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Vol. V, No. 15~ EINet News Briefs ~ Sept. 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. Notices
  3. How to join the EINet email list

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


China (Beijing) – China Raises Estimates of HIV–AIDS Cases to 1 Million
China has estimated that the number of persons infected with HIV will
reach 1 million by the end of the year and said that it would manufacture
a full complement of AIDS drugs if Western patent–holders do not lower
their prices. China's Bureau of State Security also confirmed that it had
detained the country's most outspoken advocate for AIDS patients, Wan
Yanhai, who disappeared in Beijing two weeks ago. Dr. Wan had posted on
the Internet in late August a classified document prepared by the Henan
Health Bureau.

Dr. Wan founded Aizhi Action, a small organization that ran a Web site and
conducted AIDS advocacy work in China. A New Century Scholar of the
Fulbright Foundation, Dr. Wan is to receive a prestigious Canadian human
rights award this month.

China estimated 850,000 infections at the end of last year. While the
number of infected people jumped 58 percent from 2000 to 2001, the rate of
increase this year dropped to 16.7 percent, said Qi Xiaoqiu, director
general of the Department of Disease Control at China's Ministry of
Health. However, foreign health experts have questioned China's official
AIDS figures and say that local officials are avoiding testing high– risk
people in order to meet targets for holding down the number of reported

Mr. Qi said government research showed that 68 percent of Chinese with HIV
became infected by sharing contaminated needles. In poor rural areas,
however, infection was mainly through unsanitary blood–buying methods,
accounting for about 10 percent of infections.

In their announcements, officials for the first time publicly asked for
international help. Mr. Qi said "We need more capital support and
expertise" and he also indicated that China would consider bypassing
patents to produce its own cheaper versions of AIDS drugs, especially the
expensive Western medicines used in the AIDS cocktail, if the major
Western producers do not reduce prices by the end of the year.

Earlier this year, the World Trade Organization granted developing
countries the right to bypass drug patents if the medicines were declared
essential to combating a national health emergency and were otherwise

To date, China's negotiations with drug companies have yielded only
piecemeal results, bringing the price of the AIDS cocktail here from an
exorbitant $8,000 to an unaffordable $3,000 to $4,000. The same
medicines, in generic form, cost about $300 in Thailand.

Based on government statistics, Mr. Qi estimated that in one severely
affected part of Henan, Shangcai County, about 10,000 people had
contracted AIDS and that 1,000 had died. However, the few independent
experts who worked in the area say that the majority of adults in some
villages now carry HIV and that there may well be over a million people
infected in the province.
(NYTimes.com 09/06/02, SEA–AIDS 09/08/02)


USA (Iowa) – Salmonellosis, Person–to–Person Spread
A germ usually carried by contaminated food is apparently spreading from
person to person in the Burlington, Iowa area.

Salmonellosis has sickened more than 20 residents in the past three weeks,
said Dr. Patricia Quinlisk, state epidemiologist. The most common symptom
has been severe diarrhea. About six people have been hospitalized.

Usually, the people who are sickened have eaten the affected foods. In
this case, Dr. Quinlisk said, the bacteria apparently are traveling
directly from person to person.

In spite of the relatively large number of organisms usually required to
transmit the infection (ID50 = 5 logs or more), person–to–person
transmission of both salmonella typhimurium and the non–typhoid salmonellae
have both been reported. Inadequate hand washing is likely to be a common
thread especially associated with a recipient who has lower than normal
levels of gastric acidity that may lower the ID50 of the organism.
(ProMed 09/09/02)

Canada (Ontario) – West Nile Virus Update
Two more probable cases of West Nile virus have been found in Ontario
residents, increasing the total number of suspected cases to five. One of the
affected individuals lives in Toronto, the other in Peel Region.

It was announced last week that three men in Ontario, one of whom was in
hospital in serious condition and had probably contracted the virus. One
of those was likely related to travel in the United States. All
confirmatory testing results are expected in two weeks.

There have been no confirmed cases of West Nile in humans in Canada. The
first sign that West Nile had moved into Canada came last summer 2001,
when a dead bird found in southern Ontario was confirmed to have died of
the virus.
(ProMed 09/06/02)

USA (Georgia and Florida) – West Nile Virus Infection in Organ Donor and
Transplant Recipients
On 23 Aug 2002, the Georgia Division of Public Health (GDPH) and CDC were
notified of two cases of unexplained fever and encephalitis in recipients of
organ transplants from a common donor. An investigation has identified
illness in two other recipients from the same donor: one with encephalopathy
and the other with febrile illness. West Nile virus infection in all four
recipients has been confirmed. Out of three patients with encephalitis, one
has died and the two others are still hospitalized. This cluster represents
the first recognized transmission of West Nile virus (WNV) through organ

On 1 Aug 2002, four organs (two kidneys, heart, and liver) were donated from a
single donor and subsequently transplanted into four persons. Out of the four
organ recipients, three persons who received kidneys and heart met the case
definition for WNV encephalitis. The forth case is the Florida woman, 71
years old, who had a liver transplant and then had a mild illness but did
not develop encephalitis. She is recovering at home.

Usually, one in 150 WNV infections results in encephalitis or meningitis.
It is unknown whether immuno–compromised persons, such as organ transplant
recipients, are at higher risk for severe WNV–related disease following
infection. It is unknown if the route of transmission increased the risk
for encephalitis in these organ transplant recipients.

Based on preliminary results from this investigation, clinicians should be
aware of the possibility of WNV infection in organ transplant recipients
and patients receiving blood transfusions. Clinicians who suspect WNV
infection can obtain rapid testing through state and local health

Finding the virus in all four organ recipients "very strongly suggests" that
the disease was transmitted by the organs rather than by mosquito bites,
said the official, Dr. Lyle Petersen, a West Nile virus expert at the
Centers for Disease Control and Prevention. He also said the CDC had begun
investigating a second case of possible transmission of West Nile virus by
blood transfusions. In that case, a Mississippian developed a West Nile
infection almost four weeks after receiving transfusions, well within the
incubation period for the disease.

However, Dr. Petersen said, "There is absolutely no proof at this point
that West Nile virus transmission by blood donation has occurred in the
United States." and "The medical benefit of getting blood or organs far
outweighs any potential risk of getting West Nile virus from blood."
(ProMed: MMWR 09/06/02, New York Times 09/06/02, Reuters
Health 09/06/02)

USA – CDC Update: West Nile Virus Case Count
As of Sept. 16, 2002, the total human case cases for 2002 are 1460.
Total human fatalities are 66. These numbers have been reported and
verified to CDC/Arbonet.

For more information, visit the CDC West Nile Virus Web site http://www.cdc.gov/ncidod/dvbid/westnile/index.htm
(Health Alert Network 09/09/02)

USA (Oregon) – West Nile Virus Infection Case Imported from Another StateThe Oregon State Public Health Laboratory has confirmed West Nile virus
infection in a Michigan woman visiting Oregon, health officials at the
Oregon Department of Human Services (DHS) said today (09/09/02).

"The patient was not infected in Oregon. She was bitten by mosquitoes in
her home state (Michigan) and became ill while traveling Oregon," said Mel
Kohn, M.D, state epidemiologist at DHS. Dr. Kohn emphasized that this was
not an illness that could be spread from one person to another. The virus
has not been detected in any animals or mosquitoes in Oregon, although the
virus has been detected in every state east of the Rocky Mountains.
(ProMed 09/09/02)


WHO's response to the threat of the deliberate use of biological and
chemical agents o cause harm
Since improving preparedness is one of the three pillars of WHO's strategy
for global health security (the other two being containing known risks and
responding to the unexpected), WHO is helping countries prepare by
strengthening public health systems, building worldwide networks of
experts and institutions capable of responding, and providing technical
assistance with the preparation of national response plans in the event of
deliberate use of biological and chemical agents.

A WHO Headquarters (HQ) chemical and biological weapons (CBW) working
group was established and actively facilitates the exchange of information
between all sections of the organization involved with chemical and
biological agents. Similar working groups have also been established in
regional offices.

A WHO/HQ CBW information/resources is provided at
(WHO Weekly Epidemiological Record 08/23/02)

Re–evaluation of Network of Networks Meeting, Seattle
With cooperation of the meeting participants, we have conducted the survey
of the re–evaluation of the APEC Network of Networks Meeting in Seattle,
USA, in January 2002. The evaluation was aimed to follow the impact of the
meeting in participants' current work at six–month after the meeting.

All participants were asked to fill out an anonymous web–based survey form
(lhttp://www.apec.org/infectious/index.html) or to send a MS–Word survey
form back to us. We have received responses from 12 economies out of 14
economies that attended the meeting, All responders think that the
meeting was good–excellent as whole, even six months after the meeting. More
than 90 percent of those also think that we achieved the meeting
goals. The survey results are being analyzed and more details will be
presented late this month.

EID side meeting: APEC Industrial Science and Technology Working Group
A side meeting on the APEC emerging infections initiative will be held
during the upcoming Industrial Science and Technology Working group
meetings in Taipei, scheduled for Sept. 24. Interested persons should
contact the head of their economy's delegation to the ISTWG meeting for

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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