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Vol. I, No. 7 ~~~ EINet News Briefs ~~~ 05㪛㫺

****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. Shorter AZT cure found efficient
  2. Avian flu update
  3. Overview of infectious–disease information
  4. Upcoming emerging infection conferences
  5. How to add colleagues to the EINet listserv

1. Shorter AZT cure found efficient

Researchers announced the results of a much–awaited study that showed a short course of AZT treatment effectively reduced HIV transmission from mother to child by one half. Hailing the results of the study, which involved 397 infected pregnant women, a "great success", a team of Thai and US researchers said the finding could soon be translated into global implementation <The Nation, Bangkok, Thailand>.

Principal investigator Dr Nathan Shaffer said this is the first conclusive scientific data that proves that AZT given late in pregnancy reduces the risk of HIV transmission. He said it also confirmed that transmission takes place at the very end of pregnancy, either during labour or delivery. The preliminary results showed women treated with the short–course of AZT orally twice daily from 36 weeks gestation until the onset of labour and then every three hours until delivery, had a transmission rate of 9.2 per cent, compared with 18.6 per cent in a control group which received a placebo, he said.

Many countries found the successful AIDS Clinical Trial Group 076 in the US four years ago was impractical due to its long duration and comprehensive method of treatment, with treatment costs of US$800 per person. However, an AZT short–course regimen would cost $50 per person, which would be 20 times cheaper, said Pragrom Wuthipong, Health Permanent Secretary. BY MUKDAWAN SAKBOON and ARAYA THAVORNWANCHAI <The Nation, Bangkok, Thailand, 19㪚㫺>.

2. Avian flu update

From The Lancet: The H5N1 study group of The Hospital Authority of HK, The Chinese University of Hong Kong and The University of Hong Kong documents data on the first 12 cases of H5N1 influenza in Hong Kong. Some of the key findings are these:

–Patients ranged from 1㫔 years of age.
–Five patients had clinical or radiological evidence of pneumonia at the time of presentation to hospital and two others
developed pneumonic changes after hospitalisation.
–Bacteria commonly associated with community–acquired pneumonia such as _Streptococcus pneumoniae_, _Haemophilus
influenzae_ and _Staph. aureus_ were not isolated from the respiratory tract or blood cultures in any of the patients.

The results of type and subtype specific rapid diagnostic tests for detection of influenza A were compared. An H5–specific reverse transcription polymerase chain reaction assay was the most sensitive test for rapid diagnosis. A commercially available enzyme immunoassay (Directigen Flu A; Becton Dickinson) was more sensitive than direct immunofluorescence for rapid viral diagnosis of H5N1 infected patients <From: The Lancet 351:467𤯇, 1998>. In a paper (Science 279:393𤭼, 1998) describing sequence analysis and pathogenicity studies performed by Hong Kong, CDC, and USDA, it is demonstrated that the virus remains lethal to chickens even after it has passed through a human. The study raises the possibility that a few infected people travelling beyond Hong Kong could spread it to millions of chickens worldwide. Fortunately the evidence still is that the virus cannot pass easily between human beings, limiting the chances of a pandemic.

Fears the (influenzavirus A\H5N1) can be transmitted from human to human have been rekindled after doctors found antibodies to virus in several health workers, health officials said on Monday. Some of them "may have been in contact with bird flu patients". Experts have been working to find out if person–to–person transmission is possible. If it is the disease could be spread much more widely <23㪚㫺, South China Morning Post>.

3. Overview of infectious disease information

Here is our weekly summary of relevant Asia–Pacific EID issues based on 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:



From HK Department of Health News Bulletin site, 12מ㫺: There have been 7 confirmed cases of cholera cases in Feb 1998. Food histories revealed that 6 out of the 7 cases had consumed cockles during the incubation period. The cockles were inadequately cooked. The causative organism in all the 7 cases was _Vibrio cholerae_ O1, El Tor, Ogawa. It was sensitive to cefuroxime, keflex and ofloxacin but resistant to tetracycline, cotrimoxazole and chloramphenicol.

The source of the cockles was traced and found to be imported from overseas. Wholesalers and retailers were requested to suspend the sale of cockles. Health inspectors made inspections in the market to ensure the advice was well complied with. Starting from 6 Feb 1998, imported cockles for local sale would be held and tested negative for cholera before they were permitted for sale. This measure will be reviewed a month later.

ACTION: John Tam, a health department spokesman said seafood wholesalers have voluntarily suspended cockle imports from Thailand since the government issued a cholera alert last week. He said the government will not seek to ban the imports, but will heighten surveillance on Thai cockles in the future. The cholera outbreak has raised concerns because it comes months before the summer cholera season.

<It should be noted that WHO does not support the embargo of goods as a means of preventing the transmission of cholera. However, heightened surveillance and public education are clearly appropriate.>



In New South Wales, Australia, cryptosporidiosis became reportable by labs in December 1996. Since then, a handful of cases (~3) were reported each month until November 1997. From late November to February 23, 169 (159?) cases were reported. 53% were female, and mean age was 4 years. Cases were spread widely across the state. Extensive interviews with the NSW cases about exposures (travel, commercial products or drinking water, animals, child care etc) during the 2 weeks before onset identified no common risks, although 51% reported contact with other people with diarrhoea, and 61% reported swimming (but at a variety of different pools and beaches across the state).

While the case increase over summer could represent seasonal patterns, the NSW Health Department has issued several warnings and recommends that persons with diarrhoea practice good hand washing, and stay out of child care, and avoid entering swimming pools until completely recovered. Investigations continue.


Dr Peter Kirkland, Elizabeth Macarthur Agricultural Institute in Camden (Australia), recently told a forum on human disease that the discovery of a paramyxovirus in pigs which also affected Australian farm workers last year should serve as a warning to government not to cut back funds for veterinary laboratories, and that the virus also raised questions about the potential hazards of transplanting pig tissue into humans. Kirkland was further cited as saying the affected farm, close to Sydney, was still in quarantine nearly a year after paramyxovirus caused stillbirths and deformities in pigs and made two workers seriously ill with flu–like symptoms. Kirkland added: "If farmers are discouraged from bringing in their sick animals we run the risk that a number of these diseases will remain concealed." Kirkland's research, showing that the measles–like virus probably sprang originally from fruit bats, will shortly be published in the US Center for Disease Control's journal, Emerging Infectious Diseases.



Source: ANIMALNET (D. Powell, Univ. Guelph) & Bovine Spongiform Encephalopathy: An outbreak of scrapie has, according to this story, forced the Canadian federal government to slaughter almost 5,000 sheep in Quebec over the past 14 months. The story adds that while government officials played down the public–health impact, saying scrapie poses no proven risk to humans, the outbreak has had a dramatic economic impact on some cash strapped farmers.


Seven children who attend a day care center in Spokane, Washington are reported to have suffered from _E. coli_ O157:H7 infections in recent days. Investigators have not yet identified the index case, or a common source for the outbreak. An additional case reported from the same locality has been confirmed by DNA typing of bacterial isolates, but appears to represent an early case from a recovered patient rather than an indication that the outbreak is spreading. All patients are either recovered, or out of imminent danger.



EU hygiene rules to be waived in 'BSE free' states By Toby Helm in Brussels and David Brown GERMANY and seven other EU nations could be given official "BSE free" status as part of a plan to help break the deadlock over the British beef ban. The idea – being discussed by the European Commission and the British EU presidency – would involve waiving proposed new meat hygiene rules for countries which have had no cases of mad cow disease in domestically bred cattle. The plan follows warnings by the Bonn government that it will oppose moves to ease the ban on British meat unless Germany is exempted from the new scheme.

An agreed list of banned beef parts is supposed to be in place by April 1, but Germany has made it clear it does not expect to be penalised for a mad cow outbreak in another member state. It is leading calls from the non–BSE nations to be exempted from any restrictions agreed by EU experts and the Brussels Commission. With no hope of reaching an EU–wide deal, the commission is believed to be planning a two–tier system, with tougher measures against countries with a record of BSE. Britain has the worst record but now has the toughest hygiene controls as a result – and exclusion from the terms of any ban for the rest. <It would be interesting to know if colleagues might have found such policy practical for the APEC region, for example, if the Avian Flu epidemic had been more widespread.>


Europe faces "devastating" animal disease epidemics in the future and should alter its strategy for containing them, the United Nations Food and Agriculture Organization warned Tuesday. The FAO blames European livestock disease epidemics on the dense populations of livestock and an increase in long–distance animal transportation as trade increases.

The agency has called for a cut in herd concentrations, an increase in border controls, and the development of animal identification systems. It also suggested the private sector be obliged to take on some of the costs of containing diseases and warned governments that the privatization and decentralization of national veterinary services could reduce their effectiveness. The agency's recommendations are aimed at containing fast spreading diseases such as swine fever and foot and mouth disease, rather than the BSE "mad cow" disease, which develops more slowly.

In a report Tuesday the FAO challenged the practice by which the public sector in Europe bears the cost of epidemics and compensates the private sector for losses incurred. It argued this did little to encourage sanitary methods. "Industry does not appear to be able to discipline itself and it may be that government compensation instills false security." The FAO suggests a compulsory insurance program for livestock owners to protect against the costs of disease. It said certification and identification of animals were essential for their safe movement.



WHAT: e–mail discussion list for TB (developing country perspective maintained on issues discussed)
–to discuss matters of interest relating to TB and TB control
–to provide an opportunity to share experiences, discuss policy matters, ask questions, and express opinions

HOW: To join the list, send an e–mail to: majordomo@mos.com.np with the following message: subscribe tbnet.
MORE INFORMATION: Website at http://www.south–asia.com/ngo–tb. For more information about any of the tb.net activities, please send an e–mail to tb@mos.com.np

4. Upcoming emerging infections events:


Science and Technology Working Group (ISTWG), Monday, March 16, 1998.

This meeting will be a discussion of the initiative for APEC cooperation in emerging infectious diseases. Delegates from health backgrounds or related to the Ministry of Health are especially needed for input, but discussion will be at a level appropriate for non–health specialists to participate in a valuable way. Some of the areas of cooperation we will discuss: didactic information, exchange of surveillance on selected diseases, resource access to libraries, educational/distance learning, and training. Attendance must be coordinated through each science and technology delegation, so please contact the lead of your Science and Technology delegation.

***International Conference on Emerging Infectious Diseases (US Centers for Disease Control and Prevention and 60+ other cosponsors), March 8㪣, 1998 Marriott Marquis Hotel, Atlanta, Georgia

CONFERENCE OBJECTIVES: To encourage the exchange of scientific and public health information on global emerging infectious disease issues; highlight programs and activities that address emerging infectious disease threats; identify program gaps; increase emerging infectious disease awareness in the public health and scientific communities; and enhance partnerships in addressing emerging infectious diseases.

MAJOR TOPICS: current work on surveillance, epidemiology, research, communications and training, and prevention and control of emerging infectious diseases as well as topics related to emergency preparedness and response. On–site registration will be available. The registration fee is $200. For more information contact the moderator or check the site http://www.cdc.gov/ncidod/eidann.htm

*** U.S.–Japan Cooperative Medical Science Program, 3rd International Conference on Emerging Infectious Diseases, Bali, Indonesia, March 28㪶, 1998

MAJOR TOPICS: malaria, TB, hepatitis, and infectious diseases which cause malignancy.

5. How to leave this list or post comments to it

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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