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Vol. VI, No. 15~ EINet News Briefs ~ August 22, 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
    – Japan: Fatal Hepatitis E Virus Infection from Consumption of Raw Boar Meat
    – Vietnam: Outbreak of Japanese Encephalitis in Unvaccinated Children
    – Vietnam: AIDS deaths double
    – Canada (British Columbia): Acute Respiratory Syndrome
    – USA (Colorado): E. Coli O157, ground beef – recall
    – Canada (Saskatchewan): Province Leads Nation in Number of Human Cases
  2. Articles
    – West Nile Virus (review)
    – Neurologic Manifestations and Outcome of West Nile Virus Infection
  3. Notice
    – 2003 International Conference on the Recurrence of Severe Acute Respiratory Syndrome (SARS) in Asia–Pacific Region, Taipei, Taiwan, R.O.C., October 29 – November 01, 2003
  4. How to join the EINet email list

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


Japan — Fatal Hepatitis E Virus Infection from Consumption of Raw Boar Meat
According to the Yomiuri Shimbun newspaper in Japan, a 70–year–old man from Tottori Prefecture died of hepatitis E virus infection after eating raw wild boar meat that carried the Hepatitis E virus in April 2003. In addition, 53–year–old man in the same prefecture who ate the meat also contracted the disease.

A ministry official said, "The virus is usually killed off by heat, but the risk level of eating the meat of wild animals is totally unknown. We'll investigate the situation as soon as possible". Hepatitis E virus is the only hepatitis virus that can be spread through zoonosis.
(ProMed 8/03/03)

Vietnam – Outbreak of Japanese Encephalitis in Unvaccinated Children
According to the local newspaper "Young People" on Aug. 6, the number of children suffering from Japanese encephalitis in Vietnam's central Da Nang city and Quang Nam province is increasing at an alarming rate. Although the Da Nang Hospital treated no more than 20 patients with encephalitis in the first 6 months of 2003, they received 14 cases only in July. Four children have died of the disease. Most of patients were children under 10 years old who didn’t have vaccination. Between April and June 2003, over 700 children nationwide, mainly in the northern region, suffered from Japanese encephalitis.

Dr. Huynh Thi Phuong from the Da Nang Hospital said that Japanese encephalitis was the most common in the North of Vietnam, so residents in the central region, especially rural and poor ones, pay little attention to vaccination. Parents in Da Nang and Quang Nam are encouraged to take their children between the ages of 1 and 15 years to health establishments for vaccination.
(ProMed 8/06/03)

Vietnam – AIDS Deaths Double
Vietnam says more than 900 people died of AIDS–related illnesses in the country during the first seven months of 2003.This represents an increase of nearly 100 per cent compared to the same period last year.

Ministry of Health figures say 8,800 new cases of HIV infection had been registered in this year, increasing the nationwide number of infections to 69,000.

However, international health experts believe the true level of HIV infection may be several times higher than the official figures, with estimates ranging up to 300,000
(SEA–AIDS 8/05/03)


Canada (British Columbia) – Acute Respiratory Syndrome
As of 19 Aug 2003 there have been influenza–like symptoms in 94 of 142 residents (elderly or disabled) and 49 of 160 staff at the Kinsmen Place Lodge nursing home in Surrey. (The count for residents has gone down from earlier postings due to a record review and application of the case definition). 11 residents remain symptomatic and isolated, 1 is hospitalized and isolated. Two staff members remain with symptoms and 4 are excluded from work.

The epidemic curve is available at http://www.bccdc.org

According to the scientific director of Health Canada's National Microbiology Laboratory in Winnipeg, genetic testing of blood and other samples from dead and ill Surrey nursing home residents and workers is so far consistent with SARS.

Dr. David Patrick, chief epidemiologist with the B.C. Centre for Disease Control, said a WHO representative is going to Winnipeg because "it may be the first time in the world that the virus has been found outside of the typical SARS picture," referring to the fact that the virus may still be lurking, in a mild way, in many communities, but B.C. is the first place to begin such a thorough search.

This isn't the first time patients in Canada have tested positive for SARS, but weren't all that sick.
The National Microbiology Lab revealed in June 2003 it had 170 positive SARS results in Ontario residents who had never been diagnosed with the disease.

Dr. Frank Plummer, the director–general of the Centre for Infectious Disease Prevention and Control in Ottawa says the Surrey cases are more proof that SARS can vary in its severity. "There's a very broad spectrum of illness caused by this virus, and what we saw in the epidemic in terms of the very severe cases is only the tip of the iceberg, and there's much more out there."

Dr. Patrick said that results still don't make sense clinically. He notes the Surrey patients were only mildly ill with runny noses and sore throats, and that few had pneumonia or fevers, the classic symptoms of SARS. "When we see the common cold in 48 staff members with no pneumonia, that's not SARS. When we see that the vast majority of even frail, elderly patients only have common cold symptoms, that's not SARS," he says.

Eleven deaths have been recorded in the facility over the past 7.5 weeks (baseline mortality at the facility runs approximately 4 per month). In 6 cases, pneumonia was present at death (though often with other factors), there were 2 vascular deaths and 3 deaths occurred in residents under palliative conditions who had been in decline from prior to the onset of the outbreak.

"Our priority now is to get more tissue so they can grow the virus and get samples rich in genetic material. At this point, we can't say SARS caused these deaths. We can only say that a test designed to detect SARS found some positive results," Dr. Patrick said.

"This is definitely not a SARS outbreak," but rather a "mild upper respiratory disease," said Robert Brunham, medical director at the British Columbia Center for Disease Control.

According to Dr. Patrick, possibilities at present are as follows:
1) This could be SARS Co–V exhibiting a milder clinical spectrum than previously described. This might be conceivable given the earlier focus on severe respiratory disease in case definitions used globally.
2) This could be an attenuated SARS Co–V with an important deletion or mutation accounting for a different clinical picture
3) This might still be a closely related agent now detectable by newly invented tests.

On August 18, it was announced that no new cases of illness have been reported in residents and workers at the nursing home in the past 3 days, and if the pattern continues, the quarantine on 19 health care workers will be lifted by Aug. 28, 2003, at the latest. The no–visiting policy at the nursing home will also be reviewed.
(ProMed 8/19,20/03, The Wall Street Journal 8/19/03)

USA (Colorado) – E. Coli O157, Ground Beef Recall
Two Colorado Springs teenage boys were admitted to hospital last week, and test results were positive for Escherichia coli O157:H7 bacteria, which can cause bloody diarrhea, intense abdominal cramps, and other serious problems. The teenagers recovered and were released from the hospital.

The beef was traced to Howard Beef Processors in Pipestone, MN, and sold in Colorado. It was produced between May 30 and June 11, 2003. Its code on the label is "EST.8934". Howard Beef recalled 194 700 pounds of chopped–beef steaks, ground–beef patties, and gourmet beef–steak burgers. "There is no definitive link implicating the recalled product to the 2 illnesses, but the investigation is continuing," said Patti Klocker, head of the Colorado Department of Public Health's consumer–protection division.

Alicia Cronquist, a Colorado Department of Public Health epidemiologist, said the teenagers ate the beef for several nights and may not have cooked the meat enough. "People need to cook hamburger thoroughly, to 155 to 160 degrees Fahrenheit (68 to 71 degrees Celsius), to kill the bacteria," she said.
(ProMed 8/13/03)

Canada (Saskatchewan) — Province Leads Nation in Number of Human Cases
Health officials announced on Aug. 18 that they were looking into 6 more probable cases of West Nile virus infection in the human population and were conducting several investigations. That means there are now 2 confirmed and 7 probable cases as well as 4 more needing further investigation, for a total of 13. There have been only 3 other confirmed or probable cases of the virus across the country; one in Alberta and 2 in the Ottawa area.

The medical community says it has no concrete explanation as to why Saskatchewan appears to lead the nation in infection rates. Dr. Harvey Artsob, the chief of zoonotic diseases at the National Microbiology Laboratory in Winnipeg, said a number of factors could be at play such as the types of mosquitoes found on the prairies, their life cycles, and the amount of time the virus has had to build up.
(ProMed 8/20/03)


West Nile Virus (review)
“West Nile virus (WNV) emerged from relative obscurity in 1999 when the first incursion of the virus into North America caused an outbreak of meningoencephalitis leading to 7 deaths in the New York City area. By 2002, human and veterinary surveillance documented geographic spread westward to the Pacific Coast. In the same year, WNV caused the largest arboviral eningoencephalitis outbreak ever recorded in North America.”

“In North America, WNV and St Louis encephalitis virus share similar avian hosts and amplifying mosquito species. These ecologic similarities suggest that the 2 viruses may share a common epidemiologic pattern. The wide distributions of WNV in Asia and Africa and St Louis encephalitis virus in North and South America suggest that WNV will spread widely in the Americas. In the United States, St Louis encephalitis virus produces sporadic cases of infection as well as local and regional outbreaks that are difficult to predict, resulting in highly variable annual incidence rates ranging from a handful of cases to nearly 2000 cases that occurred during the 1975 epidemic. However, WNV produces extremely high–level viremia in common bird species, many mosquito species harbor WNV, and human infections continue to occur in subsequent years after its introduction in an area. These facts suggest that WNV has greater epidemic potential than St Louis encephalitis virus and is likely to challenge clinicians and public health officials for years to come.”

The article reviewed virology, ecology, epidemiology, transmission to humans, clinical illness, clinical outcome, pathogenesis, diagnosis, treatment and prevention.
(Petersen LR, Marfin AA, Gubler DJ, JAMA. 2003 Jul 23; 290(4):524פ)

Neurologic Manifestations and Outcome of West Nile Virus Infection
“CONTEXT: The neurologic manifestations, laboratory findings, and outcome of patients with West Nile virus (WNV) infection have not been prospectively characterized.

OBJECTIVE: To describe prospectively the clinical and laboratory features and long–term outcome of patients with neurologic manifestations of WNV infection.

DESIGN, SETTING, AND PARTICIPANTS: From August 1 to September 2, 2002, a community–based, prospective case series was conducted in St Tammany Parish, La. Standardized clinical data were collected on patients with suspected WNV infection. Confirmed WNV–seropositive patients were reassessed at 8 months.

MAIN OUTCOME MEASURES: Clinical, neurologic, and laboratory features at initial presentation, and long–term neurologic outcome.

RESULTS: Sixteen (37%) of 39 suspected cases had antibodies against WNV; 5 had meningitis, 8 had encephalitis, and 3 had poliomyelitis–like acute flaccid paralysis. Movement disorders, including tremor (15 [94%]), myoclonus (5 [31%]), and parkinsonism (11 [69%]), were common among WNV–seropositive patients. One patient died. At 8–month follow–up, fatigue, headache, and myalgias were persistent symptoms; gait and movement disorders persisted in 6 patients. Patients with WNV meningitis or encephalitis had favorable outcomes, although patients with acute flaccid paralysis did not recover limb strength.

CONCLUSIONS: Movement disorders, including tremor, myoclonus, and parkinsonism, may be present during acute illness with WNV infection. Some patients with WNV infection and meningitis or encephalitis ultimately may have good long–term outcome, although an irreversible poliomyelitis–like syndrome may result.”
(Sejvar JJ, et al. JAMA. 2003 Jul 23; 290(4):511ס)


The First China International Public Health Symposium is scheduled for October 21㪯 2003 in Shanghai, PRC. Additional information can be found at www.glocompete.com
2003 International Conference on the Recurrence of Severe Acute Respiratory Syndrome (SARS) in Asia–Pacific Region, Taipei, Taiwan, R.O.C., October 29 – November 01, 2003

Conference Purpose:
1. To achieve international academic exchange through the presentation of articles and reports in the conference.
2. To allow thorough discussion among the participants in order to reinforce the disease control personnel’s ability in disease surveillance and to improve the proficiency in conducting SARS epidemiologic investigation, research and control.
3. To ameliorate the hospital infection control facilities and equipments based on the interhospital transmission event and the valuable SARS control experiences.
4. The reports and valuable suggestions made by the professional experts on the discussed topics will enhance the current SARS diagnosis and examination capability in Taiwan and can be served as a reference for the future clinical treatment and prevention of SARS.
5. The epidemiology investigations and researches discussed in the conference will collectively be a reference for making public health policy in Taiwan.
6. Through our sponsoring of such international conference, our international friends will have a better understanding of our attention in the international disease control issues, thus promoting the international position and image of Taiwan.

Conference secretariat:
No 6, Linshen South Road, Taipei 100, Taiwan, R.O.C.
Tel: 886מ��
Fax: 886מ��
E–mail: 1029SARS@cdc.gov.tw


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