1.
OVERVIEW OF INFECTIOUS-DISEASE INFORMATION
Below is a semi-monthly summary of Asia-Pacific emerging infectious diseases.
ASIA
Vietnam ( Mekong Delta) — No
H5N1 virus found in dead poultry
The H5N1 strain of avian
influenza virus was not found in dead poultry in the Mekong Delta
province of Dong Thap , but the H5 virus was, a veterinary official
has confirmed. In early May 2004, it was rumored that bird flu had
reoccurred in the province. In fact, there was an outbreak of bird
flu in the province's Cao Lanh Township , after the province had
declared itself free from the virus. Although it was contained right
afterwards, Bui Quang Anh, Director of the Ministry of Agriculture
and Rural Development's Veterinary Department, said that bird flu
might reoccur unless strict measures are taken to control the import,
trading, and slaughtering of poultry. Veterinary workers are checking
the remaining poultry in the areas.
Viet Nam declared itself free from H5N1 virus 30 Mar 2004 . The
bird flu epidemic caused a total loss of more than USD 82 million,
of which the mass culling of poultry in bird flu-affected areas
cost more than USD 63 million. In addition, the epidemic has caused
an increase in food prices in the domestic market and environmental
pollution in the bird flu-hit areas. On top of the economic losses,
Viet Nam suffered at least 16 fatalities in human patients. A Vietnamese
program for the testing of all breeding farms — requiring
compliance before they may once again begin supplying chicks to
the sector, and, also, requiring a three-month delay before allowing
depopulated farms to restock — was made public in early Apr
2004. These farms were said to be being monitored for at least
three weeks after their restocking.
(Promed 5/7/04, 5/12/04)
Thailand — New bird flu outbreak
delays announcement of all-clear
Thai authorities announced
a new outbreak of bird flu, forcing them to delay for the fourth
time an announcement that the kingdom is free of the deadly virus.
Thailand was expected to declare the all-clear 27 Apr 2004 but
the discovery last week of bird flu in Uttaradit province meant
it had to be postponed until next month, deputy agriculture minister
Newin Chidchob said. Newin said outbreaks in two other provinces
reported earlier this month, which dashed hopes that Thailand
had put the crisis behind it, were either cleaned up or in the
process of being eradicated. "Uttaradit is the
only province which currently still has a problem and must be under
surveillance," he said, adding that the 21-day monitoring
period there were to expire 10 May 2004 .
Thailand slaughtered at least 36 million poultry and slapped
quarantine regulations on affected zones in an effort to halt the
spread of the disease which hit 41 of its 76 provinces. The kingdom
has reported 12 bird flu infections in humans, including eight
deaths. Bird flu has swept through 10 countries in Asia and also
killed 16 people in Vietnam . Thai authorities have been anxious
to end the crisis which decimated its massive poultry industry,
but UN health officials cautioned against a premature announcement
that the virus has been eradicated. Thailand originally planned
to declare itself free of the disease by the end of February 2004,
but was forced to backtrack when nine more cases were announced
16 Feb 2004 . A similar announcement was then put off 16 Mar when
fears surfaced that bird flu had re-emerged in 11 provinces.
(Promed 4/27/04)
China — Test developed for simultaneous
diagnosis of subtypes exhibited by highly pathogenic avian influenza
virus strains
A multiple real-time fluorescent test
re-agent kit has been successfully developed for testing H5,
H7, and H9 subtypes of avian influenza virus in Shenzhen , Guangdong
province. A reverse transcriptase polymerase chain reaction (RT-PCR)
test, the reagent kit is able to test for three haemagglutinin
antigen subtypes of avian influenza virus simultaneously, instead
of only one subtype at a time, said Tian Bo, head of the appraisal
team at the Chinese Academy of Sciences. Experts from the team
held that the test re-agent kit is efficient and easy to use.
It is suitable for use in poultry quarantine, human disease control,
and epidemiological investigation.
Avian influenza is an infectious disease of waterfowl and poultry
that has jumped to humans. Blessed with a dense water network,
Shenzhen is a transient home to migrant birds and a major supplier
of live poultry for adjacent Hong Kong . As early as in August
2002, the local quarantine bureau began to employ the fluorescent
RT-PCR test approach to examine poultry to be supplied to Hong
Kong ; the test took about 4 hours. To lower the test cost and
raise test efficiency, researchers from the bureau have worked
with Shenzhen Taitai Gene Co, Ltd. to develop a new-type fluorescent
RT-PCP reagent kit. The scientific outcome, with independent patent,
has met the world standards, according to Liu Shengli, head of
the local entry and exit quarantine bureau.
This test may prove useful in monitoring avian influenza virus
infection in the current epidemiological situation in East Asia
, provided that the test is authenticated by external evaluation
and its production, testing, and use are subject to strict regulation
and quality control by a relevant governmental agency. It does
not identify any other of the 15 haemagglutinin subtypes of avian
influenza virus currently recognized, which potentially could initiate
disease outbreaks in domestic poultry. Nor does the test identify
any of the nine recognized neuraminidase antigenic subtypes, which
can be relevant in distinguishing epidemic strains.
(Promed 4/29/04)
China: SARS investigation continues
Investigation
of the source of the current outbreak — first
reported 22 Apr 2004 — continues to focus on the National
Institute of Virology in Beijing . The institute is known to have
conducted experiments using the live SARS coronavirus during Feb
and Mar 2004. Two researchers at the institute developed SARS late
Mar and mid-Apr 2004. However, neither is known to have conducted
research using the live virus, suggesting some other source of
infection within the laboratory or, possibly, elsewhere. Members
of a joint WHO-Chinese investigative team, wearing full personal
protective equipment, entered the institute 30 Apr and again 4
May 2004 . Initial findings indicate that the investigation will
be complex, as no single infectious source, or single procedural
error, appears likely to explain the infection in the two researchers.
Continuing investigation is needed to determine the source of infection
and to ensure that conditions, equipment, and bio-safety procedures
within the institute do not pose an ongoing risk of SARS infection.
A large number of samples from various locations within the institute
were taken for analysis at the WHO SARS laboratory in Hong Kong
.
WHO has strongly recommended that work using the live SARS virus
be conducted in bio-safety level 3 facilities in order to minimize
the risk of laboratory-acquired infections. Further investigation
of the institute is needed to ensure that any work using the
live virus fully complies with the strict requirements for physical
containment of the virus. The National Institute of Virology
was closed 23 Apr 2004 , and most of its staff was quarantined
for medical observation.
(Promed 5/5/04)
China: SARS situation update
Beijing
has reported the confirmation of three previously reported suspected
cases of SARS. During this period there have been no reports of
other cases from other provinces. The three cases are the father
of the nurse who cared for the index case from Anhui , a patient
on the same ward as the nurse, and a visitor of this latter patient.
Confirmation was made through IgM and IgG antibody testing and
the combined clinical and epidemiologic histories of these cases.
The first case in Beijing (the nurse who cared for the index case
from Anhui) is in good condition, with 18 consecutive days without
fever and will be discharged from the hospital shortly. The other
six cases in Beijing will remain in isolation at the Ditan Hospital
; 99 close contacts have been released from observation. The index
case in Anhui has now had 11 consecutive days without fever and
will shortly be discharged from the hospital; 89 close contacts
have been released from observation. Since 22 Apr 2004 , Anhui
province has reported two cases of SARS and Beijing has reported
seven cases. Confirmation of these laboratory results by an independent
outside reference laboratory is pending.
(Promed 5/4/04)
Viet Nam — Care for HIV-infected
rises 10%
A five-year project designed to help people
with HIV/AIDS receive better medical care has begun in HCM City
. The number of AIDS patients getting access to specialized medical
treatment will increase by 10 per cent every year with the program. "The
project aims to increase community-based health care and information
services for infected people including children and pregnant
women in areas with high annual growth rates of HIV/AIDS," Dr
Trinh Quan Huan, director of the project, said. The 20 targeted
areas include HCM City , Quang Ninh, Hai Phong and An Giang.
High-risk group members like drug addicts and sex workers will
continue to get regular health checks, with 90 per cent of those
receiving rehabilitation at detoxification centers and camps
to be encouraged to carry out voluntary HIV testing, he said. "To
make the services available for the patients, authorities and
health agencies in these cities and provinces will establish
good community-based care and counseling systems, and at least
80 per cent of hospitals and medical centers will be installed
with basic equipment for detecting the virus and protecting health
workers from the disease," Huan said.
Prevention techniques for mother-to-child transmission will continue
to intensify at seven obstetrics hospitals nationwide alongside
the establishment of medical treatment centers for child patients
at the Ha Noi-based Pediatric Institute and Pediatric Hospital
1 in HCM City . As many as 230 million condoms will be distributed
over five years, with five million going out free. In addition,
condom marketing and research programs will be supported under
the project. The project will launch a major public relations campaign
to increase public awareness about the proper use of condoms to
effectively prevent sexually transmitted diseases including HIV/AIDS.
In addition to funding from the Vietnamese Government, the program
has received financial support from the World Health Organization
and the Global Fund to Fight AIDS, Tuberculosis and Malaria. http://vietnamnews.vnagency.com.vn/2004-04/22/Stories/11.htm
(SEA-AIDS 4/29/04)
Hong Kong — EV-71-associated case
of hand, foot & mouth disease
The Department of
Health confirmed 26 Apr 2004 a case of Enterovirus-71 (EV-71)
infection. The case is a 2-year-old boy who became ill 10 Apr
2004 with fever and rash over hands and mouth. He was admitted
to Queen Elizabeth Hospital 14 Apr, discharged 15 Apr, and recovered.
He had not traveled recently. The Department of Health urged the
public to stay alert to the threat of EV-71 infection and take
preventive measures: wash hands before eating and after going to
toilet and changing diapers; cover mouth and nose when coughing
and sneezing; maintain good ventilation; clean thoroughly toys
or appliances which are contaminated by nasal or oral secretions.
Parents are advised to seek medical advice if their children develop
symptoms of hand, foot and mouth disease. Children suffering from
the infection should stay at home and avoid contacting other children
until the illness is over. Cumulative Total in 2004: 3 imported
and 0 local cases. The total number of cases in previous years:
60 in 1998, 22 in 1999, 6 in 2000, 30 in 2001, 5 in 2002, 1 in
2003. For more information on EV-71, members of the public can
browse the Central Health Education Unit website <http://www.cheu.gov.hk>.
Hand, foot and mouth disease (HFMD) is a generally benign form
of enterovirus 71 (EV-71) infection which produces superficial
rashes on the mouth and extremities of the limbs of children. HFMD
is relatively rare in Europe , North America , and Australasia
, but since 1997 there has been a significant increase in EV71
epidemic activity throughout the Asia-Pacific region, often associated
with severe encephalitis and high case fatality rates. The emergence
of large-scale epidemic activity in the Asia-Pacific region has
been associated with the circulation of three genetic lineages
that appear to be undergoing rapid evolutionary change.
(Promed 4/27/04)
Taiwan — Cases of acute enterovirus
infection
Seven cases of acute enterovirus infection
have been reported in Taiwan so far in 2004, all of them in central
and southern Taiwan . Wu Ping-huei, from the Health Department's
Center for Disease Control, said that the first six cases occurred
in central Taiwan , while the latest one was in Tainan County
in southern Taiwan at the end of April — a four-year-old
boy who suffered from fever, ulcers at the corners of his mouth,
and vomiting and rashes. He has since recovered and has been
released from hospital. Wu said that compared with the same period
of 2003, which saw 41 serious enterovirus cases in Taiwan , the
number so far in 2004 is low. The reason that northern Taiwan
has no enterovirus cases might be because this year the weather
has been cool so far. Tseng Shu-hui, Director of the Health Department's
Center for Disease Control branch in southern Taiwan , said that
health officials still don't know why the serious cases of enterovirus
infection converged in central Taiwan . These cases may be indicative
of the seasonal epidemic of hand, foot and mouth disease expected
in children in Taiwan at this time of year.
(Promed 5/11/04)
Australia (Perth) — record
numbers of Ross River virus
cases
Western Australian health authorities are alarmed
at record numbers of cases of Ross River virus infection in Perth
so far in 2004. Over 1400 people have been infected, prompting
them to consider more aggressive health campaigns warning about
the virus. In the metropolitan area, 466 cases have been reported,
confirming the theory that Ross River virus disease has become
more urbanized, because domestic mosquitoes are spreading the
virus. It was once thought that cases recorded in Perth were
the result of people visiting the south west. With two months
of the season still to go, the number of cases of Ross River
virus has now surpassed Western Australia 's large outbreak in
1995–96, when about 1400 people
were infected. By the end of last week ( 23 Apr 2004) over 750
cases had been reported in the south west, many from the hot spots
of Busselton and Capel. Case numbers were rising in the Kimberley
, Pilbara, and Central Wheatbelt . Health Department scientist
Sue Harrington said infection rates had dropped off in southern
areas where the nights were getting cold and mosquitoes were less
active. Ms Harrington said public health officials would look at
ways to create more awareness.
(Promed 4/27/04)
Malaysia — Signs of food poisoning
in orang asli children
Tests have shown that one of
the four orang asli (the indigenous minority peoples of Peninsular
Malaysia) children who died under mysterious circumstances had
salmonella infection, one of the commonest causes of food poisoning. "One
child who died tested positive for salmonella. We are still waiting
for the other results from the Institute of Medical Research
. They could have suffered from amoebic dysentery, cholera or
typhoid," said health minister
Datuk Dr Chua Soi Lek. Apparently four orang asli children died
between 9 and 12 Apr 2004 . Chua said blood and urine samples had
been collected from children suffering from diarrhea and vomiting
in Kampung Pos Terisu and Kampung Jarik Baru in Cameron Highlands
. Dr Chua said the ministry had received 17 reports of such cases
involving children in those two villages. In Kuantan, Pahang Mentri
Besar Datuk Seri Adnan Yaacob said a lack of hygiene and contaminated
water were believed to have caused the deaths of the children.
Water samples taken from the area showed the presence of bacteria
and parasites. He said it was too early to conclude the causes
of the deaths, but a medical team led by state Health Department
director Datuk Dr Sarah Yaacob would investigate the cases. Adnan
said no new cases were reported and 12 children, aged between 8
months and 4 years old, were still in hospital. He said such deaths
had occurred many times in the orang asli community. It is unclear
at this time whether the cases are related in etiology and whether
the case number represents an upswing in the endemic rate of gastroenteritis
and diarrhea illnesses.
(Promed 4/27/04)
Guam — Leptospirosis cases traced
to Sigua Falls
Medical
staff at the Naval Hospital has determined that the three Air
Force members who came down with symptoms of leptospirosis Mar
2004 are likely to have gotten the disease near Sigua Falls .
In early April 2004, it was reported that military officials
were cautioning their personnel about hiking and swimming in
the Sigua Falls and Lost Pond areas after potential leptospirosis
cases arose. Further investigation seems to have determined that
the hikers may have come down with the bacterial illness at Sigua
Falls , said Lt. Karen S. Corson, the department head of preventative
medicine at Naval Hospital . Corson stated that the hospital has
had one confirmed case and two suspected cases. Two of the cases
had been hiking in the Sigua Falls area, and all three had cuts
on their hands or legs from hiking. She said the hospital cautions
hikers from swimming if they have cuts or open sores, as leptospirosis
is known on the island.
Dr. Robert Haddock, Guam 's territorial epidemiologist, has said
that leptospirosis is found in water affected by waste from wild
animals that carry the bacteria. He has said that about two cases
are reported each year, and because its symptoms are similar to
that of influenza, mild cases of leptospirosis are often mistaken
for the other illness. Symptoms of leptospirosis can include fever,
severe headaches, chills, muscle aches, vomiting, stomach pain,
jaundice (yellow skin and eyes), red eye, diarrhea or a rash. Untreated,
a leptospirosis patient can develop kidney damage, meningitis,
liver failure, respiratory problems and, in rare cases, may die.
(Promed 4/27/04)
India (West Bengal) — Hepatitis
E virus outbreak in Dum Dum district
More than 800 persons
have been infected with hepatitis E virus in South Dum Dum in
West Bengal, India, during the past three weeks. The affected
areas are Chasipara, Lalgarh, Moyrapara, Azadgarh, Burmanpara,
Sethbagan, Chasirmat, Goalabagan, Basakbagan, and Swamiji colony
of the Municipal areas of South Dum Dum . The outbreak appears
to be due to contamination of the water supply. The main manifestation
was jaundice. Although at least 15 relapse cases were reported
in Moyrapara, Azadgarh, and Goalabagan areas, there was no report
of any death from the disease. It has been observed that about
30 percent of the cases have already been cured. Virologists attached
to the School of Tropical Medicine , Kolkata have examined 20 blood
samples from the affected persons, out of which 15 samples were
positive for hepatitis E virus IgM antibody. At present, drinking
water is being supplied by 12 large tankers, halogen tablets are
being distributed, and health workers have already visited at least
280 houses. Municipality engineers are now planning for the replacement
of 1000 meters of asbestos water supply pipeline--where contamination
was suspected — with iron pipes.
Hepatitis E virus is transmitted via the fecal-oral route. It
is responsible for an acute self-limited infection characterized
as acute hepatic inflammation. It has been claimed, however, that
in endemic areas in India , hepatitis E virus may be a common cause
of acute liver failure. The earliest documented cases of hepatitis
E virus infection occurred in India (Dehli) in 1955 after heavy
flooding. Subsequently sporadic outbreaks have been recorded throughout
Asia , Africa , and Central America , usually in association with
contaminated drinking water. Pigs, rats, deer, and some other animals
may act as alternate hosts. No vaccine is available at present.
(Promed 4/23/04)
India (Karnataka) — 26
cases of monkey-fever reported
Monkey-fever ( Kyasanur
Forest disease) has made a comeback in some parts of the State
of Karnataka this summer, prompting the district to go on a vaccination
drive. Shimoga District Health Officer, Dr. S.H. Satish, said
that vaccination is given free to all villagers in the Malnad
area of Shimoga, Chikmagalur, parts of Uttara and Dakshina Kannada. "The
disease would prove fatal only when it affects the brain (viral
encephalitis). Once a person realizes that he has been bitten
by a tick, vaccination should be sought at the earliest opportunity.
This lessens the severity of the disease," he said. "Irritation,
red rashes, and formation of patches appear immediately after
the tick bites. Some people are found to be allergic, which makes
it very obvious," Satish
said.
According to health officials, the number of people affected
and killed by this disease has come down drastically. So far in
2004, only one fatal case was reported — the remaining 26
recovered. "We
had vaccinated 28 000 villagers belonging to the Malnad area. The
patient who died had refused to be vaccinated," Satish said.
The disease normally appears around November with the onset of
the dry season and declines with the first rainfall. High fever,
accompanied by body-ache and bleeding of gums and intestines, are
some of the symptoms. In extreme cases, the disease obstructs the
normal functioning of the brain, from which there is no recovery.
The disease that originated in 1954, in the Malnad areas of Karnataka,
is found only in forest areas; it has not been detected anywhere
else in the world. Satish said that monkeys living in forest areas
spread the disease to others through ticks. Others who are prone
to be bitten by the ticks are cattle and humans frequenting forest
areas. "The disease was first discovered among monkeys, hence
the term monkey-fever. It is restricted to rural and forest areas," Satish
said. He said that the chances of getting the disease is greater
if a man is bitten by monkey.
The causative virus, Kyasanur Forest disease virus, was first
isolated in 1957 during a fatal epizootic affecting free-living
monkeys in the region of India formerly known as Mysore (now Karnataka).
Human infection has occurred frequently among forest workers with
a mortality reaching 10 percent. The principal tick vector is the
species Haemaphysalis spinigera. An effective inactivated
vaccine is available for protection of those at risk and for post-exposure
treatment to moderate the course of illness.
(Promed 4/24/04, 4/25/04)
India (Ahmedabad) — Outbreak of
undiagnosed jaundice
Jaundice has claimed three lives in
Ahmedabad, and more than 120 cases have been registered in the eastern
suburbs, where this water-borne disease has assumed near-epidemic
proportions. Sources in the Health Department of the Ahmedabad Municipal
Corporation (AMC) have confirmed the death of a resident of Gayatrinagar.
Two deaths had already been reported from New Bhavaninagar and Gayatrinagar
of the Amraiwadi area, and as many as 14 cases have been registered
from the Nava Vadaj area. Four more cases were reported in Ahmedabad
5 May 2004. AMC officials also suspect that many cases in the eastern
part of the city may be going unreported, as those afflicted may
be going to private practitioners. It is believed that the contamination
of drinking water supplied to Amraiwadi and other eastern suburbs
is the main cause of the disease.
AMC Health Officer Dr P K Makwana said, "The problem is
getting serious with each passing day, and efforts are on in full
swing to contain the disease." However, that does not seem
to have helped with the disease spreading to newer areas, something
that AMC officials refused to comment on. "We are making efforts
to replace damaged pipelines in affected eastern areas, where it
was discovered that residents had made holes in the supply pipeline.
Besides, we are supplying drinking water to these areas by tankers." AMC
officials are also reported to have contacted NGOs working in these
areas to create awareness about personal hygiene.
Water-borne hepatitis can usually be attributed to infection
by either hepatitis A virus or hepatitis E virus, two unrelated
enteric viruses, as a result of fecal contamination of water-supplies.
Hepatitis A virus infection generally resolves without complication,
and effective vaccines are available for prevention and control
of epidemics. Hepatitis E virus, which was first isolated in India
, has been responsible for outbreaks throughout the sub-continent
(and elsewhere) and, although usually associated with acute self-limiting
disease, can be more threatening, particularly for women in late
pregnancy. No vaccine is available at present.
(Promed 5/4/04, 5/11/04)
India (Calcutta) — Tests
point to cholera outbreak
Tests conducted by the National
Institute of Cholera and Enteric Diseases have revealed that
nearly all the patients admitted to the Infectious Diseases (ID)
Hospital at Beleghata following the gastroenteritis outbreak
in several parts of Calcutta were victims of cholera. As many
as 99 per cent of the over 1500 patients admitted to the ID Hospital
between 5 and 17 Apr 2004 — the period
during which the spate of casualties was highest — were suffering
from cholera. Hundreds of residents in the congested slum areas
of Narkeldanga, Rajabazar, Tangra, and Beniapukur had to be rushed
to the hospital with symptoms of severe dehydration and stomach
upset following consumption of contaminated piped water. Doctors
at the ID hospital pointed out that most of the patients admitted
got the infection through polluted water. Sewage water, leaking
through damaged pipes, had mixed with filtered drinking water.
Health department officials said cholera is usual in Calcutta with
the onset of summer, and the number of admissions was coming down.
(Promed 4/28/04)
AMERICA
Canada (British Columbia):
Discovery of new avian flu strain closes BC school
A new
strain of avian flu has been found in the Fraser Valley , one that
is different from anything that has been seen in the area before.
The discovery of the new strain, among geese and ducks at the Abbotsford
farm, has prompted officials to close a school across the road. Scientists
could not rule out the possibility that the strain is the H5 virus
responsible for the deaths of people in Asia , though they urged
people not to panic. "We don't
know what it is," said Sally Greenwood, a spokeswoman for
the BC CDC. "It's not the H7 we have seen in BC, we don't
know what it is. There's a possibility it could come back as being
an H5 subtype. But, even if it does, it doesn't mean it's going
to be the same virus as the one in Asia . Let's wait until we get
the test results back." Some 19 millions chickens and turkeys
in the Fraser Valley are being culled after an especially aggressive
strain of H7 avian flu began killing off birds in Mar 2004. But,
unlike that outbreak, the geese and ducks aren't showing any symptoms.
Greenwood said the mystery virus was discovered when blood tests
of the birds showed antibodies, indicating they had been exposed
to it at some point in the past. No children or staff at the nearby
school showed any signs of illness. While the H7N3 virus was especially
deadly to birds, it was not considered dangerous to humans; two
farm workers came down with pink eye. However, the industry has
been hard hit. Several Asian countries closed their borders to
Canadian or BC chicken products. During the first week of May 2004,
Agriculture officials estimated that it could take until next Mar
2005 before the industry is up and running in the province again.
(Promed 5/12/04)
USA — Mad
cow testing to expand, agriculture chief says new cases wouldn't
surprise her
Nearly six months after the first-ever
case of mad cow disease was discovered in a Holstein at a Washington
State dairy farm, the Agriculture Department is finally expected
to launch an expanded testing program June 2004. Agriculture
Secretary Ann Veneman, along with other Agriculture Departmental
and industry officials, insist that the nation's meat supply
is safe despite critics who say the government still isn't doing
enough. Nevertheless, on April 7, Veneman said that she wouldn't
be surprised if the expanded testing program ended up finding
more infected animals. Current plans call for testing up to 400
000 animals over a period of 12 to 18 months for bovine spongiform
encephalopathy (BSE). That is 10 times as many inspections as
the department planned to conduct prior to the discovery of the
infected cow in December 2003. Some lawmakers, however, have
suggested that as many as three to four million of the 35 million
cattle slaughtered every year must be tested to assess the health
of the nation's herds.
BSE was first discovered in Britain in the 1980s. Since then,
more than 181 000 cases have been reported in two dozen countries.
Humans can get a form of the disease, variant Cruetzfeldt-Jakob
disease, by eating contaminated meat. The human form of the disease
is fatal, and more than 150 people, most of them in Britain , have
died. Though Japan and some European countries test all of their
cattle for BSE before slaughter, Veneman said there was no scientific
justification for such a comprehensive program in the United States
. But the chief executive officer of a major Kansas cattle operation
said Veneman, and the Bush administration, were under pressure
from the industry not to expand testing any further and have used
science as a "cover" to hold down costs. John Stewart,
of Creekstone Farms Premium Beef, said the tests would cost only
USD 20 per animal and add only 4 cents to the price of a pound
of ground beef. And, Stewart said, consumers would be willing to
pay a premium for meat from tested cattle. In Apr 2004, the department
blocked Creekstone's plan to test all of its cattle for mad cow
disease, saying the tests did not offer any guarantee that animals
weren't infected with BSE, noting that a panel of international
experts said a total testing program wasn't called for scientifically.
Veneman also said the department had launched an investigation
into the alleged violation of BSE testing procedures involving
a suspect cow in Texas sent to a rendering plant before samples
could be taken. Department officials said no part of the animal
had entered the human food chain. Under established procedures,
the animal should have been held until tissue samples were taken. "We
quickly admitted it should have been tested," Veneman said. "There
was some miscommunication. We are investigating this to the fullest
extent."
(Promed 5/11/04)
USA ( Colorado) — First
suspected human case of West Nile virus
in 2004
Weld County could once again have the first
human case of West Nile virus infection in Colorado . The news
took Weld health officials by surprise, and Mark Wallace, director
of the Weld County Department of Health and Environment, said
many thought the first human case wouldn't come for a few weeks.
The Colorado Department of Agriculture reported the first equine
West Nile case for the state 10 May 2004 . Blood from a Weld
County resident tested positive for West Nile virus infection,
Wallace said, although it still needs to be confirmed by the
state health department and the CDC. The person was not hospitalized
but had symptoms consistent with West Nile , leading to the reason
for the test. In 2003, 402 residents were diagnosed with West
Nile virus infection, and of those, five died. Weld County has
had the first human cases in the state in the past two years.
Usually dead birds are the first sign of the disease, followed
by equine cases, and, finally, humans. But in 2004, Wallace said
dead birds had been reported, but he wasn't aware of a bird testing
positive for the virus in 2004 by the Weld County health department.
(Promed 5/12/04)
Mexico — National alert declared
in response to outbreak of measles
Mexican health authorities
have declared a state of national alert due to an outbreak of
59 cases of measles in the central part of the country. They
have also announced a vaccination campaign in the whole territory
aimed at preventing transmission. Miguel Angel Nakamura, technical
director of the National Center for Child and Adolescent Health,
commented that the transmission of measles in Mexico had already
been eliminated and that the detection of even one case is cause
for alert. Since 2 Jan 2004 , 59 cases of the disease have been
reported, the highest number since 2000, when an outbreak caused
by a virus that originated in Asia was reported. Of the cases
registered to date, 39 have occurred in the capital, 17 in the
neighboring state of Mexico , and three in the state of Hidalgo
. In all of the cases the H1 virus was isolated, and Nakamura
said that it might have been introduced by one of the members
of the Korean community in the capital.
Nakamura also explained that the first action taken to manage
the outbreak was the vaccination of all susceptible individuals
residing in the areas where the cases were detected. Next, all
Mexicans between the ages of 13 and 39 will be vaccinated. Cases
have occurred in young adults because this is the susceptible population;
they did not receive a second dose of measles vaccine, as the two
dose policy did not exist when they were younger. Children between
age one and nine have been protected with the two-dose vaccination
series. Nakamura commented that in Mexico there are currently more
than 7 million doses of the vaccine available and that it is expected
that more will be purchased, to reach 16 million doses. Throughout
the country, 2.5 million doses of the vaccine have already been
distributed.
Nakamura explained that the last indigenous case of measles in
Mexico was reported in 1996. In 2000, 30 cases of the disease,
imported from Asia , were reported. During 2001, three cases were
registered, none during 2002, and 44 during 2003. A CDC report
summarized the epidemiology of measles in the Americas during 2002-2003
and highlights progress toward measles elimination (MMWR 2004:
53(14): 304-6, 16 Apr <http://www.cdc.gov/mmwr/PDF/wk/mm5314.pdf>).
(Promed 4/29/04)
Venezuela (Zulia) — Second rabies
death in Zulia state this year
On 25 Apr 2004 , the Head
of the Epidemiology Department of the Venezuelan Ministry for Health
and Social Development reported the death of a boy from Maracaibo
from rabies. In a 13-year period, there have been 21 rabies deaths
in the state of Zulia, two of which occurred this year (2004). The
Head of Epidemiology commented that this situation indicates deficiencies
in the regional health system. He also placed special emphasis on
the need for immediate vaccination of people who have been bitten
by dogs or cats.
This report implies, but does not confirm, that the victim was
bitten by a rabid dog or cat. A recent report implicated vampire
bats in the transmission of rabies in an Amazonian town in the
state of Para . Vampire bat attacks on humans in Venezuela have
been documented (e.g. Caraba, Rev Salude Publica 30; 483-484, 1996),
and it is likely that both vampire and insectivorous bats play
a role in the maintenance of rabies infection in Venezuela and
in other Latin American countries. Genetic characterization and
antigenic analyses of isolates from human cases of rabies in Venezuela
(de Mattos et al., J Clin Microbiol 34; 1553-1558, 1996) have revealed
considerable diversity and identified several antigenic variants.
Recognition of the source of outbreaks of dog-transmitted rabies
may be necessary to achieve satisfactory control of rabies.
(Promed 5/2/04)
Ecuador (Chimborazo):
Fatal human cases of plague
A 55-year-old woman and her
22-year-old daughter died of bubonic plague in the locality of Guamote
in the province of Chimborazo . The mother and daughter raised guinea
pigs for sale, which are a common food in the Andean region. A third
person presenting similar symptoms is hospitalized in the isolation
unit of a teaching hospital in Riobamba . Five hundred persons were
treated to prevent spread of the disease, and according to authorities
a containment circle has been established and high risk areas will
be fumigated. The health department in Chimborazo Province advised
local medical personnel that patients admitted from the town of Guamote
presenting fever, cough, enlargement of the lymph nodes, weakness
and malaise, should be considered as suspected cases of bubonic plague.
Dr. Adela Vimos, Director of Epidemiology, Chimborazo Province ,
said the disease is endemic in the region, and explained why the
new re-emergence of human cases is a dangerous threat to the community
health. The health authorities of the Province of Chimborazo have
prohibited the consumption of guinea pigs and rabbits. On April
29th an alert was issued for the provinces of Cotopaxi , Tungurahua,
Bolívar, Azuay and Chimborazo . No new cases have been detected.
(Promed 5/13/04)
2. UPDATES
Dengue/DHF update
Sri Lanka
Over 180 cases of Dengue have been
detected within the Colombo metropolis, giving rise to a fear that
the disease could assume epidemic proportions. "The numbers
detected so far reveal an increase of over 90 percent over 2003",
Dr. Pradeep Kariyawasam, Chief Medical Officer of the Colombo Municipal
Council said. He said that in 2003, it was possible to avert a
crisis because the CMC had carried out a dengue awareness campaign
and conducted house-to-house visits to detect dengue breeding sites
in March, before the peak season. "We also imposed fines and
warned all householders who had dengue breeding sites that we would
take stern action if they did not clean their surroundings at our
next visit",
he said. Emphasizing the importance of a sustained campaign to
create awareness on the prevention of dengue, he said the public
tended to forget that environmental cleanliness was the most effective
way of eliminating dengue. Currently the CMC is carrying out fogging
and spraying of chemicals in high-risk areas, but because the dengue
carrying mosquito is a low-flying insect, these activities have
not proved highly effective. The CMC hopes to conduct a large campaign
involving CMC, medical students of the Colombo medical faculty,
and Rotarians who will inspect houses in the city, distribute leaflets
and enlist the support of the public to maintain a mosquito-free
environment.
Australia (Queensland)
Health
authorities in Townsville are encountering opposition to their
efforts to control dengue fever. The dengue fever outbreak has
now reached 47 cases, with the latest cases in North Ward, Gulliver
and Aitkenvale. John Piispanen from the Tropical Public Health
Unit says some residents in North Ward have been resisting efforts
to eradicate mosquito breeding sites in and around their homes.
(Promed 5/6/04)
Diarrhea and dysentery update
Argentina
A total of 211 156 cases of diarrhea
have been reported in Argentina so far this year (2004), 105 292
of them in children under five years old. Most cases have been
reported in Buenos Aires (48 565), followed by the provinces of
Salta (31 067), Cordoba (13 954), Mendoza (13 711), Santa Fe (11
856), Neuquen (11 391), and Jujuy (11 385). In addition, 44 cases
of typhoid fever have been reported — 31 cases reported in Entre
Rios, 9 in Corrientes , 2 in Formosa , 1 in Catamarca, and 1 in
Salta . For this period, no cholera cases have been reported.
Bangladesh
The diarrhea situation is alarming,
with hospitals and clinics struggling to cope with the increasing
number of patients. Around 400 patients a day were admitted in
the last two weeks to the International Centre for Diarrhoea Disease
Research, Bangladesh (ICDDR,B), the sole hospital for treatment
of waterborne diseases at Mohakhali. About 70 to 80 per cent of
the patients coming were children, hospital sources said. ICDDR,B
treated around 8000 diarrhea patients in Mar 2004. In Feb 2004,
the number was 4881 and in Jan 2004 it was 5857. The monthly number
had already crossed 10 000 mark before 25 Apr. Like the ICDDR,B,
Dhaka Shishu Hospital , Dhaka Medical College Hospital (DMCH),
Suhrawardy Hospital , National Hospital , and Mitford Hospital
are also facing rising number of diarrhea patients, who occupy
more than 20 to 25 per cent of beds in these hospitals. ICDDR,B
sources said most of the patients being treated there belong to
the city's slum areas and low-income group. The contaminated water
supplied by the Water and Sewerage Authority (WASA) is also adding
greatly to the situation, a diarrhea patient from Shantinagar alleged.
Rotavirus and enterotoxigenic _E. coli_ are the two germs mainly
responsible for diarrhea, which leads to the patient having frequent
loose motions followed by dehydration, the severity of which may
result in death in some cases.
Nepal
The diarrhea epidemic in Bagahi village
of Rautahat which broke out 23 Apr 2004 has affected over 100 people.
News reports blamed contaminated food and water as well as rising
temperatures. The VDC health post had repeatedly informed the District
Public Health Office about shortage of necessary medicines to counter
the epidemic, but no action was taken. The Himalayan Times newspaper
quoted Dr Shobhendra Karna, chief of the District Public Health
Office, as denying any knowledge of the epidemic.
China
Ninety four people, including 22 children,
were in the hospital in northern China after falling ill at a funeral
dinner, probably from salmonella poisoning. Around 160 people fell
ill at the dinner 6 May 2004 , in the Inner Mongolia village of
Zhenghao . Of those in the hospital in the Dalad district 8 May
2004 , 20 were in serious condition.
(Promed 4/30/04, 5/11/04)
Viral gastroenteritis update
Canada (Vancouver)
A
norovirus outbreak has made dozens of people sick, and judges,
lawyers, inmates in the jail, and several people in the courthouse
cafeteria have come down with the intestinal virus. Health officials
believe the virus was spread through the courthouse cafeteria,
Vancouver Coastal Health Authority spokeswoman Viviana Zanocco
said. Zanocco said an environmental health officer is monitoring
the cleanup daily. No one has been seriously ill.
USA (Wyoming)
At
least 62 patients and staff at the Shepherd of the Valley Care
Center have a stomach sickness that health officials think is due
to norovirus infection. Karen James, the center's director of nursing,
said that 50 of the 172 residents, and 12 staff members, have an
illness that can cause vomiting and diarrhea. She said the first
people became sick 26 Apr 2004 , but everyone, at this point, has
made a full recovery. City of Casper-Natrona County Health Department
spokesman Marty Thone said that the outbreak is worrisome, since
most of the center's residents are older than 70 and may have suppressed
immune systems.
USA (Caribbean/Philadelphia)
Passengers
on a Norwegian Cruise Lines ship that left Bermuda 1 May 2004 said
their journey was fraught with problems, including a stomach bug
that sickened more than 30 people. The company flew 39 of the cruise
liner's 1111 passengers home after paying for their hotel stays.
Norwegian Cruise Lines spokeswoman Susan Robison said tests had
determined that the stomach bug was not linked to food. She said
that the crew was taking steps to disinfect the ship to eliminate
the virus. Noroviruses — which include Norwalk
virus and related viruses — can cause diarrhea, stomach pain
and vomiting for 24 to 48 hours. They are spread through food,
water and close contact with infected people or with things that
they have touched.
USA (Alaska)
Public
health workers are investigating an outbreak in Fairbanks of highly
contagious norovirus infection. Eighteen people have fallen ill
with norovirus-like symptoms, which are diarrhea, nausea, and vomiting,
according to Marc Chimonas, a physician with the Alaska Division
of Public Health. Two public places believed to have been contaminated
with the virus have been disinfected. Five of the 18 norovirus
cases are extremely mild, Chimonas said. Noroviruses are spread
person-to-person, typically by eating food or by drinking water
contaminated by the feces of an infected person. Symptoms typically
last about two days. Chimonas is working with local public health
workers and officials with the Alaska Department of Environmental
Conservation to distribute information about how to prevent the
spread of the virus. "Hand-washing is key," Chimonas
said. The virus commonly makes its way to Alaska via cruise ships.
The virus has not yet been confirmed through lab testing, but the
symptoms point almost beyond doubt to norovirus, Chimonas said.
Australia
Cruise ship operator P and O blamed
poor personal hygiene among some passengers for an outbreak that
forced a ship to return. The company's Pacific Sky luxury liner
returned to Sydney 9 May 2004 after 140 passengers became sick,
suffering attacks of nausea, vomiting, and diarrhea. It was the
second time the ship had been affected by illness recently, with
a similar gastrointestinal virus outbreak attacking 200 passengers
Dec 2003. Disgruntled passengers were reported to be demanding
refunds, but the cruise company denied responsibility, saying a
passenger probably brought the virus — a
norovirus — on board, and spread it by personal contact.
The company said it would consider refunds, or credits, for future
cruises on a case by case basis.
(Promed 5/3/04, 5/11/04)
3. ARTICLES
Measles deaths drop dramatically as vaccine reaches
world's poorest children
The WHO and the United Nation's Children's
Fund (UNICEF) announced a global reduction of 30% in deaths from
measles between 1999 and 2002. At 35%, the reduction in measles
deaths was even greater in Africa , the region with the highest
number of people affected by the disease. This progress demonstrates
that collectively countries can achieve the United Nations goal
of cutting global measles deaths in half by the end of 2005.
Despite the availability of a safe, effective, inexpensive vaccine
for over 40 years, measles remains the leading vaccine-preventable
killer of children. In 1999, some 869 000 people, mostly children,
died of measles. In 2002, measles killed an estimated 610 000 people,
a decline of 30%. Recent progress is due to the adoption by the
most affected countries of the comprehensive WHO/UNICEF strategy
for sustainable measles mortality reduction. At a WHO/UNICEF meeting
in October 2003, Ministry of Health representatives from 45 high-burden
countries agreed that this strategy was highly effective in reducing
measles deaths in a sustainable fashion. The strategy is based
on achieving at least 80% routine measles immunization coverage
in every district, and ensuring that all children get a second
opportunity for measles immunization either through routine services
or periodic Supplemental Immunization Activities (SIAs) every three
to four years, whereby every child from nine months to five years
of age is immunized over a one to two week period. “Countries
have proven that routine immunization and supplemental measles
immunization will reduce measles deaths. This is an extremely important
step. Now WHO encourages all high-burden countries to implement
these strategies, and stands ready to help," said Dr Lee Jong-wook,
WHO Director-General. “However success also requires more
resources, and a long-term commitment of leaders to permanently
reducing measles deaths."
The estimated annual cost for measles mortality reduction activities
in the 45 high burden countries is approximately US$ 140 million.
An important factor in the 35% decrease in measles deaths in Africa
has been the support of the Africa Measles Partnership which has
implemented the WHO/UNICEF strategy. Starting in 2001, this partnership,
with core membership of national governments, WHO, UNICEF, the
American Red Cross, the CDC and the United Nations Foundation,
committed itself to funding and implementing large-scale measles
SIAs. Other key partners include the governments of Australia ,
Canada and Japan as well as the International Federation of Red
Cross and Red Crescent Societies and the Bill and Melinda Gates
Foundation. http://www.who.int/mediacentre/releases/2004/pr30/en/
(WHO 4/27/04)
Lyme Disease — United States, 2001–2002
“Lyme
disease (LD) is caused by the spirochete Borrelia
burgdorferi and is transmitted through the bite of Ixodes spp.
ticks. CDC began LD surveillance in 1982, and the Council of
State and Territorial Epidemiologists designated LD a nationally
notifiable disease in 1991. This report summarizes the analysis
of 40,792 cases of LD reported to CDC during 2001–2002.
The results of that analysis indicate that annual LD incidence
increased 40% during this period. The continued emergence of
LD underscores the need for persons in areas where LD is endemic
to reduce their risk for infection through integrated pest management,
landscaping practices, repellent use, and prompt removal of ticks.
For surveillance purposes, a case of LD is defined as physician-diagnosed
erythema migrans (EM) >5 cm in diameter or at least one objective
manifestation of late LD (e.g., musculoskeletal, cardiovascular,
or neurologic) with laboratory confirmation of B. burgdorferi infection
using a two-tiered assay. National, state, and age-specific incidence
was calculated by using U.S. Census Bureau data for 2001 and 2002;
incidence by county was calculated by using U.S. Census data for
2000.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5317a4.htm
(MMWR May
7, 2004 / 53(17);365-369)
Framework for evaluating public health surveillance systems
for early detection of outbreaks — Recommendations from
the CDC Working Group
“The threat of terrorism and high-profile
disease outbreaks has drawn attention to public health surveillance
systems for early detection of outbreaks. State and local health
departments are enhancing existing surveillance systems and developing
new systems to better detect outbreaks through public health surveillance.
However, information is limited about the usefulness of surveillance
systems for outbreak detection or the best ways to support this
function. This report supplements previous guidelines for evaluating
public health surveillance systems. Use of this framework is intended
to improve decision-making regarding the implementation of surveillance
for outbreak detection. Use of a standardized evaluation methodology,
including description of system design and operation, also will
enhance the exchange of information regarding methods to improve
early detection of outbreaks. The framework directs particular
attention to the measurement of timeliness and validity for outbreak
detection. The evaluation framework is designed to support assessment
and description of all surveillance approaches to early detection,
whether through traditional disease reporting, specialized analytic
routines for aberration detection, or surveillance using early
indicators of disease outbreaks, such as syndromic surveillance.” http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5305a1.htm
(MMWR
May 7, 2004 / 53(RR05);1-11)
Malaria Surveillance — United
States ,
2002
“Problem/Condition: Malaria
is caused by any of four species of intraerythrocytic protozoa
of the genus Plasmodium (i.e., P.
falciparum, P. vivax, P. ovale, or P.
malariae). These parasites are transmitted by the bite of
an infective female Anopheles species mosquito. The majority
of malaria infections in the United States occur among persons
who have traveled to areas with ongoing transmission. In the United
States , cases can occur through exposure to infected blood products,
by congenital transmission, or by local mosquitoborne transmission.
Malaria surveillance is conducted to identify episodes of local
transmission and to guide prevention recommendations for travelers.
Period Covered: This report covers cases with
onset of illness in 2002.
Description of System: Malaria cases confirmed
by blood film are reported to local and state health departments
by health-care providers or laboratory staff. Case investigations
are conducted by local and state health departments, and reports
are transmitted to CDC through the National Malaria Surveillance
System (NMSS). Data from NMSS serve as the basis for this report.
Results: CDC received reports of 1,337 cases
of malaria with an onset of symptoms in 2002 among persons in the
United States or one of its territories. This number represents
a decrease of 3.3% from the 1,383 cases reported for 2001. P.
falciparum, P. vivax, P. malariae, and P.
ovale were identified in 52.3%, 25.4%, 2.8%, and 2.8% of cases,
respectively. Eleven patients (0.8% of total) were infected by >2
species. The infecting species was unreported or undetermined in
213 (15.9%) cases. Compared with 2001, the number of reported malaria
cases acquired in Asia (n = 171) and Africa (n = 903) increased
by 4.3% and 1.9%, respectively, whereas the number of cases acquired
in the Americas (n = 141) decreased by 41.2%. Of 849 U.S. civilians
who acquired malaria abroad, 317 (37.3%) reported that they had
followed a chemoprophylactic drug regimen recommended by CDC for
the area to which they had traveled. Five patients became infected
in the United States , one through congenital transmission, one
probable transfusion-related, and three whose infection cannot
be linked epidemiologically to secondary cases. Eight deaths were
attributed to malaria. All deaths were caused by P. falciparum.
Interpretation: The 3.3% decrease in malaria
cases in 2002, compared with 2001, resulted primarily from a marked
decrease in cases acquired in the Americas , but this decrease
was offset somewhat by an increase in the number of cases acquired
in Africa and Asia . This limited decrease probably represents
year-to-year variation in malaria cases, but also could have resulted
from local changes in disease transmission, decreased travel to
malaria-endemic regions, fluctuation in reporting to state and
local health departments, or an increased use of effective antimalarial
chemoprophylaxis. In the majority of reported cases, U.S. civilians
who acquired infection abroad were not on an appropriate chemoprophylaxis
regimen for the country in which they acquired malaria.
Public Health Actions: Additional information
was obtained concerning the eight fatal cases and the five infections
acquired in the United States . Persons traveling to a malarious
area should take one of the recommended chemoprophylaxis regimens
appropriate for the region of travel, and travelers should use
personal protection measures to prevent mosquito bites. Any person
who has been to a malarious area and who subsequently experiences
a fever or influenza-like symptoms should seek medical care immediately
and report their travel history to the clinician; investigation
should include a blood-film test for malaria. Malaria infections
can be fatal if not diagnosed and treated promptly. Recommendations
concerning malaria prevention can be obtained from CDC by calling
the Malaria Hotline at 770-488-7788 or by accessing CDC's Internet
site at http://www.cdc.gov/travel.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5301a2.htm
(MMWR
April 30, 2004 / 53(SS01);21-34)
Recommended Childhood and Adolescent Immunization Schedule-- United
States , July–December 2004
“CDC’s
Advisory Committee on Immunization Practices (ACIP) periodically
reviews the recommended childhood and adolescent immunization
schedule to ensure that the schedule is current with changes
in manufacturers’ vaccine formulations and reflects
revised recommendations for the use of licensed vaccines, including
those newly licensed. Recommendations and format of the childhood
and adolescent immunization schedule for January–June 2004
were approved by ACIP, the American Academy of Family Physicians
(AAFP), and the American Academy of Pediatrics (AAP) and published
in January 2004. This report updates that schedule with the recommendation
that, beginning in fall 2004, children aged 6–23 months,
as well as household and out-of-home caregivers for such children,
receive annual influenza vaccine. This change is reflected in the
revised childhood and adolescent immunization schedule for July–December
2004. A catch-up immunization schedule for children and adolescents
who start late or who are >1 month behind remains unchanged
from that published in January 2004.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5316-Immunizationa1.htm
( April
30, 2004 / 53(16);Q1-Q3)
Prevention and Control of Influenza--Recommendations
of the Advisory Committee on Immunization Practices (ACIP)
“This
report updates the 2003 recommendations by the Advisory Committee
on Immunization Practices (ACIP) on the use of influenza vaccine
and antiviral agents (CDC. Prevention and control of influenza: recommendations
of the Advisory Committee on Immunization Practices [ACIP]. MMWR
2003;52[No. RR-8]:1--34) . The 2004 recommendations include new or
updated information regarding 1) influenza vaccine for children aged
6–23 months; 2) vaccination of health-care
workers with live, attenuated influenza vaccine (LAIV); 3) personnel
who may administer LAIV; 4) the 2004–05 trivalent inactivated
vaccine virus strains: A/Fujian/411/2002 (H3N2)-like, A/New Caledonia/20/99
(H1N1)-like, and B/Shanghai/361/2002-like antigens (for the A/Fujian/411/2002
(H3N2)-like antigen, manufacturers may use the antigenically equivalent
A/Wyoming/3/2003 [H3N2] virus, and for the B/Shanghai/361/2002-like
antigen, manufacturers may use the antigenically equivalent B/Jilin/20/2003
virus or B/Jiangsu/10/2003 virus); and 5) the assessment of vaccine
supply and timing of influenza vaccination. A link to this report
and other information regarding influenza can be accessed at http://www.cdc.gov/flu.”http://www.cdc.gov/mmwr/preview/mmwrhtml/rr53e430a1.htm
(MMWR April
30, 2004 / Volume 53;1-40)
Responding to Detection of Aerosolized Bacillus anthracis by
Autonomous Detection Systems in the Workplace
“Autonomous
detection systems (ADSs) are under development to detect agents of
biologic and chemical terror in the environment. These systems will
eventually be able to detect biologic and chemical hazards reliably
and provide approximate real-time alerts that an agent is present.
One type of ADS that tests specifically for Bacillus anthracis is
being deployed in hundreds of postal distribution centers across
the United States . Identification of aerosolized B. anthracis spores
in an air sample can facilitate prompt on-site decontamination of
workers and subsequent administration of postexposure prophylaxis
to prevent inhalational anthrax. Every employer who deploys an ADS
should develop detailed plans for responding to a positive signal.
Responding to ADS detection of B. anthracis involves coordinating
responses with community partners and should include drills and exercises
with these partners. This report provides guidelines in the following
six areas: 1) response and consequence management planning, including
the minimum components of a facility response plan; 2) immediate
response and evacuation; 3) decontamination of potentially exposed
workers to remove spores from clothing and skin and prevent introduction
of B. anthracis into the worker's home and conveyances; 4) laboratory
confirmation of an ADS signal; 5) steps for evaluating potentially
contaminated environments; and 6) postexposure prophylaxis and follow-up.” http://www.cdc.gov/mmwr/preview/mmwrhtml/rr53e430-2a1.htm
(MMWR
April 30, 2004 / 53(Early Release);1-11)
Outbreak of varicella among xaccinated children — Michigan ,
2003
“On November 18, 2003 , the Oakland County
Health Division alerted the Michigan Department of Community
Health (MDCH) to a varicella (chicken pox) outbreak in a kindergarten–third
grade elementary school. On December 11, MDCH and Oakland County
public health epidemiologists, with the technical assistance of
CDC, conducted a retrospective cohort study to describe the outbreak,
determine varicella vaccine effectiveness (VE), and examine risk
factors for breakthrough disease (i.e., varicella occurring >42
days after vaccination). This report summarizes the results of
that study, which indicated that 1) transmission of varicella was
sustained at the school for nearly 1 month despite high vaccination
coverage, 2) vaccinated patients had substantially milder disease
(<50 lesions), and 3) a period of >4 years since vaccination
was a risk factor for breakthrough disease. These findings highlight
the importance of case-based reporting of varicella and the exclusion
of patients from school until all lesions crust or fade away. Information
about recognizing vaccinated patients with mild cases should be
disseminated to health-care providers, school administrators, and
parents.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5318a4.htm
(MMWR May
14, 2004 / 53(18);389-392)
Creutzfeldt-Jakob Disease Not Related to a Common Venue — New
Jersey, 1995–2004
“Beginning in June 2003,
the New Jersey Department of Health and Senior Services (NJDHSS)
and CDC were notified of a suspected cluster of deaths caused
by Creutzfeldt-Jakob disease (CJD) in persons reportedly linked
to Garden State Racetrack in Cherry Hill , New Jersey . Concerns
were raised that these deaths might have resulted from consumption
of meat contaminated with the agent causing bovine spongiform
encephalopathy (BSE, commonly called "mad
cow disease") served at racetrack restaurants during 1988–1992.
Consumption of BSE-contaminated cattle products has been linked
to a new variant form of CJD (vCJD) in humans. This report summarizes
the results of an investigation that determined the deaths were
not linked causally to a common source of infection. The findings
underscore the need for physicians to arrange for brain autopsies
of all patients with clinically suspected or diagnosed CJD.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5318a5.htm
(MMWR May
14, 2004 / 53(18);392-396)
The world health report 2004 — changing history
WHO
launches The world health report 2004 – changing
history, which chronicles the global spread of HIV/AIDS
and details the need for linking prevention, treatment, care
and support for people living with the virus. The report concludes
that coordinated efforts now to control one of the worst global
epidemics, could change the course of history. At a crucial moment
in the pandemic's history, the international community has an
unprecedented opportunity to alter its course and simultaneously
fortify health systems for the enduring benefit of all. http://www.who.int/whr/en/
(WHO 5/11/04 )
4. NOTIFICATIONS
FAO/WHO Regional Conference on Food Safety for Asia and
the Pacific: Practical actions to promote food safety — Seremban,
Malaysia, 24-27 May 2004
This conference is part of a series of regional meetings to meet the needs
of Member countries for policy guidance and capacity building in food safety.
The delegates at the 13th session of the Codex Coordinating Committee for Asia
( Kuala Lumpur , September 2002) recommended that the Food and Agriculture
Organization of the United Nations (FAO) and the WHO convene a Regional Conference
on Food Safety for Asia and the Pacific in 2004 at the invitation of the Government
of Malaysia. This recommendation is in line with the suggestion made by the
participants at the first Joint FAO/WHO Global Forum of Food Safety Regulators
in Marrakech , Morocco , January 2002 encouraging FAO and WHO to convene regional
food safety conferences/fora in all the regions of the world.This
Asian and Pacific Conference will work to:
- Address and facilitate discussion on issues important to all
countries of the Asian and Pacific region and identify practical
actions and capacity building recommendations in support of food
safety;
- Identify opportunities for regional cooperation related to
agriculture, agribusiness, post-harvest production, food processing,
food trade, public health, and consumer protection;
- Provide a platform for broad co-operation and mutual understanding;
- Promote increased exchange of information at all levels to
improve transparency and capacity building and to more effectively
communicate with consumers, producers, and industries to improve
food safety.
http://www.foodsafetyforum.org/asian/index_en.asp
(WHO)
Fifty-seventh World Health Assembly, 17-22 May 2004
The fifty-seventh World Health Assembly, bringing the 192 Member States of
the World Health Organization together, is set to consider several critical
health issues. The Health Assembly is the supreme decision-making body for
WHO, and runs this year from 17–22 May. It will discuss actions needed
to fight HIV/AIDS, to increase safety on the world's roads, a proposed strategy
on diet, physical activity and health, a proposed strategy for reproductive
health, a resolution on family health, and will receive updates on progress
in eradicating polio, controlling measles and SARS. Keynote addresses will
also be given by former Presidents Kim Dae-jung of the Republic of Korea
, and Jimmy Carter of the United States of America . http://www.who.int/mediacentre/notes/2004/np14/en/
(WHO)
Public Library of Science (PLoS) to launch international
open-access medical journal, Call for Papers
PLoS, a non-profit
organization whose mission is to make reliable scientific and medical
literature a public resource, formally announced that it will publish
PLoS Medicine, an open-access, international, general medical journal,
beginning this fall. Dr. Harold E. Varmus, Nobel laureate, former
National Institutes of Health Director, is one of the co-founders
of the Public Library of Science (PLoS). A "call for papers" has
been issued, indicating that the journal is now accepting submissions.
PLoS Medicine will publish important peer-reviewed advances in all
areas of medical research, including epidemiology and public health,
together with summaries of all research articles written for non-specialists
and features about international developments in medicine, controversial
medical topics, neglected diseases, and other health-related subjects.
All content in the journal will be freely available online and
allowed to be reproduced worldwide for teaching, promoting awareness
of new discoveries, and other purposes.
PLoS was founded in 2000 by Dr. Varmus and colleagues Patrick
O. Brown of Stanford University and Michael B. Eisen of Lawrence
Berkeley Laboratory and the University of California , Berkeley
. In October 2003, the organization launched its first open-access
journal of peer-reviewed scientific research, PLoS Biology, whose
content has been favorably reviewed by the New York Times, Le Monde,
and countless other media outlets around the world. PLoS Medicine
will be overseen by PLoS Senior Editors Barbara Cohen, former editor
of Nature Genetics and former executive editor of the Journal of
Clinical Investigation, and Virginia Barbour, a physician and haematologist
and former executive editor of the Lancet. Working closely with
members of the editorial board and in consultation with the wider
medical and health research community, they will develop an open-access
forum for important studies and for discussion of medical research
and practice in the broader context of global health and social
responsibility. For more information about the Public Library of
Science, see http://www.plos.org For
more information about PLoS Medicine, see http://www.plosmedicine.org
(Promed 5/10/04)
EcoHealth: New scientific journal
A new journal,
EcoHealth issued part 1 of volume 1 in Mar 2004:
Publisher: Springer-Verlag , New York , LLC
ISSN: 1612-9202 (Paper) 1612-9210 (Online)
Issue: Volume 1, Number 1
Date: Mar 2004
Introduction: pp. 1-2, Bruce A. Wilcox, A. Alonso Aguirre, Peter
Daszak, et al.
Editorial Overview: EcoHealth: A Trans-disciplinary Imperative
for a Sustainable Future, pp. 3-5, Bruce A. Wilcox, A. Alonso Aguirre,
Peter Daszak, et al.
Editorial: Biocomplexity and a New Public Health Domain, pp.
6-7, Rita R. Colwell
Cover Essay: Out of the Forest , pp. 8-9, David Waltner-Toews
Profiles: Medical Geology: Emerging Discipline on the Ecosystem-Human
Health Interface, pp. 15-18, Joseph E. Bunnell
Reviews:
1) Mosquito-borne Diseases as a Consequence of Land Use Change,
pp. 19-24, Douglas E. Norris
2) Henipaviruses: Gaps in the Knowledge of Emergence, pp. 25-38,
Alex D. Hyatt, Peter Daszak, Andrew A. Cunningham, et al.
3) Trade-related Infections: Global Traffic and Microbial Travel,
pp. 39-49
4) Ann Marie Kimball, Bruce Jay Plotkin, Tabitha A. Harrison,
et al.
Original Contributions:
1) Ecosystem Approach to Community Health Planning in Ghana ,
pp. 50-59, Crescentia Dakubo
2) Impact of West Nile Virus on American Crows in the Northeastern
United States and Its Relevance to Existing Monitoring Programs,
pp. 60-68
3) Wesley M. Hochachka, Andre A. Dhondt, Kevin J. McGowan, et
al.
4) Global Politics and Multinational Health-care Encounters:
Assessing the Role of Transnational Competence, pp. 69-85, Peter
H. Koehn
5) Ecosystem Approach to Rapid Health Assessments among Indigenous
Cultures
6) Optimal Investment in Multi-species Protection: Interacting
Species and Ecosystem Health, pp. 101-110, Stefan Baumgartner