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Vol. IV, No. 20~ EINet News Briefs ~ Dec. 14 , 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 listserve

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


China (Canton) — Rotavirus
Over the past few weeks hospitals in China have been overcrowded due to an epidemic of rotavirus infection in infants. Untreated rotavirus infection is a major cause of infant mortality in underdeveloped countries, but there is currently no vaccine available for the virus. There is a short incubation period of 24㫈 hours along with a sudden onset of illness; predominantly watery diarrhea. Treatment is by oral, subcutaneous or intravenous rehydration, and is effective if begun without delay.
[Promed 12/04/01]


Chile — Hantavirus
Four new cases of hantavirus pulmonary syndrome in Chile have been confirmed, one of which was fatal. All cases occurred in rural areas of southern and central Chile. The agent causing hantavirus pulmonary syndrome in Chile is likely to be Andes virus. According to Health Minister Michelle Bachelet, hantavirus infection has caused 26 deaths this year in Chile. The number of infection this year, 71, is the highest since the disease first appeared in Chile in 1993. However, the percentage of deaths from infection has fallen from 60 percent in 1997 to 37 percent in 2001.
[Promed 12/11/01]

US (New Jersey) — West Nile Virus
A 75–year–old woman was the eighth state resident confirmed to have been infected with the West Nile virus (WNV) as of 9 Dec 2001. In mid–August the woman, who had a cardiac condition, was admitted to hospital with symptoms including fever, nausea and a headache. She had traveled to the West Coast of the United States and the New Jersey shore just prior to her hospitalization and often spent time outdoors. The Centers for Disease Control and Prevention (CDC) confirmed that the woman became infected this season. She is currently in good health.
[New Jersey Department of Health and Senior Services http://www.state.nj.us/health/index.html 12/05/01; Promed 12/12/01]


Gabon — Ebola
According to Reuters, the World Health Organization (WHO) reported on 8 Dec 2001 that there had been at least one case of Ebola virus in the Central African country of Gabon. There had been previous reports of 10 people who had died of a mystery illness and, according to a WHO officia,l 10 people had died in Gabon from a disease feared to be Ebola. The WHO also received reports of cases of suspected viral hemorrhagic fever, which includes Ebola, in a northeastern province of Gabon, Ogooue Iveindo, and had sent a team to investigate. In 1996 at least 66 people had died from Ebola in the same area of the country. Blood samples of the victims in Gabon have been sent to South Africa for tests.
In addition, another WHO official has reportedly said on 7 Dec 2001 that 28 people had died of hemorrhagic fever in the Democratic Republic of Congo. Doctors also feared that this outbreak might be Ebola. There is neither a known cure nor vaccine available for Ebola.

As of 11 Dec 2001, the World Health Organization (WHO) has received reports of 12 suspected cases of Ebola, including ten deaths from hemorrhagic fever. A laboratory in Gabon, the Centre International de Recherches Medicales de Franceville (CIRMF), has confirmed Ebola virus in one sample from a recovering case in Ogooue Ivindo Province.

The Gabon Ministry of Health has established a national task force for managing a response and an international team from WHO and its partners in the Global Outbreak Alert and Response Network arrived in Gabon on 11 Dec 2001 to assist the Ministry of Health. Assistance includes: coordination of an international response to the outbreak,
employment of disease control measures, identifying and monitoring cases and contacts, as well as supplying protective equipment. For updated information, visit http://www.who.int/disease–outbreak–news/index.html.
[Promed 12/11/01; Reuters 12/08/01; UNWIRE

Finland — BSE
On 7 Dec 2001 the first case of BSE in Finland was confirmed by the European Union (EU) reference laboratory. The infected cow had shown clinical signs of disorder and was immediately slaughtered. All bovine animals on the farm of origin, all cohort animals, and the progeny of the positive animal have been destroyed. The 6–year–old cow was born in Finland and the source of infection is not yet known.
[Promed 12/07/01]

European Union — Hepatitis A Vaccine Recall
Aventis Pasteur MSD, the European vaccines joint venture set up by Merck and Aventis, announced the recall of all stocks of VAQTA hepatitis A vaccine due to concerns that it might not be potent enough. According to a spokesman for the joint venture, only some of the syringes are not sufficiently potent. However, difficulty in identifying affected syringes led to the decision to recall every batch. The firm is withdrawing all pre–filled syringes of VAQTA vaccine for adults and VAQTA K for children. According to Dr. Pat Troop, the deputy chief medical officer of the Department of Health in the United Kingdom (UK), the VAQTA vaccine products are not being recalled for reasons of safety. It is possible that patients who have received these vaccines since their introduction to the market in 1997 and 1998, respectively, may not have adequate and continuing protection against infection with hepatitis A. The Commercial director of Aventis Pasteur MSD's German unit, Ralf Ehret, reportedly said that 532,000 doses of the vaccine were sold in Europe in 2000. As a precautionary measure, the UK Department of health has advised for anyone at continuing risk of hepatitis A who has been immunized with VAQTA products should be immunized with another hepatitis A product.
[Promed 12/09/01; UK Department of Health Chief Medical Officer's urgent communication http://www.doh.gov.uk/cmo/cmo01_16.htm]


US (Minnesota) — Unexplained Deaths
Three unexplained deaths after knee surgery were reported on 7, 11, and 16 Nov 2001. Blood cultures obtained from one of the patients before his death grew a clostridial species that was identified by biochemical and molecular typing at the Minnesota Department of Health (MDH) and the Center for Disease Control and Prevention (CDC) as Clostridium sordellii. Blood cultures from the other two patients did not yield growth of any bacteria and no Clostridium species was identified in their autopsy tissues. The cause of death in these two patients remains unknown.

No cases of C. sordellii infection associated with severe hemodynamic collapse or death in patients recently undergoing knee or large joint surgery have been identified. Because infection associated with contaminated graft tissue is a known but uncommon complication of allograft surgery, MDH, CDC, and the Food and Drug Administration (FDA) began an investigation to determine whether the allograft might have been the source for the C. sordellii found in the patient. The CDC conducted preliminary cultures of non–implanted knee tissue from the same donor source as the allograft used in the deceased patient, but have not found growth of Clostridium species. Reports of other allograft recipients infected with clostridial species have been received at CDC and are being investigated. As a result of the investigation the MDH lifted a moratorium on elective knee surgery on 25 Nov 2001.

US — Anthrax
As of 5 Dec 2001, a total of 22 cases of anthrax have been identified. Eleven were confirmed as inhalation anthrax and seven were confirmed as cutaneous. There have been four suspected cases of cutaneous anthrax. A 54–year–old man who worked at a postal facility in New Jersey (NJ) previously had been classified as having a suspected case of cutaneous anthrax, but the illness no longer meets the CDC surveillance case definition for anthrax.

Prospective and retrospective surveillance in Connecticut has not identified any additional cases of anthrax and the direct source of exposure for the case of inhalation anthrax in the 94–year–old Connecticut woman remains unknown. However, through environmental sampling, B. anthracis spores were identified in three high–speed mail sorters in the postal processing and distribution center in Wallingford, CT. This center serves Oxford, the town where the 94–year–old woman resided, and receives mail from several postal distribution facilities known to have been contaminated by B. anthracis spores.
[Promed 12/06/01; MMWR 2001 50(48); 1077ץ (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5048a1.htm)]
Japan — BSE
According to the Health, Labor and Welfare Ministry, a Holstein dairy cow born in Gunma prefecture and slaughtered in a different prefecture was found infected with BSE on 30 Nov 2001. On 2 Dec 2001 a ministry's panel of experts confirmed the third case of Bovine Spongiform Encephalopathy (BSE). The three BSE infected cows were born between March and April 1996 and were fed the same kind of powdered milk produced at the same Gunma prefecture factory.

Japanese officials found a fourth suspected case of mad cow disease on 11 Dec 2001. According to officials, a 40–month–old Holstein cow slaughtered at a meat processing center in Tsuyama tested positive in an initial examination. Further tests were planned at the Kobe Quarantine office in western Japan and an agricultural and veterinary university in Hokkaido. Japan is the only Asian country where herds have been affected by BSE.
[Promed 12/02/01; 12/12/01]


World AIDS Day
According to estimates by the World Health Organization (WHO) and UNAIDS (Joint United Nations Program on HIV/AIDS), at the end of 2001 a total of 40 million adults and children will be living with HIV/AIDS worldwide. It was also estimated that 5 million people became infected with HIV/AIDS in 2001. As of Nov 25 2001 the number of AIDS cases officially reported to WHO is 2,784,317.

The slogan for the second year of a two–year campaign to create a continued focus on the role of men in the AIDS epidemic is "I care... Do you?". This campaign culminates on World AIDS Day, a day founded by the World Health Organization in 1988 held on 1 Dec of every year. The campaign aims to involve men, particularly young men, more fully in the effort against AIDS and to involve leaders in response to the HIV epidemic.

Prior to World AIDS Day Peter Piot, the Executive Director of UNAIDS, launched the AIDS Epidemiological Report on 28 Nov 2001 in Moscow. Official UNAIDS engagements for World AIDS Day included: the participation of Pet Piot in the Ukrainian World AIDS Day events; a nationwide broadcast of a professional bicycle race in the city centre of Hanoi, Viet Nam with the cyclists dressed in T–shirts and caps promoting condom use; a march launched by the President Megawati Sukarnoputri of thousands of students from Freedom Square through the city in Indonesia; the airing of a TV campaign in Kyrgyzstan, "Leaders of Kyrgyzstan against AIDS", funded by UNESCO; the First National Meeting of People Living with HIV/AIDS at a vigil in the Grand Plaza Espana in Santo Domingo, Dominican Republic; and a Conference of Chiefs in Ghana on the importance of HIV/AIDS campaigns and the need for their involvement under the theme "Breaking the Silence". Many other events occurred worldwide on 1 Dec 2001. In addition, the US National Institute of Health (NIH) has set up a World AIDS Day Web site that details HIV/AIDS research activities sponsored by NIH.
[Associated Press 11/29/01; NIH

Merck Cuts Drug Prices in China
According to a company statement released 30 Nov 2001, the Chinese arm of Merck Sharp and Dohme (MSD) will cut the price of HIV/AIDS drugs Crixivan and Stocrin by two–thirds beginning in December. Official figures indicate that China currently has 600,000𤴐,000 HIV cases and the United Nations (UN) has predicted that the number could reach 10 million by 2010 if the crisis is not quickly addressed.
[UNWIRE http://www.unfoundation.org/unwire/2001/12/03/current.asp#22280]

Global Outbreak Alert and Response Network Meeting 2001
On 29 Nov 2001 the "Global Outbreak Alert and Response Network Meeting" held in Geneva brought together over 100 infectious disease professionals from around the world to discuss the strategies direction of Global Health Security: Epidemic Alert and Response. The meeting began with a presentation entitled "Development in Global Health Security" by Dr. Rodier, Director of CSR (Communicable Disease Surveillance and Response), followed by "Network Development and Operations" by Dr. Ryan, "Event Management System" by Dr. Taniguchi, "Communication Protocol" by Mr. Drury, and "Logistics" by Mr. Hardy. During the two–day meeting, participants reviewed and actively discussed the drafts of "Guiding Principles for International Outbreak Alert and Response" and "Structure of the Network". In addition to the main meeting, a side meeting was held to discuss infectious disease networks in Asia. The meeting ended with "Future Development" presented by Dr. Heymann, Executive Director for Communicable Disease, WHO. For more information on the Global Outbreak Alert and Response Network, please visit the following URL: http://www.who.int/emc/surveill/index.html

International Congress of Infectious Disease
On 11㪦 March 2002, the International Society for Infectious Diseases (ISID) will hold the 10th International Congress of Infectious Diseases (ICID) in Singapore. The meeting will bring together physicians, scientists, public health officials, and others interested in infectious diseases from over 100 different countries to discuss new approaches for the understanding and control of infectious diseases. Plenary speakers will include Nicholas White, Charles Weissman, Martin Blaser, Ruth Bishop, and Francis Waldvogel. Abstracts submission has been extended to 15 Dec 2001.
[ISID http://www.isid.org/10th_icid/]

Malaysia — Mandatory HIV Testing
On 13 Nov 2001, the state government of Johor implemented a fatwa, or Islamic religious decree, requiring Muslim couples to test for HIV in order to prevent the virus from being passed on to children. According to the Johor state fatwa, couples must be tested in state hospitals three months before marriage. However, if a test shows that a prospective bride or groom has HIV/AIDS, they can still go ahead with their wedding. Marina Mahathir, president of the Malaysian Aids Council, said Johor's move was inconsistent with Malaysia's participation in international efforts to reduce stigma and discrimination against HIV/AIDS patients. The World Health Organization (WHO) representative for Malaysia said it was not ethically justified and had a number of drawbacks such as possible false results which would be traumatic for couples and high costs for the state. As of April, 40,049 people in Malaysia were confirmed HIV–infected with nearly 5,000 new cases detected each year. Johor accounted for about 20% of new cases detected annually.
[Associated Press 11/28/01]

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.

Dec. 13, 2001

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