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1. INFECTIOUS DISEASE INFORMATION

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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.
(Promed 5/15/04, 5/26/04, 5/27/04)

China: latest SARS outbreak contained but biosafety concerns remain
It has been more than three weeks since the last case was placed in isolation in China's latest SARS outbreak, prompting the WHO to declare that the chain of human-to-human transmission appears to have been broken. The investigation has centered primarily on the National Institute of Virology in Beijing, where experiments using live and inactivated SARS coronavirus have been carried out. Two researchers at the institute developed SARS in late March and mid-April 2004. The outbreak was reported April 22 and the institute was closed a day later. Preliminary findings in the investigation have yet to identify a single infectious source or single procedural error at the institute. Neither of the researchers is known to have directly conducted experiments using live SARS coronavirus. But investigators have serious concerns about biosafety procedures at the institute--including how and where procedures using SARS coronavirus were carried out, and how and where SARS coronavirus samples were stored.

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.
WHO also urges member states to maintain a thorough inventory of laboratories working with and/or storing live SARS coronavirus and to ensure that necessary biosafety standards are in place. WHO commends the Chinese authorities for taking swift action to contain the latest outbreak once it was recognized and reported, by way of extensive contact tracing and the quarantine and medical observation of such individuals. Increased awareness of the disease, early recognition, and early implementation of control measures are all essential and effective in interrupting person-to-person transmission and preventing a repeat of the epidemic.
(Promed 5/22/04)

Asia Pacific: Toxic foods killing thousands of humans, UN told
Industry officials and consumer activists from 42 Asian and Pacific Rim countries met in Malaysia 24 May 2004 to counter the threat of food-borne diseases. Countries must try to ensure food is produced, handled, and distributed more safely to prevent hundreds of thousands of deaths worldwide each year from food-borne illnesses, officials said. Recent reports of toxic maize that is believed to have killed dozens of people in Kenya and the possibility of salmonella in raw almonds exported by a US company have underscored fears about how contaminated food can threaten people's health and disrupt international trade, said Hartwig de Haen of the UN Food and Agriculture Organization (FAO). De Haen said the death toll of food-borne diseases globally was staggering, especially in developing countries, where poor governments lack funds to monitor food safety and people's choices of food are often limited. Severe diarrhea kills 1.8 million people annually, and high casualties can also surface from smaller, sporadic outbreaks such as a suspected mold contamination of maize in Kenya that is believed to have killed up to 40 people.

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.
(Promed 5/25/04)

Japan (Nagasaki): Hepatitis E Virus Infection Associated with Wild Boar Barbecue
Eleven elderly men have been infected with hepatitis-E virus after eating wild boar meat at a barbecue party in Nagasaki Prefecture 14 months ago. This is the first time it has been confirmed that more than 10 people had contracted hepatitis-E virus from the same source. Doctors suspect the 11 men may have either eaten meat that had not been grilled thoroughly enough to kill the virus or used chopsticks that had touched raw meat.

"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.
(Promed 5/13/04)

Japan: Infected cow brains on menu for BSE tests
In an unappetizing experiment, health experts will feed cattle the brains of cows infected with mad cow disease to find an early detection method for the disease, officials said. The National Institute of Animal Health will begin, in Jun 2004, a series of tests using live cattle to combat possible outbreaks of bovine spongiform encephalopathy (BSE). By artificially infecting the healthy herbivores with BSE, the researchers hope to learn how the disease develops. The tests will be conducted in a tightly sealed facility in Tsukuba, Ibaraki Prefecture that cost 7.1 billion yen (USD 62 million) to complete.

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 tests (SE1736)", was reportedly launched by DEFRA in the UK several years ago.
(Promed 5/15/04)

Russia: Tick-borne diseases
Krasnoyarsk Region: Seven Suspected Tick borne Encephalitis Cases
Seven people from the Krasnoyarsk region were hospitalized this week with a suspected diagnosis of tick-borne encephalitis. According to a news report, 609 people, including 143 children, have sought treatment for tick bites. Almost half were from Krasnoyarsk itself; 315 in total, including 70 children under the age of 14. The Krasnoyarsk Region, and the city of Krasnoyarsk, are located in the southern part of Siberia where tick-borne encephalitis is endemic.

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.
(Promed 5/14/04, 5/16/04)

Kemerovo region: suspected tickborne encephalitis outbreak
Fifteen people have been admitted to hospital in Kuzbass (Kemerovo Region) with suspected tickborne encephalitis. Over 3000 local people have already sought medical help for tick bites. Officials stressed that the region has sufficient stocks of immunoglobulin: a total of 50 000 doses. About RUR 3 million (USD 103 500) has been allocated from the regional and local budgets, as well as from the territorial compulsory medical insurance fund, to purchase immunoglobulin. Vaccination is an alternative to the administration of immunoglobulin in the control of tickborne encephalitis. The current vaccines, derived from two different European strains of tickborne encephalitis virus, have been shown both to be cross-protective against the Russian and Far Eastern subtypes/strains of the virus.
(Promed 5/18/04)

Altay region: 26 hospitalized with spotted fever
Tick activity has increased, with the number of people reported to have
been bitten by ticks reaching 206. 29 have been admitted to hospital—26 diagnosed with tickborne spotted fever, two with tickborne encephalitis, and one with tickborne borreliosis. The Altay Republic has one of the highest rates of tickborne diseases in Russia. Tick bites are reported by about 1000 people/year.
(Promed 5/20/04)

Russia (central Siberia): Scientist Dies in Lab Accident Involving Ebola Virus
A Russian researcher has died after sticking herself with a needle containing Ebola virus, her organization said 24 May 2004. The accident occurred 5 May 2004, when the scientist was conducting research on Ebola virus, a virus for which no vaccine or remedy exists, said Natalia Skultetskaya, a spokeswoman for the Vector State Research Center of Virology and Biotechnology in central Siberia. The researcher was conducting a scientific experiment in the Department of Dangerous viral Pathogens of the Molecular Biology Scientific Research Institute. Skultetskaya said that efforts to save her failed and she died 19 May 2004 at the dangerous infections department of a special hospital located in the grounds of the Centre. The staff who were involved in the treatment and investigation of the patient will be kept under observation for 21 days: they will undergo a daily medical exam and twice-daily temperature measurement.

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.
(Promed 5/22/04, 5/25/04, 5/26/04)

Russia (Volgograd): Four cases of botulism reported
Four cases of botulism were reported in Volgograd, Russia, one with a fatal outcome. The affected persons were admitted to the Krasnooktyabrskiy and Sovetskiy hospitals 19 May 2004. According to the Sanitary Epidemiological Surveillance Center's Hygiene Department, all four cases ate dried fish bought from the "Petrovskiy" shop. On 25 May 2004, a 73-year-old woman died from the poisoning. Another young 20-year-old woman is currently in serious condition in the intensive care unit. The condition of two other patients, a 53-year-old man and a 73-year-old man, is satisfactory. The cause of poisoning has not been identified, but officials are warning people to avoid buying fish from the "Petrovskiy" shop. Type E botulism is frequently associated with fish products. Botulinum toxin is considered to be one of the category-A biowarfare agents by the US CDC. Classically, botulism is a food-borne disease caused by the ingestion of preformed toxin, although there also exists wound botulism (in which C. botulinum spores germinate in a wound), and infant botulism (in which the spores germinate in the intestinal tract). |
(Promed 5/26/04)

Hong Kong: outbreak of hand, foot & mouth disease in preschool children
A 21 month old boy recently contracted enterovirus 71 infection, one of several viruses that can cause hand, foot and mouth disease, said Health Department spokesman Jimmy Lee. This virus was blamed for the deaths of 50 children in Taiwan in 1998, and 30 in Malaysia in 1997. The boy has recovered, but officials were checking whether other children--including 16 of his schoolmates and 10 children at another nursery--have contracted enterovirus 71 infection. All the children had symptoms of hand, foot and mouth disease around 7 May to 18 May 2004. Although laboratory tests showed that the 21 month old boy had the sometimes deadly enterovirus 71, Lee said it was premature to say whether the others had the same virus.

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. |
(Promed 5/21/04)

Eastern China: Toxic red tide spreads
A toxic red tide has blanketed the equivalent of more than 1.3 million soccer fields of sea, off eastern China, threatening marine and human life, state media say. The tide is caused by plankton reproducing itself in large quantities through nutrients provided in part by sewage and industrial waste.

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 said. "The 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.
(Promed 5/18/04)

Pakistan: Four more Crimean-Congo hemorrhagic fever cases admitted to hospital
Four people, including two Afghans, suffering from suspected Crimean-Congo hemorrhagic fever virus infection have been admitted to the hospital in Quetta, where the highly contagious disease claimed three lives in May 2004, a senior Health Ministry official said. The Afghans, who came from Afghanistan's southern Kandahar province, were admitted to the Fatima Jinnah Hospital in Quetta. They had high fever and were bleeding through the mouth and nose, and one Pakistani, with similar symptoms, was brought from Qila Saifullah, 160 kilometres north east of Quetta and another from Zhob district, bordering Afghanistan. The patients, quarantined in a special isolation ward, were receiving treatment, including blood transfusions, and were showing signs of improvement. A Pakistani couple, and their son from Qila Saifullah, died 1 May 2004 after bleeding through multiple body openings, hospital officials said mid May 2004.

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.
(Promed 5/17/04)

Pakistan (Sindh Province): Contaminated water kills 12 people
Contaminated water from a state-run reservoir has killed at least 12 people, and made 2000 ill, in southern Pakistan. Naeem Ishtiaq, health minister for the southern province of Sindh, said about 2000 people had been admitted to the hospital in Hyderabad after consuming water from Manchar Lake. He said at least eight people had died, and other officials said four more had died before reaching the hospital. The source of contamination is unknown, and authorities have ordered an investigation. WHO is preparing a report, after taking water samples from the lake.
(Promed 5/26/04)

India (Bihar): Rural areas in grip of kala-azar (visceral leishmaniasis)
The entire rural area of Vaishali district has been suffering from the deadly kala-azar disease for the last two months, and more than a dozen villagers including children have died. However, according to official figures, only two persons have died of kala-azar, while 298 are still affected in different areas. Officially, it was admitted that as many as 157 patients with kala-azar were provided medical treatment, while 138 patients are still undergoing treatment at different primary health centers. Sources said that Mahua, Raghopur, Mahnar, Lalganj, Goraul, Sahdeibujurag, Vaishali, Bidupur and Jandaha blocks are badly in the grip of the kala-azar epidemic.

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.
(Promed 5/26/04)

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USA: FDA issues alert on additional recalled stocks of Paramount Farms raw almonds
The United States Food and Drug Administration (FDA) is advising distributors, wholesalers, and consumers that a recall of raw almonds due to reports of Salmonella enteriditis that was announced by Paramount Farms, Lost Hills, CA, on 18 May 2004 has expanded. Before eating any raw almonds having a "best before" date of 21 Aug 2004 or later, consumers are advised to check with the store where they purchased the product to see whether the almonds came from Paramount Farms. FDA has learned that Paramount Farms distributed the recalled almonds in bulk or packaged nationwide to brokers, distributors and grocery store chains, which in turn sold the almonds to consumers in various package sizes and with various brand names. The almonds were also distributed to Mexico, Japan, Korea, Taiwan, Malaysia, France, England, and Italy.

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 refund.
(Promed 5/23/04)

Canada (British Columbia): Poultry farm outbreaks Not H5N1
Tests have shown that a new variant of bird flu discovered in western Canada is not the strain of the disease that killed 24 people in Asia. Initial investigation gave cause for suspicion of an H5 infection on a farm in the Fraser Valley, and were testing to see if it was the H5N1 variant found in Asia.

"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 viral subtypes.
(Promed 5/14/04)

USA: USDA to try to track animal disease
The Agriculture Department is about to start examining systems that could help it locate, within 48 hours, animals that might have mad cow disease or other infectious diseases. The department will spend USD 18.8 million on the first phase of its multi-year animal identification program, said Bill Hawks, undersecretary for marketing and regulatory programs. The department will examine ways to label the places where animals live, such as farms, ranches, and feedlots. These systems might later be enhanced to identify the animals themselves.

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 born in the same Canadian herd as the Washington State Holstein that was diagnosed with the US's only case. Officials feared the animals could have eaten the same potentially infectious feed. In the end, the department conceded it could not locate 11 of the 25 animals it most wanted, but said the risk of disease in those animals was extremely small.
(Promed 5/15/04)

USA: USDA vets allowed to take samples from condemned cattle
US Department of Agriculture (USDA) veterinarians at slaughterhouses are now allowed to take samples from condemned cattle, a step taken in response to last month's failure to test a cow that had signs of mad cow disease. Previously, samples only could be taken by officials from the USDA's Animal and Plant Health Inspection Service (APHIS), which has offices that are often far from slaughterhouses.

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.

For humans, eating the diseased meat can cause a similarly rare but fatal illness, variant Creutzfeldt-Jakob disease. It is widely touted that the FDA established a feed ban rule in 1997, an action taken prior to detection of the disease in the US, which was hailed as a major safety advance. However, it appears not to have been strictly enforced--as warning letters to numerous feed manufacturers often appear on the FDA web site (<http://www.fda.gov>). There are allegations that not all the manufacturing sites have even been inspected for compliance. News articles from California indicate very few of their plants have been inspected, yet the FDA website indicates almost all have been inspected. DNA tests of some feed samples have detected prohibited products of mammalian origin.
(Promed 5/25/04, 5/27/04)

USA (Ohio): Hand, Foot and Mouth Disease Outbreak in Cincinnati
Hand, foot and mouth disease has doctors telling parents to keep their children at home. The disease is the most common cause of mouth sores that are often so painful that children won't want to eat. Consequently, they can become dehydrated. Signs include bumps and blisters on the palms of the hands or on top or between the fingers. Such bumps or blisters also can pop up on the tops of the feet, and mouth sores can show up on the gums, tongue and throat. Summit Pediatrics spokeswoman Dr. Robin Warner said that they've seen many children and taken numerous calls lately. Hand, foot and mouth disease is a seasonal illness that usually spreads in children age six months to four years. It's also highly contagious, and moves through day-care groups quickly. The fever is usually low-grade, and will last a few days.   Hand, foot and mouth disease occurs globally. In developed countries hand, foot and mouth disease is generally mild and often associated with outbreaks of Coxsackie A virus infection. In East Asian countries in recent years, the disease has been associated with outbreaks of enterovirus 71 infection and can be more severe, with a small proportion of children experiencing neurological complications, occasionally with fatal outcome.
(Promed 5/26/04)

USA (Nevada): Two new E. coli 0157 cases, livestock exposure suspected  
New cases of E. coli O157 surfaced 24 May 2004 in two brothers, said Dr. Dean Kelaita, the Calaveras County public health officer. The boys, aged 14 and 17, are thought to have been infected from contact with livestock, possibly at the Calaveras County Fair, a little more than a week ago, and has "no clear connection" to three other cases discovered earlier in May in Angels Camp. So far, the boys have suffered mild intestinal problems and have not had to be hospitalized. Their cases were discovered after doctors found they each tested positive for the bacterium, and the Public Health Department was notified. An investigation is under way, and they are working on an "educational message" for parents to "allay some of their anxieties" about the chances of their children contracting the bacteria, Kelaita said. It is unlikely that the two cases are related to those diagnosed earlier in May, he said. Each person was diagnosed with the most harmful strain, E. coli O157:H7.

The three earlier cases occurred 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 had a severe case, with kidney shutdown due to a rare side-effect called hemolytic uremic syndrome (HUS), and he required dialysis. Kelaita said it is uncommon for those who contract E. coli O157 to suffer from HUS as well. "Most people with this infection will develop a milder, and 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 component to their daily lives, and they're in closer contact with animals."
(Promed 5/26/04)

USA (Illinois and Texas): Outbreaks of Cyclospora from Salad Packages  
Federal regulators are alerting consumers that raw basil and spring mix salad may be linked to food poisoning outbreaks that reportedly sickened more than 90 people in Illinois and Texas. The agency has been working with CDC to determine the source of the outbreaks of cyclosporiasis, an infection of the small intestine. Cyclosporiasis can cause flu-like symptoms such as diarrhea, stomach cramps, nausea, muscle aches, and fever. Signs of infection usually develop a week after a person eats contaminated food.

The FDA urged consumers who experience those symptoms after eating basil or spring mix salad products to tell their doctors and notify local health officials. The agency says 57 people in Wheaton, Illinois reported getting sick in February 2004 after eating food containing basil and mesclun, or spring salad mix, at a restaurant. So 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 basil and mesclun at a local restaurant. Tests have confirmed that 16 of those were cyclosporiasis, FDA says. The FDA is trying to determine where the potentially contaminated food came from.   Cyclospora is a new pathogen that is easily missed unless the stool is examined after staining with a modified Ziehl-Neelsen stain. Infections tend to occur in outbreaks, and the source is usually berries or vegetables that may have been fertilized with manure. In 1996/1997 there were multiple outbreaks of cyclosporiasis associated with raspberries imported from Guatemala; this led to a ban on import of raspberries from Guatemala for 1998. For more information about cyclosporiasis, see: http://www.cdc.gov/ncidod/dpd/parasites/cyclospora/default.htm
(Promed 5/26/04)

Brazil (Para State): Vampire Bats May Have Been Responsible for 22 Deaths  
Up to 22 people may have died after being bitten by rabies-carrying vampire bats in Brazil's Amazon state of Para. Amiraldo Pinheiro, director of Para state's epidemic research centre, said 17 deaths from rabies had been confirmed in people known to have been bitten by bats. In five more cases the deceased showed typical rabies symptoms but were buried without an autopsy. Fifteen of the confirmed deaths were in the remote riverside Portel area, and two more, including the latest on 19 May 2004, in Viseu region some 280 miles to the east. Pinheiro said epidemiologists from the state health authority found about 1130 people who had been bitten by the thumb-sized bats over the past 12 months in Viseu and about 600 people in Portel.

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 vaccine has to be applied. Otherwise, rabies leads to death in 100 percent of cases. Post-exposure vaccination should be carried out as soon after exposure as possible. All bite victims received vaccines and other anti-rabies treatment, and Pinheiro said the situation was now under control with an awareness campaign. Deforestation is one of the suspected reasons for bat 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 and fly away if scared. In a 1995 PAHO document <http://www.paho.org/english/sha/epibul_95-98/be951rabies.htm> vampire bat rabies is identified as an important public health and economic concern in Latin America, French Guinea, Guyana, Suriname and Trinidad and Tobago.
(Promed 5/20/04, 5/22/04, 5/27/04)

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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.

Following a request from the European Commission, the EFSA scientific panel on biological hazards (BIOHAZ) examined the UK's application to be considered 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 as a "moderate BSE risk" country at a date no later than Dec 2004," said the authority.   Causing millions of euros in lost revenues, and costing the UK taxpayer an estimated BP 4.6 billion, the "mad-cow crisis" in the mid-1980s struck down UK farmers, as countries blocked British beef imports over contamination fears. British beef exports are currently classed as "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 opens the way for the UK to export. For a country to be labeled a "moderate risk," it must post less than 200 BSE cases per one million adult cattle.
(Promed 5/15/04)

United Kingdom: Three among 12,674 tissue samples test variant CJD positive
Researchers at Plymouth's Derriford Hospital and the Creutzfeldt-Jakob Disease Surveillance Unit tested 12 674 appendix and tonsil samples. Three showed signs of variant Creutzfeldt-Jakob disease (vCJD). Extrapolating their findings to the whole population, they estimated that 3800 Britons may harbor the disease. These findings are published in the Journal of Pathology.

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 transmission of the disease via blood products and surgical instruments."   Meanwhile, the Health Protection Agency is in the process of collecting 100 000 tonsil samples which will be tested for signs of vCJD. "The larger scale of the study should provide better estimates of the number of people who may be affected," said Professor Pat Troop, its chief executive. The study comes as the Medical Research Council said that a long-awaited trial to test potential treatments for vCJD could start within weeks. It will examine whether an anti-psychotic called quinacrine or an unlicensed drug called pentosan polysulphate can help people with the disease. Both have 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 people who had had transfusions over the past 24 years from donating blood to reduce the risk of spreading the disease. vCJD was first linked to eating beef infected with Bovine Spongiform Encephalopathy (BSE), or mad cow disease, in 1996.
(Promed 5/21/04)  

Norway: Measles outbreak in children adopted from China  
The Nasjonalt Folkehelseinstitut (Norwegian Institute of Public Health) was alerted to a measles outbreak early April 2004 by the mother of one of the sick children. A few days later there was a similar outbreak of six confirmed and three possible cases among adoptees from China in the US in March 2004. Due to the international character of the outbreak, an early warning was issued through European Union Public Health Information Network Health Surveillance System for Communicable Diseases (EUPHIN HSSCD) 14 Apr 2004. A response from Spain reported one possible case of measles in an adoptee from Hunan province in 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.

There have been no reports of secondary cases in Norway during this outbreak.   Over the past four years, 0-8 cases of measles have been notified per year in Norway, all either imported or linked to importation, and seldom resulted in secondary cases. Many of the cases in recent years have been in refugee children who fall ill shortly after arrival in Norway. At present Norway is free of endemic measles, but with MMR coverage somewhat below the desired level, the country needs to be prepared for outbreaks linked to imported cases. Adoption agencies should work with the authorities to make sure that adoptees receive the necessary vaccines and that vaccinations are properly documented. The WHO's objectives is eventual eradication of measles, and the WHO European Region has specifically targeted elimination of measles by 2010. The use of the European Union Public Health Information Network Health Surveillance System demonstrated the value of increased communication networks.
(Promed 5/20/04)  

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Africa (Nigeria): Polio targeted as vaccine opponents relent  
African leaders approved an emergency strategy 17 May 2004 to immunize 74 million children in 21 nations against polio, amid signs a heavily Muslim Nigerian state are ready to abandon the vaccine boycott that allowed the disease to mushroom. Nigeria's northern state of Kano has been the global epicenter of polio since last October, when authorities there kept children from being inoculated. Kano has finalized a deal to import polio vaccines from Indonesia, Kano government spokesman Sule Ya'u Sule said. State officials hope to permit children to be immunized in coming weeks once Kano government scientists approve the vaccines' safety. UN officials say the boycott has endangered global efforts to eradicate the potentially crippling disease.  

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 Malaria  
After years of hesitation, world health agencies are racing to acquire 100 million doses of a Chinese herbal drug that has proven strikingly effective against malaria, one of the leading killers of the poor. Artemisinin is a compound based on qinghaosu, or sweet wormwood. First isolated in 1965 by Chinese military researchers, it cut the death rate by 97 percent in a malaria epidemic in Viet Nam in the early 1990's. It is rapidly replacing quinine derivatives and later drugs against which the disease has evolved into resistant strains. To protect artemisinin from the same fate, it will be given as part of multidrug cocktails.

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 one million deaths, 90 percent of them in Africa and most of them children under five. Despite more than a century of eradication efforts, the disease is endemic from Vietnam to Brazil, and is particularly severe across central Africa. Chinese scientists first isolated artemisinin in 1965 while seeking a new antimalarial treatment for Vietnamese troops fighting American forces, said Dr. Nelson Tan, medical director of Holley Pharmaceuticals, which makes the drug in Chongqing, China. Artemisinin has no significant side effects and quickly reduces fevers and rapidly lowers blood-parasite levels, which can keep small outbreaks in mosquito-infested areas from becoming epidemics. The price of artemisinin cocktails has fallen from $2 per treatment to 90 cents or less as more companies in China, India and Viet Nam have begun making them. (Older drugs cost only 20 cents.) Novartis sells its artemisinin-lumefantrine mix, Coartem, to 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>
(Promed 5/13/04)

Avian Influenza Virus A (H10N7) Circulating among Humans in Egypt  
The National Influenza Center (NIC) in Egypt and the WHO reported the isolation of Avian Influenza A (H10N7) from two human specimens. They refer to two infants, both aged one year, residents of Ismaillia, who recovered after presenting a fever and cough. The father of one of them is a poultry merchant who frequently traveled between Isamillia and Damietta. In this last town, H10N7 was isolated from five wild ducks between mid Apr 2004, from samples taken from a market of hunted migratory birds. Additional preliminary investigation tested negative in 75 human samples collected in Ismaillia and in 13 samples from migratory birds from the same market. No influenza outbreak has been reported among poultry in Egypt. At present, there are no public-health implications from this event. H10N7 virus has reportedly been occasionally isolated from wild and domestic avians in various parts of the world, as well as from mammals. Its pathogenicity is regarded as being of low magnitude.
(Promed 5/23/04, 5/24/04)

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2. UPDATES

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*Dengue/DHF*  
Vietnam
The Ministry of Health (MOH) has ordered local staff to take preventive measures against the spread of dengue fever, which has infected almost 9000 people and killed 14 in Viet Nam, 93 percent in the southern provinces. Over 70 percent of people infected by the mosquito-borne disease are children under 15 years old, said the MOH.   Indonesia The dengue fever epidemic in Indonesia has subsided after 58 301 cases were reported in four months, which rivaled the pandemic year of 1998, according to the WHO. There were 658 deaths among cases of dengue fever and dengue hemorrhagic fever reported from January through April 2004. The case-fatality rate of 1.1 percent was lower than in previous years, officials said. At the end of April the situation has returned to normal with all provinces reporting cases at a low level," the WHO said. "Jakarta, Bali and Nus Tenggarah Timur, which were among the most affected provinces, are still being monitored closely."  

Sri Lanka
For April 2004 the number of dengue patients were as follows: Colombo 51, Gampaha 32, Kalutara 20, and Kandy 42. Dr. Nihal Abeysinghe, Epidemiologist said that this year's figures of dengue patients so far stood at: 528 in Colombo, 475 in Gampaha, 357 in Kandy, 113 in Kurunegala and 113 in Kalmunai. "Dengue usually comes in 2 peaks following the onset of the monsoons. They usually occur in mid-year June/July and at the end of the year."
(Promed 5/14/04)

*Viral gastroenteritis*
USA (Iowa)
Norovirus infection is responsible for the outbreak of gastroenteritis affecting at least 40 people in Buena Vista County. Health officials say the illness was first reported 6 May 2004 in Alta. No one was admitted to hospital, and officials believe the outbreak has tapered off. Those with the illness are being encouraged to take a lot of fluids and rest. Health officials stated that the virus is often transmitted by food workers who do not wash their hands. (Promed 5/18/04)

*West Nile Virus*
New Mexico
New Mexico has reported its first human West Nile virus case of 2004. The male case had only mild symptoms and has recovered, the state Health Department reported. The mosquito-borne virus killed four people in the state during 2003, all of them in their 70s or older. Eventually, 209 New Mexicans tested positive for West Nile during 2003. This latest case means the West Nile virus season has started early in 2004, Health Secretary Patricia Montoya said. The disease typically causes flu-like symptoms such as fever, nausea, headache and muscle aches. However, it can also lead to encephalitis, an infection of the brain, or meningitis, an infection of the lining around the brain, and can be fatal. The elderly are at most risk.  

Colorado
A Westminster woman, and a Weld County man, may be the first people in Colorado in 2004 to have contracted West Nile virus infection. Preliminary blood tests for the two persons were positive for West Nile virus. But state health officials, in the midst of a second round of tests on both persons, believe there is little epidemiological evidence that would point to West Nile virus as the culprit. In all, 2947 people in Colorado were infected in 2003--the most of any state--and 63 of them died. While they await confirmation of the disease, both of 2004's potential West Nile victims are recovering at home.  

USGS West Nile Virus Maps 2004 Now Being Posted
County level maps showing 2004 West Nile virus activity in the US are now being posted on the U.S. Geological Survey web site: http://westnilemaps.usgs.gov The web site has been completely re-engineered for 2004 with major improvements in efficiency, appearance, and usability. The maps depict the information contained in the ArboNET database of CDC, and are updated weekly. These same data are used to prepare the MMWR West Nile virus summary reports.
(Promed 5/19/04, 5/26/04)  

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3. ARTICLES

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Immunization Registry Progress — United States, January–December 2002
"Immunization registries are confidential, computerized information systems that collect vaccination data within a geographic area. By consolidating vaccination records from multiple health-care providers, generating reminder and recall notifications, and assessing clinic and vaccination coverage, registries serve as key tools to increase and sustain high vaccination coverage. One of the national health objectives for 2010 is to increase to 95% the proportion of children aged <6 years who participate (i.e., have two or more vaccinations recorded) in fully operational, population-based immunization registries (objective 14.26). This report summarizes data from CDC's 2002 Immunization Registry Annual Report (2002 IRAR), a survey of registry activity among immunization programs in the 50 states and the District of Columbia (DC) that receive grant funding under section 317b of the Public Health Service Act. These data indicate that approximately 43% of children aged <6 years are enrolled in a registry; achieving the national health objective will require increased implementation of functional standards to improve data quality." http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5320a3.htm
(MMWR May 28, 2004 / 53(20);431-433)

Fatal Cases of Rocky Mountain Spotted Fever in Family Clusters — Three States, 2003
"Rocky Mountain spotted fever (RMSF), a tickborne infection caused by Rickettsia rickettsii and characterized by a rash, has a case-fatality rate as high as 30% in certain untreated patients. Even with treatment, hospitalization rates of 72% and case-fatality rates of 4% have been reported. This report summarizes the clinical course of three fatal cases of RMSF in children and related illness in family members during the summer of 2003. These cases underscore the importance of 1) prompt diagnosis and appropriate antimicrobial therapy in patients with RMSF to prevent deaths and 2) consideration of RMSF as a diagnosis in family members and contacts who have febrile illness and share environmental exposures with the patient." http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5319a1.htm
(MMWR May 21, 2004 / 53(19);407-410)

Multifocal Autochthonous Transmission of Malaria — Florida, 2003
"The majority of malaria cases diagnosed in the United States are imported, usually by persons traveling from areas where malaria is endemic. However, small outbreaks of locally acquired mosquito-borne malaria continue to occur. During July--September 2003, an outbreak of malaria (eight cases of Plasmodium vivax malaria) occurred in Palm Beach County, Florida. During the same period, two patients were evaluated for malaria in neighboring Okeechobee County, approximately 75 miles from the Palm Beach County transmission area. One patient was thought to have acquired infection with the same parasite species (P. vivax), and concerns were raised about a possible link. To determine whether infection was acquired in Okeechobee County and whether a possible link existed to the Palm Beach County outbreak, the Florida Department of Health (FDOH) initiated an investigation. This report describes that investigation, which determined that although initial laboratory results suggested local transmission, subsequent evaluation and testing confirmed the case as imported malaria. These findings underscore the importance of a rapid and thorough investigation of any malaria case suspected to be acquired through local mosquito-borne transmission." http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5319a2.htm
(MMWR May 21, 2004 / 53(19);412-413)

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
Community-acquired lower respiratory tract infections remain the most common infections encountered by physicians. This article reviews some of the key problems that challenge specialists as well as primary care providers who manage patients with respiratory infections. (Medscape Infectious Disease 5/19/04)    

BMJ: How electronic communication is changing health care
The theme issue for May 15 2004 BMJ is about e-Health: How electronic communication is changing health care. Please visit http://bmj.bmjjournals.com/content/vol328/issue7449/  

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4. NOTIFICATIONS

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Regional emerging diseases center officially opens in Singapore
The Asia-Pacific region now has a new arsenal to fight infectious diseases and bioterrorism threats, with the opening of the Regional Emerging Diseases Intervention Centre in Singapore. "In the coming years, there will be other infectious diseases which will have serious impact on the region. It is my hope that REDI will do its part to ensure we are all ready to handle such crises," said Singapore Acting Health Minister Khaw Boon Wan. "Through vigilance and cooperation, we can minimize the impact of these new emerging, and re-emerging, diseases."

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 system  
Resolutions passed by the International Committee (IC) and recommendations issued by the Regional Commissions have instructed the OIE Central Bureau to establish a single OIE list of notifiable terrestrial animal diseases to replace the current Lists A and B. The aim in drawing up a single list is to be in line with the terminology of the Sanitary and Phytosanitary Agreement (SPS) of the World Trade Organization (WTO), by classifying diseases as specific hazards and giving all listed diseases the same degree of importance in international trade. An Ad hoc Group on Terrestrial Animal Disease/Pathogenic Agent Notification was convened, comprised of internationally renowned experts, to support the OIE Animal Health Information Department in defining criteria to determine whether a given disease should be included in the OIE list. This was also the occasion to conduct a thorough review of the OIE's animal health information system, aimed at making improvements and adapting it to meet the new requirements of a single list.  

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 that should be notified immediately are as follows:  
- The first occurrence of a listed disease or infection in a country or compartment;  
- The re-occurrence of a listed disease or infection in a country or compartment following a report by the Delegate of the Member Country declaring the outbreak closed;  
- The first occurrence of a new strain of a pathogen of a listed disease in a country or compartment;   - A sudden and unexpected increase in morbidity or mortality caused by an existing listed disease;  
- Emerging diseases with significant morbidity/mortality or zoonotic potential;  
- Evidence of a change in the epidemiology of a listed disease (including host range, pathogenicity, strain of causative pathogen), in particular if there is a zoonotic impact.  

Proposals have been made to adapt the OIE's information system to the single list, involving changes in the frequency with which Member Countries should submit regular reports to the OIE, namely 6-monthly and annual. Implementing these changes will mean completely redesigning the existing animal health information system, which will need to take advantage of the possibilities offered by the latest information and communication technology, including mapping software.
(Promed 5/16/04)    

New Definitions for Travel Notices Regarding Diseases Abroad  
The Division of Global Migration and Quarantine, Travelers' Health, National Center for Infectious Diseases, is announcing new, scalable definitions for travel notices about disease occurrences abroad. The purpose is to refine the announcements so they are more easily understood by international travelers, U.S. citizens living abroad, health-care providers, and the general public. In addition, defining and describing levels of risk will clarify the need for travelers to take recommended preventive measures. Scalable definitions will enhance the usefulness of the travel notices, enabling them to be tailored readily in response to events and circumstances. A complete description of the travel notices at each of the four levels is available at http://www.cdc.gov/travel.

The new notices are as follows:  
- In the News. This notice provides information about sporadic cases of disease or an occurrence of disease of public health concern affecting a traveler or travel destination. At this level, the risk for an individual traveler does not differ from the usual risk in that area.

 - 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 concern is expanding beyond the locales or populations that were affected initially. The purpose of a travel warning is to reduce the volume of traffic to affected areas, limiting the risk for spreading the disease to unaffected areas.http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5319a4.htm
(MMWR May 21, 2004 / 53(19);414)    

The HIV Neuroprotection Workshop and the Sixth International Symposium on NeuroVirology
The International Society for NeuroVirology (ISNV) is pleased to announce: The HIV Neuroprotection Workshop, 10-11 Sep 2004 and the 6th International Symposium on NeuroVirology, 11-14 Sep 2004 Sardinia, Italy. Registration for the meetings and information on the venue and hotels are available at <http://www.isnv.org>. Online abstract submissions through the Journal of NeuroVirology began on 15 May 2004. The deadline for abstracts is 15 Jun 2004. Instructions for abstract submission are available in the Symposium Program, which can be downloaded in PDF format from the ISNV website. Abstracts can be submitted online at <http://www.jneurovirol.com>. Please direct all inquiries concerning the meetings to the ISNV administrative office: <mail@isnv.org>. For questions concerning abstract submission, contact the Journal of NeuroVirology at: <jnv@jneurovirol.com>.
(Promed 5/19/04)

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