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Vol. VI, No. 13~ EINet News Briefs ~ July 18, 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
    1. Infectious disease information
    – Japan: Outbreaks of Measles at Colleges and High Schools
    – Vietnam: 1,300 New HIV Carriers
    – Thailand: AIDS Conference: Medicine Vowed for All in Need
    – USA (Virginia): Malaria, 2002
    – USA (Southeast): Eastern equine encephalitis
    – Mexico: West Nile virus emergency declared
    – Brazil: Giving 10 Countries Free HIV/AIDS Drugs
    – Peru: Hepatitis D Virus–related Deaths of Children in Villa Rica
    – Europe: Tenth of H.I.V. Cases Are Resistant to Drugs
  2. Update
    – Multi Country Outbreak: Severe Acute Respiratory Syndrome (SARS)
  3. Notice
    – IT in Health Forum: July 30th, Hong Kong Academy of Medicine
  4. How to join the EINet email list

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

Japan — Outbreaks of Measles at Colleges and High Schools
According to the Infectious Disease Surveillance Center, the National Institute of Infectious Diseases, there have been several measles outbreaks in three colleges and 14 high schools.

In June, 60 freshmen at the medical school in Kagoshima University were infected with measles. All 1500 medical and dental students were tested for serum measles antibody, and negative students were isolated at home until they received vaccination. Dr. Hiromi Yoshida, Dean of the Medical School, stated that medical students were voluntarily isolated at home in order to prevent further spread of measles, especially to hospitalized patients. The school will begin administering the measles antibody test to all admitted students and will give vaccinations beginning next year.

In Kanazawa Technology College, 70 students became infected with measles and 26 were hospitalized from May 8 to June 30. The college reported the outbreak to the regional health center when the number of cases exceeded 20. The college called upon every student and employee to be vaccinated, and 70 percent of them complied.

This is the first time that the Infectious Disease Surveillance Center has collected information on an intra–school outbreak. High schools in Tokyo, Miyazaki, and Ishikawa have also experienced outbreaks.

Vaccination law requires that measles vaccine be administered between the ages of 1.5 to 7.5 years, but only voluntarily. About 80 percent of children were vaccinated. MMR (mumps, measles, rubella) mixed vaccine used in the late 80's caused some adverse effects, and the Japanese Ministry of Health and Welfare stopped its use in 1993. Only measles vaccine is used now.

Dr. Kihei Terada, at Kawasaki Medical College said, "All colleges in the USA demand certification of vaccination upon admission. The same procedure should be introduced in Japanese colleges to prevent these outbreaks. Medical schools should be the first to introduce the system as an example."
(ProMed 7/07/03)

Vietnam – 1,300 New HIV Carriers
The Ministry of Health of Vietnam reported 1,299 new HIV cases in the first half of this year, raising the total number to 67,100. The country now has 10,200 AIDS cases, and more than 5,700 people have died from the disease. In order to curb the spread of HIV/AIDS, the Vietnamese government is establishing a national strategy, taking tougher measures against prostitution and drug trafficking, producing low–cost AIDS medicines, working with foreign countries, and raising HIV/AIDS awareness among citizens.
(SEA–AIDS 7/15/03)

Thailand — AIDS Conference: Medicine Vowed for All in Need
Health authorities in Thailand pledged to provide HIV/AIDS drugs for all patients in need and introduced major policies to reduce the spread of the disease. Speaking at the ninth National AIDS Conference, chief of the Diseases Control Department Charan Trinwuthipong said that by 2006, the number of new HIV infections should be limited to 15,000.

Prevention efforts, including authorities promoting the use of condoms, will also focus on youths to ensure they have adequate knowledge about the disease, said Health Minister Sudarat Keyuraphan. As part of the prevention campaign, the ministry will ask condom sellers to lower prices at vending machines, from Baht 20 (US 48 cents) for two condoms to about Baht 5 (US 12 cents), added Charan.

Health Ministry Permanent Secretary Wallop Thianua vowed that all HIV/AIDS patients needing medicines – estimated at about 50,000 – would receive them, but he added that it may be necessary for those who can afford it to pay a portion of the bill.
(SEA–AIDS 7/14/03)


USA (Virginia) — Malaria, 2002
Scientists have determined that one person was the source of the infections of three Loudoun County teenagers who contracted malaria in 2002 by matching genetic fingerprints of parasites. The Centers for Disease Control and Prevention in Atlanta also found that the strain of malaria–causing parasite, called Plasmodium vivax, found in the three originated in Central or South America.

"It's not like there were a whole bunch of people infected ... that then infected other residents," said John Barnwell, a senior biological research scientist with the CDC's Division of Parasitic Diseases, who headed the research. "It was a single source and a little outbreak." Scientists and health officials say it's likely that one or more mosquitoes bit a local resident who had returned from a trip to Latin America–or bit an immigrant from that area–and then bit and infected the teenagers, who spent time outdoors near eastern Loudoun's Sugarland Run neighborhood during the same several weeks last summer.

The issues the genetic findings still don't explain exactly are why the third patient contracted malaria in March, six months after the first two, why several pools of mosquitoes tested positive for malaria in 2002 in Loudoun and Montgomery counties, and whether more will be found this summer.
(ProMed 6/05/03)

USA (Southeast) — Eastern equine encephalitis
A Georgia man died of eastern equine encephalitis (EEE) on June 21, which is the nation's first human case of EEE this year. "Eastern equine encephalitis has been an exceptionally infrequent disease," said Dr. Anthony Marfin of the Centers for Disease Control and Prevention (CDC)."If you saw five or six (human) cases a year, that was a big year." The virus kills up to 50 percent of people who catch it, compared with up to 15 percent for West Nile Virus.

Florida, Georgia, North Carolina, and South Carolina have seen the highest number of horse cases of EEE in years. The disease, which has existed in the United States for decades, kills nearly all unvaccinated horses.

Health officials urge people to use similar precautions against EEE as they would against WNV: wearing protective clothing and using insect repellent while outdoors and getting rid of mosquito habitats, such as standing water, around the home. Horses should be vaccinated against both diseases.

Symptoms in human beings range from mild flu–like illness to frank encephalitis, coma, and death. Horses and emus have long been sentinels because of their sensitivity to the virus. The disease cannot be acquired from an infected horse and is not transmitted from horse to horse or horse to human.
(ProMed 7/08/03)

Mexico—West Nile Virus Emergency Declared
Mexico declared a state of emergency against the mosquito–borne West Nile virus, declaring it a severe risk to its horse population and a growing threat to people on July 14. West Nile virus was discovered in Mexico on May 16 in a dead crow in Tabasco state, prompting the government to launch a campaign to vaccinate the state's equine population.

Among actions to combat West Nile virus infection, Mexican sanitary authorities have asked horse owners to vaccinate their animals and to report any suspected cases of West Nile virus infection immediately. The US Agriculture Department has reported that about one third of the 15,000 horses infected with the virus in 2002 died.
(ProMed 7/15/03)

Brazil — Giving 10 Countries Free HIV/AIDS Drugs
“One thousand people in 10 developing countries in Latin America and Africa will next month begin receiving free HIV/AIDS drugs from the government of Brazil, Agencia Brasil reported yesterday.

Through the initiative, Brazil aims to help treat HIV–infected people in El Salvador, Guyana, the Dominican Republic, Colombia, Paraguay, Namibia, Burundi, Kenya, Burkina Faso and Mozambique.

Brazil's government will spent $1 million on the project, providing 100 patients in each country with drugs for a year. The 10 countries' governments will pay for the patients' treatment after the year is up.

According to Agencia Brasil, more than 90 percent of the 40 million people who have HIV around the world live in developing countries, and 250,000 people have access to free medication against the disease. Of the latter group, 115,000 are Brazilians.

Seventy orphans with HIV in Nairobi have been receiving free medication from Brazil since 2001, on a reportedly irregular schedule. Beginning next month, they are expected to receive the medication more frequently.

Brazil has been hailed as a model country where HIV/AIDS treatment is concerned. The country's Health Ministry spends around $175 million per year to provide free medication to 115,000 infected Brazilians Agencia Brasil/Jornal do Brasil, July 7).”
(Reported by Dr. Rana Jawad Asghar, Coordinator South Asian Public Health Forum)

Peru — Hepatitis D Virus–related Deaths of Children in Villa Rica
A total of four deaths due to hepatitis D have been reported in the village of Cedropampa, Villa Rica–Peru, three of them are children in the same family (8–year–old boy, a 13–year–old boy, and a 16–year–old girl). The other case was a 27–year–old man from Maine (Villa Rica). He had no contact with these children before, but he was hospitalized due to gastrointestinal bleeding in a bed near the 8–year–old boy.

Villa Rica is a jungle–like area, endemic for viral hepatitis B, but there has been no previous report of hepatitis delta virus. Currently, there are no data about the transmission of hepatitis delta virus to the first case. Nevertheless, this boy and his brother may have had contact with migrants from endemic areas for hepatitis B, and probably hepatitis D.

Because hepatitis delta virus (HDV) is dependent on hepatitis B virus (HBV) for replication, HBV/HDV co–infection can be prevented with either pre– or post–exposure prophylaxis for HBV. HDV infection can be acquired either as a co–infection with HBV or as a superinfection of persons with chronic HBV infection.

The Ministry of Health may declare an epidemiologic emergency for Villa Rica on Jul. 13. The plan is: education about transmission, vaccination against hepatitis B virus for all the people living in Cedropampa, and serologic surveillance.
(ProMed 7/12/03)


Europe — Tenth of H.I.V. Cases Are Resistant to Drugs
The biggest study, so far, of resistance to AIDS drugs, presented at an international AIDS conference in Paris, shows that about 10 percent of all newly infected patients in Europe are infected with drug–resistant strains.

The study tested 1,633 patients from 17 European countries who had just been diagnosed with the virus that causes AIDS and who had not yet been treated for it. (It is nicknamed the Catch study for "combined analysis of resistance transmission over time of chronically and acute infected H.I.V. patients in Europe.") About 9.6 percent of the patients were resistant to at least one of the three types of anti–retroviral drugs that suppress the virus that causes AIDS. Resistance was much higher, at 11.3 percent, among Europeans who had subtype B of the virus that causes AIDS, compared to those with non–B subtypes, in whom it was 3.3 percent. This new study is thought to be the first to give a reliable measure of the phenomenon across a broader population, said Dr. Charles Boucher, the virology professor at Utrecht University who led the new study.

The figure suggested that many AIDS patients who are in treatment go back to engaging in high–risk sex or needle–sharing. It also suggested that an "order of battle" approach to prescribing AIDS drugs, like that used for tuberculosis medicines, should be adopted in place of the current free–for–all.

Therefore, when the drugs come to Africa, they must be handed out carefully, with laboratories, doctors and epidemiologists monitoring patients and community resistance.
(Reported by DONALD G. McNEIL Jr., 07/16/03)


Multi Country Outbreak — Severe Acute Respiratory Syndrome (SARS)

–Preparing for the next influenza season in a world altered by SARS
Although the behavior of the SARS virus is impossible to predict on the basis of current knowledge, it is well known that many respiratory illnesses caused by a virus tend to die out when heat and humidity rise and then return when the weather turns cooler. Cases of influenza during the next influenza season are likely to raise suspicions of SARS. The symptoms of influenza, which can include pneumonia in severe cases, are easily confused with those of SARS. The risk is therefore great that health systems around the world could be overburdened by suspected SARS cases, necessitating isolation, contact tracing, and quarantine of close contacts – all costly and socially disruptive measures. The burden is all the greater in the absence of a rapid and convenient diagnostic test capable of ruling out SARS early in the course of illness and thus obviating the need for such measures. In addition, like SARS, influenza is known to have its highest mortality in persons over the age of 65 and in those already ill with certain chronic diseases. For these reasons, WHO strongly recommends that all countries immunize at least health care workers, who are at greatest risk of both influenza and SARS, with the WHO–recommended influenza vaccine. If possible, the vaccine should also be given to elderly persons, especially when cared for in institutions, and other vulnerable populations, including persons with chronic cardiovascular disease.

– Data last probable case reported
As of July 11, 2003, a cumulative total of 8,447 SARS cases, 813 deaths, and 7,452 recovered cases since November 1, 2002 are reported. The dates last probably case reported from each country are as follows: Australia (May 12), Brazil (Jun 9), Canada (Jul 9), China (Jun 25), Hong Kong Special Administrative Region of China (Jun 11), Macao Special Administrative Region of China (May 21), Taiwan (Jun 19), Colombia (May 5), Finland (May 7), France (May 9), Germany (Jun 4), India (May 13), Indonesia (Apr 23), Italy (Apr 29), Kuwait (Apr 9), Malaysia (May 20), Mongolia (May 6), New Zealand (Apr 30), Philippines (May 15), Republic of Ireland (Mar 21), Republic of Korea (May 14), Romania (Mar 27), Russian Federation (May 31), Singapore (May 18), South Africa (Apr 9), Spain (Apr 2), Sweden (Apr 18), Switzerland (Mar 17), Thailand (Jun 7), United Kingdom (Apr 29), United States (Jun 23), Viet Nam (Apr 14).

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

As of July 5, 2003, WHO no longer recommends the restriction of travel to any areas.
(WHO–WER 7/03/03, WHO website 7/16/03)


IT in Health Forum, July 30th, Hong Kong Academy of Medicine
99 Wong Chuk Hang Road, Hong Kong
“As information technology is an essential tool in information tracking and analysis, the Forum also features IT solutions from leading solution providers. It is a good opportunity to learn the use of IT in healthcare industry worldwide and interact with speakers on issues specific to your needs.” Some of featured speakers are as follows.

– Dr. William D. Henriques, Commander of US Public Health Service, Department of Health and Human Services
– Prof. John S. Mackenzie, Director–Designate, WHO Collaborating Centre for Reference & Research in Emerging Diseases
– Prof. Lap–Chee Tsui, Vice–Chancellor of The University of Hong Kong

Please see more details at the following URL:


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