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)
AMERICAS
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)
2. UPDATES
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)
3. ARTICLES
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)
4. NOTIFICATIONS
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
–Diagnosis
–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/
