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Vol. VI, No. 10~ EINet News Briefs ~ June 6 , 2003

****A free service of the APEC Emerging Infections Network*****

The EINet list serve 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 your perspectives and experiences, as your participation directly contributes to the richness of the "electronic discussions" that occur. To respond to the list serve, use the reply function.

In this edition:
  1. Infectious disease information
    Vietnam: 7 Children Die from Suspected Japanese Encephalitis
    New Zealand: Paralytic shellfish poisoning
    Russia (Southwest Siberia): New Rabies Virus Found in Bats
    USA (Washington): Suspected Human Case of West Nile Virus was St. Louis encephalitis
    USA (Montana): Fourth Case of Hantavirus Infection in Month of May
  2. Updates
    Multi Country Outbreak: Severe Acute Respiratory Syndrome (SARS)
  3. Notices
    WHO Global Conference on Severe Acute Respiratory Syndrome (SARS)
    NIH and Gates Foundation issue call for ideas on global health challenges
    15th Annual Conference of the Australasian Society for HIV Medicine (ASHM)
    Smoking among Indonesian celebrities – Final result
  4. How to join the EINet email list

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


Vietnam – 7 Children Die from Suspected Japanese Encephalitis

Seven children have died from suspected Japanese encephalitis in northern Vietnam since early April 2003. The children, all under the age of 5 years, died within 48 hours of being brought to the Central Paediatric Hospital in Hanoi from other hospitals in northern provinces, according to a doctor there. "One child died today, and currently we have 115 other children from around 10 northern provinces in our hospital with similar symptoms," he said on May 22, 2003.

"The children who died all experienced high fever and convulsions before falling into a coma and passing away," the doctor said. "We suspect they had contracted Japanese encephalitis."

Japanese encephalitis is a viral disease spread by infected mosquitoes in agricultural regions of Asia. It was first detected in Vietnam in 1985. It is one of several mosquito–borne viruses that can affect the central nervous system and cause severe complications and death. There is no cure for the disease. Fatality rates are about 20 percent in children and more than 50 percent in adults.

Japanese encephalitis is endemic in parts of Vietnam; pigs are the reservoir. Human and livestock vaccines are available.
(ProMed 5/25/03)

New Zealand — Paralytic shellfish poisoning
Levels of the Paralytic Shellfish Poisoning (PSP) toxin have risen above the Ministry of Health's safe limit, prompting a Bay of Islands shellfish–gathering ban on Thursday. A young girl had last week become ill after eating shellfish, and she feared people who had not known about the ban would be struck down after the weekend.

Some marae may have hosted functions over the weekend and could have collected shellfish earlier, holding it in storage. It is the second time since April 2003 that a ban has been placed on Bay of Islands shellfish.

The toxin, which can cause paralysis and death, was attributed to a PSP–producing phytoplankton. The first warning was lifted on 2 May, 2003. Health officials believed the latest PSP levels were probably due to the toxic algae Alexandrium tamarense. Signs and symptoms of poisoning include numbness and tingling around the mouth, face, or extremities; difficulty swallowing and breathing; dizziness; double vision and paralysis.

Kina, mussels, toheroa, pipi, tuatua, oysters, and cockles in affected areas should not be eaten. Paua, crab, and crayfish may still be eaten if the gut has been completely removed prior to cooking. Fish, such as snapper, gurnard, and terakihi are not affected by the algae and are still safe to eat.
(ProMed 6/04/03)

Russia (Southwest Siberia) – New Rabies Virus Found in Bats
Lyssaviruses from the family Rhabdoviridae are found worldwide and include 7 genotypes. Genotype 1 is represented by classical strains of rabies virus, which is a prototype representative of this genus found practically worldwide.

In 2002, researchers caught 18 bats (species Myotis daubentonii) in caves in the Novosibirsk region of southwest Siberia. Applying fluorescent antibody microscopy analysis, they determined that 6 samples were positive for rabies virus. The serological data were followed by detecting the rabies antigen in the samples by RT–PCR analysis.

By comparing their isolates of rabies virus with known rabies virus sequences available in the Gene Bank, it appears that in the bats caught in the Novosibirsk region, the circulating rabies virus is the classical genotype 1. Closest to it on the viral genealogical tree is fixed strain CVS, a rabies virus isolated in France, Japan, and Brazil.

Next closest are other animals and rabies virus isolates from bats in the USA. They have found that classical rabies virus in bats circulates in our region of southwest Siberia. This is the closest rabies viral variant to the rabies virus isolated previously in bats in the USA.
(ProMed 5/12/03)


USA (Washington) — Suspected Human Case of West Nile Virus was St. Louis encephalitis


A Franklin County man became ill in mid–May, 2003, and is being evaluated for suspected West Nile virus (WNV) infection. He was treated as an outpatient and is now recovering. Preliminary tests by CDC have identified St. Louis encephalitis. If confirmed, this would be the first identified case of it in Washington State since 1972.

St. Louis encephalitis virus has many similarities to West Nile virus. The illness is not spread person to person; it is transmitted by mosquitoes that become infected by feeding on infected birds. People cannot get the infection directly from birds or other animals.

"These new test results don’t change our recommendations about mosquito bite prevention," said state Health Officer Dr. Maxine Hayes. "Much like West Nile virus, St. Louis encephalitis is spread by mosquitoes. The best way to avoid these illnesses is to take steps to prevent being bitten and reduce mosquito habitat around your home."

Infection with St. Louis encephalitis virus has symptoms similar to those caused by West Nile virus. Mild infections often go undiagnosed; symptoms include fever and headache. More severe infections have symptoms that include headache, high fever, neck stiffness, and disorientation. There is no treatment or vaccine available for St. Louis encephalitis. People who become ill are treated with supportive care.

"State and local health departments have been working closely with health care providers to make sure they are on the look out for West Nile virus," said Dr. Jo Hofmann, State Epidemiologist for Communicable Disease for the Washington State Department of Health. "Because the symptoms are similar, it is possible increased surveillance will result in more cases of encephalitis caused by other viruses being identified as well."

According to the CDC, there were 4,478 confirmed cases of St. Louis encephalitis in the United States between 1964 and 1998. Only three of those cases were in Washington state — the last in 1972. The most recent outbreak nationally was in New Orleans, Louisiana in 1999, with 20 reported cases.

"Just because it looks like this is not a West Nile virus case, we can’t let our guard down," said Benton–Franklin Health Officer Dr. Larry Jecha. "Last year our state had positive West Nile cases in birds and horses, and we expect to see human cases this summer. Besides, protecting yourself from mosquito bites will limit your chances of being infected with West Nile virus or St. Louis encephalitis."
(Washington State Department of Health–News Release 6/01/03)

USA (Montana) — Fourth Case of Hantavirus Infection in Month of May
A Toole County man was diagnosed on May 27, 2003, with hantavirus infection, but he had already been discharged from hospital and is recovering. Health officials said the man had a history of exposure to rodents in the Shelby and Cut Bank areas.

This hantavirus case is Montana's fourth in the past month and the first ever in Toole County, health officials said. It is the 21st case of the disease in Montana since it first appeared in the state in 1993. 5 Montanans have died from the disease, including a 27–year–old man from Lewis and Clark County who died last week in Helena. A 26–year–old Cascade County woman died of hantavirus on May 8, 2003, and a Dillon man in his 60s tested positive for the virus a week later. He was released from a Dillon hospital and was expected to recover.

Health officials have said most cases of the virus come from prolonged exposure to rodents in a home or workplace. The best way to prevent the disease is to make sure to keep mice out of your house and to take precautions when cleaning out places that might have harbored mice, such as old barns or sheds.
(ProMed 6/02/03)


Multi Country Outbreak — Severe Acute Respiratory Syndrome (SARS)

Status of diagnostic tests
The development of commercial diagnostic tests for SARS has progressed more slowly than initially hoped, in part, due to certain unusual features of SARS. For many viral diseases, the greatest quantities of the causative agent are excreted during the initial phase of illness, usually in the first few days following the onset of symptoms. This is often the period during which patients pose the greatest risk of infecting others. SARS, however, follows a different pattern. During the initial phase of illness, virus shedding is comparatively low. Virus shedding peaks in respiratory specimens and in stools at around 10 days after onset of clinical illness. In effect, this unusual behavior creates the need for tests having a particularly high sensitivity.

The low sensitivity of current virus detection tests is a particular challenge for SARS control, as patients are capable of infecting others during the initial phase and therefore need to be reliably detected and quickly isolated. In SARS patients, detectable immune responses do not begin until day 5 or 6. Reliable antibody tests can detect virus only by around day 10 following the onset of symptoms.

WHO continues to recommend use of its case definitions, based on clinical presentation, distinct chest X–rays, and history of possible contact with SARS patients, to detect suspect and probable cases and make management decisions.

Training course in China
WHO is currently coordinating a series of training courses in Beijing aimed at establishing an efficient laboratory infrastructure for SARS diagnosis in all provinces throughout China. Trainers come from laboratories in the USA, the UK and Hong Kong and the work of the WHO laboratory network has made it possible to support the training courses with test materials and reagents. However, WHO and Chinese authorities remain concerned about lack of sufficient health infrastructure in some of the remote provinces, such as surveillance and reporting systems and hospital facilities, for responding to the magnitude of the SARS problem.

Speculation of origin
Many epidemiologists and veterinarians cautiously deal with the isolation of SARS virus–like coronaviruses from civet cats and some other animals in China as the origin of the SARS outbreak. There is no sufficient data to establish whether the virus has been transmitted to humans from these animals, or alternatively that these animals have been exposed to the SARS virus under circumstances currently unknown.

Dr. Henry Niman, Instructor in Surgery (Bioengineering), Harvard Medical School, mentioned in ProMED–mail that “it seems highly unlikely that the civet cat coronavirus was due to human infection of civets or any other animal (as no SARS coronavirus has been detected with a 29–nucleotide insertion which would restore homology to the carboxyl portion of the spike protein).”

Please see more details at the following URL:

Cumulative cases
As of June 4, 2003, a cumulative total of 8,402 SARS cases, 772 deaths, and 5746 recovered cases since November 1, 2002, are reported from the following countries (number of cases): Australia (5), Brazil (2), Canada (216), China (5329), Hong Kong Special Administrative Region of China (1748), Macao Special Administrative Region of China (1), Taiwan (678), Colombia (1), Finland (1), France (7), Germany (10), India (3), Indonesia (2), Italy (9), Kuwait (1), Malaysia (5), Mongolia (9), New Zealand (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 (69), Viet Nam (63).

In order to see further details, including cumulative number of cases and deaths, please visit the following URL:

As of June 5, 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:
Canada (Toronto), China (Beijing, Guangdong, Hebei, Hong Kong SAR, Inner Mongolia, Jilin, Jiangsu, Shanxi, Shaanxi, Tianjin, and Taiwan).

For the full WHO travel advisory, together with additional information about this disease, please visit the following URL:

For information from CDC including guidelines and recommendations, please visit the following URL:

For information from Department of Health Hong Kong SAR, please visit the following URL:

For information from Singapore Ministry of Health, please visit the following URL:
(WHO–WER 6/02/03,WHO–website 6/05/03, ProMed 5/25/03)


WHO Global Conference on Severe Acute Respiratory Syndrome (SARS): “Where do we go from here?”
June 17 –18, 2003, Kuala Lampur, Malaysia.
The objectives of the conference are to review the scientific findings on SARS and to examine the public health interventions to contain the diseases. The working language of the conference will be English. Chinese interpretation will be provided during plenary sessions.

Public health practitioners and leading experts on SARS have been invited. An additional 400 places will be provided to others interested in attending the meeting. For these places, registration is required prior to the meeting; places will be given to the first 400 registration forms received. There is no registration fee.

For more details, please visit the following WHO website:

NIH and Gates Foundation issue call for ideas on global health challenges
Harold E. Varmus, M.D., president and chief executive officer of Memorial Sloan–Kettering Cancer Center, called on the international health research community in May 2003 to identify the greatest scientific and technological challenges in global health–the principal current challenges standing in the way of major progress.

The Bill & Melinda Gates Foundation committed $200 million to establish the Grand Challenges in Global Health initiative, in partnership with the National Institutes of Health (NIH) and the Foundation for the National Institutes of Health (FNIH). Dr. Varmus serves as scientific board chairman of the Grand Challenges in Global Health initiative. The goal of the initiative is to identify critical scientific and/or technical challenges, which, if solved, could lead to important advances against diseases and improve health in the developing world.

Before June 15, health researchers around the world are encouraged to submit their ideas on what they consider to be the scientific challenges in global health at this time. Ten to 15 of the most compelling challenges will be selected from the submissions received. The resulting "Grand Challenges" will be announced this fall, and solicitations for research grant proposals to address them will follow.

Information: http://www.grandchallengesgh.org

15th Annual Conference of the Australasian Society for HIV Medicine
(ASHM), Cairns Convention Centre, Australia, 22 – 25 October, 2003

and is the Society's response to the UN declaration of commitment on HIV/AIDS (GLOBAL CRISIS – GLOBAL ACTION).

The annual ASHM conference is the major forum for the presentation of HIV and hepatitis research in Australasia and you will hear about all the latest advances from leading local and international figures such as Carol Jenkins, Alan Landay, Martin Markowitz, Haikin Rachmat, Ninkama Moiya, Greg Dore, Graham Cooksley, Dennis Altman and Zubairi Djoerban.

A wide range of plenary, symposium, workshop and concurrent sessions are planned to cover the fields of Aboriginal & Torres Strait Islander Health, Basic Science, Clinical Management, Epidemiology, Hepatitis, International & Regional Issues, Medical Education and Technology,
Nursing and Allied Health, Public Health or Community Program and Social
Research. Abstracts are invited from this range of areas.

The deadline for the submission of abstracts is Friday 18 July 2003. Abstracts can be submitted online at www.ashm.org.au/conference2003 or sent by email as an attached document to nadine@ashm.org.au

For further information or to register online visit the following URL:
www.ashm.org.au/conference2003 or contact at conferenceinfo@ashm.org.au
(SEA–AIDS 5/23/03)

Smoking among Indonesian celebrities – Final result
Survey result on smoking habit among top Indonesia celebrities as the World No Tobacco Day event are reported by Dr Tjandra Yoga Aditama of Indonesian Smoking Control Foundation on May 30, 2003.

“The results are as follows:
– 126 samples , 38% male and 62% female, all are Indonesian top celebrities
– Out of 126 samples, 86 are sinetron / TV film actors & actreses, 43% male and 57% female
– The remaining 40 are fashion models, singers and TV presenters
– 64.6% of male celebrities and 62% of male sinetron artist are current smokers. This figure is relatively equal to male general population of Indonesia, with a male smoking prevalence of 60%
– 42.3% of female celebrities and 34% of female sinetron artist are current smokers. This figure is 8 to 10 times higher that female general population of Indonesia, with a female smoking prevalence of 4 %
– 35% of male celeberities smokers do not want to stop smoking yet, as well as 40% of female celeberities smokers who also do not want to stop smoking yet. This figure is relatively high, since usually only less than 10% of Indonesian smokers who do not want to stop smoking , in preveious surveys that we have done before.
– Male celebrities smoke 9.16 cigarettes per day, for 13.85 years. This figure again is equal to general male population of Indonesia
– Female celebrities smoke 7.43 cigarettes per day, for 9.64 years. This figure again is higher than general female population of Indonesia who smoke 3 cigarettes per day, based on several previous surveys.”


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