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Vol. VI, No. 16~ EINet News Briefs ~ September 5, 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: Contaminated feed caused BSE outbreak
    – China: Mass food poisoning
    – Asian governments urged to fight AIDS
    – New Zealand: Sudden deaths from pulmonary hemorrhage
    – USA (Florida): Malaria, autochthonous
    – USA (multistate): Hamburger Recalled Over E. Coli O157 Suspicion
  2. Updates
    – Canada: Acute respiratory syndrome
    – SARS could re–emerge this fall
    – Etiology of SARS
  3. Article
    – Methicillin–Resistant Staphylococcus aureus Infections Among Competitive Sports Participants – Colorado, Indiana, Pennsylvania, & Los Angeles County, 2000�
  4. Notice
    – Web guide to HIV/AIDS in Asia Pacific
  5. How to join the EINet email list

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


Japan — Contaminated feed caused BSE outbreak
According to a farm ministry panel investigating BSE (bovine spongiform encephalopathy), the outbreak of mad cow disease in Japan was probably caused by contamination during the feed production process. The panel determined that abnormal prions (protein particles suspected of transmitting BSE) were in meat–and–bone meal (MBM) at some point, and this tainted feed got mixed into the feed for cows. However, the panel was unable to confirm where the tainted MBM originated.

BSE was first confirmed in Britain in 1986. It is believed to be caused by the consumption of MBM contaminated with abnormal prions. Japan's first case of mad cow disease was confirmed in September 2001. Seven Holsteins had been confirmed as infected with the brain–wasting illness as of Jan. 31, 2003.

Humans who have consumed tainted beef have developed variant Creutzfeldt–Jakob disease. Britain imposed a complete ban on the use of MBM for cattle feed in 1996. The Japanese government did not impose a similar ban until October 2001, following the discovery of the first BSE–infected cow in Japan.
(ProMed 8/28/03)

China – Mass Food Poisoning
About 400 Chinese construction workers in Suzhou city in China's eastern Jiangsu province became ill from food poisoning and were treated in hospital. The mass poisoning is being traced to a construction site canteen. According to workers, the canteen served the same leftovers each day until they were finished. The workers were all suffering from vomiting, stomach aches, and fever.

On Aug. 22, sixty students from Yangzhou University were hospitalized, complaining of vomiting and dizziness, in a suspected food poisoning case.

Food poisoning in China normally peaks in the summer months when food is not adequately protected from the heat. About 140 people died from food poisoning in the country in 2002, but figures are declining on a year–to–year basis, according to the Chinese government.

Deliberate poisonings have also been reported. Chinese police arrested the head of a nursery school on suspicion of poisoning 70 children and 2 teachers at a rival school in November 2002. The man had opened his own school one month prior to the attack but was reportedly jealous of his rival's success. There was another mass poisoning in September 2002 by a restaurant owner who was said to be envious of his business rivals in the eastern city of Nanjing.
(ProMed 8/24/03)

Asian governments urged to fight AIDS
“Asian governments have been urged to make condoms cheaper and more accessible in the global fight against AIDS. Health officials from eight Asian countries are meeting in the Lao capital, Vientiane, to discuss HIV prevention in the commercial sex industry, which accounts for many infections in Asia. A World Health Organization official has told the conference it is possible to turn the AIDS epidemic around if governments help fight the disease.

Health specialists estimate the Asia Pacific region is home to 7 million people living with HIV, and could account for 40 per cent of new global infections by 2010 if prevention efforts are not stepped up.

HIV infection rates are climbing in China, and infections among sex workers in Vietnam's two main cities are also on the rise. Thailand and Cambodia are the only two Asian countries where HIV infection rates are on the decline.”

To see the entire article, visit http://www.goasiapacific.com/news/GoAsiaPacificBNA_927283.htm
(SEA–AIDS 8/26/03, Go Asia Pacific website)

New Zealand — Sudden deaths from pulmonary hemorrhage
Health authorities in New Zealand were on high alert following the sudden deaths of three people suffering pneumonia–like symptoms in the southern city of Dunedin.

According to Otago Medical Officer of Health John Holmes, all three patients (two women and one man in their 40s and 50s) came from a small geographical area in Dunedin and suddenly fell ill; dying within hours from pulmonary hemorrhage, but the cause of the bleeding into their lungs was yet to be determined.

Director General of Health Dr Karen Poutasi said hospitals nationwide were being notified of the mystery deaths, and were being asked to investigate any recent unexplained deaths. Dr Poutasi said the Health Ministry was putting surveillance measures into place throughout the country.
(ProMed 8/28/03)


USA (Florida) – Malaria, autochthonous
According to health officials two more cases with flu–like symptoms were diagnosed as malaria in Palm Beach County. A total of seven cases have now been diagnosed in the area.

Tim O'Connor, spokesman for the Palm Beach County Health Department, said the two latest cases, a 17–year–old boy and a 48–year–old man, are unrelated and not geographically close together, although they fall within a 3–mile zone, which the distance mosquitoes can fly.

That many locally acquired cases of a disease that is not normally present in the United States is "highly unusual," said Dr. Carina Blackmore, an expert in mosquito–borne diseases at the state Health Department. Blackmore said there usually are a few cases each year in which people are infected with malaria by mosquitoes that bite someone who brought it in from outside the country. "But usually it's only one or two cases," she said. "I don't remember hearing about seven."

Blood specimens from the malaria–infected people are being analyzed by the federal Centers for Disease Control and Prevention to see how closely they match each other, and to determine other characteristics of the disease, she said.

The rising number of cases increases the possibility of a second and third wave of malaria, said Dr. Don Krogstad, chairman of tropical medicine at Tulane University's School of Public Health in New Orleans.
(ProMed 8/27/03)

USA (multistate) – Hamburger Recalled Over E. Coli O157 Suspicion
According to the Agriculture Department on Aug. 23, about 76 000 pounds of fresh and frozen ground beef produced by J&B Meats Corp. of Coal Valley, Illinois, may be contaminated by E. coli and are being recalled.

The products subject to recall bear the date code “5630053” and establishment code “EST. 5712” inside the USDA seal of inspection. The meats were produced May 30, 2003 and shipped to wholesalers nationwide. An E. coli illness in Wisconsin triggered an investigation by the state Health Department, and tests of J&B Meats ground beef proved positive for E. coli, a potentially deadly contaminant.

So far there is no definitive link implicating the meat which was voluntarily recalled to any illness, the department's Food Safety and Inspection Service said.
(ProMed 8/25/03


Canada — Acute respiratory syndrome
WHO has concluded that an outbreak of respiratory illness in an aged–care facility in Canada is not SARS. The following evidences have converged to dismiss the SARS concern.

Clinically, the disease itself was strikingly different from the SARS outbreak in the spring of 2003. The features of the current outbreak included a low case fatality, runny nose, lack of fever in most patients, and no SARS–like changes in the lung seen on X–ray.

Furthermore, sequencing of a portion of the virus causing the outbreak has led to the finding that it was not the SARS coronavirus but another human coronavirus known as OC43. This virus, which is one of the causes of the common cold, has been associated with respiratory outbreaks in aged care facilities in other countries.
(ProMed 8/25/03)

SARS could re–emerge this fall
According to international health experts and U.S. intelligence officials, SARS could re–emerge this fall as cold temperatures in the Northern Hemisphere allow respiratory illnesses to spread.

"The wave of severe acute respiratory syndrome (SARS) has been overcome, but SARS has not been eradicated," says the report, prepared by Karen Monaghan, acting national intelligence officer for economics and global issues. It adds that "many health experts fear it could return again in the fall when cooler temperatures return in temperate areas. We remain vulnerable."

The World Health Organization, the U.N.'s health agency, fears the disease could become seasonal. It urged medical authorities worldwide to launch an influenza vaccination campaign, saying it would help stop confusion in future outbreaks of SARS.

The U.S. intelligence report offers three scenarios that health officials might face in the coming months and years:
• Developed countries frequented by international travelers experience a new wave of SARS cases, similar to the original outbreak that started in China last November. The first wave infected more than 8,400 people worldwide and killed about 815, mostly in Asia, before subsiding in June.
• SARS cases arise sporadically but are detected before the disease can spread.
• The disease gains a foothold in poor countries in Asia or Africa that lack adequate health care systems. In this case, SARS could cause more deaths than did the first outbreak.

A quick response from national and international authorities is critical to containing the disease, the report says. "China's efforts to hide the initial outbreak allowed SARS to build up dangerous momentum before Chinese officials became more open," the report adds.

SARS disrupted business worldwide but hit Asian economies and people the hardest, the report says. Canada also suffered, with a secondary outbreak in the Toronto area.
(CNN.com 9/03/03)

Etiology of SARS
Fourteen United Nations and Chinese experts visited farms and markets in Guangdong province in search of a possible animal carrier of the SARS virus and were astounded to see how many different species were infected. "What is surprising is we got positive results from mammals, from birds, and from reptiles," said Francois Moutou, a French expert on epidemic disease. "This is very strange, because usually we don't find viruses ... affecting so many different animals," he said in his briefing in Beijing. "There may be many animals that are capable of being infected, but they might not be capable of transmitting the virus to people," Hume E. Field, an expert from Australia's Animal Research Institute, told the briefing.

The researchers warned that detecting the source of the disease might take years, which means measures to curb further transmission must be undertaken before it is fully understood. "Obviously we can't wait until we've got the whole jigsaw together before action is taken," said Field. "So really we have to look at the best information we've got at the time in terms of risk and respond according to that." "We need to recognize that if it doesn't return this year, that doesn't mean it will never return," Field added.

The World Health Organization (WHO) said it would train thousands of medical workers in China. The training program is meant to better equip health workers to prevent infectious diseases from spreading in hospitals, said Alan Schnur, a WHO communicable diseases expert.

"Whether or not SARS returns, China must have a strong surveillance network already in place," says Dr Henk Bekedam, WHO's China Representative. "China has a unique opportunity to contribute to the international understanding of this disease. Investing now in this safety net may be the key to successfully combating SARS."
(ProMed 8/21/03)


Methicillin–Resistant Staphylococcus aureus Infections Among Competitive Sports Participants — Colorado, Indiana, Pennsylvania, & Los Angeles County, 2000�
“Although outbreaks of methicillin–resistant S. aureus (MRSA) usually have been associated with health–care institutions, MRSA is emerging as a cause of skin infections in the community. This report summarizes several reported clusters of skin and soft tissue infections associated with MRSA among participants in competitive sports and identifies possible risk factors for infection (e.g., physical contact, skin damage, and sharing of equipment or clothing). The findings underscore 1) the potential for MRSA infections among sports participants; 2) the need for health–care providers to be aware that skin and soft tissue infections occurring in these settings might be caused by MRSA; and 3) the importance of implementing prevention measures by players, coaches, parents, and school and team administrators.”

To see the eintire article, visit: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5233a4.htm
(MMWR August 22, 2003/ 52(33);793𤴋)


Web guide to HIV/AIDS in Asia Pacific

As part of the World AIDS Campaign, Church World Service (CWS) Indonesia is a compiling a list of HIV/AIDS related web resources, in Asia–Pacific region to be published as a resource book and on the web page of CWS (www.cwsindonesia.or.id ) as well. If you or your agency is hosting a web page on AIDS related issues and you are based in Asia–Pacific region, please help us to compile a comprehensive list of Web resources on HIV/AIDS in Asia Pacific region.

It will be appreciated if you could fill the following questionnaire and send it to us at within next 20 days.

Please forward this message to other HIV/AIDS web masters/ moderators in Asia
Pacific region
1. Name of the agency
2. Name of the web page
3. URL of the web page
4. Please briefly describe the web page
5. How you classify your web page:

1. Advocacy
2. AIDS Service Agency
3. Alternative Therapies
4. Basic Science
5. Clinical Trials
6. Conference Reports
7. Drugs and Drug interactions
8. Education and Prevention
9. Drug Manufacturers
10. News Services
11. Iinternet Forums/Discussion Groups
12. Newsletters & Magazines
13. Peer–reviewed Journals
14. Support Services
15. Treatment Advocacy
16. Women & Children
17. Stigma & Discrimination Reduction
18. Other

Please send back the filled questionnaire to ardita@cwsindonesia.or.id

Thank you,

Ardita R. Caesari
Development Information Officer,
Church World Service Indonesia
E–mail: ardita@cwsindonesia.or.id


The APEC EINet listserv was established to enhance collaboration among academicians and public health professionals in the area of emerging infections surveillance and control. Subscribers are encouraged to share their material with colleagues in the Asia–Pacific Rim. To subscribe (or unsubscribe), contact apec–ein@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://www.apec.org/infectious.


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