1. INFECTIOUS DISEASE INFORMATION
ASIA
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 )
AMERICA
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.