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Vol. I, No. 10 ~~~~~~~ EINet News Briefs ~~~~~~~ 24㪞㫺

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

"EINet News Briefs" is transmitted over the EINet listserv, which was created to foster discussion, networking, and collaboration in the area of emerging infectious diseases (EIDs) 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 subscribe to the listserv, see the bottom of this page.

In this edition:

  1. Taiwan epidemic of enterovirus, emerging viruses in pediatric disease–Asia Pacific
  2. Foodborne illness– a regional concern
  3. Overview of infectious–disease information from Pro–MED and other sources
  4. Update: Dengue briefs
  5. Report of emerging infections conferences and other news:

    + Global Conference On Lung Health
    + Asian Solidarity Against Aids, 5th International Workshop
    + Prototype Web Page On TB Cross Cultural Issues

  6. How to add colleagues to the EINet listserv

1. TAIWAN EPIDEMIC OF ENTEROVIRUS, EMERGING VIRUSES IN PEDIATRIC DISEASE: ASIA–PACIFIC    Emerging infections often affect children disproportionately. This is certainly true of the major epidemic of severe enteroviral disease which is underway in Taiwan. The causative agent, enterovirus type 71, which is seen as a seasonal illness, has emerged as a severe illness among young children in Taiwan this summer. To date, the Taiwan Ministry of Health estimates that at least 300 000 infants have been infected and 50 have died of the disease. The government has mobilized and sought international assistance in controlling the epidemic which is projected to affect up to 500,000 or 600,000 infants before reaching the end of its seasonal cycle.

Clinically, the illness can be severe and sudden with pulmonary edema, septicemia and cardiac complications. In fact, recent information suggests that the primary mechanism of sudden death is actually bainstem involvement with encephalitis, and a new clinical grading system with attendant supportive fluid management has been helpful in improving clinical outcomes according to studies at Chang Hua Christian Hospital. Further information on this is available from Dr. Lam at email lamsk@medicine.med.um.edu.my. The picture resembles that seen in the Malaysian Sarawak epidemic of 1997 which killed some 30 toddlers. The relationship between the viruses involved is under study according to Dr. Kenneth Lam Sai Kit of Malasyia.

Given that the season for enteroviral infection is still in course, neighboring countries should heighten their clinical awareness of this disease. Good clinical guidelines for physicians have been published on the Hong Kong DOH website at http://www.info.gov.hk/dh/new/index.htm (News Bulletin/Information on Enteroviruses for Physicians). Updates on the epidemic can be found at the Taiwan website http://www.dsqs.gov.tw. In Taiwan measures to interrupt the epidemic include cancelling activities which would congregate young children together. It is of note that this virus is probably spread person to person through both respiratory droplets and fecal oral so handwashing is a key strategy to preventing spread.

<Agence France Presse 16/06/98>
<Agence France Presse 31/05/98>
<CDC Press Release June 8, 1998>
<CNA, 16/06/98>
<The Star, Malaysia, Sunday, 31 May 1998>
<WHO health bulletin 16/06/98>
<WHO WER and Epidemiological Report, Enterovirus Outbreak in Chinese Taipei, China – Update No.1>

2. FOODBORNE ILLNESS– A REGIONAL CONCERN Foodborne illnesses have made headlines around the Asia Pacific in the last month. In the US, Salmonella poisoning is estimated to account for about one–fourth of food–borne diseases, killing about 500/year. The risk of being infected by drug–resistant salmonella bacteria is increasing dramatically in the US, and the continued practice of feeding antibiotics to livestock is exacerbating the problem. In June 1998, there were 180 cases of Salmonella Agona. These cases were found in 11 states and resulted in 40 hospitalizations. A case–control study identified consumption of Millville brand Toasted Oats cereal to be associated with these cases of S. Agona infections. In response, Malt–O–Meal began recalling millions of pounds of cereal sold under 39 brand names on June 5th. A Malt–O–Meal spokesperson said the recall involves 2 million to 3 million pounds of plain toasted oat cereals sold at grocery stores. <AP 5/6/98> <CDC press release, 4/6/98> <Nando net, 7㪝㫺>

Similar recall of food products are occurring across the Pacific. In Australia there is an on–going investigation of an outbreak in which 85 cases of _Salmonella oranienburg_ infection have been identified. A case–control study was conducted which showed an increased risk of infection when eating Italian food or eating gelato of the brand, Alba Gelati, which supplies about 600 outlets across the State. Factory samples of the brand of gelato have been examined microbiologically, and _Salmonella oranienburg_ has been isolated from several samples. The manufacturer has undertaken a voluntary recall of gelato products.<Adriana Milazzo, Ingrid Tribe, Peter Brennan and Robert Hall, Communicable Disease Control Branch, South Australian Department of Human Services>

Food product recalls are occurring across borders as well. Venetian Meat and Salami Co, a Canadian meat processing company, recently recalled products distributed in the US following an E. coli outbreak in Canada in which 33 people became ill from eating Venetian products. The food products were also distributed in Chicago, New York, New Jersey and northern Pennsylvania. <Nando net, 3㪞㫺>

In Hong Kong, nine people fell sick when they ate pig's lung soup. Subsequent tests found clenbuterol in stocks of pig offal believed to be imported from the mainland, where it is outlawed. Farmers use the potentially lethal growth drug in livestock feed to promote leaner meat at higher prices. Traders yesterday voluntarily suspended offal sales after health officials warned people not to eat pig organs. <South China Morning Post – 4 May>

New Tracking System for Foodborne Illness In May, the US government officials unveiled a new computer database tracking system called PulseNet track nationwide that will enable health officials to identify foodborne illness outbreaks five times faster than before. PulseNet, will use the Internet to link the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, the Agriculture Department, four laboratories and state health departments in all 50 states by 1999. The database will compare and log the DNA "fingerprints" of pathogens from samples of tainted food and make that information available. Washington State is planning to collaborate with CDC and Korea to refine this technologic approach in that country under a New APEC project approved in Chinese Taipei in March. PulseNet will replace CDC's 2–year FoodNet project, which seeks to collect reliable data on how many Americans fall ill from tainted meat, vegetables and other foods. A recently released FoodNet report found that campylobacter was the bacteria most often linked to bad food, followed by Salmonella. Campylobacter, most often found in raw chicken, accounted for nearly half the food–borne illness cases tracked by FoodNet. <FSNET and news media, 25㪝㫺>


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:


Thailand – Anthrax 28㪝㫺 The Public Health Ministry and the Livestock Department have stepped up measures to control the cross–border movement of cattle in order to prevent the transmission of communicable diseases from animals to humans. Concerned about falling beef sales due to an anthrax scare a few months ago, government organisations have joined hands in an attempt to assure the public that the situation is now under control. Deputy Public Health Minister Sunthorn Vilavan disclosed that illegal immigration to Thailand via the 26 border provinces was one cause of epidemics. Mr Sunthorn said after the outbreak of the disease, the authorities worked hard to put the situation under control by educating beef traders and staff of slaughterhouses on how to screen cattle, taking beef sold in the market for examination, and tightening measures on cattle imports. To curb cattle smuggling, special checkpoints have been erected in many provinces. <Bangkok Post May 28, 1997>


Australia (Western Australia) – Encephalitis, Undiagnosed 8 to 19㪝㫺 There have been five deaths in the past three years in Western Australia from a "mystery" agent, believed by the press to be a virus that causes an encephalitis–like disease. The head of the infectious diseases department of Fremantle Hospital in Perth, Dr. Miles Beaman, said all usual infective causes have been ruled out. The patients, all of whom died within 10 weeks after seeking medical help, suffered headaches, cognitive distortion and fever before lapsing into a coma. None of the patients had traveled abroad just prior to becoming sick, and three of the cases came from an area south of Perth. While the cases come from a broad geographical area and are not necessarily connected to each other, Dr. Beaman explained that it is unusual for a cluster of unexplained cases to occur over such a reasonably short time. Doctors have only recently put them together and are now seeking assistance from the US Centre for Disease Control to find a cause. <Australian Associated Press – 8 May 1998>

Australia – Mosquito Viruses on the Increase Arboviruses (mosquito borne) are spreading and becoming established in new areas, which is of growing concern, according to the latest edition of the Communicable Diseases Intelligence (CDI), the official journal of the Communicable Diseases Network Australia New Zealand (CDNANZ). In a special edition of the CDI which reviews arboviruses in the Australian region from 1990 to 1998, communicable diseases experts express concern that the flaviviruses, Murray Valley encephalitis, Kunjin, Japanese encephalitis and dengue virus types 1, 2 and 3 and the alphaviruses, Ross River and Barmah Forest, are causing significant human disease in Australia. The CDI can be accessed on the internet on the Communicable Diseases Australia homepage: http://www.health.gov.au/pubhlth/cdi/cdihtml.htm <Dr. Bronwen Harvey, Editor, Communicable Diseases Intelligence, National Centre for Disease Control (MDP 6), Australian Department of Health and Family Services>

Papua New Guinea – Typhoid 18㪝㫺 A recent study conducted by the Papua New Guinea Institute of Medical Research in Goroka found that 10 out of every 1000 in Papua New Guinea is exposed to typhoid. Dr Megan Passey, who was one of the doctors who conducted the study, said the disease could only be eradicated if measures were taken to improve hygiene and sanitation in the community. The doctor said typhoid was most common in the highlands, Port Moresby and Lae and admissions to hospitals in these areas had soared in the past 10 years to alarming proportions lately.

Typhoid is a relatively new problem in Papua New Guinea. From very few cases in the 1960s, the incidence has gradually increased to a situation where it was now endemic in the Highlands and some larger coastal towns. Because typhoid symptoms are confused with pneumonia and malaria and because malaria drugs were readily available, this is the first line of treatment received by typhoid patients. The results from the study also indicated that prevention would be difficult and it would require a long–term integrated approach, involving improvements in hygiene and sanitation. <Pasifik Nius is an e–mail service provided by the South Pacific University in Papua New Guinea. Mina Vilayleck <MinaV@SPC.ORG.NC> Via: Pacific Public Health Surveillance Network <PACNET@LISTSERV.SPC.ORG.NC>


TB GENOME MAPPED In an article in Nature, scientists at the Pasteur Institute in Paris and at Britain–s Sanger Centre report they have decoded and analyzed the 4,000–gene sequence, or genome, of a well–known strain of TB called H37Rv. The genome contains more than 4.4 million base pairs of genes, the scientists report. By identifying all the genes and predicting what many of them do, the scientists have made it easier and safer for other researchers in the field to advance their work, says Carl Nathan, professor of medicine at Weill College of Medicine, Cornell University, Ithaca, N.Y. Knowing which genes are active in disease–causing mechanisms gives drug and vaccine researchers something to shoot at, he says. <Genetic code for TB cracked Next: Disabling a killer, Anita Manning, USA TODAY 11㪞㫺>


Australia: 270 cases of dengue fever have been reported – compared to 188 last year. Dengue fever is restricted to northern Queensland, where the carrying mosquito can be found. The mosquito (vector) has now spread towards the Northern Territory and New South Wales borders. <Radio Australia – World News, 18㪞㫺>

Brazil: Biological Insecticide Developed Researchers at the Oswaldo Cruz Institute in Brazil have developed a biological insecticide that can kill the larva of the mosquito Aedes aegypti more efficiently than the products the Ministry of Health currently use. According to Leon Rabinovitch, head of the Dept of Bacteriology of the Institute, the new insecticide is made from the active portion of the bacteria Bacilus thuringiensis sorovar israelensis, which produces a toxin that is ingested by the Aedes larva and dissolved in the intestine, where toxic fragments become fixed on the intestine walls, killing the host. Rabinovitch notes that the insecticide targets only Aedes aegypti larva, without affecting other insect species, so that its action does not affect the fauna equilibrium. There was no mention in the article of the relative effectiveness of this insecticide compared to others in the market. <O Globo, 16/5/98 & Jornal da Ciencia, 18㪝㫺>

Singapore: Heavier Fines for Mosquito Breeders Stiffer fines are in store for those hauled to court for having mosquito breeding sites on their premises. Under a new Bill tabled in Parliament on Monday, offenders face a fine of up to $5,000 –– five times more than the current $1,000. <Strait Times: 3㪞㫺>

4. REPORT OF EMERGING INFECTIONS CONFERENCES AND OTHER NEWS: ======================================================================

Global Conference on Lung Health
Deadline for Abstracts has been extended by 2 weeks to 30 June. Details available from mail: atat1@ksc.th.com



ASIAN SOLIDARITY AGAINST AIDS, 5th International Workshop


27th June, 1998: 1430 – 1730 hrs


12th World AIDS Conference in Geneva


open at 1400 hrs on Saturday, 27㪞㫺 in Session Hall IV. (registration is free, but restricted to the delegates of 12th World AIDS Conference)


  1. To assess the current HIV/AIDS situation in Asia
  2. To assess the impact of HIV/AIDS on women and children and devise appropriate intervention strategies for prevention, control and care.
  3. To develop cost–effective intervention strategies in resource poor setting.
  4. To identify issues in HIV management as also anti–retrovirals in resource poor settings.
  5. To formulate strategies on issues related to anti–retroviral drugs, support services, rehabilitation of AIDS widows & orphans and discrimination.


HIV/AIDS In Asia, Women & Child Issues, Cost–Effective Interventions, Issues In Hiv/Aids Management, Support, Networking, Ngos And Government, Socio–Cultural Constraints, Human Resource Development(Hrd), Regional Research Priorities


PROTOTYPE WEB PAGE ON TB CROSS CULTURAL ISSUES  Dear Colleagues: I would like to ask for your help in improving a web page devoted to cross–cultural issues in tuberculosis. The web page is part of EthnoMed, a website at the University of Washington devoted to disseminating medical and cultural information pertinent to the health care of refugees in the United States. The TB web page is under construction and no doubt contains many errors. Some of the links do not work. However, at this early stage in its development I would appreciate your comments about its structure and organization, and suggestions on how to improve it. The URL for the prototype page is: http://weber.u.washington.edu/~kwangett/tb/tb.html
Thank you. Tao Sheng Kwan–Gett, MD, General Pediatrics Fellow Robert Wood Johnson Clinical Scholars Program Box 357183, Seattle, WA 98195�

6. 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.

June 24, 1998

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