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.
ASIA
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]
OCEANIA
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]
AMERICAS
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]
OTHER
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]
3. NOTICES
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.
http://www.eurosurv.org/main.htm
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.
