada — Organic Beans Recall
The Canadian Food Inspection Agency is warning the public not to consume nine varieties of Green House brand organic bean products due to possible Clostridium Botulinum contamination. C. Botulinum produces toxins causing a life–threatening illness, botulism, in humans. Products include green lentils, chick peas, white kidney beans, bean salad, lima beans, pinto beans, red kidney beans, red kidney beans in tomato sauce, and spicy red kidney beans in tomato sauce. These products, which are manufactured by Lockwood's, Italy in Concord, Ontario, are known to have been distributed in Ontario and may have been distributed throughout Canada. No illnesses associated with the consumption of these products have been reported.
[Promed 11/14/01]

Canada — E. coli Outbreak
As of 26 Nov 2001, 12 cases of Escherichia coli O157:H7 phage type (PT) 32 have been confirmed in Southern Ontario. Cases include two people in the Middlesex–London area and 10 other cases in Ottawa, Kingston, Toronto, York Region, Simcoe County, and Windsor. None has died. The source of the outbreak is unknown, but health officials say it is unlikely that the infections were caused by contaminated tap water. The limited number of cases and their wide geographic spread make sources such as contaminated food and drink seem more likely.
[Promed 11/26/01]

US (Minnesota) — Unexplained Deaths
As a precautionary measure, the Minnesota Health Department has asked all Minnesota hospitals and surgery centers to cease performing any elective knee operations for a one–week period so that state health officials can investigate the deaths of three male surgical patients. A 23–year–old patient had knee surgery at St. Cloud Hospital on 7 Nov 2001 and died on 11 Nov 2001. A 78–year–old patient had knee surgery at the same hospital on 9 Nov 2001 and died on 11 Nov 2001. The third man, a 60–year–old patient, had knee surgery at Douglas County Hospital in Alexandria on 13 Nov and died on 16 Nov 2001. The three men did not have the same procedure done. They had previously been healthy and became ill up to several days after having surgery. According to the Minnesota Health Department, symptoms of all three cases strongly suggested an infection.
[Promed 11/22/01; Minnesota Department of Health http://www.health.state.mn.us/news/pressrel/knee.html]

US — West Nile Virus
Three cases of human West Nile Virus (WNV) encephalitis or meningitis have been reported during the period of
7 – 13 Nov 2001. Two cases occurred in New York and one case occurred in Louisiana. During 2001, a total of 45 human cases of WNV encephalitis or meningitis have been reported. During this time period, WNV infections were also reported in 266 crows, 15 other birds, and six horses.

A 44–year–old man was the first person in Alabama to die from WNV infection, state health officials said on Friday 16 Nov 2001. The man, who was not identified, died on 30 Oct 2001 after becoming infected in late August. The man is the fifth person in the United States to die from the mosquito–borne virus this year.

In addition, blood samples from three horses in Virginia have recently tested positive for West Nile Virus (WNV). The United States Department of Agriculture (USDA) National Veterinary Services Laboratory has confirmed the results. Six horses have now tested positive for WNV in Virginia. The first case reported in the state occurred in September 2001.
[MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5045a4.htm; Promed 11/18/01; 11/23/01]

Chile — Anthrax
On 19 Nov 2001 Chilean authorities announced that they had found anthrax in a letter postmarked from Florida. Although the letter was postmarked from Florida, it appeared to carry a Swiss postage stamp. The Public Health Institute confirmed the presence of anthrax spores in the letter sent to a private office in Santiago. The Health Minister, Michelle Bachelet, has said that thirteen people who may have been exposed to the anthrax are taking antibiotics, but that so far no one has shown signs of infection.
[Promed 11/19/01; Associated Press 11/23/01]


US (Connecticut, Washington D.C.) — Anthrax
A 94–year–old Connecticut woman, Ottilie Lundgren, died of inhalation anthrax on 21 Nov 2001, five days after being admitted to hospital. Officials have not determined how the woman contracted the disease because she had no known connection to government offices, postal facilities, or news outlets. Preliminary testing of Lundgren's home in Oxford found no signs of the bacteria. Investigators from the Center of Disease Control (CDC) also tested two post offices and the woman's church for anthrax spores, but found no positive results. The strain of anthrax that killed the elderly woman was similar to strains found in other recent cases and, therefore, the Federal Bureau of Investigation (FBI) has begun a criminal investigation of her death. Investigators have sealed off the woman's house and are questioning friends and family members in order to trace her recent movements. She is the fifth anthrax–related fatality since several anthrax–laced letters began appearing in the mail in October.

In addition, a letter laced with anthrax was sent to Vermont Democrat, Senator Patrick Leahy. The letter was discovered 16 Nov 2001 in a set of unopened mail sent to Capitol Hill and quarantined since the discovery of an anthrax–contaminated letter to Senate Majority Leader Tom Daschle on 15 Oct 2001.
[Promed 11/22/01; Associated Press 11/26/01]

US (CONNECTICUT) — Poultry Avian Influenza Correction
It was reported in the previous bulletin that the state agency said avian influenza virus was found in chickens on a farm raising broilers. Antibodies to avian influenza were detected in broiler chickens from a multi–age operation in Scotland, Connecticut. However, no influenza virus was isolated.
[Promed 11/19/01]


WHO Opens Office in Pyongyang
The World Health Organization (WHO) has opened up an office in North Korea's capital, Pyongyang. A WHO spokesman in Beijing is reported to have said that North Korea's health care system was near collapse. According to WHO officials, the mortality rate there has risen by more than 35 % in recent years because the country suffers from harsh winters, food shortages, and malnutrition. The WHO has had an emergency liaison office in the North since 1997, but a representative office, which has better resources and staffing, will permit the WHO to expand its work as well as focus on longer–term issues such as technical collaboration and health policy development. The WHO has previously been involved in emergency programs in North Korea to aid in re–emerging diseases such as tuberculosis, polio and malaria as well as contribute in training and technical support.
[WHO http://www.who.int/inf–pr�/en/pr2001㫊.html]

WHO Global Outbreak Response Meeting
The World Health Organization convened its " Global Outbreak and Response" meeting in Geneva on 29㪶 Nov 2001. The group of international experts will work towards a common agenda for reinforcing global efforts at epidemic prevention, surveillance and response. In addition, an evening side–meeting focusing on Asia will be held.


Gene May Protect Against Creutzfeldt–Jakob Disease
According to a paper by John Collinge of Imperial College School of Medicine in London and his colleagues, people who lack the gene DQ7, which is involved in immune responses, may be three times more likely to suffer from variant Creutzfeldt–Jakob disease (vCJD). vCJD is thought to occur when people are exposed to misshapen prion proteins from cows with bovine spongiform encephalopathy (BSE) or 'mad cow disease'. The gene, however, does not seem to protect against classical Creutzfeldt–Jakob disease(CJD). Of the 50 British, caucasian patients with vCJD in the study, only 12% have a gene called DQ7. In contrast, 36 % of the normal British, caucasian population has the gene. Although the findings do not identify any immediate therapy for the disease they could be helpful to researchers looking for treatments and aid in understanding host susceptibility to infection by BSE prions. However, due to the small sample size of the study, the results are to be interpreted with caution.
[Jackson GS et al. HLA–DQ7 antigen and resistance to variant CJD. Nature, 414, 269 – 270, (2001)]

Hemoglobin C Protects Against Malaria
A recent case–control study by David Modiano and colleagues shows that a mutant form of hemoglobin is associated with a reduction in risk of clinical malaria. Hemoglobin is the oxygen–carrying molecule in red–blood cells. According to the 4,348 subject study, there is a 29 % risk reduction in HbAC heterozygotes (P = 0.0008) and a 93 % reduction in HbCC homozygotes (P = 0.0011). Hemoglobin C is common in malarious areas of West Africa where the Mossi group lives, but is rare outside this ethnic group. Researchers hope that understanding the effect of Hemoglobin C will lead to treatments for malaria.
[Modiano D, Luoni G, Sirima BS. et al. Haemoglobin C protects against clinical Plasmodium falciparum malaria. Nature, 305𤬤, (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.30, 2001

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