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Vol. V, No. 08~ EINet News Briefs ~ April 19 , 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.


Malaysia (Selangor, Melakar) — Hand, Foot and Mouth Disease
Thirty–five cases of hand, foot, and mouth disease (HFMD) were detected in children between the ages of three and five years old in Selangor, Malaysia during January to March 2002. Four of the children were admitted to hospital and the others received outpatient treatment. No complications were reported in any of the cases, but the Health Department continues to monitor the situation. According to the Selangor Health Committee, health authorities have been instructed to report HFMD cases to the state Health Department and government hospitals have been advised to be on the alert for cases. Private clinics are required to refer cases to the hospitals, as clinical diagnosis alone is not sufficient to verify the ailment. The virus associated with the outbreak, Coxsackie virus A16, causes a mild form of the disease where patients usually recover in approximately seven to 10 days without medical treatment. The disease is spread mainly through feces contaminated food and water or air–borne secretions produced from the mouth or nose of patients. The symptoms of HFMD include fever, sore throat, and sometimes blistering rashes on the hands and feet. Cases of Enterovirus 71 (EV71) infection, which may cause inflammation of the brain membrane and brain, have not been detected in Malaysia.

In Malacca, Malaysia 10 cases of suspected HFMD have been reported in children less than seven years of age, as of 09 April 2002. According to the State Human Resource, Health, and Consumer Affairs Committee, cases were admitted to private and government hospitals for one to two days for observation before being discharged. The state is closely monitoring all suspected cases.
[Promed 04/09/02]

Japan — Newcastle Disease
According to the Animal Health Division of the Ministry of Agriculture, Forestry, and Fisheries, an outbreak of Newcastle disease has been reported in Kamikita Gun, Aomori Prefecture in Tohoku, Japan in commercial chicken flocks. The first case was detected on 26 Mar 2002, but the origin of infection is still under investigation. According to reports, no chickens on the infected farms had been vaccinated against the disease. A total of 336 chickens have been destroyed and there have been 119 cases, all of which have died. Diagnosis was made using hemagglutination inhibition test and Polymerase Chain Reaction (PCR) at the Towada Livestock Hygiene Service Center in Aomori Prefecture. Control measures for the outbreak have included sanitization of the infected premises, destruction and burial of chickens on the infected farms, and supervision of a commercial flock within a 5–km radius of the farms. Isolation of the virus and pathological examinations are under way.
[Promed 04/10/02; OIE Disease Information 04/12/02, volume 15, no. 15]

Australia (Tasmania) —– Ross River Virus Infection
According to officials, 37 cases of Ross River virus have been reported in Tasmania for the year 2002, as of 10 April 2002. Only 12 cases were reported in 2001. The virus, which is transmitted by both day– and night–biting mosquitoes, causes a wide variety of symptoms including headaches, muscle pain, rashes and fever. In addition, the virus may cause polyarthritis. Travelers and citizens have been advised to use insect repellent, keep their homes secure, and wear long–sleeved shirts and long trousers in order to avoid being bitten by mosquitoes.
[Promed 04/10/02]

Australia (Melbourne) — Influenza A Outbreaks
The Australian Department of Human Services has investigated two recent unseasonable outbreaks of influenza A involving vaccinated residents in aged–care facilities in Melbourne, Australia. An initial diagnosis of influenza A (H3N2) was made by the Victorian Infectious Diseases Laboratory (VIDRL) based on respiratory multiplex Polymerase Chain Reaction (PCR) assays of throat and nose swabs.

The first outbreak occurred in January 2002 in a hostel where 23 cases were identified by means of laboratory confirmation and two cases were suspected. Nineteen (45%) of the hostel residents and six (21%) of the staff members were identified as cases. A total of 10 residents were hospitalized and there were no deaths. Thirty–eight (90%) of the residents and two (7%) of the staff members had been vaccinated.

The second outbreak occurred in March 2002 in a nursing home in which 16 cases were laboratory–confirmed and 12 cases were suspected. Fifteen (47%) of the residents and 10 (36%) of the staff members were identified as cases. A total of three staff members and seven residents were hospitalized, one of whom died due to influenza infection. Vaccination histories had been collected on 20 residents and all staff. Eighteen (90%) of the residents with a known history and three (10%) of the staff members had been vaccinated.

The World Health Organization (WHO) Collaborating Center for Reference and Research on Influenza in Melbourne, Australia performed analyses and determined that both outbreaks were due to influenza A(H3N2) strains that were antigenically related to the current and 2001 A/Moscow/10/99 (H3N2)–like vaccine component as well as genetically similar to the recent strains circulating worldwide. According to analyses, the two outbreaks did not have a common source.
[Promed 04/09/02]

New Zealand — Hepatitis A
Health officials in New Zealand have issued a warning on the consumption of blueberries bought between 23 December 2001 and 31 January 2002. The health warning stated that berries bought during this time period posed a potential risk and, even if frozen, should be discarded or cooked thoroughly, preferably by boiling, before being eaten. An investigation into an unusually high number of hepatitis A cases in Auckland found 17 of 29 cases since January 2002 were linked to blueberries. According to the Director–General of Health, berries distributed under the Waikato Blueberries brand could be contaminated with hepatitis A virus. It is now known that a person with the highly contagious virus was at Marshmeadows Farm during part of the harvesting period and some of the berries linked with the Auckland cases were from this farm. The Ministry has been working with the blueberry industry to provide detailed information on what products might be affected, how they could be identified, and where they were sold.

Symptoms of this most common form of viral hepatitis include nausea, vomiting, fever, stomach ache, loss of appetite, and jaundice. Food–borne transmission of hepatitis A virus often occurs due to preparation of uncooked foods or harvesting of produce by an infected individual. The majority of hepatitis A transmissions occur by the fecal–oral route.
[Promed 04/14/02]


United States (Virginia, North Carolina) — Avian Influenza
The United States Department of Agriculture (USDA) has confirmed the presence of a low pathogenic H7N2 avian influenza virus in turkey breeder flocks and meat turkey flocks in Virginia and North Carolina. Neither Virginia nor North Carolina has had a "highly pathogenic" strain of the virus. The virus, which is not an OIE List A disease, was first detected in mid–March 2002 and has been detected in 19 turkey flocks and one flock of broiler chickens. As of 03 April 2002, a total of 61,000 birds have been destroyed and health officials plan to destroy another 235,000 birds. Both states have decided to depopulate the flocks.

The USDA, Animal and Plant Health Inspection Service (APHIS), Veterinary Services (SV) has been assisting Virginia and North Carolina with tracing the source of infection for the outbreak, aiding in final laboratory diagnostic typing of virus isolates, and handling of international trade consequences of the outbreak. Currently, the source of the virus is not known, but it is thought that the virus did not come from wild birds. Sequence analysis has shown that the isolates are most similar, but not identical, to H7N2 viruses that have been isolated in the live–bird markets.
[Promed 04/06/02, 04/09/02, 04/11/02]

United States (Texas) — Yellow Fever
On 16 March 2002 an unvaccinated 47–year–old male from Texas died from yellow fever after returning from a fishing trip to Manaus, Brazil in early March 2002. Onset of symptoms occurred on 10 March 2002 and the traveler was hospitalized on 12 March 2002.
[Weekly Epidemiological Record, World Health Organization 04/12/02]

United States — Transmissible Spongiform Encephalopathy
In March 2001 a flock of 125 sheep from a Vermont farm were confiscated by the USDA and tested for a transmissible spongiform encephalopathy (TSE) after four animals from an associated flock tested positive in July 2000. In 2001 the sheep were transported to the USDA's National Veterinary Services Laboratories (NVSL) in Iowa, where they were euthanized and tissue samples were collected for diagnostic testing. On 11 April 2002 the US Department of Agriculture (USDA) announced the confirmation of positive test results for an atypical undifferentiated TSE of foreign origin in two of the sheep tested in 2001. The USDA will continue to conduct additional tests to determine the type of TSE in these sheep.

According to the USDA's Animal and Plant Health Inspection Service, none of the confiscated sheep had entered the animal or human food supply. According to reports, as part of USDA's scrapie control efforts the sheep, which were imported from Belgium and the Netherlands in 1996, were placed under federal restrictions when they entered the United States. In 1998, the USDA discovered that it was likely the sheep from Europe had been exposed to feed contaminated with bovine spongiform encephalopathy (BSE). At that time, the state of Vermont imposed a quarantine that prohibited slaughter or sale for breeding purposes on these flocks.
[Promed 04/12/02]


Japan — BSE
It has been reported that on 11 April 2002 an official from the Japanese Agriculture, Forestry, and Fisheries Ministry estimated the damage to farming and related industries due to bovine spongiform encephalopathy (BSE) to be more than 365 billion yen (USD 2.73 billion). The estimate approximates the damage caused between Sept 2001, when BSE was first confirmed in Japan, and February 2002. During that time period revenues at farms are thought to have declined by 131 billion yen (USD 992 million) from a year before and sales by meat–selling industries are estimated to have declined by 160 billion yen (USD 1.21 billion). In addition, sales of beef barbecue restaurants have declined by approximately 74 to 90 billion yen (USD 560 to 681 million).
[Promed 04/15/02]

Health Canada Orders Withdrawal of Dura Mater Grafts
On 11 March 2002 the Canadian Health Ministry suspended the license for Tutoplast Dura, the last dura mater graft on the market. The use of these grafts, which are made from human corpses, has been banned by Health Canada because of concern that they may spread Creutzfeldt–Jakob Disease (CJD). In addition, the government has requested that physicians place any supplies they may have in a secure place. The graft is used to repair the brain's dura mater as well as for other operations such as shoulder surgery and bladder lifts. It has been associated with at least one CJD death in the United States, prompting a Canadian review of the product.

Recently the Canadian Neurosurgical Society estimated that surgeons used the German–made dura mater grafts for about 200 patients a year. Lyodura, another brand of these grafts that had its license revoked in 1987, has been linked to approximately 115 CJD deaths worldwide, including four deaths in Canada. Production methods of the Lyodura grafts associated with these deaths differed from that of other dura mater graft producers.
[Promed 04/12/02]

Chinese Estimates of HIV Carriers
The Chinese government announced on 11 April 2002 that the number of confirmed AIDS cases in China is approximately 200,000, 17% above the figure announced in mid�, and that the estimate of people infected with HIV is 850,000, an estimate more than 40% higher than the previous. In addition, it is thought that approximately 100,000 people might have died from the disease. By the end of 2001, the Ministry of Health had recorded 30,736 people with HIV, among whom 1,594 had AIDS and 684 had died of the disease. Unofficial estimates by Chinese health officials for the number of HIV carriers in China have risen steadily from 400,000 in 1999 to 500,000 in 2000 and 600,000 in 2001. Authorities believe China's official AIDS statistics are far lower than the true figure because of poor reporting by local health officials.

Needle–sharing among intravenous drug users accounted for 68% of confirmed HIV cases, while illegal blood transfusions accounted for 9.7% and unsafe sex 7.2%. Beijing went public with its fight against AIDS last year after state media exposed the spread of the virus in rural Henan province, where farmers sold their blood to purchasing stations. In the village of Wenlou in the central province of Henan, 43% of people who sold blood are infected, according to a statement by the Deputy Health Minister in August 2001. China held its first AIDS conference in November 2001, and a state–owned pharmaceutical company announced plans to produce low–cost anti–AIDS drugs. Despite increased openness by health officials at the national level, many local leaders are accused of suppressing information about the disease for fear of acknowledging prostitution or drug trafficking in their areas.
[Reuters Health Online 04/11/02; SEA–AIDS 04/12/02]

Meningitis Vaccine
A team of British scientists, led by Andy Gorringe, is developing a vaccine to combat meningitis B and C based on the harmless bacterium Neisseria lactamica. Scientists at the government's Center for Applied Microbiology and Research in the United Kingdom reported that early tests of their prototype vaccine have proven effective. Laboratory and animal studies have been completed, but the vaccine is still in pre–clinical studies. The scientists began researching N. lactamica because people who carry the bacterium seem to have protection against meningitis B. The researchers hope to develop it into a nasal spray for young children and, according to reports, the vaccine may also be effective against septicaemia. Findings will be presented at a meeting of the General Society for Microbiology in Britain.
[Reuters Health Online 04/10/02]

Certain Cosmetics Banned in China Due to Fear of BSE
On 12 March 2002 China placed a ban on the import and sale of substances that could cause bovine spongiform encephalopathy (BSE) from 18 countries unless they could prove that their products were free from ingredients extracted from cow and sheep offal and tissue. The countries affected include: Austria, Belgium, Britain, Denmark, Finland, France, Germany, Holland, Ireland, Italy, Japan, Liechtenstein, Luxembourg, Oman, Portugal, Slovakia, Spain, and Switzerland.

The Chinese ban comes one month after the European Union (EU) blocked imports of Chinese meat and seafood products because they contained what were considered harmful antibiotics. As of 04 April 2002, Beijing customs authorities have seized 177 items of cosmetics from Japan and Europe that were produced in France, Britain, Italy and Japan. While many department stores in Beijing have discontinued the sale of restricted products, others in smaller markets are reportedly continuing until they receive a list of specified imports to pull. According to reports, a ministry official said that the list would not be distributed until after 20 April 2002. The estimated sale of cosmetics from the affected countries is more than one million US dollars a year, according to Chinese officials.
[Reuters Health Online 04/10/02]

AIDS Vaccine Combo Enters Second Human Testing Phase
Two AIDS vaccines, a naked DNA formulation and one constructed from a weakened poxvirus, have proven safe and well tolerated in 26 volunteers of a Phase I trial that began in August 2000. The vaccines are being tested as a combination by the International AIDS Vaccine Initiative (IAVI) in the United States, the Kenya AIDS Vaccine Initiative, and the British Medical Research Council. These vaccines will be tested on larger numbers of British volunteers in the second stage of clinical development. Phase I/II studies have begun at Imperial College of Science, Technology and Medicine and will soon begin in Oxford. Studies of the vaccine combination also started in Kenya in March 2001 and Phase II trials are expected to begin in Africa by the end of 2002. The vaccines, which are among more than six being developed with IAVI support, are designed to offer protection against strains of HIV predominant in east Africa (specifically HIV subtype A). The DNA vaccines were produced for testing by Cobra Pharmaceuticals Ltd. in the UK and Impstoffwerk Dessau Tornau of Germany produced the poxvirus vaccines.
[Reuters Health Online 04/05/02]

Vaccine Shortage
During a recent meeting sponsored by the United Nations Children's Fund (UNICEF), health and finance ministers were warned of a serious shortage of children's vaccines. The conference, which had the goal of mapping strategies to ensure stable vaccine financing and uninterrupted supplies, was held in Cape Town on 12 April 2002 and was attended by health and finance ministers from Africa, Asia, Latin America, and Eastern Europe.

The survival of three million children each year has been attributed to vaccination programs. However, according to the UN's Children's Fund (UNICEF) an additional three million children die because they cannot receive the needed vaccines. In addition, 10 of 14 vaccine manufacturers partially or totally stopped production of children's vaccines between 1998 and 2001. According to UNICEF, this is because vaccine manufacturers want a commitment long in advance of delivery date, but some countries cannot make such a commitment because funding is often set on an annual basis. Vaccine shortages threaten the success of the worldwide campaign to eradicate polio by 2005, according to a UNICEF spokeswoman.
[Reuters Health Online 04/12/02]

Ban on Import of Thai Prawn Fry in Malaysia
The state of Kelantan in northern Malaysia announced a ban on the import of prawn fry from Thailand on 9 April 2002 after an outbreak of white spot disease (WSD) at breeding ponds in the country. According to the Kelantan fisheries department, initial investigations revealed that Thai prawns brought into the country were infected with WSD. The disease, which was first reported in Japan in 1993, causes premature death in crustaceans and is characterized by high and rapid mortality. It is caused by white spot syndrome virus (WSSV) or white spot virus (WSV) and is one of three crustacean diseases reportable to the OIE. The virus has resulted in losses of almost two million ringgit (USD 526,316) after some 400,000 fry from 87 breeding ponds in Malaysia's northwestern Kedah state were recently infected.
[Promed 04/09/02]

XIV International AIDS Conference 2002
Information on the upcoming International AIDS Conference being held in Barcelona, Spain from 7㪤 July 2002 is available at: http://www.aids2002.com/IE_Home.asp. The theme of the conference, which will consist of satellite meetings, plenary sessions, workshops, and poster presentations, is "Knowledge and Commitment for Action". Advance registration is closes on 01 May 2002 and registration forms are available online.


Oral Cholera Vaccine Effective in Human Tests
A study in the April issue of Infection and Immunity by Dr. Cohen and colleagues of Children's Hospital Center in Ohio, United States tested a new oral vaccine against cholera called Peru㪧 in 59 healthy volunteers. The existing vaccine available for preventing cholera is given by injection, and protects about half of people who receive it and produces adverse reactions at the injection site and throughout the body. In the study volunteers received either the vaccine, made from live, weakened Vibrio cholerae bacteria, or an inactive placebo shot. Approximately three months later 36 volunteers were exposed to live V. cholerae bacteria.

Headache and abdominal cramps were reported more often with the Peru㪧 vaccine than with the placebo, but the occurrence of abdominal cramps was not statistically significant. All but one person who received the vaccine (97%) showed at least a fourfold increase in the amount of anti–cholera antibodies in their blood. When exposed to the cholera germ, five (42%) individuals in the placebo group and none of the 24 individuals in the vaccine group developed moderate or severe cholera. Seven placebo recipients (58%) and one (4%) person recipient of the vaccine reported any diarrhea. According to Reuters Health, investigators plan on conducting a larger, multi–center challenge study to replicate the results obtained using a production lot of the vaccine. The length of time that the new vaccine protects against Cholera has yet to be determined.
[Infection and Immunity 2002;70:1965� Reuters Health Online 04/08/02]

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