Vol. VII, No. 12~ EINet News Briefs ~ May 28, 2004
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In this edition:
Thailand (Chiang Mai): Bird flu hits research farm
A recurrence of the fatal bird-flu virus killed more than 1000 chickens at an isolated research farm at Chiang Mai University, an official with the Department of Livestock Development said. Laboratory tests confirmed that the dead chickens were infected with the H5N1 virus. More than 1000 chickens and 7 ostriches at the research farm were found dead May 26 2004.
Agriculture Ministry officials have culled 1575 chickens at the Chiang Mai University farm after being informed about the outbreak, said Yukol Limlamthong, director general of the Livestock Department. The farm, which is in an isolated area, has been quarantined, and the research farm will be closed for the next three months. The department has informed the World Organisation for Animal Health (OIE) of the latest development.
Since December 2003, more than 39 million chickens--about 800 000 of which were raised in Chiang Mai--were culled across the country due to the bird-flu outbreak. The disease also killed 16 persons in Vietnam and eight in Thailand. On 14 May 2004, the Thai Agriculture Ministry declared that the country had brought the outbreak to an end (after the last area to suffer an outbreak was declared safe at the end of a 21-day monitoring period) but also said it would need to monitor the situation for another six months. The latest outbreak "clearly demonstrates that the virus is still circulating", said Hans Wagner, of the UN Food and Agricultural Organisation. He urged countries in the region not to let their guard down. Vietnam said it was bird flu-free at the end of March, though the WHO warned that it was premature to declare the disease under control.
Chiang Mai duck farmer Kong Pintasa said he was still too afraid
to start raising a new batch of ducklings after losing more than
400 ducks to bird flu earlier in 2004. Kong, who had raised ducks
for eggs for more than a decade, switched to vegetables after the
bird-flu outbreak. Ban on the import of Thai chicken is still being
observed by the European Union, which is due to review its stance
in August 2004. For a cumulative table of HPAI outbreaks in Eastern
Asia officially notified to OIE by the affected countries, see http://oie.int/downld/AVIAN%20INFLUENZA/A_AI-Asia.htm.
China: latest SARS outbreak contained but biosafety concerns
WHO urges all member states to view this latest outbreak as an opportunity to review the biosafety practices of institutions and laboratories working with SARS coronavirus. During and after the SARS outbreak of 2003, a large number of specimens were collected from possible human cases, animals and the environment. These specimens, which may contain live SARS coronavirus, are still kept in various laboratories around the world. WHO has issued the following laboratory safety guidelines and recommendations:
WHO biosafety guidelines for handling of SARS specimens (25 Apr 2003) http://www.who.int/csr/sars/biosafety2003_04_25/en/
Summary of the discussion and recommendations of the SARS laboratory workshop 22 Oct 2003 http://www.who.int/csr/sars/guidelines/en/SARSLabmeeting.pdf
WHO post-outbreak biosafety guidelines for handling of SARS coronavirus specimens and cultures (18 Dec 2003) http://www.who.int/csr/sars/biosafety2003_12_18/en/
WHO strongly recommends Biosafety Level 3 as the minimum
containment level to work with live SARS coronavirus.
Asia Pacific: Toxic foods killing thousands of humans,
Outbreaks linked to food production can badly strain health care systems, as demonstrated by recent regional health emergencies such as bird flu and SARS, said Han Tieru, the WHO's representative for Brunei, Malaysia and Singapore. "Even though avian flu and SARS are clearly not food-borne diseases, they are all in some way related to the way food is produced or how animals are handled in the food market," he said. Malaysian Deputy Health Minister Abdul Latiff Ahmad said his country was concerned about "the globalization of food trade," which has triggered international health scares in recent years over cases of dioxin contamination, mad cow, and foot-and-mouth disease. "The danger of food-related outbreaks is particularly acute in Asia and the Pacific, because of the instances in which animals and people live in proximity and the way in which some food is produced and distributed," says Dr Kerstin Leitner, WHO Assistant Director-General responsible for Food Safety. The avian influenza epidemic, as the most recent example of a disease linking food, animals and human health, has been historically unprecedented and of great concern for human health as well as for agriculture, with 23 fatal human cases and about 100 million birds died or culled. However, in the region, more than 700 000 people die and many more are debilitated every year from single cases of food- and water-borne disease.
On the trade side, disruptions due to shortcomings in food quality have also been on the increase. "Since 2001, unacceptable pesticide residue levels in fruits and vegetables, chloramphenicol and other antibiotic residues in seafood and poultry, pathogens in seafood and mycotoxins in crops and peanuts have been the cause of rejection of food export from the Asian region,'' according to De Haen. A ban on fish imports into the EU cost one Asian country $335 million of lost export opportunities. The export of peanut meal by one Asian country to the EU dropped by more than $30 million per year since the EU introduced new mycotoxin regulation in the early 1980s. Recent scandals with life-threatening sub-standard or chemical contaminated food are just part of a widespread and growing public health problem. They are symptomatic of food safety systems not properly working and of the lack of integrated mechanisms in the region--and often within individual countries--to predict potential outbreaks and organize rapid responses to prevent them.
The conference is the response to the urgent need for countries
in the region to work together to develop coordinated food safety
systems, resulting in uniform emergency responses. It is part of
a series of regional meetings that FAO and WHO are jointly organizing
to meet the needs of member countries for policy guidance and capacity-building
in food safety.
Japan (Nagasaki): Hepatitis E Virus Infection Associated
with Wild Boar Barbecue
"The virus is generally killed if sufficiently heated. I urge people to be careful when handling raw meat," Koji Yano, a doctor at the National Nagasaki Medical Center in Omura, said.
Thirteen men aged between 64 and 82 held a barbecue party in Nagasaki Mar 2003 using meat from a wild boar they had caught, according to Yano. Two of the men, both aged 69, showed symptoms of acute hepatitis in late Apr 2003, and underwent a medical check-up. The doctor who examined the two suspected that they may have contracted hepatitis from the wild boar and notified the medical center, which detected hepatitis-E virus. The medical center conducted tests on 10 of 11 other men who had attended the party, and found three of the men tested showed symptoms of acute hepatitis while six others had contracted the virus. In Mar 2003, two people living in Tottori Prefecture suffered from hepatitis-E after eating the raw liver of a wild boar, and one of them died later.
Hepatitis E virus (HEV)
is globally distributed and is transmitted enterically as well
as zoonotically. In developing countries HEV is transmitted principally
via fecal-oral route, and water-borne epidemics are common. In
industrialized countries zoonotic transmission may be more usual.
Sporadic cases of hepatitis E have been reported in Japan in the
past, and widespread infection of HEV has been reported among wild
rats. A recent survey suggests that generally 15.4 percent of Japanese
patients with liver diseases had a history of HEV infection.
Japan: Infected cow brains on menu for BSE tests
The National Institute of Animal Health, an incorporated administrative agency under the jurisdiction of the farm ministry, has invited local residents to take a tour of the new facility to alleviate fears that the disease might leak out. The new tests are needed, officials say, because of deficiencies in the current BSE screening method. The current test is conducted on the brain tissue of cattle, meaning, that the cows are already dead. To prevent abnormal prions from leaking during the live cattle tests, the facility is equipped with air and water purifiers. It also has a special high-pressure, high-temperature system to safely dispose of cattle parts after dissection. The infected brains will be collected from the Hokkaido Animal Research Center, where researchers started raising infected calves in Jan 2004 by injecting prions into their brains. After the healthy cattle are fed the infected brain matter, the Tsukuba institute researchers can try to find a biochemical marker that indicates BSE infection in the living animals, according to the officials.
Japan now tests all cattle slaughtered for consumption for BSE.
The mandatory testing started in Oct 2001, after Japan's first
mad cow case was confirmed. A BSE research project, "Experimental
production of bovine tissue for the validation of BSE diagnostic
was reportedly launched by DEFRA in the UK several years ago.
Russia: Tick-borne diseases
Tick-borne encephalitis (TBE) is common in Russia, although there
are only a few reports with epidemiological data. TBE is the disease
subsuming Central European encephalitis (CEE) and Russian spring-summer
encephalitis (RSSE). TBE is spreading, with an actual distribution
pattern from eastern France (in the West), to northern Japan (in
the East), and from Scandinavia (in the North), to Croatia and
northern Italy (in the south). Besides the prevention of tick bites
(repellents like DEET being less effective than against mosquitoes),
vaccination is an excellent prophylactic tool, but unaffordable
for many people in Russia.
Kemerovo region: suspected tickborne encephalitis outbreak
Altay region: 26 hospitalized with spotted fever
Russia (central Siberia): Scientist Dies in Lab Accident
Involving Ebola Virus
The incident was the third case of accidental contraction of
a deadly virus at Vector. The center was established in 1974 to
study dangerous virus pathogens and to develop treatment and diagnostic
preparations in the interests of health care and defense. One Vector
researcher accidentally contracted Marburg virus and died in 1988,
while another worker contracted the same virus and survived in
1990. In a 1996 incident at the Defense Ministry's Virology Center
in Sergiyev Posad near Moscow, a worker accidentally contracted
the Ebola virus infection and died, Skultetskaya said. A similar
accident occurred in a US Laboratory in February 2004; the scientist
involved was fortunate not to develop hemorrhagic fever. Ebola
virus is spread by contact with body fluids, including sweat and
saliva. Outbreaks of the disease are rare, and the source and vector
of the virus are unknown.
Russia (Volgograd): Four cases of botulism reported
Hong Kong: outbreak of hand, foot & mouth disease
in preschool children
Symptoms usually include fever, mouth sores and rashes on the hands and feet. The infectious disease is not usually life-threatening, but can potentially cause fatal inflammation of the heart muscles, spinal cord or brain. Only two of the 27 children who showed symptoms of the disease in the two latest apparent outbreaks have required hospital treatment, and their parents were advised to keep them away from school until they have completely recovered.
Hand, foot and mouth disease most commonly occurs in summer and
early autumn. It usually affects children and can be spread through
direct contact with body fluids. In March 2004 five children from
the kindergarten section of the Yew Chung International School
in Kowloon Tong were reported to have contracted hand, foot & mouth
disease. None of the children, all aged four years, developed complications.
A two year old boy who became ill 10 Apr 2004 with fever and rash
over hands and mouth was admitted to Queen Elizabeth Hospital on
14 Apr, discharged on 15 Apr, and recovered. Up to that time, cumulative
hand, foot & mouth
disease cases in Hong Kong in 2004 were three imported and no local
cases. The total number of cases in previous years is: 60 in 1998,
22 in 1999, six in 2000, 30 in 2001, five in 2002, one in 2003.
Eastern China: Toxic red tide spreads
The vice-minister at the State Environmental Protection Administration,
Pan Yue, warned people about eating fish from the area off Zhoushan
in Zhejiang province. "It might cause damage to
humans, because the red tide contains paralyzing toxins," he
phenomenon, though colorful in appearance, is very dangerous, because
it can lead to the death of aquatic life, and, therefore, cause
damage to the fishing industry." The red tide first appeared
at the beginning of May. "Due to the fact that the current
environment in the sea areas is good for the organisms to survive,
the tide will continue for a period of time," the newspaper
said. Numerous algal organisms can produce the toxic phenomenon
known as red tide. The algae most often affect seafood that is
consumed by people, and its effects are reported as paralytic shellfish
poisoning. Red tides may produce respiratory irritation in swimmers
and beach goers.
Pakistan: Four more Crimean-Congo hemorrhagic fever cases
admitted to hospital
Blood samples from the victims who died of suspected Crimean-Congo
hemorrhagic fever have been sent to South Africa for further tests,
and health teams have been sent to the affected areas to create
awareness among the villagers. The disease is endemic in the border
region between the Baluchistan province of Pakistan and Afghanistan.
Crimean-Congo hemorrhagic fever virus is a tickborne virus stemming
from livestock, which is transmitted into open cuts and sores.
It causes massive bleeding through the nose, mouth and ears and
can lead to organ failure. This extremely contagious disease can
be passed on by contact with the blood, and other body fluids,
of a patient. Initial symptoms include headaches, fever, and vomiting.
Pakistan (Sindh Province): Contaminated water kills 12
India (Bihar): Rural areas in grip of kala-azar (visceral
Since 1989, Vaishali district has been gripped by kala-azar,
but no concrete measures have been undertaken to eliminate the
sand-fly, which is the carrier of the disease. During the current
financial year, INR 3 million (approximately USD 66 000) was provided
to the department concerned but was returned unused. In 2003, INR
11 66 260 (approx. USD 26 000) was received for kala-azar elimination,
but only INR 75 643 (USD 1670) could be utilized, said official
sources. The scarcity of DDT has also added to the kala-azar menace.
The district magistrate H R Srinivas said he was personally monitoring
the situation and preventive steps were being taken.
USA: FDA issues alert on additional recalled
stocks of Paramount Farms raw almonds
The almonds have the potential to be contaminated with Salmonella enteriditis, an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy people infected with salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting, and abdominal pain. In rare circumstances, infection with salmonella can result in the organism getting into the bloodstream and producing more severe illnesses. Consumers who are experiencing symptoms that could be salmonellosis should consult their health care providers or their local health department.
Paramount Farms announced a limited recall 18 May 2004 of whole
natural raw almonds sold under the Kirkland Signature, Trader Joe's
and Sunkist brands. FDA, the CDC, and state health and agriculture
departments are aware of about 18 reports of Salmonella enteriditis
infection possibly related to the consumption of the almonds now
under recall. FDA continues to work with CDC and state and local
agencies to investigate the source of this outbreak. Individuals
who have purchased the recalled raw almonds should not consume
them but instead return them to the place of purchase for a full
Canada (British Columbia): Poultry farm outbreaks Not
"Further testing has revealed that geese on a Fraser Valley farm were not infected with either H5 or H7 avian influenza," the agency said. "There is strong evidence indicating the geese were exposed to the H6 avian influenza virus. The H6 virus is not associated with serious animal or human illness." Neither clinical signs nor high mortality were observed in this flock. Additional tests currently underway may further define the virus type in the geese. Further testing will also determine the type of virus present in the ducks on the farm.
Canadian authorities ordered a massive cull of about 19 million
poultry in the Fraser Valley area, the center of an outbreak of
H7N3 bird flu that has so far been found on 40 farms and 10 small
poultry operations. The suspected flock was located within 3km
of three known infected premises and was targeted for depopulation
as part of the CFIA's avian influenza response. The regional depopulation
of animals in response to contagious diseases such as avian influenza
reflects internationally accepted animal disease management strategies.
Detecting various subtypes of the avian influenza virus is not
surprising, particularly in birds such as geese and ducks that
are usually raised outdoors. Under such conditions, commercial
birds have contact with wild birds, which are known to carry various
USA: USDA to try to track animal disease
In the initial phase, the department will evaluate the pilot programs it currently funds, and look for others. Some pilot programs are studying equipment that would identify the animals, such as microchips that can be implanted in individual cattle. Others are creating databases to store records. The department expects that the facilities that keep the animals could start receiving their identification numbers later in 2004, with identification numbers for livestock possibly following shortly thereafter. The animal identification program would eventually replace the current recording system that left authorities scrambling after mad cow disease was found in the US Dec 2003.
Officials wanted to track animals
the same Canadian herd as the Washington State Holstein that
with the US's only case. Officials feared the animals could have
same potentially infectious feed. In the end, the department
could not locate 11 of the 25 animals it most wanted, but said
the risk of
disease in those animals was extremely small.
USA: USDA vets allowed to take samples from condemned cattle
On 28 Apr 2004, a cow brought to slaughter at the Lone Star Beef meatpacking plant was condemned after it staggered and fell, indicating injury or a potential central nervous system disorder that is one of the signs of mad cow disease. No part of the animal entered the human food chain and there was no risk to public health, officials said. The cow was taken to a rendering plant where the Food and Drug Administration (FDA), which regulates rendering plants, approved it for use in swine feed. The vet recommended samples be taken from the cow's brain for testing, but the USDA APHIS in Austin said no test would be done on the animal.
"We said very clearly that was a mistake," said Ed Loyd, a USDA spokesman. "We want to make sure that doesn't happen again."
Health inspection service officials will begin training as many as 90 Food Safety and Inspection Service (FSIS) vets on how to take samples, and eventually, all of the 300 vets at beef slaughterhouses will be trained. On 1 Jun 2004, the USDA will begin testing more than 220 000 cattle, more than 10 times the number it tested during 2003. The surveillance tests, which will last for 12 to 18 months, will include 201 000 animals considered at high risk for mad cow disease, because they show signs of nervous system disorders. Random tests also will be conducted on about 20 000 older animals sent to slaughter even though they appear healthy. Those tests are aimed at sampling cattle old enough to have eaten feed produced before 1997, when the FDA banned the use of cattle tissue in feed for other cattle. Cattle eating the tissue of a diseased cow is considered the primary way the misshapen protein blamed for mad cow disease is transmitted.
humans, eating the diseased meat can cause a similarly rare but
illness, variant Creutzfeldt-Jakob disease. It is widely touted
FDA established a feed ban rule in 1997, an action taken prior
detection of the disease in the US, which was hailed as a major
advance. However, it appears not to have been strictly enforced--as
warning letters to numerous feed manufacturers often appear
on the FDA web
There are allegations that not all the
manufacturing sites have even been inspected for compliance.
from California indicate very few of their plants have been inspected,
the FDA website indicates almost all have been inspected. DNA
some feed samples have detected prohibited products of mammalian
USA (Ohio): Hand, Foot and Mouth Disease Outbreak in Cincinnati
USA (Nevada): Two new E. coli 0157 cases, livestock exposure
The three earlier cases
in a 4-year-old boy, his 8-month-old sister and a 3-year-old
girl, who was
being taken care of by the two children's mother. Only the boy
severe case, with kidney shutdown due to a rare side-effect called
hemolytic uremic syndrome (HUS), and he required dialysis. Kelaita
is uncommon for those who contract E. coli O157 to suffer from
well. "Most people with this infection will develop a milder,
self-limiting, type of illness". He added, "E. coli
O157:H7 is considered
an emerging infection, and, each year, we tend to see a little
bit more of
this kind of infection," he said. "Where we live, in
Calaveras County, we
have people who are exposed to livestock. They have a ranching
to their daily lives, and they're in closer contact with animals."
USA (Illinois and Texas): Outbreaks of Cyclospora from Salad
The FDA urged consumers who experience those
after eating basil or spring mix salad products to tell their
notify local health officials. The agency says 57 people in Wheaton,
Illinois reported getting sick in February 2004 after eating
containing basil and mesclun, or spring salad mix, at a restaurant.
far, lab tests have confirmed that 20 of those cases were cyclosporiasis.
Also in February 2004, 38 people in
Irving, Texas, also reported that they got sick after eating
mesclun at a local restaurant. Tests have confirmed that 16 of
cyclosporiasis, FDA says. The FDA is trying to determine where
potentially contaminated food came from.
Cyclospora is a new pathogen that is easily missed unless the
examined after staining with a modified Ziehl-Neelsen stain.
tend to occur in outbreaks, and the source is usually berries
vegetables that may have been fertilized with manure. In 1996/1997
were multiple outbreaks of cyclosporiasis associated with raspberries
imported from Guatemala; this led to a ban on import of raspberries
Guatemala for 1998. For more information about cyclosporiasis,
Brazil (Para State): Vampire Bats May Have Been Responsible
for 22 Deaths
Health ministry representatives arrived in Para on 24
May 3004 to
help study the outbreak.
Rabies has an incubation period of up to a year, during which
to be applied. Otherwise, rabies leads to death in 100 percent
Post-exposure vaccination should be carried out as soon after
possible. All bite victims received vaccines and other anti-rabies
treatment, and Pinheiro said the situation was now under control
awareness campaign. Deforestation is one of the suspected reasons
attacks on humans, as it could have changed bats' migration patterns.
Vampire bats normally feed on the blood of large birds and sleeping
cattle. They often transmit rabies to cattle. They are not aggressive
fly away if scared. In a 1995 PAHO document
rabies is identified as an important public health and economic
Latin America, French Guinea, Guyana, Suriname and Trinidad and
United Kingdom: BSE crisis draws to an end
Fallout from the BSE crisis that hit the UK meat industry in the 1990s could be nearly over, as the EU's food safety body paves the way for British beef to move down from its 'high risk' classification. The European Food Safety Authority (EFSA), whose task is to assess risk in food, said mid May 2004, that British beef will soon be downgraded to a "moderate BSE risk," the same as meat from the rest of Europe. Between Nov 1986 and Nov 2002, 181 376 cases of the fatal cattle disease Bovine Spongiform Encephalopathy (BSE) were confirmed in the UK.
request from the European Commission, the EFSA scientific panel
biological hazards (BIOHAZ) examined the UK's application to
as a "moderate BSE risk" according to the standards
of the World
Organization for Animal Health (OIE). "The panel concludes
that the UK
will reach the threshold that will enable it to be considered
"moderate BSE risk" country at a date no later than
Dec 2004," said the
Causing millions of euros in lost revenues, and costing the UK
estimated BP 4.6 billion, the "mad-cow crisis" in the
down UK farmers, as countries blocked British beef imports over
contamination fears. British beef exports are currently classed
"high-risk" incurring stiff restrictions for UK farmers.
The UK's National
Farmers' Union welcomed the news, saying it "reconfirms
the effect of the
UK's BSE controls and shows that BSE is in rapid decline," and
way for the UK to export. For a country to be labeled a "moderate
it must post less than 200 BSE cases per one million adult cattle.
United Kingdom: Three among 12,674 tissue samples test variant
A total of 141 people have died from vCJD in the UK since the disease emerged in 1995. Scientists have been suggesting that the number of deaths from the disease had peaked. A recent study by researchers at Imperial College London predicted the disease would claim fewer than 540 lives. The scientists who carried out this latest study said their findings "need to be interpreted with cautionthe presence of the protein in these tissue samples does not necessarily mean that those affected will go on to develop vCJD," said lead researcher David Hilton.
Professor James Ironside of the National CJD Surveillance Unit in Edinburgh said the findings suggest some people could carry the disease without ever showing any symptoms. But he added: "I think the findings do have to be taken seriously. Generally, one has to be cautious about interpreting these data, but they may indicate that there are people who are not infected in the normal way but could represent a source of infection." "I find these results very concerning," said Professor John Collinge, head of the MRC Prion Unit at St Mary's Hospital, in London. "Our experience is that looking at appendix samples will underestimate the true pictureThere is a concern that individuals who are incubating the disease, who themselves don't show any evidence of the disease, could still pose a risk to others, if they were blood donors, or if they had an operation which involved instruments contacting infected tissues," he added. He suggested the government should look again at whether surgeons should use disposable instruments in operations where there may be a risk of transmission, such as the removal of tonsils.
A Department of Health spokesman said
it had "already put in place measures to reduce any risk of possible
of the disease via blood products and surgical instruments."
Meanwhile, the Health Protection Agency is in the process of
100 000 tonsil samples which will be tested for signs of vCJD. "The
scale of the study should provide better estimates of the number
who may be affected," said Professor Pat Troop, its chief
study comes as the Medical Research Council said that a long-awaited
to test potential treatments for vCJD could start within weeks.
examine whether an anti-psychotic called quinacrine or an unlicensed
called pentosan polysulphate can help people with the disease.
shown some promise in patients.
There have been 141 definite or probable deaths from vCJD in
Britain, at a
current rate of around 20 deaths a year. In March Britain banned
who had had transfusions over the past 24 years from donating
reduce the risk of spreading the disease. vCJD was first linked
beef infected with Bovine Spongiform Encephalopathy (BSE), or
disease, in 1996.
Norway: Measles outbreak in children adopted from China
An epidemiological investigation, which included an internet search and contact with the parents of the adoptees, found that the Norwegian adoptees came from the same orphanage in Hunan province as the American adoptees with measles. The children were all 11-12 months old at the time of the outbreak, with the exception of one, aged 16 months. The Norwegian parents traveled to China as a single group, and collected their children from the orphanage 22 Mar 2004, arriving in Norway via Copenhagen 31 Mar 2004. Before the flight, one child was admitted to hospital in Beijing due to illness with a rash, and her journey to Norway was delayed by a few days. Three children came down with fever and a rash shortly after arrival in Norway, and two of them were admitted to hospital. Laboratory testing confirmed measles in all four children who had developed a rash, including the child who had been admitted to hospital in Beijing. Two of the four children who stayed well during the outbreak were given immunoglobulin, and all children with measles are reported to have recovered fully.
have been no reports of secondary cases in Norway during this
Over the past four years, 0-8 cases of measles have been notified
in Norway, all either imported or linked to importation, and
resulted in secondary cases. Many of the cases in recent years
in refugee children who fall ill shortly after arrival in Norway.
present Norway is free of endemic measles, but with MMR coverage
below the desired level, the country needs to be prepared for
linked to imported cases. Adoption agencies should work with
authorities to make sure that adoptees receive the necessary
that vaccinations are properly documented. The WHO's objectives
eventual eradication of measles, and the WHO European Region
specifically targeted elimination of measles by 2010. The use
European Union Public Health Information Network Health Surveillance
System demonstrated the value of increased communication networks.
Africa (Nigeria): Polio targeted as vaccine opponents
After smallpox, polio would be only the second disease known to be wiped out by man. Polio usually infects children under age five via contaminated drinking water and attacks the central nervous system, causing paralysis, muscular atrophy, deformation and, in some cases, death. "When we are sure (the new vaccine) is safe, we will immediately conduct polio immunizations," Sule said. The UN and Nigerian federal authorities have vigorously rejected claims polio vaccines are unsafe, pointing to tests conducted by scientists in Nigeria and abroad. Kano officials say their own scientists found trace levels of a hormone the officials fear could cause infertility in young girls. Some Islamic clerics have seized on the controversy as evidence the immunization program is part of a U.S.-led plot to cause cancer, AIDS and infertility. Nigeria's health minister said that Nigeria's federal government recently agreed with Kano on terms to restart immunizations. As these conditions are now being met, preparations to support full catch-up immunization campaigns in Kano ahead of the nationwide activities in the fall are being made.
As the epidemic continues to spread out from Nigeria, African health ministers meeting in Geneva agreed on a plan to immunize 74 million children in 21 countries — most of them nations previously thought to have eliminated the disease. Nigeria currently has 119 confirmed polio cases, highest in the world and five times the 24 recorded one year ago. In that period, polio has spread from 10 to 23 Nigerian states and nine other African nations where it had previously been eradicated. A $3 billion, 16-year global campaign to eradicate polio has reduced cases of the disease from 350,000 in 1988 to fewer than 1,000 last year. Among challenges facing anti-polio campaigners is raising the millions of dollars to help fund the upcoming 21-country immunization drive. In Kano, health workers hope to conduct a two-week long door-to-door vaccination campaign in coming months. In neighboring Niger, which reported a tenfold increase in cases for 2003 over 2002, work is needed to increase the proportion of children being reached by the vaccination campaigns, said David Heymann, head of WHO's polio eradication program. Even if the WHO reaches its goal of stopping transmission by the end of the year, officials say they will need to monitor the situation for three years before they can certify that polio is wiped out. http://edition.cnn.com/2004/WORLD/africa/05/17/africa.polio.ap/ (CNN.com 5/17/04)
**This article shows that final efforts at polio eradication are ongoing and the support provided are producing desired results. The WHO's efforts are in line with a campaign which has been very successful in the Asia Pacific, and we hope the global effort will also succeed.**
Africa: Agencies Turn to Artemisinin in Treating Resistant
Until recently, big donors like the US and UK had opposed its use on a wide scale, saying it was too expensive, had not been tested enough on children and was not needed in areas where other malaria drugs still worked. Unicef, the United Nations Children's Fund, which procures drugs for the world's poorest countries, opposed its use during an Ethiopian epidemic in 2003. But now almost all donors, Unicef and the World Bank have embraced the drug. The new Global Fund for AIDS, Tuberculosis and Malaria has given 11 countries grants to buy artemisinin and has instructed 34 others to drop requests for two older drugs, chloroquine and sulfadoxine-pyrimethamine, and switch to the new one. The fund expects to spend USD 450 million on the drug over the next five years. The WHO estimates that 100 million doses will be needed by late 2005.
Malaria causes about 300 million illnesses a year, and at least
million deaths, 90 percent of them in Africa and most of them
under five. Despite more than a century of eradication efforts,
disease is endemic from Vietnam to Brazil, and is particularly
across central Africa. Chinese scientists first isolated artemisinin
1965 while seeking a new antimalarial treatment for Vietnamese
fighting American forces, said Dr. Nelson Tan, medical director
Pharmaceuticals, which makes the drug in Chongqing, China. Artemisinin
no significant side effects and quickly reduces fevers and rapidly
blood-parasite levels, which can keep small outbreaks in mosquito-infested
areas from becoming epidemics. The price of artemisinin cocktails
fallen from $2 per treatment to 90 cents or less as more companies
China, India and Viet Nam have begun making them. (Older drugs
20 cents.) Novartis sells its artemisinin-lumefantrine mix, Coartem,
poor countries for 10 cents less than it costs to make. Further
information on resistance and the use of ACT can be found in
the WHO 2003 Africa Malaria Report, chapter 3: <http://mosquito.who.int/amd2003/amr2003/pdf/amr2003.pdf>
Avian Influenza Virus A (H10N7) Circulating among Humans
*West Nile Virus*
USGS West Nile Virus Maps 2004 Now Being Posted
Registry Progress — United States, January–December 2002
Fatal Cases of Rocky Mountain Spotted Fever in Family Clusters
Multifocal Autochthonous Transmission of Malaria — Florida,
Severe Acute Respiratory Syndrome: Clinical Features, Diagnosis, and Management Curr Opin Pulm Med 10(3) 2004 The first published reports of SARS appeared on-line in March 2003, and by December, more than 1000 indexed articles had appeared in print. This article reviews the epidemiology, cause, case definitions, clinical features, hematologic and biochemical changes, radiologic appearances, diagnosis, prognosis, pathology, and management of SARS. (Medscape Infectious Disease 5/19/04)
Current Issues in Treatment of Respiratory Infections
Infect Med 21(4) 2004
BMJ: How electronic communication is changing health
Regional emerging diseases center officially opens in
Set up at a cost of S 400 000 (approximately USD $233,622), the REDI Centre's top priority is the surveillance of emerging infectious diseases like SARS. But, the Centre, nestled alongside key research institutes, and pharmaceutical companies, will also be a base for the training of public health officials, researchers, clinicians, and other health professionals. "While this Centre is primarily bilateral, we hope to see other countries come into the REDI Centre to share their expertise, to learn, and to participate, particularly in training activities that will take place here on the ground," said Claude Allen, US deputy secretary of Health and Human Services. "That's what's key about this, that the REDI Centre is not just a bilateral activity. It's a bilateral activity that hopes to draw multi-national support and cooperation." Backed by the US CDC and the Food and Drug Administration, the REDI Centre hopes to increase its staff and to start training courses by the end of 2004.
The Centre is headed by Dr. Kimi-Lin from the US National Institutes of Health. Its first project is flu surveillance. "In light of the Avian Influenza earlier in 2004, we're quite concerned about the emergence of a new strain of the influenza virus. And, if a new strain comes out that most populations in the world have no immunity against, that means the new strain could cause a pandemic outbreak," said Dr. Kimi-Lin. It is hoped that REDI can tap US and regional expertise to develop new vaccines, drugs, and diagnostic tests. Already, the Centre's many-hands approach has received a shot in the arm from WHO. WHO head, Dr. Lee Jong Wook, has affirmed its commitment to work with the REDI Centre. (Promed 5/26/04)
The OIE paves the way for a new animal disease notification
The overriding criterion for a disease to be listed is its potential for international spread. Other criteria include a capacity for significant spread within naive populations and the zoonotic potential. Each criterion is linked to measurable parameters: if a disease fulfills at least one of these parameters, then it becomes notifiable. Under the future OIE notification system, not only the disease but other related events will require urgent notification. All events of epidemiological significance must be notified immediately to the OIE. These changes will improve the efficiency of the OIE early warning system for the benefit of the international community.
The events of epidemiological significance
should be notified immediately are as follows:
Proposals have been made to adapt the OIE's information system
single list, involving changes in the frequency with which Member
Countries should submit regular reports to the OIE, namely 6-monthly
annual. Implementing these changes will mean completely redesigning
existing animal health information system, which will need to
advantage of the possibilities offered by the latest information
communication technology, including mapping software.
New Definitions for Travel Notices Regarding Diseases
notices are as follows:
- Outbreak Notice. Information is provided regarding a disease outbreak in a limited geographic area or setting. The risk for travelers is defined and limited, and the notice reminds travelers about standard or enhanced travel recommendations such as vaccination.
- Travel Health Precaution. Specific information is provided to travelers regarding a disease outbreak of greater scope and over a larger geographic area, aimed at reducing the risk for infection. This precaution also provides guidance to travelers about what to do if they become ill while in the area. At this level, CDC does not recommend against travel to a specific area, but might recommend limiting exposure to a defined setting (e.g., poultry farms or health-care facilities).
- Travel Health Warning. A recommendation is issued against
nonessential travel to an area because a disease of public health
is expanding beyond the locales or populations that were affected
initially. The purpose of a travel warning is to reduce the volume
traffic to affected areas, limiting the risk for spreading the
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Copyright 2003, The University of Washington