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1. OVERVIEW OF INFECTIOUS-DISEASE INFORMATION
Below is a semi-monthly summary of Asia-Pacific emerging infectious diseases.

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East Asia—Avian influenza, latest updates
 
Thailand :
The Ministry of Public Health in Thailand has confirmed the country's tenth case of H5N1 infection. The case is a 47-year-old woman from Lopburi Province who has fully recovered. She fell ill with fever and cough on 3 February and was diagnosed with pneumonia on 20 February. Hospital discharge followed 5 days later. She had exposure to diseased and dead chickens at her home in January. To date, Thailand has reported 10 cases, of which seven have been fatal.   About 140 officials and international experts from 23 Asia-Pacific countries began a 3-day emergency meeting in Bangkok on Thursday to determine measures to contain the avian influenza outbreak that has spread through much of the world and killed 22 people in Asia. The meeting is jointly organized by Thailand 's Ministry of Agriculture and Cooperatives, the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), and the World Health Organization.

Vietnam:
Laboratory tests have confirmed an additional case of avian influenza A (H5N1) virus infection in Viet Nam . The case is a 16-month-old baby girl from Dong Nai Province. She has been hospitalized since 16 Feb 2004 in Ho Chi Minh City and remains in stable condition. To date, Viet Nam has reported 23 confirmed cases, of which 15 have been fatal. This additional case in Viet Nam brings the total number of laboratory confirmed human cases of avian influenza A (H5N1) in East Asia to 33, of whom 22 have died.  

Japan:
About 28,000 chickens have died in the past week at a chicken farm in the town of Tamba, Kyoto Prefecture, and preliminary tests have found birds positive for avian influenza, the prefectural government said. The Asada Nosan Funai Nojo farm, which raises more than 200,000 chickens for eggs, said the number of dead chickens totaled 28,000 by Friday. The farm, however, failed to report to the authorities and had already shipped about 15,000 live chickens to a meat packing firm in the town of Yachiyo in the same prefecture on Wednesday and Thursday and about 160,000 eggs per day. The H5N1 strain of avian flu virus was detected in January 2004 in chickens at a poultry farm in Yamaguchi Prefecture, in the first bird flu outbreak in Japan since 1925. In Oita Prefecture, the H5N1 strain of the virus has been detected among pet bantams.  

South Korea:
The strain of bird flu virus that has ravaged South Korea's poultry flocks is genetically different from that which has killed 22 people and millions of chickens in Asia, South Korea said yesterday, citing tests by U.S. CDC. The tests showed the bird flu virus in South Korea was not the same variant of the H5N1 avian influenza that also killed six people in Hong Kong in 1997 and 1998. "The U.S. CDC's test results showed that South Korea's bird flu virus is a purely avian influenza virus with no history of affecting humans," a statement from the state-run Korea Center for Disease Control & Prevention said.  

South Korea first reported an outbreak of the disease among chickens and ducks on 10 Dec 2003, and a week later the authorities asked the United States for help to determine the genetic makeup of the virus. Almost 2,000 people living in areas near the 19 poultry farms with reported outbreaks of the virus were given blood tests as a precaution but none have shown symptoms of the disease. The outbreak prompted consumers to shy away from poultry, and exports of chickens and chicken meat to Japan, Hong Kong, and China were halted. Prices of chicken meat fell by as much as 40 percent to 611 won (USD 0.522) per kg after the outbreak was reported, but have jumped to 1.669 won (USD 1.426) per kg due to tight supplies, triggered by a mass poultry slaughter and import bans. South Korea has slaughtered almost 4.5 million chickens and ducks from its entire poultry stocks of almost 108 million birds in an effort to contain the disease. The government has halted imports of poultry from 12 countries, including Taiwan, Japan, Viet Nam, Thailand, Cambodia, Indonesia, Laos, Pakistan, China, Canada, Hong Kong, and the United States because of bird flu outbreaks.

China:
Despite the fact that no new bird flu cases were reported in China in the past days, Vice-Premier Hui Liangyu reported on bird flu prevention and treatment, and said there is still a chance of new cases or even human transmission. That is due to the outbreaks in surrounding countries and the large number of wild birds migrating and carrying the virus north with them. In addition, 60 percent of China's 13.2 billion chickens are raised in small farms, where it is not uncommon for them to live in close quarters with domestic animals and people. In addition, quarantine conditions in many places are not as strict as they should be. Hui spoke about the country's bird flu situation during Thursday's seventh session of the Standing Committee of the 10th National People's Congress. With the FAO and the World Health Organization, China's Ministry of Agriculture has established a system for distributing information on the epidemic situation. China has provided countries like Viet Nam and Thailand with USD 450,000 for emergency aid, and the Ministry of Agriculture has recently offered Viet Nam aid materials worth 200,000 yuan (USD 4000), including exposure suits and gloves, according to the ministry.  

Malaysia:
Malaysians are eating more chicken, as fears subside that bird flu is going to break out in the country, giving relief to local producers who watched prices slump in recent weeks. Kamarudin Mohamad Isa, the head of Malaysia 's Disease Control and Veterinary Biologics Unit, said the price of chicken in Malaysia was recovering since plummeting in recent weeks because of disease fears. Prices were also rising because breeders reduced their supply of chicken products into the market during the scare, creating a shortage.

"There may be a slight contribution from that to the price increase, but it's up because demand is improving, indicating that consumer confidence is back," Kamarudin said. The government says Malaysia remains free of the avian influenza that has swept through at least 10 Asian countries in recent months, killing 22 people and causing the slaughter of millions of fowl. Chicken is a staple in many Asian countries, but consumption plummeted in recent months because of disease fears. Malaysia 's Deputy Prime Minister Najib Razak and other leaders in the region have publicly eaten a variety of chicken dishes in an effort to allay public concerns.
(Promed 2/23/04, 2/27/04)

Thailand:
Three pet cats have died of bird flu and a white tiger has been infected by the virus at a zoo in Thailand, an official said, raising concerns about the spread of the avian disease among mammals. It was unclear whether the virus could spread from felines to humans, but the veterinarian who announced the latest confirmed infections advised people to avoid contact with pet cats in areas with poultry, which are at high risk of catching the disease.

"At this moment we know that felines can get infected for sure," said Dr. Teeraphon Sirinaruemit, a veterinarian at Kasetsart University. So far, cases in people have been traced largely to direct contact with birds sickened by the H5N1 virus that has decimated poultry stocks through wide swaths of Asia. It has jumped to humans in Thailand and Vietnam, killing 22. The pet cats are the first domesticated mammals known to have contracted the disease in the current outbreak. WHO viral expert Dr. Prasert Thongcharoen said this development is "very dangerous because pets are very close to humans. Because this disease is new to the world, nobody knows how far it can go".  

Teeraphon said that the carcasses of the three pet cats who died were tested, along with samples from a white tiger at the Khao Khiew zoo in Chonburi province near Bangkok. All were found to have the H5N1 virus. The Khao Khiew zoo is the same one where a clouded leopard died of the bird flu last month, the first mammal apart from humans to die in this year's outbreak. Teeraphon said lab tests on three house cats and the tiger has "confirmed 100 percent identical genetic code to the bird flu virus found in chickens." The owner of the three dead cats is healthy but is being monitored because one of the cats used to sleep in her bed. Health experts are concerned about the bird flu sickening other animals, in part because that could prompt mutations in the virus that in turn makes it easier to pass among people. That concern holds especially for pigs because of their genetic similarities to humans.
(Promed 2/21/04)

Australia troops suffer side effects from anthrax vaccine
Australian troops headed for Iraq in 2003 received compulsory anthrax shots but were not told that troops sent earlier to Afghanistan had suffered severe side effects from the vaccine, an Australian daily said. The Australian newspaper said defense documents received under freedom of information laws showed that the defense force had had problems with the vaccine back in November 2001. The vaccination program was halted for two months after 75 percent of the 1,500 Afghan deployment in 2002 fell ill. Reported side effects included swelling and pain severe enough for troops not to be able to use the affected arm, and flu-like illness severe enough for some personnel to require sick leave for 24-48 hours.   At the time Britain allowed its troops go to the Gulf without the anthrax shots as long as they signed a legal waiver. The American anthrax vaccine has been given to about 1.1 million people since 1998; the British anthrax vaccine somewhat fewer. These anthrax vaccines are known commodities. American troops and clinicians have indeed seen reactions occurring in 1/3 of vaccinees: redness, tenderness, swelling, headache, malaise; adverse events seen after any vaccination. The United States led Australian and British forces into Iraq in 2003, accusing Iraq of developing weapons of mass destruction including biological agents such as anthrax.
(Promed 2/24/04)    

Russia (Novosibirsk): Opisthorchiasis Opisthorchiasis has been found in the Obskoye Sea)
It was long believed that fish from this Novosibirsk reservoir are free from Opisthorchis because of the reservoir's hydrologic regime. However, an investigation by the Clinical and Experimental Veterinary Institute has found otherwise. According to preliminary data presented by Konstantin Fedorov, 13 per cent of the reservoir's bream are affected by opisthorchiasis, along with 70 to 80 per cent of dace, 15 per cent of roach, and 75 per cent of ide (dace, roach, and ide are types of European freshwater cyprinid fish). The main source of opisthorchiasis is the lower stream of the Ob river, in the Hanti-Mantiyskiy region. Novosibirsk itself is now becoming a source of opisthorchiasis; however, because of its sewage disposal system—the cities of Kamenka, Elzovka, and Tula are all dumping their contaminated sewage into the Ob river. Opisthorchis eggs in the sewage collect on the bottom of the Siberian river, and opisthorchis larvae penetrate into the fish's body and collect there for years. The Vengerskiy region has the highest human opisthorchiasis rate, and 1030 people have been diagnosed with this parasite. Once they reach the human liver, Opisthorchis larvae can mature into the parasite and live for 25 years.
(Promed 2/13/04)  

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USA ( Texas )/ Europe—EU bans U.S. poultry
The European Union is banning imports of U.S. poultry for one month after bird flu was discovered in Texas. The EU said the ban, which is being adopted Tuesday, would apply to all live bird and egg imports from the United States and follows a similar ban on imports of Thai poultry. U.S. health officials said they were monitoring farm workers in Texas after the chickens were diagnosed with a highly infectious and fatal form of the avian disease. However, the strain is said to pose little risk to humans—in contrast to the disease blamed for the deaths of at least 22 people in Asia and prompted the slaughter of tens of millions of fowl.  

"We want to make sure there's no risk posed by the imports," EU Health and Consumer Protection Commissioner David Byrne said, adding that the ban would remain in place until March 23. The U.S. is a major poultry exporter to the EU. A quarter of annual EU egg imports are from the U.S., about 13,000 tons of eggs worth 20 million euros ($25.17 million) in trade. Byrne said half the egg imports were consumed while the rest were hatching eggs. The EU also imports 800,000 day-old chicks a year from the U.S., mostly turkeys, accounting for 50 percent of the 15-nation bloc's imports. The trade was worth 2.5 million euros ($3.15 million) a year. Byrne said EU farm ministers would decide whether to renew the ban following an incubation period of four weeks on March 23. He said he planned to discuss the situation with U.S. officials when he visited Washington on March 18.
(CNN.com, 2/24/04)

USA ( Texas )—USDA Confirms Highly Pathogenic Avian Influenza
The U.S. Department of Agriculture confirmed Feb 23 that the H5N2 strain of avian influenza in a flock of chickens in Texas is highly pathogenic avian influenza (HPAI), the first such case in the United States in 20 years. There is no evidence to date of any human health implications of this HPAI virus in Texas.

"The H5 strain can be high- or low-pathogenic, and the clinical signs observed at the outset of this outbreak suggested that the disease was low-path avian influenza," said Dr. Ron DeHaven, USDA's chief veterinary officer. "However, further testing by our National Veterinary Services laboratory in Ames, Iowa, determined that this strain is highly pathogenic avian influenza."   The premises in Gonzales County, Texas, remains under quarantine, and the flock of approximately 6608 broiler chickens were depopulated over the weekend. USDA and the Texas Animal Health Commission (TAHC) have started an epidemiological investigation that includes determining the source of the infection and surveillance testing within a 10-mile radius of the infected property. HPAI spreads through bird-to-bird contact. HPAI viruses can also be spread by manure, equipment, vehicles, egg flats, crates, and people whose clothing or shoes that may have come in contact with the virus.  

For more information on avian influenza, please visit the APHIS Web site: <http://www.aphis.usda.gov/>   A major outbreak of HPAI would be costly to the poultry industry, consumers, and taxpayers. Eradication of an HPAI outbreak that occurred during 1983 and 1984 in the northeastern United States resulted in the destruction of more than 17 million birds at a cost of nearly USD 65 million. This outbreak also caused retail egg prices to increase by more than 30 percent. (Promed 2/23/04)    

USA (North Carolina)—Death of Youth Infected with West Nile virus
A 14-year-old North Carolina youth died from West Nile Virus infection that he contracted in September 2003, state health officials said 23 Feb 2004. A resident of Kill Devil Hills who suffered from acute lymphatic leukemia when he was diagnosed with West Nile virus infection died on 19 Jan 2004. Chemotherapy had weakened his immune system, making him more susceptible to the effects of West Nile virus infection. The youth was eulogized earlier this month during the National West Nile Conference by Dr. Lyle Petersen, director of the vector-borne infectious disease section of the Centers for Disease Control. Petersen told West Nile virus experts from across the country that the youth's passing put a "human face" on the disease. He emphasized that the disease must be taken seriously and vigorously controlled in order to prevent future tragedies. During 2003, 22 North Carolinians were infected with West Nile virus and two of them died. The other North Carolina fatality was an elderly Davie County man who also had a weakened immune system.
(Promed 2/24/04)    

USA ( Maryland )—Suspected Norovirus Outbreaks at Two Hospitals in Baltimore
Carroll Hospital Center had no new cases yesterday of an infectious gastroenteritis virus that sent 10 people to the hospital and sickened a dozen of the staff over the holiday weekend. In addition to dealing with an "unusual number of patients at the same period of time and on the same unit," the hospital also had 12 employees out sick on 16 Feb 2004, said Brenda Kitchen, infection control coordinator at the Westminster hospital. The staff affected by the gastrointestinal virus seemed to be those who worked in the 24-bed progressive care unit of the hospital. The symptoms of virus infection begin with nausea, which leads to severe vomiting and diarrhea. Most of the patients admitted with the virus were elderly. "It is not life-threatening, but certainly uncomfortable for the patient," Kitchen said. The four patients still experiencing gastrointestinal problems yesterday remained hospitalized and were isolated from other patients, she said. The staff is wearing masks, gowns and gloves while treating them; their visitors also must don protective gear. The hospital will continue to take measures to prevent transmission of the virus for at least 24 hours after the last patient's symptoms disappear, Kitchen said. A similar viral illness that spread to dozens of workers at Good Samaritan Hospital during the past three weeks also appears to have peaked, a hospital official there said on 16 Feb 2004. An emergency notification system had alerted hospitals across the state about the outbreak at Good Samaritan.
(Promed 2/22/04)    

USA ( Georgia )—Suspected Norovirus Outbreak at University of Georgia
More students continue to report symptoms of a viral gastroeneteritis outbreak at the University of Georgia. Almost 200 students have been infected by the virus, including 22 who visited the University Health Center on 18 Feb 2004, complaining of severe vomiting, diarrhea, and nausea. Officials say the infectious agent is likely to be a norovirus, a typically short-lived intense gastroenteritis virus. They also say reported cases of the virus normally taper off quickly. More than 120 students checked into the Health Center and St. Mary's hospital during the first week of the outbreak, followed by 24 students who reported symptoms 16 Feb and 21 on 17 Feb., 2004. University of Georgia and local health officials said earlier this week there was no evidence linking the sick students to each other that would suggest food-borne illness. The students live in different residence halls and eat at different locations.
(Promed 2/22/04)    

Guatemala—Rotavirus Outbreak Death Toll Reaches 50
The number of children dead as a result of rotavirus infection rose to 50 on 12 Feb, 2004, as health authorities continued to struggle to contain the outbreak, which began in January 2004. "Since 29 Jan 2004, 50 children have died as a result of rotavirus," Health Ministry spokeswoman Raquel Leon said, adding that physicians have treated nearly 35,870 cases of children with symptoms of rotavirus infection. Of that number, Leon said, "6,500 cases have tested positive for rotavirus" and those children have received treatment at hospitals. Leon said authorities have no plans to declare a national health emergency as "only 0.74 of every 1000 children infected have died." According to the Health Ministry, the rotavirus outbreak has spread to 17 of the country's 22 provinces, and the measures promoted by authorities have been unable to stem the illness. Leon said those responsible for the spread of rotavirus "are the parents, because they don't take the sanitary measures that we have stressed so much." Rotavirus infection is transmitted by fecal contamination of food and water that affects mostly children under age five. Its principal symptoms are diarrhea, high fever, abdominal pain, and dehydration.
(Promed 2/17/04)    

USA/Mexico—300 People Fall Ill on Carnival Cruise to Mexico
A Carnival Cruise Lines ship returned from a five day cruise to Mexico on 14 Feb., 2004 with more than 300 people sick with a gastrointestinal illness. Carnival officials said preliminary tests show the outbreak might have been caused by a norovirus. The virus is spread through contaminated food, contact with infected people, or poor hygiene. It can be prevented by regular hand-washing. The Celebration left Galveston 9 Feb., 2004. On Wednesday, Carnival contacted the CDC to report an unusual number of ill passengers, with predominant symptoms of vomiting and diarrhea. By 13 Feb., 2004, 297 of 1576 passengers and 19 of 689 crew members were ill. CDC investigators boarded the 733-foot ship after its regularly scheduled arrival for investigation. Miami-based Carnival said it plans to compensate passengers who got sick. (Promed 2/17/04)    

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2. UPDATES

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WHO announces the influenza vaccine composition for the 2004/05 season
The composition of the influenza vaccine for the 2004/05 season (Northern Hemisphere winter) was announced by the World Health Organization on 13 Feb 2004. The vaccine will contain:   (1) an A/New Caledonia/20/99(H1N1)-like virus; (2) an A/Fujian/411/2002(H3N2)-like virus; (3) a B/Shanghai/361/2002-like virus.   This decision presupposes that the avian influenza A (H5N1) virus currently circulating in East Asia will remain confined to avian hosts and will not acquire by mutation or sub-unit reassortment properties facilitating human-to-human transmission, thereby becoming a novel pandemic virus. The composition is decided by consensus among an international group of influenza experts. The decision has to be taken in February in order to give the manufacturers sufficient time to gear up and produce the vaccine.
(Promed 2/20/04)    

Dengue/DHF update 2004—Singapore
Six areas in Singapore have been identified to have dengue fever: Cornwall Gardens and the Holland area, Marine Terrace and Marine Crescent, Hougang Avenues 8 and 10, Simei Street 3, Thomson Ridge and Sawnage Road. Each area has had two or more cases within 150 meters, occurring within a two-week period. Dengue cases reached a peak last year 2003. A total of 4,772 people fell ill with the disease—the highest number since 1998. The National Environment Agency (NEA) has come up with a plan to bolster its 700-strong Dengue Prevention Volunteer Group. By the end of 2005, 2,000 primary school children will have been trained by the NEA to identify mosquito breeding areas. The youngsters will help keep an eye out for stagnant water in their homes and neighborhoods.  

With six people dying in 2003 from the disease and 4644 people hospitalised, urgent prevention work is needed to stop mosquitoes from breeding, particularly in households. During 2003, 796 households were found breeding mosquitoes, a jump of over 50 percent compared to 2001. Homeowners were issued warning letters after they were found breeding mosquitos, and 451 households were fined after they failed to get rid of the breeding areas. Another 5349 households were also warned for having environments conducive to breeding mosquitos.  

Sri Lanka (Trincomalee)
The North East Provincial health department recently launched an Emergency awareness campaign in Trincomalee to educate the residents of the eastern port town of dengue fever, after medical officials detected 11 suspected positive cases in recent days. One death had taken place. Health officials sought the assistance of students in a house-to-house campaign to educate the residents to keep their houses and premises clean and to destroy all discarded coconut shells, tires, empty tins and bottles, which are considered breeding grounds for mosquitoes.  

Hong Kong SAR
Hong Kong Special Administrative Region's Department of Health confirmed Friday an imported case of dengue fever and urged the public to guard against the disease. The new case is the seventh reported case in Hong Kong in 2004. All of the reported cases are imported, said the department. A 27-year-old man developed fever and headache on 31 Jan., 2004, after he traveled to southeast Asian countries on 10 Jan., 2004. He returned to Hong Kong on 3 Feb., 2004. He has since recovered and been discharged from Hong Kong's Prince of Wales Hospital.  

Australia (Queensland)
Hundreds of people across north Queensland and the Torres Strait have contracted Dengue Fever in recent months. Two hundred people have been infected in the latest outbreak on Thursday Island, and now, for the first time in 100 years, the first death has been reported from the fever's complications. Of the three cases with dengue haemorrhagic fever, two women from Yam Island in the Torres Strait survived, but a female relative living on Thursday Island died. At present, the only method of preventing dengue is to control mosquitoes carrying the virus, so extensive education campaigns encourage north Queenslanders to get rid of containers of water around their homes where mosquitos can breed.  

Honduras
In 2003 health authorities reported 7,397 cases of dengue and 111 of DHF. So far in 2004, there have been three more deaths. In El Progreso, in the Sula valley (capital, San Pedro Sula ) there were two deaths from DHF there in 2003, and 25 cases of dengue were seen there in January 2004, some of them suspected of being DHF. In 2001 there was no dengue in the area, in 2002 there was one case, but from Sep-Dec 2003 there were 1741 cases, including 16 with laboratory confirmation of DHF, one of them fatal, in a 12-year-old boy.  

Indonesia
An outbreak of dengue fever has killed 17 people in the capital and infected thousands more, health officials in Jakarta said. As of Monday, officials said 2518 people in the capital had been hospitalized for dengue—twice the number hospitalized in 2003. Health officials attributed the rise to heavy rains in recent weeks, and the failure to rid the capital of stagnant water and other breeding spots for mosquitos. With a population of 11 million, Jakarta 's crowded conditions and poor sanitation are also a contributing factor in any outbreak. As of 26 February, the Ministry of Health of Indonesia has reported a total of 14,626 cases with 260 deaths (case fatality rate, 1.8%) from 1 January 2004 in all provinces in Java and 2 in Sumatra. Den-3 is the most common serotype circulating, although all four serotypes are present. The health authorities are carrying out tests to determine the specific virus strain responsible for this outbreak. The Ministry of Health has begun intensive space spraying to eliminate the mosquitoes that carry the virus. WHO and the WHO Collaborating Centre, NAMRU-2, are assisting the Ministry of Health with laboratory diagnosis.
(Promed 2/17/04 , 2/24/04)  

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4. ARTICLES

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Interim Guidelines for the Evaluation of Infants Born to Mothers Infected with West Nile Virus During Pregnancy
"West Nile virus (WNV) is a single-stranded RNA flavivirus with antigenic similarities to Japanese encephalitis and St. Louis encephalitis viruses. It is transmitted to humans primarily through the bites of infected mosquitoes. Flavivirus infection during pregnancy has been associated rarely with both spontaneous abortion and neonatal illness but has not been known to cause birth defects in humans (1–4). During 2002, a total of 4,156 cases of WNV illness in humans, including 2,946 cases of neuroinvasive disease, were reported to CDC by state health departments. In 2002, a woman who had WNV encephalitis during the 27th week of her pregnancy delivered a full-term infant with chorioretinitis, cystic destruction of cerebral tissue, and laboratory evidence of congenitally acquired WNV infection (5,6). Although this case demonstrated intrauterine WNV infection in an infant with congenital abnormalities, it did not prove a causal relation between WNV infection and these abnormalities. During 2002, CDC investigated three other instances of maternal WNV infection. In all three cases, the infants were born at full term with normal appearance and negative laboratory tests for WNV infection; cranial imaging studies and ophthalmologic examinations were not performed. During 2003, CDC received reports of approximately 9,100 cases of WNV illness, including approximately 2,600 cases of neuroinvasive disease. CDC is gathering data on pregnancy outcomes for approximately 70 women with WNV illness during pregnancy."
(CDC, unpublished data, 2003)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5307a4.htm
(MMWR February 27, 2004 / 53(07);154-157)  

For more information on West Nile virus, please visit the following website (information available in French, Spanish, Chinese, and Vietnamese): http://www.cdc.gov/ncidod/dvbid/westnile/index.htm    

Fatal Case of Unsuspected Pertussis Diagnosed from a Blood Culture—Minnesota , 2003
 "Pertussis (i.e., whooping cough) is a prolonged cough illness caused by the bacteria Bordetella pertussis and associated typically with an inspiratory "whoop," paroxysmal cough, and posttussive vomiting. B. pertussis can cause severe illness or death, especially in infants who have not completed their pertussis vaccination series. Adolescents (i.e., persons aged 13–17 years), adults, and recently vaccinated persons often report atypical symptoms, resulting in delay of recognition and creation of infectious reservoirs for further transmission. In 2003, the Minnesota Department of Health (MDH) investigated a fatal case of unsuspected B. pertussis infection in an elderly adult. This report summarizes the case investigation, which documents the rare isolation of B. pertussis from blood and underscores the need for clinicians to consider pertussis infection in adolescents and adults who have a prolonged cough illness."
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5306a5.htm
(MMWR February 20, 2004 / 53(06);131-132)

Using the Internet for Partner Notification of Sexually Transmitted Diseases—Los Angeles County, California, 2003
 "An estimated one third of Internet visits by persons aged >18 years are to sexually-oriented websites, chat rooms, and news groups that enable users to view sexual images or participate in online discussions of a sexual nature (1). Although so-called "virtual sex" carries no risk for transmission of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), use of the Internet to find partners for actual sexual activity does carry such risk (2). During 2001–2003, of 759 men who have sex with men (MSM) and who had early syphilis, 172 (23%) reported using the Internet to meet sex partners ( Los Angeles County Department of Health Services [LACDHS], unpublished data, 2003). Because the Internet enables sex partners to maintain anonymity by withholding identifying information (e.g., full name, address, and place of employment), it poses challenges for public health authorities (3). Use of the Internet by public health authorities to notify sex partners of persons with STDs has been reported previously (2). This report describes two cases in Los Angeles County (LAC), California, in which public health officials used the Internet to notify partners who were otherwise anonymous. Local public health authorities might develop similar strategies to use the Internet to reduce transmission of STDs. LACDHS reviewed disease intervention specialist (DIS) interview records to identify cases of online partner notification."  
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5306a4.htm
(MMWR February 20, 2004 / 53(06);129-131)  

Identification of a second bovine amyloidotic spongiform encephalopathy: Molecular similarities with sporadic Creutzfeldt-Jakob disease 
"Abstract: Transmissible spongiform encephalopathies (TSEs), or prion diseases, are mammalian neurodegenerative disorders characterized by a post-translational conversion and brain accumulation of an insoluble, protease-resistant isoform (PrPSc) of the host-encoded cellular prion protein (PrP/C). Human and animal TSE agents exist as different phenotypes that can be biochemically differentiated on the basis of the molecular mass of the protease-resistant PrP/Sc fragments and the degree of glycosylation. Epidemiological, molecular, and transmission studies strongly suggest that the single strain of agent responsible for bovine spongiform encephalopathy (BSE) has infected humans, causing variant Creutzfeldt-Jakob disease. The unprecedented biological properties of the BSE agent, which circumvents the so-called "species barrier" between cattle and humans and adapts to different mammalian species, has raised considerable concern for human health. To date, it is unknown whether more than one strain might be responsible for cattle TSE or whether the BSE agent undergoes phenotypic variation after natural transmission. Here we provide evidence of a second cattle TSE. The disorder was pathologically characterized by the presence of PrP-immunopositive amyloid plaques, as opposed to the lack of amyloid deposition in typical BSE cases, and by a different pattern of regional distribution and topology of brain PrPSc accumulation. In addition, Western blot analysis showed a PrP/Sc type with predominance of the low molecular mass glycoform and a protease-resistant fragment of lower molecular mass than BSE-PrP/Sc. Strikingly, the molecular signature of this previously undescribed bovine PrP/Sc was similar to that encountered in a distinct subtype of sporadic Creutzfeldt-Jakob disease."  
"Proceedings of the National Academy of Science of the USA "
http://www.pnas.org/cgi/content/abstract/0305777101v1
 

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4. NOTIFICATIONS

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Interim Recommendations for Persons with Possible Exposure to Avian Influenza During Outbreaks Among Poultry in the United States  
Outbreaks of avian influenza A occur among U.S. poultry flocks from time to time. Since early February 2004, avian influenza outbreaks have been reported in several locations in the United States, most recently in Texas. This document briefly describes the current outbreak in Texas and provides interim guidance for persons who might be exposed to avian influenza; health-care professionals; and consumers of poultry.  
http://www.cdc.gov/flu/han022404.htm
(CDC 2/24/04)  

WHO guidelines, recommendations, and descriptions regarding avian influenza: http://www.who.int/csr/disease/avian_influenza/guidelines/en/

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