Untitled Document

China—Suspected SARS case
A 32-year-old man who has been receiving treatment in quarantine in south China's Guangdong Province was confirmed to be a suspected case of SARS, said China's Ministry of Health on 27 Dec 2003. The man, a freelance TV station worker, lives in Panyu District of Guangzhou, capital of Guangdong Province. He began to have a fever and headache in the evening of 16 Dec 2003 and went to see a doctor at No. 1 Hospital affiliated to Zhongshan University on 20 Dec 2003 . He was diagnosed as pneumonia with the right lower lung and was quarantined for treatment. The patient was transferred to the quarantine ward of Guangzhou No. 8 People's Hospital on 24 Dec 2003. The Health Ministry and a panel of medical specialists confirmed this case of suspected SARS on 26 Dec 2003. The patient's present condition is stable. All close contacts at present have not been identified to have fever.

Wang Zhiqiong, deputy head of the provincial health department, said that the patient claimed he has stayed in Guangzhou City and eaten no wild animals for one month before hospitalization. The provincial health department is organizing further epidemic investigation and lab examinations. This is the first suspected SARS case ever found since 23 May 2003 when the WHO lifted the SARS-related travel advisory against Guangdong Province . The first SARS case was found in Foshan City of the province in November, 2002.

But a laboratory test for antibodies against the virus was inconclusive, possibly because blood was drawn for the test early in the illness, while a genetic test for the virus has not yet been completed, Dr. Lam said. "There is reason to believe it is SARS," based on the symptoms, but the evidence is not conclusive, he added. Dr. Lam said that Hong Kong would
deploy extra staff to check the health of people entering this autonomous Chinese territory from the mainland and to check the health of people entering and leaving at the airport. The territory has declared a "yellow alert" at all hospitals, requiring all hospital visitors to wear masks and taking other precautions.
(Promed 12/27/03 )

China ( Guangdong )—Tests show possible infection of SARS suspect
On 26 Dec 2003, the Chinese Ministry of Health (MOH) informed the WHO office in Beijing of a suspected case of SARS in a hospital in Guangzhou, Guangdong province. The patient, a 32-year-old television producer, is
still in isolation in hospital. His condition is said to be stable, and his temperature has been normal for three days. All his relevant human contacts identified so far are well; some have already been removed from medical observation. Others remain in quarantine, but are expected to be released over the next few days, as the 14-day observation period mandated
by China 's health authorities draws to a close.

Initial results of a gene sequencing test show the man with the suspected case of SARS in Guangdong Province last week may possibly have the SARS coronavirus, said an official with the provincial center for disease prevention and control, 2 Jan 2004. The China Diseases Prevention and Control Center is still cross-checking the results.

If the man has SARS now and had it before, his would be the first known case of reactivated SARS, adding a new problem for doctors and health officials in diagnosing and controlling SARS. Reactivated or recurrent SARS "is among the theories we are considering" in the case of the man, said Dr. Julie L. Hall, the SARS team leader in Beijing for the WHO. If confirmed, the patient would be the first outside a laboratory setting to become infected with the SARS coronavirus since the WHO said its transmission stopped last summer. The only two cases since then have been in scientists who acquired the infection in labs in Singapore and Taiwan.

The Chinese MOH says epidemiological investigations show that in the two weeks prior to the onset of symptoms, the patient had no known contact with high-risk groups such as health workers or animal handlers. The source of the suspected SARS infection is therefore unclear. At China 's invitation, the WHO has sent three experts to Guangdong to find more details about his case and to search for other cases. One aim is to determine what medical care the man sought last winter and whether blood or other specimens taken then remain for tests that may yield clues. Although the final diagnosis of this case is still awaited, WHO has been strongly assured that all appropriate steps have been taken by health authorities to ensure that any risk to the public health has been minimised.

Beijing public health departments have responded quickly to the latest suspected SARS case found in Guangdong Province and issued emergency measures to prevent the spread of the disease. Guo Jiyong, deputy director of the bureau, led a team to check the city's airports and railway stations on their work on SARS prevention and control. Guo said that all municipal entry-exit inspection and quarantine departments should strengthen temperature screening systems and send any travelers with a body temperature over 38 degrees Celsius to government-designated hospitals. Special attention should be paid to the travelers from Guangdong, and the bureau has kept a keen eye on the information about the
suspected case in Guangdong, said Guo.
(Promed 1/2/04, 12/28/03; GOARN 12/30/03, 12/29/2003)

Singapore—SARS quarantine order lifted
Singapore sounded the all-clear after its latest SARS scare on 20 Dec 2003, lifting mandatory home quarantine orders for 75 people who came into contact with a visitor from Taiwan who was infected with SARS coronavirus. The Health Ministry in Singapore, the only other country to report a case since the outbreak was pronounced over in July, said six people who fell ill did not have SARS. The six remain well but are being kept under observation.

In Taiwan , initial findings showed that the military scientist diagnosed with SARS was likely to have contracted the virus on 6 Dec 2003, a day before he left for Singapore , as he tried to disinfect a trash bag in his lab. Singapore 's Health Ministry said 75 people who came into contact with the scientist during his four-day visit to Singapore had been released
from 10 days home quarantine overnight. The man is now in stable condition. The Taiwan case is only the second since the WHO declared in July that the last outbreak of the disease was over--and both have been traced to laboratories. A 27-year-old Singaporean medical student who tested positive for SARS coronavirus after a laboratory accident on 9 Sep
2003 has since recovered.

"We always said that if there were a new infectious disease, labs should work together. And they did work together," said Peter Cordingly, WHO spokesman, adding that the labs' cooperation had slackened. "Since the outbreak ended in July, an element of competition and commercial rivalry seems to have been introduced into the scenario," he added. "We understand this, but we're hoping we can return to the days of full cooperation between the member labs," he said.
(Promed 12/22/2003)

South Korea—Avian influenza spreading across country
Nearly a million chickens and ducks will be slaughtered across South Korea to combat a highly contagious strain of avian influenza virus, A(H5N1), that has spread across the country, the government said on 22 Dec 2003.
Avian influenza, which in rare cases can be deadly to humans, has caused poultry sales to tumble as authorities confirm outbreaks at farm after farm across the country. So far there has been no evidence of transmission of avian influenza virus from chickens and ducks to humans during the course of this outbreak.

Since authorities confirmed on 15 Dec 2003 the first outbreak of avian influenza among chickens at a farm 80 km southeast of Seoul, cases have since been discovered at eight more poultry farms, and another six farms are being tested for suspected infections. Faced with the rapid increase in cases, the agricultural authorities have raised slaughter targets to
about 950,000 birds among the 100 million chickens and eight million ducks in the poultry sector. So far, 1/3 of the target poultry stocks have been destroyed. Prime Minister Goh Kun stated that the government should err on the side of caution and cull as many birds as necessary. He cited the example of the Netherlands , which slaughtered around 26 million birds—or more than 1/2 the poultry population—after an outbreak of avian influenza was discovered in February 2003.

South Korean consumers have shunned poultry, and the country's modest exports to Japan, Hong Kong, and China have virtually stopped, prompting authorities to support prices. The farm ministry stepped in to buy 2.5 million chickens after producer prices plunged by 30 percent to 693 won/kg ($0.581) from early this month. The agricultural authorities are now
monitoring all of the country's duck hatcheries and slaughterhouses, intensifying disinfection measures and restricting the transport of birds.

Icy winter weather has hampered efforts to contain the disease, spread by a virus that is more active at lower temperatures. The Korean authorities have asked U.S. experts for help in determining whether the virus is
genetically similar to the strain of avian influenza A (H5N1) virus that killed six people in Hong Kong in 1997 and 1998. Hundreds of people living in the affected areas have undergone blood tests, although no one has
shown symptoms of the disease.
(Promed 12/23/03)

Russia-Meat import from Tajikistan, Kyrgyzia, Kazakhstan and Uzbekistan restricted
Meat from Tajikistan , Kyrgyzia , Kazakhstan and Uzbekistan will not appear in markets in the Nijegorod oblast of Russia in the near future. This import limit on all meat products is because of the threat of anthrax. In 2003, 10 locations with anthrax were identified: Orenburg, Penza, Lipezk, Rostov, Omsk, Volgograd, Republic of Chechnya, and Republic of Tatarstan. At present, the situation with anthrax in Nijegorod oblast is under control due to the rapid measures taken against the epizootics. However, there is still a potential threat of anthrax, said Valeriy Dushkov—this
problem has been the basis of a long-time complaint by the Russian authorities.
(Promed 12/22/2003)

Australia (Sydney)—200 contract gastroenteritis on Pacific island cruise
Up to 200 passengers have been taken ill on a cruise liner after a mass outbreak of a stomach virus infection. Victims among the 1,500 passengers on board the P & O's "Pacific Sky" included a 3-year-old child and several travellers in their 70s. Most of the victims suffered nausea, vomiting, and diarrhea, lasting up to three days. Many passengers were still ill
when they disembarked from the ship at Darling Harbour, Sydney, after a 12-day Pacific island cruise. Doctors suspect that a norovirus is responsible for this outbreak of gastrointestinal infection although tests have yet to confirm this.

The first passenger contracted the virus six days ago, a P & O spokesman said. It soon spread throughout the ship, overwhelming the medical staff. Passengers were told to return to their cabins and to drink plenty of fluids. The ship made contact with Australian health authorities on 24 Dec 2003 . The public health unit gave advice about infection control.

Norovirus carriers remain contagious for up to seven days after they contract the disease. Despite an "extensive sanitation program", staff were unable to prevent the virus spreading. Both P & O and NSW Health said a passenger was the likely source of the virus. NSW Health epidemiologist Jeremy McAnulty said the virus was transmitted through fecal particles.
"It is a fairly common virus and is the main cause of gastroenteritis in the community," he said. Those who contract infection usually recover in two to three days without serious or long-term health effects.
(Promed 12/27/03)

Australia (Western)—Ross River virus cases reach alarming proportions
Ross River virus cases in the southwest have increased from two reported cases in 2002 to 208 between 1 Jul and 29 Dec in 2003. Department of Health Senior Scientific Officer Sue Harrington said between 10 and 20 cases of the virus were being reported in the southwest daily. The increase was typical of Ross River virus infection, which occurs in cycles
dependent on environmental conditions such as tides and rainfall.

"People should wear long sleeve shirts, loose-fitting protective clothing, personal repellents, ensure that insect screening is adequate in homes, and avoid known mosquito areas in wetlands especially at dusk and dawn," Ms. Harrington said. Symptoms of Ross River virus infection include painful swollen joints, sore muscles, skin rash, fever, chronic fatigue
and headaches. Ms Harrington urged people with Ross River virus symptoms to see a doctor and request a blood test. "It is a debilitating disease and the symptoms last for weeks, months, or in some cases years. Young and fit people can be affected just as badly as elderly people."

Ross River virus is a mosquito-transmitted virus. It is associated with moderate epidemics of benign polyarthritis. It is endemic in most coastal regions and along inland waterways in Australia and Polynesia. A variety of wild and domestic animals serve as reservoir hosts. Humans exhibit significant viremia, and the virus can be maintained in some epidemics in
a human-mosquito-human transmission cycle. Different mosquito vectors are important according to habitat. The incubation period for Ross River virus infection is variable, from 2-21 days, and the illness can take the form
of severe arthritis which may persist for a considerable time, but there is no long-term damage. No vaccine is available at the present time.
(Promed 12/30/03)

Australia (South)-Legionellosis—pneumonia warning for persons using potting soil
Gardeners using potting mix could be exposing themselves to a deadly form of pneumonia, health officials warned 24 Dec 2003. Five cases of the potentially fatal Legionella longbeachae pneumonia have been detected in
South Australia in the past two weeks. Four recent victims had recently used potting mix, SA's Department of Human Services director of communicable disease control Dr Rod Givney said. "Legionella longbeachae can be found
in potting mixes, mulches, composts, and soils". Tow South Australians have died from Legionellosis from among 49 cases notified to state health officials this year. Gardeners using potting mix should take precautions, such as wearing gloves and a dust mask, dampening the contents before opening, and avoiding breathing potting or compost dust, Dr Givney said.
(Promed 12/29/03)

New Zealand—Gardeners warned of Legionnaires' disease
Gardeners are being urged to take care when using potting mix this summer after an increase in cases of Legionnaires' disease. Medical officer of health Margot McLean said there had been 13 cases of legionellosis in the wider Wellington region in 2003, compared with nine in 2002. Four of the recent cases of the disease, which could cause anything from mild flu-like symptoms to severe pneumonia, were likely to have been caused by a specific strain of the disease usually found in potting mix, Dr McLean said. She warned gardeners to take the following precautions to minimize the risk from potting mix and compost:

- Open the bag away from your face.
- Make sure potting sheds and glasshouses are well ventilated.
- Moisten the contents of potting mix in the bag before using it to avoid creating dust.
- Wash hands thoroughly after handling potting mix or soil, even if gloves have been worn.

People should see their doctor if they develop a fever, muscle aches, headache, cough, or diarrhea. Antibiotics are effective in early treatment of the disease, which has an incubation period of two to ten days, and most commonly affects smokers, those over 50, and people with lowered immunity, Dr McLean said.
(Promed 1/2/04)

Israel (Ashkelon)—Woman dies from infection after contact with St. Peter's fish (tilapia)
A woman about 60 years old died as a result of an infection she apparently contracted as a result of contact with a fish carrying rapidly spreading bacteria, Vibrio vulnificus. The woman, a resident of Sderot, died at Barzilai Medical Center in Ashkelon . It is believed to be the first such case in Israel of a person who has died as a result of bacteria originating with fish. Israel Radio reported that the woman came to the hospital a few days ago with a wound to her hand. She was treated and sent home. After a few hours she returned because of swelling at the site of the wound. Doctors noticed that the infection had spread and amputated her hand in an effort to save her life. During the operation it became apparent that the infection originated in bacteria that grows in pools where St. Peter's fish (tilapia) are bred for sale. Although the woman
was placed in intensive care, her immune system collapsed and she died on the operating table.

Vibrio vulnificus has been laboratory-confirmed as the etiological agent of this case. This bacterium is the etiologic agent for severe human infection acquired through wounds or contaminated seafood, and opportunistic infection in susceptible individuals can result in death within 24 to 48 hours of exposure. Implementation of proper diagnosis and therapeutic intervention at the early phase of the infection is essential. The bacterium is abundantly present in estuarine ecosystems throughout the world. Mortality from V. vulnificus infection has been reported in USA ,
Europe, Israel, Korea, Taiwan, and other countries.
(Promed 12/29/03 )

***Although the following news is not infectious in etiology, it is included as the emergence of threats from globalization which seriously affect populations is also relevant to our service.

China ( Szechuan )—Mass poisoning from gas well explosion
Beijing 's official Xinhua news agency reported additional deaths Sunday, saying 35 more bodies had been found in mountainous villages near Chuandongbei field in Kaixian county in the densely populated city of Chongqing. A total of 233 persons have so far been killed due to the explosion of the gas well. Some of the more than 42,000 people evacuated
from a 25-square-kilometer area around the blast site began returning home, as investigators tried to find out what caused a well to burst and spew poisonous gas for four days. Investigators say negligent gas well workers were to blame for the accident; the government had earlier blamed an unspecified drilling accident. Technicians capped the well on 27 Dec
2003 , stopping the flow of sulphurated hydrogen that turned the surrounding area into a death zone. More than 9,000 people were poisoned or burned by the fumes, and Xinhua says about 10 percent of them remain hospitalized. About 1,000 health workers and soldiers have begun a cleanup in the area, carrying away thousands of animal carcasses and disinfecting several villages.

The death toll was high even by the standards of accident-plagued Chinese industry, where thousands of people are killed every year in coal mine explosions and other disasters. China 's natural gas industry is an emblem of modernization in a country heavily dependent on coal. The gas field belongs to the state-owned China National Petroleum Corp. A CNPC subsidiary, PetroChina, began building a US$400 million pipeline in August 2003 to pump natural gas from Chongqing to central China.
(Promed 1/3/04, 12/26/03)

AMERICAS

USA(Washington)—Confirmation of BSE (mad cow disease) case
On the morning of 25 Dec 2003, the BSE world reference lab in Weybridge, England, confirmed USDA's 23 Dec 2003 preliminary diagnosis of BSE in a single nonambulatory dairy cow that had been slaughtered on 9 Dec 2003 at Vern's Moses Lake Meats in Washington State. Mad cow disease, also known as bovine spongiform encephalopathy (BSE) had previously not been found in the United States , but it devastated the European cattle industry in the 1990s. Scientists believe humans can be infected with the brain-wasting disease by eating diseased meat.

The positive Holstein cow was traced back from the slaughter plant, where the positive brain tissue was collected, to a 4,000-animal dairy premises near Mabton , Washington . Records obtained from the owner correspond with Canada 's records indicating that this animal was approximately 6-1/2 years old at the time of slaughter. The cow would have been born before feed bans were implemented in North America in August 1997; the feed bans prohibit the inclusion of ruminant protein in feed intended for other ruminants to eat. That practice has been identified as the primary means
by which BSE spread.

At the time of USDA's preliminary diagnosis on 23 Dec 2003 , USDA's Food Safety and Inspection Service (FSIS) issued a Class II recall for the facility's entire day's production. The recall was classified as Class II due to the extremely low likelihood that the beef being recalled contains the infectious agent that causes BSE. The herd that the affected animal came from is under a State quarantine in Washington .

A recall was initiated out of an abundance of caution. The beef products were distributed from Vern's Moses Lake to Midway Meats on 11 Dec 2003 . All of the central nervous system related tissue, brain, spinal cord and distal ileum, were removed at the Vern's facility during the slaughter. Those are the tissues that are most likely to contain the BSE agent. Because the meat leaving Vern's did not contain these high-risk materials, the recalled beef presents an essentially zero risk to consumers.

Dr. Kenneth Petersen, a veterinarian with the USDA's Food Safety Inspection Service (FSIS), said investigators have now determined that some of the meat from the cow slaughtered went to Alaska, Hawaii, Idaho, Montan , and Guam . Earlier, officials had said most of the meat went to Washington and Oregon , with lesser amounts to California and Nevada, for distribution to consumers. Despite assurances that meat is safe, Japan, the top importer of American beef, and more than two dozen other countries have blocked U.S. beef imports. U.S. beef industry officials estimated this week that they've lost 90 percent of their export market.

USDA's Food Safety Inspection Service is verifying that the customers have been notified of the recalled products and know how to handle the product. In overseeing this process, FSIS has found that all of the companies that have received these products have been proactively notifying their customers. There has been close cooperation between Canadian and American officials, which has greatly benefited the investigation. USDA is working with Canada to conduct DNA testing to verify that the correct animal has been identified. The DNA results are expected by next week.

Because of concerns over mad cow disease, the European Union in 1994 banned the use of mammalian meat and bone meal in cattle feed, but it has allowed the products to be used in feed for other animals like chickens, pigs and fish. The FDA of the US instituted a ruminant-to-ruminant feed ban in 1997 that was subsequently extended to a mammalian-to-ruminant ban in feeding, so the US has also taken steps to prevent recycled animal remains out of cattle feed. Milk or dairy products are not known to carry the BSE agent. Although no blood test is yet available to diagnose BSE infection in living animals, the prions, which cause the disease, can be detected in the brains of slaughtered cattle before the meat is processed.
(Reuters 12/23/03, Promed 12/27/03, 12/28/03, 12/30/2003, 1/3/04)

USA ( Santa Fe —Suspected smallpox scabs dating from 1888 found in library
On Mar 31, 2003 , Susanne Caro, a Librarian at the College of Santa Fe 's Fogelson Library, discovered a small, yellowed envelope suspected of containing smallpox scabs dating from 1888. The envelope was found in an 1888 book on Civil War medicine, and had the inscription "scabs from vaccination of W.B. Yarrington's children", with the signature "Dr. W.D. Kelly," the book's author. After a cross-country relay involving the FBI, the National Museum of Civil War Medicine in Frederick and the District's Walter Reed Army Medical Center, the envelope rests in a freezer at the
Centers for Disease Control and Prevention in Atlanta , awaiting a battery of tests.

Researchers believe the scabs found are either from smallpox vaccine patients or from victims. During the late 1800s, pus or bits of scabs from smallpox patients with mild cases were implanted in the skins of healthy people to generate a mild illness that bestowed lifetime immunity. At the very least, inoculation scabs would shed light on the historic development
of American vaccines for smallpox, which though eradicated a generation ago has returned to public consciousness as a potentially devastating weapon for bioterrorists.

Inger Damon, chief of the CDC pox virus group, said the scabs "will be potentially the oldest material we'll have looked at in terms of being able to determine any kind of genomic characterization". Through a series of tests slated for 2004, the CDC hopes to develop a genetic portrait of the virus used in the vaccine--likely cowpox, a nonlethal virus used in inoculations in 1796 by Edward Jenner. That could bring insight into the evolution of smallpox vaccine in the United States, of great interest amid fears of bioterrorism.

If the scabs do yield live smallpox, the laboratory could grow it, compare it to more modern strains and study how vaccines function against them. But Damon called that possibility "highly unlikely". Several years ago in Kentucky, she said, a construction crew unearthed a metal coffin containing the mummified corpse of an apparent smallpox victim that researchers traced to the mid-1800s. The CDC checked the tissue for live virus and came up empty.
(Promed 1/2/04)

Mexico (Jalisco)—Number of conjunctivitis cases now 9,612
The Department of Health of the state of Jalisco (SSJ), through the General Directorate of Public Health, reported that as of 23 Dec 2003, 9,612 cases of conjunctivitis had been registered in 56 municipalities of that state. The number of cases represents an incidence rate in the state of 141.8 cases per 100,000 inhabitants. The SSJ reported also that last week there was an outbreak of conjunctivitis in the municipalities of Puerto Vallarta, Tamazula, and Tala. The SSJ has indicated that the number of cases will probably increase, given that for every reported case there are four unreported. In the metropolitan area of Guadalajara, 128 cases were reported, representing 1.3 percent of the official total. In order to
avoid contagion, the SSJ has urged all persons living in close proximity with those affected to maintain impeccable hygiene, to not share eyeglasses or towels, to not touch the eyes with unclean hands, and should symptoms appear, to not self-medicate. Viral conjunctivitis may develop as a result of irritation of the conjunctiva by smoke, creams, or other cosmetics. It may affect persons of all ages, but it is most common in children and young adults.
(Promed 12/28/03)

2. UPDATES

Influenza ( USA )—Influenza activity update, 2003/2004 season
Influenza activity in the United States continued to increase during the period 14 Dec to 20 Dec 2003 . The proportion of patient visits to sentinel providers for influenza-like illness overall was 7.7 percent, which is above the national baseline of 2.5 percent. Influenza activity was reported as widespread by health departments in 45 states, New York City,
and the District of Columbia ; four states reported regional influenza activity; and one state reported local influenza activity.

Of the 330 influenza viruses collected by U.S. laboratories since 1 Oct 2003 and characterized antigenically by CDC, 326 were influenza A (H3N2) viruses, 2 were influenza A (H1) viruses, and 2 were influenza B viruses. All 50 states have reported laboratory-confirmed influenza this season. As of the week ending Sat 20 Dec 2003, pneumonia and influenza accounted for 7.8 percent of all deaths reported through the 122 Cities Mortality Reporting System. The epidemic threshold for that week was 7.8 percent.

In order to see the entire article, please visit the following site: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5251a5.htm
(MMWR January 2, 2004 / 52(51);1255-1257)

Dengue/DHF update 2003

Brazil (Minas Gerais):
From January up to the beginning of December 2003, the state of Minas Gerais has reported the circulation of types 1, 2, and 3, with 22,346 cases of dengue, 23 confirmed cases of DHF, and three deaths. In 2002, 61,918 cases of dengue were notified, including 68 confirmed cases of DHF and two deaths.

Bangladesh (Dhaka):
Five more patients with dengue symptoms were admitted to Suhrawardy Hospital and Holy Family Red Crescent Hospital in Dhaka city yesterday, raising the total number of such patients to 452 this season, sources at the Dengue Control Room said. Sources also informed that nine patients have died so far due to dengue.

Indonesia (West Java):
An outbreak of dengue fever has killed four people in the West Java district of Majalengka.

Philippines (Manila, Iloilo):
Dengue cases are on the rise in Manila. Philippine health officials on Tuesday raised an alert over the increasing cases, which have killed at least 170 people in the country.

The Iloilo provincial health office reported two more fatalities due to dengue hemorrhagic fever. This brought to 317 the total recorded casualties, with five deaths, as of last week. The most recent victims were identified as age 9 and 3 years, both of barangay Asluman, Carles, Iloilo. Six other victims, aged 2 to 8 years, were also reported in Asluman.

Venezuela:
The Venezuelan Ministry of Health and Social Development acknowledged today the increase in the number of cases of dengue fever over the past six weeks in the capital district and in the states of Merida and Miranda, but emphasized that, at the national level, there is a marked decrease in the number of cases. Jose Mendoza, director of Epidemiology and Strategic Analysis for the Ministry noted that between January and November 2003, 23,125 cases were registered, in comparison with the 36,142 cases registered over the same period of 2002. So far in 2003, there have been four confirmed deaths, compared to the nine deaths registered as the annual average in 1999 and 2002. The highest average incidence of dengue fever in the country was recorded in 2001, when there were weeks during which up to 6,000 cases were registered.
(Promed 12/26/03)

3. ARTICLES

Half a million patients suffering from tuberculosis to get free life-saving medicines
"Half a million of the world's poorest tuberculosis patients are to benefit from free life-saving drugs under an agreement signed today by the World Health Organization (WHO) and the pharmaceutical company, Novartis. Novartis will donate the drugs to the Global Drug Facility, which is hosted by WHO and operated by the Stop TB Partnership. The facility has
supplied procurement support and medicines to 2.8 million TB patients in 65 countries since its launch. The drugs will be provided over a five-year-period to countries scaling up TB control with support from the Global Fund to fight AIDS, Tuberculosis and Malaria. WHO Director-General Lee Jong-wook welcomed the agreement as a major contribution to TB control. "Novartis has taken a strong lead in fighting tuberculosis and we encourage other drug manufacturers to follow their example. Massive investment in patient care from the pharmaceutical industry will have an enormous impact on reducing the TB death toll," he said.

In order to see the entire article, please visit the following site: http://www.who.int/mediacentre/releases/2003/pr94/en/
(WHO 12/29/03)

Incidence of Acute Hepatitis B—United States, 1990—2002
"Hepatitis B virus (HBV) is a bloodborne and sexually transmitted virus that is acquired by percutaneous and mucosal exposure to blood or other body fluids of an infected person. Clinical manifestations of acute hepatitis B can be severe, and serious complications (i.e., cirrhosis and liver cancer) are more likely to develop in chronically infected persons.
In the United States , approximately 1.2 million persons have chronic hepatitis B virus (HBV) infection and are sources for HBV transmission to others. However, since the late 1980s, the incidence of acute hepatitis B has declined steadily, especially among vaccinated children. To characterize the epidemiology of acute hepatitis B in the United States , CDC analyzed national notifiable disease surveillance data for 1990–2002. This report summarizes the results of that analysis, which indicated that, during 1990–2002, the incidence of reported acute hepatitis B declined 67%. This decline was greatest among children and adolescents, indicating the effect of routine childhood vaccination. The decline was lowest among adults, who accounted for the majority of cases; incidence increased among adults in some age groups. To reduce HBV transmission further in the United States, hepatitis B vaccination programs are needed that target men who have sex with men (MSM), injection-drug users (IDUs), and other adults at high risk."

In order to see the entire article, please visit the following site: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5251a3.htm
(MMWR January 2, 2004 / 52(51);1252-1254)

Murine Typhus—Hawaii, 2002
"Murine typhus, a zoonotic disease caused by Rickettsia typhi, is uncommon in the United States. Hawaii typically reports five or six cases annually; however, 47 cases were reported in 2002. This report summarizes clinical data for three of these cases and describes murine typhus activity in Hawaii during 2002 and control efforts of the Hawaii Department of Health
(HDH). The high number of reported cases in 2002 underscores the need for community education to prevent murine typhus and an assessment of environmental factors that might contribute to local disease transmission."

In order to see the entire article, please visit the following site: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5250a2.htm
(MMWR December 19, 2003 / 52(50);1224-1226)

Internet Use and Early Syphilis Infection Among Men Who Have Sex with Men—San Francisco, California, 1999—2003
"During the summer of 1999, an outbreak of early syphilis among men who have sex with men (MSM) who met their sex partners on the Internet (1) presaged a rapidly expanding syphilis epidemic in San Francisco. By 2002, San Francisco had the highest rates of primary and secondary syphilis of any metropolitan area in the United States (2). During 1998–2002, the number of early syphilis cases increased, from 41 cases in 1998 to 495 cases in 2002 (3). Concomitant with the increase in early syphilis was an increase in the proportion of cases among MSM, from 22% in 1998 to 88% in 2002 (Figure 1) (3). To assess the association between early syphilis infection and use of the Internet by MSM to meet sex partners, the San Francisco Department of Public Health (SFDPH) analyzed surveillance data and case reports. This report summarizes the results of that analysis, which suggest that public health officials might find the Internet to be an important tool for 1) promoting disease awareness, prevention, and control and 2) accessing sex partners of syphilis patients to conduct appropriate partner notification, evaluation, and management. The findings underscore the need for public health officials to understand the role of the Internet in facilitating the spread of sexually transmitted diseases (STDs), including the human immunodeficiency virus (HIV). With the assistance of community partners, other jurisdictions can examine the online social/sexual networks that are used commonly in their gay and bisexual communities and develop an effective means of communicating prevention and control messages online."

In order to see the entire article, please visit the following site: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5250a4.htm
(MMWR December 19, 2003 / 52(50);1229-1232)

4. NOTIFICATIONS

Mad Cow Disease: New and updated information on Bovine Spongiform Encephalopathy (BSE) and variant Creutzfeldt-Jakob Disease (vCJD) are available at:
http://www.cdc.gov/ncidod/diseases/cjd/cjd.htm

SARS: Updated (Dec 18 2003) CDC guidance can be viewed at:
http://www.cdc.gov/ncidod/sars/updatedguidance.htm