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Vol. V, No. 07~ EINet News Briefs ~ April 5 , 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. Updates
  3. Notices
  4. Journal Articles
  5. How to join the EINet listserve

Below is a semi–monthly summary of Asia–Pacific emerging infectious diseases.


Hong Kong, Ireland — Norwalk–like 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 Norwalk–like 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 Norwalk–like 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. Food–borne outbreaks of Norwalk–like 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.
[Promed 03/31/02]

Malaysia (Shah Alam, Selangor) — Dengue Fever and Hemorrhagic Fever
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 40–year–old woman from Taman Sri Serdang and a 19–month–old 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 outbreak.
[Promed 03/16/02]

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 Agri–Food 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 three–week freeze on all shipments of elk within and out of Alberta.
[Promed 04/01/02]

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 life–threatening 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 pre–packaged cheeses, may be viewed at: http://www.cdfa.ca.gov/ahfss/mdfc/pdfs/Illegal_Cheese_Fact_Sheet.pdf
[Promed 04/01/02]

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.
[Promed 03/23/02]

US (Colorado, Nebraska, Wisconsin) — Chronic Wasting Disease
As of yet, 79 out of 154 (51.3 percent) white–tailed deer within an 800–acre 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 5–mile 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 white–tailed 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 white–tailed deer live. Officials plan to kill and test 500 deer in a 415–square–mile 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.
[Promed 04/01/02]


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 four–year–old 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.
[Promed 03/26/02]

France — Rabies
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 anti–rabies 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 September–October 2001 OIE bulletin.
[Promed 03/27/02]


Brazil —– Dengue
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 "home–kill 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 low–likelihood 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 up.

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 unpasteurized milk.
[Promed 03/28/02]


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 1–to㪢 ratio and still confer protection to more than 98 percent of the healthy adults they studied. Dilutions of a 1–toס 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 Online 03/28/02]

Thailand to Launch Low–Cost AIDS Drug
It was announced on 22 Mar 2002 that, beginning in April 2002, anti–AIDS 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 GPO–VIR, is the first locally produced anti–retroviral (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 GPO–VIR testing on up to 16,000 HIV–AIDS patients. International group Medecins Sans Frontieres, also known as Doctors Without Borders, approve of the introduction of GPO–VIR into the market and reportedly said it was considering buying the drugs for international use.
[SEA–AIDS 03/25/02]

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.


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 laboratory–confirmed 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 vaccine–derived 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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