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Vol. VII, No. 18 ~ EINet News Briefs ~ Aug 20, 2004

A free service of the APEC Emerging Infections Network

The EINet listserve was created to foster discussion, networking, and collaboration in the area of emerging infectious diseases (EID's) among academicians, scientists, and policy makers in the Asia-Pacific region. We strongly encourage you to share your perspectives and experiences, as your participation directly contributes to the richness of the "electronic discussions" that occur. To respond to the listserve, use the reply function.

In this edition:

1. Infectious disease information

-Viet Nam:Three fatal human cases of avian influenza
-Viet Nam: Another suspected avian influenza case in Hau Giang province
- Viet Nam: Small bird flu outbreaks contained, but risk remains high
-Viet Nam: Joins international network to combat bird flu
-Malaysia: Confirms outbreak of H5N1 bird flu virus
-Thailand: Bans use of bird flu vaccine
-Indonesia: Industry and consumer groups pressure Indonesia to curb illegal beef imports
-South Korea: Japanese Encephalitis Warning Issued
-Japan: Suspected First Human Case of West Nile Virus May Be Travel-related
- Japan: Increase in Blood Transfusion-related Hepatitis Infection
- Philippines: Five Rabies Deaths in the city of Koronadal( Mindanao)
- Russia: Six year old girl dies of Rabies in Chelyabinsk
- Russia: Meningitis outbreak affects Novosibirskregion
- USA(Multistate): Salmonellosis, tomatoes traced to Florida
- Canada (multiprovince): Recall, E. coli-contaminated beef warning issued
- Canada(Quebec): Health minister urges proper hygiene to fight Clostridium difficile

2. Updates

- Cholera, Diarrhea, and Dysentery
- Dengue/DHF
- Viral gastroenteritis
- West Nile Virus

3. Articles

- Bush-meat trade breeds new HIV
- Assessment of the Effectiveness of the 200304 Influenza Vaccine Among Children and Adults Colorado, 2003
- Epidemiology of Measles United States, 20012003
- Congenital Syphilis United States, 2002
- Tuberculosis Transmission in Multiple Correctional Facilities Kansas, 20022003
- Possible Dialysis-Related West Nile Virus Transmission Georgia, 2003

4. Notifications

- Health Leadership: Call for applications, young professionals program
- International HIV/AIDS Clinical Training Program
- Broadening Horizons: 2004 HIV/AIDS Educational Meeting
- Public Comment Sought on CDC's Vaccine Safety
- Health Informatics Asia 2004

5. APEC EINet Activities

6. How to join the EINet email list


Below is a semi-monthly summary of Asia-Pacific emerging infectious diseases.


Viet Nam: Three fatal human cases of avian influenza

In the present outbreak in Viet Nam three fatal human cases of avian influenza have now been laboratory confirmed, two in the north and one in the south. For two of these cases, further testing has identified the H5N1 strain as the causative agent. The most recent case died 6 August 2004 and no new cases have been identified since then. With support from the Ministry of Health in Viet Nam , arrangements are under way to send specimens from these cases to a laboratory in the WHO Global Influenza Surveillance Network. The lab will perform analyses of the virus in order to yield information immediately relevant to assessment of the public health risk. Studies will determine whether the virus responsible for these cases has mutated. It is particularly important to learn whether the H5N1 virus strain remains entirely of avian origin. Health officials in Viet Nam have called for close cooperation between WHO and the National Institute of Hygiene and Epidemiology in Hanoi and the Pasteur Institute in Ho Chi Minh City . This cooperation is expected to expedite the sharing of test results on any additional cases that might require investigation. A small team of WHO staff will be traveling to Viet Nam , and will be working closely with the Ministry of Health to assess the present risk to public health and to work out plans to strengthen surveillance capacity for the detection of human cases.
(Promed 8/18/04)

Viet Nam: Another suspected avian influenza case in Hau Giang province

Doctors in Viet Nam are testing a 27 month old boy for avian influenza virus infection, after he was admitted to the hospital in critical condition. The boy is from the district of Hau Giang province where one person was confirmed to have died of avian influenza virus infection 2 Aug 2004 , and, where three others died of suspected bird flu but were not tested for the disease. The boy was admitted to the hospital 14 Aug 2004 , after two days of high fever, said a doctor from the Can Tho Pediatrics Hospital. The doctor said the boy had eaten duck raised by his family from an animal that had died mysteriously. The boy's condition is improving, but he is not yet in stable condition. A blood sample from the boy has been sent to the Pasteur Institute to test for the presence of the H5N1 virus.

A 20 year old woman, who had been suspected of having the disease, and who was also from Hau Giang province, has tested negative, and, is expected to make a full recovery. Viet Nam recently confirmed three new deaths, including two children, aged one and four, from the H5N1 strain.
(Promed 8/18/04)

Viet Nam: Small bird flu outbreaks contained, but risk remains high

The bird flu outbreak has almost been contained, and only small scattered outbreaks have recurred, director of the Animal Health Department (AHD), Bui Quang Anh said 16 Aug 2004 . Between 9 and 25 Jul 2004 , the virus reappeared in 16 areas, in eight southern provinces, killing 24 000 fowl. Affected areas have been reduced to seven households, in four provinces, with 4200 poultry culled since Jul 25 2004 . But Mr Anh warned that the risk of recurrence remained very high. Mr Anh affirmed that the AHD has frequently provided up-to-date information about the development of the outbreak in Viet Nam for media agencies and international organizations.

Acting minister of agriculture and rural development Cao Duc Phat asked the Ministry of Health to identify the transmission mechanism of bird flu from fowl to fowl and from fowl to humans, and to implement preventive measures to curb the spread of the epidemic. The medical sector should provide preventive medicines for veterinarians working directly with sick birds, announce the possible transmission of the bird flu virus to humans, and develop preventive measures. According to Mr Anh, local farmers were hesitant to have their products quarantined, because quarantine fees are too high. Bui Ba Bong, deputy head of the National Steering Committee on Bird Flu Prevention, said that the preventive work was difficult, as most affected poultry was raised on a small scale by farmers. He said that many households are in the habit of killing sick birds for meat. As a result, the risk that the disease would spread was very high. It has been confirmed that the three latest human deaths came from households that raised poultry. People have been advised not to eat sick poultry until the transmission mechanism has been identified.
(Promed 8/18/04)

Viet Nam: Joins international network to combat bird flu

Viet Nam has become an official member of a global network, set up by the WHO, to curb the current outbreak of bird flu, the Ministry of Health announced 17 Aug 2004 . Participating in the network, Viet Nam will receive technical assistance, and financial support, from international organizations to detect outbreaks early, implement preventive measures, and stop the spread of bird flu. The Preventive Medicine Department (PMD) has worked out methods to prevent bird flu from infecting humans, and these measures are being widely disseminated by the media to all localities. On 16 Aug 2004 , the Veterinarian Department held an expert-level working session with the WHO on cooperation with research and coordination to prevent an epidemic of flu with the type A virus. The State has created a regular budget for epidemic prevention at localities, while the Ministry of Health has prepared a volume of medicines and chemicals to help localities cope with possible ARS, dengue fever, or viral pneumonia outbreaks.

The Food and Agriculture Organization (FAO) will grant USD 401 750 to help Viet Nam control bird flu. The grant is part of a USD 1.6 million project entitled "Emergency program for the control of avian influenza in Cambodia , Indonesia , Laos , and Vietnam " donated by the Japanese Government through FAO. The project is expected to be completed February 2005. It aims to put into place systems for the early detection of, and reaction to, possible outbreaks; to improve gathering of epidemiological data during outbreaks; and to provide training in reporting and investigation for the purpose of getting more accurate, and prompt, reports by extension staff. The project also targets laboratory procedures and standards to ensure bio-safety for laboratory staff, policy regarding compensation incentives to farmers who give early reports of outbreaks, and, bio-security in poultry farms to ensure that all safety measures are in place for restocking.
(Promed 8/18/04)

Malaysia: Confirms outbreak of H5N1 bird flu virus

Malaysia ’s Agriculture and Agro-Based Industry Ministry confirmed that the deadly strain of bird flu virus, the H5N1 strain, has infected poultry in the country, in chickens in a northern Malaysian village. The village is about 100 km south of Narathiwat, southern Thailand , where bird flu cases were reported in February and July 2004. Officials have ordered the slaughter of all poultry in the village to halt the potential spread of the disease. The ministry's secretary-general Abi Musa Asa'ari Mohamed Nor said that the outbreak in Baru Pasir Pekan Village was an isolated case. "Only two of the 103 chicken and ducks bred by the villagers have been infected with the bird flu virus, of the H5N1 strain." he said. Abi Musa Asa'ari said that the outbreak was expected to be curbed within three weeks. He said that it would be left to the importing countries to decide whether there will be a ban on chicken export from the country. The Agri-Food and Veterinary Authority of Singapore (AVA) has decided to ban the importation of Malaysian poultry and poultry products. Malaysia exports about 130 000 chickens and two million eggs to Singapore every day. Abi Musa Asa'ari also said that the Veterinary Service Department had advised exporting farms to defer the dispatch of their consignments.
(Promed 8/19/04)

Thailand: Bans use of bird flu vaccine

Thailand has officially banned the use of bird flu vaccine and started a crackdown on any violation. A regulation has been adopted to ban the import, production, sale and use of all avian influenza vaccine in the country. The government took the action for the sake of public health, and anyone violating it would face up to five years' imprisonment. The ministry also opened a hot line and offered a cash reward for those reporting the violators. Thailand 's poultry industry was hit hard by two waves of bird flu attacks (February and July 2004). In the first bird flu outbreak lasting more than three months, Thailand , the world's fourth largest poultry exporter, suffered no less than a loss of USD 880 million. The major buyers such as Japan and the European Union have not fully lifted their ban on the kingdom's poultry imports. EU also warned it would ban Thai chickens if the country carried on its vaccine experiment.
(Promed 8/10/04)

South Africa: Bird flu spreads through Eastern Cape

After slaughtering 6000 ostriches on the two affected farms, agriculture ministry officials moved to put down 4000 other birds in the Eastern Cape , said the South African Ostrich Business Chamber (SAOBC). As many as 30 000 ostriches could be culled. Tests conducted in early August found traces of the mild strain of avian influenza, H5N2. The agriculture ministry has said it is not harmful to humans. The outbreak prompted the European Union and Switzerland to ban imports of ostrich meat from South Africa , the world's biggest exporter of the product. The slaughter and an export ban on all poultry products could cost the South African ostrich industry about R100-million (15.5 million USD) in losses.
(Promed 8/17/04)

Indonesia: Industry and consumer groups pressure Indonesia to curb illegal beef imports

The Indonesian Consumers Foundation (YLKI) issued a warning 25 May 2004 that illegally imported meat products are putting Indonesia at risk for foot and mouth disease (FMD) and mad cow disease. YLKI documented the widespread selling of illegally imported meat products. YLKI chairwoman Indah Sukmaningsih said that there was an unusually low selling price for the illegally imported meats, about 60 percent of the usual rate for local meat products and far less than half of the normal price for imported meat products. YLKI suspects that meat products are being imported illegally from India , Brazil , Argentina , and the US in defiance of bans on the importation of meat products from these countries imposed because of FMD or BSE issues. The Ministry of Agriculture issued in 2003 a decree that bans importation of meat products from countries with FMD, including India , Brazil , and Argentina . The YLKI survey also found that meat products imported from the US were sold at some supermarkets. "It only shows that the government does not supervise the implementation of the regulation." said Indah. YLKI is urging the Ministry of Agriculture to cooperate with the Ministry of Industry and Trade, and with the customs and excise office, to curb all meat smuggling.

The Association of Indonesian Beef Importers (ASPIDI) blames the current BSE ban on US beef imports and skyrocketing prices of beef products from Australia and New Zealand for the increasing amounts of illegally imported beef products from India . Smuggled Indian buffalo meat is being re-packed in Indonesia into counterfeit Australian meat cartons. Australian Quarantine and Inspection Service (AQIS) is providing summary reports of health certificates to Indonesia on a weekly basis to help ascertain the authenticity of imported meat. Smuggled meat is thought to have caused the 2001 FMD epidemic in the UK .
(Promed 8/19/04)

South Korea: Japanese Encephalitis Warning Issued

The Korea Center for Disease Control and Prevention (KCDC) issued a warning 6 Aug 2004 concerning Japanese encephalitis, urging people to take measures to prevent an outbreak of the disease. The KCDC announced the warning after confirming that Japanese encephalitis virus-carrying mosquitoes accounted for over 50 percent of all mosquitoes found in North Cholla Province . The warning came three weeks earlier in the summer than in 2003, and three months after the KCDC issued a health advisory over the disease. Japanese encephalitis causes high fever, headache, vomiting and can lead to a coma after an incubation period of 7 - 20 days. About 95 percent of those carrying the disease do not show any symptoms; some may suffer a minor fever at an early stage, but death often occurs after encephalitis develops. The KCDC advised people to refrain from outdoor activities at dawn or after sunset when mosquitoes are most active, while children under 15 should have inoculations against the disease. The nation had one Japanese encephalitis patient in 2003, six in 2002, one in 2001, and none in 2000.
(Promed 8/7/04)

Japan: Suspected First Human Case of West NileVirus May Be Travel-related

An Okinawan woman recently back from a trip to the US is suspected of having contracted either West Nile virus or Japanese encephalitis virus, health ministry officials said 5 Aug 2004 . The National Institute of Infectious Diseases will investigate the cause of the disease, examining samples of the woman's blood and spinal fluid. If the woman, who is 42, tests positive for the West Nile virus, it will be Japan 's first case of the disease. Preliminary tests have detected either West Nile virus or Japanese encephalitis virus. Both types of virus are carried by mosquitoes and have similar genetic make-up. The symptoms of the diseases are also similar.

The woman was taken to hospital in Okinawa after suffering fever, headache, vomiting and drowsiness during her return flight from the US 31 Jul 2004 . The woman traveled with her husband and son to California , Arizona , Washington , New York , Boston and Pennsylvania beginning 17 Jun 2004 . The woman has since left the hospital and is recovering, and her husband and son are healthy. The Ministry called for calm in Japan , saying West Nile virus does not transmit from person to person. The Ministry decided last month to extend the period of banning blood donations from those returning to Japan from abroad as part of stepped-up efforts to contain West Nile virus, for which there is no vaccine.

About 80 percent of those who contract the virus develop no symptoms. Those who do develop symptoms begin to experience them about two weeks after being infected. Serious cases, mainly in elderly people, include such symptoms of encephalitis as paralysis and impaired consciousness. During 2003, nearly 10 000 people suffered the disease worldwide and about 260 of them died.
(Promed 8/6/04)

Japan: Increase in Blood Transfusion-related Hepatitis Infection

About 80 patients are suspected to have been infected with hepatitis viruses and other diseases through blood transfusions in the past four months, according to the Pharmaceutical Affairs and Food Sanitation Council of the Health, Labor and Welfare Ministry. According to medical institutions, the number of reported cases of infection through transfusion is set to far exceed that of normal years, in which a total of about 120 cases are reported. From April to early August 2004, 41 people contracted hepatitis B virus infection through transfusion, 27 contracted hepatitis C virus infection, and 11 contracted other diseases. Among hepatitis patients, 80 percent, or 57 patients, were found to have been infected via transfusion. In the cases of four patients with hepatitis B virus infection, the virus was detected when transfused blood was reexamined. As for other infection cases, a man in his 20s who was given a blood transfusion at the end of April 2004 died of blood poisoning five days later. The Japanese Red Cross Society examined stocks of the blood that was transfused into the man who died, but did not detect contaminating bacteria. The agent responsible for the patient's death was identified as Pseudomonas aeruginosa.
(Promed 8/13/04)

Philippines: Five Rabies Deaths in the city of Koronadal (Mindanao)

Health officials in Koronadal City have declared a rabies outbreak. Dr. Raymundo Prieto, city health officer, warned residents against possible contacts or bites from four-legged animals, particularly stray dogs and cats. Since 1 Jul 2004 at least 26 persons have been found positive with rabies and five others have died. Prieto said the 26 patients are still undergoing anti-rabies treatment through their office and the city veterinary office (CVO). He said they have requested assistance from the Department of Health, Central Mindanao Regional Office, particularly for anti-rabies vaccines, which currently cost at least P35 000 (USD 630) per patient. CVO has launched massive anti-rabies vaccination of dogs and cats at various barangays. CVO also quarantined several animals and gathered for surveillance all stray dogs and cats at areas with confirmed rabies cases. There have been unusual cases of rabies infection in the city, like the one that led to the death of a 25-year-old man last June. The young man died only four days after he was bitten by a dog. It may be that he had another exposure at an earlier date.
(Promed 8/8/04)

Russia: Six year old girl dies of Rabies in Chelyabinsk

A 6 year old girl died 18 Aug 2004 of rabies, the first fatal case registered in the south Urals in the past eight years. The girl was bitten by a dog six weeks ago, and her parents took her to a hospital in the Upper Urals region, but physicians who admitted the child did not prescribe any specific treatment. Later the girl was transferred to the intensive care unit of Chelyabinsk hospital, but it was too late to save her life. Her death could have been prevented by prompt initiation of post-exposure prophylaxis, and initial vaccination with a potent rabies virus vaccine, followed by a full course of vaccination according to the particular vaccine employed. Rabies is an acute infectious disease that can be contracted through the bite of an infected animal and can result in irreparable damage of the nervous system. After the virus enters the body through the wound, it starts to spread through nerve fibers to the central nervous system, where it damages nervous centers and the cerebral cortex. Following paralysis of upper and lower extremities, the patient usually succumbs to heart failure.
(Promed 8/19/04)

Russia: Meningitis outbreak affects Novosibirskregion

The number of people who have contracted meningitis in the Novosibirsk region has reached 413, including more than 300 children. But the outbreak of the disease has now been brought under control. "Over the past 24 hours, only three children have been taken to hospitals, while 15 to 25 people had to be hospitalized in the past two weeks”, an official of the regional sanitary and epidemiological inspection said. She said 204 people were staying in Novosibirsk hospitals receiving treatment for aseptic meningitis. The dumping of sewage into the Omsk reservoir was the cause of the outbreak. Three recreation camps had to be closed, with a ban on swimming. Enteroviruses, the presumed cause of the outbreak, have been isolated from the reservoir. Workers that dumped sewage into the reservoir have paid fines of RUR 2000 (USD 68.50), but the regional prosecutor's office has initiated criminal charges. By 2 Aug 2004 , when the cause of the outbreak had been determined, the number of meningitis cases had reached 250.
(Promed 8/17/04)


(Multistate): Salmonellosis, tomatoes traced to Florida

The Roma tomatoes tainted with salmonella, that sickened at least 416 people in five states, have been traced to farms in Florida , and, possibly, South Carolina . The outbreak, linked to Sheetz convenience stores, infected people in Pennsylvania , Ohio , West Virginia , Maryland , and Virginia with salmonellosis, a gastrointestinal illness. People became sick early July 2004. Growers in five states that supplied tomatoes that could have ended up at Sheetz are being checked out. The FDA investigators, including experts in sanitation, inspections, microbiology, and epidemiology, will review the farms' operations and records, try to determine in which fields the tomatoes were grown, and do water tests. According to the FDA, it could be "several weeks to months" before the agency identifies the cause of the outbreak or the specific farms involved.
(Promed 8/11/04)

(Multiprovince): Recall, E. coli-contaminated beef warning issued

E. coli -contaminated beef may be sitting in Calgary refrigerators, the Canadian Food Inspection Agency warned 7 Aug 2004. It is not known how many packages of ground beef from Westfair Foods Ltd. are affected; the agency said not to eat meat purchased 12 21 Jun 2004. The meat in question would have been purchased at local Real Canadian Superstores, Real Canadian Wholesale Club, and Extra Foods. Super Valu stores, and Food Fair outlets, in Whitehorse, Yukon are also included. So far, two people in Manitoba have fallen ill with one person sent to the hospital. The Canadian Food Inspection Agency was informed of those cases 28 Jul 2004, and on 7 Aug 2004, officials were able to trace the source of the infection. Alberta-based Westfair Foods is voluntarily recalling the affected products, which have also been distributed in British Columbia, Saskatchewan, the Northwest Territories, Yukon, and in Ontario.
(Promed 8/8/04)

Health minister urges proper hygiene to fight Clostridium difficile

On 5 Aug 2004, Quebec's health minister urged better hygiene, and more information, to combat a bacteria commonly found in health-care settings that apparently killed 100 patients in the last 18 months at the University of Sherbrooke 's medical center. But, Philippe Couillard questioned whether the deaths at the medical center could be directly blamed on Clostridium difficile. "The study shows that the rate of infection has increased in Sherbrooke , as elsewhere in Canada …100 died while having the bacteria in them. It doesn't mean that their deaths were due to the bacteria." Couillard said a more efficient and detailed program of surveillance is needed. He said public health officials had urged provincial health-care institutions to practice better hygiene. Couillard also said that doctors should be cautious about prescribing antibiotics, which can spark the illness in certain combinations. “Basic preventive measures, like hand washing, as easy as it may seem, are not followed as rigidly as they should be," he said. In Sherbrooke , Dr. Maurice Roy said the hospital has been working to control the infection and that there has been a decrease in the number of cases since February 2004, due to new measures put in place. The measures included the distribution of more information, the presence of more nurses, and the use of stronger disinfectants for cleaning. Dr. Jacques Pepin, one of the authors of the report that highlighted the situation at the hospital, found that the disease killed 10 times more elderly patients in 2003 than it did in 1991. He said the problem is not confined to Sherbrooke.

Pseudomembranous enterocolitis, the illness caused by toxins produced by C. difficile, causes diarrhea, fever, and an elevated white blood cell count. In the early 1970s, an association was made with administration of the antimicrobial agent clindamycin. Many other antimicrobial agents, especially ampicillin, have been associated with the illness. Enteric administration of either vancomycin or metronidazole is usually effective, but, relapse may occur.
(Promed 8/8/04)


*Cholera, Diarrhea, and Dysentery *
Hong Kong

The Food and Environmental Hygiene Department (FEHD) closed on 3 Aug 2004 a fresh food shop in Kowloon City after the discovery of Vibrio cholerae, the bacterium that causes cholera, in a water sample from its fish tank. It is the third case within two weeks following the discovery of the bacterium in water samples taken from restaurants in Tai Kok Tsui and Fanling. The shop was one of the suppliers of the troubled Fanling restaurant which was closed due to Vibrio cholerae. The department immediately ordered the shop to close for thorough disinfection.
(Promed 8/7/04)


The Philippines remains a safe place for tourists despite a new outbreak of cholera, the Philippine Health Department said 12 Aug 2004 . "It is still safe for people to travel here since the outbreak is only confined to central Pangasinan (in the northern Philippines ). The risk for travelers is very low even in the area where the epidemic actually occurred," Health Secretary Manuel Dayrit said. 47 people have died out of 4403 acute gastroenteritis cases reported between 28 May and 5 Aug 2004 , according to the department. The number of cases being admitted into the Pangasinan Provincial Hospital, where most of the cases are being treated, has started to go down.
(Promed 8/13/04)

Russia (Western Siberia)

The number of persons hospitalized as a result of food poisoning has increased to 216 in Surgut City . The condition of 187 of them is estimated as moderately ill and of 29 of them as severe to moderately ill. There are no children hospitalized. All those hospitalized are on the staff of the Turkish enterprise Kotek. These people were building a business center for the Surgut oil company. The Turkish firm organized the meals in a temporary hostel without knowledge of the sanitary surveillance center. Products were reported as being bought in local market. The preliminary diagnosis is salmonellosis.
(Promed 8/13/04)

Hong Kong

The Hong Kong Department of Health confirmed three more imported dengue fever cases 10 Aug 2004. The cases were three women, aged 33 to 35, who developed fever, muscle, and joint pain. Two of the women have recovered, while the third is hospitalized in stable condition. They all had traveled to Southeast Asia throughout the incubation period, and had returned to Hong Kong recently. All 20 dengue cases reported in Hong Kong in 2004 were imported.
(Promed 8/15/04)


The Center for Disease Control (CDC) announced another case of dengue fever in Pingtung City 6 Aug 2004. However, the new patient is affected by a different type of virus, indicating that another source of infection has yet to be identified. Health officials said that if it is not well-monitored, the disease could develop into fatal dengue hemorrhagic fever by cross-infection. The CDC says 44 cases of dengue fever have been linked to travelers returning from abroad. Of these, 32 patients were identified during airport temperature checks.
(Promed 8/15/04)


Dengue has hit a new weekly peak in Singapore, with 312 new cases confirmed the first week of August 2004. This tops the last spike, in June 2003, when there were 258 in a week. Until now, that was the highest since 1998. As of 7 Aug 2004, a total of 3525 people have been infected with dengue. Overall, there have been an average 114 cases per week in 2004, which is 26 percent higher than the 2003 average of 90.3. The reason for the spike in cases is the presence of an "excessive number" of breeding spots for mosquitoes. Six people died from dengue in 2003.
(Promed 8/15/04)

Viet Nam

Dengue fever has claimed 59 lives in Vietnam as of 2 Aug 2004, posting a year-on-year increase of 52 percent. The disease has also affected a total of 56 100 people across the country in the period, doubling the figure in the same period in 2003. 86 percent of dengue fever sufferers and over 90 percent of the deaths are from the country's southern region, where the weather is most favorable for the development of mosquitoes. The main reasons for the severe outbreak of dengue fever are sudden climatic changes, shortage of clean water, and poor awareness of many rural residents about the disease. The Ministry of Health has launched a program on dengue fever prevention, called for local health agencies to promote information campaigns, and supplied localities with more mosquito-killing chemicals, medicines and equipment. Vietnam reported 35 073 cases of dengue fever infections, including 58 fatalities in 2003.
(Promed 8/7/04)


The incidence of dengue hemorrhagic fever is at 124 in the entire Pangasinan. There has been one death due to dengue fever. Dr. Nemesia Mejia, provincial health officer, said the increase in the cases of dengue hemorrhagic fever was due to reports being received by the PHO from public and private hospitals and clinics as well as from the health units. Mejia reminded the public to make the "four o'clock habit" as part of their daily chores--maintaining clean surroundings by emptying water found in containers that hold water, aside from general cleaning of the house premises. She said the PHO has also embarked on fogging operations and conducting treatment of stagnant water in various communities within the 1364 barangays in the province.
(Promed 8/7/04)

*Viral G astroenteritis*
USA (Ohio)

As of 17 Aug 2004, County health officials have received a new spate of reports from people who say they were sickened by an unidentified gastrointestinal illness at Put-in-Bay. There were 94 calls 16 Aug 2004 . Symptoms include nausea, vomiting, fever, headache, abdominal cramps and diarrhea. Laboratory analysis is being performed on samples from stricken victims; the source of the illness and methods of transmission has not yet been identified. Some food service establishments are now operating on alternate water supplies. Water sample testing has revealed some unsafe wells on South Bass Island. Samples of the village water supply have tested safe.
(Promed 8/18/04)

USA (Wyoming)

A norovirus outbreak affected 134 people at Yellowstone National Park in June and July 2004, the National Park Service said. Of those who became sick, 53 were visitors and 81 were employees. Many of the workers were infected while cleaning up after sick visitors in a hotel room or living in close quarters at a dormitory. Housekeepers and concession workers who live in dormitories were hit hardest. In response, the National Park Service has sent out an advisory to concession companies in all national parks about how best to avoid spreading the virus. Tips include the use of gloves and facial masks while cleaning contaminated areas and isolating those who become sick. The virus, which causes vomiting, nausea and stomach cramping, spread primarily through contact between people or with contaminated surfaces during this outbreak.
(Promed 8/10/04)

New Zealand

An upsurge in winter illnesses, combined with a viral gastroenteritis outbreak that hit two wards at Princess Margaret Hospital, prompted Canterbury District Health Board (CDHB) to issue a stay-away warning for the first time in two years. Patients with non-urgent conditions are being advised to go to their GP or another 24-hour emergency service, or face a long wait. Chief Medical Officer Nigel Millar said that an outbreak of norovirus infection had forced two of Princess Margaret Hospital 's seven aged-care wards to be put in quarantine for nearly two weeks. "We'd estimate over 70 staff and patients were infected," he said. At this time of year in the northern hemisphere, outbreaks occur mainly at recreational centers or cruise ships, whereas in the southern hemisphere outbreaks tend to occur mainly in health-care settings.
(Promed 8/10/04)

*West Nile Virus*

United States, August 11–17, 2004

During August 11-17, a total of 194 cases of human West Nile virus (WNV) illness were reported from 17 states (Alabama, Arizona, California, Colorado, Florida, Illinois, Louisiana, Maryland, Minnesota, Mississippi, Missouri, New Mexico, Ohio, South Dakota, Texas, Utah, and Virginia). During 2004, a total of 27 states have reported 689 cases of human WNV illness to CDC. Of these, 291 (42%) cases were reported from Arizona. A total of 386 (56%) of the 689 cases occurred in males; the median age of patients was 50 years (range: 1 month–99 years). Illness onset ranged from April 23 to August 12; a total of 20 cases were fatal. A total of 55 presumptive West Nile viremic blood donors (PVDs) have been reported in 2004. Of these, 33 (60%) were reported from Arizona, eight from California, three each from Florida, New Mexico, and South Dakota, two from Colorado, and one each from Iowa, Missouri, and Wisconsin. Of the 55 PVDs, two persons aged 66 and 69 years subsequently had neuroinvasive illness, and 11 persons (median age: 55 years [range: 22–73 years]) subsequently had West Nile fever.
(MMWR August 20, 2004/ 53(32); 742-743)


Bush-meat trade breeds new HIV

The HIV virus has jumped from primates to people on at least seven separate occasions in recent history, not twice as is commonly thought. And people in Cameroon are showing up with symptoms of HIV, but are testing negative for both the virus and its primate equivalent SIV, the virus from which HIV is thought to have evolved. That suggests that new strains of an HIV-like virus are circulating in wild animals and infecting people who eat them, sparking fears that such strains could fuel an already disastrous global HIV pandemic.

The warnings come from experts who gathered this week for the annual meeting of the Society for Conservation Biology at Columbia University, New York. They say that deforestation and the trade in bush meat are creating the ideal conditions for new diseases to emerge, as people have ever closer contact with exotic animals that harbour novel pathogens. The conference reports follow the discovery earlier in 2004 that simian foamy virus, another disease that infects monkeys, has been found in bush-meat hunters and three different species of primates. As yet, it has not caused ill-effects, but it could mutate into something more insidious.

Despite those concerns, we still do not have a clear idea of how many wild animals are killed and eaten, said David Wilkie, co-chair of the Bushmeat Crisis Task Force (BCTF). He has carried out the first-ever survey of daily bush-meat consumption by rural communities in Gabon . Over two years, he documented a flourishing, but previously unrecognised, informal trade in bush meat, where rural communities hunted and ate small game, having already caught most available primates. He thinks official studies of bush meat sold in markets account for only 40 per cent of the total bush meat eaten in the country.

And the dangers of eating such animals are real. The BCTF points out that SIV infection has now been reported in 26 different species of African nonhuman primates, many of which are hunted and sold as food. The bush-meat trade is not the only way new diseases could jump into humans. The trade in wildlife, both for agriculture and as pets, is a major global business estimated to be worth billions of dollars. In 2002 alone, for instance, over 38,000 mammals, 365,000 birds, two million reptiles, 49 million amphibians, and 216 million fish were imported into the US . In 2003, monkeypox jumped from pet prairie dogs to humans. Previously the disease had only been known to infect humans after bush-meat hunters ate red colobus monkeys.

The trade in exotic farmed meat also appears to have sparked an unusual outbreak of a common human parasite called Trichinella. In 2004, a farmed crocodile in Papua New Guinea was discovered with Trichinella, which was only thought to infect mammals, after being fed wild pig meat (Emerging Infectious Diseases, vol 10, p 1507). In 1999, another farmed crocodile in Zimbabwe was similarly infected. "There is a strong chance that infected crocodiles may be in other countries, and could infect humans who eat them," says Edoardo Pozio, a parasitologist at Rome 's institute of public health. People in Papua New Guinea who eat crocodile meat have already been found to have the parasite, which can cause fever, rashes, and respiratory and neurological problems in humans.
(New Scientist, 8/9/04)

Assessment of the Effectiveness of the 2003–04 Influenza Vaccine Among Children and Adults — Colorado, 2003

“The 2003–04 influenza season was characterized by the early onset of influenza activity, reports of severe illness, particularly in children, and predominant circulation of an influenza A (H3N2) virus strain that was antigenically different from the influenza A (H3N2) vaccine strain. In 2003, a retrospective cohort study among children and a case-control study among adults in Colorado were conducted to provide preliminary data on the effectiveness of the 2003–04 influenza vaccine. This report summarizes the results of those studies, which indicated vaccine effectiveness (VE) among both adults and children, differing from results of a previous study that did not indicate effectiveness among adults…Influenza vaccine remains the primary means for the prevention of influenza and its complications and can provide benefit even in years when the influenza vaccine and circulating strains are not matched optimally. Efforts to increase vaccination rates in groups at high risk and their contacts are needed to reduce the burden of influenza. In addition, vaccination with 2 doses of influenza vaccine for children not vaccinated previously against influenza is needed to maximize protection. For optimal assessment of influenza VE, prospective studies should be conducted annually.”
(MMWR August 13, 2004/53(31);707-710)

Epidemiology of Measles — United States, 2001 2003

“Measles is a highly infectious, acute viral illness that can cause severe pneumonia, diarrhea, encephalitis, and death. To characterize the epidemiology of measles in the United States during 2001–2003, CDC analyzed data reported by state and local health departments. This report summarizes the results of that analysis, which indicated that no endemic measles virus is circulating in the United States; however, imported measles cases continue to occur and can result in limited indigenous transmission. Maintaining immunity through high vaccination coverage levels is essential to limit the spread of measles from imported cases and prevent measles from becoming endemic.”
(MMWR August 13, 2004/ 53(31); 713-716)

Congenital Syphilis — United States, 2002

“Congenital syphilis (CS) occurs when the spirochete Treponema pallidum is transmitted from a pregnant woman with syphilis to her fetus. Untreated syphilis during pregnancy can lead to stillbirth, neonatal death, or infant disorders such as deafness, neurologic impairment, and bone deformities. This report summarizes 2002 CS surveillance data, which indicated that CS rates have decreased among all racial/ethnic minority populations and in all regions of the United States except the Northeast. To further decrease CS, collaborative efforts among health-care providers, health insurers, policymakers, and the public are needed to increase prenatal care and syphilis screening during pregnancy for women at risk for delivering infants with CS.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5331a4.htm (MMWR August 13, 2004/ 53(31); 716-719)

Tuberculosis Transmission in Multiple Correctional Facilities — Kansas, 2002—2003

“Tuberculosis (TB) is a substantial health concern in correctional facilities; inmates and employees are at high risk, and TB outbreaks can lead to transmission in surrounding communities. The Advisory Council for the Elimination of Tuberculosis (ACET) recommends that all correctional facilities have a written TB infection–control plan (TBICP). In September 2002, after diagnosis of smear-positive pulmonary TB in a prison inmate, the Kansas TB Control Program, with assistance from CDC, initiated a 6-month contact investigation. This report summarizes the results of that investigation, which determined that, while symptomatic for TB, the inmate had resided in three different jails and a state prison, placing hundreds of employees and other inmates at risk for TB infection. The circumstances of this case underscore the need for effective TBICPs to be implemented by trained employees in jails and prisons and for establishment of mechanisms to facilitate information-sharing between correctional facilities and local and state health departments.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5332a2.htm (MMWR August 20, 2004/ 53(32); 734-738)

Possible Dialysis-Related West Nile Virus Transmission — Georgia, 2003

“In October 2003, the Georgia Division of Public Health (DPH) was notified of two patients from the same county with confirmed West Nile virus (WNV) disease who had received hemodialysis on the same day and on the same dialysis machine. The two dialysis patients (patients A and C) had the only confirmed cases of human WNV disease reported in their county in 2003. Review of the dialysis center's records indicated that another patient (patient B) had received dialysis on the same machine between these two patients on the same day. This report summarizes results of the epidemiologic investigation, which suggested that WNV might have been transmitted at the dialysis center. Hemodialysis centers should adhere strictly to established infection-control procedures to avoid WNV transmission through dialysis.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5332a3.htm (MMWR August 20, 2004/ 53(32); 738-739)


Health Leadership: Call for applications, young professionals program

“Dynamic health leaders with sound technical skills, working together to combat inequities and promote health for all.” Through the Health Leadership Service, the WHO will recruit outstanding young health professionals to a two-year work and training program, specifically aimed at strengthening the knowledge and skills essential for leadership roles in public health at all levels — national, regional and global. For further information, please visit: http://www.who.int/health_leadership/apply/en/

International HIV/AIDS Clinical Training Program

The International HIV/AIDS Clinical Training Program is an annual short course designed to educate infectious disease clinicians and other health care providers from developing and transitional countries in clinical, therapeutic, epidemiological, and public health issues relevant to the field of HIV/AIDS clinical care. Since 1998, ISID has trained approximately 100 clinicians from almost 47 different countries. Program curricula include formal lectures, case discussions and practical experience in caring for HIV-infected adults and children. Emphasis is on the various presentations of HIV infection, differential diagnosis, patient management and new and experimental protocols for the diagnosis and treatment of HIV-infected individuals with opportunistic infections and HIV-associated neoplasms. The program also covers practical laboratory experience in procedures used to diagnose HIV infection and AIDS-associated infections. In addition, participants are also given the opportunity to spend time at the public health departments associated with the respective training institutions to learn about AIDS- related public health issues in the U.S. Participants are expected to play an active role in discussions on pressing HIV/AIDS public health issues as well as community and global responses to the epidemic. The next course will take place April/May 2005. Applications are due October 15, 2004. Please visit http://www.isid.org/programs/prog_hiv_training.shtml

Broadening Horizons: 2004 HIV/AIDS Educational Meeting

September 29–30, New Orleans, LA
The 2004 HIV/AIDS Continuing Education Meeting is designed to provide public health professionals, staff and volunteers of community based organizations and AIDS service organizations, HIV/AIDS and STD program staff, and HIV prevention community planning group members updated information and educational opportunities on the prevention and treatment of HIV and STDs. The following institutes will be presented: (1) Integration of Hepatitis; (2) Interventions that Work with Adolescents; (3) Setting Up your Financial Systems; (4) Correctional Programs; (5) Motivational Interviewing; (6) Make Your Plan, Make Your Life; (7) Prevention with Positives; and (8) Interventions that Work with Migrants.

For more information: http://www.cdcnpin.org/scripts/Display/ConfDisplay.asp?ConfNbr=5273
(CDC National Prevention Information Network)

Public Comment Sought on CDC's Vaccine Safety

In consultation with outside stakeholders, the CDC has undertaken a review of vaccine safety activities at CDC. The CDC is seeking public comments regarding the current state of the agency's vaccine safety program and to identify ways in which excellence in vaccine safety monitoring, research and communication can be maximized and sustained in the future. Comments should focus on the following objectives:

CDC will post presentations of facts about CDC's vaccine safety activities on the CDC Web site so that the public can make informed comments about the objectives. The link to the objectives is: http://www.cdc.gov/od/vaccsafe/comments.htm. The links to the presentations are also provided on the Web site. We invite the public to review the information and provide comments and input. The public comment period will end October 12, 2004 . If you have any questions or need more information, please email vaccsafe@cdc.gov.

(MMWR August 13, 2004/ 53(31);720)

Health Informatics Asia 2004

This event provides an opportunity for healthcare IT solutions providers to present their ideas to decision makers from Asia 's major healthcare institutions. It is Asia’s first business-focused healthcare IT event, where Asia’s healthcare IT decision makers congregate to share, learn and network. Main topics to be covered are:

For more information, visit: http://www.pharma-rd.net/2004/hiw%5Fsg/

5. APEC EINet Activities

The APEC EINet team held a point-to-point videoconference discussion with Taipei 's National Applied Research Laboratories (NARL) and Taipei Department of Health experts on 13 Jul 2004 . The successful one hour virtual meeting was held utilizing high quality Access Grid node technology. Topical disease priorities for bio-preparedness, such as SARS and avian influenza, were discussed, in addition to biopreparedness efforts currently practiced in Taipei and the USA . Additional videoconference meetings are currently being scheduled. The plenary in the future is envisioned involving all interested APEC member economies over time.


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/.

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Last updated: 23 August, 2004