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Vol. V, No. 11~ EINet News Briefs ~ June 14, 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 email list

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

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 anti–fungal 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.

Forty–six 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 pre–existing lung condition or were smokers. Cell–mediated 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 available.
[Promed 06/09/02, 06/08/02]

Cuba – Measles Vaccine Death
On 30 May 2002 Cuba announced that the Pan American Health Organization (PAHO) follow–up measles vaccination campaign had been suspended after three children died and 42 others became sick from imported vaccines thought to be contaminated. In the campaign a total of 750,000 children between four and nine years of age were vaccinated without any reported adverse reactions.

Preliminary results have identified Gram–positive aerobic bacilli in vaccine vials initially thought to be closed. However, this information is not definitive. The identification of the supposed Gram–positive 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 Gram–positive. 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 non–sterile 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 multi–system 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.
[Promed 06/01/021; 05/31/02]

United States (Florida) – Rabies
On June 6 2002, United States Centers for Disease Control and Prevention (CDC) reported a case of rabies in a beaver in Florida, the first such incident in Florida. The case occurred in November 2001 and was detected when the animal began acting aggressively and charging boaters on the Ichetucknee River. There have been no human reports of bites from the infected animal, but park rangers who handled the animal were treated for possible rabies exposure. Rabies, a deadly viral infection of the central nervous system, is most commonly found in raccoons, skunks, foxes and bats. Beavers are likely to come into contact with these animals that usually act as reservoirs of the rabies virus. Testing showed that the beaver was infected with a strain of rabies found in raccoons.

According to the CDC, bites from smaller rodents are unlikely to carry rabies due to low survival among small animals when attacked by a rabies–infected 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.
[Morbidity and Mortality Weekly Report 2002;51:481𤯒 Reuters Health 06/06/02]

Chile – Avian Influenza
On 30 May 2002 Chile reported an outbreak of suspected avian influenza, based upon clinical and serological observation, to the Office International des Epizooties (OIE). According to authorities, no positive serology of avian influenza has ever been detected in Chile. On 31 May 2002, agricultural authorities stated that at least 400,000 birds would be slaughtered at a plant in San Antonio due to the outbreak, in which 110,000 chickens have died. The plant will be quarantined along with a smaller plant in Rancagua that has also tested positive for the virus. In addition, shipments of poultry from Chile to Japan were suspended on 31 May 2002 because the type of avian influenza has yet to be determined. According to the deputy agriculture minister, purchasers of Chilean poultry have been informed.

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.
[Promed 06/02/02; OIE ]

Canada (Ontario) – West Nile Surveillance
Preliminary tests indicate West Nile virus (WNV) was present in a dead crow found in Mississauga, Ontario on 19 May 2002. The virus was first detected in Canada in 2001, the year in which a total of 128 birds in southern Ontario were found and confirmed to have the virus. The first cases in 2002 have been detected more than two and a half months earlier than in 2001, when the first birds were found on 8 Aug 2001. The United States also has confirmed cases of WNV earlier than usual. Health officials, who have not yet identified an explanation for the occurrence, are concerned that it may indicate a higher level of virus activity. Increased surveillance for WNV and a milder winter in the north may explain the increase in cases seen earlier in the year. Warnings and instructions for the public, such as avoidance of areas with high mosquito populations, the use of mosquito repellent, and elimination of standing water, have been issued.
[Promed 06/03/02]

United States (Utah) – Hantavirus Pulmonary Syndrome
On 8 Jun 2002 Valley View Medical Center in Utah reported that Hantavirus Pulmonary Syndrome (HPS) was confirmed in a 41–year–old woman who died in the early part of Jun 2002. The woman, from Cedar City, Utah was admitted to hospital on 2 Jun 2002 with flu–like symptoms. Her condition quickly deteriorated and she was pronounced dead five hours after admission. Her symptoms included muscle aches, fever, vomiting and shortness of breath. It is not yet known when she contracted the virus. The woman had reportedly been cleaning up mouse droppings at home. In order to determine the source of the infection, an environmental assessment will be conducted at the woman's home.
[Promed 06/09/02]

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 co–hosting 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.
[Promed 06/09/02]


Malawi – Bubonic Plague
The Malawian Ministry of Health has reported a total of 71 cases of bubonic plague to the World Health Organization (WHO), as of 27 May 2002. The outbreak, which first occurred on 16 April 2002, has affected 26 villages. Villages affected include two in Chimombo, 23 in Ndamera, and one in neighboring Mozambique. According to the WHO, collaboration between Malawian and Mozambican health teams has been going well. The WHO is providing supplies and technical support, including training, to the Malawian Ministry of Health surveillance unit and the Nsanje district health staff.
[World Health Organization 05/06/02]


Australia (Victoria) – Newcastle Disease
A follow–up 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
The director of the Animal Health Division, Ministry of Agriculture and Forestry (MAF) in Seoul reported on the current Foot and Mouth Disease outbreak on 24 and 29 May 2002. According to the report, a total of 12 outbreaks have occurred in 2002. Two outbreaks occurred on 2 and 3 May, four on 10 May, two on 12 May, one on 18 May and three on 19 May. All the affected farms were located within a 9–km radius of the primary affected farms in Ansung City and Yongin City. Laboratory diagnosis was made by the National Veterinary Research and Quarantine Service in Anyang, Kyonggi and diagnostic tests used included clinical inspection as well as serological and virological tests. Serological and virological tests have shown the current FMD virus, identified as FMDV serotype O, to be different from that detected in the 2000 outbreaks.

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 500–m radius of the affected farms and all pigs within a 3–km radius of the primary outbreak farm have been slaughtered. As of 23 May 2002, 29,717 animals from 45 holdings within a 500–m radius of the affected farms and 30,139 animals from 39 holdings within a 3–km 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.
[OIE 05/31/02]

Electronic Survey of Recent Network of Networks Meeting
The APEC Emerging Infections Network will conduct a Web–based follow–up 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 e–mail 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 Asia–Pacific economies.

Brazil Launches New Anti–AIDS Campaign
On June 4 2002 Brazil launched its first anti–AIDS campaign targeted for homosexuals in efforts to combat the rising infection rate among young, gay men. Between 1996 and 2001, the rate of infection for gay men between the ages of 15 to 24 years old grew 8.7 percent compared with 3.4 percent growth for those aged 25 to 34. According to the Health Ministry, homosexual men have 11 times higher risk of contracting AIDS than men who only have sexual relations with women and the rate of infection is 4.5 percent among homosexual men, compared with 0.4 percent for heterosexual men.

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 “self–esteem 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.
[Reuters Health 06/05/02]

Incidence of Re–occurring 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.
[Pediatrics 2002;109:1068� Reuters Health 06/06/02]

The Human Gut Sheds Light on Cholera Epidemics
A study published in the June 6th issue of Nature reports on the process by which cholera, a diarrheal illness caused by the Vibrio cholerae bacterium, may be propagated by the human host. Researchers, of Tufts University in Massachusetts, United States, found that cholera bacteria from human stool samples were up to 700 times more infectious than cholera grown in the lab and that the cholera in human stool remained highly infectious hours after being placed in a sample of pond water. According to the study, human digestive fluids activate genes in the Vibrio cholerae bacterium, such as those responsible for movement and nutrient acquisition, which make microbes highly infectious. Recognizing if this or any other pathogen is highly infectious after it leaves the body will help researchers in developing prevention methods for individual infections and epidemics. In addition, findings from the study may be useful in developing diagnostic tests or a vaccine against the bacterium when it is at its most infectious state. Cholera, which is transmitted through contaminated food and water, is rare in countries where there are modern water– and sewage–treatment facilities, but remains prevalent in less–developed parts of the world.
[Nature 2002;417:642𤱵 Reuters Health 06/05/02]

The APEC EINet listserv was established to enhance collaboration among academicians and public health professionals in the area of emerging infections surveillance and control. Subscribers are encouraged to share their material with colleagues in the Asia–Pacific Rim. To subscribe (or unsubscribe), please contact apec–ein@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://www.apec.org/infectious.


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