Japan—Bovine Spongiform Encephalopathy
On 11 May 2002 the fourth case of Bovine Spongiform Encephalopathy
(BSE) to have been reported in Japan was detected in a slaughtered
cow on a dairy farm in Hokkaido, Japan. Preliminary tests in which
the six–year–old female Holstein cow tested positive were done on
10 May 2002. On 13 May 2002 a panel of experts appointed by the Health,
Labor and Welfare Ministry confirmed the positive diagnosis based
on data gathered from a pathological examination and from a western
blot examination. Beginning in October 2001, Japan implemented BSE
testing in all cows slaughtered for beef. On 13 May 2002 the Agriculture,
Forestry and Fisheries Minister announced that the government may
conduct intensified screening of cows born in 1996 because all four
of the BSE infected cows were born that year. According to the farm
ministry, two animals were born 26 March and the other two were born
23 March and 4 April.
[Reuters Health Online 05/11/02; Promed 05/11/02]
Taiwan—Measles Imported from Philippines
The Center for Disease Control and the Department of Health in Taiwan
have confirmed a case of measles in an 11–month–old daughter of a
Filipino woman. According to reports, the baby had not received the
recommended vaccination at nine months and had traveled to Taiwan
with her mother. The case, which is the first to occur in Taiwan in
2002, is believed to be imported from the Philippines. In 2001, five
of nine confirmed cases of measles in Taiwan were imported from mainland
China, three of which were infants. Two of the three infants from
China had not received measles vaccination according to the recommended
schedule and the third had not yet reached the recommended age for
vaccination.
[Promed 05/11/02]
South Korea—Foot and Mouth Disease
On 04 May 2002 South Korea's Agriculture Ministry first reported a
confirmed outbreak of foot and mouth disease at a pig farm in Jinchon
district and another in Anseong district, 60 miles south of Seoul.
Four more cases were confirmed 11 May 2002 at two farms in Anseong
and two others in the nearby Yongin district. In addition, pigs at
a farm in Yongin and a farm in Jinchon district also tested positive
on 12 May 2002.
As of 12 May 2002, the government has slaughtered approximately 35,000
livestock, mostly pigs, in an effort to contain the disease. According
to the Agriculture and Forestry Ministry, authorities will slaughter
all pigs at farms within a 1.8 mile radius of where initial cases
were detected. According to reports, comparable measures will be taken
for other livestock if they are also found to be infected. In addition,
all farms with a 100–km radius of the outbreak have been closed and
two–thirds of the country's 106 livestock markets have also been shut
down. Soldiers and health officials are decontaminating farms and
vehicles passing through affected areas. According to reports, checkpoints
are in place in the quarantine area and animals within a smaller radius
are likely to be vaccinated. Japan has banned the import of South
Korean pigs and other livestock. In addition, visitors who spent time
near contaminated farms are required to disinfect their shoes at ports
of entry.
[Associated Press 05/12/02, 05/11/02, 05/04/02; Promed 05/06/02]
South Korea (Gangwon)—Classical Swine Fever
According to the Ministry of Agriculture and Forestry, the National
Veterinary Research and Quarantine Service (NVRQS) of South Korea
confirmed an outbreak of swine fever in Gimwha, Gangwon Province.
The ministry has said that 99 (28%) pigs at the livestock farm in
Gimwha died from the disease and all other pigs on the farm were to
be slaughtered. NVRQS officials are currently tracing the source of
contamination and pigs of nearby farms may be slaughtered or vaccinated,
depending of investigation results. The ministry had ceased nationwide
vaccinations in December 2002. Pigs infected with swine fever, a first–class
(A list) communicable disease that is unique to swine, usually have
a high fever, loss of appetite, diarrhea, and constipation. The outbreak
of the disease will likely delay the resumption of pork exports to
Japan, which was scheduled for July 2002.
[Promed 04/20/02]
South Korea—Vibrio Vulnificus
According to Korea's National Institute of Health (NIH), a nationwide
Vibrio vulnificus watch was initiated on 14 May 2002. The NIH said
it has discovered V. vulnificus bacilli in seawater, turban shells,
and in the aquariums of raw fish restaurants on Gangwha Island near
Incheon, Yeonggwang, South Jeolla Province and Daejeon. The disease
usually breaks out annually from June to October in waters off the
south and west coasts. Healthy individuals are rarely susceptible
to illness, however, individuals with pre–existing liver disease or
those who are immunosuppressed are more likely to become ill and die.
Most commonly, a vulnificus infection results in acute septicemia,
or blood poisoning and symptoms may include blistering of the skin,
vomiting, diarrhea, abdominal pain, fever, and chills. The incubation
period is usually one to two days. V. vulnificus can cause disease
in those who eat contaminated seafood or have an open wound that is
exposed to seawater or uncooked fish. According to the Korean NIH,
the mortality rate from the disease is approximately 40 to 50 percent.
[Promed 05/14/02]
Australia—Newcastle Disease
An outbreak of Newcastle Disease (ND) initially detected on 08 May
2002 near the town of Meredith in Victoria, Australia has been confirmed.
A laboratory diagnosis was made by the Australian Animal Health Laboratory
(AAHL) in Geelong, Victoria. Diagnostic testing included serology,
virus isolation and DNA sequencing. Immunohistochemistry and Intracerebral
pathogenicity index results are pending. A total of 250,000 animals
were susceptible to the outbreak and no animals have been destroyed
or slaughtered. The outbreak occurred in an egg production enterprise
comprising nine atmospheric–controlled rise sheds, each containing
approximately 22,000 to 25,000 birds. According to reports, the affected
flock has been quarantined and there is no evidence that the disease
has spread from the infected property. Two layer flocks in Victoria
identified as having had contact with the affected flock are being
tested, although these flocks remain healthy with no clinical or serological
evidence of ND. In addition, health officials have increased surveillance
in a 3–km radius restricted area and a 10–km radius control area implemented
around the infected property. There are no additional commercial poultry
flocks within the restricted area and five broiler flocks within the
control area. The origin of infection is currently unknown, however,
epidemiological investigations are continuing.
[Promed 05/12/02]
AMERICAS
Chile (Biobio)—Hantavirus Pulmonary Syndrome
A new case of hantavirus in Chile was confirmed by the Public Health
Institute on 7 May 2002. The infected patient, a 9–year–old child from
Balseadero de Megrete, was admitted to the Victor Rios Hospital in Los
Angeles and then transferred to the pediatric intensive care unit of
the Regional Clinical Hospital of Concepcion. The Health Service of
Biobio is conducting an investigation. The boy, who is currently in
stable condition, was admitted to hospital with typical symptoms, including
high fever, vomiting, diarrhea, and muscle pains. An additional suspected
case, an adult who is hospitalized in Victor Rios Hospital, is being
investigated.
[Promed 05/10/02]
US (Florida)—vCJD
A 22–year old woman living in Florida is thought to have variant Creutzfeldt–Jakob
disease (vCJD), a fatal, degenerative brain disorder. It is believed
that the disease cannot be transmitted from person to person, but
that people become infected through consumption of products from cattle
contaminated with bovine spongiform encephalopathy (BSE). The woman,
a citizen of the United Kingdom, was clinically diagnosed in the UK,
but resides in the Florida. The only method available to confirm a
diagnosis is achieved through brain biopsy or autopsy, but the patient's
clinical condition and history are thought to be indicative of vCJD.
The Florida Department of Health and the Center for Disease Control
(CDC) are still investigating the case. According to the United States
Department of Agriculture (USDA), there have been no previous cases
of vCJD in the United States. Due to the long incubation period of
the disease, the CDC believes that the patient acquired vCJD while
living in the UK. Of the 125 vCJD patients worldwide, almost all had
multiple–year exposures in the United Kingdom between 1980 and 1996
during the occurrence of a large UK outbreak of BSE among cattle.
[Florida Department of Health press release 04/19/02]
US (North Carolina)—Pertussis
A 10–month old infant adopted from Russia was reported to have pertussis
by the North Carolina Department of Health and Human Services on May
2 2002. The infant was picked up on 8 April 2002 in the orphan ward
at hospital A in Bryansk, Russia and on 24 April 2002 the infant and
parents traveled on commercial airline flights from Moscow to Raleigh,
North Carolina via New York. The Center for Disease Control and Prevention
(CDC) is working with the US Embassy, the airline, visa applicant
medical clinics in Moscow, and adoption agencies in order to notify
persons who may have been exposed to the infant during his communicable
period. State health departments in the United States as well as the
CDC are notifying persons and ensuring appropriate chemoprophylaxis
and vaccination for exposed persons. In addition, public health officials
and healthcare providers are being alerted of the case in order to
appropriately detect patients with symptoms. CDC information on pertussis,
including guidelines on the management of patients and their contacts,
can be viewed at: http://www.cdc.gov/nip/publications/pink/pert.pdf
[CDC Morbidity and Mortality Weekly Report 2002;51(18):394ס]
US (California, Hawaii)—Multidrug Resistant Gonorrhea
Researchers in Hawaii have identified the first American cases of
gonorrhea resistant to treatment with multiple drugs. More than half
of gonorrhea cases in East Asia and approximately 20 percent of cases
in Hawaii are resistant to fluoroquinolones, one of the two classes
of antibiotics typically used to treat the disease. Cephalosporins,
such as cefixime and ceftriaxone are also used to treat gonorrhea.
Fluoroquinolone–resistant strains of Neisseria gonorrhoeae have become
increasingly prevalent in California cities. The CDC has published
new guidelines for treating sexually transmitted diseases in the May
3rd edition of the Morbidity and Mortality Weekly Report (MMWR 2002;51(RRע):1㫨).
[Promed 05/07/02]
Canada (Ontario)—Recall of Gefilte Fish
The Canadian Food Inspection Agency (CFIA) has issued a warning regarding
gefilte fish sold at a Sobeys retail store in Toronto, Ontario due
to concerns of food contamination with Clostridium botulinum. The
product, imported by BH Kosher Products of Montreal, is sold in an
aluminum foil tray and is packaged in a box labeled in Hebrew with
an English ingredient list. BH Kosher Products is voluntarily recalling
the affected products. The CFIA is monitoring the effectiveness of
the recall.
[Promed 05/10/02]
Canada (Ontario)—Three Cases of Neonatal Tuberculosis
Two infants in the neonatal intensive care unit (NICU) at Toronto's
Hospital for Sick Children in Ontario, Canada were diagnosed with
tuberculosis (TB). One infant was diagnosed upon postmortem examination
in early February 2002 and the other was diagnosed on 12 April 2002.
The source of the infection has yet to be identified and it is not
clear whether the two cases are thought to have congenital tuberculosis
or to have acquired the infection in the NICU. According to the hospital's
chief of infectious disease, this is the first case of infant TB documented
at this hospital. Three hundred cases of infant TB have been documented
worldwide.
Two hundred and fifty staff and 103 families who were in the unit
between 15 December 2001 and 5 February 2002 are being tested for
the bacteria Mycobacterium tuberculosis. Before being transferred
to Toronto the babies were in Oshawa, Ontario at the Lakeridge Health
Corporation. For this reason the Durham health department is testing
more than 100 families who may have been exposed to one of the babies
there. The majority of the 103 babies who were potentially exposed
are from the General Toronto area, but all Ontario health units have
been notified, according to Ontario's chief medical officer of health.
Three babies from Manitoba, Saskatchewan, and Newfoundland will also
be tested. Affected families have been asked to attend special clinics.
Babies will be examined clinically, undergo TB skin testing, radiography,
and be given preventative medication.
A third case of neonatal tuberculosis that was diagnosed in mid March
2002 in central Ontario is also being investigated. Preliminary information
suggests that the case is not related to the two cases in Toronto.
The third patient was never the same hospital as either of the two
Toronto cases and the mother is suspected to have pelvic tuberculosis.
Efforts to evaluate the possible relatedness of these three cases
via pulse field gel electrophoresis and review of epidemiological
data are underway. The third Ontario case of neonatal tuberculosis
appears to have been caused by a different strain from the one that
caused the other two.
[Promed 04/25/02, 04/21/02]
RELATED NEWS
Greece—Acute Respiratory Syndrome
The Greek Ministry of Health and Welfare has reported 51 cases of
acute respiratory syndrome with pericarditis and/or myocarditis, as
of 29 April 2002. Further analyses are under way.
[WHO Weekly Epidemiological Record. 2002;77(19):157]
Germany—Malaria Imported from Thailand
Two unrelated cases of falciparum malaria have been reported to the
Robert Koch–Institut in Berlin. Both patients had visited Thailand,
where tourist destinations are regarded as non–malarial. No recommendations
for chemoprophylaxis have so far been issued for tourists.
The first case, a 20–year–old woman, had traveled to Thailand as
a backpacker with a friend. She arrived in Bangkok and from there
traveled around the south of the country, including Khao Sok national
park, where she stayed for two nights. She became symptomatic on 3
April 2002 with a headache, aching limbs, and slight inflammation
of the conjunctiva and presented to a doctor on 7 Apr 2002. She was
prescribed a combination drug consisting of salicylic acid, paracetamol,
and codeine and the next day she presented to her general practitioner,
who prescribed doxycycline without further diagnosis. She then presented
to the outpatient department at the hospital for tropical diseases
on 9 Apr 2002. Blood analysis showed P. falciparum at a parasite concentration
under 0.1 percent. Her friend, who was also ill with a fever, was
admitted at the same time and was diagnosed with dengue fever, but
found to be free of malaria. The second case, 43–year–old woman who
had a parasitaemia of 0.1 percent, had visited southern Thailand on
the island of Phuket during 11 to 21 March 2002. She also visited
Khao Sok national park for two days during this time.
Both patients were successfully treated with Malarone (atovaquone
and proguanil) and were discharged after a few days. There was no
link between the two patients except for the time of travel and the
stay at Khao Sok national park. No previous cases of falciparum malaria
have been reported from this area.
[Eurosurveillance Weekly Issue 19, 05/09/02]
2. UPDATES
Gabon—End of Ebola Hemorrhagic Fever Outbreak
The Gabonese Ministry of Public Health has officially declared the end
of the Ebola hemorrhagic fever outbreak in Ogooue–Ivindo province, as
of 6 May 2002. The last notified case died on 19 Mar 2002. No further
cases have been reported for a period equivalent to twice the maximum
incubation period for Ebola fever.
[WHO Update 23]
3. NOTICES
2002 STI & HIV Conference in China
The 12th International Union against Sexually Transmitted Infections
(IUSTI) Asia–Pacific Congress on STI, HIV/AIDS is being held at the
Beijing International Convention Center (BICC) in Beijing, China during
24㪳 October 2002. The conference, hosted by the Chinese Medical Association
and IUSTI, is being organized by the National Center for STD and Leprosy
Control; the Beijing Branch of Chinese Society of Dermatology; and the
Institute of Dermatology, Chinese Academy of Medical Sciences. The conference,
which will be held in English, has the theme of "Care of the Family".
Invited speakers include: Dr. Adrian Renton (UK), Dr. Bhushan Kumar
(India), Dr. Geo von Krogh (Sweden), Dr. James Bingham (UK), Dr. John
Tapsall (Australia), Dr. Judy Wasserheit (USA), Dr. Mikhail Gomberg
(Russia), Prof. Jorma Paavonen (Finland), Prof. Peter Piot (Belgium),
Dr. Raj Patel (UK), Dr. Shao Yimin (China), Dr. Wang Baoxi (China),
Dr. Xu Wenyan (China), Dr. Zheng Xiwen (China). Topics to be discussed
at the conference include: the epidemiology of STIs in Asia, syphilis,
genital HPV infection, HIV/AIDS, genital chlamydia trachomatis infections,
traditional Chinese medicine in STIs and AIDS, and advances of diagnosis
technique for STIs. For more information regarding the conference,
please contact the Secretariat at:
IUSTI APC 2002 Secretariat
International Convention Services
Chinese Medical Association
42, Dongsi Xidajie, Beijing 100710, China
Telephone: +86 (10) 6524 9989 ext. 1606/1608
Fax: +86 (10) 6512 3754/6524 4086
Email: ronmeng@chinamed.com.cn
Web: http://www.chinamed.com.cn/iusti
HIV Drug Label Switch
On 13 May 2002 the drug company GlaxoSmithKline announced that patients
and doctors should be on alert for counterfeit labels on one of its
HIV drugs. The company is not issuing a recall on the drugs. Glaxo
reported on 10 May 2002 that fake labels for Combivir (lamivudine
and zidovudine), a white capsule–shaped tablet engraved with "GX
FC3", had been placed on two bottles actually containing the
cheaper drug Ziagen (abacavir), a yellow capsule–shaped tablet engraved
with "GX 623". Although the drugs are both antiretroviral
agents used to treat HIV, officials are concerned because approximately
five percent of individuals who take abacavir develop a potentially
life–threatening allergic reaction. According to the company, the
incident, which is thought to be confined to the United States, was
motivated by financial reasons and could lead to a criminal prosecution.
No injuries or adverse reactions have been reported and company tests
have shown no problems with the medicine itself.
[Reuters Health Online 05/13/02]
Carrots Containing Hepatitis B Vaccine
Plant specialists and virologists from Giessen University in Germany
have successfully grown genetically modified carrots that contain
the vaccine for hepatitis B. The carrots are ready to begin pre–clinical
trials and, according to researchers, the "carrot vaccines"
could be ready in approximately three years. The current vaccine against
hepatitis B is expensive to produce and is administered via three
injections. Researchers believe that carrots are a particularly good
vehicle for the vaccine, as they are easy to store, transport and
consume raw and carrots can be grown in many different climates and
soil types. Researchers, who have been working on the carrots for
almost two years, inserted the gene for the hepatitis B surface antigen
normally used in the vaccine into carrots. According to one of the
researchers from Giessen University, approximately 100,000 plants
can be made in two weeks and the carrots are ready to eat within three
months. An initial report will be published in a summer edition of
the Dutch journal Plant Cell, Tissue and Organ Culture. Giessen University
estimates there are around 350 million people around the world infected
with hepatitis B virus and one million people are believed to die
from the disease annually.
[Reuters Health Online 05/10/02]
