Vol. VI, No. 15~ EINet News Briefs ~ August 22, 2003
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In this edition:
1. OVERVIEW OF INFECTIOUSDISEASE
Japan — Fatal Hepatitis E Virus Infection from Consumption
of Raw Boar Meat
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.
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.
Vietnam AIDS Deaths Double
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
Canada (British Columbia) – Acute Respiratory Syndrome
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.
Dr. Frank Plummer, the directorgeneral 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:
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 novisiting policy at the nursing home
will also be reviewed.
USA (Colorado) – E. Coli O157, Ground Beef Recall
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 choppedbeef steaks, groundbeef patties, and gourmet beefsteak 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 consumerprotection 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
Canada (Saskatchewan) — Province Leads Nation in Number of Human Cases
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.
West Nile Virus (review)
“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 highlevel 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
Neurologic Manifestations and Outcome of West Nile Virus Infection
OBJECTIVE: To describe prospectively the clinical and laboratory features and longterm outcome of patients with neurologic manifestations of WNV infection.
DESIGN, SETTING, AND PARTICIPANTS: From August 1 to September 2, 2002, a communitybased, prospective case series was conducted in St Tammany Parish, La. Standardized clinical data were collected on patients with suspected WNV infection. Confirmed WNVseropositive patients were reassessed at 8 months.
MAIN OUTCOME MEASURES: Clinical, neurologic, and laboratory features at initial presentation, and longterm neurologic outcome.
RESULTS: Sixteen (37%) of 39 suspected cases had antibodies against WNV; 5 had meningitis, 8 had encephalitis, and 3 had poliomyelitislike acute flaccid paralysis. Movement disorders, including tremor (15 [94%]), myoclonus (5 [31%]), and parkinsonism (11 [69%]), were common among WNVseropositive patients. One patient died. At 8month followup, 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 longterm
outcome, although an irreversible poliomyelitislike syndrome may result.”
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 AsiaPacific Region, Taipei, Taiwan, R.O.C., October 29 – November 01, 2003
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