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Vol. VI, No. 03~ EINet News Briefs ~ Feb. 7 , 2003

****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): Avian influenza
    Japan: Suspected Source of BSE
    Canada (Ontario): E. coli O157
    USA: Newcastle disease, game fowl, poultry
    Chile (Valdivia): Hantavirus pulmonary syndrome
    USA: Measles imported from Philippines: alert
    USA (California): Staph. aureus (MRSA), community acquired
    USA (Washington): TB rate at 30–year high in King County, Seattle
  2. Updates
    USA: CDC Update: West Nile Virus Case Count
  3. Notices
    WHO: Dr Jong Wook Lee nominated To Be WHO Director–General
    WHO: Guidelines for Bioterrorism, Food Safety
    Thailand: Vacancies at Health and Development Networks (HDN)
  4. How to join the EINet email list

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


China (Hong Kong) — Avian influenza
According to information received on Jan. 17, 2003 from the Director of Agriculture, Fisheries and Conservation Department, Hong Kong, outbreaks of highly pathogenic avian influenza virus H5N1 have been reported. The first deaths noted in Penfold Park, Shatin, on Nov. 30, 2002 and the estimated date of the first infection is Nov. 27, 2002. Wild bird introduction is suspected to be the origin of these outbreaks.
For additional information, please visit the following URL: http://www.oie.int/eng/info/hebdo/AIS_35.HTM
(ProMed 1/26/03)

Japan — Suspected Source of BS
The agriculture department of the Hokkaido Prefectural Government confirmed that the 6th cow infected with mad cow disease was fed a milk substitute similar to the one given to all 5 cows previously found suffering from the disease. The first 5 cows had been fed either Miru Food A or a similar brand, called Pure Milk, that has nearly identical ingredients. Pure Milk is also made by the Gunma factory. The feed was found to have included animal fat made in the Netherlands.

BSE prions could have been introduced through calf–milk–replacers that included (probably contaminated) animal fat from the Netherlands. However, a causal relationship between the feed and the infections has not been determined. The Dutch report does not support the hypothesis incriminating calf–milk–replacements.
(ProMed 2/02/03)


Canada (Ontario) — E. coli O157
An outbreak of E. coli O157 has affected at least 225 people who attended a Polish Alliance Hall dinner in Hamilton, and consumed the Scottish national delicacy, “Haggis” in Ontario on Jan. 19, 2003. 55 people have reported stomach pain, fever, vomiting, and diarrhea, and 9 people have required hospital care. Monir Taha, Associate Medical Health Officer of health, said the outbreak began on Jan.26, 2003.

Public health inspectors started with a list of dozens of potential food and drink contaminants. They've now cut the list down to 4 "risk items": haggis, white wine, milk, and roast beef, in that order. To get to the final 4, 218 people were questioned on what they ate and how they felt afterward. Food and drink samples have been sent to the Ontario public health lab in Toronto to test for traces of the bacteria, Taha said. Results are pending..
(ProMed 1/28/03, 2/03/03)

USA: Newcastle disease, game fowl, poultry
Dr. Richard Breitmeyer of the California Department of Food and Agriculture warned that the current crisis surrounding an outbreak of exotic Newcastle disease (END) could get even more complicated. Since the initial diagnosis in a game fowl flock in October 2002, the disease has spread among backyard poultry flocks, exotic specialty birds, and fighting cocks in 4 Southern California counties. On Dec. 19, 2002, the agent was found in commercial laying hens. According to Breitmeyer, by Jan. 23, 2003, some 7000 premises had been quarantined and more than 75 000 non–commercial birds destroyed. Furthermore, as of Jan. 20, 2003, 6 farms housing 1.8 million hens have been depopulated.

In a simlar outbreak in 1971, eradication of END required 3 years and involved the destruction of 12 million commercial hens and other birds at a cost of $60 million.
(ProMed 1/29/03)

Chile (Valdivia) — Hantavirus pulmonary syndrome
A second case (40–year old female) of hantavirus pulmonary syndrome (HPS) in 2003 was confirmed by the microbiology laboratory of the Southern University of Valdivia, and a third case (27 year–old male) was confirmed by the health service of Talcahuano. Both patients are in stable condition. The respective sanitary authorities are stepping up preventive activities in the areas affected.

During 2002, 64 cases of HPS were confirmed in Chile. Characteristics of HPS cases since 1993 are reported at the Chilean Ministry of Health Epidemiology website:

Also, a detailed description of an outbreak of hantavirus pulmonary syndrome in Chile can be seen at the following URL: http://www.cdc.gov/ncidod/EID/vol4no4/toro.htm
(ProMed 2/01/03)

USA — Measles imported from Philippines: Alert
A 24–year–old woman from the Philippines arrived at JFK Airport, New York, USA at approximately 1 PM on Jan. 17, 2003 after a 4–hour stopover at Narita Airport in Japan to visit family. She was on a Northwest airlines flight from Manila to Tokyo, and the flight from Tokyo, Japan to JFK was another Northwest airlines non–stop flight. Within hours of arrival, she had a temperature of 104, cough, rhinitis, sore throat, and conjunctivitis.

Within 2 days she developed a morbilliform rash starting on her face and extending to her legs by the third day. She gave a vague history of having measles at age 3 and never received a measles–mumps–rubella immunization. She was diagnosed serologically as having measles by the New York City Department of Health and has recovered. The local and national public health authorities are involved.

Physicians should be aware that any susceptible contacts on the airplane or at the airport may present with measles after an incubation period of 10㪦 days, i.e., from Jan. 27㪷, 2003.
(ProMed 1/31/03)

USA (California) — Staph. aureus (MRSA), Community Acquired
A painful skin infection not treatable with most common antibiotics is spreading through the Los Angeles County jail system, affecting more than 1000 inmates in the last year and causing at least 57 hospitalizations. Jail doctors are using more powerful drugs to treat all skin lesions and stepping up hygiene measures.

Federal health officials believe that the outbreak of drug–resistant Staphylococcus aureus, is the largest of its kind in any of the nation's correctional systems. By comparison, a similar outbreak in Mississippi prisons in 1999� infected 59 inmates.

Similar outbreaks of the same strain have been found elsewhere in the Los Angeles area since the summer, among gay men, members of a sports team, and newborns in a hospital's nursery. Some inmates are entering the jails with infections picked up in the community and are spreading the staph behind bars, doctors said.

Some hygienic precautions that are routine in a hospital can't be followed in jails. Replacing bar soap with plastic soap dispensers poses a security risk, and jails won't use paper towels instead of cloth towels because inmates could use them to stuff toilets.

"The problem at the jail is not under control yet," said Dr. Jonathan Fielding, the county's public health director. More than 100 infections have been reported this month.
(ProMed 1/31/03)

USA (Washington) — TB rate at 30–year high in King County, Seattle
An outbreak of tuberculosis among Seattle's homeless population has driven the rate of infection in King County to a 30–year high. The number of cases has been rising over the past four years. There were 139 and 158 cases reported in 2001 and 2002 respectively. Seattle's average baseline for TB cases is between 100 and 110 cases a year, said Dr. Masa Narita, Director of Public Health, Seattle & King County's TB outreach program.

Using DNA testing techniques, health department investigators have determined that the cases in the homeless population are related to the same molecular strain of bacteria, which means the disease was being transmitted from person to person.

Health officials believe it spread quickly in the homeless population because many people on the streets have compromised immune systems and other health problems that make them susceptible. Also, homeless people often share close quarters at shelters or in makeshift tents.

Although TB is treatable with antibiotics, because the drugs must be taken for at least six months, it's particularly difficult to ensure compliance in the homeless population, Narita said. The health department sends outreach workers out daily to make sure homeless patients are taking their medicine.

Even without the homeless outbreak, however, TB cases were climbing. This is primarily due an increase in cases among foreign–born patients. There have been a few cases of foreign students with TB, but there has been no evidence of transmission in educational settings, Narita said. About a third of the world's population has been infected with TB, and with global travel patterns, refugee movement and immigration, the disease is easily introduced in new areas. Health officials have said that the majority of King County cases are in foreign–born patients.
(Seattle Post–Intelligence 01/29/03)


USA—CDC Update: West Nile Virus Case Count
As of Jan. 29, the total reported human case cases of West Nile Virus for 2002 reached 4,007. There have been 263 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


WHO — Dr Jong Wook Lee nominated To Be WHO Director–General
Dr. Jong Wook Lee was nominated today by the World Health Organization's Executive Board for the post of Director–General of the agency. The Director–General is WHO's chief technical and administrative officer and sets the policy for the Organization's international health work.

Born on 12 April 1945, in Seoul, Republic of Korea, Dr Lee received a Medical Doctor degree (M.D.) from Seoul National University and a Master of Public Health degree from the University of Hawaii.

He has worked at WHO for 19 years in technical, managerial and policy positions. After heading the WHO Global Programme for Vaccines and Immunizations and serving as a Senior Policy Advisor, he became Director of the Stop TB programme in 2000.

This nomination will be submitted for approval to the 56th World Health
Assembly scheduled to meet in Geneva from 19㪴 May 2003.
(WHO Press Release 1/28/03, SEA–AIDS 1/30/03)

WHO Guidelines — Bioterrorism, Food Safety
The World Health Organization (WHO) today published guidance intended to help national governments establish mechanisms that will minimize potential terrorist acts against food supplies.

The document, entitled "Terrorist Threats to Food: Guidance for Establishing and Strengthening Prevention and Response Systems", is available at the following website: http://www.who.int/fsf

“The guidance document emphasizes the need to strengthen existing emergency alert and response systems by improving links with all relevant agencies and with the food industry. Many developed and most developing countries are not yet adequately prepared to deal with a large–scale food safety emergency. All countries should undertake preparedness and response planning to be able to cope with food safety emergencies regardless of their cause. Also described are the services of various technical programmes of WHO, as well as other organizations, that may be of assistance to countries in addressing this newly emerging public health concern.”
(WHO 1/31/03, ProMed 2/01/03)

Thailand — Vacancies: Health and Development Networks (HDN)
Health and Development Networks (HDN) is a non–profit organization. Its mission is to mobilize a more effective response to HIV/AIDS, TB and Malaria and other health–and–development–related issues by improving information, communication and the quality of debate.

Current vacancies:
1. Project Manager(s)
2. Programme Manager (Asia Pacific)
3. Human Resource Manager (Asia Pacific)

HDN is developing several new project areas during the course of 2003, as part of a plan of work for 2003� supported by the Government of Ireland. Each work area will be managed by a Project Manager. The candidates for these positions will be considered for specific project assignments depending upon their previous experience and project–related knowledge.

Application closing date is February 15, 2003. To see further information about HDN and the vacancies, please visit the following website: http://www.hdnet.org
(SEA–AIDS 1/23/03)


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