Vol. VII, No. 15 ~ EINet News Briefs ~ Jul 9, 2004
A free service of the APEC Emerging Infections Network
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In this edition:
1. Infectious disease information
- East Asia/Avian
influenza: Current evaluation
of risks to humans from H5N1
- China (east): New bird flu case confirmed
- Thailand:
New outbreak of bird flu suspected
- Viet Nam: Bird flu downplayed
but urges vigilance
- China: Beijing schoolchildren face compulsory
AIDS education
- Cambodia: Protects 75% of children against
parasites—first country to reach key target
- Philippines:
Malaria affects 122 persons in South Cotabato
- Hong Kong:
Second Japanese Encephalitis Case Confirmed
- Russia: 19 People
in Ulyanovsk Region Bitten by Rabid Dog
- Russia: Tickborne
encephalitis outbreak in Republic of Altai
- Russia: HFRS
a continuing problem in Udmurtia
- Russia: More victims at
graduation party held in the Amur region
- USA (Colorado):
First Case of Hantavirus Pulmonary Syndrome of 2004
- USA
(New York): Number of possible E. coli cases at Bronx day care center rises
-
USA (Florida): Malaria resurfaces in Palm Beach County
- Peru:
Current Situation of Jungle Yellow Fever (JYF)
2. Updates
- Cholera, Diarrhea, and Dysentery
- Dengue/DHF
- Viral gastroenteritis
- West Nile Virus
3. Articles
- Genesis of a highly pathogenic and potentially pandemic
H5N1 influenza virus in eastern Asia
- Update: Influenza
Activity—United States and Worldwide, 2003–04 Season, and Composition
of the 2004—05 Influenza Vaccine
- Trends in Primary and
Secondary Syphilis and HIV Infections in Men Who Have Sex with Men—San
Francisco and Los Angeles, California, 1998–2002
- Updated
Recommendations for Use of Pneumococcal Conjugate Vaccine: Reinstatement
of the Third Dose
- Investigation of Rabies Infections in
Organ Donor and Transplant Recipients:Alabama, Arkansas, Oklahoma,
and Texas, 2004
- Racial Disparities in Tuberculosis:Selected
Southeastern States, 1991-2002
- Surveillance Data from
Public Spa Inspections— United States, May–September 2002
-
AIDS epidemic grows at record rate
- China: Recent SARS
outbreak--important lessons for global public health
4. Notifications
- HIV Content Guidelines Announcement
- XV International
AIDS Conference
6. How to join the EINet email list
1. OVERVIEW OF INFECTIOUS-DISEASE INFORMATION
Below is a semi-monthly summary of Asia-Pacific emerging infectious diseases.
ASIA
East Asia: Avian influenza
- Current evaluation of risks to humans from H5N1
In the last two weeks, avian influenza appears
to have re-emerged in poultry in East Asia. These outbreaks could either
be new outbreaks of Highly Pathogenic Avian Influenza A(H5N1) virus or a
continuation of the outbreaks reported earlier. These events, in addition
to two new research reports, about the virus becoming increasingly pathogenic
and becoming more widespread in birds in the region, fuel the WHO's concern
about the threat the virus poses to human health.
WHO has been concerned about influenza A(H5N1) because of its threat to humans both in farm settings in Asia and its greater, potentially global risk. Several countries in Asia have witnessed this virus crossing the species barrier, moving from infected chickens or ducks directly into humans in three documented outbreaks since 1997. These direct human infections have produced severe and sometimes fatal outcomes. Moreover, the virus has the potential to acquire the ability to spread easily from human to human, and thus, trigger a global influenza pandemic. Now, two research reports have added to our understanding of this virus. First, members of China's Ministry of Agriculture and colleagues reported in a paper published last week in the Proceedings of the National Academy of Sciences that the virus appears to be widespread in domestic ducks in southern China. Further, the scientists found that the virus is causing increasingly severe disease. However, these trials were done in mice.
This week, the journal Nature published a report which indicates domestic and wild birds in the region may have contributed to the increasing spread of the virus and suggests that the virus is gaining a stronger foothold in the region. These observations suggest that control of the virus may be even more difficult than thought in the spring. Effective risk management tools exist to control outbreaks of influenza A(H5N1) when they are detected in poultry operations. China, for example, was quick to employ these tools last week when an outbreak was discovered in Anhui province. These risk management measures include the culling of infected and exposed birds, stringent biosecurity measures and vaccination. While this approach can still take months or even years to contain the virus completely, these methods have been effective in the past.
However, tools to assess the risk to human health are less well developed. While recent reports indicate the virus has been present consistently in the environment for the last several years, it has still not acquired the ability to infect humans easily for unknown reasons. WHO urges and offers assistance that risk assessment activities, including surveillance in animals and humans, and strain analysis, be undertaken as soon as possible. More knowledge of the virus could be acquired if WHO had full access to all virus isolates and clinical specimens from recent outbreaks. All H5N1 viruses are not the same, and how they differ could provide important insights. For example, the Indonesian avian influenza virus, while belonging to the genotype of viruses seen in Viet Nam and Thailand, is also distinct. With this information, public health planners would know that they are confronting the same virus in all of the recent outbreaks in Asia.
Pandemic preparedness activities started by WHO in the wake of the outbreaks reported earlier this year continue. Less than two weeks ago, WHO hosted a meeting in Kuala Lumpur with experts from 13 countries and areas of the Asia-Pacific region. Among other activities, the meeting participants were provided with a WHO preparedness self-assessment tool. WHO is collaborating with scientists and the pharmaceutical community on a global surveillance system to monitor changes in the virus's susceptibility to known antivirals. Finally, pandemic vaccine development continues. Two vaccine manufacturers, both based in the US, have produced a supply of trial vaccine which will be tested for safety and efficacy in humans. In summary, recent developments suggest that:
- the virus is more widespread than previously thought and found in wild birds, and therefore it may be more difficult to eliminate.
- virus isolates and specimens from all recent outbreaks need to be shared with the WHO laboratory network to monitor the circulating viruses and to assess the adequacy of the current pandemic vaccine strain.
- as control measures are strengthened, national governments are encouraged to provide human influenza vaccinations to culling workers.
- all people, especially culling workers, exposed to infected birds need to be provided with antivirals.
- human trials of experimental influenza pandemic vaccines should be accelerated.
- while early identification of avian influenza cases in humans is difficult, stepped up surveillance for the early detection of the disease in humans is essential. The risk of emergence of a new human pandemic virus will remain as long as the avian influenza virus exists in the environment. WHO's concern and activities continue at a high level following recent reports. Because the H5N1 threat is unlikely to be resolved in the short term, WHO is working with other international agencies, including the Food and Agricultural Organization (FAO), and World Organization for Animal Health (OIE), to monitor events.
China (east): New bird flu case confirmed
The national bird flu reference laboratory confirmed, 6 Jul 2004, that
the latest death of chickens in east China's Anhui province was caused
by H5N1 strain of bird flu virus. The case happened at a chicken farm of
the Juchao District, Chaohu City, east Anhui Province. Officials with the
Ministry of Agriculture said that the ministry received the report of chicken
death 3 Jul 2004 and soon dispatched a group of experts to guide the relevant
work of prevention and control of the disease. Sources from the ministry
said that the local government has taken the necessary measures of slaughter,
or quarantine to prevent a spread, and sent samples to the authorities.
It has also isolated the area following the death report in accordance
with China's Lawon Animal Epidemic Prevention. The local health authority
killed all the poultry within a 3 km radius of the chicken farm and vaccinated
all the poultry within a 5 km radius of the affected area.
The ministry said the farm is located close to the wide Chaohu Lake, and
all the chicks are bought from the local markets, where no avian flu case
had been reported before. The experts estimated that the virus might be
spread by migrants or wild water birds. The ministry has informed the Food
and Agriculture Organization (FAO) of the United Nations, the World Health
Organization (WHO), and the relevant authorities of Hong Kong, Macao, and
Taiwan about the case.
(Promed 7/7/04)
Thailand: New outbreak of bird flu suspected
Thailand suspects a new outbreak of bird flu at a farm in a central province
where thousands of chickens have died, the deputy agriculture minister said
6 Jul 2004. "I have received reports that there are suspected bird flu cases
in Ayutthaya province, and the result of lab tests will be confirmed in the
next couple of days,'' Newin Chidchob told reporters. "It is possible that
the outbreak will return.'' An outbreak in Ayutthaya would be the second since
the government declared 14 May 2004 that it was all but certain that Thailand
was free of the disease following widespread outbreaks earlier in 2004. An
isolated outbreak in northern Chiang Mai province in late May 2004 also raised
alarms. The deadly strain of bird flu that swept through 10 Asian nations earlier
in 2004 killed, or forced the cull of, more than 100 million poultry. It killed
more than 37 million birds in Thailand alone, where it also jumped to humans
and killed eight people. An additional 16 people died in Vietnam.
Chickens at the afflicted farm in Ayutthaya began to die during the last two
weeks of Jun 2004, farm owner Veera Sripramong said. Officials from the local
Livestock Office visited his farm and told him to cull all of his 43 000
chickens. "They
ordered me to kill all chickens, but I don't have enough manpower, so I will
do what I can,'' Veera said. He said about 7000 chickens have died during
the past two weeks. Chalit Seenimanomai, the chief of the Livestock Office
in Ayutthaya, said that, by law, all chickens in a radius of 3 miles around
the affected farm would have to be destroyed. Fortunately, there are no other
farms in that area.
(Promed 7/8/04)
Viet Nam: Bird flu downplayed but vigilance urged Viet Nam said an emergence of bird flu in southern provinces did not mean a return of the epidemic that killed 16 people earlier in 2004, but urged farmers to remain on guard. The bird flu has caused the cull or deaths of more than 10 000 chickens in the Mekong Delta provinces of Bac Lieu and Tien Giang. "The recent incident when chickens died was just an echo of the last bird flu outbreak because there were still chickens from the infected flock," Bui Quang Anh, an agriculture ministry official said. "It cannot be called an outbreak," Anh said.
Viet Nam was struck by bird flu earlier in 2004 involving the deadly H5N1 strain
that also killed eight people in Thailand. Hanoi declared the epidemic over
at the end of March. Deputy prime minister Nguyen Tan Dung issued an emergency
directive, published in newspapers, outlining measures to quell any recurrence
of the bird flu, including immediately destroying sick fowl.
The bird flu erupted across many parts of Asia from late in 2003 and killed millions
of chickens and devastated poultry industries in several countries, particularly
Thailand. People who got infected are believed to have caught the disease from
close contact with sick birds. There were no confirmed cases of human to human
transmissions. The United Nation's Food and Agriculture Organization (FAO)
urged caution and more detailed testing. "Viet Nam doesn't have the capacity
to analyze the samples," said Anton Rychener, Viet Nam representative of the
FAO. "I have urged him (Anh) to send the samples to Hong Kong…" Rychener said. "I
have said all along that the virus is continuing to exist in Viet Nam."
(Promed 7/2/04)
China: Beijing schoolchildren face compulsory AIDS education
Secondary schools in Beijing will soon be required to provide children with
compulsory HIV/AIDS education. And schools in other Chinese cities are set
to follow suit, according to the Ministry of Education. Beijing's municipal
commission of education announced last week that the HIV/AIDS courses for
secondary school students would begin this autumn. There will be four hours
of HIV/AIDS-related education during each of the first three years of secondary
education. Courses will cover the science of HIV/AIDS, how it spreads within
populations, the social and economic threats of the disease, and information
about effective disease prevention. Beijing's move follows recommendations
by the education ministry that teaching on drug control and HIV/AIDS prevention
should be strengthened during basic education. On 9 May 2004, the State Council
demanded that secondary schools across the country should add education on
HIV/AIDS prevention to their normal courses.
By the end of 2003, China had reported 840,000 HIV/AIDS carriers and patients.
But researchers estimate that without effective control, that number will
reach 10 million by 2010. The Chinese government has recently strengthened
its efforts to prevent and control the spread of HIV/AIDS. In April, the
Ministry of Health and the Ministry of Finance jointly declared to offer
free HIV/AIDS drugs to low-income rural and urban AIDS patients. However,
experts say education on HIV/AIDS, drug addiction, and sex are still underdeveloped
in the world's most populous country. Before this year, virtually no schools
in China taught pupils about HIV/AIDS. http://www.scidev.net/gateways/index.cfm?
(AIDS-Asia 7/1/04)
Cambodia: Protects 75% of children against parasites; first country
to reach key target
With the recent completion of its latest treatment campaign against
intestinal parasites, Cambodia has become the first country to protect 75%
of school-aged children against intestinal parasites and reach WHO's anti-parasite
target—six years ahead of schedule. Just five years ago, more than 70%
of Cambodian children were infected with intestinal worms. Not only do
affected children weigh as much as 2kg less than healthy children, they
also have a much higher chance of becoming anaemic. Once anti-parasite
treatment is administered, infected children show a dramatic increase in
their short-and long-term memory, as well as their reasoning capacity and
reading comprehension. School absenteeism drops by as much as 25%.
In 2001, WHO set a target of covering at least 75% of school-aged children with regular treatment as the global goal for parasite control for 2010. According to reports sent in from the more than 6500 schools where the campaign took place, more than 75% of Cambodia's nearly three million school-aged children have now been treated. "This is a huge step forward not only for Cambodia, but for all countries working to control intestinal parasitic diseases," said Dr Lorenzo Savioli, WHO's Coordinator of Parasitic Diseases Control.
Intestinal worm infections affect at least two billion people worldwide and are a significant public health threat in regions where sanitation and hygiene levels are inadequate. These worms can be contracted when skin comes into contact with contaminated water, soil or through ingestion. Heavy infection can impede intellectual and physical development. Symptoms include fever, chills, and muscle aches, and if left untreated, leads to irreversible organ damage. Treatment is with cheap, single dose and effective drugs between three times a year and once every two years, depending on the prevalence of infection in the area. Cambodia's success follows a progressive expansion to the national level, which now involves a twice-yearly anti-parasite campaign. Drugs are administered across all 24 provinces by thousands of teachers, who distribute the pills to students in classrooms. The campaigns were conducted by the Cambodian Ministry of Health, Education and Sport, with the support of WHO, together with UNICEF, the Japanese Embassy in Cambodia, and the Sasakawa Memorial Health Foundation. Dr Kevin Palmer, Regional Adviser in Parasitic Diseases for the Western Pacific Regional Office of WHO said, "Reaching the target this early wasn't accidental. It demonstrates what can be achieved when the political will is there together with financial support from donors and partners."
To promote campaigns against parasites in other affected countries, WHO together
with UNICEF recommends that such campaigns simply be integrated into other
disease campaigns. "We will never control parasitic infections until the global
community starts to think and act on a large scale," said Dr Hiroyoshi Endo,
WHO's Director of the Control, Prevention and Eradication of Communicable Diseases. "The
best way to treat as many people as possible is to piggyback onto other disease
initiatives." It
is a remarkably cost-effective strategy. Anti-parasite pills cost only about
two cents per tablet. "That's a very small price to pay for helping to control
a public health problem," said Dr Savioli. WHO hopes that Cambodia's early
success will generate momentum for other countries to combat parasitic infections.
(WHO 7/2/04)
Philippines: Malaria affects 122 persons in South Cotabato The provincial government of South Cotabato has intensified its operations against an outbreak of malaria, which has reportedly afflicted at least 122 people in five municipalities over the last few weeks. Arnold Giniseran, team leader of the provincial health office's malaria control program, said they have quarantined several upland villages in the municipalities of Lake Sebu, T'boli, Tantangan, Tupi, and Banga to prevent the further spread of malaria. Of the five municipalities, barangays Ned and Halilan in Lake Sebu were hit hardest with at least 40 people already affected by malaria. Other areas placed under quarantine were barangays Kematu, Edwards, and Zigzag in T'boli; Tacub and El Ulit in Tantangan; sitio Mambusong in barangay Cebuano, Tupi; and sitio Lambukay in barangay Lamba, Banga.
"These case numbers are quite higher than the same period last year," said Giniseran, adding that no deaths have been reported. Giniseran said they are currently conducting massive malaria eradication activities in the affected areas. These include case finding and treatment, particularly the collection of smears, treatment of symptomatic patients and confirmation of positive cases, and distributing treated mosquito nets. He said that houses of affected residents are sprayed with disinfectants. "We also conduct massive information dissemination and capability building training to rural health midwives and barangay health workers," Giniseran added.
Dr Edgardo Sandig, provincial health officer, warned residents about theresurgence
of malaria due to the rainy season. He immediately directed the intensification
of health education among residents on preventive measures against malaria.
He attributed the high incidence of malaria in Lake Sebu and T'boli to the
area's topography and high altitude, which he said are conducive for mosquitoes
to thrive. Malaria is endemic on Mindanao, but the areas reporting an increase
in transmission have previously been regarded as low risk areas. Overall there
has been little progress in malaria control in the Philippines over the past
10 years.
(Promed 6/29/04)
Hong Kong: Second Japanese Encephalitis Case Confirmed
The
Centre for Health Protection has confirmed Japanese encephalitis virus infection
in a 45-year-old Yuen Long man. It is the second case reported in 2004. A hotline
has been set up to offer health advice and arrange follow-up action for symptomatic
people in the vicinity of Palm Springs, where the sick man lived. He developed
fever, headache and drowsiness 8 Jun 2004 and was admitted to Pamela Youde
Nethersole Eastern District Hospital. He is now in critical condition. A neighbourhood
survey is being conducted for active case finding. The Centre for Health Protection
will hold a health talk for residents and blood tests will be offered.
Centre Consultant Dr Thomas Tsang said the case is not related to the first case involving a foreign domestic helper in Kau Wa Keng San Tsuen, Kwai Chung. Dr Tsang said 518 people from 269 families have been contacted in the Kwai Chung investigation. No one has contracted the disease. Nine viral encephalitis reports have been received since the Centre, the Hospital Authority and the private medical sector established an alert system 11 Jun 2004 to monitor the occurrence of viral encephalitis cases. He said the number is similar to past trends and is within an acceptable range. Investigations into the cases are continuing.
Food & Environmental Hygiene Department Consultant Dr Ho Yuk-yin
said anti-mosquito work in the area and around nearby piggeries has been stepped
up, and larvicides have been applied to control breeding. He said Culex tritaeniorhychus,
the key vector of Japanese encephalitis virus, is found in Tuen Mun, Yuen Long,
North District, Kwai Chung, Sha Tin and Ma On Shan. These mosquitoes breed
where there is abundant water and become infected by biting pigs and wild birds
which have the virus. The infected mosquito can then transmit the virus to
humans through a bite. Agriculture, Fisheries & Conservation
Department Senior Veterinary Officer Dr Howard Wong said there are three
pig farms located within 2km of the patient's residence. Routine mosquito mitigation
measures have been carried out for farms, and inspections over the last two
weeks have found neither sick pigs nor mosquito breeding grounds. Visits to
all pig farms and mosquito surveillance will be stepped up in the coming two
weeks.
(Promed 6/25/04)
Russia: 19 People in Ulyanovsk Region Bitten by Rabid
Dog
In the Zavolshsk district of the Ulyanovsk region, a rabid dog has bitten
19 people, half of whom are children. The dog was brought to a veterinary
service clinic where the diagnosis was confirmed. All those known to have
been bitten by the dog have been vaccinated, and according to the Gazeta.Ru
newspaper, their lives are no longer considered to be at risk. However, physicians
are worried that other people possibly bitten by the dog might have suffered
only minor injury and have not sought medical attention. As a consequence
all local radio and television channels are broadcasting information warning
of the danger and stressing the necessity for immediate vaccination of feral
and domestic dogs.
(Promed 6/26/04)
Russia: Tickborne encephalitis outbreak in Republic
of Altai
The Republic of Altai, with its 203 000 inhabitants, is one of the most
favorable places for tickborne diseases in Russia. During the second and
third weeks of June 2004, the number of people bitten by ticks has increased
almost 50% from 515 to 732, 154 of whom are children. The total number of
patients admitted to hospital has risen to 103, which is higher than the
comparable number for the corresponding period of 2003. The head of the Epidemiological
Surveillance Center, Valentina Mednikova, stated that 45 residents of the
Altai Republic have been diagnosed with tickborne encephalitis, 53 with tickborne
typhus (rickettsiosis), and 5 with tickborne borreliosis (Lyme disease).
(Promed 6/28/04)
Russia: HFRS a continuing problem in Udmurtia
Most of the people infected with hemorrhagic fever with renal syndrome
(HFRS) were working in the basements of their houses. Basements and attics
are favorite places for mice. This season the virus transmitted by these rodents
appears to have enhanced virulence. Furthermore, entomologists state that 50%
of mice are carrying hantavirus. Unfortunately, most homeowners have rejected
disinfestation of their gardens on account of the expense involved. This has
resulted in a serious outbreak of disease. So far 108 people have been admitted
to hospital with HFRS. During the same period of 2003, only five people were
admitted with hemorrhagic fever. Local physicians are predicting that the number
of patients will increase through summer and fall. Previous posts earlier in
2004 reported a large increase in field voles, the vector of the hantavirus
responsible for HFRS, which may explain to some extent the apparent severity
of this outbreak.
(Promed 7/2/04)
Russia: More victims at graduation party held in the
Amur region
The number of people admitted to hospital with salmonella poisoning has
risen to 207. The incident of food poisoning was reported after a school
graduation party, held in Tambovka, in the Amur region during the third
week of June 2004. Eighty-four per cent of the patients have tested positive
for salmonellosis. The rest have been diagnosed as infected with staphylococcus.
Most of the patients admitted to hospital are in a satisfactory condition.
Sanitary preventive measures have been taken in the settlement where the
incident took place. Experts established that the infection was in egg
and squid salads served at the party. Documents with the results of the
medical examination have been sent to the local prosecutor's office, which
will open a criminal case. The number of individuals who were at the graduation
party is not stated in this report. It appears that most of the cases are
due to salmonellosis,
although a small percentage of cases, apparently, suffered from staphylococcal
toxin illness. The illnesses should be relatively easily distinguished, as
salmonellosis has an incubation period of 18 to 48 hours and is associated
with fever and diarrhea, whereas staphylococcal food poisoning has an incubation
period of less than 8 hours, is generally not associated with fever, and causes,
primarily, vomiting, not diarrhea.
(Promed 6/30/04)
AMERICAS
USA (Colorado): First Case of Hantavirus Pulmonary
Syndrome of 2004
This year's first reported case of hantavirus infection in Colorado has
resulted in the death of a Douglas County woman, health authorities said
25 Jun 2004. John Pape, an epidemiologist specializing in animal-related
diseases at the Department of Public Health and Environment, said the woman
lived in a more rural part of the county, and it's believed she contracted
it there. "This
disease is carried by deer mice, which primarily stay in more rural areas," he
said. "They aren't as likely to act like the common house mouse, which will
come indoors and live with you in the city." The
deer mouse is brown on top with a white belly. House mice usually are gray.
Hantavirus pulmonary syndrome is a respiratory disease caused by a virus carried mostly by deer mice that can infect humans when they inhale dirt or dust contaminated with mouse urine and feces. Usually it happens when people are cleaning rodent-infested structures such as barns, garages, storage sheds, trailers or cabins. The virus was first diagnosed in the US in 1959, but the earliest case in Colorado was in 1985. In 1993, an outbreak of hantavirus infection in the four Corners area infected five Coloradoans, killing four. Since then, in Colorado there have been 35 cases of people being infected with 16 deaths, Pape said. The Pan American Health Organization reported this April that since 1993, there have been 362 cases in the US, including 132 deaths; and 1910 cases in North and South America, with 384 total deaths. During 2003 in Colorado there were five cases and one fatality. Among the counties in Colorado that have tested positive for the disease are Douglas, Jefferson, Boulder and Adams, Pape said.
If there is evidence
of mice in or around your home, Pape said, remove them as soon as
possible. If they are brown with a white belly, spray them with bleach,
put them in a double plastic bag and place them in the outdoor trash
can. He advised wearing protective gloves, making sure there is plenty
of ventilation where you are working, and use face masks if possible.
In North America, cases of hantavirus pulmonary syndrome are caused
by infection with Sin Nombre virus, whose reservoir host is the deer
mouse Peromyscus maniculatus. In the Old World other hantaviruses carried
by different rodents are associated with a milder form of disease known
as hemorrhagic fever with renal syndrome, of which there can be up
to 200 000 cases annually.
(Promed 6/26/04)
USA
(New York): Number of possible E. coli cases at Bronx day care
center rises
The number of possible cases of Escherichia coli O157:H7 infection at a
Bronx day care center has climbed from 18 to 26 as the center remains closed.
The For Kids Only Day Care and Nursery has been closed since 1 Jul 2004, after
three children were admitted to hospital. One other child, who did not
attend the center, was also infected. Doctor Marguerite Mayers, who treated the
kids at Montefiore Medical Center, says the condition of all of the children
was serious but all were stabilized and released. The center hired a private
team to run tests in order to determine where the bacterium came from.
In addition, New York City Department of Health inspectors say the center will
be thoroughly sterilized before kids can step foot back inside. Experts
say there is really no way to protect against E. coli but add that proper hygiene
can help. Health officials say parents should be on the lookout for symptoms
such as abdominal pain, diarrhea that becomes bloody, fever and irritability.
They say the infection is caused by poor hand washing, handling of diapers
and unsafe food preparation.
Some levels of E. coli bacteria are normally
found in the intestines of humans and animals. Although most strains
are harmless, E. coli 0157:H7 can cause a diarrheal illness that
sometimes leads to kidney damage and severe illness. The spread of
infection is usually caused by poor sanitary practices like inadequate
handwashing and the unsafe preparation of food.
(Promed 7/2/04, 7/6/04)
USA (Florida): Malaria resurfaces in Palm
Beach County
The Palm
Beach County Health Department has identified a person with malaria
who may have infected mosquitoes. This occurrence could leave other
residents at risk at this time. Residents are being asked to protect
against mosquito bites and report to a medical provider any symptoms
of high fever and teeth-chattering
chills. The Health Department has launched a full-scare awareness campaign
in the hopes of identifying other potential cases, creating awareness of
the situation, and contacted mosquito control to increase spraying and
trapping of mosquitoes.
The incident is similar to the malaria outbreak of eight cases in 2003. No one died during last year's outbreak, but it lasted more than 3 months and was finally controlled in October. During last year's outbreak, investigators never identified the index case. Last year's outbreak is unrelated to this case, although both are the mild strain of the virus. Molecular typing of the cases in 2003 showed that all had been infected from the same source, but the source was never identified. Molecular typing of the parasites in this patient will show whether they are closely related to last year's patients or whether there is another source.
The current case had active malaria in early June. He was hospitalized at Delray Beach Medical Center from June 4 to 7 and is now cured. The cycle to infect another person is about 30 days. Given this time frame, the potential for infection is very high, according to health director, Jean Malecki, MD: "We know last year's carrier had the disease in June and the first two local cases were exposed around the 4 July holiday. The potential exists for this cycle to begin now.”
Malaria
is a parasitic disease transmitted by the anopheles mosquitoes and can
be treated. The symptoms vary depending on which of the four human malaria
strains has been contracted. Symptoms include; headache, aching in the
bones, anorexia, vomiting, teeth-chattering chills coupled with sensations
of heat and high fever and sweating. The onset of symptoms can be as
early as 7 days and as long as several months. People exhibiting any
signs or symptoms of the disease should report to their nearest hospital.
(Promed 7/3/04)
Peru: Current Situation of Jungle Yellow Fever (JYF)
Peru has reported 52 cases, with a case-fatality rate of 52 percent.
Another 31 suspected cases are undergoing epidemiological and laboratory
investigation.
Considering the extensive infestation by Aedes aegypti in all the countries
of the Region, with the exception of the continental part of Chile, the
occurrence of outbreaks increases the risk of the re-urbanization of
yellow fever. The PAHO Technical Advisory Group (TAG) on Vaccinations
has systematically recommended that the countries vaccinate all persons
residing in enzootic areas in the Americas for yellow fever, as well
as all travelers to those areas, and introduce routine vaccination for
children against the disease. Also highly recommended is putting into
place control measures against A. aegypti in accordance with PAHO recommendations
for the control of this vector. Evidence of the spread of yellow fever,
through the confirmation of at least one human case and of epizootics
(dead monkeys), is sufficient grounds for initiating outbreak-control
measures in the affected municipality and immediate vicinity. These measures
include vaccinating all residents who lack proof of previous inoculation
against yellow fever, vaccinating all those traveling to the area, actively
searching for suspected cases, putting into place surveillance of both
febrile icteric syndrome and epizootics, in addition to declaring epidemiological
alerts. If new cases are identified in other municipalities of the Region,
the vaccination ring should be expanded along with other control measures. Cholera, Diarrhea, and Dysentery Australia The bride and groom are still recovering from food poisoning themselves during
their honeymoon. Overall, six guests were treated at hospital emergency departments
within 48 hours of the wedding. Dr Guest said he could not say at this stage
whether food poisoning or viral gastroenteritis had caused the illness, but
gastroenteritis had been "very common" in the region this year. He said health officials had
no reason to close the Boat House By The Lake because there was no ongoing public
health hazard. Dr Guest said six functions were held at the restaurant, but the
outbreak of gastroenteritis was confined to the two weddings. The investigation
was focusing on common threads such as the health status of staff who worked
both functions and food served at both weddings. Dengue/DHF Indonesia In February 2004, the government placed Nanggroe Aceh Darussalam, Jakarta,
West Java, Central Java, Yogyakarta, East Java, Banten, Bali, West Nusa Tenggara,
East Nusa Tenggara, South Kalimantan, and South Sulawesi under extraordinary
status due to the high number of people affected by dengue fever. The ministry
recorded 59 321 cases and 669 deaths during this year's 2004 outbreak. Four distinct, but closely related, serotypes cause dengue, with the _Aedes
aegypti_ mosquito being the vector. All 4 serotypes—DEN-1, DEN-2, DEN-3,
and DEN-4—were found in dengue patients here, said I Nyoman Kandun, the
ministry's expert staff member on environment, health and epidemiology. Blood
samples from 10 Jakarta hospitals revealed that two thirds of total patients
were affected by DEN-3. Recovery from an infection caused by a particular
serotype results in a lifelong immunity against that serotype, but provides
only a partial, transient protection against subsequent infections by any
of the other serotypes, he said. Despite the normal status, the minister called on people to maintain precautionary
measures, as the country was not yet dengue-free. The government has long
urged public participation in its dengue eradication program through a change
in household habits, such as draining open tanks, covering vats of bathing
and standing water, and burying used cans—locally called the 3M measures—to
eliminate the breeding grounds of Aedes aegypti. Viral gastroenteritis West Nile Virus In addition, during 2004, a total of 861 dead corvids and 86 other dead birds
with WNV infection have been reported from 24 states, and 42 WNV infections
in horses have been reported from 11 states (Alabama, Arizona, California,
Idaho, Missouri, North Carolina, Oklahoma, South Dakota, Tennessee, Texas,
and Virginia). WNV seroconversions have been reported in 110 sentinel chicken
flocks from four states (Arizona, California, Florida, and Louisiana). Three
seropositive sentinel horses were reported from Puerto Rico. A total of 226
WNV-positive mosquito pools have been reported from 12 states (Arizona, California,
Illinois, Indiana, Louisiana, Michigan, Missouri, New Jersey, Ohio, Pennsylvania,
Texas, and Virginia). http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5326a5.htm (MMWR July 9, 2004 / 53(26);586) Canada
Up to 23 Jun 2004, the Ministries of Health of Colombia, Peru, Brazil
and Bolivia reported to the Pan American Health Organization (PAHO) the
occurrence of 86 confirmed cases of Jungle Yellow Fever (JYF), with 41
deaths. In all the countries, cases occurred predominantly among males
over the age of 15 who work in the countryside. The case distribution
by Epidemiological Week and by country is shown in a figure available
at the following web site:
(Promed 6/25/04)
2. UPDATES
Indonesia
Dozens of children under the age of 5 are being treated for diarrheal diseases
in several hospitals in Bogor, which suggests that residents may lack access
to clean water and basic information on good hygiene and health. Spokesman
of the Indonesia Red Cross (PMI) Hospital in Bogor, Andi Mukti, said the hospital
had treated 104 children since early Jun 2004, 94 of whom were outpatients.
Officials of the city health agency expressed concern that the number of patients
with diarrheal diseases would increase during the dry season, which will start
in Jul-Aug 2004. "Not only children, but adults will be affected by the proliferation
of E. coli that causes diarrhea," said head of the infectious disease eradication
unit at the agency, Eddy Darma. Data from the Indonesia Demographic and Health
Survey (SDKI) shows that in 2002 and 2003, about 11 per cent of children aged
below 5, most of whom were from low-income families, suffered from diarrheal
diseases. The percentage has not changed since 1997.
Health officials are investigating an outbreak of gastroenteritis among guests
at two weddings held at the Boat House By The Lake restaurant 26 Jun 2004.
Deputy chief health officer Dr Charles Guest said that 40 out of 80 guests
at the lunchtime wedding developed symptoms such as diarrhea and vomiting.
Some guests at the evening wedding also became ill, but health officials were
still attempting to ascertain the illness' attack rate. One of the weddings
was between a Department of Defense worker and a Department of Foreign Affairs
and Trade employee and had a number of high-profile people on the guest list.
Malaysia
It was reported 2 Jul 2004 that 96 people were hospitalized at the district
hospital in Permaisuri, Setiu, following a dengue outbreak. Meanwhile, State
Health director Datuk Dr. Ahmad Razin Ahmad Maher said the situation in Kelantan
was under control, with a small number of cases reported so far. Local councils
have been directed to take immediate precautionary measures against a dengue
outbreak in the Setiu district of Terengganu.
The government declared the dengue fever outbreak over and lifted the red
alert status in 12 provinces, as the prevalence rate had decreased to a baseline
level. Minister of Health Achmad Suyudi said the number of dengue cases had
been decreasing since mid-April 2004. "In May, there were only 506 cases with 4 casualties deaths,
far below the 3616 cases recorded a month earlier, with 25 people succumbing
to the disease. We can see that the number has declined significantly," Suyudi
said 16 Jun 2004. He added that the outbreak had slowed faster than the government
had expected. In May last year 2003, 6425 cases were recorded, of which 78
died.
(Promed 7/7/04)
New Zealand
In the last posting, there was a suspected Norovirus outbreak in Dunedin,
New Zealand. Norovirus has been isolated from specimens. A further 32 staff
and 13 patients have been notified as of 1200 NZST 25 Jun 2004.
(Promed 6/23/04,
7/6/04)
USA
During June 30–July 6, a total of 21 human cases of West Nile virus (WNV)
illness were reported from two states (Arizona and California). During 2004,
eight states have reported a total of 78 human cases of WNV illness to CDC
through ArboNET. Of these, 57 (73%) were reported from Arizona. Forty-seven
(61%) of the 78 cases occurred in males; the median age of patients was 53
years (range: 1-84 years); the dates of illness onset ranged from April 23
to June 28; and one case was fatal. A total of 20 presumptive West Nile viremic
blood donors (PVDs) have been reported to ArboNET. Of these, 19 were reported
from Arizona, and one was reported from New Mexico. Of the 20 PVDs reported
to ArboNET, one person aged 69 years subsequently had neuroinvasive illness,
and four persons aged 22, 51, 52, and 57 years subsequently had West Nile
fever. In New Mexico, the first reported human WNV infection in 2004 was
in a PVD; in Arizona, three of the first seven reported human WNV infections
of 2004 were in PVDs.
The number of confirmed West Nile virus-positive birds is 49 (and presumed
positives from 4 to 9). Manitoba, Ontario, Quebec and Saskatchewan remain
the only provinces to report West Nile virus-positive birds, so far, in 2004.
So far, there has been no report of human cases of West Nile virus infection
or of infection of any other species of animal.
(Promed 7/8/04)
3. ARTICLES
Genesis of a highly pathogenic and potentially pandemic
H5N1 influenza virus in eastern Asia Abstract:
"A highly pathogenic avian influenza virus, H5N1,
caused disease outbreaks in poultry in China and 7 other east Asian countries
between late 2003 and early 2004; the same virus was fatal to humans in Thailand
and Viet Nam. Here, we demonstrate a series of genetic reassortment events
traceable to the precursor of the H5N1 viruses that caused the initial human
outbreak in Hong Kong in 1997, and, subsequent avian outbreaks in 2001 and
2002. These events gave rise to a dominant H5N1 genotype (Z) in chickens
and ducks that was responsible for the regional outbreak in 2003 - 2004.
Our findings indicate that domestic ducks in southern China had a central
role in the generation and maintenance of this virus, and, also, that wild
birds may have contributed to the increasingly wide spread of the virus in
Asia. Our results suggest that H5N1 viruses with pandemic potential have
become endemic in the region and are not easily eradicable. These developments
pose a threat to public and veterinary health in the region, and, potentially,
the world, and suggest that long-term control measures are required."
(Promed 7/8/04)
Update: Influenza Activity—United States and Worldwide, 2003–04 Season,
and Composition of the 2004–05 Influenza Vaccine
“During the 2003–04
influenza season, influenza A (H1), A (H3N2), and B viruses co-circulated
worldwide, and influenza A (H3N2) viruses predominated. Several Asian countries
reported widespread outbreaks of avian influenza A (H5N1) among poultry.
In Vietnam and Thailand, these outbreaks were associated with severe illnesses
and deaths among humans. In the United States, the 2003–04 influenza season
began earlier than most seasons, peaked in December, was moderately severe
in terms of its impact on mortality, and was associated predominantly with
influenza A (H3N2) viruses. This report 1) summarizes information collected
by World Health Organization (WHO) and National Respiratory and Enteric Virus
Surveillance System (NREVSS) collaborating laboratories, state and local
health departments, health-care providers, vital statistics registries, and
CDC and 2) describes influenza activity in the United States and worldwide
during the 2003--04 influenza season and the composition of the 2004--05
influenza vaccine.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5325a1.htm (MMWR July 2, 2004 / 53(25);547-552)
Trends in Primary and Secondary Syphilis and HIV Infections in Men Who Have Sex with Men: San Francisco and Los Angeles, California, 1998–2002 “Because syphilis infection facilitates acquisition and transmission of human immunodeficiency virus (HIV), recent outbreaks of syphilis among men who have sex with men (MSM) in major U.S. cities, including San Francisco and Los Angeles, and reported increases in sexual risk behavior have raised concerns about potential increases in HIV transmission. In 2002, MSM accounted for the majority of primary and secondary (P&S) syphilis cases in men reported in San Francisco (93%) and Los Angeles (81%). To investigate a potential change in HIV incidence associated with the syphilis outbreaks in the two cities, local, state, and federal health officials analyzed data from HIV counseling and testing centers and a municipal sexually transmitted disease (STD) clinic. This report describes the results of that investigation, which indicated that, as of 2002, the outbreaks of syphilis had not had a substantial impact on HIV incidence among MSM in these two cities. However, the continued increase in syphilis cases in MSM underscores the need for integrated HIV- and STD-prevention strategies to control syphilis outbreaks and prevent potential increases in HIV infections and for further systematic studies of HIV incidence among MSM infected with syphilis.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5326a1.htm (MMWR July 9, 2004 / 53(26);575-578)
Updated Recommendations for Use of Pneumococcal Conjugate Vaccine: Reinstatement of the Third Dose “In February 2004, production of the 7-valent pneumococcal conjugate vaccine (PCV7), marketed as Prevnar® and manufactured by Wyeth Vaccines (Collegeville, Pennsylvania), failed to meet demand, resulting in shortages. To conserve the limited supply, CDC recommended that the fourth dose of PCV7 be withheld from healthy children. In March, because evidence indicated that production would be curtailed for several months, CDC recommended that the third dose also be withheld. Production problems now appear to have been resolved. As a result, deliveries are projected during the near term to permit the recommendation that every child receive 3 doses. Some providers might have short-term difficulties obtaining vaccine because of distribution delays; however, every effort will be made to provide sufficient vaccine to all providers.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5326a7.htm (MMWR July 9, 2004 / 53(26);589-590)
Investigation of Rabies Infections in Organ Donor and
Transplant Recipients in Alabama, Arkansas, Oklahoma, and Texas, 2004
“On June 30, 2004, CDC confirmed
diagnoses of rabies in three recipients of transplanted organs and in their
common donor, who was found subsequently to have serologic evidence of rabies
infection. The transplant recipients had encephalitis of unknown etiology after
transplantation and subsequently died. Specimens were sent to CDC for diagnostic
evaluation. This report provides a brief summary of the ongoing investigation
and information on exposure risks and postexposure measures.
Organ Donor
The organ donor was an Arkansas man who visited two hospitals in Texas with
severe mental status changes and a low-grade fever. Neurologic imaging indicated
findings consistent with a subarachnoid hemorrhage, which expanded rapidly in
the 48 hours after admission, leading to cerebral herniation and death. Donor
eligibility screening and testing did not reveal any contraindications to transplantation,
and the patient's family agreed to organ donation. Lungs, kidneys, and liver
were recovered. No other organs or tissues were recovered from the donor,
and the donor did not receive any blood products before death. The liver and
kidneys were transplanted into three recipients on May 4 at a transplant center
in Texas. The lungs were transplanted in an Alabama hospital into a patient who
died of intraoperative complications.
Liver Recipient
The liver recipient was a man with end-stage liver disease. The patient did
well immediately after transplantation and was discharged home on postoperative
day 5. Twenty-one days after transplant, the patient was readmitted with tremors,
lethargy, and anorexia; he was afebrile. The patient's neurologic status
deteriorated rapidly during the next 24 hours; he required intubation and critical
care support. A lumbar puncture indicated a mild lymphocytic pleocytosis (25
white blood cells/mm3) and a mildly elevated protein. Magnetic resonance imaging
(MRI) of the brain indicated increased signal in the cerebrospinal fluid. His
neurologic status continued to deteriorate. Six days after admission, a repeat
MRI indicated diffuse encephalitis. The patient subsequently died.
Female Kidney Recipient
The first kidney recipient was a woman with end-stage renal disease caused
by hypertension and diabetes. She had no postoperative complications and was
discharged home on postoperative day 7. Twenty-five days after transplant, she
was readmitted with right-side flank pain and underwent an appendectomy. Two
days after this procedure, she had diffuse twitching and was noted to be increasingly
lethargic. Neurologic imaging with computed tomography and MRI indicated no abnormality.
During the next 24–48 hours, the patient had worsening mental status, seizures,
hypotension, and respiratory failure requiring intubation. Her mental status
continued to deteriorate, and cerebral imaging 2 weeks after admission indicated
severe cerebral edema. The patient subsequently died.
Male Kidney Recipient
The second renal recipient was a man with end-stage renal disease caused
by focal, segmental glomerulosclerosis. His posttransplant course was complicated
briefly by occlusions of an arterial graft leading to infarction of the lower
pole of the transplanted kidney. The patient was discharged home 12 days after
transplantation. Twenty-seven days after transplantation, he visited a hospital
emergency department and was then transferred to the transplant center with myoclonic
jerks and altered mental status; he was afebrile. An MRI of the brain performed
on admission revealed no abnormalities. His mental status deteriorated rapidly
during the next 24 hours. A lumbar puncture revealed mild lymphocytic pleocytosis
(16 white blood cells/mm3) and a mildly elevated protein. His mental status continued
to deteriorate, leading to respiratory failure requiring intubation. A repeat
MRI performed 10 days after admission indicated diffuse edema. The patient subsequently
died.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm53d701a1.htm (MMWR July 1, 2004 / 53(Dispatch);1-3)
Racial Disparities in Tuberculosis: Selected Southeastern States, 1991–2002
“Despite
substantial declines in tuberculosis (TB) in the United States, in 2002, non-Hispanic
blacks continued to have TB at rates eight times greater than non-Hispanic
whites. To better understand racial disparities in TB, CDC analyzed surveillance
data collected during 1991–2002, comparing TB cases in seven southeastern
states where TB rates were higher than the national average with TB cases in
the rest of the United States. This report summarizes the results of that analysis,
which indicated that TB rates among non-Hispanic blacks in the seven southeastern
states continued to exceed those among non-Hispanic whites but were similar to
rates among non-Hispanic blacks in the rest of the country. In addition, non-Hispanic
blacks with TB in the southeastern states were more likely than non-Hispanic
whites to report certain risk factors, suggesting that differences in socioeconomic
status might create barriers to diagnosis and treatment. The continued disparity
in TB cases underscores the need for effective, targeted strategies to prevent
TB in non-Hispanic blacks.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5325a3.htm (MMWR July 2, 2004 / 53(25);556-559)
Surveillance Data from Public Spa Inspections in the United States, May–September
2002
“Approximately 5 million public and private hot tubs, whirlpools, and
spas are used in the United States. Extensive spa use combined with inadequate
maintenance contribute to recreational water illnesses (RWIs) caused by pathogens
such as Pseudomonas spp., Legionella spp., and Mycobacterium spp. In the
United States, local environmental health inspectors periodically inspect
public spas to determine their compliance with local or state health regulations.
During inspections for regulatory compliance, data pertaining to spa water
chemistry, filtration and recirculation, and management and operations are
collected. This report summarizes spa inspection data from six sites in the
United States during May 1–Sept. 1, 2002. The findings underscore the
utility of these data for public health decision-making and the need for
increased training and vigilance by operators to ensure high-quality spa
water for use by the public.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5325a2.htm (MMWR July 2, 2004 / 53(25);553-555)
AIDS epidemic grows at record rate
The AIDS epidemic is continuing to grow at a record rate with roughly 4.8
million people becoming infected last year with the virus that causes AIDS,
according to a United Nations report <http://www.unaids.org/en/other/functionalities/ViewDocument.asp?href=http://gva-doc-owl/WEBcontent/Documents/pub/Media/Press-Releases02/PR_Globalreport2004_06Jul04_en.pdf>.
That
is the largest increase in any year since the global outbreak began.
Thirty-eight million people are living with HIV, as the epidemic continues to deepen in sub-Saharan Africa, by far the hardest hit region, and new epidemics seem to be swelling unchecked in Asia and Eastern Europe. Life-prolonging drugs are not getting to those who need them most. Some 400 000 people in the developing world have access to the drugs out of 6 million who need them. Most global epidemic in history is also becoming increasingly feminine. Now, nearly half of all people infected between the ages of 15 and 49 are women.
The report comes at a time when the world has significantly boosted its commitment and resources to HIV/AIDS, but the need is still far greater, according to the fourth global report by the Joint United Nations Program on HIV/AIDS released in advance of the 15th International AIDS Conference. "Over 20 years of AIDS provides us with compelling evidence that unless we act now we will be paying later—a trenchant message for the countries of Asia and the Pacific," said Peter Piot, the program's executive director, in the report.
In Asia, with 60% of the world's population, 7.4 million people are living
with HIV. One of every 4 newly-infected people is Asian. The epidemic is fueled
by drug use, sex work, and sex between men, but it is fast moving into
the general population. China and India have severe epidemics in a number of
provinces, territories, and states. In Indonesia and Vietnam, infections
among injecting drug users have soared. "There's a . . . window of opportunity
to get prevention programs up to scale in Asia," said Kathleen Cravero, the
program's deputy executive director. "If
we miss it, we will see an epidemic the likes of which we never imagined
despite what has happened in Africa."
(Promed 7/6/04)
China: Recent SARS outbreak: important lessons for global
public health
It has been more than two months since the Ministry of Health of China notified
WHO and the world about an outbreak of SARS in Beijing and Anhui Province.
Since then, WHO experts have been supporting the Chinese authorities in their
investigation into the cause of the laboratory-acquired cases, and in assessing
the effectiveness of measures taken to control the outbreak. On 1 Jul 2004,
the Ministry of Health of China released its status report on the investigation.
The outbreak has now been successfully contained, but initial findings from
the investigation and the assessment of control measures have raised several
important lessons for global public health. WHO/WPRO Press release is available
at http://www.wpro.who.int/sars/docs/update/update_07022004.asp.
Topics included are: Investigation into the source of the outbreak, biosafety concerns raised by the outbreak, and assessment of effectiveness of outbreak control measures. WHO emphasizes that scientists working with highly pathogenic viruses such as SARS need to handle inactivated material with the utmost caution. WHO recommends that:
- researchers use appropriate and internationally accepted methods for validating the inactivation of live viruses. - inactivated material should be handled only in laboratories at biosafety level (BSL) 2 or above.
- researchers handling inactivated material should wear appropriate personal protective equipment.
- new methods for inactivation should be adopted only after rigorous testing.
- clear and comprehensive protocols should be available for all inactivation techniques.
There are a number of lessons from this outbreak that are important globally, for member states and for WHO itself:
- health care workers, laboratory workers and people in close contact with certain animals are at risk of contracting a range of infectious diseases with outbreak potential. Disease detection systems need to be designed to take these risk factors, as well as clinical information, into account–and to be robust enough to ensure that nobody slips through the net and evades detection.
- health care workers need to be aware of the risks associated with certain occupations (including their own) and to be able to take a detailed occupational history from a patient.
- health care workers also need to be aware of the importance of asking about the health of close contacts of anyone with a potentially contagious respiratory illness. Quickly identifying possible clusters of respiratory illness is important in the control of such diseases and the detection of new or rare infectious diseases.
- all health care workers should be empowered to initiate effective measures to protect themselves and others from potentially contagious diseases, in a "safety first" approach. This means that health care workers should be aware of potential clinical and epidemiological risk factors; have ready access to the equipment and knowledge needed to protect themselves and others; and be allowed to initiate the most appropriate infection-control measures immediately -- with validation and approval from senior members of staff later.
(Promed 7/4/04)
4. NOTIFICATIONS
HIV Content Guidelines Announcement
The Centers for Disease Control and Prevention (CDC) has published two
notices in the Federal Register requesting public comments on proposed revisions
of the Interim HIV Content Guidelines, revised in 1992. The first notice
requests comment on the Guidelines, entitled "Content of AIDS-related written
materials, pictorials, audiovisuals, questionnaires, survey instruments,
marketing, advertising and website materials, and educational sessions in
CDC regional, state, territorial, local, and community assistance programs." The
second notice requests comments on new Interim Guidelines, entitled "Content
of AIDS-related written materials, pictorials, audiovisuals, questionnaires,
survey instruments, marketing, advertising and website materials, and educational
sessions in CDC school-based assistance programs."
The public comment period ends August 16, 2004. Please visit http://www.cdc.gov/nchstp/od/content_guidelines/default.htm
(CDC)
XV International AIDS Conference
11-16 July 2004, Bangkok
The theme for this year's event is "Access for all", reflecting the need
for all groups, including scientists, community workers and leaders,
to have access to all resources such as education, information and medication.
Also, on 10 July 2004, WHO and UNAIDS will release the "3 by 5" Progress Report
and "HIV Plan". What progress has been made in scaling up treatment six
months on, and what more needs to be done? What is the WHO plan to continue
to assist countries to increase access to prevention, treatment and care
for HIV/AIDS? The reports include the latest treatment data from regions
(up to June 2004). WHO will also issue 26 country profiles.
What: Press conference on the "3 by 5" Progress Report and HIV Plan When: Saturday, 10 July 2004 from 12:00 noon to 1:00 pm (Bangkok time)
Where: Royal Orchid Sheraton Hotel, Ballroom 2, Bangkok (address: Siphya Road, 2 Captain Bush Lane Bangkok, phone (66) (2) 266-0123)
Speakers: Dr Jack Chow, Assistant Director-General, HIV/AIDS, Tuberculosis
and Malaria, WHO Dr Peter Piot, Executive Director, UNAIDS Dr Jim
Kim, Director of HIV Department, WHO Rolake Odetoyinbo Nwagwu - Activist,
Treatment Action Movement, Nigeria http://www.aids2004.org/
(WHO)
5. APEC EINet Activities
The APEC EINet team will be holding a point-to-point video conference discussion with Taipei health and informatics workers on 13 Jul 2004. The aim of the discussion is to prepare an agenda for a broader plenary discussion of bio-preparedness practices and topical disease priorities. This virtual meeting will utilize Access Grid and will test the existing level of communications network technologies. The plenary in the future is envisioned involving all interested economies over time.
6. JOIN THE E-LIST AND RECEIVE EINet NEWS BREIFS REGULARLY
The APEC EINet listserv was established to enhance collaboration among academicians and public health professionals in the area of emerging infections surveillance and control. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe (or unsubscribe), contact apec-ein@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://depts.washington.edu/apecein/.