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Vol. V, No. 09~ EINet News Briefs ~ May 17 , 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.


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]


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]


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]


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]

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]


Revision of the International Health Regulations
The May 10th edition of the World Health Organization's Weekly epidemiological record (WER) details a progress report of revisions to the international health regulations (IHR). The regulations aim to "ensure the maximum security against the international spread of diseases with a minimum interference with world traffic" and involve reporting of specific diseases to the WHO. In 2001 the World Health Assembly adopted a resolution on "Global health security: epidemic alert and response" in which the revision is linked to WHO's activities in "identifying, verifying, and responding to health emergencies of international concern". The WER report touches upon the definition of public health emergencies of international concern, updates of routine preventive measures, IHR focal points, and the revision process. A copy of the issue can be viewed at http://www.who.int/wer/pdf/2002/wer7719.pdf.
[WHO Weekly Epidemiological Record. 2002;77(19):157𤪐]

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