News Briefs Archive

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In this edition:

Infectious disease information
– Indonesia (Jakarta): Indonesia's Low Rates Could Mask Growing Trend, UNAIDS Warns
– WHO: New AIDS Treatment Strategy for Asian Countries
– China: suspected avian influenza H5N1
– ASEAN Regional Workshop on HIV/AIDS: Addressing Stigma and Discrimination
– Australia (New South Wales): Psittacosis, birds
– Canada (Alberta): BSE, bovine
– USA (Arkansas, Georgia, Louisiana): West Nile Virus
– USA (Montana): Hantavirus pulmonary syndrome
– USA (Oregon): Demoic acid, razor clams
Updates
– Multi Country Outbreak: Severe Acute Respiratory Syndrome (SARS)
Notices
– APEC 24th Industrial Science and Technology Working Group
Side Meeting on Health, Rotorua, New Zealand – May 26, 2003
– Brief extract from a draft (May 13, 2003) of APEC action plan on SARS
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1. OVERVIEW OF INFECTIOUS–DISEASE INFORMATION
Below is a semi–monthly summary of Asia–Pacific emerging infectious diseases.

ASIA

Indonesia (Jakarta) — Indonesia's Low Rates Could Mask Growing Trend, UNAIDS Warns
At the launch of Indonesia's National HIV/AIDS Strategy through 2007, Joint U.N. Program on HIV/AIDS Director Peter Piot said that Indonesia had the opportunity to deal a decisive blow against the disease with a relatively low HIV/AIDS prevalence of 0.1 percent and warned that the low rates of the disease could also mask the growing risk of HIV spreading in the country.

Piot said urgent action is needed to slow the spread of the disease. "The current low levels of condom use and widespread sharing of unsterilized needles among injecting drug users can be a lethal mix for HIV spread in the country." According to UNAIDS, the majority of the estimated 90,000 to 130,000 HIV/AIDS cases in the country are concentrated in high–risk groups, including drug users and sex workers.

Indonesia's National AIDS Commission decided to revise the National HIV/AIDS Strategy because of an increase in HIV infections in recent years and to respond to commitments made at the 2001 U.N. General Assembly Special Session on HIV/AIDS. The new national strategy outlines six priority areas –– surveillance of the epidemic; prevention; treatment, care and support of people living with HIV/AIDS; human rights of people living with HIV/AIDS; research; and government coordination at all levels.

"AIDS cannot be fought by one sector alone –– every part of the government and every force in society must be harnessed in a common fight," Piot said. "The challenge now is to implement the national strategy and to ensure that resources and capacity are in place so that it can be translated into action" (UNAIDS release, May 9).
(SEA–AIDS 5/15/03)

WHO — New AIDS Treatment Strategy for Asian Countries
A World Health Organization (WHO) consultation on scaling up HIV/AIDS care including antiretroviral (ARV) drug treatment, taking place during May12㪧, is the first of its kind to be held in Asia. The WHO will bring together representatives from governments, non–governmental organizations, people living with HIV/AIDS groups and international organizations from throughout the Asia– Pacific region.

Thailand will play host to this consultation, which is organized jointly by the WHO Regional Office for South–East Asia and its Regional Office for the Western Pacific. The goal of the meeting is to develop new strategies to address the care needs of the nearly 7 million people living with HIV/AIDS in the Asia–Pacific region – about one–sixth of all people living with HIV and AIDS globally.

Dr. Shigeru Omi, the Regional Director for WHO's Western Pacific Regional Office added said, "In order to develop effective and sustainable HIV/AIDS care including antiretroviral treatment, it is crucial to establish partnerships between public health and medical services, people living with HIV/AIDS, NGOs and the community at all levels."

Stigma, legal issues, and other humanitarian concerns remain important topics for discussion within this AIDS care framework. With respect to all of these critical issues, the regional WHO consultation will propose concrete recommendations and strategies for the advancement of HIV policy at the national and regional levels.
(SEA–AIDS 5/13/03)

China — suspected avian influenza H5N1
The Japanese government had temporarily banned imports of poultry products from China after its quarantine office detected the bird flu virus in imported Chinese duck products. The Agriculture Ministry said in a statement that the tests on duck products from China had discovered the H5N1 bird flu virus. China is one of the top broiler exporters to Japan.

A similar ban by Japan in 2001 that lasted for 2 months caused tight supply on the domestic market, especially for frozen broilers, and contributed to rising trade tensions between the Asian neighbours. Traders said that the ban could also push broiler prices up in Thailand, Brazil and the
United States.

There are concerns that the disease could mix with human flu, producing a strain against which humans have no resistance.
(ProMed 5/12/03)

ASEAN Regional Workshop on HIV/AIDS: Addressing Stigma and Discrimination
The World Youth Foundation (www.wyf.org.my) in cooperation with UNAIDS, Ministry of Youth & Sports Malaysia, World Assembly of Youth and the Ministry of Health Malaysia successfully hosted the above workshop during April 25㪴th, 2003, in Melaka, Malaysia. The workshop attracted 156 youth representatives from various national youth coordination councils in the ASEAN and non–ASEAN Region.

The workshop provided a forum for networking, sharing of knowledge experiences and ideas on initiatives to reduce the impact of HIV/AIDS among youth and youth serving organizations and other stakeholders besides promoting cross–country exchange of best practices for implementing youth–friendly health services in the ASEAN region. The workshop was a success and made a difference in addressing stigma & discrimination related to HIV/AIDS.

The participants unanimously agreed that there was a need that an ASEAN Regional Youth Network on HIV/AIDS. The World Youth Foundation is now embarking on the next phase of establishing the network by the development of mail discussion group /website. thus evolving a networking structure and partnership among youth and stakeholders in the field of youth programmes and activities in the ASEAN region.
(SEA–AIDS 5/05/03)

Australia (New South Wales) — Psittacosis, birds
According to the Southern NSW (New South Wales) Public Health Unit, an increased number of wild birds in the Goulburn area have become sick and died. Post mortem results on two animals have identified the cause as psittacosis.

Psittacosis is a bacterial disease that can be transmitted from birds to humans. Infection usually occurs when a person inhales the bacteria through aerosolized bird droppings or by handling the feathers or tissues of infected birds. People can also become infected by mouth–to–beak contact with birds. It is not transferred from person to person.
(ProMed 5/09/03)

AMERICAS

Canada (Alberta) — BSE, bovine
Officials said an 8–year–old cow from a farm in northern Alberta had been diagnosed with the disease. The herd was quarantined and will be destroyed. According to a spokeswoman for the Canadian Food Inspection Agency (CFIA), they had quarantined 2 more cattle farms to trace the origin of the animal diagnosed with mad cow disease (Bovine Spongiform Encephalopathy, BSE).

The United States, Australia, Japan, Taiwan, and South Korea have all stopped Canadian beef imports. Alberta accounts for nearly 60 percent of Canada's beef production, providing C$3.8 billion (US $2.8 billion) in annual farm cash receipts. In 2002, Alberta shipped more than half a million live cattle to the United States.

Canadian officials are now waiting for results of probes on the origins of the diseased animal. U.S. Agriculture Secretary Anne Veneman mentioned that it could be difficult to trace where the animal had come from. Canada's only other case of brain–wasting bovine spongiform encephalopathy was in 1993, but the animal was imported from Britain.

Agriculture Minister Lyle Vanclief stressed the animal had not entered the food chain. "This must be kept in perspective. It's one cow out of 3.6 million animals that we slaughter a year in Canada," he told CBC radio.
(ProMed 5/22/03)

USA (Arkansas, Georgia, Louisiana) — West Nile Virus
In Arkansas, according to State Veterinarian, Dr. Paul Norris, of Arkansas Livestock and Poultry Commission, test results received from USDA's National Veterinary Services Laboratory indicated that a horse in the Ft. Smith area had been infected with the virus.

"No Arkansas residents have been diagnosed with West Nile encephalitis this year; however, the identification of West Nile virus in a horse is a reminder that the virus is here and we all need to take precautions," said Dr. Sharon Williams, State Public Health Veterinarian with the Department of Health. "Since the majority of human and veterinary West Nile virus cases occurred from June through September (in 2002), a positive horse case this early is a little surprising, but some other states have already seen positive horses, birds, and even mosquitoes. It's certainly not too early to start protecting yourself and your loved ones from mosquito bites. We especially urge protecting our senior citizens, who are at greater risk of the more serious form of the disease."

In Georgia, local health officials are warning residents to protect themselves from mosquito–borne disease after a bird (a wood thrush) from mid–town Savannah tested positive for the West Nile virus.

In Louisiana, 3 more parishes reported dead birds that tested positive for West Nile Virus and then the virus has spread now to 24 of Louisiana's 64 parishes.
(ProMed 5/8, 9, 16/03)

USA (Montana) — Hantavirus Pulmonary Syndrome
According to state health officials, A Cascade County woman died of a hantaviral infection on May 8, 2003. The death was Montana's 4th fatality and 18th case of the life–threatening disease. The last confirmed hantavirus cases in the state were in April and June 2001, in Gallatin. The first case in Montana was diagnosed in September 1993.

Through the end of March 2003, the Centers for Disease Control and Prevention (CDC) had reported a total of 335 cases of hantavirus in the United States. 38 percent of all reported cases have resulted in death. Cases have been reported in 31 states, including most of the Western half of the country and some Eastern states as well.
(ProMed 5/14/03)

USA (Oregon) — Demoic acid, razor clams
A naturally occurring marine biotoxin in razor claims has extended closure of recreational and commercial shellfish on the Oregon Coast. Meanwhile, the Oregon Department of Agriculture diligently continues its routine of sampling shellfish and checking levels of domoic acid to see whether clamming can resume.

Domoic acid is a naturally occurring toxin produced by marine phytoplankton or algae.
Eating shellfish contaminated with low levels of domoic acid can cause minor illness within minutes to hours after consumption. In mild cases, symptoms can include vomiting, diarrhea, abdominal cramps, and headache. More severe cases of domoic acid poisoning can result in memory problems and even death. The toxin cannot be destroyed by cooking, adding baking soda, or any other method. Domoic acid levels must be lower than 20 ppm for 2 consecutive sampling periods.
(ProMed 5/08/03)

2. UPDATES

Multi Country Outbreak — Severe Acute Respiratory Syndrome (SARS)
The first global consultation on SARS epidemiology was held at WHO headquarters in Geneva from 16 to 17 of May. The meeting united face–to–face and via video and audio linkage more than 40 leading epidemiologists from 16 countries, including representatives from all areas experiencing significant outbreaks and from WHO teams at these sites.
• No reports indicate that persons without symptoms have transmitted SARS to others. In addition, no reports indicate that SARS has an animal host or reservoir in the environment.
• The maximum incubation period used for control purposes has proven effective.
• The experts further supported the current WHO recommendation that persons who have an acute febrile respiratory illness should not travel.
• Risk of SARS transmission during air travel

WHO has analyzed information on 35 flights in which a probable symptomatic SARS case was among the passengers or crew as of May 12, 2003. Symptomatic probable SARS cases on 4 of these flights have been associated with possible transmission of infection to fellow passengers or crew. The total number of cases resulting from exposure during these four flights has been revised to 27. It is now known that, on one flight, persons sitting seven rows in front and five row behind a person with symptomatic SARS developed the disease. WHO is aware of four flight attendants, of which two were on the CA112 flight, who have become infected.

• Comment on SARS virus in "healthy control" people
from Dr.Zhiru Guo, Laboratory of Genetic Engineering, Department of Virology, Veterinary Institute, Changchun Universityof Agriculture and Animal Sciences
“I noticed that Canadian scientists found evidence of SARS virus in some "healthy control" people [see: ProMed "SARS – worldwide (69): diagnostic testing 20030425.1015"]. It is a puzzling finding. During investigation of the cause of bovine "sudden death syndrome" in past years, researchers in my institute also found coronavirus–like particles in ultrathin sections of several tissues of some clinically heathy animals, even in sections of hearts. A similar situation existed in pigs and dogs; it seems that coronavirus was a "normal parasite" of those "healthy animals." We still cannot explain those puzzling findings now.”

• As of May 21, 2003, a cumulative total of 7,9556 SARS cases, 666 deaths, and 4085 recovered cases since November 1, 2002, are reported from the following countries (number of cases): Australia (6), Brazil (2), Canada (140), China (5249), Hong Kong Special Administrative Region of China (1719), Macao Special Administrative Region of China (1), Chinese Taipei (418), Colombia (1), Finland (1), France (7), Germany (9), India (3), Indonesia (2), Italy (9), Kuwait (1), Malaysia (8), Mongolia (9), New Zialand (1), Philippines (12), Republic of Ireland (1), Republic of Korea (3), Romania (1), Singapore (206), South Africa (1), Spain (1), Sweden (3), Switzerland (1), Thailand (8), United Kingdom (4), United States (66), Viet Nam (63).

In order to see further details, including cumulative number of cases and deaths, please visit the following URL:
http://www.who.int/csr/sars/country/2003_05_21/en/

• As of May 21, 2003, WHO has listed the following areas with recent local transmission of SARS, where in the last 20 days, one or more reported cases of SARS have most likely acquired their infection locally regardless of the setting in which this may be occurred:
China (Beijing, Guangdong, Hebei, Hong Kong SAR, Inner Mongolia, Jilin, Jiangsu, Shanxi, Shaanxi, Tianjin, and Taiwan), and Singapore.
http://www.who.int/csr/sars/areas/2003_05_21/en/

For the full WHO travel advisory, together with additional information about this disease, please visit the following URL:
http://www.who.int/csr/sars/en/

For information from CDC including guidelines and recommendations, please visit the following URL:
http://www.cdc.gov/ncidod/sars/

For information from Department of Health Hong Kong SAR, please visit the following URL:
http://www.info.gov.hk/dh/new/index.htm

For information from Singapore Ministry of Health, please visit the following URL:
http://app.moh.gov.sg/
(WHO–WER 5/22/03, ProMed 5/19/03)

3. NOTICE

APEC 24th Industrial Science and Technology Working Group
Side Meeting on Health, Rotorua, New Zealand – May 26, 2003
The main topics proposed for discussion are (a) Severe Acute Respiratory Syndrome (SARS) and (b) planning for the March 2004 S&T Ministerial meeting; followed by discussion of existing and new health projects, addressing health actively within ISTWG, and planning over the next months to year.

Brief extract from a draft (May 13, 2003) of APEC action plan on SARS
“ It is important that APEC member economies unite to confront this common threat by adopting a multi–faceted approach in dealing with SARS, utilizing all necessary means and resources within the APEC community, and working closely with the World Health Organization (WHO), to ensure that SARS is contained. To this end, we have adopted the APEC Action Plan for Severe Acute Respiratory Syndrome (SARS) which aims to build public confidence through:
i) a common standard for health screening procedures;
ii) cooperation towards a cure for SARS;
iii) a coordinated approach to public education and travel advisories; and
iv) a communications strategy that highlights standard practices and mutual confidence in each other’s response to SARS.

Within APEC, we have tasked all APEC’s committees, Working Groups and Fora to assess the impact of SARS in areas relevant to their work. We have also asked them to do everything they can to contain the spread of SARS as soon as possible and minimize its impact on APEC. Our strategy to win the battle of SARS contains several measures that shall be implemented immediately and in the medium to longer terms.”

The following items are measures that we have agreed to implement Immediate Steps:
a) Information sharing
b) Developing an Infectious Diseases Strategy
c) Adopting Common Guideline on Health Screening at Border

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