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Vol. V, No. 06~ EINet News Briefs ~ March 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.


Chile (Easter Island) – Dengue Fever
On 16 Mar 2002 the Chilean Health Ministry declared a health alert on Easter Island, a Chilean territory located west of the continent, following the confirmation of a dengue fever case. The case, a 21–year old woman diagnosed on 13 Mar
2002, is the first case of contagious dengue reported in Chile. The woman was admitted to a private clinic in Santiago where dengue virus infection was suspected. The Virology Laboratory of the Pontificia Universidad Católica de Chile identified dengue fever and the Public Health Institute later confirmed the identification.

The woman, who has been released from the hospital, had resided and remained on Easter Island for two months. Investigators are not certain whether the woman contracted the disease on Easter Island or in Chile. However, Aedes aegypti, the mosquito that transmits dengue, has been detected on the island for the last 18 months and no reports of disease have occurred elsewhere in Chile. At this point in time dengue fever is thought to be confined to Easter Island only. A team of epidemiologists, infectious disease physicians, and environmental specialists led by the Ministry of Health has visited Easter Island to investigate the outbreak and reinforce prevention measures. Currently 12 patients have been confirmed as dengue fever cases by IgM. In addition, 93 patients have yet to undergo laboratory analysis. Further investigations are still underway.
[Promed 03/18/02; 03/20/02]

New Zealand – Possible Brucellosis Outbreak
A man in South Auckland is thought to have contracted the bacterium Brucella suis from butchering two home–killed
pigs. In addition, a woman with similar symptoms is undergoing tests because she is also believed to have caught
brucellosis from home–killed pigs. Agriculture officials in New Zealand have begun testing pigs at 20 farms in Auckland
and Waikato as part of an investigation into a possible brucellosis outbreak. Thirty–six people who slaughtered or
butchered pigs at home in December 2001, or who ate the meat from the home–killed pigs, have been tested for brucellosis,
as of 16 Marc 2002. According to an Auckland health official, several positive tests have resulted, but further tests are necessary.

Brucellosis, also known as undulating fever, Malta, and Mediterranean fever in humans, is often difficult to diagnosis because of nonspecific clinical features in those infected. Indicators of the disease may include fever, headaches, joint pain, weight loss, and depression. The most common symptoms are osteoarticular and genitourinary. Treatment is available, but if left untreated, the case fatality rate may reach two per cent. There are several Brucella species, which are often associated with a particular reservoir species, although the bacterium is not confined to those species. B. abortus is usually associated with cattle, B. suis with pigs, and B. melitensis with goats. Brucellosis can also be acquired from consumption of unpasteurized milk.
[Promed 03/16/02]


US (New Hampshire) – Bacterial Conjunctivitis
Approximately 100 students presenting at the student health service in the University of New Hampshire had symptoms of
clinical conjunctivitis during 1 – 14 Feb 2002. Streptococcus pneumoniae was isolated from all eye cultures collected on 12 consecutive students. The New Hampshire Department of Health and Human Services was notified about the outbreak and assistance was requested from the Center for Disease Control and Prevention (CDC) on 22 February 2002. According to the CDC, the definition of probable pneumococcal conjunctivitis included a diagnosis of conjunctivitis–unspecified, viral conjunctivitis, or mucopurulent conjunctivitis (pink eye) in a student who presented to the University health service during 15 January to 7 March, 2002. A confirmed pneumococcal conjunctivitis case was defined as a diagnosis of conjunctivitis with a S. pneumoniae isolation from eye secretions.

According to investigators, there were 493 (9.7%) students with probable pneumococcal conjunctivitis and 81 (1.6%) students with confirmed pneumococcal conjunctivitis among the 5,060 students enrolled during the term. First year students were the most affected (18.0%). The number of conjunctivitis cases in individuals not attending college was not above that which would be expected. Affected students were treated with topical antibiotic therapy and prevention measures included distribution of information concerning transmission reduction. Local primary–care physicians and ophthalmologists were notified of the outbreak. In addition, they were asked to report cases and obtain cultures from patients with symptoms of conjunctivitis.
[MMWR 03/15/02, http://www.cdc.gov/mmwr/PDF/wk/mm5110.pdf]

US (International) – Medical Devices Recall
The United States Food and Drug Administration (FDA) has issued a recall of all products manufactured by A & A Medical, Inc. of Alpharetta, Georgia labeled as sterile or ethylene oxide processed and shipped since 1999 within the United States and internationally. Products manufactured include Obstetric/Gynecology and surgical devices. Curettes, uterine dilators, fetal blood samplers, laparoscopy accessories, as well as other devices are included in the recall.

The recall is due to inadequate sterilization practices, resulting in the possibility of serious and life–threatening infections. The recalled products are also produced and sold under the names of A & A Medical, Rocket USA and Lifequest. The products under question may be sold by firms other than the ones listed in the FDA report, however, the FDA is working to identify all distributors. A continually updated list of distributors and the products they receive from A & A Medical can be accessed on the FDA's website at http://www.fda.gov/cdrh/recalls/recall31402.html. Distributors of the products identified are being asked to contact all customers who received the affected products. It is currently recommended by the FDA not to use any A & A Medical, Inc., Rocket USA, or Lifequest products. Additional information regarding the recall can be found on the FDA's MedWatch web site at http://www.fda.gov/bbs/topics/NEWS/2002/NEW00799.html.
[Food and Drug Administration Center for Devices and Radiological Health, http://www.fda.gov/cdrh/safety/safety031502.html]

US (National) – Turkey Recall
According to the United States Department of Agriculture (USDA) Food Safety and Inspection Service (FSIS), approximately 23,000 pounds of fully cooked turkey products are being recalled voluntarily by West Central Turkeys Inc., of Pelican Rapids, Minnesota due to possible contamination with Listeria monocytogenes. Products to be recalled were produced on 31 Dec 2001 and include: 18 to 20 pound boxes of "JENNIE–O BLUE RIBBON, Smoked White Turkey with Broth & Carmel Coloring" (case code 8698㪚), distributed in Arkansas, Colorado, Florida, Kansas, Minnesota, Mississippi, Missouri, North Carolina, Oklahoma, Texas and Washington; "JENNIE–O HICKORY SMOKED, TURKEY BREAST WITH BROTH” (case code 8547㪱), distributed to Indiana; and "Wegmans Delicatessen, 99% Fat free, 1% Fat, Fully Cooked Turkey Breast" (case code 11115 WEGMANS, 0111㪧), distributed in New York. In addition, 10 to 12 pound boxes of the product entitled “JENNIE–O TURKEY HAM, CURED TURKEY THIGH MEAT CHUNKED & FORMED, WATER ADDED” (case code 8569) are being recalled from their distribution in Minnesota

Infection with Listeria monocytogenes may cause Listeriosis. Symptoms include high fever, severe headache, neck stiffness, and nausea. Miscarriages, stillbirths, as well as serious and sometimes fatal infections may be caused in individuals with weak immune systems. Additional news releases may be viewed on the web at: http://www.fsis.usda.gov.
[FDA http://www.fda.gov/cdrh/safety/safety031502.html]


Brazil – Dengue Fever
On 9 March 2002 more than 50,000 volunteers, soldiers, firefighters, and health workers acted to eradicate breeding grounds for the mosquitoes Aedes aegypti in order to prevent the spread of dengue fever. The day, called “D–day against dengue”, was also part of an effort to educate the population on how to prevent standing water accumulation. Residents as well as tourists are receiving information on vector control through actions such as the use of mosquito repellant. According to Rio State health officials, over 72,000 people in Rio de Janeiro have been diagnosed with dengue fever and 28 have died. According to ProMED–mail source, a total of 76,946 cases of dengue fever, including 31 deaths have occurred in the state of Rio de Janeiro between 1 Jan and 12 Mar 2002. These reports state that 33,357 of these cases, including 395 cases of dengue hemorrhagic fever and 23 deaths, occurred in Rio de Janeiro City. Some experts believe that estimates may be much higher due to underreporting. Recent outbreaks of dengue fever have been reported in seven other Brazilian states as well as Cuba, Peru, and El Salvador. This epidemic is the largest one to date, surpassing the 1991 epidemic in which 24 people died.
[Promed 03/09/03; Promed 03/14/02]

Cuba – Dengue Fever
As of 5 Mar 2002, there have been 4,000 confirmed cases of dengue fever in Cuba. In addition, 12,000 cases are suspected. Eighty–seven cases are severe and are thought to be dengue hemorrhagic fever. As of yet, four deaths have been reported.
[Promed 03/11/03]

South America – Dengue Fever
On 9 Mar, 2002 southern South American countries agreed to a joint program that aims to prevent the spread of the dengue
fever epidemic in the Brazilian state of Rio de Janeiro. According to the Health Ministry’s national vector coordination director, unified strategies and actions have been taken to prevent spread of the epidemic in Rio de Janeiro to the rest of the region. Intensive efforts have been made along the border of Brazil. A “Committee to Combat Dengue” meeting was held in Buenos Aires, Argentina on 8 Mar, 2002. Doctors as well as experts from Argentina, Brazil, Paraguay, and Uruguay, and Chile attended the meeting.
[Promed 03/09/03]


CDC International Conference on Emerging Infectious Diseases 2002
The 2002 International Conference on Emerging Infectious Diseases (ICEID), hosted by the Center for Disease Control and Prevention (CDC), will be held in Atlanta, Georgia during the time period of March to March, 2002. The ICEID 2002 Program Book is now available on–line in Adobe Acrobat .PDF Format at http://www.cdc.gov/iceid/program.htm and information about Continuing Education Credit is available at http://www.cdc.gov/iceid/credit.htm. A web cast of the ICEID 2002 conference will be available by 5 April, 2002. In addition, continuing education credits may be earned on–line.

APEC Infectious Disease Strategy Meeting 2002 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 23 March, 2002 from prior to the formal commencement of the ICEID meeting. Topics to be discussed at this 2002 “APEC Infectious Disease Strategy” meeting include: electronic networking, surveillance and food safety, outbreak response, capacity building, bioterrorism, and setting standards of excellence. Details of the side meeting will be provided in a subsequent bulletin.

Smallpox Drug
US scientists reported on 20 Mar, 2002 that they had developed an oral drug that may be used to treat smallpox, an illness caused by the variola virus. Smallpox, a highly contagious virus that kills approximately 30 percent of those infected, was eradicated in 1980. A vaccine can prevent smallpox up to four days after exposure to virus, but is only effective in those who are asymptomatic and may be unsafe for individuals with weakened immune systems.

Scientists at the Veterans Affairs San Diego Healthcare System and the University of California at San Diego had been working since 1999 to develop an oral form of cidofovir, sold by Gilead Sciences Inc. as Vistide to treat an AIDS complication. The new oral drug, which is a derivative of the intravenous, antiviral medicine named cidofovir, is called hexadecyloxypropyl–cidofovir (HDP–CDV). Although HDP–CDV blocked reproduction of the smallpox virus in laboratory tests and worked effectively in mice infected with the related virus cowpox, it has yet to be tested in people. In addition, it may be years before it will be considered for government approval and the effects of the medicine have yet to be investigated in individuals already exhibiting smallpox lesions. Further research may include: determination of drug effectiveness and side effects in monkeys; analysis of the rapidity of drug effect; and testing of drug safety in health people, as there are no infected people on which to test the drug.

The research has not been published in an academic journal, but researchers announced their findings at the 15th International Conference on Antiviral Research in Prague, the Czech Republic. According to researchers at the University of Birmingham, HDP–CDV has also proven effective in lab tests against several other common viruses, including cytomegalovirus, herpes and Epstein Barr virus.
[Associated Press 03/19/02; 03/20/03 Reuters Health Online, www.reutershealth.com]

India to Bar Foreigners with HIV from Entering Country
The Indian Welfare Minister, C.P. Thakur, has reportedly stated that HIV infected individuals will be barred by Indian officials from entering the country. Visitors will be required to provide medical records stating whether or not they are infected with HIV and HIV–positive individuals will not be allowed to travel within India. The new policy is related to a recent report in India that stated “contacts with foreigners are responsible for the sharp rise in HIV cases”. North Korean citizens are currently tested for HIV before and after traveling abroad. It is not required that the new policy go to Parliament due to Health Ministry authority to pass regulations after ministerial consultation.


Characteristics of Lyme Disease
A new study on the characteristics of Lyme disease has been published in the 19 Mar 2002 issue of Annals of Internal Medicine. The study, which was associated with a vaccine trial for Lyme disease, suggests that most people in the early stages of illness do not develop a “bull’s eye” rash known as erythema migrans, an established feature of Lyme disease. The results of this study differ from those of most prior research studies that found a much higher frequency of bull's eye rashes in people with Lyme disease. All 118 patients in the study who had early Lyme disease developed a rash, but only 9% developed a “bull's eye” rash, a red rash that is white in the center. Fifty–nine percent of the study population acquired a rash that was red throughout and 32% acquired a rash that was redder in the center. The majority of people in the study visited a doctor within a few days of developing symptoms of Lyme disease. According to the researchers, the short time period between disease onset and care may not have been long enough for the rash to develop into the classic bull's eye form. The results of this study, that bull's eye rashes are uncommon in early Lyme disease, are supported by the findings of an earlier study conducted in New York, United States. Information on characteristics
of early Lyme disease may affect the diagnosis and treatment of the disease.

Lyme disease, a bacterial infection that is spread by ticks, is most common in the US in the Northeast, Wisconsin, Minnesota, and northern California. Symptoms of illness include a rash and flu–like symptoms. Lyme disease is treatable with antibiotics, but may cause arthritis and heart complications if left untreated.
[Annals of Internal Medicine 2002;136(6):421𤮜, 477𤯏.]

Chagas Disease Following Organ Transplant
Chagas disease, which is caused by the protozoan parasite Trypanosoma cruzi, was reported for the first time in the United States on 23 April, 2001. The 15 March, 2002 edition of Morbidity and Mortality Weekly Report (MMWR) describes three US cases of T. cruzi infection associated with transplantation of solid organs from a single donor. The Centers for Disease Control and Prevention (CDC) will collaborate with US transplant organizations to determine whether or not potential donors should be screened for T. cruzi infection and to discuss details of screening if it is an option chosen. Serologic screening of organ donors and recipients for antibody to T. cruzi is standard practice in Latin America, where transmission of T. cruzi infection by solid–organ transplantation has been reported.
[MMWR 51(10):2002;210מ, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5110a3.htm]

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.


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