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Vol. V, No. 18~ EINet News Briefs ~ Oct. 25 , 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
    China (Hong Kong): Possible transmission of dengue virus by blood transfusion
    Australia (Queensland): Listeria in meat, Factory forces meat goods recall
    Vietnam (Hanoi): HIV/AIDS could erode Vietnam's economic development
    UNAIDS: AIDS epidemic in Asia may become the largest in the world
    USA: Recall of Poultry, Listeriosis
    Canada: Mosquito transport in goods shipments
  2. Updates
    USA: CDC Update on West Nile virus case count
  3. Journal articles
    USA (Florida): Probable variant of Creutzfeldt–Jakob Disease in a U.S. resident
  4. How to join the EINet email list

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


China (Hong Kong) — Possible Transmission of Dengue Virus by Blood Transfusion
Blood donated in the Hong Kong Special Administrative Region (SAR) was sent to Australia for routine screening. After the blood was returned to Hong Kong SAR, it was used in medical treatment. Subsequently two patients in Hong Kong who received these transfusions contracted dengue fever.

This appears to be the first report of the transmission of dengue virus infection by transfusion of virus–contaminated blood.

Hong Kong health officials warned Australia of a shipment of dengue fever virus–contaminated blood from Hong Kong to Australia after those two cases. Therapeutic Goods Administration spokeswoman Kay McNiece said no blood from Hong Kong was used in the Australian supply. "Australia is self–sufficient with blood," she said. "There is no suggestion that blood from Hong Kong or anywhere else would get into the Australian blood supply."

"Australia does provide a service to Hong Kong, which is done by CSL laboratories, to import blood from Hong Kong to screen and make blood products, and then export those products back to Hong Kong," she said. "This process is totally segregated from the production of Australia's blood supply. In addition, the Red Cross Blood Service tests some blood for Hong
Kong and sends it back. But again, this is totally segregated from the Australian blood supply."

Hong Kong has reported 36 cases of dengue fever since an outbreak began in September 2002. The blood sent to Australia may be linked to that outbreak.
(ProMed 10/10/02)

Australia (Queensland) — Listeria in Meat Factory Forces Recall
Byrnes Quality Meats is conducting a voluntary recall of a variety of its sliced cooked meat products because routine company testing has detected Listeria monocytogenes in the company's factory in the Atherton tableland in north Queensland. The products are: roast beef, roast lamb, roast pork, sliced 4x4 shoulder ham, shaved sliced cooked silverside, Danish salami, and Hungarian salami. These products have been sold in vacuum–sealed packs ranging in size from 250 grams to one kilogram with a "use by" date between 10 Sep 2002 and 11 Nov 2002.

The products have been on sale in stores in only two towns in the Cairns region of northern Queensland since 10 Jul 2002, with no associated cases of human disease reported. According to the "Control of Communicable Diseases Manual 2000," the maximum recorded incubation period for listeriosis is 70 days.
(ProMed 10/11/02, 10/14/02)

Vietnam (Hanoi) — HIV/AIDS Could Erode Vietnam's Economic Development
International experts said HIV/AIDS could severely erode Vietnam's economic development and its fight against poverty unless the government changes it approach to the epidemic. "HIV has the potential of reversing all the development gains over the past 15 years since Vietnam began its economic reforms," said Jordan Ryan, the United Nations Development Program's representative to Vietnam at the opening of a World Health Organization conference aimed at encouraging China, Indonesia, Myanmar, and Vietnam to address the HIV/AIDS crisis among injection drug users.

"IDUs (injecting drug users) play a critical role in the dynamics of the epidemic," said Andrew Ball, a WHO expert on HIV/AIDS. "If we don't address it, it will be very difficult to control the epidemic in these four countries and elsewhere in the region."

"There needs to be a separation of HIV/AIDS from social evils. HIV/AIDS is not an evil, it is a virus," Ryan said. "Social evils" is the term used by the Vietnamese government to refer to drug addicts and prostitutes. Health experts have long criticized the government for focusing on AIDS as an affliction of these two groups, rather than raising awareness about the epidemic among the wider population.

"Harm reduction programs should be introduced if we want the epidemic not to spread quickly," said Pascale Brudon, the World Health Organization’s representative to Vietnam. "We have more and more good evidence coming from the rest of the world that things need to change here."

That transformation is underway, Ryan said. "The mindset of the government is beginning to change. Awareness is coming home to roost, but now the focus has to be on implementation."

While Vietnam acknowledges 54,640 HIV cases, the real number is at least 200,000, experts say.
(SEA–AIDS 10/09/02)

UNAIDS – AIDS Epidemic in Asia May Become the Largest in the World
"The epidemic in Asia threatens to become the largest in the world," said Dr Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). "With more than half the world's population, the region must treat AIDS as an issue of regional urgency. The question is no longer whether Asia will have a major epidemic, but rather how massive it will be."

"HIV has already spread to more than six million people across Asia," Dr. Piot said. "By not tackling it now while it is still manageable, the epidemic will have far–reaching effects, destabilizing societies and damaging productivity." Dr. Piot was speaking at the World Economic Forum's (WEF) East Asia Economic Summit, which he co–chairs.

"It is a question of good economic sense," Dr. Piot also said. "By protecting their employees from HIV and caring for those who are infected, businesses minimize the loss of skilled workers and managers, and boost their long–term productivity."

"Governments cannot go it alone, and businesses can play a pivotal role in the response in Asia. Taking action on AIDS goes beyond a matter of corporate responsibility — it is about making a good investment now to save paying vast costs later," he added.

A document package* released at the summit outlines examples and options for businesses committed to working on AIDS and shows that providing treatment and care to employees is often cheaper than the overall cost of AIDS to businesses.

Key to supporting workers is protecting them from discrimination, Dr. Piot said. Protecting rights is essential to fighting the fear and denial that surround HIV/AIDS.

* The document package, prepared by WEF, the Asian Business Coalition on AIDS, the International Labour Organization and UNAIDS, is available on www.unaids.org/partnership/index.html.
(SEA–AIDS 10/10/02)


USA: Recall of Poultry, Listeriosis
Poultry processor Pilgrim's Pride is recalling 27.4 million pounds of cooked sandwich meat after warnings of possible contamination from Listeria monocytogenes, the largest meat recall in US history. The company pulled 295,000 pounds of turkey and chicken products Oct. 9 2002, but expanded the recall over the weekend after tests came back positive for a strain of the potentially fatal bacteria, the company said Oct.. 13, 2002.

Although this contamination was discovered in the search for the origin of the multistate outbreak of listeriosis in the northeastern US, no products have been linked to that outbreak and the genetic strain that caused the outbreak is different from the strain found at the plant. Deli meats are always a significant concern in the spread of listeriosis since they are ready to eat. The size of this recall re–emphasizes the potential for food–borne llnesses in the global marketplace.

The largest previous meat recall in US history was in 1997, when Hudson Foods recalled 25 million pounds of ground beef after 15 people in Colorado fell ill from E. coli after eating hamburger from its plant in Columbus, Neb.
(ProMed 10/13/02)

Canada — Mosquito Transport in Goods Shipments
According to Dr. Stephen A. Kells, Technical Director of Abell Pest Control, Inc., their personnel intercepted a shipping container from China with a large number of live adult mosquitoes. The species was thought to be Aedes aegypti although it is not confirmed yet. Regardless of the identification, this incident illustrates an important point: The container held plastic goods that had obviously been left outside and had enough collected water to provide oviposition sites. Shipment over seven to 10 days placed the container in a new area just before (and during) adult emergence.

Based on this experience, Dr. Kells suspects that containers and trailers may play a far more important role for east–to–west movement of WNV. Container movement of oviposition sites has the potential to translocate not just one or two adults, but hundreds to thousands of mosquitoes. Considering the potential, with a daily movement of 3,000 or more 20–foot–equivalent containers through any one of five or more major ports, the potential for mosquito movement is impressive, both between and within countries.

The origin of the aberrant case of West Nile virus in California, in the absence of any evidence of bird or horse infection, could well have been infected mosquitoes escaping from a container coming from east of the Rocky Mountains, as previously suggested.

Apart from mosquito movement, Dr. Kells also thinks that container shipment is an important factor when considering any disease with the potential to vertically transmit to the progeny from the parent vector. Containers brought vector mosquitoes from East Timor to Australia during a dengue outbreak in 2000.
(ProMed 10/08/02)


USA — CDC Update: West Nile Virus Case Count
As of Oct. 21, the total human case cases for 2002 reached 3,231. Total human fatalities are 176. These numbers have been reported and verified to CDC/Arbonet. For more information, visit the CDC WNV Web site at http://www.cdc.gov/ncidod/dvbid/westnile/index.htm


USA (Florida) – Probable Variant Creutzfeldt–Jakob Disease in a U.S. Resident
On April 18, 2002, the Florida Department of Health and CDC announced the occurrence of a likely case of variant Creutzfeldt–Jakob Disease (vCJD) in a Florida resident aged 22 years, representing the first probable vCJD case in a United States resident.

The patient was born in the United Kingdom in 1979 and moved to Florida in 1992. It is likely that this patient was exposed to the Bovine Spongiform Encephalopathy (BSE) agent one or more times during 1980 � before moving to the U.S. and that the interval between the patient's exposure to BSE and onset of illness was 9㪭 years. Such an incubation period would be consistent with known incubation periods for other similar diseases in humans, such as kuru and CJD related to exposures to pituitary–derived human growth hormone.

The patient never had donated or received blood, plasma, or organs and never had received human growth hormone. There was no family history of CJD. In October 2001, before the onset of the illness, the patient's wisdom teeth were extracted, but there was no history of major surgery. The patient is unlikely to have transmitted the disease to others.

As of late September 2002, the patient had become bedridden, experienced considerable weight loss requiring surgical insertion of a feeding tube, and was no longer communicating with family members. On the basis of a case definition developed in the United Kingdom, the patient's illness met criteria for a probable case of vCJD.

The report in MMWR documents the investigation of this case and underscores the importance of physicians increasing their suspicion for vCJD in patients presenting with clinical features described in the report who have spent time in areas in which (BSE) is endemic.
(MMWR 51(41);927𤶑, 10/18/02)

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