IV, No. 20~ EINet News Briefs ~ Dec.
14 , 2001
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In this edition:
- Infectious disease information
- How to join the EINet listserve
1. OVERVIEW OF INFECTIOUSDISEASE INFORMATION
Below is a semimonthly summary of AsiaPacific 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.
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.
US (New Jersey) West Nile Virus
A 75yearold woman was the eighth state resident confirmed to have
been infected with the West Nile virus (WNV) as of 9 Dec 2001. In
midAugust 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]
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
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/diseaseoutbreaknews/index.html.
[Promed 12/11/01; Reuters 12/08/01; UNWIRE
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 6yearold cow was
born in Finland and the source of infection is not yet known.
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 prefilled 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
. 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
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 nonimplanted 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.
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 54yearold 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 94yearold Connecticut
woman remains unknown. However, through environmental sampling, B.
anthracis spores were identified in three highspeed mail sorters
in the postal processing and distribution center in Wallingford, CT.
This center serves Oxford, the town where the 94yearold 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)]
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 40monthold 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 twoyear 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 Tshirts 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
[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 twothirds 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.
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 twoday
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.
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 HIVinfected with
nearly 5,000 new cases detected each year. Johor accounted for about 20%
of new cases detected annually.
[Associated Press 11/28/01]
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