|
|
||||
|
|
|
|||
|
About EINet
|
"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. ENTEROVIRUS 71: UPDATE
As of July 1998, there have been 11 confirmed
and 16 suspected cases of enterovirus 71 infections among
children in Hong Kong, indicating that the virus has begun
to be transmitted beyond Taiwan. The epidemic continues in
Taiwan with 240 hospitalized cases and 52 deaths reported to
date. Health providers and public health authorities in the
region are asked to be on heightened alert for suspected
cases of enterovirus 71. According to the HK Department of
Health, the HK strain is of a weaker variety than the Taiwan
strain and all patients have made full recovery. In Taiwan,
the epidemic has already peaked; the number of suspected
clinically apparent infections totaled more than 1,000
island wide, with 55 deaths. However, the DOH urges that the
public continue with preventative measures such as
frequently washing their hands. Clinical Disease
The HK Department of Health asserts that definitive
diagnosis of enterovirus 71 infection requires isolation of
the virus from cell culture. Specimens for virus isolation
include nasopharyngeal swabs, cerebrospinal fluids, rectal
swabs, stool samples etc. The incubation period for
enterovirus diseases is usually between 1 to 2 weeks, and
viruses may be shed from the oropharynx from 2ן days before
to 1מ weeks after onset of symptoms, and in feces for
several weeks to months. In Taiwan, the DOH has completed
examination of 108 cultured virus specimens obtained from
those suspected to have died of the viral infections and
those who had shown either severe or mild clinical
manifestations. Among all these specimens, only 16 had shown
positive reactions toward enterovirii, with 12 to
enterovirus 71, two to Echo 6, and one each to
Coxsackievirus Bס and Echo 4. Although enteroviruses can cause a number of clinical
diseases affecting the neurological, cardiovascular and
respiratory systems, the majority of enterovirus infections
in children are asymptomatic. Enteroviruses are important
causes of aseptic meningitis and enchephalitis, neonatal
sepsis, and acute febrile illnesses in children. They are
also capable of causing paralysis and acute motor weakness.
Enteroviruses are well known to cause pericarditis,
myocarditis, stomatitis, hand, foot and mouth disease,
haemorrhagic conjunctivitis etc. Control and prevention efforts focus on avoiding
congregations of young children, stressing handwashing, and
early clinical detection and appropriate treatment. H. M.
Hsu, deputy director of the Taiwan DOH's Bureau of
Communicable Disease, suggested doctors check patients'
brains with the aid of the magnetic resonance imaging to
more effectively treat the disease. Clinical experience
suggests that treating patients as though they had a primary
cerebral process––i.e. by limiting intracranial swelling
etc.––may enhance survival. The Taiwanese Dept of Health has a new site on symptoms,
diagnosis, treatment, and prevention at
http://www.doh.gov.tw/focus/virus/english.html; the HK
Department of Health has an updated clinical guide at
http://www.ha.org.hk/clnguide/ev71v2.htm (or write the
message GET http://www.ha.org.hk/clnguide/ev71v2.htm– to
getweb@usa.healthnet.org). A comprehensive compilation of
links and discussion on Enterovirus 71, HFM disease, the
Malaysian, Taiwanese, and Japanese experiences can be
located at
http://www.geocities.com/HotSprings/2188/outbreak.html Sources:
Malaysia (Sarawak): For
the first 25 weeks of this year, 665 cases of dengue were
reported; only 668 were reported last year. The disease had
killed two persons and caused brain damage to another,
Public Health Minister Dr Soon Choon Teck disclosed. The
high number of cases were attributed to an outbreak of the
disease during the beginning of this year. <Sarawak
Tribune Online, 9㪟㫺> Singapore: Twenty
workers from China came down with dengue fever in June at
their work site at the proposed Singapore Mega Exhibition
Centre. One worker died. Environment Ministry (ENV) officers
found _Aedes_ mosquito breeding sites in various locations
at the work site, and ordered Hyundai Engineering and
Construction to stop work for 4 days to clean up the
premises. The place was fogged continuously with insecticide
for seven days and work teams have been set up to keep the
premises clean and safe. <The Straits Times,
3ף㫺> Singapore: Environment
Ministry (ENV) officers are testing high–tech aids in the
battle against mosquitoes. Closed–circuit TV cameras are
used to check mosquito breeding grounds, such as roof
gutters and other areas that are difficult to reach.
Insecticide–spraying equipment has been modified, with hoses
rigged to poles that allow roof gutters to be sprayed
without the need for ladders. In a one–year pilot project, a
heating element placed in the drain was switched on and off
automatically twice a week, to test the effectiveness of
warm water in killing mosquitoes. In another experiment, officials found that adult
mosquitoes traps were able to catch the Aedes mosquitoes
only when dry ice was added, because the carbon dioxide
given off attracted the mosquitoes. However, the results
were three to 11 times worse than the number of mosquitoes
trapped by human bait, so the traps are now being used for
Anopheles mosquitoes in malaria control. <Straits Times:
17㪟㫺> Taiwan: Hsu Hsu–mei,
deputy director of the Department of Health's Bureau of
Communicable Disease Control, reported that 32 cases of
dengue fever have been reported in Taiwan this year, and all
were contracted during visits to Southeast Asian countries.
<Central News Agency, 30㪞㫺> Thailand (Gulf Islands):
Three Australian tourists who recently traveled to islands
in the Gulf of Thailand developed febrile illnesses. Dengue
1 virus was isolated from all three patients. These cases
highlight the need for travellers to be aware of preventive
precautions required when visiting dengue endemic regions,
as well as for doctors to be alert to the possibility of
dengue in travelers in order to diagnose cases early.
Although it is considered unlikely that dengue will become
endemic in Australia, large outbreaks can result from
imported cases in the dengue receptive areas.
<Communicable Diseases Intelligence (Australia), Vol 22,
No 6, June 11, 1998> Vietnam 08㪟㫺: The
central province of Quang Tri's healthcare sector reports
that 83 of its 138 communes have nearly 4,500 dengue
patients, ten times more than last year. Healthcare workers
have instructed local residents in mosquito–killing
methods.
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: Cambodia (Phnom Penh) – Cholera
29㪞㫺 At least 30 people died in
the town of Poipet between June 14 and 29 after a suspected
cholera outbreak. The deaths take the number of suspected
cholera cases to 110. Verena Carrara of Medecins Sans
Frontiers (MSF) added that the real magnitude of the problem
was hidden due to a "quasi–total absence of public health
care services in the past," which inhibited those stricken
from coming forward for treatment. Maurits van Pel, the MSF
country coordinator, describing Poipet as a densely
populated slum area with malnourished migrant workers.
<AFP, 27㪞㫺> <The Straits Times, 10ף㫺,
11ף㫺> Japan – Vancomycin–Resistant
Enterococcus, Imported Chickens 09㪟㫺
Japan has found potentially lethal bacteria in chicken
meat imported from France and Thailand, and has called for
the governments of both countries to investigate the matter,
Japanese government officials said yesterday. The meat
carried vancomycin–resistant _Enterococcus_ (VRE), an
intestinal bacteria resistant to antibiotics, which could
kill aged or ill people whose immune systems are weak,
Japan's Health and Welfare Ministry reported. The bacteria
is believed by some experts to be linked to the use of
avoparcin, an antibiotic used in chicken feed to prevent a
range of diseases which if used extensively, fosters
bacteria resistant to antibiotics like VRE. However, both
the Japanese and Thai chicken industry officially stopped
using avoparcin in feed years ago. <The Straits Times
Interactive, 9ף㫺> Singapore – Hand–Foot–Mouth
Disease, Fatal 27㪞㫺 A
2ם/2–year–old Singapore boy has died of severe
complications from hand, foot and mouth disease, the first
death of its kind here since 1993. The disease is caused by
a virus that is from the same family as enterovirus 71,
which is linked to the deaths of 50 children in Taiwan.
However, the boy and his family have not travelled to Taiwan
recently, so health authorities believe the death may be a
sporadic case of hand, foot and mouth disease with severe
complications. According to the MOH, it has not detected any
case of enterovirus 71 infection here so far this year. Taiwan – Infectious Diseases on the
Rise 10ף㫺 Following a period of
scorching temperatures, a host of infectious diseases are
invading the island, the Department of Health announced. So
far this year, scrub typhus case counts are three times
higher than the number reported in the same period last
year. In addition, there have been nearly twice the number
of Taiwanese infected with scarlet fever, dengue, and
Japanese encephalitis compared to the same period last year.
Meanwhile, malaria and typhoid fever are also on the rise in
Taiwan. National Quarantine Service Director Wu Tsung–neng
indicated that the warming of the climate has made the
viruses and micro–organisms particularly active, while a
damp environment such as Taiwan–s allows them to breed more
easily.
New Zealand – Meningitis,
Meningococcal 20㪟㫺 The
outbreak of meningococcal meningitis that began in April has
now totaled 187 cases, with 12 deaths. This represents 27
more cases, and 3 more fatalities than were experienced last
year during the same time period. However, last year's
outbreak was far above previous norms.
Parents have been warned to take children back to the
doctor if their condition deteriorates rapidly after the
initial visit. Dr. Michael Baker, of the Communicable
Diseases Centre in Wellington, said that occurrence of the
disease in New Zealand typically occurs in 5 to 15–year
epidemics. The country is now in its 7th year of the current
cycle. <Christchurch Press, 27㪞㫺>
USA (Georgia) – E. coli, Hemolytic
Uremic Syndrome 26ע㫺 Georgia
Public Health officials have confirmed 25 cases of E. coli
0157:H7 in children. All cases, of which 17 were from
Georgia and eight from out of state, attended White Water
Recreation Park on June 11, 12 or 17. Authorities believe
children were infected after swimming in a pool in which an
infected child defecated. Park managers acknowledged that
chlorine levels in one children's pool had registered as low
as one–quarter of the county's minimum standard on the days
that state officials say E. coli bacteria in that pool
infected several children. <David L. Swerdlow, MD, Acting
Chief Acting Chief and Robert V. Tauxe, M.D., M.P.H. of the
CDC> USA (Illinois) – E. coli Foodborne
Outbreak 24㪞㫺 A form of the _E.
coli_ bacterium lurking in food prepared by a catering
company caused more than 5,000 people to fall ill, health
officials said. The Illinois case was the largest documented
outbreak in the US of the strain called enterotoxigenic
_Escherichia coli_, or ETEC, Cook County Health Department
officials said. The bacterium was identified in stool
samples from three victims of the illness known as
"traveler's diarrhea," said Stephanie Smith, the
department–s director of communicable disease. So far, the most common link between patients is potato
salad, though it remains only one suspect food in the
investigation. Officials from the federal Centers for
Disease Control and Prevention were conducting tests to
isolate the bacteria in the food or water at the catering
company in suburban Orland Park. Although ETEC is common in
developing countries, the CDC in Atlanta has tracked just 14
ETEC outbreaks in the U.S. in the last 23 years, Smith said.
<Nando net, 24㪞㫺> USA (Illinois & Wisconsin) –
Leptospirosis 18㪟㫺 The Centers
for Disease Control and Prevention on Friday asked for help
in warning 966 people who participated in the Springfield,
Ill., Ironhorse Triathlon (a foot, bicycle, and swimming
race) on June 21 and 850 athletes from the 1998 Bally
Total Fitness USTS Triathlon in Madison, Wisconsin, on July
5. Five people from the competitions became ill with fever
and other symptoms consistent with leptospirosis, an illness
that, if left untreated, could result in liver or kidney
damage. More than 1,800 participating athletes from 44
states may be at risk. USA (Indiana) – E. coli, Foodborne
Outbreak 25㪞㫺 In May, the
Indiana State Department of Health investigated an outbreak
of E. coli O157:H7. Twenty–seven confirmed cases were
eventually identified. None developed HUS (hemolytic
uremic syndrome), and none died. A case control study
identified one particular franchise of a restaurant chain as
the source and implicated cole slaw as the food vehicle
responsible. A consumer sample of cole slaw yielded E. coli
O157:H7 which shared the same PFGE (pulsed field gel
elecctrophoresis) pattern as the cases. A review of cole slaw preparation procedures at the
restaurant revealed that food service workers at the
implicated restaurant were removing the outer leaves but
were not washing cabbage heads prior to shredding, which was
not consistent with the restaurant chain's standard
operating procedures, which requires the washing of cabbage
prior to shredding. The CDC and FDA are collaborating on the
cabbage traceback investigation and environmental
sampling. USA (Wyoming) – E. coli Infections,
Unknown Source 14㪟㫺 According to
the Wyoming Dept of Health, as of July 13, 11 people have
tested positive for _E. coli_ (0157:H7) poisoning in the
Star Valley area, 4 of which were hospitalized. However,
everyone confirmed to have the infection had onset between
June 28–July 3, indicating there is no continuing source of
contamination. A total of 48 people displayed symptoms of
the infection and the additional cases are still under
investigation. Officials in Alpine, Wyoming have no clue
about the source of the bacteria, but are looking at the
water supply, which is not routinely chlorinated. <Green
River Star newspaper, July> US – Hepatitis C & Transfusions
8㪟㫺 The U.S. government has
begun the first phase in notifying people who may have been
accidentally infected with the hepatitis C virus during
blood transfusions. Letters will be mailed to those who
received transfusions from blood donors who have since
tested positive for the virus. People who received blood
before June 1992, when the most reliable screening test was
instituted, are at risk. Screening tests for the virus were implemented after
1990, greatly reducing the risk of transfusion–borne viral
transmission. Experts believe the chance of such
transmission today is between 1–in㪢,000 and 1–in𤩔,000.
Last year, a government panel composed of liver experts and
medical ethicists estimated that 290,000 people may have
contracted the potentially serious liver infection during
pre� transfusions. ARTICLE: Korea – Malaria
"Reemergence of Plasmodium vivax
Malaria in the Republic of Korea" Emerging Infectious
Diseases, Feighner et al., U.S. Army, Republic of Korea –
4(2):295𤬙, 1998, CDC. Plasmodium vivax malaria reemerged in the
Republic of Korea in 1993. The number of cases has tripled
each year since, with more than 1,600 cases reported in
1997. All 27 cases in U.S. troops resolved uneventfully with
chloroquine/primaquine therapy. Disease is localized along
the western Demilitarized Zone and presents minimal risk to
tourists. Full article at
http://www.cdc.gov/ncidod/EID/vol4no2/feighner.htm UK – Transfusion–Transmitted Virus,
(TTV), Research 17㪟㫺 A
newly–discovered virus that may infect up to one in 10 of
the (British) population. The virus, known as TTV,
was discovered in Japan a year ago. But two British studies
about to be published will reveal for the first time that
the infection is probably worldwide. One study found that
TTV was present in two per cent of blood donors in Scotland,
that half of the blood products were contaminated with it,
and that one in five sufferers of severe hepatitis were
infected. The second study found TTV in one in 10 healthy
people in England. Researchers concluded that TTV probably
does not cause chronic liver disease and does not seem to be
connected to any other illness. The PROMED moderator (CHC) noted that thus far no one has
shown that this DNA is infectious, so its status as a virus
is unclear. <Daily Telegraph, London,
17㪟㫺>
ASTWeb, the Web
site of the APEC Industrial Science and Technology Working
Group (ISTWG), has been revised with new features. The site
offers information, resources and discussion fora for
individuals and organizations with an interest in the
ISTWG's vision of sustainable economic prosperity built on
industrial science and technology (including policies
oriented toward human health). Visit http://www.apecst.org
and use the "guest" login.
|
|||
|
Revised: |
© 1998, The University of Washington |
|||
