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>Vol. VI, No. 04~ EINet News Briefs ~ Feb. 21 , 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): Outbreak of Influenza A (H5N1)
    Thai: Children Orphaned by AIDS Increasingly Growing
    Japan: Proposal to WTO on Generic Drug Access Fails
    South Asia: Nearly 4.2 Million people living with AIDS in
    China (Guangdong): Outbreak of Acute Respiratory Syndrome
    USA (Texas): Influenza, multiple types
    Chile: Cholera, alert
    Indonesia (Java): Chikungunya Outbreak
  2. Updates
    USA: CDC Update: West Nile Virus Case Count
  3. Articles
    Monitoring the occurrence of emerging forms of Creutzfeldt–Jakob disease in the
    United States
  4. How to join the EINet email list

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


China (Hong Kong) — Outbreak of Influenza A (H5N1)
As of Feb. 19, two laboratories have confirmed an avian influenza virus, influenza A (H5N1), from two samples of a single child in Hong Kong SAR. A similar virus caused an outbreak in Hong Kong SAR in 1997, with 18 cases detected and six deaths.

In the current outbreak, a 9–year–old boy who traveled to Fujian Province (China) in January with his mother and his two sisters became ill on Feb. 9 and was admitted to a Hong Kong hospital on Feb. 12. He has recovered and is in a stable condition. Other members of his family presented with a similar illness. The child's sister and father (33–year–old) have died. The boy's mother was ill but has recovered. As of Feb. 20, the Department of Health in Hong Kong SAR confirmed that the father had been infected with a strain of the influenza A (H5N1) virus as well.

The World Health Organization is collaborating closely with health authorities in Hong Kong SAR and China in investigating the outbreak. The WHO Global Influenza Surveillance network has been alerted.
(WHO Disease Outbreak News (www.who.int/csr/don/en/) 2/19, 20/03, ProMed 2/20/03)

China (Guangdong) – Outbreak of Acute Respiratory Syndrome
An unidentified pneumonia has killed 5 people and 305 people have been hospitalized in a region of Guangdong province near Hong Kong from Nov. 16 to Feb. 9, 2003. One third of them doctors, nurses, and other health workers, said an official of the provincial Disease Prevention and Control Center. The disease was first reported in the last November in 4 cities in Guangdong including Zhongshan, about 100 kilometers (60 miles) northwest of Hong Kong.

Health officials said the outbreak had been brought under control and Health Ministry investigators sent from Beijing were trying to find the source of the disease. Investigations carried out by the Chinese authorities have ruled out anthrax, pulmonary plague, leptospirosis, and haemorrhagic fever.

According to Guangzhou City's Director of the Municipal Health Bureau, Huang Jiong Lie, Mycoplasma pneumoniae is suspected as a causative organism. In addition, Chlamydia has been identified as the cause of a pneumonia outbreak on Feb. 18, 2003.The Chinese Center for Disease Control and Prevention, in cooperation with the Guangdong Center for Disease Control and Prevention, found Chlamydiain 2 specimens taken from the lungs of patients who died from the strain of pneumonia.

Rumors that hundreds of people had died prompted residents to stock up antibiotics and pay inflated prices for white vinegar for use as disinfectant, officials said. Photos in Hong Kong newspapers showed people in Guangdong wearing surgical masks to avoid infection.
(ProMed 2/11/03, 2/14/03, 2/18/03, WHO Weekly Epidemiological Record 2/12/03)

Thai — Children Orphaned by AIDS Increasingly Growing
San Francisco Chronicle has reported that Thailand is facing a huge increase in AIDS orphans. About 63,000 Thai children had lost parents due to AIDS in 1995. The last year, that number increased to 289,000. In 2005, there will be 380,000, according to a UNAIDS report "Children on the Brink."

Imported drugs cost about $490 per person per month, which is extremely expensive to the nation with an annual per capita income of $6,600, according to the 2002 CIA World Factbook. The last September, Thailand's government increased the number of patients receiving free medication from 3,000 to 13,000 through the Access to Care program, which became possible due to a cheap, single–pill HIV cocktail that combines three generic drugs manufactured by a Thai pharmaceutical company.

To see the entire article, please visit the following URL:
(SEA–AIDS 2/07/03, San Francisco Chronicle 12/19/02)

Japanese Proposal to WTO on Generic Drug Access Fails
According to Agence France–Presse, a Japanese proposal offered as an attempt to solve the current "impasse" in World Trade Organization talks over allowing developing countries that do not have the ability to domestically produce medicines the right to import low–cost generic drugs, including those used to treat HIV/AIDS, failed.

Japan's proposal would have offered a list of 22 diseases for which developing countries could import drugs, but it also recommended that the WTO Trade–Related Aspects of Intellectual Property Rights Council confirm coverage of any diseases not listed and seek "views of any outside experts".

The proposal was one of several attempts to reach an agreement after ambassadors representing 144 nations in December 2002 failed to meet a self–imposed deadline to clarify the November 2001 Doha declaration. The agreement states that WTO member nations can ignore pharmaceutical patents and domestically produce generic drugs in cases of public health emergencies. The talks stalled after the United States "insisted" that the deal should apply only to drugs used to treat certain infectious diseases such as HIV/AIDS.

To see the entire article, please visit the following URL:
(SEA–AIDS 2/07/03, Kaiser Daily HIV/AIDS Report 2/06/03)

Nearly 4.2 Million people living with AIDS in South Asia
About 4.2 million people are living with AIDS in South Asia in 2001 compared to 2 million in 1994 and the epidemic is getting worse in the region, said health officials from eight South Asian countries and the United Nations. Delegates from Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan and Sri Lanka participated in the two–day meeting in Nepal's capital, Katmandu. They reviewed previous commitments to combat the spread of AIDS and planned new, speeded–up strategies to fight the disease.

"Over 4 million people are living with AIDS in the region. Of them, over 1 million are young people, who account for about half of all the new infections, including a growing number of young women," said Carol Bellamy, executive director of United Nations Children's Fund. "Communication and peer education campaigns must be stepped up to ensure that young people are armed with the facts about HIV and its prevention," she said.

Delegates also said the disease is largely being spread by migration and the cross–border trafficking of women. About 5,000 Nepalese women work as prostitutes in neighboring India, and many come home with AIDS.
(SEA–AIDS 2/10/03, Planet Wire 2/03/03)

Indonesia (Java) — Chikungunya Outbreak
A disease, locally known as chikungunya (meaning "doubled up"), has spread further in West Java. According to data from the public health center in Cikalongwetan, the number of people infected by the disease has increased to 231, from 90 in December 2002, in which Chikungunya was first detected in the West Java capital of Bandung.

Jarnadi Kusmayadi, senior official with the city's health office, said that the local administration had been taking measures to prevent the disease from spreading to other villages in Cirebon and neighboring towns.

Chikungunya virus was isolated during an epidemic in Tanzania in 1952 from both patients and mosquitoes. Subsequently it has been isolated frequently from humans and mosquitoes in tropical Africa, India, and Southeast Asia. Non–human reservoir species have not been identified, and migrants and travelers are often blamed for spread of infection

Recent laboratory studies suggest that in southeast Asia, Aedes albopictus is a more competent vector of chikungunya virus than Aedes aegypti. The clinical picture resembles that of dengue fever. After an incubation period of 2 to 4 days, there is sudden onset of fever followed by crippling joint pains which may temporarily incapacitate patients. Arthralgia is the most typical sign, occurring in around 70 percent of cases. The acute phase of the disease lasts for 2 to 4 days with recovery in 5 to 7 days. Treatment is palliative.
(ProMed 2/17/03)


USA (Texas) — Influenza, multiple types
Texas is hit by one of the oddest influenza seasons with 5 distinct strains circulating in the state.
"This is unprecedented, the number of schools and school districts that have been closed this year," said Neil Pascoe, who tracks flu for the Texas Department of Health. "As of last week, 53 school districts have closed (in Texas sometime during the flu season). How many last year? None."

The graph of "The spread of flu" can be seen at: <http://www.mysanantonio.com/images/art/flash/0211flu.swf>

Although B–Hong Kong has been the primary strain, Texas also has seen a second B strain and 3 A strains in smaller numbers. A–type flu strains tend to be more genetically stable, allowing people to develop some immunity from year to year. However, B strains are more sporadic and vary more, causing more problems among the young.
(ProMed 2/11/03)

Chile – Cholera Alert
Chilean health authorities have declared a state of alert after the detection of cholera bacteria in the central coastal area of the country. The Ministry stated that it has urged all health services to activate cholera control measures. There have been no reports of illness, but cholera bacteria were detected between the localities of Tejas Verdes and Llolleo, in the estuary of the Maipo river, 62 miles west of Santiago.

Chile has not had cases of cholera over the past 5 years, after controlling an outbreak that originated in neighboring Peru that affected approximately 150 persons between 1991 and 1994.
(ProMed 2/14/03)


USA—CDC Update: West Nile Virus Case Count
As of Feb. 5, the total reported human case cases of West Nile Virus from 2002 reached 4,008. 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


Monitoring the occurrence of emerging forms of Creutzfeldt–Jakob disease in the United States.
“Transmissible spongiform encephalopathies (TSEs) attracted increased attention in the mid�s because of the emergence among UK cattle of bovine spongiform encephalopathy (BSE), which has been shown to be transmitted to humans, causing a variant form of Creutzfeldt–Jakob disease (vCJD). The BSE outbreak has been reported in 19 European countries, Israel, and Japan, and human cases have so far been identified in four European countries, and more recently in a Canadian resident and a US resident who each lived in Britain during the BSE outbreak. To monitor the occurrence of emerging forms of CJD, such as vCJD, in the United States, the Centers for Disease Control and Prevention has been conducting surveillance for human TSEs through several mechanisms, including the establishment of the National Prion Disease Pathology Surveillance Center. Physicians are encouraged to maintain a high index of suspicion for vCJD and use the free services of the pathology center to assess the neuropathology of clinically diagnosed and suspected cases of CJD or other TSEs.”
(Belay ED, et al. Neurology 2003 Jan 28;60(2):176㫩)


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