Vol. V, No. 11~ EINet News Briefs ~ June 14, 2002
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In this edition:
1. OVERVIEW OF INFECTIOUSDISEASE INFORMATION
Canada (British Columbia) – Cryptococcal Disease
On 6 Jun 2002 an alert was issued by the British Columbia Centre for Disease Control (BCCDC) concerning an outbreak of illness due to the fungus Cryptococcus neoformans on the east coast of Vancouver Island. A travel advisory has not been issued due to the relative infrequency of infection, despite an increase in incidence in the past few years. As of 1999 health officials have identified 52 cases, including one death, with 11 occurring so far in 2002 and two to three cases occurring annually prior to 1999. According to public health officials, this outbreak from the fungus is the largest seen anywhere in the world.
Symptoms of cryptococcus infection, which has an incubation period of approximately two to nine months, include infection of lungs, kidneys, prostate, and bone; subacute or chronic meningitis; and skin lesions, ulcers, or subcutaneous nodules. Eye infections have resulted in blindness. The infection is curable with antifungal drugs. There are several variations/strains of Cryptococcus neoformans, the two most common are C. neoformans var. neoformans and C. neoformans var. gattii, which has never been found before outside tropical or subtropical climates. The var. gattii had only been seen in North America in subtropical southern California. Through subtyping, health officials have determined that the strain detected in Vancouver Island is serotype B, variety gattii.
Fortysix of the cases have been residents of Vancouver Island, and six of them were mainlanders who had traveled to the island. Clinical presentations of cases have been primarily respiratory infection or meningitis and about 80 percent of those affected either suffered from a preexisting lung condition or were smokers. Cellmediated immunodeficiency and immunosuppression are predisposing conditions for clinical disease. Currently, 80 to 90 percent of infections worldwide are associated with AIDS and the disease is found in 30 percent of AIDS patients in Africa and Southeast Asia as well as 6 to 10 percent of AIDS patients in the United States. C. neoformans infection is also documented in 2.8 percent of organ transplant recipients. None of the cases are known to have had HIV infection. Officials also have identified approximately 40 cases in animals, including felines, canines, and some porpoises found dead along the coast of the island. Other animals, such as foxes, birds, cattle, horses, and goats, are also susceptible to infection.
It is not yet understood why the fungus has recently emerged on Vancouver
Island, but some have hypothesized that it is due to importation with
tropical plants and global warming. Investigations are continuing
and include surveillance, environmental sampling and molecular subtyping.
Despite the number of cases, health officials say the risk of contracting
the illness is low. According to reports, the parks ministry will
post signs and make brochures addressing the fungus and fungal infection
Cuba – Measles Vaccine Death
Preliminary results have identified Grampositive aerobic bacilli
in vaccine vials initially thought to be closed. However, this information
is not definitive. The identification of the supposed Grampositive
aerobic bacilli suggests the possibility of external contamination.
Contamination of vials often involves bacteria found on skin, such
as staphylococci or streptococci, both of which are Grampositive.
Health officials believe that if the current information is correct,
then the events are most likely related to operational aspects of
the program. Investigations concluded that the deaths following administration
of the measles vaccine were related to toxic shock syndrome resulting
from possible contamination due to the use of nonsterile syringes
and the use of “expired” reconstituted vaccine. Toxic
shock syndrome is characterized by sudden onset of fever, chills,
vomiting, diarrhea, muscle pains, and rash followed by hypotension
and multisystem failure. A team of personnel from the Division of
Vaccines and Immunizations of PAHO is presently in the field aiding
in the investigation. Specimens of the vaccine vials have been sent
for sterility testing.
United States (Florida) – Rabies
According to the CDC, bites from smaller rodents are unlikely to
carry rabies due to low survival among small animals when attacked
by a rabiesinfected animal. Because large rodents such as beavers
and woodchucks are more likely to survive, they are at risk of becoming
infected. The number of cases is increasing in the US with a total
of 97 cases reported in rodents between 1971 and 1984, compared to
an average of 52 cases per year between 1995 and 2000. The rise is
attributed to cases in large rodents such as woodchucks and beavers.
The Florida Department of Health tested 3,751 animals in 2001 and
found five percent were positive for rabies, including 124 raccoons,
34 foxes, 19 bats, 15 cats, two otters, a dog, a bobcat and a horse.
Chile – Avian Influenza
Authorities, with aid from a United States laboratory, have begun
an investigation to determine the origin of the outbreak and identify
the virus. Laboratory investigations, which may take at least two
weeks, are underway to determine if the virus strain involved has
the virulence of highly pathogenic avian influenza (HPAI), an OIE
list A disease. Further measures taken to manage the outbreak will
depend, in part, on the findings.
Canada (Ontario) – West Nile Surveillance
United States (Utah) – Hantavirus Pulmonary Syndrome
South Korea – Foot and Mouth Disease Detected in a Milk Cow
On 8 June 2002, officials reported that a milk cow in central South Korea tested positive for foot and mouth disease (FMD). The government has slaughtered tens of thousands of pigs since an outbreak of the disease began in Ansung, on 2 May 2002 and several cows had been included in the precautionary slaughter. No cattle in the area were found to be infected until a farmer located approximately one mile from where the outbreak began reported on 7 June 2002 that one of his cows was showing signs of FMD infection. Tests have since confirmed that the cow was infected with FMD. As a preventive measure, authorities slaughtered 130 milk cows in nearby areas. South Korea, which is cohosting the World Cup with Japan, has been struggling to soothe international concerns about possible spread of FMD during the tournament. The nearest World Cup city is Suwon, 25 miles north of the affected region.
Malawi – Bubonic Plague
Australia (Victoria) – Newcastle Disease
A followup emergency report was provided to OIE on 31 May 2002 regarding the outbreak of Newcastle disease on a farm in the State of Victoria, Australia. Destruction and disposal of all 249,069 birds on the infected farm was completed on 24 May 2002 and officials have begun cleaning and disinfecting the infected premises. The rest of Victoria and Australia outside the zone of surveillance continues to remain free of Newcastle disease.
[Promed 06/03/02; OIE 05/31/02]
Korea – Foot and Mouth Disease
According to the report, all animals in the 12 affected farms have
been destroyed, including 51,233 pigs, 116 cattle and nine deer. As
a precautionary measure, all susceptible livestock within a 500m
radius of the affected farms and all pigs within a 3km radius of
the primary outbreak farm have been slaughtered. As of 23 May 2002,
29,717 animals from 45 holdings within a 500m radius of the affected
farms and 30,139 animals from 39 holdings within a 3km radius of
the first affected farms had been destroyed. The origin and spread
of infection is still under investigation. The last cases in pigs
were reported on 19 May 2002.
Electronic Survey of Recent Network of Networks Meeting
The APEC Emerging Infections Network will conduct a Webbased followup evaluation of the APEC Network of Networks meeting held in Seattle, Washington in January, 2002. This work will describe the impact of the meeting on the current activities of organizations and professionals who attended. All participants in the meeting will receive email notice of this survey from us at the end of this month (28 June 2002). The input and evaluation of the meeting from all participants is invaluable for the improvement of our collaborations among AsiaPacific economies.
Brazil Launches New AntiAIDS Campaign
Brazil has reduced HIV/AIDS infection rates to 0.6 percent of the
adult population due to, in part, an aggressive AIDS prevention programs.
Previous campaigns have not focused on homosexuality so as not to
reinforce stigmas about AIDS and sexual orientation. The current government
campaign was developed with gay rights activists and aims to raise
tolerance toward homosexuals aged 15 through 24, especially among
health professionals, educators and parents. The campaign is based
on a concept embodied in a statement made by the president of the
Gay Movement of Mina Gerais in a Reuters report, that “selfesteem
in one of the pillars of AIDS prevention”. Advertisements illustrate
acceptance of homosexuality by families, colleagues and society. The
campaign, estimated to cost US$1.2 million, will play commercials
in gay movie theaters and 80 gay groups will distribute posters and
key rings in gay clubs and bathhouses.
Incidence of Reoccurring Chickenpox Infections
A new study in the journal of Pediatrics has found that repeat infection of chickenpox, caused by the varicella virus, may occur more frequently than previously thought. Susan Hall of the University of North Carolina at Chapel Hill and colleagues investigated cases of chickenpox identified through a surveillance project in a region of Los Angeles County between 1 Jan 1995 and 31 Dec 1999. The researchers also examined those who reported previous infection with onset between 1 Jan 1998 and 30 Sep 1998. They found that 4.5 percent of cases in 1995 and 13.3 percent of cases in 1999 reported a previous infection with chickenpox. Almost half of those suspected of double infections said that other members of their families also had had chickenpox twice.
A single infection with chickenpox has long been thought to offer immunity
from subsequent infections with the disease. Reports of repeated infections
may be due to an inaccurate diagnosis of chickenpox or perhaps a small
proportion of people can acquire a second infection. The study authors
recommend that doctors carefully document any doubts they have about a
child's diagnosis, and perhaps vaccinate any children who may have been
mistakenly diagnosed in the past.
The Human Gut Sheds Light on Cholera Epidemics
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