---

1. INFECTIOUS DISEASE INFORMATION

---

---

Viet Nam : New alert on bird flu
The Vietnamese government has issued an instruction asking localities nationwide to continue their efforts to prevent the reoccurrence of bird flu, following the deaths of fowls in several areas, including some testing positive to avian influenza viruses. Under the instruction issued by Prime Minister Phan Van Khai, the Ministry of Agriculture and Rural Development and the People's Committees of localities must take four measures to prevent the return, and rehabilitate the local poultry industry, local newspaper Pioneer reported 17 Jun 2004.

First, they have to actively supervise the usage of state money in recovering the industry and minimizing the risk of a relapse of bird flu, and quickly lay a siege to any outbreaks detected to contain them immediately. Second, strict controlling measures such as comprehensively disinfecting and detoxifying farms, residues and landfills must be maintained in areas once hit by bird flu or being vulnerable to the disease. Dead fowls, if detected, must be incinerated or buried in a hygienic way. Third, the ministry and the committees are to inspect the granting of state financial assistance to fowl raisers so that the right people receive the right amount of money, facilitating the recovery and development of the local poultry industry. Finally, quarantine activities towards the transport, slaughter and trade of fowls, and their eggs must be conducted pursuant to veterinary regulations.

In April 2004, the government decided to allocate 245.3 billion Vietnamese dong (VND) (USD 15.6 million) to 57 localities, helping them prevent bird flu reoccurrence and revive the poultry industry. Each farmer is to receive 5000 VND (0.32 dollars) for each fowl culled, and another 2000 VND (0.13 dollars) for each chick to be raised in the post-epidemic period. In late March 2004, Viet Nam declared an end to the bird flu that killed 17 percent of its poultry population and claimed 16 human lives since it broke out December 2003. A total of 43.2 million fowls in 57 out of 64 localities nationwide either died or were culled, causing the local poultry industry to suffer direct losses of 1.3 trillion VND (USD 82.8 million).
(Promed 6/18/04 )

China: Rabies top killer among all reported infectious diseases
China 's Health Ministry said that tuberculosis retained the highest incidence rate in May 2004 on the Chinese mainland among all reported infectious diseases, and rabies remained the top killer. The ministry said rabies had the highest death rate among the communicable diseases on the Chinese mainland, followed by AIDS, infant tetanus and epidemic cerebrospinal meningitis. The authors attribute the recurrence and sharp rise in human rabies to five main factors: the increasing numbers of dogs, low inoculation rate of dogs, poor control on the quality of rabies vaccine, incorrect treatment of the wounds, and lack of cooperation between different official departments regarding rabies control. Poor quality of animal vaccines has been repeatedly noted in relation to animal diseases in China , with special recent reference to avian influenza. One cannot stress enough the critical need for efficient state control on vaccine production, licensing, and certification. Full implementation of internationally prescribed requirements is urgently needed in order to safeguard safe and efficacious vaccines and protect animal and human life.

The most recent monthly report issued by the China Ministry of Health on morbidity and mortality due to infectious diseases in China is available at <http://www.moh.gov.cn/zhgl/gzdt/1200406110002.htm>. In this report, there is mention that "rabies, pulmonary tuberculosis, AIDS, hemorrhagic fever, (and a fifth disease not easily translated by machine translation) accounted for 80.7 percent of deaths due to infectious diseases during May. In contrast, pulmonary tuberculosis, hepatitis B, amoebic dysentery, gonorrhea, and measles, account for 84.8 percent of reported cases of infectious diseases during May. Case fatality rates for rabies, AIDS, neonatal tetanus, and two other diseases (that did not easily translate through machine translation) are the highest observed during this month.
(Promed 6/21/04 )

China (Hong Kong): Fatal Case of Japanese Encephalitis
There has been wide media coverage 10 Jun 2004 in Hong Kong regarding a fatal case of viral encephalitis in an Indonesian maid caused by Japanese encephalitis virus. Investigations are ongoing and information is available at http://www.info.gov.hk/dh/diseases/announce.htm. Japanese encephalitis virus (JEV) is widespread throughout Asia . It is the most important cause of arthropod-transmitted viral encephalitis. It is transmitted to humans by culicine mosquitoes, and pigs often feature as an amplifying host. The most important vector of Japanese encephalitis virus is _Culex tritaeniorhynchus_, a species that breeds in rice fields and is found in most parts of Asia , including Hong Kong . Other Asian vectors include _Culex gelidus_ and _Culex vishnui_, both of which are present in Hong Kong . The incubation period is 5-14 days, and onset of symptoms is usually sudden. In the absence of CNS involvement, illness usually resolves in 5-7 days. When there is CNS involvement, neurological sequelae are common, although mortality is usually lower than 10 percent, except in children, in whom it can reach 30 percent. Several effective vaccines are available and have been used widely in mainland China . In 2002 local transmission of JEV was reported in Hong Kong , although in the present case the identification of the victim as Indonesian may indicate that the authorities believe the disease was imported.
(Promed 6/11/04 )

China (Hong Kong): Suspected Case of Japanese Encephalitis
The Hong Kong Center for Health Protection is monitoring a suspected case of Japanese encephalitis (JE) involving a 45-year-old man living in Yuen Long, Hong Kong . The center is performing lab tests to confirm the diagnosis. As a precautionary measure, Hong Kong 's Food Environmental Hygiene Department has carried out vector surveys and mosquito control measures near the patient's residence. The man, a local resident, developed fever, headache, and drowsiness 8 Jun 2004 . He was admitted to North District Hospital and later transferred to Pamela Youde Nethersole Eastern Hospital , where he is in critical condition. The patient did not travel outside Hong Kong in the past three months. The Center's medical staff visited the patient's four household contacts and put them under surveillance. They did not have any symptoms of the illness. Relevant departments are taking action in the event this case is confirmed.

Seven cases have been reported in Hong Kong since 1992, including one local case in 1996, one imported case in 1997, one imported case in 2001, two imported cases in 2002, and one local case in 2003. Hong Kong has been launching a citywide anti-mosquito campaign in an effort to prevent the mosquito-related diseases. As of 14 Jun 2004 , the Centre for Health Protection (CHP) of the Department of Health was still investigating the case involving a 29-year-old Indonesian woman who died 7 Jun 2004 . The staff of CHP has contacted 269 households, and over 500 persons were interviewed with a questionnaire survey. None of them reported having neurological symptoms of JE. A CHP spokesman said so far 115 blood samples from local residents were collected for serological tests to ascertain JE exposure. Serology tests on blood samples of the seven house contacts of the Indonesian woman yielded negative results for JE. Laboratory work on blood samples of the remaining 115 residents is ongoing. The Food and Environmental Hygiene Department is continuing with a vector survey covering 2km around the woman's residence. District pest control officers are enhancing mosquito control efforts with weekly fogging and larviciding for elimination of mosquito breeding sites. As of 14 Jun 2004 no new case has been discovered, and the departments concerned have taken comprehensive measures to reduce the risk of JE in the area.

The two cases reported so far in 2004 originate from different geographic areas within Hong Kong --the first case (now also considered to be a local case) was in the Kwai Chung area in the New Territories section closer to Kowloon , and this second case is in Yuen Long, in the New Territories section. Both areas are on the mainland (http://www.vectormap.com/eng/english.htm).
(Promed 6/23/04 )

China: Snail fever (shistosomiasis) outbreak
China has vowed stronger measures to contain the spread of a potentially lethal parasitic worm, carried by freshwater snails, that attacks the blood and liver of humans. The Government hopes research in its fight against the disease, known as shistosomiasis (snail fever), will help identify infection sources and develop new prevention methods. It is believed that more than one million Chinese are infected, but given the current prevalence of the carrier snail, a total of 65 million Chinese are in danger of being infected, previous reports said. In 2003 alone, 843,000 Chinese were infected, most of them living in frequently flooded areas along the Yangtze River . By the 1980s, China thought it had effectively controlled snail fever, but a mixture of natural disasters and human error has facilitated its return. After a massive deluge along the Yangtze six years ago, the disease moved on to large, previously unaffected areas. The disease has been allowed to spread due to public ignorance and the erosion of China 's healthcare system, the report said. Chronic patients, who account for most of those contracting the disease, can experience high fever, weakness of the limbs, and severe stiffness of the joints. According to medical experts, snail fever has infected more than 200 million people worldwide.
(Promed 6/14/04 )

 Japan: Staphylococcus aureus (MRSA), community acquired
A "virulent" strain of methicillin-resistant Staphylococcus aureus (MRSA), whose prevalence outside hospitals is sparking concern in Europe and the USA , has been isolated for the first time in Japan from the skin of a child who had never been hospitalized, Professor Tatsuo Yamashita of Niigata University, a bacteriologist, said. This child suffered from impetigo contagiosa, a skin infection, which has successfully been treated with ordinary antibiotics. However, Prof. Yamamoto warns that surveillance of this type of MRSA should be strengthened in Japan because some fatal cases of virulent MRSA infection have been reported in Western countries. The strain that Prof. Yamamoto has isolated has some features in common with those strains of MRSA found in non-hospital personnel in Europe , USA , and Australia , such as the ability to produce a leukocyte-attacking toxin named PVL (Panton-Valentine leukocidin). This type of MRSA is called "community-acquired MRSA," to be distinguished from hospital-acquired MRSA’s. In Japan , some strains of MRSA have recently been isolated from the skin of kindergarten children who had never been in hospital, but none have contained the gene for the PVL toxin.
(Promed 6/19/04 )

 Indonesia ( Jakarta ): Disease-carrying vaccine destroyed
The Animal Quarantine Center at the Soekarno-Hatta International Airport ( Jakarta , Indonesia ) burned some vaccines and substances suspected of carrying animal diseases that had been illegally imported from China . Officials burned 300 250-milliliter bottles of Avian Influenza vaccines smuggled from China and a pallet of substances classified as Infectious Substances Affecting Humans from China . Budi Tri Akoso of the Ministry of Agriculture said the bird flu vaccine was smuggled in April 2004 from China into the country in a box. The suspicious samples were examined at the Bogor Institute of Agriculture Laboratory and found to contain the Avian Influenza virus. Budi said the outbreak of bird flu in Indonesia late in 2003 was caused by, among other things, the illegal import of animal vaccines by individuals and companies. The officers also burned some items designated Infectious Substances Affecting Humans, as they contained Leptospira interrogans serotype canicola and Mycoplasma gallisepticum bacteria (not regarded as pathogenic for humans).

None of the illegal importers were detained, although they had violated Animal Quarantine Laws. The center has foiled eight smuggling attempts from China and Hong Kong through the airport since December 2003. All of the smuggled vaccines were destroyed. China and Indonesia are the only Eastern-Asian countries that have officially approved the use of avian influenza (AI) vaccines in their respective territories. Reportedly, there are currently at least nine AI vaccine manufacturing plants in China , while unofficial sources give a higher figure. As indicated in the International Terrestrial Animal Health Code, any vaccine used should comply with the standards described in OIE's Manual of Standards for Diagnostic Tests and Vaccines http://oie.int/eng/normes/mmanual/A_00035.htm.
(Promed 6/20/04 )

Russia (Tyumenskaya): High Level of Tick Exposure in Tyumenskaya
In the Tyumenskaya oblast of Russia ( Siberia ), a total of 5083 people have sought treatment for tick bites. So far 128 people have been admitted to hospital suffering from tick-borne encephalitis and Lyme disease, 29 of whom are children. During the past week 41 people were admitted to hospital: eight are confirmed with tick-borne encephalitis and 21 people were confirmed with tick-borne borreliosis (Lyme disease). According to A. Ogurzov, Director of the Sate Epidemiological Surveillance Centre, people are submitting ticks for testing, and it has been established that 7 percent of ticks are carriers of tick-borne encephalitis virus and 3-4 percent are carriers of Lyme disease. In comparison with the same period in the years 2002 and 2003, these figures are 20 percent lower. Control of tick infestation is in progress. This year all hospitals in the south of Tyumenskaya oblast have been provided with adequate supplies of immunoglobulin, and up to 85 percent of the population have received vaccine.
(Promed 6/13/04 )

Russia (Sverdlovskaya Region): First Fatal Case of Tick-borne Encephalitis
The first fatal case of tick-borne encephalitis of the year has been recorded in the Sverdlovskaya Region. Every year there are several victims of this infection in the central Urals. According to the Regional Epidemiological Surveillance Centre, the man who died was a resident of the village of Kedrovka , in the Berezovsky area. He was born in 1946 in the Urals and had never been vaccinated against tick-borne encephalitis. He was bitten by ticks 28 May 2004 ; however, he did not seek medical attention immediately. Several days later, he felt unwell and was admitted to Berezovsky City Hospital . On 10 Jun 2004 his condition worsened and he was transferred to the intensive care unit and required assisted ventilation. Despite this he died 14 Jun 2004 . The provisional assessment of local physicians is that he died as a result of tick-borne encephalitis virus infection. However, this diagnosis has to be confirmed by laboratory tests.

Presently, several tens of people in the Sverdlovskaya Region are receiving treatment for tick-borne encephalitis. None are seriously ill, but officials are advising the population to seek medical treatment immediately if bitten by ticks. The Regional Epidemiological Surveillance Centre is emphasizing that the tick-borne encephalitis virus prevalent in that Urals is distinct from the virus present in western Russia , and is responsible for more serious disease and a higher frequency of death. The local heath specialists are cooperating with virologists in Moscow in a large-scale study of the molecular epidemiology of tick-borne encephalitis.

Tick-borne encephalitis is caused by closely related but distinct flaviviruses. Three subtypes are recognized at present: A far-eastern subtype, a Siberian subtype and a European subtype. The Siberian subtype is associated with Russian spring-summer encephalitis and is transmitted predominantly by the tick _Ixodes persulcatus_, whereas the European subtype causes central European encephalitis and is transmitted by the tick _Ixodes ricinus_. The former causes the more serious disease, with mortality that can reach 25 percent, whereas mortality in the case of the latter seldom reaches 5 percent. Effective vaccines are available against each subtype, but information on the extent of their application in disease control is scarce.
(Promed 6/16/04 )

---

---

USA (Washington, Oregon): States investigate salmonellosis outbreak
Public health authorities in Washington and Oregon are investigating an outbreak of salmonellosis that is related to handling chicks, the Washington state Department of Health announced. More than 10 people in the two states were infected with the bacteria after handling chicks, the agency said. Salmonellosis can cause severe diarrhea, fever, chills and abdominal discomfort. In Washington , the state departments of health and agriculture are working with hatcheries and feed stores to reduce the risk of exposure to infected animals. The Health Department urged people to wash their hands with soap and warm water after handling animals. People should also refrain from nuzzling or kissing pet chicks.
(Promed 6/22/04 )

USA (California): First Case of Hantavirus Pulmonary Syndrome in San Diego County
The first locally acquired human case of hantavirus pulmonary syndrome, caused by a potentially dangerous virus carried by rodents, has been reported in San Diego County . A 32-year-old woman came down with symptoms of the disease late May 2004, and she has since recovered. The virus is generally spread through inhaling particles of rodent droppings and rodent saliva. The virus may also be spread by touching the mouth and nose after handling infected rodents or contaminated objects. It can cause febrile symptoms, including fatigue, muscle aches, chills, dizziness and abdominal pain. Symptoms can progress to include severe difficulty breathing and, in some cases, death. Hantavirus pulmonary syndrome was first identified in 1993 and, as of mid-August 2003, there had been 36 cases of hantavirus pulmonary syndrome in California . This figure indicates that about 10 percent of the total number of cases of hantavirus pulmonary syndrome reported in the US occur in California .
(Promed 6/20/04 )

 USA (California): Workers exposed to anthrax; Live samples sent to Children's Hospital Oakland by mistake
At least six researchers working on an anthrax vaccine at Children's Hospital Oakland Research Institute were exposed to anthrax, possibly due to a shipping mix-up. The workers handled the live anthrax bacterium, and several other researchers were also present. None has shown signs of illness, and seven are now on the antibiotic Cipro as a precautionary measure. The incident poses no risk to any other staff, the surrounding community or Children's Hospital, which is about one mile from the research facility, state health officials said.

The institute's researchers believed they were working with a dead sample of the anthrax bacterium, but were inadvertently shipped live anthrax by their supplier, Southern Research Institute of Frederick, MD. Children's Hospital Oakland Research Institute is not authorized to handle live anthrax. The sealed liquid agent was shipped via FedEx, double-boxed, about three months ago to Oakland , officials said. Researchers began injecting what they thought was dead anthrax (bacilli or spores) into mice 28 May 2004 . Over that weekend, 10 mice died in separate cages, but it was not brought to the immediate attention of lead researchers that all the mice in the experiment had died. Another batch of mice was inoculated and they also died, and the lead researcher obtained cultures from the cavity of a dead mouse and found anthrax organism growing in the abdominal cavity of the dead mouse.

The institute contacted the state Department of Health Services and the CDC, which launched their own investigations. Agents from the Federal Bureau of Investigation's bioterror unit then confirmed the presence of the live bacterium. Samples have been sent to the CDC for further testing, and nasal samples from the lab workers are also being evaluated. Southern Research Institute's Thomas Voss, who is in charge of the institute's emerging infectious disease program, said it's unclear whether the institute did ship live anthrax to Oakland . Voss said the institute's hot labs in Frederick and Birmingham , Ala. , handle most "select agents" listed with the CDC, and that they are one of 350 entities registered to handle live anthrax. He said the institute rarely ships out the agents. "We receive agents on a routine basis," Voss said. "But on our end, we ship very infrequently. I can't even recall shipping live agents."

Dr. Frederick Murphy, a microbiologist at University of California , Davis , said such mixups are extremely rare. Namely, deadly live bacteria require extensive permits to ship and are typically handled by couriers. The agents would be encased in a safe-like container to prevent tampering or any exposure. Edward Hammond, director of the Sunshine Project, a watchdog group on biological weapons research, said with so many federal funds pouring into biodefense research, there should be more controls in place. Neighbors of the institute are wondering the same thing. "When (the institute) opened, they told us they would be researching meningitis, but they never talked about anthrax," said Bob Brokyl, a North Oakland activist.
(Promed 6/11/04 )

 USA (Colorado): Prairie dogs die of plague
Weld County officials are asking people who visit or live around Pawnee National Grasslands to look out for signs of plague after finding the disease in six dead prairie dogs. A researcher observing prairie dogs in the park found the infected colony. Six of the eight dead prairie dogs handed over to CDC tested positive for bubonic plague. Officials think the other two also have the disease, but more tests are needed. On average, 13 cases of plague in humans are reported in the US each year. Most occur in the southwestern states. Humans and their pets can be infected when a prairie dog with the plague dies and the fleas look for another host. The last known case of plague infecting a person in Weld County occurred a little more than 10 years ago. Investigators believe that a university student caught the disease while playing baseball in a Fort Collins field. Over the past few years, Weld county officials have suspected plague when they have seen populations of prairie dogs die off. However, without animals to test, officials could not confirm that plague was responsible. Prairie dogs are very sensitive indicators of when the plague organism, Yersenia pestis, is in an area. Prairie dogs are often considered sentinel animals; domestic cats are also sensitive to the plague agent. Residents are told to watch rodent populations near their homes and report any sudden die-offs to the health department.
(Promed 6/14/04 )

Peru: Foot-and-mouth disease outbreak
Peru reported an outbreak of the highly contagious foot-and-mouth disease (FMD), saying eight infected cattle and 80 animals in contact with them have been slaughtered and more were being killed. "It's been a fairly light outbreak, and now it is under control," Jose Ochoa of the National Service of Agrarian Health (SENASA) said. He said the three establishments in Lurin, where the disease was detected, had been sealed off. FMD affects cloven-hoofed animals, and although Peru does not export beef, it is keen to recover its FMD-free status because the virus can be transported with fruit and vegetables. Peru is a big exporter of limes, mangoes, asparagus and other agricultural produce (FMD virus can be carried on a number of different fomites, and fruit could be classified as a fomite, as most fruit is shipped without washing). The country also exports live alpacas, which are susceptible to FMD. Ochoa said "more animals that were close (to those infected) are being slaughtered now…We believe that given the way we are handling it, this accident will be overcome and won't affect Peru's status of having become FMD-free," he said. Britain had recovered its disease-free status after a devastating outbreak confirmed in 2001 when four million animals were slaughtered.

The 11 Jun 2004 outbreak, Peru 's first in three years and seven months, was in an area where cattle are brought from other parts of the country to be fattened. The area is one of five departments considered at risk of the disease where livestock are vaccinated. Peru 's other 19 departments are FMD-free without vaccination. The country is seeking the World Organization for Animal Health's (OIE) stamp of approval of southern Peru as an area completely free of the disease without vaccination and will be reviewed on that in October, Ochoa said. In the wake of the outbreak, SENASA was controlling cattle movement to prevent the spread of the disease to central and southern areas and stepped up other checks. Brazil reported an outbreak of the FMD disease recently, but Ochoa said there was no link. "Our research shows it is most likely that the virus came in from the north (of Peru )," he said, referring to Piura , near the border with Ecuador . That is another at-risk area where cattle are vaccinated under a USD 5 million-a-year national eradication program sponsored by the Inter-American Development Bank (IADB) and in place since 1998. In northern Peru there is contraband where Ecuadorian animals are passed off as Peruvian, he said. Ochoa said Peru 's neighbors Ecuador , Bolivia and Brazil all have FMD in some areas. Chile and Colombia , however, are free of the disease. Ecuador and Colombia , like Peru , are negotiating a U.S. free-trade deal.
(Promed 6/22/04 )

---

UPDATES

---

*Cholera, Diarrhea, and Dysentery *

China
Health supervision officials said 18 Jun 2004 that salmonella contamination was to blame for the mass food poisoning that began 14 Jun 2004 in Guangdong Province . The latest number of victims rose to at least 120 five days after the accident. At least 120 customers of 100 Point Artistic Bakery in Meizhou, a city in Guangdong , complained of stomach ache, nausea, vomiting, fever and dehydration and sought medical treatment beginning after eating sandwich cakes from the bakery chain, the city's health bureau said. Workers failed to clean and disinfect the eggshells when making the cakes, according to an investigation by local health supervision authorities. The salmonella then contaminated the one of the ingredients of the cakes. The bakery was ordered to suspend the sale and production of the food suspected of contamination, and local health authorities have organized a recall.

Russia ( Moscow )
148 people have been identified with signs of an intestinal infection. These people were personnel of supermarket chain "Ashan" in Odinzovskiy, Leninskiy, Krasnogorskiy and Mitishinskiy parts of the Moscow region. 40 of them were discovered with bacterial dysentery due to Shigella sonnei. 16 people were hospitalized. Epidemiological surveillance center identified that the outbreak is associated with food supplied for the supermarket.

Also, a mass outbreak of dysentery has been reported among children in Mitishi in the Moscow region. According to the sanitary epidemiological surveillance center, during the period 5-12 Jun 2004, in two children's camp facilities there were 13 cases of acute dysentery in children aged 3-7 years. 11 children are hospitalized. The diagnosis was bacteriologically confirmed in 14 children. Specialists from the epidemiological surveillance center are testing water and food and also testing children and staff from the facilities where children were infected.

The Nestle-Zhukovsky confectionery plant of the Russia-based subsidiary of Switzerland 's Nestle Group in the Moscow Region was closed due to an outbreak of dysentery among 24 employees in early June 2004, an official with the Federal Service on Consumers' Rights said. The official said that the operations of the plant had been temporarily halted and would be resumed only after permission had been granted by an official from the local Sanitation Service. The management of the company is now investigating the outbreak of dysentery among the plant's workers. The source of the infection has not yet been found.
(Promed 6/19/04 )

 *Dengue/DHF*

Viet Nam
Dengue fever infections in Viet Nam have tripled to 15 923 cases during the 2nd quarter of the calendar year, taking deaths from the disease this year [2004] to 29, state media reported.Around 10 people died from the mosquito-borne disease and 5350 more were infected during the period from January to March. Officials of the health ministry said most of the infections were concentrated in southern Viet Nam , the Lao Dong (Labor) daily said. The health ministry is holding an emergency meeting in southern Viet Nam this week to find ways to fight the deadly disease. Dengue fever, which is carried by the _Aedes aegypti_ mosquito and normally hits tropical Viet Nam each year from the start of the rainy season in April.
(Promed 6/20/04 )

*Viral gastroenteritis*

USA ( Colorado )
The Texas Roadhouse (Fort Collins, Colorado) reopened 18 Jun 2004, two days after it shut down for cleaning in the wake of viral outbreak like none ever witnessed by the chain. Larimer County health officials say about 270 people complained of having been affected by severe viral gastroenteritis virus after eating at the steak house 12 Jun 2004 . County health officials confirmed that norovirus infection was responsible for the outbreak. Noroviruses have been linked to massive outbreaks of viral gastroenteritis on cruise ships and are spread easily, especially by people who fail to wash their hands after using the bathroom. The viruses can be transmitted to other people and surfaces, such as plates, glasses and silverware. Restaurant officials, who said as many as 20 employees might have had the illness, are not exactly sure how the outbreak began.

Australia (NSW)
Bilyara is under strict quarantine due to an outbreak of viral gastroenteritis, a common but highly infectious condition affecting the stomach and intestines that results in vomiting and diarrhoea. Bilyara administrator Ray Harris said the outbreak began with several cases late last week and grew to 16 cases, precipitating the decision to quarantine the village. Access to Bilyara is restricted to essential services only, with general visitors unable to access the Centre. Mr. Harris said he had notified the Public Health Unit and staff were taking all necessary precautions. Gastroenteritis has appeared at other regional institutions, including Canowindra, Molong and as many as 300 cases in Dubbo. There is no specific treatment for viral gastroenteritis except rest and drinking plenty of fluids; most people recover without any complications.

New Zealand
There have been an increased number of cases of vomiting and diarrhoea in the Dunedin district over the past month. Other parts of the country have also experienced similar illnesses recently. Norovirus has been found in fecal specimens tested from some of these cases. Norovirus is a reasonably common viral illness which typically affects places where large numbers of people are in close contact. The infection can be spread from person to person by inhaling airborne particles of virus released during vomiting. The virus can survive for long periods on surfaces such as toilets and tap fittings. It also survives in contaminated water and on food. People should be careful when cleaning up after ill people. Vomit or feces should be cleaned up using a solution of household bleach. Hands should be thoroughly washed with soap and water and dried after cleaning up, going to the toilet and before preparing food.

Recently three wards in Dunedin Hospital and one from the Mental Health area have reported cases. At least 19 patients and 26 staff have so far been affected. "We are still waiting for confirmation of Norovirus. However the symptoms suggest the cases in Dunedin Hospital could be a Norovirus infection" says Dr John Holmes, Medical Officer of Health, Otago. Three people today had their surgery postponed due to shortage of staff and the risk of possible infection. Dr Holmes says "Most people will experience discomfort for about 36 to 48 hours and make a good recovery. Treatment is not necessary but fluid intake must be kept up." Dr Roy Morris, Primary Care Advisor, ODHB advises "Children and the elderly are most at risk of dehydration…" Information has been sent to all ODHB staff, general practitioners, rest home and private hospitals in Otago. Dr Holmes comments "Any health care worker, food handler or child-care worker with vomiting or diarrhoea should not be working. They should be remain away from work until they have been symptom free for 48 hours.”
(Promed 6/23/04 )

 *West Nile Virus*
As of 22 Jun 2004 , seven states reported a total of 32 human cases of West Nile virus (WNV) illness to CDC through ArboNET. Twenty cases were reported from Arizona , six cases from California , two cases from Florida , and one case each from Nebraska , New Mexico , South Dakota , and Wyoming . Twenty-three (72%) of the cases occurred in males; the median age of patients was 52 years (range: 9-78 years), and dates of illness onset ranged from May 8 to June 7. Sixteen (50%) of the patients had neuroinvasive WNV illness, 14 (44%) had West Nile fever, and two (6%) had clinically unspecified illness. A total of 13 presumptive West Nile viremic blood donors have been reported. Of these, 12 were reported from Arizona , and one was reported from New Mexico . Of the 13 donors reported, one person aged 69 years subsequently had neuroinvasive illness, and three persons aged 22, 51, and 52 years had West Nile fever.

During 2004, a total of 616 dead corvids and 58 other dead birds with WNV infection have been reported from 20 states, and 17 WNV infections in horses have been reported from Alabama , Arizona , Missouri , Oklahoma , Texas , and Virginia . WNV seroconversions have been reported in 65 sentinel chicken flocks from Arizona , California , Florida , and Louisiana . One seropositive sentinel horse was reported from Puerto Rico . A total of 129 WNV-positive mosquito pools have been reported from Arizona, California, Illinois, Indiana, Louisiana, Missouri, Pennsylvania, and Texas. Additional information about national WNV activity is available from CDC at http://www.cdc.gov/ncidod/dvbid/westnile/index.htm and at http://westnilemaps.usgs.gov.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5324a6.htm
(MMWR June 25, 2004 / 53(24);535-536)

---

ARTICLES

---

National HIV Testing Day — June 27, 2004
“National HIV Testing Day is June 27. This annual event is sponsored by the National Association of People with AIDS to encourage persons at risk for human immunodeficiency virus (HIV) infection to get tested and learn their status. This year's theme, "It's Better to Know," underscores the importance of being tested for HIV. An estimated 850,000-950,000 persons in the United States are HIV positive, and an estimated one in four are not aware of their infection. Persons who know they are infected can benefit from advances in medical care that can prolong their lives, and they can take action to prevent transmission to others. HIV testing has become easier, more accessible, and less invasive in 2004. One antibody test can provide preliminary results in as little as 20 minutes and can be used in both medical and nonclinical settings. A new oral version of that test, approved by the Food and Drug Administration in April, will make getting tested even easier by eliminating the need for a finger-stick blood sample. Additional information about where to get tested and local events being held to encourage testing among populations at greatest risk (e.g., non-Hispanic blacks, Hispanics, and men who have sex with men) is available at http://www.hivtest.org.”

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5324a1.htm
(MMWR June 25, 2004 / 53(24);523)

 Voluntary HIV Testing as Part of Routine Medical Care — Massachusetts , 2002
“In 2003, CDC released Advancing HIV Prevention: New Strategies for a Changing Epidemic. One of the four strategies of this initiative is to expand routine, voluntary human immunodeficiency virus (HIV) testing. This report describes the results of a state-funded program in Massachusetts that offered HIV counseling, testing, and referral (HIV CTR) to patients entering one of four hospital-associated urgent care centers. Among the 3,068 patients tested, the program identified an HIV seroprevalence of 2.0%. The findings underscore the effectiveness of routine HIV CTR in HIV case identification.”

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5324a2.htm
(MMWR June 25, 2004 / 53(24);523-526)

 Diminishing Racial Disparities in Early-Onset Neonatal Group B Streptococcal Disease — United States, 2000—2003
“Increased use of intrapartum antibiotics to prevent perinatal group B streptococcal (GBS) disease during the 1990s led to substantial declines in the incidence of GBS disease in newborns. Despite this success, at the end of the 1990s, early-onset GBS disease (in infants aged <7 days) continued to be a leading infectious cause of neonatal mortality in the United States , and black infants remained at higher risk than white infants. In 2002, CDC and the American College of Obstetricians and Gynecologists (ACOG) revised guidelines for prevention of early-onset GBS disease to recommend late prenatal screening of all pregnant women and intrapartum antibiotic prophylaxis (IAP) for GBS carriers. These guidelines were expected to result in further declines in early-onset disease. This report updates early-onset incidence trends since 1999 analyzed by using population-based, multistate data from the Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network. The results of the analysis indicated that 1) after a plateau in early-onset disease incidence during 1999--2002, rates declined 34% in 2003 and 2) although racial disparities in incidence persist, rates for blacks now approach the 2010 national health objective of 0.5 cases per 1,000 live births. Continued implementation of screening and prophylaxis guidelines by clinicians and public health practitioners should lead to further declines in racial disparities.”

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5323a2.htm
(MMWR June 18, 2004 / 53(23);502-505)

 Laboratory Practices for Prenatal Group B Streptococcal Screening — Seven States, 2003
“In the United States , group B streptococcus (GBS) is the leading cause of serious bacterial infections in newborns. In 1996, consensus guidelines for use of intrapartum antibiotic prophylaxis (IAP) to prevent perinatal GBS disease recommended either of two methods for identifying candidates for chemoprophylaxis: 1) late prenatal culture-based screening for GBS colonization or 2) monitoring of women intrapartum for particular risk factors associated with early-onset GBS disease. Evidence that culture-based screening was substantially more effective than the risk-based approach led to revised guidelines in 2002 recommending late prenatal GBS screening for all pregnant women. Although methods for isolation and identification of GBS from prenatal specimens remained the same as those recommended in 1996, the 2002 guidelines recommended that laboratories perform antimicrobial susceptibility testing on prenatal GBS isolates from women at high risk for penicillin anaphylaxis and clarified that laboratories should report the presence of any GBS in urine specimens from pregnant women. To assess laboratory adherence to recommendations in the 2002 guidelines, CDC's Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network surveyed clinical laboratories about prenatal culture-processing practices in 2003. This report summarizes the results of that survey, which indicated that, although adherence to GBS isolation procedures was high, opportunities exist to improve implementation of recommendations related to antimicrobial susceptibility testing and GBS bacteriuria.”

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5323a3.htm
(MMWR June 18, 2004 / 53(23);506-509)

---

4. NOTIFICATIONS

---

APEC Agrees to New Measures to Enhance Agricultural Biosecurity
APEC Member economies have agreed to strengthen biosecurity planning and surveillance capacity in the agricultural sector at a meeting of APEC's Agricultural Technical Cooperation Working Group (ATCWG) in Chiang Mai , Thailand . Acting on a proposal from Malaysia , the ATC Working Group has agreed to develop the new measures through a series of regional workshops on bio-security planning and surveillance for plant pests. The Chair of the ATC Working Group and Director of the Korea Rural Economic Institute, Dr. Se-Ik Oh, said the damage inflicted upon the poultry industry by the recent outbreak of Avian Influenza demonstrates the need for increased biosecurity planning and surveillance capacity. "Enhancing the capacity of economies to respond to outbreaks of diseases such as Avian Influenza will have significant economic benefits for the region," he said.

"The agricultural sector must be prepared for worst case scenarios in order to protect our crops and wildlife. The new biosecurity planning and surveillance capacity measures are intended to ensure the agricultural sector can attempt to avert disasters and recover quickly after any threat has passed. The ATC Working Group is intending to hold the first workshop on Risk Assessment, Management and Emergency Issues in Agricultural Biotechnology in Korea in November 2004." Other initiatives supported by the 8th Plenary Meeting of ATC Working Group meeting from June 15-18 included facilitating trade in agricultural products through the use of electronic health and quarantine certificates and building networks to transfer agricultural technology, particularly to developing economies. The next full ATC Working Group meeting will take place in June 2005 in Korea . An important objective of the ATC Working Group is to assist agricultural producers, both large and small, around the APEC Region to enhance their efficiency. The ATC Working Group is providing a high level of support to assist small and medium enterprises increase exports of fresh fruit and vegetables by enhanced supply chain management. Further information about the ATC Working Group can be found at: http://203.127.220.65/content/apec/apec_groups/working_groups/agricultural_technical.html

For further information contact:
Sang-doo Bae in Chiang Mai, Thailand, +82-16-341-456 or baesd@maf.go.kr(baesd@maf.go.kr)
Sakol Ooraikul in Chiang Mai, Thailand, +66-2-940-7212 or sakol@oae.go.th(sakol@oae.go.th)
Sheryl Lowe in Singapore on +65 9617 7588 (Cellular), +65 6772 7617 (Office) or sl@apec.org(sl@apec.org )

http://www.apecsec.org.sg/apec/news___media/media_releases/190604_agribiosecnewmeasures.html#
(APEC 6/19/04 )

Escherichia coli O157:H7 Outbreak in Foodborne Disease Computer-Based Case Study Series
“CDC announces the release of a new computer-based case study, "E. coli O157:H7 Infection in Michigan ." Based on a real-life disease outbreak investigation, this self-instructional, interactive exercise teaches public health practitioners epidemiologic skills and allows them to practice these skills. In the case study, students work through the E. coli O157:H7 investigation from beginning to end. Students can select learning activities focusing on particular areas of interest or those most relevant to their job activities. The new case study is the second in the Foodborne Disease Outbreak Investigation Case Study Series. The first computer-based case study, "Botulism in Argentina ," was released in 2002 and received the American Society for Training and Development's E-Learning Courseware Certification and the 2002 Outstanding Practice Award from the Design and Development Division of the Association for Educational Communications and Technology. The Foodborne Disease Outbreak Investigation Series is designed for students with knowledge of basic epidemiologic and public health concepts. Each case study was developed in collaboration with the original investigators from CDC and the Council of State and Territorial Epidemiologists. Both "E. coli O157:H7 Infection in Michigan " and "Botulism in Argentina " can be downloaded free of charge at
http://www.phppo.cdc.gov/phtn/casestudies or purchased on CD-ROM through the Public Health Training Network. Continuing education credit is offered to those who complete the case studies.”

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5323a8.htm
(MMWR June 18, 2004 / 53(23);512)

WHO/UNAIDS welcomes G8 endorsement of the Global HIV Vaccine Enterprise
The WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) welcomed the G8's endorsement of the Global HIV Vaccine Enterprise, a virtual consortium proposed by an international group of scientists that is being established to accelerate HIV vaccine development.

HIV/AIDS vaccine development has been slow, due mainly to the enormous scientific, logistical and financial challenges. Since the discovery of HIV as the cause of AIDS in 1983/84, multiple vaccine candidates have been tested in more than 70 human clinical trials with moderate success. So far, only one vaccine candidate has concluded the stage of definitive trials and it did not show any noticeable level of efficacy. This indicates a need to consolidate and intensify all international efforts to ensure further progress in this field.

The Global HIV Vaccine Enterprise would enhance coordination, information sharing and global collaboration amongst the world's HIV vaccine researchers in industrialized and developing countries in both private and public sectors. It would prioritize the scientific challenges that need to be addressed, coordinate product development efforts and encourage greater use of information sharing technologies. Existing resources would be better aligned and would be channeled more efficiently. Its work would also promote more effective synergies between research into new technologies and global efforts to scale up the preventive and therapeutic interventions for HIV/AIDS which already exist. To achieve these goals, the Enterprise will develop a strategic plan for development, testing and production of HIV candidate vaccines in collaboration with major national and international partners, as well as vaccine manufacturers. Partners in the Enterprise include the National Institute of Allergy and Infectious Diseases (NIAID) Vaccine Research Centre at the US National Institutes of Health (NIH), the European Research Institutes, the International AIDS Vaccine Initiative (IAVI), European Union and national HIV vaccine programs and research institutions from developing countries. WHO and UNAIDS are committed to supporting the Enterprise, by contributing to capacity building in developing countries in conducting clinical trials at the highest scientific and ethical levels, addressing issues such as future access to HIV vaccines as part of HIV/AIDS prevention, treatment and care programs.

http://www.who.int/mediacentre/releases/2004/pr41/en/print.html
(WHO 6/11/04 )

CDC Requests Comments on New Guideline for Isolation Precautions
In the Mon 14 Jun 2004 Federal Register, the Department of Health and Human Services (HHS), through the Centers for Disease Control and Prevention (CDC) issued notice of its request for review and comment on the Draft Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2004, which is available electronically at: http://www.cdc.gov/ncidod/hip/isoguide.htm This guideline updates the 1996 Guideline for Isolation Precautions in Hospitals and addresses new concerns about the transmission of infection to patients and healthcare workers in the US . This guideline aims to improve the safety of the nation's healthcare delivery system. It is divided into the following 5 parts:

 

• Review of the transmission of infectious disease in healthcare settings and discussion of emerging pathogens of special concern.
• Discussion of fundamental infection control elements needed to prevent transmission of such agents.
• Review of 2 tiers of transmission precautions developed by the Healthcare Infection Control Practices Advisory Committee (HICPAC).
• Consensus recommendations of HICPAC for preventing the transmission of infectious agents in healthcare settings.
• Suggests healthcare performance measures to assist healthcare facility staff in monitoring the recommendations of the guideline.

 

New issues addressed in this guideline include Respiratory Hygiene/Cough Etiquette, "Protective Environment," which concerns the protection of allogeneic hematopoietic stem cell transplant patients, and strategies for control of multidrug-resistant organisms. Requests for hard copies of the draft guideline can be sent to the Resource Center, Attention: ISOGuide, Division of Healthcare Quality Promotion, CDC, Mailstop E-68, 1600 Clifton Road, NE., Atlanta, Georgia 30333 or by fax to 404-498-1244 or by email to isorequests@cdc.gov Comments on the draft guideline must be received in writing on or before 13 Aug 2004 and should be submitted to the Resource Center, Attention: ISOGuide, Division of Healthcare Quality Promotion, CDC, Mailstop E-68, 1600 Clifton Road, NE., Atlanta, Georgia 30333 or by fax to 404-498-1244 or by email to isocomments@cdc.gov A comment form is also available at:
http://www.cdc.gov/ncidod/hip/isoguide.htm
(Promed 6/16/04 )

HDN, ICASO and HIV/AIDS Alliance launch structured discussion: Questioning the AIDS Community Sector: Are we making a difference?
The International Council of AIDS Service Organizations (ICASO), the International HIV/AIDS Alliance (the Alliance) and Health and Development Networks (HDN) will co-host a structured discussion in the weeks leading up to the International AIDS Conference (IAC) in Bangkok. The discussion will take place on the Community Research eForum and will be entitled: Questioning the AIDS Community Sector: Are we making a difference?

The Alliance and ICASO see the upcoming Bangkok IAC as an ideal opportunity to convene a candid dialogue on how effective the community-led movement to fight HIV and AIDS has been, and next steps for the future. On July 12, the two organizations will host a satellite session to reflect on how far the movement has come, to take stock of the impact the community sector is or is not having at various levels of policy-making and program implementation, and to look at ways of equipping the sector for the challenges ahead. The online structured discussion will raise critical issues by asking a series of questions, including: How does the community sector face the new epidemics of the 21st century?

- What do we need to do to address new challenges?

- What are we doing right and what are we doing wrong?

- What are we doing that is outdated?

- What are we doing that is forging new ground?

- Are we evolving with the epidemic or are we stuck?

- How can we evolve to better address the epidemic?

- How can we broaden our scope and our reach?

A summary of this pre-conference structured discussion will be presented during the July 12th session in Bangkok . All people interested in or working on HIV/AIDS issues are urged to be a part of this exciting new discussion. To join the Community Research Forum, please email: join-community-research@eforums.healthdev.org
(Health & Development Networks 6/16/04 )

WHO: Saving lives through HIV/AIDS treatment
The world health report 2004 shows how the history of HIV/AIDS has changed. It describes how innovative HIV/AIDS treatment programs can save millions of lives in developing countries and how, crucially, such efforts can drive improvements in health systems. The changing history of HIV/AIDS is graphically illustrated through this feature story, which shows how HIV/AIDS treatment has transformed the lives of two young people who were on the brink of death. Saving lives through HIV/AIDS treatment can be viewed as a flash movie or HTML version.
http://www.who.int/features/2004/hiv_aids/en/
(WHO)

OIE: BSE — status recognition, member countries
Chapter 2.3.13 "Bovine spongiform encephalitis" in OIE's Terrestrial Animal Health Code has been updated during the 72nd General Session. The following subchapters describe the conditions upon which OIE member countries may be officially classified in one of the 5 categories:

1. BSE free country or zone

2. BSE provisionally free country or zone

3. Country or zone with a minimal BSE risk

4. Country or zone with a moderate BSE risk

5. Country or zone with a high BSE risk

At present, no country has been officially classified by the OIE as "free." Four countries have been classified as "BSE provisionally free." For further details, see the OIE web-site: Evaluation of country's status for bovine spongiform encephalopathy http://oie.int/eng/info/en_statesb.htm
(Promed 6/14/04 )

Eighth Biennial Conference STVM: Hanoi, Viet Nam, 26 Jun - 1 Jul 2004
“This is the first announcement for the 8th Biennial Conference of the Society for Tropical Veterinary Medicine. The conference will be held 26 Jun - 1 Jul 2005 in Hanoi , Vietnam . The theme for the conference will be "Impact of Emerging Zoonotic Diseases on Animal Health". The theme is a timely one, and we are anticipating a full and exciting program. The format for the conference will be as in previous meetings, with keynote addresses, specialty symposia, plenary and poster sessions, as well as a social program for delegates and accompanying persons. Please examine the Conference page and if you have questions feel free to contact the organizing committee. An Intention form has been included under Fees and Registration. We ask that those considering attending the Conference to submit the form by 1 Oct 2004.This will insure that potential delegates and attendees receive timely information as the Conference organization progresses. Abstract submission, meeting registration and hotel arrangements will be done through the website. On behalf of the STVM Board and International Organizing Committee we invite you to attend the 8th Biennial Conference of STVM in Vietnam . Follow the link below to the Conference site.We look forward to seeing you in Vietnam in June 2005.”

Edmour F. Blouin, President
Jean-Charles Maillard, President-elect and Local Chair
Truong Van Dung, Director-National Institute of Veterinary Research ( Hanoi )
STVM 2005 Hanoi, Vietnam, http://www.stvmvietnam.org
(Promed 6/16/04 )

 Institute of Medicine: The Infectious Etiology of Chronic Diseases:
The Institute of Medicine (IOM) is releasing “The Infectious Etiology of Chronic Diseases”. Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary, a report that summarizes a two-day workshop in which experts presented findings on a range of recognized and potential chronic sequelae of infections - such as cancers, cardiovascular disease, demyelinating syndromes, neuropsychiatric diseases, hepatitis, and type 1 diabetes.
To read online visit http://www.nap.edu/catalog/11026.html
(Institute of Medicine )

USA (multi-state): HHS Launches Cities Readiness Initiative (CRI)
A coalition of federal agencies led by the Department of Health and Human Services announced a new plan aimed at further enhancing the nation's ability to respond to public health emergencies. The plan involves an eight-month pilot program that will focus on preparing 21 cities across the USA to quickly dispense medical supplies that may be needed in response to a terrorist attack or other large-scale public health emergency. The purpose of the planned Cities Readiness Initiative is to increase cities' capacity to quickly dispense medical supplies, thereby unifying the Federal, State, and Local response plans in the event of a major public health emergency. Using population and location as a guide, 21 cities have been chosen to receive assistance. Those cities are: Atlanta , Houston , Phoenix , Boston , Las Vegas , Pittsburg , Chicago , Los Angeles , St. Louis , Cleveland , Miami , San Diego , Dallas , Minneapolis , San Francisco , Denver , New York , Seattle , Detroit , Philadelphia , and Washington , DC . The Department of Health & Human Services (HHS) is the lead agency for the government coalition that includes the Centers for Disease Control and Prevention (CDC), the Department of Homeland Security (DHS), and the United States Postal Service (USPS). For more information on CRI visit http://www.bt.cdc.gov/cri
(CDC 6/15/04 )

---

APEC ACTIVITIES

---

The APEC EINet team, in collaboration with several economies in the Asia Pacific, are preparing point-to-point discussions over the month of July. The aim of these discussions is to prepare an agenda for a broader plenary discussion of bio-preparedness practices and topical disease priorities. These virtual meetings will utilize existing video-conferencing facilities and will test the existing level of communications network technologies.

---

---