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Vol. V, No. 04~ EINet News Briefs ~ Feb. 22, 2002

****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—Avian Influenza
Avian Influenza H5N1 has been confirmed in chickens in Hong Kong. As a result of the recent avian influenza outbreak, the third recurrence in five years, approximately 860,000 chickens will have been slaughtered by 22 Feb 2002. The virus is from the same H5N1 family as the 1997 influenza that passed to humans, but is not the same strain. On 08 Feb 2002 Hong Kong's Department of Environment scheduled a one–day shutdown on poultry sales in order to prevent the spread of the avian flu by disinfecting stalls. Chicken sellers in markets across Hong Kong used blowtorches and high–powered water jets to eradicate the virus. The slaughter of chickens in farms and markets as a result of the epidemic is expected to cost at least five million HK dollars. The outbreak originated at a Kam Tin farm and spread to many other farms. A total of 25 farms have had cases of the virus in the current outbreak and Hong Kong's remaining 121 chicken farms are thought to be "safe". The government has ordered an investigation into the outbreak.
[Promed 02/10/02, 02/09/02; Associated Press 02/20/02]

Indonesia (Banjarnegara) — Malaria
An outbreak of malaria in November and December of 2001 that spread from Banyumas and Cilacap to the Central Java regency has killed at least 23 people in Banjarnegara. According to reports, hundreds have been infected and villages of Kalitengah, Kaliajer, Merden, Karananyar, and Purwonogoro regencies have been affected. The total number of deaths in Kalitengah has reached 300.
[Promed 02/11/02]

Indonesia (Jakarta) — Fear of Diarrhea and Dengue Hemorrhagic Fever Epidemic
Health officials in Jakarta, Indonesia are worried about a possible diarrhea and dengue hemorrhagic fever epidemic due to recent storms across Indonesia. Torrential rains have created landslides and the worst flooding in decades, ruining crops, causing many to leave their homes, and killing at least 125 people. Reports stated on 14 Feb 2002 that at least 16 people, mostly children, have died over the past few weeks of illnesses brought on by the heavy showers. These include diarrhea, dengue fever, respiratory problems, malaria and hemorrhagic fever. According to reports, floods rose to approximately 10 feet in some areas on 14 Feb 2002, carrying piles of rotting garbage into homes and contaminating water supplies. The diseases of concern can also spread to those whose homes have not been flooded. Officials are warning of more rain throughout Indonesia until the end of February.
[Reuters Health Online 02/14/02]

US — Unexplained Rash
School children from seven states around the United States have broken out in a rash of unknown causes. Health investigators believe the rash, which is not considered to be a serious health risk, is due a new or unidentified virus. Children in Pennsylvania, New York, West Virginia, Ohio, Oregon, and Washington state reported rashes on various parts of their bodies and as a result some schools were temporarily closed. The simultaneous occurrence of an unknown rash in different pars of the country has doctors baffled. An environmental company in Quakertown Community School District in Pennsylvania collected air and water samples and examined carpets, floor mats, vacuum bags, and clothing, but all tested negative for contaminants. Explanations for the rashes differ among school districts and some include an overactive ventilation system, a mutation of fifth disease (erythema infectiosum), an unidentified virus, or "hysteria". Fifth disease, which is more common among children, is manifested as a blotchy rash on the cheeks and spreads to the extremities. It is usually accompanied by fever and malaise and is caused by a parvovirus.
[Promed 01/16/22]


India (Chandigarh) — Suspected Plague Outbreak
As of 19 Feb 2002, four people have died and at least 12 more cases have been reported due to a suspected outbreak of plague in the town of Rohru in India's northern state of Himachal Pradesh. A special team from the National Institute of Communicable Diseases (NICD) was investigating the outbreak and tests were being carried out to determine if the deaths were caused by the plague. The symptoms of pneumonic plague, anthrax and any other respiratory infection are similar, so the final diagnosis cannot be made until test results are determined. Symptoms of pneumonic plague include high fever, chills, cough, breathing difficulty, body pain, and blood in sputum. Incubation in humans is approximately one to seven days after infection.

Prior to the determination of the official cause of death, doctors at the Indira Gandhi Medical College in Shimla believed that the outbreak was due to pneumonic plague. Tests carried out by the NICD have confirmed the presence of Yersinia pestis in clinical samples. Himachal health authorities believe the cause of infection might have been contact with a wild animal because those affected had gone hunting prior to the onset of disease.

As a preventive measure, the government distributed approximately 675,000 antibiotic capsules to 17,000 people and is keeping the area under surveillance. Other measures taken include the fumigation of affected villages and transport vehicles; a public education campaign; and further administration of chemophylaxis to residents of neighboring villages and health professionals. The Health Minister, J.P. Nadda, has said no new cases of illness related to the outbreak have been reported as of 08 Feb 2002 and according to the NICD, the outbreak is under control. Local transport has resumed after it was temporarily suspended last week. However, schools and colleges in the area remained closed and government doctors are forbidden from going on leave. In 1994 more than 50 people in western India died due to a plague outbreak.
[Reuters 02/15/02 02/18/02; World Health Organization 02/20/02; Promed 02/17/02]


Argentina to Cut Pharmaceutical Costs
Argentina's Ministry of Health, Dr. Gines Gonzalez Garcia, announced that he is planning to begin a drug policy allowing pharmacists to substitute the higher cost prescribed medications with their generic drug equivalent. The intent of the policy, which would decrease the cost of medicine, is said to be the protection of patients. Pharmaceutical companies have said that the reason medicine costs rose 10% to 20% during the week of 11 Feb 2002 was because of the importation of prescription drugs and the drop in peso value. Generic drugs in Argentina are locally manufactured copies of patented drugs that can be sold under another name. Manufacturers of the low–cost drugs are not required to verify the bioequivalence or bioavailability of the generic drug in comparison to the original one. On 02 Feb 02, President Eduardo Duhalde said that the Health Ministry and the Army would produce approximately 20 different generic products to be delivered in the health centers that needed them most. News reports have stated that scientists of the Institute of Biology and Experimental Medicine in Buenos Aires and a local pharmaceutical company will receive a $2,000,000 credit from Nation Bank to start producing human insulin for the first time in the country.
[Reuters Health Online 02/15/02]

World Health Day
The World Health Organization (WHO) has planned events for World Health Day 2002; an annual event held on 07 April and created by the World Health Organization to emphasize public health issues of worldwide concern. The Director–General of the WHO, Dr. Gro Harlem Brundtland, has announced that the theme of World Health Day 2002 will be "Move for Health". Several events will take place worldwide in cities such as Cairo, Washington D.C., Sao Paulo, Madrid and Geneva. More information can be found at: http://www.who.int/world–health–day/index.en.shtml.

APEC Infectious Disease Side Meeting
Public health professionals will meet in the US in March 2002 for the second International Conference on Emerging Infectious Diseases (ICEID). In addition to the ICEID meeting, a side meeting will be held in Atlanta, Georgia on 24 March 2002 from
12נ p.m. An agenda will be available within the next few weeks and details of the side meeting will be provided in a subsequent bulletin.

Information on APEC Network of Networks Meeting 2002
Information on the APEC Network of Networks meeting that convened in Seattle, Washington on 28㪶 Jan 2002 will be available through the APEC website on 4 March 2002. The website will contain a meeting agenda with links to slide presentations, information on presenters, a participant list and an executive summary. A direct URL will be available next bulletin (8 March 2002).


Malaria Genome Sequence
An international team of researchers, including the Sanger Centre in the UK, the Institute for Genomic Research (TIGR) in the US, the US Naval Medical Research Center (NMRC), and Stanford University in the US, is close to completing their sequencing of the genome of Plasmodium falciparum, a malaria parasite. The sequencing project began six years ago and results are expected to be published in four to six months. Most of the P. falciparum sequence is currently available in public databases. The same group is investigating other Plasmodium species and is expecting results before the end of 2002. In addition, a separate international team is planning on publishing the genome sequence of Anopheles gambiae, an important malaria mosquito.
[Enserink M and Pennisi E. Researchers Crack Malaria Genome. Science 2002;295:1207]

Antimalarial Drugs
An article published in the 15 Feb 2002 edition of Science magazine details a new class of inexpensive antimalarial drugs that are showing promise in animal trials. The international team of researchers was led by biochemist Dr. Henri Vial of the University of Montpellier II and the Centre National de la Recherche Scientifique (CNRS). The new compound called G25 targets the third stage of the malaria life cycle by inhibiting a parasites' ability to create protective membranes when residing within red blood cells. Parasites first enter the bloodstream as sporozoites and then infect liver cells where they multiply and later emerge as merozoites. Merozoites, the target of G25, infiltrate red blood cells and become trophozoites. Trophozoites then reinvade the bloodstream and further colonize red blood cells. The compound G25 has been shown to work on mutlidrug–resistant strains of Plasmodium falciparum.
[Wengelnik K, Vidal V, Ancelin ML, et al. A class of potent antimalarials and their specific accumulation in infected erythrocytes. Science 200;295:1311�.]

HIV Transmission Through Injection Drug Use in Thailand
An international team of researchers has found that government efforts to reduce HIV infection in Thailand have led to a remarkable decrease in sexually transmitted cases of HIV. However, transmission of the disease through injection drug use continues to rise. Dr. Kenrad E. Nelson of Johns Hopkins University in the United States and colleagues in Thailand and Israel have published the results of their study in volume 29 of the Journal of Acquired Immune Deficiency Syndromes. The study measured risk behaviors and HIV infection for eight groups of 21–year–old randomly selected male military recruits in northern Thailand between 1991 and 1998. The investigators found a decrease in HIV prevalence among the recruits from more than 11 % in 1991 through 1993 to 2.4 % by 1998. The percentage of men who said they visited commercial sex workers went down from 80 % in 1991 to 38 % in 1998. In addition, in 1998, 96 % of men who have sex with prostitutes used a condom during their last visit compared to 61 % in 1991. Although sexual transmission of HIV has decreased, HIV transmission through drug use continues to increase. One percent of the study participants reported injection drug use in 1991, while four % reported use by 1997. In addition, the percent of HIV–positive men with a history of drug use increased from 1 % in 1991 to 25.8 % in 1998.
[Nelson KE, Eiumtrakul S, Celentano DD, et al. HIV Infection in young men in northern Thailand, 1991�: Increasing role of injection drug use. Journal of Acquired Immune Deficiency Syndromes 2002;29:62㫜.]

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.

Feb. 22, 2002

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