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Vol. VI, No. 19 EINet News Briefs ~ October 14, 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
    – Bangkok: U.N. official says leaders must educate Asians on AIDS
    – Thailand: Begins distributing free AIDS drugs to 50,000
    – Philippine: Health chief warns of AIDS epidemic
    – Japan (Ibaraki): Bull confirmed as having mad cow disease
    – Western Australia: Early detection of Ross River virus in mosquitoes
    – Russia: Outbreak of meningitis recorded in Novodvinsk
    – USA (New Jersey): First case with eastern equine encephalitis in 20 years
    – USA: Suspected norovirus outbreak on cruise ship out of New Orleans
    – USA (Michigan): Two cases of West Nile Virus infection detected through blood donations
    – USA (Georgia): Health officials point to outside source for hepatitis outbreak
  2. Updates
    – SARS: Orthoreovirus Co–infection in SARS patients
    – Japan: Progress in investigation of blood donation screening
    – USA: West Nile Virus
    – Canada: West Nile Virus surveillance
    – Mexico: West Nile Virus surveillance
    – North America: The role of bird migration in the spread of West Nile Virus
  3. Article
    – Prevalence of IgG Antibody to SARS,Associated Coronavirus in Animal Traders in Guangdong Province, China
  4. Notifications
    – APEC Leaders' Declaration, Bangkok, Thailand, Oct. 21, 2003
    – International Symposium on the Integration of Science to launch its new Okinawa institute
    – CDC Releases Draft Version of New SARS Plan – WHO SARS Scientific Research Advisory Committee
  5. How to join the EINet email list
    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://depts.washington.edu/apecein.

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


Bangkok — Leaders Must Educate Asians on AIDS, says U.N. Official
A United Nations official said that leaders of the Asia–Pacific region must brush aside cultural taboos and step up efforts to educate their people about HIV/AIDS if a serious epidemic is to be averted."One of the illusions in Asia is to think that this is just a disease of the poor, the junkies, the prostitutes and their clients," UNAIDS Executive Director Peter Piot told Reuters. "The choice is clear for me. It's either act now or pay later," he said of a region which the U.N. says could see an "African–style" crisis and could account for 40 percent of new global infections by 2010. To succeed, governments must destigmatize safe sex and widen education on prevention measures, he said. Piot said the Oct. 20㪭 Asia Pacific Economic Cooperation (APEC) summit in Bangkok, attended by 21 regional leaders, including President Bush, presented an opportunity for leaders to press ahead with measures to control AIDS. "There's no way you can win over a problem if you have to be underground about it," said the 54–year–old Belgian doctor, who co–discovered the Ebola virus in Zaire in the 1970s. "We need strong leadership, acting now to make sure that our children are not affected later on."
(SEA–AIDS 10/20/03)

Thailand — Begins distributing free AIDS drugs to 50,000
The Thai government started a program to provide free drugs to slow down the symptoms of AIDS among 50,000 citizens who harbor the virus that causes the deadly disease. The program, with a budget of nearly 1 billion baht (US$25 million), is the first in any country to provide continuous treatment with antiretroviral drugs to so many people, Public Health Minister Sudarat Keyuraphan said. As many as 1 million of Thailand's 63 million people have HIV, the virus that causes AIDS, according to estimates by the United Nations and other organizations. The new program, aimed especially for postpartum women and children, will focus on people whose clinical symptoms are still at a relatively mild stage. However, all AIDS sufferers under the age of 12 months will be eligible to receive the drugs regardless of their condition. Antiretroviral drugs such as those being used in the program slow the spread of HIV rather than cure the disease. Thailand's Government Pharmaceutical Organization manufactures generic versions of such drugs at low cost, even though patents on many such drugs are held by multinational drug companies. Thailand and other countries such as India have used loopholes in patent laws to manufacture their own versions of such drugs to make them more affordable.
(SEA–AIDS 10/09/03)

Philippines — Health chief warns of AIDS epidemic
Health Secretary Manuel Dayrit expressed deep concern Monday about the possibility of an AIDS epidemic in the Philippines, citing reports of increasing sexually transmitted infections (STIs) among Filipinos. "Most of these STIs are transmitted in the same manner as the human immunodeficiency virus (HIV), the infectious agent that causes AIDS, so where there is an epidemic of STIs, AIDS cannot be far behind," Dayrit said in a news briefing.

The secretary also reported continuing increases in the number of specific STI cases, such as chlamydia, up by 21 to 36 percent; gonorrhea, 15㪷 percent; syphilis, one to seven percent; and HIV/AIDS, one percent. In 2001, the number of chlamydia cases were estimated anywhere from a low of 2.2 million to a high of 3.1 million. Gonorrhea and syphilis were estimated to have about 482,000 and 80,000 cases. The health department's National Epidemiology Center reported that 15 new HIV cases were reported in August, bringing to 91 the total number of registered HIV/AIDS patients this year and to 1,921 cases since 1984. Of the total number of patients, 255 have died due to AIDS–related complications. Dayrit said there were about 6,000 to 10,000 unreported HIV/AIDS cases in the Philippines.
(SEA–AIDS 10/05/03)

Japan (Ibaraki) — Bull confirmed as having mad cow disease
A Holstein bull slaughtered in Ibaraki Prefecture in September 2003 was confirmed Monday to have been infected with mad cow disease. According to the Health, Labor and Welfare Ministry, the 23–month–old bull is the 8th case of the brain–wasting illness found in Japan and is believed to be the world's youngest carrier of the disease, also known as bovine spongiform encephalopathy (BSE).
(ProMed 10/07/03)

Western Australia — Early Detection of Ross River Virus in Mosquitoes
Ross River virus in mosquitoes was detected at several South West locations. "There was actually a case of Ross River virus infection confirmed in Mandurah last week," Shire of Dardanup Environmental Health Officer Tim Batt said. People were being urged to take extra care when outdoors and take measures to avoid being bitten by mosquitoes. Mr. Batt said detection so early in the season was unusual, but Ross River virus outbreaks came in 7–year cycles. Between 1995 and 1996 there were 272 confirmed cases in the Leschenault area and 253 in Capel and Bunbury. The number of cases declined steadily, so that there had only been a total of 20 confirmed cases in the last 3 years. Ross River virus is associated with epidemics of benign polyarthritis often involving thousands of cases and is endemic in most coastal regions and along inland waterways in Australia and beyond. Recovery is complete and there have been no fatalities.
(ProMed 10/08/03)

Russia — Outbreak of Meningitis Recorded in Novodvinsk
Eighteen cases of enteroviral infection were registered in Novodvinsk during the period Sept. 3 to Sept. 29, 2003. Twelve cases of serous meningitis were confirmed by serological analysis. According to Viktor Sosnizkiy of the Epidemiological Surveillance Center, no fatal cases were registered. Sosnizkiy explained that these were cases of serous meningitis and not purulent meningitis, which often has a fatal outcome. Most of the infected are children. According to Sosnizkiy, the children probably contracted infection after swimming. The fact that the epidemic occurred in September can be explained by the long incubation period of the illness. According to Sosnizkiy, enteroviral infections resulting in meningitis are caused by coxsackieviruses or echoviruses. According to the Moscow Center for Sanitary Epidemiological Surveillance, pre–school and elementary school children in Moscow will be vaccinated because of the increase in meningitis cases. There were 230 cases of meningitis in Moscow during the last 8 months. This is almost two times more then average but is less then the epidemic threshold.
(ProMed 10/08/03)


USA (New Jersey) — First case with eastern equine encephalitis in 20 years
A 2–year–old was hospitalized for treatment for severe neurological damage after becoming the first person in New Jersey to be infected with eastern equine encephalitis in nearly 20 years. The girl developed a fever, seizures, and other symptoms and the Centers for Disease Control confirmed the infection was eastern equine encephalitis. Eleven cases of eastern equine encephalitis have been reported in the United States in 2003, but this is the first in New Jersey since 1984. "The reappearance of eastern equine encephalitis infection in humans in New Jersey, with its serious neurological consequences, serves a powerful reminder of the importance of avoiding mosquito bites, even late in the season," Health and Senior Services Commissioner Clifton R. Lacy said. Eastern equine encephalitis infections are rare but pose a significantly higher risk of death than West Nile virus infection. According to a CDC fact sheet, about 35 percent of people infected die. There is no licensed vaccine for the disease or effective drugs to treat it. There have been about 200 confirmed cases nationwide since the disease was first diagnosed in the United States in 1964. States with the largest number of cases are Florida, Georgia, New Jersey, and Massachusetts.
(ProMed 10/21/03)

USA — Suspected Norovirus Outbreak on Cruise Ship Out of New Orleans
U.S. health officials started an investigation into a possible virus outbreak aboard a cruise ship on Oct. 16, 2003 after dozens of passengers were taken ill. According to Carnival Cruise Lines, 97 of the 1650 passengers and 53 crew members on its ship Holiday had complained of nausea, vomiting, and diarrhea during a 5–day trip from New Orleans to Carmen and Cozumel, Mexico. The ship had been cleaned and would depart later for a 4–day voyage to Cozumel. A spokeswoman at the Centers for Disease Control said specimens were collected from the ship, and tests to determine whether a norovirus was present would be completed in about 10 days. Another cruise ship, the Regal Princess, cut short a North Atlantic voyage in August after 340 passengers and crew were affected by a norovirus infection.
(ProMed 10/1703)

USA (Michigan) — Two Cases of West Nile Virus Infection Detected through Blood Donations
According to Michigan Department of Community Health officials, two new cases of the West Nile virus infection have been identified through blood donations in Michigan. The donations never entered the state's general supply, the department said, and the women, ages 30 and 50, have recovered. The women gave blood in mid–September and developed West Nile symptoms shortly thereafter, Health Department spokesman T.J. Bucholz said. West Nile can be transmitted from infected birds to humans by mosquitoes. Most people infected either have no flu–like symptoms or develop only mild ones. Cool weather in the state has helped reduce the number of mosquitoes this year, and the infection rate has been much lower. Experts said the virus appears to be moving west. In 2002, Michigan had the nation's second–highest number of West Nile virus, cases in humans: 644 cases, including 51 deaths, whereas as of Oct. 15, 2003 the number of cases and deaths confirmed by CDC–ArboNET in 2003 are four and two respectively. (ProMed 10/14/03) USA (Georgia) – Health Officials Point to Outside Source for Hepatitis Outbreak Health officials believe food distributors or farms, rather than specific restaurants, may have been the source of an outbreak of hepatitis A in Georgia. Prepackaged vegetables or salads, which often are not washed before being served, could have been responsible for hepatitis in at least 170 people who contracted the illness in September 2003. "We are looking for a perishable item that was probably around in mid–August," said state Division of Public Health spokesman Richard Quartarone. "It could go all the way back to the farm environment."
(ProMed 10/03/03)


SARS — Orthoreovirus Co–infection in SARS patients
According to a recently published finding, 1.2 to 2.9 percent of healthy individuals tested in Guangdong were seropositive for SARS–associated coronavirus. The study conducted by the Academy of Military Medical Sciences (AMMS) in July 2003 reported that while the SARS coronavirus "has been confirmed" as the cause of SARS, the presence of reovirus in 24 of 38 serum samples taken from SARS patients, and only 1 of 35 subjects in a healthy control group, suggests the possibility of co–infection. The authors conclude, with due caution, that SARS could be a combination of the SARS coronavirus and a retrovirus. The AMMS study is available in the Chinese Science Bulletin at the following URL: http://www.scichina.com/ZTYJ/SARS/ky1293.pdf
(ProMed 10/19/03)

Japan — Progress in Investigation of Blood Donation Screening
The virus probably slipped through a new blood screening test started in 1999, officials say. A highly sensitive screening test likely failed to detect tainted blood used in transfusions to a man who has since tested positive for HIV, the Health Ministry said. If officials confirm the man contracted HIV from tainted blood, it will be the first such case since the introduction in 1999 of the nucleic acid amplification test (NAT) to screen donated blood. According to the Japanese Red Cross Society, which oversees the nation's blood donation programs, stored blood samples from the 8 donors have been re–tested using a screening system even more sensitive than the ordinary NAT. None of the samples tested positive for HIV, Red Cross officials said. But it is possible the virus went undetected because the viral load was too low at the time of donation, maybe because the donor had only recently contracted HIV, officials said. Blood plasma from three of the eight donors has already been used on 3 other patients, one of whom later died of an unrelated illness. The other two patients are being tested for infection. Blood plasma from the remaining five donors has not yet been used.
(ProMed 10/03/03)

USA – West Nile Virus
As of Oct. 22, a total of 7386 human cases of WNV infection and 155 deaths during 2003 have been reported. Many of the cases are west of the Mississippi River, in Colorado, South Dakota, and Nebraska. In order to see more details, please visit the following URL: http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount03.htm

Canada — West Nile Virus Surveillance
As of Oct. 15, there have been a total of 1217 probable or confirmed cases of human infection in Canada and 10 deaths (an increase of 87 cases and 3 deaths since Oct. 6 2003). Saskatchewan remains the most severely affected province with 709 probable or confirmed cases and 6 deaths followed by Alberta with 252 confirmed cases and no deaths. 446 presumptive or confirmed equine cases have been reported. In addition, 12,056 birds submitted for testing, 11,158 birds tested, and 1,608 confirmed West Nile virus–positive.
(ProMed 10/15/03)

Mexico — West Nile Virus Infection Surveillance
As of Oct. 15, a cumulative total of 505 individual residents in 22 of the 32 states have been tested for evidence of West Nile virus infection: 501 were seronegative and asymptomatic and four were classified as West Nile virus–positive. A total of 4915 horses from 20 of the 32 states have been tested for evidence of West Nile virus infection. Of these animals 1803 were seropositive and 3111 seronegative. All these animals were asymptomatic. In addition, one animal was symptomatic and died. A total of 17,369 birds from 8 of the 32 states have been tested for evidence of West Nile virus infection. Of these birds 102 were seropositive (and considered to be asymptomatic) and 17,266 were seronegative. In addition 2 dead birds were seropositive.
(ProMed 10/19/03)

North America — The Role of Bird Migration in the Spread of West Nile Virus
The human cases of West Nile virus infection reported so far in 2003 for the USA and Canada show a conspicuous pattern: most of the reported cases in Canada have occurred east of the Rocky Mountains, but in the USA they have occurred west of the Mississippi River. More than 85 percent of reported U.S. cases summarized on ProMED–mail have occurred in a vertical column of eight states: Texas, New Mexico, Colorado, Nebraska, South Dakota, Wyoming, North Dakota, and Montana. In Canada more than 90 percent of reported cases have been in the three prairie provinces: Alberta, Saskatchewan, & Manitoba. The Rocky Mountains seem to be an important boundary for this year's human infections, if one contrasts the case reports in New Mexico with those in Arizona, Colorado versus Utah, and Montana and Wyoming versus Idaho. The states and provinces with the most West Nile virus cases are on major migratory routes for birds traveling north as far as Canada. Compared with human West Nile virus infections in earlier years, it appears that in 2003 the disease moved not merely west, but to a different set of migration routes. Information relevant to the following two questions, which have not yet been addressed adequately, might be very helpful to prepare for next year's West Nile virus outbreak. (1) To what extent has the U.S. distribution of human West Nile virus cases been predictable or constrained by major bird migration "routes" and the timing of migrations in each year of cases? (2) What explanations have been proposed (and possibly tested) thus far for the 2003 shift of West Nile virus cases from the eastern USA and Ontario to the states and provinces of the central plains? In order to see the entire article, please visit the following site: http://www.promedmail.org/pls/askus/f?p=2400:1001:11074358899792382184::NO::F240 0_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1003,23080
(ProMed 10/07/03)


Prevalence of IgG Antibody to SARS—Associated Coronavirus in Animal Traders in Guangdong Province, China
"Severe acute respiratory syndrome (SARS) was identified in 2003 as an infectious disease caused by the SARS–associated coronavirus (SARS–CoV), a member of the coronavirus family not observed previously in humans. Because its sequence data differ from that of known human coronaviruses, SARS–CoV is suspected to have crossed the species barrier between an animal host and humans. The SARS outbreak began in China's Guangdong Province, where approximately 1,500 probable cases were identified during November 2002–June 2003. Detection of SARS–like coronavirus has been reported previously in masked palm civets (sometimes called civet cats) and a raccoon dog for sale in a live animal market in Shenzhen municipality. This report summarizes results of an investigation conducted by public health authorities in Guangdong Province, which compared the seroprevalence of SARS–CoV IgG antibody in animal traders (i.e., workers in live animal markets) with that of persons in control groups. The results indicated that 13 percent of the animal traders, none of whom had SARS diagnosed, had IgG antibody to SARS–CoV, compared with 1ן percent of persons in three control groups. Although the results provide indirect support for the hypothesis of an animal origin for SARS, they also underscore the need for detailed patient histories and more focused animal studies to confirm an animal origin for SARS." In order to see the entire article, please visit the following site: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5241a2.htm
(MMWR October 17, 2003 / 52(41);986𤷋)


APEC Leaders' Declaration, Bangkok, Thailand, Oct. 21, 2003
The "Bangkok Declaration on Partnership for the Future," which is the Leaders' Declaration from the 11th Annual APEC Leaders Meeting, has been posted at the APEC Secretariat Website. Some of the topics on the statement are as follows:

1. Promoting Trade and Investment Liberalization
2. Enhancing Human Security
–the establishment of a Regional Emerging Disease Intervention (REDI) Center by Singapore and the United States
3. Using APEC to Help People and Societies Benefit from Globalization

In order to see the entire statement, please visit the following URL: http://www.apecsec.org.sg/apec/leaders_declarations/2003.html

International Symposium on the Integration of Science to launch its new Okinawa institute
Japan hosted the International Symposium "New Horizons in Molecular Sciences and Systems: An Integrated Approach" in Okinawa, Japan, October 16㪪, 2003. This symposium was planned in coordination with the efforts of Japanese government to establish a "world top class" graduate univeristy in Okinawa to reform Japanese science as well as to promote collaboration in science with Asia and the world. In order to see more details, please visit the following URL: http://www.okinawasympo2003.jp/

CDC Releases Draft Version of New SARS Plan
The Centers for Disease Control and Prevention (CDC) has posted the working draft version of its "Public Health Guidance for Community–Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS)." In order to see the draft, please visit the following URL: http://www.cdc.gov/ncidod/sars/sarsprepplan.htm

WHO SARS Scientific Research Advisory Committee
The WHO SARS Scientific Research Advisory Committee concluded its first two–day meeting in Geneva on Oct. 21. The meeting brought together more than 30 leading SARS researchers, aiming to identify the specific research most urgently needed to understand the disease better and prepare for its possible recurrence.

Participants agreed on the priority research questions to be addressed in the coming months. Questions fall into the main areas of epidemiology, laboratory diagnostics, outbreak management, case management, including treatment outcomes and infection control, and social impact. The research agenda, which will undergo further review by participants, is expected to be finalized for public release within a week.

Participants expressed a great need to ensure that the world can recognize and respond to a recurrence of SARS in ways that work faster to achieve control and are less costly and socially disruptive.

Some of the main issues discussed are as follows:
–The global SARS alert system
–Preparedness in resource–poor settings
–Possible evolution of the SARS coronavirus
–Amplification in hospitals: the role of infection control
–Laboratory biosafety
–Control interventions

In order to see the entire article, please visit the following URL: http://www.who.int/csr/sars/archive/research/en/


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.


Contact us at apecein@u.washington.edu
© 2003, The University of Washington