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Vol. I, No. 12~ EINet News Briefs ~ August 26, 1998

****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. Dengue updates and prevention
  2. Overview of infectious–disease information from PRO–MED and other sources
  3. Notices
  4. How to add colleagues to the EINet listserv

Southeast Asian countries are expecting an increase in dengue cases due to advent of the heavy rainy season this August and September, which is likely to be compounded by the La Nina phenomenon. The region has already experienced record highs. In Thailand, the ministry of health reported 32,662 cases nationwide during the first five months of the year, while Vietnam is reporting four times more dengue deaths and twice the number of cases so far this year compared to the same period last year (84,500 as of August 15). In Cambodia, health officials are expecting over 16,000 cases by the end of the year. On the other hand, in Oceania, the arrival of cooler and drier weather is helping to block further spread of dengue in Vanuatu and New Caledonia, which has seen 15 times more cases year–to–date than in 1997. Regions that are not endemic, such as Hawaii, Chinese Taipei, and Australia, are at heightened alert as they continue to import dengue cases.
Dengue control in the region has been implemented with mixed effort and success. In Malaysia, for instance, public health efforts have led to a drastic drop in confirmed dengue cases reported this year in Petaling Jaya, while in Sarawak, dengue cases have still increased over last year despite preventive measures. Queensland, Australia, reports a highly virulent and persistent DEN 3 virus that evades control efforts.
New Project Proposal: Molecular Epidemiology of Dengue Viruses The increase of dengue in Asia and the Americas has increased the importance of cooperation among Asian–Pacific economies. A new project to watch for that will be proposed in the next APEC ISTWG meeting is the Molecular Epidemiology of Dengue Viruses, headed by Dr. Duane Gubler, Dr. Gary Clark, and Dr. Robert Lanciotti of the Division of Vector–Borne Infectious Diseases, CDC. The project objectives will center around enhanced surveillance for DHF, laboratory capacity, and data exchange; all APEC economies at risk for epidemic dengue will be invited to participate.
[CNN Custom News 21/08/98]
[News media 18/8/98]
[The Sarawak Tribune Online – 4 August]
[The Star Online – Malaysia August 11 1998]
[Wire services, 31/07/98]
[Xinhua News, 21/08/98]

2. OVERVIEW OF INFECTIOUS–DISEASE INFORMATION FROM PROMED   Here is our regular 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), co–sponsored by WHO.


China (Hong Kong) –Cholera
Eleven new cases of cholera have been confirmed during the first two weeks of August, 1998. Ten cases were acquired locally, and one is thought to have been imported after the patient visited Shekou [location?]. The outbreak brings this year's total to 36 imported and 28 locally acquired cases. This recent outbreak is thought to be related to improper hygiene in some of Hong Kong's more than 9,000 restaurants, cooked food stores and other premises. Thousands of these establishments will be inspected in the next three weeks, according to Deputy Director of the Department of Health, Dr. Paul Saw Thian–aun.
[South China Morning Post – 21/08/98]

China (Hong Kong) – Enterovirus 71 Epidemic
According to the HK Department of Health, there have been 47 confirmed and four suspected Enterovirus 71 cases since DH set up a surveillance system in mid–June this year. The single fatal case reported to date occurred in an 8–year–old girl who was the first case in which the victim had shown serious complications but was not suffering from hand–foot–mouth disease. This was the second case related to the Coxsackie virus. Control measures instituted by the Inter–departmental Working Group on EV㫟 have been effective and the threat of a major outbreak of enterovirus infections would be most unlikely, the Deputy Director of Health said on August 5th. The number of hand–foot–mouth cases recorded at sentinel centres and in public hospitals showed a downward trend in early August. Health officials have been in contact with health experts in Chinese Taipei, where the epidemic has killed more than 55 people and is also fading. A spokesman for DH reminded the public that the best prevention of enterovirus diseases was to maintain good personal hygiene at all times.
[South China Morning Post, Hong Kong online, 6㪠㫺]
[South China Morning Post, Hong Kong on–line, 26㪟㫺]

Japan (Kyushu) – VRE, Human Fatality
Medical personnel at a hospital in Kyushu, Japan have reported what may be Japan's first documented death due to infection with vancomycin–resistant_ Enterococcus_ species (VRE). A 60 year–old male developed peritonitis following abdominal surgery, and died last March despite vancomycin therapy.
[News media, 23/07/98]

Japan (Wakayama) – Food Poisoning, Cyanide? Arsenic Also Used in Japan Mass Poisoning
Japanese police were cited as saying today that arsenic was also used in a pot of curry laced with cyanide which killed four people and sickened 60 others at a town festival late last month. A local police official said the presence of both poisons led police to believe the culprit had aimed to kill as many people as possible. The deadly curry was made on July 25 at a neighbourhood festival in the western Japan city of Wakayama.
[FSNET and news media, 04/08/98]

Chinese Taipei – Enterovirus 71 Epidemic, Children
Summary report in MMWR: During April–July 1998, the Ministry of Health in Chinese Taipei received approximately 90,000 reports of hand, foot, and mouth disease (HFMD) among young children based on passive surveillance from sentinel physicians. Approximately 320 children have been hospitalized with HFMD associated with suspected meningitis, encephalitis, or acute flaccid paralysis (AFP), and at least 55 have died. This report describes the clinical course of two fatal cases and presents summary findings from an ongoing clinical, epidemiologic, and laboratory investigation of the 55 deaths. A case was defined as refractory shock following a prodromal acute illness characterized by fever or rash that resulted in the death of a previously healthy child. For summary findings, write the message "GET http://www.healthnet.org/programs/promed–hma/9808/msg00071.html" to getweb@usa.healthnet.org.
[MMWR, Vol. 47 / No. 30, 7/08/98]

Chinese Taipei – Japanese Encephalitis
The Department of Health issued a forewarning of Japanese encephalitis again. Twelve cases of Japanese encephalitis [JE] have been confirmed to date this year (more than twice the number for the same period last year). The Acting Head of the Department of Health's Disease Control Bureau, K.S. Hsu, said that though most infants and young children in Chinese Taipei have been vaccinated against JE, the effectiveness of vaccination on adults has worn off, thus increasing their chance of infection. However, the Department of Health is not advocating the vaccination of adults against JE because the side effects of vaccination are greater among adults. The basic preventive measures will have to be elimination of mosquitoes and avoidance of mosquito bites.
[Internet news from Chinese Taipeiese paper, Min–Sheng Daily, 16/07/98]

Thailand – Cholera
Reported cases of "severe diarrhea" among foreigners in Phuket town have nearly doubled during the first seven months of 1998 compared to the same period last year. While cases of "severe diarrhea" were on the increase, reported cases of food poisoning among foreigners were down (15 cases to date compared to 23 cases during the same period a year ago). The provincial health department has been using surveillance teams to collect food and water samples from stalls and fresh markets since the beginning of the year to ensure safety as part of its "Amazing Hygienic Food" campaign. In response to media reports of a cholera outbreak earlier this year, Thailand's Deputy Chief of Communicable Diseases declared that El Tor Ogawa, a _Vibrio cholerae_ biotype, were classified by Thai health authorities as "severe diarrhea" because it is not as severe as "classical" cholera.
[Phuket Gazette Online 4/08/98]


New Zealand – Diphtheria
Scores of children in New Zealand are being tested for diphtheria, after a toddler attending an Auckland child care centre was diagnosed with the disease –– the first case in New Zealand since 1980. The potentially fatal disease, which is passed on by close contact, starts with a sore throat, fever and neck swelling, but can progress to blocked breathing passages and paralysis.
[NZL – HEALTH: RadAustralia; PACNEWS 2: 12/08/98]


USA (Alaska), Canada (Yukon) – Influenza A Advisory
The CDC and Health Canada investigation of a summertime outbreak of influenza and pneumonia among travelers to Alaska and the Yukon territory has identified more than 1,600 cases, including 47 cases of pneumonia. No evidence suggests increased respiratory illness activity among residents of these areas. The CDC recommends that travelers to this area who are 65 years of age and older and those with chronic medical conditions first consult with their physicians before travel. In cooperation with CDC, numerous cruise lines have initiated active surveillance for respiratory illnesses, and some have organized vaccination campaigns for crew members and have acquired stocks of antiviral medications. Antivirals can be used to decrease the duration of influenza illness caused by A strain viruses, if administered within 48 hours after symptoms begin. Preliminary characterization has identified the strain as influenza A/Sydney/5/97/ (H3N2)–like.
[CDC Media Advisory, 24/08/98]

USA (Texas) – Cryptosporidiosis
Lab tests have confirmed that 32 Brushy Creek residents have been infected with _Cryptosporidium_; the Texas Department of Health estimates that 1,300 people in the Brushy Creek area are also infected. The Health Department was able to attribute the spread of the parasite to drinking water from four Brushy Creek MUD wells that officials believe were contaminated by a July 14 raw sewage spill, which occurred when an Austin pumping station lost power during a thunderstorm on July 13. Since the spill, 25 private wells have been found to be contaminated. A week following the spill, four of the five Brushy Creek MUD wells were shut down, when the Texas Natural Resource Conservation Commission realized the wells showed traces of _E. coli_ bacteria, which serves as an indicator that contaminants such as Cryptosporidium could have made their way into the drinking water supply. However, by that time residents of the MUD were already exposed to the parasite in their drinking water.
Since the outbreak began, health officials have urged residents who have had diarrhea to stay out of pools and water parks for at least two weeks after the symptoms subside. Officials also are recommending that residents wash their hands thoroughly and often to prevent the spread of the disease.
[American–Statesman, 6/08/98]

USA (Washington) – Hantavirus Infection, Human
According to the state Department of Health, a Franklin County man is the first person this year to have contracted a hantavirus infection in Washington and the fifteenth reported case in the state. Monitoring of rodent populations in areas in the southwestern United States has shown a 10㪬 fold increase in the numbers of mice infected with a hantavirus. There is no statewide rodent monitoring effort in Washington, but it is possible that similar increases in rodent populations have occurred this year in certain parts of the state. Of the 625 deer mice tested in Washington since 1993, about 10% were hantavirus positive.
[Media, 14/07/98]

USA (Wyoming) – E. coli 0157:H7 Infections, Unknown Source
Since July 1, 1998, the Wyoming Department of Health has identified 61 culture–confirmed cases of _E. coli_ 0157:H7 infection among residents of Alpine, Wyoming, a small town located approximately 60 miles south of Jackson. The majority of cases occurred between June 28 and July 10; there have been no additional cases diagnosed since July 14. Twenty–one patients have required hospitalization. Epidemiological studies conducted jointly by the Wyoming Department of Health and CDC have implicated the local municipal water supply as the source of the outbreak. In addition, the cover story of the August 3, edition of Time magazine, entitled "The Killer Germ," describes the investigation and highlights the work of CDC epidemiologists and State and local health officials on the epidemic.
[DHHS weekly update, 31/07/98]


Study on HIV Spread to Infants in Breast Milk
An article in The Lancet reports that about 5% of infants born to HIV–positive women in developing countries become infected with HIV through breastfeeding. Based on the study findings, an international team of researchers conclude that the risk of postnatal HIV transmission via breast milk is "substantial." Dr. Valeriane Leroy of Universite Victor Segalen Bordeaux in France and colleagues pooled data from four studies conducted in developed countries and four studies in developing countries that followed infants born to HIV–positive women who were HIV–negative at birth. They found that in developing countries, most HIV–infected mothers breastfed, and "postnatal transmission occurred in 5% of the 902 children in four (study groups)." For these infants, the team calculated that if breastfeeding had been halted by 4 months, no HIV transmissions would have occurred. And if breastfeeding had been halted by 6 months, only 3 HIV transmissions would have occurred. Based on these findings, they suggest that "the risk of acquisition of HIVם through long–term breastfeeding may outweigh its benefits in populations with high prevalences. Avoidance of breastfeeding by HIVם–infected women is recommended if safe and affordable alternatives are available, a practice reinforced by WHO, UNICEF, and UNAIDS."
[The Lancet 1998;352:597𤱈]


EUROSURVEILLANCE WEEKLY – This timely bulletin is part of the infrastructure for collaboration envisaged in the draft European Charter for communicable disease surveillance and prevention. Newsflashes, updates, and reliable data on communicable disease incidents or trends in Europe that enable an international incident control team to inform professionals and scientists throughout Europe as events occur.

4. HOW TO JOIN THE EMAIL LIST and receive EINet News Briefs regularly    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 Asia–Pacific Rim. 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.

August 27, 1998

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© 1998, The University of Washington