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Vol. VI, No. 05~ EINet News Briefs ~ March 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): Genetic Characterization of Human Isolate of H5N1 Influenza Virus
    Middle East and West Asia: HIV/AIDS Cases Triple
    Indonesia (Java): Chikungunya Outbreak Spreading in West and Central Java
    USA (Massachusetts): Staph. aureus (MRSA), community acquired
    USA (California): Staph. aureus (MRSA), community acquired
    USA (California, Florida): Smallpox vaccination, adverse events
  2. Updates
    USA: CDC Update: West Nile Virus Case Count
  3. Articles
    Fatal Degenerative Neurologic Illnesses in Men Who Participated in Wild
    Game Feasts: Wisconsin, 2002

    International distance–learning outreach: the APEC EINet experience
  4. Notices
    2003 PulseNet Update Meeting, April 29 – May 2, 2003 St. Anthony Hotel, San Antonio, Texas
  5. How to join the EINet email list

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


China (Hong Kong) – Genetic Characterization of Human Isolate of H5N1 Influenza Virus
Genetic characters of the avian influenza virus H5N1 that has killed at least one person in South China two weeks ago are different from those of the avian influenza virus strain that infected 18 people in Hong Kong and killed six of them in 1997. The new strain does not appear to contain sequences from human flu viruses that would speed its spread from person to person, meaning that the risk of person–to–person transmission is low.

According to Malik Peiris, a microbiologist at the University of Hong Kong who is studying the new virus, the avian influenza virus strain from the 9–year–old boy is completely sequenced. The six internal genes of the virus, as well as the neuraminidase gene, are derived from a different genetic lineage from that of the 1997 virus. Only the haemagglutinin derives from the same lineage as 1997. “In addition, we also can establish that the virus has not acquired any human influenza internal genes,” said Pieris.

As of 27 February no further cases of human influenza A(H5N1) have been reported in Hong Kong SAR. To date the current outbreak of influenza A(H5N1) in Hong Kong SAR has been limited to two cases, an 9–year–old boy and his 33–year–old father. The boy’s 8–year–old sister died and the cause of her death is under investigation. The mother has now recovered from what was thought to have been a parainfluenza infection.
(ProMed 2/24, 28/03, WHO Disease Outbreak News (www.who.int/csr/don/en/) 2/27/03)

HIV/AIDS in Middle East and West Asia Tripled
According to new figures released at a World Health Organization conference in Cairo, Egypt, the number of people living with HIV/AIDS in the Middle East and West Asia has more than tripled over the last three years.

The figures indicate that 700,000 people are HIV–positive in the Eastern Mediterranean region — which includes 18 countries, including Libya, Pakistan and Afghanistan, compared with 220,000 HIV–positive people in the region in 1999. In addition, the proportion of HIV–positive women nearly doubled in 2000 to 32% of the total number of cases from 17% in previous years. An unnamed conference attendee said that the numbers presented were “well below reality” and added that HIV/AIDS is a “real scourge” in some countries, including Libya, Djbouti and Sudan.

Jihane Tawileh, head of the WHO HIV/AIDS program in the region, said that many of the countries do not have the equipment, staff and facilities to deal with the increasing number of people affected by the disease. Some conference attendees said that people in the region do not seek treatment due to the stigma associated with the disease. Dr. Stewart Flavell, coordinator of the nongovernmental group People Living with AIDS, said, “There is an aura of shame that prevails in this region. You cannot fight a disease as long as you deny its existence.”
(SEA–AIDS 2/25/03)

Indonesia (Java) — Chikungunya Outbreak Spreading in West and Central Java
Health officials have warned that further outbreaks of chikungunya were possible anywhere in Indonesia, with the mosquito–borne disease already having infected hundreds of people in several towns in West and Central Java. Thomas Suroso, the director of the Arbovirus Diseases Eradication Unit at the Ministry of Health, told The Jakarta Post on Feb. 20, 2003 that unlike the generation of 20 years ago, which was immunized against chikungunya, the current generation was highly susceptible to the disease, as it had not been immunized by prior exposure to the virus.

The disease has infected more than 500 people in certain parts of Yogyakarta province and 250 others in the West Java capital of Bandung since last December, 2002, local officials said. It spread last week to Cirebon, West Java, where more than 70 people have been affected since mid–January, 2003.

However, a local senior health official, Sri Budiartiningsih, said that her agency had recorded at least 94 cases of chikungunya disease in Cirebon, adding that the disease was first detected in Bojor Lor village in Klangenan subdistrict and spread to the adjacent villages of Bojong Wetan and Kreyo. Last year, the disease also hit the West Javan town of Bekasi and the Central Javan towns of Purworejo and Klaten.
(ProMed 2/23/03)


USA (Massachusetts) — Staph. aureus (MRSA), community acquired
Five men in Boston have been infected with a drug–resistant bacteria, methicillin–resistant Staphylococcus aureus (MRSA). Beginning last fall, doctors at the Fenway Community Health Center started seeing patients with pneumonia, sinus infections, and skin conditions caused by MRSA. All five men have been treated and recovered without lasting complications,

“It's of great concern,” said Dr. Scott Fridkin, a medical epidemiologist at the US Centers for Disease Control and Prevention. “The reports are becoming more frequent, and it appears to be a growing problem.”

Fenway physicians alerted the CDC about the cluster of cases, and the Massachusetts Department of Public Health has begun an investigation, hoping to establish whether the cases are linked and, if so, to identify a common source of infection. The men are all HIV–positive, but neither
physicians providing treatment nor disease investigators can say with certainty that the patients’ HIV status had anything to do with the bacterial infection.
(ProMed 3/2/03)

USA (California) — Staph. aureus (MRSA), community acquired
Public health officials in California are alerting male homosexuals to the dangers of a new skin infection of methicillin–resistant Staphylococcus aureus (MRSA), which is communicable during sex. The San Francisco Health Department has sent out informational bulletins on MRSA to chiropractors, masseurs, and gymnasium and sex–club operators, alerting them to increases of the infection. Officials also have held informational forums at homosexual community centers.

Since early last summer, the San Francisco Health Department has identified an increasing number of patients with soft tissue infections among city jail inmates. More recently, Los Angeles health officials also have identified an increase in MRSA among male homosexuals.

In order to control an epidemic, officials need to have some idea what the incidence is. However, officials can't provide numbers of staph infections because MRSA is not a reportable disease in California. A San Francisco doctor estimated the city's cases number between 200 and 300.
(ProMed 2/27/03)

USA (California, Florida) – Smallpox vaccination, adverse events

In California, an adult's eye became infected with the same virus used in the military's smallpox vaccination program. The patient had been in close contact with someone who had been inoculated, health officials said. However, Dr. Jonathan Fielding, Los Angeles County's director of public health, said it remained unclear exactly how the patient became infected.

Public health officials have declined to release the patient's gender or age, but have said the patient's condition was improving. It was the first known case in California linked to the national drive to vaccinate emergency health workers and military personnel.

In Florida, officials are investigating medical problems among 3 health care workers who became ill after receiving the vaccine. Only one appears to have had a reaction to the inoculation, with the other 2 experiencing symptoms not normally related to the inoculations.

As of last week, 7354 people had been vaccinated in 38 states and Los Angeles and New York, which are running separate programs. In the military, where more than 100 000 people have been vaccinated, there have been 5 serious reactions. All 5 men are in good condition, officials said. In most cases, the symptoms were not severe.
(ProMed 3/1/03)


USA — CDC Update: West Nile Virus Case Count
As of Feb. 28, the total reported human case cases of West Nile Virus from 2002 reached 4,071. There have been 274 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


Fatal Degenerative Neurologic Illnesses in Men Who Participated in Wild Game Feasts: Wisconsin, 2002
During the period 1993 to 1999, three men who participated in wild game feasts in northern Wisconsin died of degenerative neurologic illnesses. This article summarizes the investigation of these deaths, which was initiated in August 2002 and which confirmed the death of only one person from Creutzfeldt–Jakob disease (CJD).

The confirmed case was a Minnesota man aged 55 years with no previous history of a neurologic disease sought evaluation and treatment following a 3–month history of progressive difficulty in writing and unsteadiness of gait in May 1999. In June 1999, he was hospitalized following onset of dementia, speech abnormalities, and myoclonic jerking. An EEG indicated left–hemispheric periodic sharp waves and moderate generalized background slowing; CJD was diagnosed clinically. In July 1999, following worsening symptoms and development of right upper extremity dystonia, the patient died. The man was not a hunter but had a history of eating venison once during the mid�s.

Out of 53 persons who were identified as possibly participating in the wild game feasts, information was obtained for 45 (85 percent); all were male, by direct interview or from family members of decedents. Among those 45 persons, 34 were reported to have attended wild game feasts. 7 of the 34 feast attendees were deceased, including the 3 patients reviewed in this article. None of the 4 other decedents had a cause of death attributed to or associated with a degenerative neurologic disorder. None of the living participants had any signs or symptoms consistent with a degenerative neurologic disorder.

“Although no association between chronic wasting disease (CWD) among deer and elk and CJD was found, continued surveillance of both diseases remains important to assess the possible risk for CWD transmission to humans.”

In order to see the entire article, pleas visit the following URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5207a1.htm
(MMWR 2003 Feb. 21;52(07):125㪳)

International distance–learning outreach: the APEC EINet experience.
“BACKGROUND: The Emerging Infections Network is a mature electronic network that links Public Health professionals in the Asia Pacific through regular e–mail bulletins and an extensive Web site (http://www.apec.org/infectious). Emerging infections is a new area of study; learning materials help foster education. Our objective is to quantify the response of the network to the introduction of distance–learning materials on the Web site.

METHODS: Distance–learning materials, developed by the University of Washington School of Public Health, were field tested and launched on the site. Publicity was carried out prior to the launch of the materials. Access was tracked prospectively using server counts of page downloads.

RESULTS: Web access increased substantially during the month after the materials were launched, especially among Asia based computers. The effect was isolated to the distance–learning pages, and not general to the site.

CONCLUSIONS: This Web site appears to be responsive to the advertisement and to the materials. Prospective Web–site monitoring proved useful.”
(Kimball AM, Shih L, Brown J, Harris TG, Pautler N, Jamieson RW, Bolles J,
Horwitch C, Int J Med Inf 2003 Jan;69(1):57㫖)


2003 PulseNet Update Meeting, April 29 – May 2, 2003 St. Anthony Hotel, San Antonio, Texas
The 2003 PulseNet Update Meeting will be April 29–May 2 at the St. Anthony Hotel in San Antonio, TX. The theme this year will focus on Back to Basics issues. This annual meeting continues to serve as a highly successful forum to discuss innovations in molecular subtyping of foodborne pathogens, PulseNet protocols, software changes, and expansion of the Program to include non–foodborne pathogens.

• Please register by Friday, April 4, 2003.
• Pre–conference BioNumerics training courses will take place on Monday, April 28 and Tuesday, April 29.
• Hotel Reservations MUST be made by March 31, 2003 (Phone: 1𤴐–Wyndham). The conference rate is $91.00 per night (government rate for San Antonio).

Training Course Information: Susan Hunter 404𤱯� or sbh1@cdc.gov
Other Information: Shari Rolando 202𤴦�, ext 205 or srolando@aphl.org


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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