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Vol. V, No. 16~ EINet News Briefs ~ Sept. 27, 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.


Japan—BSE origins baffle Japan
The Japanese government said it was unclear how mad cow disease, or bovine spongiform encephalopathy (BSE), had infected Japanese cattle, one year after the brain–wasting disease was first diagnosed in the country. However, it suggested at least three possibilities involving contaminated meat and bone meal (MBM) and fertilizer from Europe.

The source of BSE infection in Japan, where five cases have been diagnosed since September 2001, remains debatable. Since the first four infected dairy cows, from different farms, were of the similar age group and said to have been fed during their first months with a calf milk–replacer (CMR) from a common source, earlier commentaries raised the possibility that CMRs might have played a role in the epidemiology. Reportedly, the fifth cow was “probably” fed the same substitute. A Japanese delegation visited The Netherlands in June 2002 to discuss the matter, since the Japanese CMR’s were said to have contained Dutch animal fats; however, the results of this visit remained inconclusive.

The Scientific Steering Committee of the EU (SSC) has been working on an updated quantitative assessment of the possible residual BSE risk in bovine–derived products such as tallow, gelatin, and dicalcium phosphate (DCP). A specialized working group is preparing a report containing proposals for the basic assumptions and input data to be used in the risk assessment. The final report is expected before the end of the year.
(ProMed 09/14/02, Financial Times 09/11/02)

Taiwan—Dengue Fever Cases Reach Highest Total Since 1988
The number of people infected with dengue fever nationwide this year is closing in on the year 2000 cases, reaching the highest total since 1988. According to the (Taiwan) Center for Disease Control (CDC), there have been 1,924 cases of dengue fever reported nationwide so far this year, including 876 cases in Kaohsiung City, 991 cases in Kaohsiung county, and 57 cases in the rest of the country. As of Sept. 7, 2002, three people have been confirmed to have died as a result of dengue hemorrhagic fever in Taiwan

Officials from the Environmental Protection Administration (EPA) said that there were signs that the number of mosquitoes was on the decline in some areas of Kaohsiung, and that the cleanup and inspection efforts were working. The EPA said they were more concerned about an epidemic next year, explaining that a more serious dengue epidemic usually occurs in the year following a year like this one if prevention work is not carried out thoroughly. As a consequence, the EPA is planning to start its mosquito cleanup effort next year in February rather than May.
(ProMed 09/16/02)

Singapore—Rise in Dengue Fever Cases
Singapore is battling against mosquitoes after a jump in the number of dengue fever cases and the deaths of three people in June and July 2002. A mix of hot weather and downpours is being blamed for an average of 440 cases a month since June compared with 318 during the same period of last year. In 2001, four people died of the mosquito–borne infection and two died in 2000.

The World Health Organization estimates there may be 50 million cases of dengue infection each year, with 2.5 billion people, a fifth of the world's population, at risk.
(ProMed 09/16/02)

Malaysia—Dengue Alert in Federal Territory and Four States
On Thursday, Sept. 12, 2002, four states and the Federal Territory issued a dengue alert in view of the alarming 142.8 percent increase in cases since January 2002, compared to the same period in 2001.

There were 17, 341 cases reported by the end of last month with 16, 258 being dengue fever and the rest dengue hemorrhagic fever cases. There were 34 deaths during the period. State health department officials attributed the increase in cases to a stretch of wet weather followed by a short dry spell recently.
(ProMed 09/16/02)

China (Nanjing)—Fatal Food Poisoning
A jealous businessman has been arrested and confessed to a mass food poisoning in China that caused at least 38 deaths and hundreds ill, state media reported. “Because of business competition, he developed hatred (for his competitor) and used a rat poison ‘Du Shu Qiang’ banned by the government to poison and commit the crime,’ said the Xinhua News Agency's Web site.

Hundreds of people, including many children, fell ill after eating food laced with rat poison at a snack shop, selling fried dough, sesame cakes, and rice in the Chinese city of Nanjing. Several of the victims were reported to have collapsed, some coughing up blood, just minutes after eating at the restaurant. The China Daily said 500 medical personnel have been mobilized to deal with the case.

The product that caused the poisonings has been identified as a popular tetramine rat poison marketed as “Du Shu Qiang,” an official at the Nanjing Military Region General Hospital said. Production of Du Shu Qiang is banned in China, but the poison is widely used in rural areas because of its low cost and high effectiveness, according to a report in the Shanghai Daily on Tuesday Sept. 17, 2002. As little as five milligrams of the poison is enough to kill someone, a local doctor told the newspaper. The active ingredient is Tetramine; Tetramethylene Disulfotetramine.
(ProMed 09/17/02, 09/18/02)

Mongolia reports three cases of plague (one fatal) during the period Aug. 1㪴, 2002. These cases have no implications for international travel. Plague is endemic in Mongolia, and human cases of bubonic plague are reported every year, mainly in country dwellers who have been hunting marmots for their fur. Marmots are large, burrowing rodents similar to groundhogs (woodchucks) in the USA.
(ProMed 09/19/02)


USA (Wisconsin)—Chronic wasting disease in captive deer
According to department of Natural Resources in Wisconsin, a white–tailed buck shot on a game farm in Portage County tested positive for chronic wasting disease, which is similar to mad cow disease in cattle. The Wisconsin natural resources officials are concerned that chronic wasting disease has spread from the initial outbreak area near Madison to infect deer in other parts of the state.

The infected deer was killed by a hunter on a preserve Sept. 4. Officials said the buck was believed the first captive deer to test positive for the disease in the nation. Previously only captive elk had tested positive for chronic wasting disease. The game farm has been quarantined, along with another game farm in Walworth County. It has not yet been determined whether all the animals will be destroyed.

No cases of chronic wasting disease have been found in Wisconsin 's wild deer population.

Like mad cow disease in cattle and scrapie in sheep, chronic wasting disease is caused by abnormal proteins that attack the brain and nervous system, causing weight loss and behavioral changes. Researchers have not yet determined how chronic wasting disease is spread or whether it is transmittable to humans.
(ProMed 09/21/02)

Canada (Nova Scotia)—West Nile Virus Infection of Birds Confirmed
On Friday Sept. 20, 2002, the Nova Scotia Department of Health confirmed the previously presumptive diagnosis of West Nile virus infection in a blue jay found in Dartmouth, and announced a presumptive positive crow found in Kingston on Aug. 26, 2002. These locations are northeast of the state of Maine, and the furthest east that West Nile virus has been detected in North America (approximately at the 65th meridian).
(ProMed 09/21/02)

USA (multi–states)—Listeriosis
According to New York City health officials six people in the metropolitan area have died of the food–related illness listeriosis this summer. New Jersey health officials have reported four listeria–related deaths among elderly people. In Pennsylvania , where this summer's outbreak was first identified, four elderly people have died from the disease. The outbreaks also have been found in Connecticut, Maryland, and Michigan.

Although DNA testing has shown that the bacteria in the cases in New York City was the same strain as that in the Pennsylvania cases, laboratory tests have not determined whether those deaths in New Jersey are tied to the Pennsylvania cases.

Listeriosis is caused by Listeria monocytogenes, a species of bacteria sometimes found in raw foods, including uncooked meat and unpasteurized milk. Although the bacteria should be killed during processing by food manufacturers, it has been found to survive in some ready–to–eat meats. In New York City, recent outbreaks have been linked to hot dogs, turkey meat, and refrigerated pate.

Eating listeria–contaminated food results in flu–like symptoms, which may not show up for 10 weeks, including fever, muscle aches, and diarrhea in otherwise healthy people. Pregnant women are at particular risk; they are 20 times more likely to contract listeriosis.

The people who died had weakened immune systems, which placed them at high risk. New York City Health Department officials said 20 percent of those who have compromised immune systems typically die if they contract listeriosis.
(ProMed 09/17/02)


USA—West Nile Virus Transfusion Transmission
CDC, FDA, the Health Resources and Services Administration (HRSA), the Georgia Division of Public Health, and the Florida Department of Health identified West Nile virus (WNV)–associated illnesses in four recipients of organs from the same donor. However, the source of the organ donor's infection remains unknown; an investigation of the numerous transfusions received by the organ donor is ongoing.

The recent MMWR summarizes two investigations of recipients of organs and blood products, four investigations of transfusion recipients, and one investigation of a WNV–seronegative person with fever and encephalopathy who received a potentially contaminated unit of blood.

The initial investigation demonstrated transmission from a WNV–viremic organ donor to four recipients of those organs. In another investigation, the isolation of live WNV from a unit of Fresh Frozen Plasma (FFP) indicates that the virus can survive in some blood components and probably can be transmitted by transfusion. Although this case is highly suspicious for transfusion–associated transmission, this patient lived in an area where WNV was active, and the exact means of WNV acquisition cannot be determined. In contrast, the preliminary results of another case investigation indicate that not all recipients of potentially WNV–contaminated units (i.e., those that are positive for WNV by TaqMan) will become infected with WNV.

Approximately 4.5 million persons receive blood or blood products annually. Although persons needing blood transfusions or organ transplants should be aware of the risk for WNV infection, the benefits of receiving needed transfusions or transplants outweigh the potential risk for WNV infection. In addition, blood donation poses no risk to the donor for acquiring WNV, and PHS encourages blood donation.
(MMWR 2002;51(37);833𤴴, ProMed 09/19/02)


USA—Mass Smallpox Vaccination Clinic Guide Now Posted on CDC Web site
CDC has posted the clinic guide for post–event mass smallpox vaccination planning at: http://www.bt.cdc.gov/documentsapp/smallpox/rpg/index.asp

This document describes the operational and logistical considerations associated with implementing a large–scale voluntary vaccination program in response to a confirmed smallpox outbreak.
(CDC 09/24/02)

EID Side Meeting: APEC Industrial Science and Technology Working Group (ISTWG)
A side meeting on Emerging Infections is being held in Taipei in conjunction with the ISTWG meetings of APEC this week. Please look for a report of this meeting in our next bulletin.


Accumulation of Prion Protein in Tonsil and Appendix: Review of Tissue Samples
In recent British Medical Journal, DA Hilton, et al. has published the first estimate of the number of people who may be a potential source of variant Creutzfeldt–Jakob disease by iatrogenic spread.

In their study, one appendix showing the lymphoreticular accumulation of prion protein, the infectious agent responsible for variant Creutzfeldt–Jakob disease (vCJD), out of 8,318 samples tested gives an estimated detectable prevalence of prion protein accumulation of 120 per million (95 percent confidence interval, 0.5 to 900) among people aged 10㫊 between 1995 and 1999.

"It offers some limited reassurance, the findings could have been a lot worse than this," said Professor Peter Smith, chairman of the Spongiform Encephalopathy Advisory Committee that advises the government on vCJD. "This is the first time that anybody has been able to get any sort of handle on the level of exposure. But it is a small sample and what is needed now is larger–scale studies," Smith added in an interview.

In the seven years since vCJD appeared, 115 people have died and 12 patients have the disease. The number of deaths during the first eight months of this year was 11, compared with 20 in 2001 and 28 in 2000.
(British Medical Journal 2002;325:633𤱪, ProMed 09/21/02)

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