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Vol. V, No. 17~ EINet News Briefs ~ Oct. 11 , 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
    Hong Kong SAR: Third locally acquired dengue fever case confirmed
    Taiwan: Dengue fever continues to spread
    USA (Midwest): E. coli O157, ground beef recall
    USA (Michigan): West Nile Virus Infection and Breastfeeding
    USA (Washington): West Nile Virus, Bird
    Canada: West Nile Virus
    Canada (Nova Scotia): Lyme Disease
    USA (Virginia): Malaria parasites identified in Loudoun Mosquitoes
    Switzerland: concerns over harmful nitrofuran found in food
  2. Updates
    USA: CDC Update: West Nile Virus Case Count
    USA: Smallpox Vaccination Strategies
    USA (multistate): Listeriosis, Deli meat suspected
  3. Notices
    Report from 23rd APEC ISTWG Meeting, Taipei
    Re–evaluation of Network of Networks Meeting, Seattle
  4. Journal articles
    Salmonella Sepsis Caused by a Platelet Transfusion from a Donor with a Pet Snake
  5. How to join the EINet email list

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


Hong Kong SAR – Third Locally Acquired Dengue Fever Case Confirmed
On Sept. 23, two more local cases of dengue fever were confirmed as the government launched an all–out publicity campaign to try to stem the spread of the potentially fatal disease. The two workers, aged 28 and 38, from a Ma Wan construction site, contracted the disease earlier this month, laboratory tests revealed. They have since recovered. Those workers are employed on the same construction site as a third man in whom dengue fever was confirmed on Sept. 22.

The World Health Organization's regional adviser, Dr. Allan Schapira, said dengue fever has been endemic in South East Asia for centuries and Hong Kong was on the northern fringe of the high–risk area. Because of its location, Hong Kong had reported small outbreaks of imported dengue cases in recent years. Dr. Schapira said the role of travelers was important in the spread of dengue: "An infected traveler can trigger a new epidemic," but that the risk of death could be "close to zero" with proper timely treatment.
(ProMed 09/30/02)

Taiwan – Dengue Fever Continues to Spread
The Department of Health (DOH) under the executive Yuan reported on Sept. 24 that the number of reported dengue fever cases in Taiwan had reached 2,505 as of that day. DOH officials said that Kaohsiung County and Kaohsiung City together comprise the worst–affected area, with 2,410 cases.
(ProMed 09/30/02)


USA (Midwest) – E. coli O157, Ground Beef Recall
At least 56 Midwesterners have become ill in the latest suspected contamination of ground beef with E. coli O157 bacteria. As of Sept. 27, symptoms among 52 people in Wisconsin, three in Minnesota, and one in Illinois have been linked to the contamination. Nineteen in Wisconsin were admitted to hospital. "The suspected vehicle for transmission of E. coli 0157:H7 in these outbreaks is ground beef," the Wisconsin health agency said. A Wisconsin meat packing company said that it is recalling, for a precaution, about 400,000 pounds of ground beef that may be connected to E. coli outbreaks in three states. In May 2002, the company recalled 471,000 pounds of ground beef because of possible contamination with E. coli. The USDA's recent declaration of war on the deadly strain of E. coli called for random testing of all US meat processing plants as a precaution. Companies also were ordered to review their food safety measures and adopt stricter ones to reduce the risk of contamination. Congressional investigators with the General Accounting Office said USDA food safety inspectors were not reliable in identifying or documenting companies that failed to meet federal standards.
(ProMed 09/30/02)

USA (Michigan) – West Nile Virus Infection and Breastfeeding
Based on a recent case in Michigan, it appears that West Nile virus (WNV) can be transmitted through breast milk. A new mother in Michigan contracted WNV from a blood transfusion shortly after giving birth. A sample of the mother's breast milk obtained 16 days after delivery tested positive for WNV–specific IgM. She breastfed her infant, and three weeks later, her baby's blood tested positive for WNV. Because of the infant's minimal outdoor exposure, it is unlikely that infection was acquired from a mosquito. The infant was most likely infected through breast milk. The child is healthy, and does not have symptoms of WNV.

The case does not mean that current recommendations in favor of breastfeeding should change, according to the Centers for Disease Control and Prevention, because the health benefits of breastfeeding are well established, and the risk for WNV transmission through breastfeeding is unknown. The American Academy of Pediatricians and the American Academy of Family Physicians recommend that infants be breastfed for a full year of life. Lactating women who are ill or who are having difficulty breastfeeding for any reason, as always, should consult their physicians.

According to Dr. Lyle Petersen, a West Nile expert at CDC, two other viruses in the same family as West Nile had been transmitted to people from drinking milk from cows or goats. Neither of those viruses has been found in North America. One is from India and the other from Eastern Europe and parts of Asia. There is no information about whether those viruses pass into human breast milk.

There were just two viral infections in which women are told not to breast–feed, HIV and a very rare illness, human T–cell leukemia virus type 1. With other viral illnesses like colds and flu, women are generally told to continue nursing because the illnesses are not severe enough to justify stopping.

Although mosquitoes are by far the most important source of infection, Dr. Petersen said, the illness in two transfusion recipients was further evidence that the virus could spread through blood and blood products. Transmission via blood is thought to have occurred in three other transfusion recipients. Officials theorize that four people, including one who died, contracted the disease from organ transplants.

There is no screening test to detect WNV in the blood supply. Dr. Jesse Goodman of the Food and Drug Administration said his agency was "urgently working with manufacturers and others with potential blood screening tests to try to facilitate their availability."
(ProMed 09/29/02, NY Times 09/30/02, MMWR 10/04/02)

USA (Washington) — West Nile Virus, Bird
WNV has been detected in a dead raven collected near Newport, Washington. Testing at the National Wildlife Health Center Laboratory in Madison, Wisconsin confirmed the virus. This is the first WNV detection in Washington, according to the state Department of Health. No human or horse cases of WNV infection have been reported in Washington. Nationwide, 43 states have detected the virus.
(ProMed 10/03/02)

Canada — West Nile Virus
As of Sept. 30, Health Canada has reported a total number of 38 human cases of WNV infection: 28 suspected cases, 10 confirmed cases, including one death. Three suspected cases and one confirmed case are resident in the province of Quebec, while the other 25 suspected cases and nine confirmed cases are resident in the province of Ontario (see previous report). One confirmed case likely acquired infection while traveling in the U.S. whereas all other cases acquired their infection within their home province. More information is available at Health Canada ..
(WHO WER 10/01/02)

Canada (Nova Scotia) — Lyme Disease
Health officials have confirmed the first case of Lyme disease in Nova Scotia. The provincial health department said on Friday that a person living on the province's South Shore contracted the disease, which is caused by tick bites. The patient is recovering and did not require hospital admission like most Lyme disease patients.

Dr. Richard Gould, a provincial health officer said the discovery of the disease in Nova Scotia was not unexpected because it has been present in the eastern United States (USA) for years, and the tick most closely associated with the disease are present in the province.
(ProMed 09/30/02)

USA (Virginia) – Malaria Parasites Identified in Loudoun Mosquitoes
Health authorities say they have discovered malaria–carrying mosquitoes in two Loudoun County neighborhoods, several miles from where two teenagers became ill with the disease in a rare outbreak over the summer. The finding marks the first time in at least 20 years that mosquitoes carrying the parasite have been identified in a U.S. community where humans were also infected with malaria, according to Richard W. Steketee, chief of the malaria epidemiology branch of the federal Centers for Disease Control and Prevention in Atlanta. On Oct. 4, mosquitoes trapped in Montgomery County, Maryland, near the Virginia state line tested negative for malaria, offering the first results from a series of follow–up tests being performed in Maryland. The tests were conducted for Montgomery by military malaria experts from the Uniformed Services University of the Health Sciences.
(ProMed 09/28/02, 10/06/02)


Switzerland – Concerns over Harmful Nitrofuran Found in Food|
According to the Swiss Federal Office of Public Health, traces of the antibiotic nitrofuran above the safe–limit, which is thought to cause cancer, have been found in 43 of 121 tested samples of poultry and shrimp imported from Asia and South America.
(ProMed 10/06/02)


USA — CDC Update: West Nile Virus Case Count
As of Oct. 4, the total human case cases for 2002 are 2703. Total human fatalities are 146. These numbers have been reported and verified to CDC/Arbonet. More information is available at CDC WNV.

USA — Smallpox Vaccination Strategies
On Oct. 5, the USA' top public health officials, which included Dr. Julie L. Gerberding, director of CDC, said that they favored offering smallpox vaccine to the public, even in absence of a bioterror attack, but only after up to 10 million health care workers are immunized, and after a vaccine is licensed for general use, which is not likely until 2004. It was the first time federal officials have said that the public should have access to the vaccine, which carries significant risk of serious side effects. However, the final decision rests with President Bush, and a White House spokesman said the issue was still under review.
(ProMed 10/06/02, NY Times 10/05/02)

USA (multistate) – Listeriosis, Deli Meat Suspected
Forty people in seven the northeastern U. S. (Pennsylvania, New York, New Jersey, Delaware, Maryland, Connecticut, Michigan) have become sick, and 40 have died from infection with the foodborne listeria bacteria, according to officials at CDC in Atlanta, Georgia. "Analysis of data collected to date indicate that the leading suspect food in this outbreak is sliced turkey deli meat," say CDC experts. They say health officials are working hard to track down the exact brand of meat responsible for the outbreak. More information on listeria is available at CDC .
(ProMed 10/06/02)


Industrial Science and Technology Working Group Side Meeting on Emerging Infections, Taipei
The United States and Canada co–chaired a side meeting on infectious disease and health on Sept. 24, the day before the formal 23rd ISTWG began. Key recommendations, all subsequently endorsed at the ISTWG, included: (1) Change name of Sub–group to "Health and Sustainable Development"; (2) identify one Health Sector contact person from each economy, for subsequent networking to include all economies; and (3) develop or explore new project proposals in selected priority areas. Priority areas of interest to the group for which an economy committed to developing a proposal included: pandemic influenza planning (Canada); national health databases online (Philippines); water, agriculture and health (Mexico). Other priority areas of particular interest were: climate change and vector–borne disease; malaria; and antimicrobial resistance.

Re–evaluation Results of Network of Networks Meeting, Seattle Posted
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 months after the meeting. All participants were asked to fill out an anonymous Web–based survey form or to send a MS–Word survey form back to us. We have received responses from 12 of 14 economies that attended the meeting, All responders rated the meeting good to excellent as whole even six months after its conclusion. More than 90 percent of those also reported that we achieved the meeting goals. Survey details.


Salmonella Sepsis Caused by a Platelet Transfusion from a Donor with a Pet Snake
Dr. Jefary and colleagues report the occurrence of sepsis due to infection with Salmonella enterica serotype enteritidis infection in two patients, one of whom died. The infection originated in a single platelet donation that had been divided into two units. The donor had regularly donated platelets obtained by apheresis and was apparently healthy; subsequent studies suggested that he had acquired asymptomatic S. enterica bacteremia from handling his pet boa constrictor.
(NEJM 2002;347:1075�, 10/03/02)

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