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Vol. V, No. 21~ EINet News Briefs ~ Dec. 6 , 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
    Taiwan: HIV Cases Exceed 4,000 (Official Figures)
    Australia (Queensland): Malaria
    New Zealand: Hepatitis A and Blueberries
    Russia (Siberia): Trichinellosis
    USA (Florida): Norwalk–like virus, cruise ship
    USA (Florida): Virus Outbreak on Disney Cruise Ship
    Canada (Toronto): Viral gastroenteritis, hospital
    New BSE cases: Switzerland, Italy, Denmark, Netherlands, Ireland
  2. Updates
    USA: CDC update: West Nile Virus case count
    USA: Poultry recall for Listeria outbreak widens
  3. Notices
    U.N. Releases Latest Global Assessment Before World AIDS Day
  4. How to join the EINet email list

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


Taiwan — HIV Cases Exceed 4,000 (Official Figures)
According to the Cabinet's Department of Health in Taiwan, 4,590 people have become infected with HIV in Taiwan since 1984 by the end of October. Taiwanese nationals accounted for 4,217 cases and 373 were foreigners. There were 603 new cases reported this year. Of the HIV–infected Taiwanese, 1,319 have been diagnosed with AIDS. There have been 820 deaths.

HIV–positive 20 and 30–year–olds account for 36 percent and 33 percent, respectively, of the cumulative number. Nearly 93 percent of the 4,217 HIV–infected Taiwanese are male. Results of two recent studies by the department indicate the real number of Taiwan's HIV/AIDS cases could be about twice the official statistics, said department Deputy Director–General Hsu–mei Hsu.

Obligatory HIV testing in Taiwan includes soldiers, prisoners, blood donors and pregnant women. In addition, some medical centers offer free, anonymous testing and counseling. Hsu said there have been more than 20 million testing records so far. "We estimate five out of 100,000 persons in Taiwan are HIV–positive, and the infection rate is increasing gradually," Hsu said. Taipei is the city most heavily affected by HIV/AIDS in Taiwan. Shiow–ing Wu, of Taipei City STD Control Center, said that about one in four
HIV–positive persons live in the country's largest city.

A recent survey of 39 sex workers conducted by the Department of Health showed 86 percent were unable to persuade clients to use condoms, Wu said. "The problem is that they believe they might be lucky," Wu said. In anticipation of World AIDS Day on Dec. 1, the Department of Health distributed 20,000 condoms at Taipei gas stations Nov. 25㪵.
(SEA–AIDS 11/21/02)

Australia (Queensland) — Malaria
An outbreak of Plasmodium vivax malaria at a campsite in Northern Queensland occurred during the first two weeks of October. Ten people were affected including three overseas visitors (one from Ireland, one from Germany, and one from Canada).

Park rangers have used details from visitors’ self–registration forms during the period of malaria transmission and then the Tropical Public Health Unit in Queensland contacted individuals to inform them of the occurrence of malaria and offer advice.

The individual believed to be the source of the outbreak stayed at the campsite in late September 2002 for four days. He had traveled to Indonesia in 2001, to Africa in 2002, and was diagnosed with Plasmodium vivax malaria the day after he left the campsite. Local mosquitoes may have become infectious from around Oct. 8, 2002. Mosquito trapping revealed a large number of Anopheles farauti, which can transmit malaria in Northern Queensland, breeding in two creeks on either side of the campsite. If, as is assumed, there are no further human cases to act as a reservoir, then it is unlikely that further infectious mosquitoes remain at the campsite, because of their short lifespan. Visitors rarely stay at the campsite for more than two or three nights, and so the presence of a human reservoir is unlikely to be sustained. These considerations may explain why there has not been a larger outbreak.

Australia was declared malaria–free in 1981. However, imported cases have occasionally occurred. A similar outbreak of Pl. vivax involving five cases occurred in the Cape Tribulation area in 1986; the source was believed to be a man who had arrived from the Solomon Islands and spent a week in Cape Tribulation before going onto Brisbane. He was diagnosed with Pl. vivax infection in November 1986.
(ProMed 11/23/02)

New Zealand — Hepatitis A and Blueberries
Eighty–one cases of hepatitis A virus (HAV) infection were identified in New Zealand during the first five months of 2002. This sharp increase was investigated with descriptive and analytical epidemiology, virology, product trace back, and an orchard investigation.

Consumption of raw blueberries was the only significant risk factor (adjusted odds ratio 7.6; 95 percent confidence intervals 2.6㪮.4). Trace back of product through retailers and wholesalers implicated a single commercial orchard. HAV was detected in cases' feces and in blueberries from the orchard. Sanitary audit of the orchard revealed multiple opportunities for fecal contamination of product by pickers and the possibility of contamination by sewage–contaminated groundwater. A child with confirmed hepatitis A was in the orchard during harvest. Speculation that pickers urinated on picked fruit to increase the weight is unfounded.

Extensive food safety improvements in the berry fruit industry are underway. The report on the investigation has been submitted for publication.
(ProMed 11/28/02)

Russia (Siberia) — Trichinellosis
A trichinosis epidemic has occurred in Siberia. According to a Russian health officials report, 71 people were affected in Khakassia and Kemerovo, including 21 children under 14 years of age. All the patients have been hospitalized, and their condition is evaluated as serious, yet stable. According to the officials, the mass contamination has presumably been triggered by consumption of smoked meat of a bear infested with trichinae. Investigation has now been launched to identify the actual causes of the epidemic.

Trichinella spp. are found worldwide in many carnivores and are prevalent in Russia. Undercooked wild boar is a well–known source of infection.
(ProMed 11/23/02)


USA (Florida) — Norwalk–like virus, cruise ship
Holland America has canceled its next 10–day Caribbean cruise aboard the Amsterdam because of the gastroenteritis virus (a Norwalk–like virus) that has sickened more than 500 passengers across four consecutive voyages. The cruise line said it has called off Thursday's sailing to break the person–to–person cycle of the illness. Its symptoms are vomiting, diarrhea, abdominal cramps, headache, and low–grade fever, which usually last one or two days.

CDC spokeswoman Susan McClure said the agency has been closely monitoring the ship, but that Holland America voluntarily chose to cancel the Nov. 21 cruise. Historical data show that it takes four days of cleaning, with no passengers on the ship, to significantly reduce the virus amount, she said.

Dr. Gio Baracco, an infectious disease specialist and assistant professor of medicine at the University of Miami, said it is unknown how long the virus remains active on surfaces. But victims of the virus still can be contagious for up to several days after their symptoms have disappeared.

Onboard cruise ships, the virus has become more prevalent since this summer, said David Forney, chief of the CDC's vessel sanitation program. In a contained environment, it spreads quickly, despite warnings to passengers to wash their hands frequently.

The Amsterdam outbreak marks the second time in four months that hundreds of passengers have contracted the virus on one of Holland America's ships. The Ryndam, which sailed to Alaska in July 2002, reported 395 cases before being pulled from service, disinfected and returned to sea.
(ProMed 11/20/02

USA (Florida) — Virus Outbreak on Disney Cruise Ship
Two hundred seventy five passengers on a Disney cruise ship have contracted a contagious gastroenteritis virus. Passengers and crew members on the Disney Cruise Line ship Magic became ill on Nov. 20. The ship departed on Nov. 17 from Port Canaveral, Florida, with 3,200 people on board. The ship returned on Nov. 23 and disinfected on Nov. 23. However, at least 85 people on the Disney cruise ship Magic have contracted a flu–like illness this week, even after the vessel was scrubbed, officials said.

The illnesses are believed to be caused by a “Norwalk–like virus”, one of the most common gastrointestinal viruses. (The virus is named for an outbreak in Norwalk, Ohio, 30 years ago). The Centers for Disease Control and Prevention in Atlanta was conducting tests to identify the virus, spokeswoman Bernadette Burden said. Results were expected later this week.

The CDC said on Nov. 23 that it did not suspect that the outbreaks on the Magic and Amsterdam were intentional or related in any way. "These are two separate incidents," spokeswoman Bernadette Burden said. "There are no direct links."
(ProMed 11/22/02, 11/27/02)

Canada (Toronto) — Viral gastroenteritis, hospital
An outbreak of suspected “winter vomiting disease” caused the closure of Sunnybrook Hospital's emergency department on Monday morning, Nov. 25. Over the previous weekend, a number of patients and staff were sickened. By Monday afternoon, 28 staff members and 13 patients showed symptoms of the virus infection, which is highly contagious and spread through person–to–person contact.

“We haven't determined what the infection is yet. We suspect it to be a case of something called “winter vomiting disease,” hospital spokesman Craig DuHamel said. “Obviously we have to be very vigilant to ensure this is contained in our emergency department.” The emergency department was expected to be closed until the afternoon of Wednesday, Nov. 27 at least, DuHamel said.

Patients walking into emergency were told about the situation upon arrival and, if their condition was stable, asked to go to another hospital. Those who were unable to go to another facility would be treated, the hospital said in a news release. Winter vomiting disease is an infection caused by a virus commonly transmitted from person–to–person in cold weather, when people are indoors more often and in closer contact. Symptoms include severe nausea and vomiting that can last between 24 and 48 hours. DuHamel said the virus is not life–threatening and is similar to the Norwalk virus.
(ProMed 11/26/02)


New BSE cases — Switzerland, Italy, Denmark, Netherlands, Ireland
In Switzerland, according to the national veterinary office, two new cases of mad cow disease have been discovered in the western and central cantons of Fribourg and Lucerne. The discoveries bring to 21 the total number of cases of Bovine Spongiform Encephalopathy (BSE) identified in Switzerland since the start of the year. A total of 42 cases were recorded in Switzerland in 2001, compared to 33 the previous year.
(ProMed 11/17/02)

In Italy, three additional cases have recently been identified; the total number of BSE cases for this year is 33 to date. During 2001, fifty BSE cases were recorded in Italy. Italy has carried out more than a million tests for BSE since it began a BSE testing program in January 2001 in compliance with the European Union regulations. All cows over 24–months–old now have to undergo such testing prior to slaughter. The number of confirmed cases of BSE has risen to 80.

A government task force was set up and BSE control measures were introduced last February after the discovery of the first suspected case of the human form of the brain–wasting disease, variant Creutzfeldt–Jacob Disease (vCJD), in a young Sicilian woman. The case of vCJD was confirmed last month.
(ProMed 11/09/02)

In Denmark, the tenth case of mad cow disease was confirmed. According to the Danish Veterinary and Food Administration said that two tests were done on a 4–year–old milking cow that was found dead in early November, adding that both tests were positive. Out of the 10 cases of BSE, 9 were in Danish–born cows and one in a cow imported from Scotland in 1992.
(ProMed 11/20/02)

In the Netherlands, 51 cases of BSE have been recorded since 1997, including 23 during 2002.
(ProMed 11/22/02)

In Ireland, the Department of Agriculture has discovered five new cases of BSE this week, bringing the total number of cases so far this year to 303.
(ProMed 11/22/02)


USA—CDC Update: West Nile Virus Case Count
As of Dec. 3, the total reported human case cases of West Nile Virus for 2002 reached 3,775. There have been 216 human fatalities. 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

USA— Poultry recall for Listeria outbreak widens
According to the US Agriculture Department (USDA), a New Jersey poultry company linked to a Listeria monocytogenes outbreak that sickened 50 people in the Northeast United States expanded its recall of ready–to–eat turkey and chicken to 4.2 million pounds on Nov. 21. “The sample is being further analyzed to determine whether or not it matches the outbreak strain,” the USDA said in a statement.

On Nov. 2, the company recalled 200,000 pounds of poultry, after its products were linked to an outbreak in the Northeast that has killed seven people. USDA said the strain found in both incidents were “indistinguishable.” Despite the government's findings, the company said “to our knowledge, no one has become ill as a result of consuming these products.”

Pilgrim's Pride, the No. 3 poultry producer based in Pittsburg, Texas, was also linked to the listeriosis outbreak. It recalled 27.4 million pounds of its Wampler brand turkey and chicken. Despite USDA test results finding the listeria outbreak strain at its plant, Pilgrim's Pride also has said its products were not to blame for the illnesses.

Despite the expanded recall, the USDA said the plant remained open because the Nov.14 sample that tested positive for listeria was actually produced on Aug. 30. “The plant is still open because all the (USDA) action took place at the Nov. 2, 2002 recall,” said Steve Cohen, spokesman for USDA's Food Safety and Inspection Service. “The complete plant was cleaned up.”

About 1,500 meat plants that either do not test for listeria or choose not to share their results with USDA were subject to USDA's directive, the U.S. Department of Agriculture said on Nov. 18. The directive
will take effect on Dec. 9, 2002.
(ProMed 11/21/02


U.N. Releases Latest Global Assessment Before World AIDS Day
The HIV/AIDS pandemic is rapidly spreading in some parts of the world and is worsening the effects of a lingering southern African famine, according to a new World Health Organization–Joint U.N. Program on HIV/AIDS report released prior to the Dec. 1 commemoration of World AIDS Day.

“The face of the epidemic is changing,” and the disease has changed from being a “gay white man's disease” to an epidemic that is greatly affecting women in southern Africa, UNAIDS Executive Director Peter Piot told reporters today. The epidemic has also begun to rapidly emerge in other areas outside of Africa and the developed world, particularly in the former Soviet Union, India and China.

Subtitles of the report are:

• With 42 Million Now Infected, Epidemic Emerging In New Areas
• Not All Bad News, Epidemic Stabilizing In Some Countries
• HIV/AIDS "Potent" Factor In Southern Africa Food Crisis And Vice Versa
• HIV/AIDS In Conflict Situations
• Effective Prevention Efforts Will Require Up To $15 Billion Annually

The entire report is available at:
(SEA–AIDS 11/27/02)


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), 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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