V, No. 07~ EINet News Briefs ~ April
5 , 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.
Hong Kong, Ireland Norwalklike Virus Outbreak
Due to an outbreak in Hong Kong, the Food Safety Authority of Ireland
(FSAI) was advised by its Hong Kong counterpart in February of 2002
that Norwalklike virus was traced to contaminated oyster farms from
Cork Harbor, Ireland. The two oyster farms that are located in Cork
Harbor, Atlantic Shellfish and Oyster Farms Ltd, produce approximately
450 tons of oysters, according to reports. It is believed that a sewage
outfall may have contributed to water pollution in the North Channel.
Symptoms of Norwalklike virus, which belongs to the Caliciviridae
family, may include nausea, diarrhea, vomiting, abdominal pain, fever,
and malaise. Contaminated water supplies are often associated with
outbreaks. Foodborne outbreaks of Norwalklike virus are frequent
and contaminated shellfish are major causes of epidemic gastroenteritis.
As a precautionary measure, a ban has been placed by the Department
of Marine on shellfish harvesting in the harbor's North Channel. No
outbreak in Ireland has been linked to the oysters.
Malaysia (Shah Alam, Selangor) Dengue Fever and Hemorrhagic
A total of 823 cases of dengue fever and dengue hemorrhagic fever
(DHF) have been recorded this year in Malaysia, as of 9 Mar 2002.
This is 54 percent higher than the number reported in the same time
period last year. According to reports, there have been 199 cases
in the Shah Alam City Council, 130 in Selayang, 129 in Subang Jaya,
112 in Petaling Jaya, 69 in Klang, 52 in Kajang and 29 in Ampang Jaya.
A 40yearold woman from Taman Sri Serdang and a 19monthold boy
from Shah Alam are the two deaths reported. Local authorities in the
state have been ordered to set up operation centers to monitor the
Canada Chronic Wasting Disease
On 26 Mar 2002 a captive elk in northern Alberta, Canada was confirmed
by the Canadian Food Inspection Agency (CFIA) to have Chronic Wasting
Disease (CWD). The elk was one of 160 slaughtered at a southern Alberta
packing plant on 7 Mar 2002.
Voluntary surveillance for CWD in Alberta, which began in Oct of 1996,
is a joint initiative among the AgriFood Surveillance Systems Branch
and Livestock Diversifications Branch of the Alberta Agriculture,
Food, and Rural Development as well as the Alberta cervid industry.
Brain from the infect elk was obtained as part of this surveillance
program. The CFIA has quarantined the affected elk farm and is working
closely with Alberta Agriculture Food and Rural Development to determine
where the infected animal originated and where breeding stocks were
sold. The government will compensate up to $3,000 (Canadian) per slaughtered
animal. Additional elk will be slaughtered if other farms are found
to be infected. As of 22 Mar 2002, the CFIA has depopulated 7,782
farmed elk in order to control the spread of CWD. In addition, federal
veterinarians have ordered a threeweek freeze on all shipments of
elk within and out of Alberta.
US (California) Salmonella Newport and Soft Cheeses Warning
The California Department of Health Services (CDHS) issued a public
warning on 04 Apr 2002 about consumption of illegally manufactured
soft cheeses, such as queso fresco and crema fresca. These cheeses,
also known as "bathtub" cheeses, are often made with raw
unpasteurized milk and may be contaminated with harmful bacteria.
Previous outbreaks of Salmonella have been associated with these illegally
manufactured cheeses. Salmonella and Listeria are the most common
bacteria found in illegally manufactured cheese. The bacteria can
cause severe illnesses and may be lifethreatening to individuals
with a compromised immune system, children, and the elderly. This
warning comes after the report of more than 50 cases of Salmonella
Newport in Northern California, since December 2001. According to
officials, no deaths have been reported, but several cases have been
hospitalized. Investigations are continuing. The warning, which warns
consumers about buying cheese from street vendors and advises buyers
to check labels on prepackaged cheeses, may be viewed at: http://www.cdfa.ca.gov/ahfss/mdfc/pdfs/Illegal_Cheese_Fact_Sheet.pdf
US (Louisiana) West Nile Virus
A bird from East Baton Rouge Parish, Louisiana has tested positive
for West Nile virus (WNV). The cardinal was found at a Baton Rouge
residence and tests were conducted at the Louisiana Veterinary Diagnostic
Lab of the Louisiana State University Veterinary School. According
to health officials, this is the first case of West Nile virus ever
confirmed in East Baton Rouge Parish. Surveillance of common WNV carriers,
such as crows, blue jays, and raptors is in place. In addition, the
local community has been advised to limit the breeding ground for
mosquitoes and take measure to prevent mosquito bites as well as notify
the nearest Environmental Health Services of dead birds.
US (Colorado, Nebraska, Wisconsin) Chronic Wasting Disease
As of yet, 79 out of 154 (51.3 percent) whitetailed deer within an
800acre enclosure in northwestern Nebraska have tested positive for
Chronic Wasting Disease (CWD). Testing is complete, but not all test
results are known. CWD was first observed in November 2000, at which
point no live deer or elk have been allowed to enter or leave the
facility. In order to prevent the spread of CWD, every animal in the
herd was destroyed, the last of which were killed by 18 March 2002.
It appears that the portion of infected wild animals has not reached
that of captive herds. Nine of 113 wild deer shot within a 5mile
radius of the enclosure in late January 2002 tested positive for CWD.
In addition, officials tested 183 animals killed along the border
of Nebraska and South Dakota and found no infected animals.
Officials in Wisconsin have found five wild whitetailed deer to
be infected with CWD, as of 29 Mar 2002. They are now attempting to
assess the distribution of CWD infected animals in the state, where
approximately 1.6 million whitetailed deer live. Officials plan to
kill and test 500 deer in a 415squaremile area surrounding the place
where the first three infected deer were found.
A wild deer with chronic wasting disease (CWD) was found near Craig,
Colorado. According to the Division of Wildlife Director, two other
deer on the same ranch are likely infected, but tests are not yet
complete. This is the first time CWD has been found west of the Continental
Divide in Colorado, a long series of summits along the Rocky Mountains
that separates the two main drainage systems of the United States.
The Colorado ranch has been quarantined and officials plan to kill
10 more wild deer and the 39 captive elk there. In addition, wild
deer within five miles of the ranch will be killed to determine if
the disease has spread.
Bolivia (Ichilo) Yellow Fever
A total of four cases of yellow fever, including two deaths, have
been confirmed in Bolivia, as of 26 Mar 2002. Two of these results
follow the recent testing of 35 suspected cases of yellow fever from
Yapacani. The two newly confirmed cases include a fouryearold girl
from Santa Fe who died on 23 Mar 2002 and an adult from San Juan de
Yapacani who is under care. The tests of three more suspected cases
are currently being analyzed. In response to the confirmed cases,
the entire population of Yapacani, San Juan, and San Carlos are being
immunized, regardless of previous vaccinations. In addition, doctors
are being educated on the treatment of yellow fever, houses in Yapacani,
San Carlos, and Santa Fe are being spraying with insecticide, and
control teams plan to visit Buenavista.
On 24 Oct 2001 the French Ministry of Agriculture reported to OIE
that no rabies case associated with fox rabies has been recorded in
France since December 1998. To maintain its status France will begin
epidemiological surveillance, preventive campaigns of antirabies
oral vaccination along "at risk" borders, and sanitary measures
associated with import control of domestic carnivores. In addition,
an emergency stock of oral vaccination is maintained. Information
regarding the rabies status of France has been published in the SeptemberOctober
2001 OIE bulletin.
According to the World Health Organization (WHO), Brazilian health authorities
have reported a total of 104,469 dengue cases and 40 deaths in Rio de
Janeiro state, as of 19 Mar 2002. In addition, municipal health authorities
have reported 49,149 cases of dengue and 435 cases of dengue hemorrhagic
fever, with a total of 29 deaths in the city of Rio de Janeiro. This
is the largest outbreak ever recorded in the state of Rio de Janeiro.
Efforts to control the epidemic include: activities to involve communities
in the eradication of mosquito breeding sites and avoidance of mosquito
bites as well as state and municipal vector control programs.
[Weekly Epidemiological Record 2002;77(13):97. http://www.who.int/wer]
New Zealand Brucellosis
In early March 2002 public health authorities notified the Ministry
of Agriculture and Forestry (MAF) of a case of human brucellosis.
The infection was confirmed through blood cultures performed by the
Counties Manukau District Health Board and reviewed by the Institute
of Environmental Science and Research. Biochemical profiling by MAF
National Centre for Disease Investigation led health officials to
believe that the isolate was Brucella suis. Although not confirmed,
the lab typing the isolate, the Veterinary Laboratory Agency (VLA)
in Weybridge UK, reports that it is likely to be Brucella suis
biovar three. It is thought that case acquired the infection
in December 2001 in New Zealand. The infected person, who had not
traveled outside New Zealand for 10 years, purchased two pigs that
were killed and butchered in a "homekill situation". The
case had visited a country where Brucella suis is endemic
10 years ago.
Brucella suis has not been recorded in New Zealand
livestock previously. At the present time this remains the situation,
as the results reported below indicate. A previous human case of Brucella
suis in New Zealand has been attributed to infection acquired
in the Pacific Islands, where the disease is known to be present in
some countries. Imported human brucellosis cases caused by
other species are also occasionally diagnosed. Health authorities
have traced the two pigs to the point of purchase and the likely farms
of origin. Seven farms classified as having a high likelihood of being
the farm of origin as well as three farms classified as medium likelihood
and one farm as low likelihood have been visited. All pigs on the
farms that were over six months of age were bled and tested using
ELISA. As of yet, no tests have resulted positive. Pigs on the remaining
seven lowlikelihood farms will be tested and farmers will be interviewed
in order to determine suppliers for the high likelihood farms. All
individuals associated with the confirmed case are being followed
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
2 percent. 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
US Stockpile of Smallpox Vaccine
The New England Journal of Medicine is releasing the findings of a study
investigating the effectiveness of diluted smallpox vaccine on its Web
site in advance of the April 25th publication in the journal. Research
suggests that existing US stockpiles of smallpox vaccine can be diluted
and still effective to protect from smallpox virus, a virus of concern
due to possible bioterrorist threats. However, there is a debate as to
whether the threat is real enough to warrant mass vaccination. In a report
released on 28 Mar 2002, investigators report that they were able to dilute
samples of smallpox vaccine to a 1to㪢 ratio and still confer protection
to more than 98 percent of the healthy adults they studied. Dilutions
of a 1toס ratio produced a 100 percent success rate.
The only known existing samples of the virus are in a repository in Russia,
at the Centers for Disease Control and Prevention (CDC) in the United
States, and the new discovery of the virus vaccine made decades ago at
a pharmaceutical company in France. According to reports, Aventis Pasteur
of Lyon, France, which has its U.S. operations in Pennsylvania, produced
the newly discovered liquid vaccine doses. It is possible that other countries
also have samples.
[The New England Journal of Medicine 2002; 346:1265 Reuters Health
Thailand to Launch LowCost AIDS Drug
It was announced on 22 Mar 2002 that, beginning in April 2002, antiAIDS
drugs would be sold in Thailand for less than a U.S. dollar a day. The
drug, produced by the Government Pharmaceutical Organization (GPO) and
called GPOVIR, is the first locally produced antiretroviral (ARV) "cocktail"
in Thailand. According to reports, GPO produced a successful batch of
120,000 tables on 18 Mar 2002. The drug, which is a single pill combining
Stavudine, Lamivudine and Nevirapine, will be marketed at six GPO outlets
in early April. It will be sold for 20 baht (46 US cents) per tablet and
with a dosage set at two tablets per day, the monthly cost will be approximately
1,200 baht (27 dollars). This cost, the cheapest available in the world,
is significantly less than the current lowest monthly cost of 2,500 baht
for ARVs. In order to meet demand, future production is projected to grow
to three million tablets per month over the next six months.
It has been reported that GPO, Mahidol University in Bangkok, and the
Health Ministry Department of Medical Science will submit a proposal for
GPOVIR testing on up to 16,000 HIVAIDS patients. International group
Medecins Sans Frontieres, also known as Doctors Without Borders, approve
of the introduction of GPOVIR into the market and reportedly said it
was considering buying the drugs for international use.
ICEID Meeting 2002
The 2002 International Conference on Emerging Infectious Diseases (ICEID),
hosted by the Center for Disease Control and Prevention (CDC), convened
in Atlanta, Georgia between 24 to 27 March, 2002. The meeting included
plenary sessions and symposia with invited speakers, presentations on
emerging infections, and oral poster presentations. Key topics covered
in the conference included surveillance systems, epidemiology, communication
and training, prevention and control of emerging infectious diseases internationally,
as well as bioterrorism. Webcasts of the conference are available at http://www.cdc.gov/iceid/webcast/index.htm.
APEC Side Meeting
A side meeting on infectious diseases convened on Sunday, March 24, immediately
preceding the 2002 ICEID meeting in Atlanta, Georgia. Attendance included
approximately 30 participants from five economies (Canada, Chinese Taipei,
Thailand, Singapore, and the United States). Topics presented and discussed
included electronic networking, surveillance and food safety, special
event surveillance, capacity building, outbreak response, and setting
standards of excellence. In addition, presentations were given on an APEC
proposal from Chinese Taipei and EWORS/SE Asia Outbreak Alert and Response.
4. JOURNAL ARTICLES
Decline in Polio Cases
The 29 March 2002 additions of the Weekly Epidemiological Record (WER) and
the Morbidity and Mortality Weekly Report (MMWR) devote portions of their
publications to the progress towards the global eradication of poliomyelitis.
In their publications they describe the worldwide decline in polio infection
rates. The number of laboratoryconfirmed polio cases declined from 719
in the year 2000 to 473 cases in 2001. Polio is endemic in 10 countries,
seven African countries and three Asian countries. Nigeria, India and Pakistan
are considered to be major reservoirs of the virus while the Americas and
Western Pacific region have been declared free of wild poliovirus. In 1988,
when the first efforts were made to eradicate poliomyelitis from the planet,
the virus was endemic in 125 countries and there were 99 percent more cases
than in 2001.
According to reports, technical advisory groups in endemic countries
constantly review vaccination levels and are planning four to six mass
vaccination campaigns per year. Once polio is officially eradicated globally,
a new strategy will be implemented that requires countries to identify
all laboratories storing wild poliovirus or potentially infectious materials
to ensure proper handling or disposal under appropriate biosafety conditions.
Health experts will plan for prevention of vaccinederived poliovirus
outbreaks and reintroduction of the virus after its eradication.
[Weekly Epidemiological Record 2002;77(13):98𤩛. http://www.who.int/wer;
MMWR 2002;51(12):253𤫰 Reuters Health Online 03/28/02]
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