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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 34 confirmed cases, 23 deaths

Viet Nam
WHO is aware of media reports of a new fatal case of H5N1 infection in a 12-year-old boy from a southern province in Viet Nam. According to the media, the boy was hospitalized 13 March and died two days later. WHO has not yet received confirmatory information. If confirmed, this will be the first reported case in Viet Nam since 20 February, when authorities announced infection in a 16-month old girl hospitalized on 16 February.
(WHO 3/22/04)

 Indonesia
Although the spread of bird flu has slowed in most countries, outbreaks have appeared across Indonesia, where government resources are stretched thin. The virus has extended its range in southern Sumatra, while West Kalimantan recently became the latest province to be infected, the U.N. Food and Agriculture Organization (FAO) said. It said the disease is strongly suspected to have also spread to Lombok, Sumbawa, Flores, and West Timor. Although some Asian countries have said their outbreaks are coming under control, international health officials have repeatedly warned that the Asia bird flu crisis isn't yet over. Indonesia has been criticized for waiting months before it acknowledged the existence of bird flu there and for being slow to order culling. The FAO statement said the movement of livestock and livestock products from affected areas to clear zones is a cause for serious concern in Indonesia. Due to inadequate resources, the government is not able to effectively quarantine affected areas, and many farms are not able to apply basic bio-security measures, the statement said.
(Promed 3/22/04)

South Korea
South Korea confirmed Monday its first case of bird flu for more than a month, dashing hopes it had seen the last of the epidemic. The outbreak, discovered at the weekend at a chicken farm in Kyonggi province, was the first new case since 5 Feb 2004, and 16 000 poultry at the affected farm were destroyed. Agriculture Minister Huh Sang-man visited the area and urged thorough disinfection measures to contain the outbreak, the ministry said in a statement. "One farm located in the city of Yangju has tested positive for highly pathogenic avian influenza," it said. Yangju is about 25 miles north of Seoul.

Before the latest discovery, South Korea had destroyed nearly five million poultry and confirmed outbreaks at 19 farms across the country since early December 2003. South Korea 's poultry consumption has been hit badly by bird flu so far in 2004, and exports of chickens and chicken meat to Japan, Hong Kong, and China were halted. South Korea also 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.
(Promed 3/22/04)

Japan
Japan will have spent 104.8 million yen (USD 951 427) by 31 Mar 2004 on emergency measures to eradicate avian influenza, which has broken out in three locations in the country, said Sadakazu Tanigaki, Japan's finance minister. The FAO said that Japan has pledged USD 1.6 million to help Cambodia, Indonesia, Laos, and Viet Nam in their fights against bird flu. The FAO will use the money to provide technical expertise, basic emergency equipment and materials for investigations, culling operations, and cleaning and disinfection of infected premises.
(Promed 3/16/04, 3/22/04)

Singapore
Singapore has suspended all imports of poultry and birds from the Netherlands after bird flu was discovered there, the city state said. "We have received a report that there is a positive diagnosis of avian influenza in the Netherlands," the Agri-Food and Veterinary Authority of Singapore (AVA) said in a statement. "To prevent the disease from entering Singapore, AVA is taking precautionary measures to temporarily suspend the imports of all poultry and birds from the Netherlands with immediate effect. Singapore is free from bird flu," it said. The island imported 447 tons of chicken meat from the Netherlands in 2003, which was valued at USD 502 986.
(Promed 3/22/04)

East Asia — FAO demands poultry tests
Asian countries that declare victory over avian influenza should base such statements on in-depth investigations, FAO and the World Organisation for Animal Health (OIE) urged in a joint statement. There have been fears that Viet Nam is planning to begin poultry restocking before adequate checks have been carried out. Vietnam, where an estimated 38 million poultry died, is expected to declare the virus eradicated later this month. Thailand, whose poultry export business annually tops USD 1 billion, has been forced to cull over 25 million chickens. Like Viet Nam, the country is hoping to restore its poultry industry. But not everyone is confident that Thai assurances that the country remains free from the virus can be trusted — the government denied the existence of the virus for weeks.

"Collaboration between countries and the international community is essential to ensure that the avian influenza virus really is under control and that effective preventive and control measures have been put in place in each affected country and its neighbors," said the FAO and OIE. Both organizations said that they were prepared to provide international experts to assess the epidemiological situation. EU officials have been keen to reiterate that a Europe-wide 6-month ban on the import of all southeast Asian poultry is currently in place, and that the ban will remain in force until categorical proof that the disease has been eradicated.
(Promed 3/22/04)

China — H5N2 inactivated vaccine
China used H5N2 inactivated vaccine to prevent spread of H5N1 strain highly infectious bird flu virus and that has proved to be effective, the Ministry of Agriculture (MOA) said 16 Mar 2004. Jia Youling, MOA spokesman for highly pathogenic avian influenza (HPAI) control confirmed at a press conference that China reported 49 bird flu cases and killed 9 million poultry in the infected areas since the first one was confirmed in Dingdang Town, Long'an County of southern Guangxi Zhuang Autonomous Region 27 Jan 2004. Thanks to compulsory vaccination measures in areas near the infected areas, the bird flu epidemic had been brought under control in China, Jia said. MOA announced 16 Mar 2004 the ending of isolation in the last two bird flu-hit areas, in Nanning of Guangxi and Lhasa of southwest China 's Tibet Autonomous Region. After five years of efforts, Chinese scientists had developed an inactivated vaccine using H5N2 strain virus isolated from goose in Foshan, Guangdong Province, which was found carrying H5N2 strain virus in 1996. They also have made progress in developing H5N1 fowlpox vaccine. Jia said both kinds of vaccines were expected to play a key role in preventing and controlling the spread of bird flu virus in China. Jia said, lab experiments showed that 100 percent of poultry vaccinated with both vaccines proved to be strong enough against bird flu virus.
(Promed 3/18/04)

Cambodia —malaria cases jump 22.5 percent in 2003
Cambodia 's malaria cases jumped by 22.5 percent in 2003 to 132,571 cases, due partly to improvements in reporting but also due to a lack of funding, health officials say. The latest figures from the National Centre for Malaria Control showed that better information was being distributed across the country, encouraging people to seek treatment, program coordinator Neang Sophan Dara from the centre said. However, he also said some activities were held up in 2003 due to a lack of funding, which has been improved by the release of USD 900,000 from the Global Fund for AIDS, Tuberculosis and Malaria to be spent by the end of June 2004. "We had a gap in funding in 2003, so this may have led malaria cases to increase. Funding from the Global Fund didn't come through in 2003," Neang Sophan Dara said.

Malaria is one of Cambodia 's foremost public health problems. In an estimated population of 11.7 million, approximately 500,000 individuals live in forested areas with intense malaria transmission. Prevalence rates range from 15–40 percent in villages near or in forested areas to 0–3 percent in the plains and rice field areas. The resistance situation is difficult, with multiresistance to several drugs including chloroquine and mefloquine, and the Ministry of Health adopted in 2000 a single national treatment policy for falciparum malaria. This recommends a combination of artesunate and mefloquine. The policy also involves the strong promotion of rapid diagnostic tests so that the relatively expensive combination treatment is given only to those who need it. A map of the distribution of malaria in Cambodia can be found at: <http://www.wpro.who.int/themes_focuses/theme1/focus2/map_cam.asp>.
(Promed 3/19/04)

Russia (Karachayevsk-Cherkessia)—Hepatitis A outbreak
One hundred eighty people were diagnosed with hepatitis A, including 142 children. The first cases were registered in December 2003 in the village of Zelenchukskaya in the Autonomous Republic of Karachaevo-Cherkessia. Later hepatitis cases were diagnosed in other parts of Karachayevo Cherkessiya. According to the Sanitary Epidemiological Surveillance Center, the cause of the outbreak was the unhygienic condition of drinking water sources. To limit the outbreak and prevent further spread of hepatitis, vaccination of children and food production staff has begun. In Zelenchukskaya a drinking water pipeline is under reconstruction. Neglect of the public water-supply and drainage infrastructure has been a recurrent feature of recent hepatitis outbreaks in remote parts of Russia. Preventative vaccination is a short-term solution.
(Promed 3/12/04)

Russia (South Urals)—Rise in incidence of Diphtheria
A rise in the incidence of diphtheria has been observed in Chelyabinsk, a major center for industry, culture, and science in the southern Urals; 35 people have been reported with the disease since the beginning of 2004. In March 2004, the first fatal case was reported in a child. The chief physician of the state center on epidemiological diseases, Vyacheslav Alexandrov, acknowledged the rise, but commented that it was expected, because the last mass vaccination for diphtheria was in the 1990s, and the vaccine is known to work for 10 years. In April 2004, mass vaccination from diphtheria will start in the capital of Southern Ural. 12,000 doses of vaccine were bought by the government, but this is far from sufficient; according to physicians' calculations, 170,000 people must be vaccinated. Routine boosters for diphtheria (given as Td) should be given at 10-year intervals, assuming a full primary series, to maintain immunity, especially to fatal disease.
(Promed 3/20/04)

Russia (Komi)—Typhoid fever case registered
A case of typhoid fever was registered in the Siktikvar district of the Komi region in Russia. For Komi, it is an extremely rare disease; no cases were recorded for years, and only two cases were registered in 2003. According to the chief physician of Epidemiology and Surveillance Center, a young woman from Siktikvar has been diagnosed with typhoid fever. The source of infection is not yet known, but the woman is said to have had contact with relatives from Dagestan. At present, all people who had contacts with her are being checked and the woman is undergoing treatment in the hospital. Typhoid fever is transmitted through contaminated water and direct contact with people. As a rule, typhoid fever is more common in southern Russia. To prevent spread of infection, market sanitary hygienic control has been implemented and places where people from the southern regions of Russia reside are being checked.
(Promed 3/16/04)

South Korea —Cholera Warning Issued for Thailand
The Korea Center for Disease Control and Prevention announced 25 Feb 2004, that anyone traveling to Thailand and Southeast Asia where cholera is prevalent must take care of one's hygiene. Nine cases of cholera have been discovered in Thailand, and the cases were caused by eating uncooked food and unboiled drinking water, the center announced. If any traveler returns home with suspicious symptoms like diarrhea and vomiting, the center requested that the individual immediately report to the nearest quarantine station or public health center.
(Promed 3/17/04)

Australia (Northern Territory)—Five cases of melioidosis
The Northern Territory Health Department says there have been five cases of melioidosis in the Territory this year. A 2-year-old girl is the latest victim of the disease and is in critical condition in the Royal Darwin Hospital. However, the health department says it is unusual for children to catch the potentially fatal disease. The disease is spread through bacteria in soil and can enter the body through cuts in the skin; symptoms include headache, fever, and often a non-healing sore. So far this 2003/4 wet season, 15 cases of melioidosis have presented to the Royal Darwin Hospital, the referral center for the endemic Top End region of the Northern Territory. The association between rainfall and cases is well-described. Clustering has also been noted after other severe weather events such as the Katherine floods in Jan 1998 and heavy rainfall after tropical cyclone Thelma in Dec 1998. The disease — with potential use as a bioterror agent — is endemic in the northern regions of Australia.
(Promed 3/19/04, Promed 3/22/04)

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USA —New regulations for BSE
The United States Agriculture Department (USDA) is planning a 10-fold increase in the number of cattle tested for BSE (bovine spongiform encephalopathy) in response to discovery of the nation's first BSE case in December 2003. The USDA announced plans to test more than 221,000 animals over a 12 to 18-month period beginning in June 2004. Included would be 201,000 animals considered to be at high risk of BSE because they show signs of nervous system disorders. Tests also will be conducted on about 20,000 apparently healthy older animals sent to slaughter; these tests are aimed at sampling cattle old enough to have eaten feed produced before 1997, when the use of cattle tissue in cattle feed were banned. The government during 2003 conducted BSE tests on tissues from 20,543 animals, virtually all of which were cattle that could not stand or walk. After the case in December 2003, the department initially doubled the number of animals to be tested in 2004 to 40,000. The expanded testing regime announced is a one-time deal only. Dr. Ron DeHaven, the USDA's top veterinarian, said the need for testing in the range of 200 000 animals a year will be re-evaluated once the initial round is completed.

Agriculture Secretary Ann Veneman estimated that the new testing will cost USD $70 million. She said the expanded testing reflects the recommendations of an international scientific review panel she appointed a week after BSE was confirmed in a Washington 9 Dec 2003.

Before BSE, exports accounted for about 10 percent of the nation's more than 26 billion pounds of beef produced each year. Nearly 50 countries imposed bans on American beef after the first US case was confirmed. Poland has lifted its ban and Mexico has relaxed its prohibitions, but major importers like Japan and South Korea have said they will not import American beef until all 35 million cattle slaughtered in the US each year are tested. The new US testing plan still does not meet Japanese requirements, said a Japanese agricultural official.

The Agriculture Department expects to announce soon a new system of rapid tests that will make the increased surveillance possible. The National Cattlemen's Beef Association (NCBA) supported the limited-duration testing program, but said the new rapid tests may potentially label animals as BSE-infected when they are not (false positives). The Department has said any positive results from the rapid tests will be verified by more exact tests. The rapid tests could be done at laboratories around the nation, as well as the department's National Veterinary Services Laboratory (NVSL) in Ames, Iowa, currently the only facility that can do testing.
(Promed 3/18/04)

Canada —Feed in Mad Cow Investigation is Traced to Two Mills in Canada
Canadian officials have traced to two mills the feed that probably caused North America's two cases of mad cow disease, one in Canada in May 2003 and the other in the United States in December 2003. The feed from these mills could have contained infectious protein from imported British cattle, said Dr. George Luterbach, an official from the Canadian Food Inspection Agency (CFIA). Canadian law prohibits disclosing the identity of the mills. Both North American cases had been raised in Alberta, and both ate feed containing meat and bone meal while they were calves. "Our best hypothesis was the animals were exposed by contaminated feed," Dr. Luterbach said. In both animals, the feed was presumably given to them as calves just before Canada and the US banned the use of cattle tissues in feed intended for cattle in 1997. Dr. Luterbach said the feed could have contained tissue from infected cattle imported from Britain before Canada banned the importation of British cattle after an outbreak of mad cow disease there.

Canadian investigators had performed mad cow tests on all they could find of the 192 British cattle imported to Canada from 1980 to 1989, when Canada banned such imports, Dr. Luterbach said. The investigators followed the cattle until 1993, but could not find 68 animals that died or were culled. Protein from those animals could have been processed into feed, he said. The feed would have been shipped in large batches to individual farms and consumed in about a week, he said, and would not have been widely distributed.
(Promed 3/23/04)

 USA —Testing for Avian influenza
Government and poultry industry officials intend to expand testing for bird flu to cover most of the poultry raised in the US, an Agriculture Department official said. The $12.5 million program would focus on the most dangerous forms of the most common variety, low pathogenic avian influenza. These forms, H5 and H7, if left to spread, can mutate into highly pathogenic varieties that can kill entire flocks in a day. The new testing system could take effect 29 Mar 2004, assuming it gets final Bush administration approval, said Andrew Rhorer, senior coordinator of the Agriculture Department's Poultry Improvement Plan.

Until now, low-path bird flu received a low priority from regulators. The disease is found globally, and governments are not required to notify international livestock health officials when an outbreak occurs. High-path flu, on the other hand, does require notification, which triggers poultry export embargoes by uninfected countries. But even the low-path form can be economically devastating. Sick chickens do not grow as fast as healthy ones, so growers have to keep the birds longer and spend more on feed. States sometimes order flocks killed and have quarantined infected farms to prevent the virus from spreading. In addition, importing nations sometimes ban exports from low-pathogenic infected areas. Current testing for low-path bird flu focuses on birds raised for breeding that will be exported to nations which require certification that the animals are free of low-path bird flu. State health officials also test flocks if the birds show signs, but there is currently no federal testing program for low-path bird flu.
(Promed 3/13/04)

Colombia, Peru —Yellow Fever
Following the two epidemic peaks occurring on the Colombian–Venezuelan border in 2003 during January and July—which affected the states of Zulia, Norte de Santander, and Cesar—authorities began to detect in December 2003 some new cases of yellow fever originating in the region of Sierra Nevada de Santa Marta, departments of Cesar, Magdalena, and La Guajira. This new outbreak brought the total number of cases to 28 with 11 deaths, bringing the fatality rate to 39 percent. The municipalities most affected were Santa Marta (with 14 cases), Valledupar (7 cases), and Dibulla (5 cases). By 16 Feb 2004, the Virology and Pathology Laboratories of the National Institute of Health had received a total of 850 samples from suspected human cases, of which 28 were positive for yellow fever. During this same period, three more cases unrelated to the Colombian outbreak were detected in Meta (2 cases) and Amazonas in Peru (1 case).

The broad dissemination and high density of the mosquito Aedes aegypti, linked to the increase of human traffic back and forth within the region, brings with it the risk of yellow fever being reintroduced into the urban centers of the Americas. The prevention of jungle yellow fever is only possible by means of vaccination. In the urban form of the disease, prevention is also possible through the implementation of vector-control measures in addition to vaccine use. Following the outbreaks in Colombia in 2003 and early 2004, there has been a strengthening of epidemiological surveillance and laboratory diagnosis. As a preventive measure to avoid reemergence of the urban form of the disease, there has been a strengthening of vector-control measures. There is a need to maintain these actions and to continue to incorporate PAHO recommendations into activities to prevent and control JYF and to deter its possible re-urbanization.
(Promed 3/14/04)

USA —Disease early warning system, climate and GIS-based
With the help of satellites, scientists can identify high-risk "hot spots" for deadly diseases before outbreaks strike. Last year more than a million people died of malaria, and outbreaks of Dengue Fever, hantavirus, West Nile Fever, Rift Valley Fever, and Plague still occasionally strike some regions. When an outbreak occurs, often it is because environmental conditions such as rainfall, temperatures, and vegetation allow population surge in disease-carrying pests.

Scientists have been trying to watch these environmental factors and warn when conditions are ripe for an outbreak. The idea was first expressed by the Russian epidemiologist E. N. Pavlovsky in the 1960s. Ronald Welch of NASA's Global Hydrology and Climate Center in Huntsville, Alabama, is one of the scientists working to develop such a system. The approach employed by Welch and others combines data from high-tech environmental satellites with old-fashioned fieldwork. Scientists seek out and visit places with disease outbreaks, and then scrutinize satellite images to learn how disease-friendly conditions look from space. The satellites can then watch for those conditions over an entire region. In India, for example, where Welch is doing research, health officials are talking about setting up a satellite-based malaria early warning system for the whole country. Welch is hoping to do a pilot study in Mewat, a predominantly rural area of India south of New Delhi. "We expect to be able to give warnings of high disease risk for a given village or area up to a month in advance," Welch says. "These 'red flags' will let health officials focus their vaccination programs, mosquito spraying, and other disease-fighting efforts in the areas that need them most, perhaps preventing an outbreak before it happens."

Outbreaks are caused by a bewildering variety of factors. For the mosquito species that carries malaria in Welch's study area, for example, an outbreak hotspot would have pools of stagnant water. A malaria hotspot would be warmer than 18°C, because in colder weather, the single-celled plasmodium parasite that causes malaria operates too slowly. But the weather must not be too hot, or the mosquitoes would have to hide in the shade. The humidity must hover in the 55% to 75% range that these mosquitoes require for survival. Preferably there would be livestock within the mosquitoes' 1 km flight range, because these pests prefer to feed on the blood of animals. Documenting some of these factors, such as soil type and local bucket-leaving habits, requires initial field work, and are plugged into Geographical Information Systems database (GIS). Other factors, like the locations of cattle pastures and human dwellings, temperature, rainfall, and vegetation types are also inputted into the GIS map. A computer simulation that runs on top of a digital map of the landscape can then provide an estimate of outbreak risk.

The basic soundness of this approach for estimating disease risk has been borne out by previous studies. A group from the University of Nevada and the Desert Research Institute were able to "predict" historical rates of deer-mouse infection by the Sin Nombre virus with up to 80% accuracy, based only on vegetation type and density, elevation and slope of the land, and hydrologic features. A joint NASA Ames / University of California at Davis study achieved a 90% success rate in identifying which rice fields in central California would breed large numbers of mosquitoes and which would breed fewer. These encouraging results suggest that reasonably accurate risk estimates can be achieved by combining fieldwork with new satellite technologies.
(Promed 3/13/04)

Mexico (Yucatan)—Outbreak of Varicella
An outbreak of varicella (chickenpox) that so far has affected more than 1,000 persons, both children and adults, has placed the health authorities of the state of Yucatan on alert, as they face the risk of acute dissemination of the disease over the coming weeks. Jose Pereira Carcano, Health Secretary, indicated that to date, 1060 cases of the disease have been reported throughout the state, a number more than 100 percent higher than that registered during the same period in 2003. In addition, over the past few weeks, health officials have detected rotavirus infection in some 30 people as well as eight cases of dengue fever, one of which was of the haemorrhagic type. These findings have contributed to the concern expressed by health authorities.
(Promed 3/18/04)

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2. UPDATES

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New Human Coronavirus Identified
Dutch scientists have announced they had identified a previously unknown coronavirus that causes respiratory disease and is likely to have spread around the world. The virus is only the fourth coronavirus to be found in nearly four decades and could explain many cases of unexplained respiratory illness. Named HCoV-NL63, the virus causes symptoms similar to a bad cold and does not unleash the pneumonia characterized by severe acute respiratory syndrome (SARS) coronavirus. Young children and people whose immune system has been compromised by HIV or other diseases are more at risk although not apparently fatally so.

In a study published online by the journal Nature Medicine, the University of Amsterdam team reports their work, launched after a 7-month-old girl was admitted to their hospital in April 2003 with bronchiolitis. Tests for common cold viruses, influenza virus, and other well-known respiratory viruses all proved negative. Closer examination of its genetic code showed it shares about 2/3 of its nucleotides with the three established coronavirus human coronaviruses. It was an independent member of the coronavirus family that had never been spotted before.

The team then tested stored samples taken from other admissions and found that another seven patients with respiratory problems — seven percent of admissions — had been infected by the same virus. "This novel coronavirus is already widespread in the population," said Lia van der Hoek. Dr Berkhout admitted it was "surprising" that this virus had never been found before, but part of the problem was the lack of tools to detect new agents easily. In general, coronaviruses are usually transmitted by airborne droplets breathed in from someone in proximity. The paper is published in the current online edition of Nature Medicine: "Identification of a new human coronavirus, by Lia van der Hoek, Krzysztof Pyrc, Maarten F. Jebbink, Wilma Vermeulen-Oost, Ron J. M. Berkhout, Katja C. Wolthers, Pauline M. E. Wertheim-van Dillen, Jos Kaandorp, Joke Spaargaren, Ben Berkhout University of Amsterdam."
(Promed 3/22/04)

 Global Human Influenza Surveillance
Influenza activity remained low in most parts of the world. Only Hong Kong and Japan reported high levels of influenza A (H3N2) virus infection.

Canada
During weeks 9–10, influenza activity was reported as sporadic or "no activity" in most of Canada, while in Quebec and parts of Nova Scotia and Newfoundland, localized activity was reported. The Influenza-like Illness (ILI) consultation rate was below the expected range for this time of year.

Hong Kong, SAR China
Influenza activity continued to increase in weeks 9-10 when a number of outbreaks in schools were reported. Most of the isolates were identified as influenza A (H3N2) virus.

Japan
Influenza activity continued to decrease in weeks 9-10 but was still reported as regional activity for week 10. From 20 of 47 reporting prefectures, the ILI consultation rate was below the epidemic threshold.

Russia Federation
Influenza activity continued to decline. In week 9, the influenza morbidity was below epidemic threshold in all regions under surveillance. In week 10, no influenza virus was detected.

United States
Influenza activity remained low during week 9, when the ILI consultation rate remained below national baseline, and no reports of widespread activity were received from individual states. Mortality due to pneumonia and influenza continued to decline and to be below epidemic threshold for the first time in the past 10 weeks.

Dengue/DHF update:

 Indonesia
The death toll of dengue fever across Indonesia since January 2004 has increased to 427, while the number of sufferers has reached some 35,000, the health ministry said Friday. Jakarta is still the most infected area, and 12 of the 30 infected provinces have extraordinary numbers of cases. The current attacks differ from the normal 5-year cycle mainly due to the change of rainy season from October, November, and December to January and February. The disease has been widespread in Indonesia since 17 Jan 2004.

Vietnam
Dengue fever has killed at least five people and infected 3,300 others in Vietnam so far in 2004, doubling the number of infections in the same period last year. The disease is found mostly in southern Vietnam, with 93 percent of the patients from Ho Chi Minh City and surrounding provinces in the Mekong Delta. Pham Ngoc Dinh, deputy director of the Institute of Hygiene and Epidemiology in Hanoi, said so far Vietnam 's northern region has not been affected, but health officials have been warned about the possible spreading of the virus. Dengue fever normally strikes Vietnam every year from April, the start of the rainy season.

New Caledonia
Health authorities in New Caledonia have begun a new television advertising campaign warning the population they need to take action to combat dengue fever. Last year 17 people died from the dengue fever outbreak in New Caledonia, which peaked in March and April. An epidemiologist with the Pasteur Institute has said that he is alarmed by the fact that the number of reported cases of dengue at the end of February this year 2004 was the same as for February last year. Health authorities believe that the heavy rains that accompanied Cyclone Ivy and the current hot weather have created ideal breeding conditions for the dengue-carrying mosquito.

Venezuela
In the first week of 2004 there were 901 cases of dengue, including 82 cases of DHF. Cases are increasing, and the situation is classified as an outbreak. The population under 15 years old represents 50.2 percent of total cases. Most cases are from the Capital District (144). The morbidity rate is 3.5 per 100,000 pop. In 2003 there were a total of 26,996 cases of dengue (8.3 percent were DHF) and the morbidity rate was 105.7 per 100,000 pop.

Brazil (Minas Gerais)
The State Health Secretary of Minas Gerais registered as of 2 Mar 2004, 1,502 cases of dengue in 2004, including six cases of DHF. This compares with 646 cases of dengue in the first two months of 2003. The most affected regions are Leste & Triangulo Mineiro. This is in contrast to the rest of Brazil, where dengue case counts are well below those of 2003.
(Promed 3/13/04)

Viral gastroenteritis update:

Canada (British Columbia)
The British Columbia Centre for Disease Control (BCCD) has confirmed that oysters are behind a rash of illnesses reported over the past couple of months. The BCCDC issued an advisory last month warning people to cook all oysters before eating them. BCCDC epidemiologist Laura McDougall says the problem is the common norovirus. "We have been able to detect the virus in clinical samples — samples from human that became ill." McDougall says the number of cases of norovirus illness being reported has dropped off dramatically in the last few weeks.

USA (Alaska)
State health officials mingled with race officials and visitors on the trail of the Iditarod Trail Sled Dog Race trying to control an outbreak of highly contagious norovirus infection. Dr. Joe McLaughlin, an epidemiologist with the state Department of Health, said a dozen cases have been traced to McGrath, but the illness has traveled to Anchorage and the village of Ruby. "Severe bouts can lead to dehydration," he said. "That's why it's such a concern among the athletes" who already may be dehydrated from their race.

USA (Washington D.C.)
An outbreak of norovirus infection has occurred at a nursing facility in Northwest D.C. A spokeswoman of The Washington Home says that the outbreak of gastroenteritis began about two weeks ago, but the number of people who have come down with it has increased in the past few days. The Washington Home has reportedly stopped admitting new patients until further notice, and visits have been suspended. Nursing homes in Northern Virginia were recently hit by an outbreak also believed to have been caused by norovirus. At Terra Centre Elementary in Burke, officials cleaned the building last month after about 50 children came down with the illness.

USA (Texas)
Contaminated raw oysters sickened dozens of conventioneers in Galveston during February 2004, the county health district announced. Norovirus was detected in stool specimens from two cases. The oysters were served at a catered meal at the Lone Star Flight Museum on 27 Feb 2004. Most of the 47 people who fell ill at the convention had eaten the oysters. The oysters came from a part of Galveston Bay subsequently closed to harvesting by state health authorities. The health district declined to identify the caterers but said they were based outside Galveston County.

USA (Nevada)
The Health Department in Las Vegas says that since 3 Dec 2003 1174 people who stayed at the California Hotel and Casino have reported suffering from norovirus infection. The number has been rising as more people come forward after seeing news reports on the outbreak. Most of those sickened are Hawaii residents; Boyd Gaming Corp., which owns the California, sells many Las Vegas packages to people in Hawaii. A California spokesman said that the hotel has stepped up cleaning practices, but the Clark County Health Department said it cannot give a clean bill of health until it has observed a sustained decline for a period of at least one month.

Russia (Sverdlovsk Region)–rotavirus
In the city of Irbit (Sverdlovsk) 154 people were hospitalized as a result of an outbreak of intestinal infection, according to Sanitary epidemiological center physician Alexandr Rostyuk. "At the present time, 154 people are hospitalized, of them 113 are children under 2 years old. Most of the victims are suffering with rotavirus enteritis". Chlorination measures were launched and physicians are recommending the use of boiled water only and sanitary hygiene rules. Twelve kindergartens in the city are under quarantine. He indicated that the outbreak of intestinal infection was due to contamination of the public drinking water supply by spring flood water.
(Promed 3/13/04, Promed 3/19/04)

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4. ARTICLES

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Canada provides additional funding to the final assault against polio
The spearheading partners in the global fight to eradicate polio — WHO, Rotary International, US CDC and UNICEF — today welcomed Canada ’s announcement of an additional US$ 9.7 million to support the global polio eradication campaign. The contribution comes in response to an intensification of eradication efforts in the few countries that remain polio-endemic. "These new funds come at a critical juncture for us," said Dr David Heymann, Representative of the Director-General for Polio Eradication, WHO. "Polio has been beaten back to just a few remaining strongholds, mainly in Nigeria, India and Pakistan. The goal is to finish the job by the end of 2004 — but to succeed, eradication efforts must be intensified, and this means more financial resources are urgently needed. This contribution from Canada could not come at a more important time." The donation, made through the Canadian International Development Agency to WHO and UNICEF, becomes the most recent contribution made in fulfillment of the G8’s pledge to support polio eradication.

The contribution is in addition to a commitment by CIDA to provide one dollar for every three dollars raised by Canadian Rotarians for polio eradication. The partners urged the global community to follow Canada ’s lead and provide the necessary resources. The poliovirus is now circulating in only six countries (Nigeria, India, Pakistan, Niger, Afghanistan and Egypt), down from over 125 when the Global Polio Eradication Initiative was launched in 1988. http://www.who.int/mediacentre/releases/2004/pr_canadapolio/en/print.html
(WHO 3/11/04)

Trends in Tuberculosis — United States, 1998--2003
“During 2003, a total of 14,871 tuberculosis (TB) cases (5.1 cases per 100,000 population) were reported in the United States, representing a 1.4% decrease in cases and a 1.9% decline in the rate from 2002. This decline is the smallest since 1992, when TB incidence peaked after a 7-year resurgence. In addition, the rate remains higher than the national interim goal of 3.5 cases per 100,000 population that was set for 2000. This report summarizes data from the national TB surveillance system for 2003 and describes trends during a 5-year period, with comparison to 1998 and 2002. Despite a decline in TB nationwide, rates have increased in certain states, and elevated TB rates continue to be reported in certain populations (e.g., foreign-born persons and racial/ethnic minorities). Targeted interventions for these at-risk populations, continued collaborative efforts toward the global fight against TB, and adequate local resources are essential to eliminating TB in the United States.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5310a2.htm
(MMWR March 19, 2004 / 53(10);209-214)

School-Associated Pertussis Outbreak — Yavapai County, Arizona, September 2002 —February 2003
“On September 21, 2002, a pertussis case (confirmed by isolation of Bordetella pertussis) was reported to the Yavapai County Health Department (YCHD). The patient was a child aged 13 years in the 8th grade at a middle school in Yavapai County ; the child had attended school during the illness. A case consistent with the clinical definition of pertussis had been reported in another student in the same classroom two weeks earlier. On September 22, a second culture-confirmed case was reported from the same classroom. Subsequent investigation identified five additional persons (two students in the same classroom, two 8th-grade teachers, and one parent of an ill student) with prolonged cough illnesses. In comparison, during the previous 10 years, an average of four pertussis cases were reported annually from this county. On September 26, YCHD, in conjunction with the Arizona Department of Health Services (ADHS) and school officials, notified the community of the pertussis outbreak in the middle school and initiated control measures. This report summarizes the epidemiology of the outbreak and the control measures used to contain it. Health-care providers should consider pertussis in persons of any age with acute cough illnesses and consider obtaining nasopharyngeal (NP) specimens for B. pertussis culture.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5310a4.htm
(MMWR March 19, 2004 / 53(10);216-219)

Immunogenicity of a highly attenuated MVA smallpox vaccine and protection against monkeypox
Abstract: "The potential use of smallpox as a biological weapon has led to the production and stockpiling of smallpox vaccine and the immunization of some healthcare workers. Another public health goal is the licensing of a safer vaccine that could benefit the millions of people advised not to take the current one because they or their contacts have increased susceptibility to severe vaccine side effects. As vaccines can no longer be tested for their ability to prevent smallpox, licensing will necessarily include comparative immunogenicity and protection studies in non-human primates. Here we compare the highly attenuated modified vaccinia virus Ankara (MVA) with the licensed Dryvax vaccine in a monkey model. After 2 doses of MVA or one dose of MVA followed by Dryvax, antibody binding and neutralizing titres and T-cell responses were equivalent or higher than those induced by Dryvax alone. After challenge with monkeypox virus, unimmunized animals developed more than 500 pustular skin lesions and became gravely ill or died, whereas vaccinated animals were healthy and asymptomatic, except for a small number of transient skin lesions in animals immunized only with MVA." Published in the 11 Mar 2004 issue of Nature (Nature, 428, 182-185, 2004.
<http://info.nature.com/cgi-bin24/DM/y/eOH60Bfvsv0Ch0JiB0AR>).
(Promed 3/11/04)

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4. NOTIFICATIONS

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The Food and Agriculture Organisation (FAO) and the World Organisation for Animal Health (OIE) have held an emergency meeting on avian influenza control in Asia, during 26-28 Feb 2004. The published report can be seen at: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/avian_recomm.html

Every breath counts — stop TB now!
"Every breath counts — stop TB now!" is the theme for World Tuberculosis Day 2004. The day will coincide with the opening of the second Stop TB Partners Forum, to be held in India, the country with the world's highest TB burden. For more information, visit the “Stop TB” website: http://www.stoptb.org/

World TB Day — March 24, 2004
This annual event commemorates the date in 1882 when Dr. Robert Koch announced his discovery of the tuberculosis (TB) bacillus. Worldwide, TB remains a leading cause of death from infectious disease. An estimated 2 billion persons (one third of the world's population) are infected with the bacteria that cause TB. Each year, approximately 8 million persons become ill from TB; of these, 2 million die. World TB Day provides an opportunity for TB programs, non-government organizations, and other partners to describe TB-related problems and solutions and to support TB-control efforts.

During 1985–1992, after years of decline, the number of TB cases reported in the United States increased 20%. Renewed emphasis on TB control and prevention has produced substantial gains in the United States, but provisional data indicate that 2003 marked the smallest annual decline in new TB cases since 1992. These data raise concerns that increased efforts might be required to maintain the progress made in controlling TB. CDC is committed to eliminating TB in the United States. Achieving this goal demands targeted interventions for populations at high risk, active involvement in the global fight against TB, and strong local programs. Additional information about World TB Day and CDC's TB-elimination activities is available at http://www.cdc.gov/nchstp/tb/worldtb2004/default.htm.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5310a1.htm
(MMWR March 19, 2004 / 53(10);209)

Association of Pacific Rim Universities presents “Infectious Diseases and the Society”
The conference will be held from July 7–9, 2004 at Fudan University, Shanghai, China. The conference theme of “Infectious Diseases and the Society” aims to look at the development of infectious diseases research as well as the impact and implications of infectious diseases on social and public health. Target participants are public health experts, social scientists and others involved in community health, as well as the medical and scientific community. The objective is to provide a platform for APRU universities to exchange and share information on research and other public health initiatives in the field of infectious diseases. For more information, visit www.fao.fudan.edu.cn and/or email 2004infesoc@fudan.edu.cn

Second International Workshop and Scientific Meeting "Leptospirosis – Havana 2004"
“The "Pedro Kouri" Tropical Medicine Institute (IPK), Havana, Cuba, is honored and pleased to invite you to the Second International Workshop and Second Scientific Meeting "Leptospirosis – Havana 2004" to be held in Havana City, 17–28 May 2004. The Cuban Ministry of Public Health (MINSAP), the "Pedro Kouri" Tropical Medicine Institute (IPK), the Pan American Health Organization (PAHO), the Third World Academy of Sciences (TWAS), and the leading institutions and professionals in the Leptospirosis field will support this event. We would like to encourage your participation, which will enrich the exchange of knowledge and experience in controlling leptospirosis infection. For further information please visit: <http://www.ipk.sld.cu/eventosipk/leptospirosis_2004.htm> (Spanish) <http://www.ipk.sld.cu/eventosipk/leptospirosis1_2004.htm> (English)

Avian Influenza Surveillance Timeline
A recent timeline of avian influenza outbreaks in East Asia in humans and animals as reported by WHO is posted on the APEC EINET website. Please visit: http://depts.washington.edu/apecein/

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