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Vol. V, No. 20~ EINet News Briefs ~ Nov. 22 , 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
    Vietnam: German firm donates mother–to–child anti–HIV drug
    China (Jiangsu): HIV/AIDS Law Praised
    Russia (Krasnodar region): Dysentery outbreak puts 400 in hospital
    Canada (multiprovince): E. coli O157
    USA (Texas): Staph. aureus (MRSA), community acquired
    USA: Fungal meningitis due to contaminated drug
    USA (California): Bovine tuberculosis
  2. Updates
    USA: CDC update: West Nile Virus case count
  3. Notices
    WHO Web sites on infectious diseases
  4. Journal Articles

  5. Bacterial contamination of animal feed and its relationship to human foodborne illness

  6. How to join the EINet email list

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


Vietnam—German firm donates mother–to–child anti–HIV drug
Vietnam will become the first country in Asia to use a new antiviral treatment that aims to prevent the spread of HIV from infected mothers to their children.

The German pharmaceutical firm, Boehringer Ingelheim, donated the first of five deliveries of its Viramune product to the Ministry of Health. The product is a new antiviral treatment that aims to prevent the spread of HIV from infected mothers to their children. The ministry began a global program to prevent the mother–to–child transmission of HIVם. Ninety percent of all childhood cases of HIV are attributable to HIV infection from their mothers during pregnancy, childbirth or breastfeeding.

According to UNDP and WHO, the number of HIV–positive people in Vietnam is 54,640, but some estimate the figure could be much higher. Of these, about 0.34 percent are estimated to be pregnant women.
(SEA–AIDS 11/11/02)

China (Jiangsu)– HIV/AIDS Law Praised

Suzhou, a city of one million in Jiangsu province, passed a new law in October guaranteeing patients and their families equal access to employment, education and health care, and giving people living with HIV/AIDS (PLWHA) the right to sue for redress. The law is the first of its kind in China.

"Suzhou has taken the lead, but the rest of China is dragging its feet," said Joanne Csete, director of the HIV/AIDS and Human Rights program at Human Rights Watch. "The national government urgently needs to follow Suzhou's example."

The Chinese Ministry of Health has acknowledged that it faces a rapidly escalating AIDS epidemic and has asked for international assistance in combating it. However, local and national laws still permit many forms of discrimination against PLWHA. National laws prohibit HIV–positive persons from marrying, and local laws in some cities forbid them from swimming in public swimming pools or working in food service or childcare. There have been widespread reports in Chinese and international media of community harassment and of discrimination by employers, hospitals and schools.

These laws increase the public stigma surrounding HIV/AIDS, and discourage people from voluntarily testing for the virus. "If the state wants people to come forward, get tested, and learn about how the disease is transmitted, then legal reform is an urgent priority," said Csete.
(Human Rights Network News 11/15/02)
Russia (Krasnodar region)—Dysentery outbreak puts 400 in hospital
An outbreak of dysentery in southern Russia has occurred and more than 400 people, mostly children, have hospitalized. Officials blamed a dairy plant for the mass contamination. The Health Ministry said 404 people were receiving treatment in the Krasnodar region, 75 percent of them children.

Deputy Health Minister Gennady Onishchenko told reporters seven were seriously ill, with most cases in Kropotkin, a town 250 km (150 miles) from the Black Sea. He said the number of cases could still increase.

"Eighty percent of those who are ill said they ate sour cream from the local plant," Igor Kalashnikov, Krasnodar region's chief epidemiologist, told First Channel television. However, the plant denied any involvement, according to television reports, and blamed a plot by competitors.

The Health Ministry said production at the dairy plant had been halted and workers were undergoing tests. But a manager told NTV the plant was functioning, subject to tighter checks.

Hospital workers said treatment was effective against fever, nausea, vomiting, and diarrhea and the rate of admissions were declining. However reports said patients with non–urgent cases were being discharged to make room for other victims of the outbreak.

More microbiological information is needed to confirm the etiology of the dysentery outbreak.
(ProMed 11/07/02)


Canada (multiprovince)—E. coli O157
Federated Co–op Limited, Saskatoon is warning consumers not to eat Country Morning and CO–OP Gold Brand frozen beef burgers produced on June 14, because these products may contain E. coli O157:H7 bacteria. There have been two cases of reported illness, which may be linked to the improper cooking of this product.

There is another outbreak of E. coli at Prince Edward Island Hospital, Canada, which is not linked to the above outbreak. Since Oct. 29, a total of 14 patients and 31 staff at Hillsborough Hospital have experienced symptoms of E. coli. An official said there has been no further cases since Wednesday, Oct. 6. Officials said staff that showed symptoms will not be allowed back to work until all tests from culture come back negative.
(ProMed 11/09/02)

USA (Texas) —Staph. aureus (MRSA), community acquired
The genetic characterization of the prototypical community acquired MRSA (CA–MRSA) strain, the clone that caused the four pediatric deaths in Minnesota and North Dakota, revealed a unique genotype. Both the genetic background of the CA–MRSA strain and the organization of the element that harbors the mecA gene, termed the staphylococcal chromosomal cassette (SCC mec), were distinguishable from the major nosocomial MRSA clones.

Pulsed–field gel electrophoresis, multilocus sequence typing, and spa typing, all methods used to compare the genetic background of S. aureus strains, distinguished the CA–MRSA from nosocomial MRSA clones. These strains were further differentiated on the basis of a novel SCC_mec (type IV). This element differs from types I–III on the basis of its small size, as it does not harbor other integrated antibiotic resistance determinants, and it encodes a functional recombinase which facilitates its movement.

The genotyping of CA–MRSA has revealed that this clone has spread across the US and commonly cultured from soft–skin infections. A current hypothesis is that the panton–valentine leukocidin and enterotoxins B and C play are involved in the "hyper–virulence" of community acquired–MRSA.
(ProMed 11/15/02)

USA—Fungal meningitis due to contaminated drug
The Food and Drug Administration (FDA) is announcing a nationwide alert concerning all injectable drugs prepared by Urgent Care Pharmacy of Spartanburg, South Carolina, based on the lack of assurance that their products are sterile. FDA inspection of Urgent Care's facility revealed the firm failed to have adequate controls to ensure necessary sterility, including the absence of appropriate testing for potency and sterility prior to distribution.

On Sept. 16, 2002, Urgent Care recalled all lots of its injectable methylprednisolone acetate based on reports of four patients who developed a rare fungal (Wangiella) meningitis after use of their product. These patients were treated at three different North Carolina hospitals/clinics. Spinal fluid from all of these patients tested positive for a fungus consistent with that found in the Urgent Care product analyzed by both the FDA and Centers for Disease Control and Prevention (CDC). One patient later died despite antifungal therapy.

Urgent Care refused to recall any other drugs, the FDA said. So the government told health workers to avoid using any of the following injected drugs made by Urgent Care: baclofen, betamethasone, Bimix 30:1, clonidine, estradiol, hydromorphone, fentanyl, morphine, papaverine, Super Trimix, mesylate/prostaglandin, and testosterone.

The FDA said the drugs were sold in Connecticut, Illinois, Indiana, Kentucky, Louisiana, Massachusetts, Mississippi, New Hampshire, North Carolina, South Carolina, and Virginia. Also, the South Carolina pharmacy board recently ordered a halt to further sales by Urgent Care, the FDA said.

Urgent Care is not a pharmaceutical company. Pharmaceutical companies manufacture injected drugs under conditions designed to guarantee sterility. Instead, Urgent Care "compounded" drugs, brewing prescription medicines to fit a doctor or clinic's special order instead of simply dispensing a drug made by a pharmaceutical company. Compounding is a common practice—pharmacists routinely flavor medicines for children, for example, or remove an allergy–causing ingredient from common drug brands. The FDA is investigating whether Urgent Care compounded drugs legally.
(ProMed 11/17/02)

USA (California)—Bovine tuberculosis
The federal government paid a dairy farmer to slaughter his herd of 6,400 cows after an outbreak of bovine tuberculosis (TB). The herd was euthanized to protect the state's status of being free of bovine TB. "If you didn't depopulate, the whole state would lose its whole TB–free status, and that would have an impact," said Larry Hawkins, a US Department of Agriculture (USDA) spokesman. A cow at a nearby dairy also tested positive for the disease last week. A second outbreak would jeopardize the TB–free status and require costly statewide testing.

The bovine TB outbreak was discovered in May at Friesian Dairy after a federal meat inspector found traces of the bacteria at a Hanford meat packing plant. The disease was linked to a particular farm where 90 cows tested positive. Agriculture officials don't know how the outbreak occurred.

Bovine tuberculosis (TB) is an infectious zoonotic disease caused by Mycobacterium bovis. In bovines, it is usually characterized by formation of nodular granulomas known as tubercles. Although commonly defined as a chronic debilitating disease, bovine TB can occasionally assume an acute, rapidly progressive course. Any body tissue can be affected, but lesions are most frequently observed in the lymph nodes, lungs, intestines, liver, spleen, pleura, and peritoneum.

M. bovis has been identified in humans in most countries where isolates of mycobacteria from human patients have been fully typed. The incidence of pulmonary TB caused by M. bovis is higher in farm and slaughterhouse workers than in urban inhabitants. One of the results of bovine TB eradication programs has been a reduction in disease and death from TB among the human population. Pasteurization of milk and improved sanitation also have been of great importance.
(ProMed 11/17/02)


USA—CDC Update: West Nile Virus Case Count
As of Nov. 19, the total human case cases for 2002 are 3698. Total human fatalities are 212. These numbers have been reported and verified to CDC/Arbonet. For more information, visit the CDC WNV Web site: http://www.cdc.gov/ncidod/dvbid/westnile/index.htm


WHO Web sites on infectious diseases
Antimicrobial resistance information bank http://oms2.b3e.jussieu.fr/arinfobank/
Buruli ulcer http://www.who.int/gtb–buruli
Cholera http://www.who.int/emc/diseases/cholera
Deliberate use of biological and
chemical agents
Eradication/elimination programmes
Filariasis http://www.filariasis.org
Geographical information
Health topics http://www.who.int
Infectious diseases http://www.who.int/health–topics/idindex.htm
Influenza network (FluNet) http://oms.b3e.jussieu.fr/flunet/
Integrated management of
childhood illnesses
International travel and health http://www.who.int/ith/
Intestinal parasites http://www.who.int/ctd/intpara
Leprosy http://www.who.int/lep/
Malaria http://www.rbm.who.int
Newsletter ( Action against infection) http://www.who.int/infectious–disease–news/
Outbreaks http://www.who.int/disease–outbreak_news
Poliomyelitis http://www.who.int/gpv/
Rabies network (RABNET) http://oms.b3e.jussieu.fr/rabnet/
Report on infectious diseases http://www.who.int/infectious–disease–report/
Salmonella surveillance network http://www.who.int/salmsurv/
Surveillance and response http://www.who.int/emc/
Tropical disease research http://www.who.int/tdr/
Tuberculosis http://www.who.int/gtb/
Vaccines http://www.who.int/gpv/
Weekly epidemiological record http://www.who.int/wer/
WHO pesticide evaluation
scheme (WHOPES)

(WHO Weekly Epidemiological Record 11/08/02)


Bacterial Contamination of Animal Feed and Its Relationship to Human Foodborne Illness
Dr. John A. Crump and his colleagues of CDC has reported, in recent Clinical Infectious Diseases, that contamination of animal feed before arrival at and while on the farm contributes to infection and colonization of food–producing animals with pathogens such as Campylobacter species and non–Typhi serotypes of Salmonella enterica, Shiga toxin producing strains of Escherichia coli, and Yersinia enterocolitica. The pathogens can then be transmitted through the food chain to humans and cause human foodborne illness. Below is their abstract.

“Animal feed is at the beginning of the food safety chain in the ‘farm–to–fork’ model. The emergence of variant Creutzfeldt–Jakob disease has raised awareness of the importance of contaminated animal feed, but less attention has been paid to the role of bacterial contamination of animal feed in human foodborne illness. In the United States, animal feed is frequently contaminated with non–Typhi serotypes of Salmonella enterica and may lead to infection or colonization of food animals. These bacteria can contaminate animal carcasses at slaughter or cross–contaminate other food items, leading to human illness. Although tracing contamination to its ultimate source is difficult, several large outbreaks have been traced back to contaminated animal feed. Improvements in the safety of animal feed should include strengthening the surveillance of animal feed for bacterial contamination and integration of such surveillance with human foodborne disease surveillance systems. A Hazard Analysis and Critical Control Point program should be instituted for the animal feed industry, and a Salmonella–negative policy for feed should be enforced.”
(Clinical Infectious Diseases 2002;35:859𤵑)

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