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Vol. VI, No. 14~ 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: Hepatitis B virus, blood transfusion, 2000
    – Japan: HIV, Hepatitis, and Syphilis contaminated blood
    – Japan: Transmission of Hepatitis E Virus from Wild Sika Deer to Humans
    – Philippines (Igugao province): Malaria kills 87 in Nueva Vizcaya
    – China (Guangdong): 74 Cases of Rabies Reported in Province
    – China (Hong Kong): Influenza
    – China: AIDS Violence Flares
    – Thailand: Cost–effectiveness of universal ARV access
    – Russia (Volga Region): Parasitic infection, Capillaria
    – Russia (Stavropol): Crimean–Congo hemorrhagic fever outbreak
    – Ukraine (Luhansk): 12 More Hepatitis A Cases in Luhansk
    – Canada (Saskatchewan): West Nile Virus–positive Blood donor
    – USA (Florida): State's first Human Cases of West Nile Virus Infection in
    – USA, Canada: Toxic algae
    – Five countries including Canada and the USA: PCB contamination, salmon
    USA: Two more US soldiers develop severe pneumonia, put on ventilators
  2. Update
    – China: Last SARS Cases Declared Free of Virus
  3. Notice
    – Population Health: Implementation Success Stories from Developing
    Countries Workshop (available presentations)
    – CDC: A Free Informational kit for Fighting HIV/AIDS in the Workplace
  4. How to join the EINet email list

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


Japan — Hepatitis B virus, blood transfusion, 2000
The Japanese Red Cross Society reported on July 17 that a 75–year–old man had become infected with HBV after receiving a blood transfusion in 2000 at a hospital in Nagasaki Prefecture. After the man developed the symptoms
of HBV infection, the Red Cross initiated an investigation into the case.

The inquiries revealed that the blood used in the transfusion had come from 8 donors, one of whom was later found to have HBV, but with a viral load so low it slipped through the improved Nucleic Acid Test
blood–testing system introduced in autumn 1999.

The donor had donated blood several times over the past 5 years and has not developed the symptoms of HBV infection, the Red Cross said. Detailed analyses that the society conducted on samples of blood newly drawn from
the donor showed that the viral count was one–third the minimum level that could be detected by the current testing system. Red Cross researchers also found minute amounts of the virus in blood samples from the donor
held for reference at the time of donation. According to the society, the Nagasaki man is the only person to have contracted HBV infection from blood donated from the donor. However, it admitted that the follow–up investigations could not cover all recipients of blood from the HBV carrier, as some of them are dead.

The Red Cross said that HBV–infected blood that could slip undetected through the current testing system would be limited to blood from persons who are in the early stages of infection called the "window period." The
risk of spreading the disease by low–viral–count HBV blood donors is considered to be higher than by window–period carriers, since blood donated by them can be remain undetected irrespective of how many times
they have donated blood, the medical experts said.
(ProMed 7/21/03)

Japan — HIV, Hepatitis, and Syphilis contaminated blood
The Japanese Red Cross traced the records of donors who later tested positive for AIDS, hepatitis B and C, and/or syphilis, after having donated their blood between July 13, 2002 and July 21, 2003. They determined that the donations had been processed into 6419 units for blood transfusion.

According to the organization, initial laboratory tests of the blood were negative, but it is possible that the results were misleading, given that conventional technology is unable to detect the viruses during the period immediately after the donor becomes infected.

The Red Cross will carry out a survey to determine how many people have received blood from HIV–infected donors. It estimates that the number could reach 50 000, and that the blood, distributed over the past 13 months, could also be tainted by syphilis and viral hepatitis.

So far, the Red Cross has only been able to recover 13 of the 6419 units, suggesting that the rest have already been used. However, the Ministry of Health, Labor, and Welfare, has assured that the risk of infection from this blood is low, but that the Ministry will contact everyone to whom it was administered in order perform tests and confirm that no one has become infected.
(ProMed 7/30/03)

Japan — Transmission of Hepatitis E Virus from Wild Sika Deer to Humans
Shuchin Tei and colleagues have identified potential zoonotic transmission of hepatitis E virus (HEV) from Japanese Sika deer (Cervus nippon nippon) to humans.

Some of family members had several times eaten raw meat from deer caught in the wild in the 7 weeks preceding the first hospital admission of hepatitis. They were negative for hepatitis A, B, and C viruses. Leftover meat had been frozen and dated at the time of eating. HEV RNA sequences in the meat of one deer and most of the patients' samples were 100 percent identical. They also believe consumption of substantial amounts of raw deer meat is necessary for transmission, since eating only a little did not lead to infection in other family members.
(ProMed 8/03/03)

Philippines (Igugao province) — Malaria kills 87 in Nueva Vizcaya
According to the semi–annual report from January to June 2003 by the malaria–control program of the Nueva Vizcaya health office, Malaria killed 87 people and infected 279 others consisting of 152 males and 127 females.
The patients contracted P. falciparum (235), P. vivax (40), and mixed infection (4). 252 cases were indigenous (or malaria infection originated from the place), and 27 cases were considered "imported," meaning these
originated from other places.
(ProMed 7/21/03)

China (Guangdong) — 74 Cases of Rabies Reported in Province
The state press and local officials reported on July 21 that, at least 74 people contracted rabies and with fatal outcome in southern China, Guangdong Province between January 5 and June 30. According to the Xinhua News Agency, 7000 dogs have been rounded up and killed. Governments at various levels in the province have stepped up precautionary measures, including the organized killing of stray dogs and the immunization of local residents. A total of 786 rabies cases have been reported in Guangdong since 1990, the Xinhua Agency reported.

Guangdong, where the SARS virus originated, has also witnessed a "mini–outbreak" of encephalitis B caused by Japanese encephalitis virus since the end of April 2003. The most recent figures available, from July 2, 2003, showed that the disease had killed 27 people from 310 confirmed infections.
(ProMed 7/21/03)

China (Hong Kong) — Influenza
As of July 28, the Department of Health in Hong Kong SAR China reported four institutional outbreaks of an Influenza–like illness. Two of them are elderly homes and the other two are homes for the mentally deficient. The number of patients in each outbreak ranged from 7㪰. As of July 26, 31 patients from these institutions remain in hospital. All are in a stable
condition except one who has a genetic condition and is in an intensive care unit.

None of the laboratory tests conducted so far is positive for SARS. At least eight patients from the Lai King Hostel outbreak have positive laboratory results for influenza A. The Government Virus Unit of Hong Kong, SAR China has isolated 2 viruses from this outbreak which are further subtyped as similar to the reference strain A/Panama/2007/99(H3N2), the recommended strain for influenza vaccination for 2003� influenza season by WHO.

For more information,
Department of Health, Hong Kong, SAR China:
Recommendations for Influenza Vaccine Composition:

Editors note: If any of our listserv members is aware of the influenza immunization practices for Hong Kong in institutional settings this would be important additional information for this outbreak.
(ProMed 7/28/03)

China — AIDS Violence Flares
Prominent AIDS and human rights activists say that, in recent months, AIDS patients in China have been beaten, jailed, harassed and denied medicines that could extend their lives. Human Rights Watch says that the recent
events began on May 18 when about 100 AIDS patients tried to speak to a World Health Organization team investigating SARS cases in a Wenlou village hospital in Henan province, where an estimated 1 million peasants became infected during the 1990s after selling their blood to government–run clinics and then being transfused with pooled, contaminated
blood. As a protest began against discrimination by doctors and nurses against HIV–positive patients, police moved in, beating and arresting leader Yang Nidan, who is HIV–positive, in view of journalists.

For more details, please visit the following URL:

Thailand — Cost–effectiveness of universal ARV access
According to the Nation daily newspaper, Thailand, July 5, 2003, researchers said that the government should include anti–retroviral drugs in the universal healthcare scheme, as studies show that it is a cost–effective treatment for HIV/Aids.

Depending on different options and regimens, the inclusion of these drugs would cost Bt4 billion to Bt10 billion a year, said Sathitpong Thanawiriyakul, faculty, Pharmaceutical Sciences of Chulalongkorn University. Comparing hospital expenses and other costs incurred if patients are not given anti–retroviral drugs with the overall improvement
of the quality of the patient's life if they are treated, it is cost–effective to provide these drugs through the universal
health–coverage scheme, he said.

There are about one million people living with HIV/Aids in Thailand, of whom 70,000 to 100,000 are believed to be in need of medication, according to authorities and Aids–care advocates. The Public Health Ministry announced that it would spend some Bt1.6 billion next year to provide GPO–vir to cover 50,000 patients whose symptoms met the medical criteria that required treatment.
(SEA–AIDS 7/22/03)

Russia (Volga Region) — Parasitic infection, Capillaria
A new subcutaneous parasite, which is believed to be Capillaria spp., was discovered in Ulyanovsk, Volga Region. Physicians misdiagnosed the infection as a tumor. It is not known how Capillaria could have reached as far north as central Russia.

Parasitologist Viktor Kiselev suggests that it was caused by eating dried fish. Other theories point to raw or semi–raw food, or perhaps this unknown parasite was carried by birds and fish and has adapted to life in a closed reservoir.

Editors note: Capillaria philippensis usually causes a malabsorption picture and typicall has been associated with eating raw infected fish. C. hepatica is a rodent nematode and causes liver enlargement and parenchymal damage.
(ProMed 7/23/03)

Russia (Stavropol) — Crimean–Congo hemorrhagic fever outbreak
The epidemiologic situation of Crimean–Congo hemorrhagic fever in the Stavropol region is not improving. 3974 people have been bitten by ticks, which transmit the Crimean–Congo hemorrhagic fever virus. 14 of those bitten became ill, 2 of whom have died. Tick activity is not decreasing and active measures will be required to contain the epidemic.
(ProMed 7/1/03)

Ukraine (Luhansk) — 12 More Hepatitis A Cases in Luhansk
According to the Emergency Situations Ministry (ESM) of Ukraine, 8 adults and 4 children were admitted to hospital. At the present time 293 people are receiving treatment. The cause of the epidemic was consumption of " unclean" water due to contamination of the water supply following rupture of a waste water pump.
(ProMed 7/18/03)


Canada (Saskatchewan) — West Nile Virus–positive Blood donor
The Canadian Blood Services reported in a news release that the virus was found in a unit of blood donated in the province. "He was well when he donated and remains well," said Ted Alport, medical director of Canadian Blood Services Saskatchewan. This is the Canada's first domestic case of West Nile virus in a human this year and it is also the first time a person has contracted the virus in Saskatchewan.

Once the blood tested positive for the virus, it was withdrawn from inventory and the donor, who has been notified, will not be eligible to donate blood again for 56 days, at which time the virus will no longer be present.
(ProMed 8/03/03) USA (Florida) — State's first Human Cases of West Nile Virus Infection in
West Nile virus has been detected in 2 Florida residents, marking the state's first human cases of the deadly mosquito–borne virus in 2003. A 76–year–old Marco Island man and an 85–year–old Panhandle woman have been
diagnosed with the virus on July 24.

The Central Florida Blood Bank The blood bank also found the 2 men's infected samples among 15 000 donations it has tested since June 30, 2003, using a new machine that identifies viral nucleic acid. One of the men recovered from a brief illness by the time he gave blood. The other man didn't suffer any significant illness.

The Centers for Disease Control in Atlanta has reported 12 human cases of West Nile so far in 2003 in 8 states, numbers that do not include the 2 Florida cases. In 2002, more than 4000 people in the United States had symptoms of the virus, and 284 died. Hardest hit was Illinois, with 884 cases and 64 deaths. Florida had 28 cases and 2 deaths last year.
(ProMed 7/25/03) USA, Canada — Toxic algae
Environment Canada has identified the algae as "a growing threat to water quality in Canada and around the world." Hamilton Harbour and Bay of Quinte on Lake Ontario face serious algae problems, as does Lake Winnipeg. The Vermont Department of Health reported 2 dogs died in 2002 after swallowing algae; one on the Canadian side of Missisquoi Bay and one on the American side. That followed several algae–related dog deaths in Lake Champlain in 1999 and 2000.

Some of the symptoms are stomach ache, diarrhea, vomiting, and nausea. Also possible are irritation of the skin, nose, throat and eyes, and "more rarely" liver damage and nervous system damage.
(ProMed 8/04/03)

Five countries including Canada and the USA — PCB contamination, salmon
The Environmental Working Group, a nonprofit environmental research and advocacy organization reported that 10 samples of farmed salmon bought at markets on the East and West Coasts were found to be contaminated with PCB's, or polychlorinated biphenyls, at an average level far higher than any other protein source, including all other seafood. The high levels do NOT exceed those set in 1984 by the FDA for commercially sold fish. But they are in excess of the guidelines set by the Environmental Protection Agency (EPA) in 1999 for recreationally caught fish. The salmon tested came from 5 countries, including Canada and the USA. However, this report gives no indication of how the samples were selected.

Kimberly Rawlings, a press officer for the FDA, said the FDA was considering updating its guidelines. "We are clearly aware of it and actively looking at the science to see whether the science dictates that it needs to be changed," she said.
(ProMed 8/02/03) Two more US soldiers develop severe pneumonia, put on ventilators
Army officials said on July 31 that 2 more US soldiers serving in the Middle East were placed on ventilators this week after developing severe pneumonia. Since Mar 1, 2003, approximately 100 troops have been afflicted with the illness, according to a news release from the Army Surgeon General. Of those cases, 14 have been placed on respirators and 2 have died.

"The 14 cases were geographically dispersed and came from different units," the release stated, adding there's no evidence soldiers were exposed to chemical or biological weapons, environmental toxins or severe acute respiratory syndrome (SARS).

The surgeon general's office says young, healthy soldiers dying from pneumonia is rare, but does occur. From 1998 to 2002, 17 soldiers have died from pneumonia or complications from the illness.
(ProMed 8/01/03)


China — Last SARS Cases Declared Free of Virus
Official media said that Beijing's last 12 SARS patients had recovered from the disease, marking an apparent end to the scourge in China. The World Health Organization said the reported recoveries were expected, but it was still on alert, given the possibility the disease could rebound in China or elsewhere.

The 12 patients were still in hospital receiving treatment for other illnesses but no longer showed symptoms of Severe Acute Respiratory Syndrome and were not infectious, the Communist Party newspaper People's Daily quoted Beijing's deputy health chief Liang Wannian as saying. "Beijing has no more SARS patients," he said.
(ProMed 7/29/03)


Population Health: Implementation Success Stories from Developing Countries Workshop
June 21㪮, at the Instituto Nacional de Salud Publica in Cuernavaca, Mexico

Slides of presentations are available at the following URL:
CDC: A Free Informational kit for Fighting HIV/AIDS in the Workplace
The CDC has developed a free informational kit for businesses and labor groups to use in developing workplace policies on HIV/AIDS. CDC's Business/Labor Responds to AIDS program helps large and small businesses and labor unions meet the challenges of HIV/AIDS in the workplace and the community. Visit http://www.hivatwork.org/tools/tools.htm or call the Business and Labor Resource Service at 1𤴐𤮺� for resources and tools to fight HIV/AIDS in the workplace.


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