V, No. 06~ EINet News Briefs ~ March
22 , 2002
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In this edition:
- Infectious disease information
- Journal Articles
- How to join the EINet listserve
1. OVERVIEW OF INFECTIOUSDISEASE INFORMATION
Below is a semimonthly summary of AsiaPacific 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 21year
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 homekilled
pigs. In addition, a woman with similar symptoms is undergoing tests
because she is also believed to have caught
brucellosis from homekilled 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. Thirtysix people who slaughtered or
butchered pigs at home in December 2001, or who ate the meat from
the homekilled 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.
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 conjunctivitisunspecified, 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
primarycare 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 lifethreatening 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
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
"JENNIEO 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; "JENNIEO 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
JENNIEO TURKEY HAM, CURED TURKEY THIGH MEAT CHUNKED & FORMED,
WATER ADDED (case code 8569) are being recalled from their distribution
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.
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 Dday 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 ProMEDmail 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. Eightyseven
cases are severe and are thought to be dengue hemorrhagic fever. As
of yet, four deaths have been reported.
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 Ministrys 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.
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 online 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 online.
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.
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
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 hexadecyloxypropylcidofovir
(HDPCDV). Although HDPCDV 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, HDPCDV 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 HIVpositive 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.
3. JOURNAL ARTICLES
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 bulls
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. Fiftynine 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 flulike 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 solidorgan transplantation has been reported.
[MMWR 51(10):2002;210מ, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5110a3.htm]
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