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Vol. I, No. 2 ~~~ EINet News Briefs ~~~ 01㪤㫹

****A free service of the APEC Emerging Infections Network*****

The EINet listserv 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 their perspectives and experiences, as your participation directly contributes to the richness of the "electronic discussions" that occur. To respond to the listserv, use the reply function.

In this edition:

  1. Influenza reports

    + New influenza strain A Type H5N1: Summary
    + Influenza in South Korea
    + Influenza virus, new strain isolated

  2. Overview of infectious–disease information from Pro–Med
  3. How to add colleagues to the EINET list.


New influenza strain A Type H5N1: Summary

The WHO reports that as of 12 December, 1997, three suspected cases of influenza A(H5N1) are now under investigation. Influenza Type A(H5N1), which was known previously to infect only birds, was first isolated from a 3 year old boy in Hong Kong in May 1997, who died of Reyes syndrome during an acute respiratory illness. According to "Outbreak," there have been 4 confirmed cases, 2 deaths, and 9 additional suspected cases. Influenza surveillance now includes all hospitals and 63 public health clinics. So far no case of person–to–person transmission has been identified, but further tests of blood specimens are required to ascertain the origin of the infection with greater precision. In the absence of human–to–human transmission and of any documented outbreak, WHO does not recommend the development of a specific H5N1 vaccine. However, the WHO Collaborating Centres for Influenza are working with various H5 strains to prepare high growth reassortants which could be used for vaccine production, in case of need. In the meantime, the WHO Collaborating Centre at CDC has prepared a kit of reagents which will be despatched shortly to all National Influenza Centres for diagnosis of H5N1 (adapted from http://www.who.org/programmes/emc/news.htm).

Influenza in South Korea

Dr Hur from the CDC, Minstry of Health and Welfare, Korea, reports that Korean surveillance reported the separation of influenza virus type A (subtype now under investigation) on Nov 25 for the first time this season. He also noted that there was "4.1% of ILI (influenza like illness) which showed a little bit rapid increase during recent 2 weeks." Dr. Hur notes that the CDC is now constructing an "Infection Information system" website for reporting acute illness information with GIS technology which is supposed to be finished by the end of next year. Thank you for sharing this information with us; we look forward to link APEC EINet on to this new site.

Influenza virus, new strain isolated

Caroline Akehurst reported in Eurosurveillance Weekly, of the identification of a strain of influenza virus (A/Sydney/05/97, like (H3N2)) similar to but antigenically distinguishable from the H3N2 strain incorporated in the influenza vaccine recommended for 1997/98. The outbreak occurred among passengers and crew on consecutive voyages on the same cruise ship between New York and Montreal (1). This (A/Sydney/05/97–like (H3N2) ) antigenic variant has not yet been detected in Africa, Europe, South America, or the continental United States (US) and represents an antigenic drift of the virus. It is antigenically distinguishable from A/Nanchang/993/95, which is the A(H3N2) component of the 1997/98 influenza vaccine currently in use in the US. The A/Nanchang/993/95 strain is very similar to the A/Wuhan/359/95(H3N2)–like strain which the World Health Organization recommended should be a component of trivalent vaccines for the 1997/98 season in Europe (2).

The efficacy of the 1997/98 vaccines against this variant is unknown but the protection of this year's vaccine could be reduced if this variant circulates widely.


Here is our weekly summary of relevant Asia–Pacific postings to the ProMED Electronic Network, which is a prototype for a communications system to monitor emerging infectious diseases globally as an initiative of the Federation of American Scientists (FAS) and co–sponsored by WHO. More information about PROMED can be acquired contacting the moderator. Please contact the moderator if you would like more any of the reports below:


CJD & DURA MATER TRANSPLANTS – THAILAND Dr. Hemachudha from Chulalongkorn University reports of a CJD patient from iatrogenic transmission, dura mater graft. The 43–year–old patient was initially was admitted to Department of Psychiatry, Chulalongkorn University Hospital for the management of depression and anxiety. She subsequently demonstrated dystonic movement of the arms and legs and became mute within the following month. In 1990, she had a spinal cord surgery, removal of astrocytoma, and a dura mater graft, lyophilized product from a German company. Dr. Hemachudha advise the hospital to use disposable neurosurgical instruments for lumbar puncture, an idea also supported by WHO.


INFLUENZA, AVIAN, H5 SEROTYPE – ITALY A highly pathogenic strain (H5) of avian influenza has been identified in outbreaks in Italy; the diagnosis was made by the Experimental Animal Disease Co farm. – DP.)

Other developments reported by the South China Morning Post:

12,000 tablets of amantadine (Symmetrel) are being flown in on an emergency basis, after there was a "run on the drug in the past two days and private practitioners are unable to buy supplies from the limited stocks of manufacturers." This shipment, enough to treat 1200 persons, will not arrive until next week.



Two new cases of H5N1 in HK. Dr. Paul Saw, DOH Deputy Director stated that the increased surveillance the first case in August may have resulted in the detection of the 3 subsequent cases.

At least 7 hospital staff members who had contact with the man who died and the young woman who is in critical condition have developed flu–like–symptoms and have been asked to go on leave.


INFLUENZA, AVIAN, H7 SEROTYPE – AUSTRALIA (02) There's been a second outbreak of avian influenza, on another poultry farm near Tamworth in northern New South Wales. A further 30,000 layer hens will be destroyed and buried in the next few days, taking the total to 150,000 birds destroyed on two separate farms in the Tamworth district after Australia's fifth–ever outbreak of the disease was discovered earlier this week. In addition more than one million eggs from the chickens involved in the latest outbreak have also been destroyed at two hatcheries in Sydney.

INFLUENZA, BIRD–TO–MAN – CHINA (HONG KONG) (12) A major wire service today provided information on an outbreak of H5N1 in poultry that was originally published in the Hong Kong Standard on 22 August of this year.

There was an outbreak of the virus in chickens in Guangdong province in February and March, killing approximately 1.7 million birds. In April, there was another outbreak, according to the newspaper, killing 4500 chickens on 3 farms in Lau Fau Shan, Hong Kong province. According to official statements of the Agriculture and Fisheries Department (AFD) in late August, the virus was believed to have burned itself out, because there were no further reports from farmers. After the first human case of H5N1, the department's Castle Peak laboratory took 80 blood samples from 5 farms to test for viral activity. Laboratory results, supposed to be ready within 4 weeks (i.e., late Sept.), were not made public.


INFLUENZA, AVIAN, H7 SEROTYPE – AUSTRALIA (03) Update on incursion of highly pathogenic avian influenza in New South Wales, Australia from Australia's latest advice to the Office International des Epizooties on avian influenza in New South Wales indicates that the isolated virus has an Intravenous Pathogenicity Index (IVPI) of 2.54. Studies of the haemagglutinin (H) and neuraminidase (N) antigens have subtyped the virus as H7N4.

INFLUENZA, BIRD–TO–MAN – CHINA (HONG KONG) (13) Investigations of the 4 H5N1 influenza cases observed to date show that the initial clinical presentation is not different from ordinary influenza cases. However, respiratory distress syndrome and renal failure set in rapidly in three cases. Hence, doctors taking care of influenza patients are advised to watch for symptoms and signs of complications, and early hospitalization is advised once the clinical conditions warrant. Doctors are also advised to not wait for the laboratory diagnosis of H5N1 infection before they start appropriate treatment. It is prudent to note that treatment for H5N1 infection is essentially the same as for other influenza viruses. Appropriate treatment, including the use of amantadine, should be guided by the clinical assessment and should be started immediately once influenza with complications is clinically diagnosed.

INFLUENZA, BIRD–TO–MAN – CHINA (HONG KONG) (14) Deputy Health Director Dr. Paul Saw Thian–aun announced that the 2 children infected by H5N1 (1 fatality, 1 recovery) "caught it through direct contact with birds." This statement was based on tests done at CDC in Atlanta. Dr. Saw reported, however, that the families of the 2 children are "adamant" that they did not ever have close contact with birds.

According to this report, the 54–year–old man who died from H5N1 was a dentist who treated patients during the week before his death. Complicating the attempt by health authorities to trace the patients is the fact that the dentist was practicing illegally. In addition, 12,000 tablets of amantadine (Symmetrel) are being flown in on an emergency basis (source: South China Morning Post).

Provisional legislator Edward Leong Che–hung called for the administration of a new blood test to a random sample of 1מ thousand people in HK to see if, or how many, others may have contracted the virus. But, according to Dr. P.Y. Lam, another director in the Hong Kong Health Department, this is not yet feasible because the test has not yet been released for use and probably would not be ready for "some time". Dr. Lam will be passing on the legislator's suggestion to CDC specialists, three more of whom are scheduled to arrive. (source: The Hong Kong Standard)


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 own material with their colleagues in the Asian–Pacific Rim by addressing comments to apec–ein@u.washington.edu. To subscribe or unsubscribe, please contact Nedra Floyd Pautler at pautler@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://www.apec.org/infectious.

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June 25, 1998

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