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Vol. V, No. 22~ EINet News Briefs ~ Dec. 20 , 2002

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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
    New Zealand: First TB in deer for 14 years confirmed
    India (Uttar Pradesh): Undiagnosed febrile among children
    Canada (multi provinces): Viral Gastroenteritis continue to affect Canadians
    USA (Michigan): Suspected bovine Tuberculosis
    USA (Florida): Cruise Ship Outbreak: A Total of 212 Passengers and Crew Affected
  2. Updates
    USA: CDC update: West Nile Virus case count
  3. Journal Articles
    USA: Drug–resistant bacteria in chicken
    USA: Measles Outbreak among Internationally Adopted Children
  4. How to join the EINet email list

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


New Zealand — First TB in deer for 14 years confirmed
Deer near Tauranga were confirmed to be infected with bovine tuberculosis. It is 14 years since the last outbreak in the region, at Te Puna, and also involving deer. The latest infection was found in four out of a herd of 120 deer from an Omanawa Rd farm in the lower Kaimai ranges, about 25 km from Tauranga.

Routine tests picked up TB when the herd was sent to the slaughterhouse. The rest of the animals were clear. "It is nothing like foot and mouth in England. We do not have any major concerns at all," AgriQuality veterinarian Keith Paterson said. The diseased deer were bought several months ago from a Taupo source which had been TB–free for 10 years. Four or five animals in the Taupo herd were also found to be infected and were killed.

Wildlife was the likely source of contamination and a rigorous control program had been carried out on possums and ferrets in the area, Mr. Paterson said. He did not believe there was any evidence bovine TB had spread beyond the one 18 ha Omanawa property in the Western Bay of Plenty.

Bovine tuberculosis (TB) is an infectious zoonotic disease caused by Mycobacterium bovis. However, 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 have also been of great importance.

Cattle are considered to be the true hosts of _M. bovis_, but the disease has been reported in several other species of domestic and wild animals such as deer and ferrets. Extensive investigations of sporadic M. bovis recurrence have also shown that wildlife reservoirs exist in some countries.
(ProMed 12/8/02)

India (Uttar Pradesh) — Undiagnosed febrile among children
The death toll due to undiagnosed febrile among children is 44, according to Dr. GC Shrivastava, joint director communicable diseases. “twenty two fresh cases have been reported over the last two days but no deaths so far,” said Shrivastava, adding that “according to tests on mosquitoes from the area, dengue, malaria, and Japanese encephalitis have been ruled out.”

Panic–stricken parents insisted on keeping their children from going to school. Attendance in the primary schools has dropped drastically as the toll of children dying of the mysterious illness continued to rise.
(ProMed 12/3/02)


Canada (multi provinces) — Viral Gastroenteritis continue to affect Canadians
In Toronto, Norwalk virus infection hit at least six schools and eight Greater Toronto Area (GTA) hospitals. The public school board sent letters to parents warning them to keep their children at home if they show any signs of the highly contagious pathogen. Dr. Michael Gardam of Toronto General Hospital said “Wave after wave of patients were coming in, 10 to 12 patients a day, and were getting violently ill in the emergency room.” By last Sunday, the hospital was so short–staffed it was becoming impossible to care for patients. “We had to close. We couldn't, in good conscience, stay open,” Gardam said.

Toronto Public Health reports there are at least 50 outbreaks in the city. For now, no new patients are being admitted into Toronto General's emergency ward, where 10 patients are confined until the outbreak is over. They were receiving treatment when the ER closed and can't be transferred to another bed for fear of spreading the virus. Toronto Western and Mount Sinai hospitals were taking emergency patients who would otherwise go to Toronto General, and Emergency Medical Services said ambulances were coping with the loss of an emergency room. The emergency room won't reopen until two days after the last symptom disappears in the last viral gastroenteritis patient.

The same viral gastroenteritis outbreaks are occurring across Canada from Prince Edward Island in the east to Vancouver Island in the west. It has not been confirmed, however, that Norwalk–like viruses are the etiologic agents in every case. Ontario’s chief medical officer of health urged Ontarians to take precautions to avoid contracting the virus. As in Toronto, hospitals in Brampton, Kitchener, Brantford, Alberta, Quebec and New Brunswick have been forced to restrict access because of the virus.

Norwalk viruses spread rapidly and cause severe vomiting, nausea, stomach cramps, and diarrhea that lasts for a couple of days. Outbreaks of Norwalk–like viruses are common in winter, particularly in confined places such as nursing homes, cruise ships, and other venues where people are gathered for several days or more. Laboratory diagnosis of Norwalk is difficult, so diagnosis is often based on the observation of a combination of symptoms and the short duration of the illness.
(ProMed 12/5, 8, 9, 10, 11, 12/02)

USA (Michigan) — Suspected bovine Tuberculosis
State officials quarantined an Alcona County (Michigan) dairy herd after tests indicated the possible presence of bovine tuberculosis (TB) in one of the cows.

Dr. Joan Arnoldi, veterinarian with the Michigan Department of Agriculture, said tests likely indicate bovine TB in a 5–year–old cow in the 200–plus animal herd. The herd was quarantined on 27 Nov. “(Researchers) isolated an organism from a cow that was a suspect,” Arnoldi said. “The cow didn't show lesions, but they could have been microscopic lesions that we couldn't see.” Final tests results should be available by mid–January, she said.

White–tailed deer also are susceptible to bovine TB and are blamed for passing on the disease to cattle. The state has aggressively reduced deer numbers in Montmorency, Alpena, Oscoda, and Alcona counties and continues to test deer for the disease.

Before this year, the state had tested 103 405 deer for bovine TB. Of those, 398 tested positive, Bridget Patrick, spokeswoman for the state's bovine TB program said. This year, between 23 and 29 tested deer show signs of TB infection, she said.
(ProMed 12/8/02)

USA (Florida) — Cruise Ship Outbreak: A Total of 212 Passengers and Crew Affected
The Centers for Disease Control and Prevention said on Dec. 9 that 197 passengers and 15 crew members aboard the cruise ship Oceana have come down with a gastrointestinal illness. A CDC field team boarded the ship on Dec. 7 in Barbados to gather more information on the outbreak. “We conducted interviews with passengers and crew members and gathered samples,” said CDC spokeswoman Susan McClure. “The investigation continues.” There are 1859 passengers and 868 crew members aboard the ship, according to a statement released by the CDC.

The Oceana was the latest cruise ship to be stricken by outbreaks in recent weeks. Passengers and crew on four consecutive cruises of Holland America's Amsterdam and two cruises of Disney's Magic were sickened by a Norwalk–like virus. A Norwalk–like virus is also suspected in a recent outbreak aboard Carnival's Fascination.

A shipboard laboratory determined that Salmonella bacteria caused a recent outbreak of stomach illness on the Seven Seas Mariner, but the CDC has yet to confirm that finding. (ProMed 12/10/02)


USA—CDC Update: West Nile Virus Case Count
As of Dec. 11, the total reported human case cases of West Nile Virus for 2002 reached 3,829. There have been 225 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 — Drug–resistant bacteria in chicken
A consumer magazine reported that they found bacteria contamination in about half of the chickens they bought at stores nationwide and many of the contaminated chickens harbored strains of salmonella and campylobacter. Those bacteria are resistant to antibiotics commonly used.

They tested 484 fresh, whole broilers bought at supermarkets and health–food stores in 25 cities nationwide last spring., including four leading brands (Foster Farms, Perdue, Pilgrim's Pride, and Tyson), 14 supermarket brands, nine premium brands (usually from smaller companies, usually more expensive, labeled as raised without antibiotics, and including free–range and organic brands), and two kosher brands. Their shoppers packed the raw birds in coolers and shipped them overnight to a lab. There, tests determined whether salmonella and campylobacter were present, showed whether those bacteria were resistant to a range of human antibiotics, and measured the chickens' total plate count, an indicator of spoilage.

Below are their main findings:
Campylobacter was present in 42 percent of the chickens, salmonella in 12 percent. Five percent of all chickens had both campylobacter and salmonella; 51 percent had neither. No major brand was less contaminated than others overall. Pilgrim's Pride had an exceptionally low incidence of salmonella but, along with Tyson, a higher incidence of campylobacter than most other brands. All 12 samples from Ranger, a premium brand sold only in the Northwest, were free of campylobacter and salmonella. Ranger's chickens also had among the fewest bacteria that can cause spoilage. Ranger was the only brand that was clean across the board. Ninety percent of the campylobacter bacteria tested from their chicken and 34 percent of the salmonella showed resistance to one or more antibiotics.

For viewing the entire report, please visit the following URL:
(Consumer Reports, January 2003 issue)

USA — Measles Outbreak Among Internationally Adopted Children
On February 16, 2001, the Texas Department of Health was notified about a child aged 10 months adopted from orphanage A in China who was taken to a Texas hospital with fever, conjunctivitis, coryza, Koplik spots, and a maculopapular rash. Measles was confirmed by serologic testing. Public health authorities in Texas notified CDC, which then collaborated with health officials in other states to contact other recently adopted children from China and their adoptive families. The multistate contact investigations identified 14 U.S. measles cases.

During the investigation, representatives of orphanage A retrospectively identified cases of suspected measles that preceded the index patient's illness and reported that newly arrived children at orphanage A had not been vaccinated adequately against measles. After completion of a measles vaccine campaign at orphanage A, no additional cases were reported, and the adoption of children from the orphanage resumed on March 29, a total of 3 weeks after the onset of the last known case of measles.

During 1997�, the annual number of reported measles cases in the United States ranged from 86 to 138, with imported cases accounting for 26%㫇% of the total. The proportion of imported cases of measles among internationally adopted children increased from 2% in 1997 to 20% in 2001; 10 of the 11 imported cases of measles among internationally adopted children in 2001 were associated with this outbreak. During fiscal year 2001, the U.S. Immigration and Naturalization Service reported that 19,230 internationally adopted children, of whom 4,681 (24%) were from China, were admitted to the United States.
(MMWR December 13, 2002 / 51(49);1115�)


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