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 – HEMORRHAGIC FEVER, EPIDEMIC WARNING
The health department of China’s heavily flood–damaged northeastern Heilongjiang
Province has issued a warning of an outbreak of haemorrhagic fever caused
by hantavirus due to a sharp increase of rodents in flooded areas which
carry the virus. A program to exterminate the rodents is due to begin,
according to Xinhua. 10 to 14 million people have been left homeless as
a result of the floods and 500,000 people in Heilongjiang province alone
are still sleeping in makeshift accommodations. Crowded, unsanitary conditions
in refugee camps as well as the spread of human sewage by flood waters
have called for increased surveillance by health authorities.
[Agence France–Presse, ex Xinhua, 04/09/98]
[China Today, 06/09/98]
–CHOLERA?
A cholera epidemic is suspected in view of the fact that 50 people have
been hospitalised for acute diarrhoea in Xiaogan, Hubei, China, last week.
The official reaction was treatment with norfloxacin and another local
intestinal antiseptic, preventative treatment with doxycyclin for chldren
above 8 years, and vaccinating more than 50,000 people against cholera.
[ProMed mail, 16/09/98]
– TYPHOID
The state–run news agency (Xinhua)has reported cases of typhoid from flood
ravaged regions of northeastern China in Heilongjian and Jilin Provinces.
82 cases were reported in Jilin Province and major epidemics are feared
even though 2 million people have been evacuated from Heilongjiang Province.
[News media, 02/09/98]
CHINA (HONG KONG) – CHOLERA
The Health Department yesterday announced plans for a food hygiene drive
as the number of cholera cases (66) reached its highest level in five
years. 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. The department urged people to step up food hygiene
and said it would work with the Urban Council and Regional Council to
prevent a widespread outbreak. Spread of the bacteria was attributed to
changes in the weather –sudden rains and hot sunny spells.
[South China Morning Post, 21/08/98 & 07/09/98]
– E. COLI 0157:H7
A four–year–old boy was found to be infected with E.coli 0157:H7 while
on holiday in Britain. This is the same strain of bacteria that killed
more than a dozen Japanese people last year thought the source of infectiion
then was under–cooked minced beef. In this case the boy was said to have
drunk unpasteurised milk on a farm in Britain. The Health Department has
issued warnings against unhygienic food practices, even though the infection
has been classified to be imported.
[Hong Kong Standard, 01/09/98]
– ENTEROVIRUS 71 EPIDEMIC –
As of today, the Department of Health recorded a total of 54 confirmed
cases and two suspected cases of EV㫟 infection this year. Of these,
three confirmed cases and the two suspected ones presented with neurological
complications. These three patients had recovered and were discharged.
Patients of all other confirmed EV㫟 infections had made full recovery.
The latest patient was a 2 year–old girl. The beginning of the new school
term ans congregation of young children in schools and child care centres
called for increased vigilance in these places to prevent enterovirus
infections.
[ProMed mail, 18/09/98]
– PARVOVIRUS B19
113 women in a Hong Kong hospital were tested for parvovirus B19 after
three medical staff from the hospital’s obstetrics and gynecology ward
were found to have been infected with the disease. The parvovirus B19,
which causes fever, fatigue, rashes and pain in joints, was a risk for
pregnant women of 24 weeks or less and for people with weak immune systems,
the Queen Mary Hospital said. However, there was a less than 1 percent
chance of miscarriage when exposed to the virus and the risk to pregnancies
past 24 weeks was negligible, it said. No evidence of acute infection
was found in those tested for the virus.
[ProMed–mail, 04/09/98]
JAPAN – CHOLERA, IMPORTED
It is interesting to note that 100% of cholera cases reported in Japan
this year from January to June were imported, though none have proved
to be fatal so far. From 1962 to June 1998, 1,782 cases were reported
and 1,351 of them were imported, mainly through seafood.
[ProMed, 29/08/98]
NEPAL – JAPANESE ENCEPHALITIS
An epidemiological alert is in effect in Nepal following an increase in
the number/cases of Japanese Encephalitis. May–October is the season for
this zoonotic desease with a peak between August and September. 300 cases
and 52 deaths have been reported this year, in contrast to last year when
1500 cases and 86 deaths were recorded. 123 samples tested positive for
JE from a total of 229 samples that were collected.
[JM LUNA, Medical Officer, WHO, Nepal 2/09/98]
SOUTH KOREA – JAPANESE ENCEPHALITIS
The first case of Japanese encephalitis in four years was reported on
21 Aug 1998 in Wando, South Cholla Province when a 29–year–old man was
admitted for high fever, paralysis, and blurring of consciousness. He
was diagnosed with the disease in Seoul National University Hospital after
being transferred on 27 Aug 1998. On 13 Aug, the Ministry issued a warning
across the nation, advising that children under the age of 15 be vaccinated
against the diease.
[Media reports, 09/09/98 ]
THAILAND – CHOLERA An epidemic of cholera has broken out in Thailand
on the border with Cambodia. It is believed that poor sanitary conditions
in Cambodian refugee camps are the source of the disease. Mortality appears
to be high as bodies are being brought to Buddhist temples for burial.
[Itar–Tass & CNN Custom News, 11/09/98 ]
OCEANIA
AUSTRALIA – UNSAFE WATER
On 25 Aug the Health Department ordered three–quarters of Sydney’s population
to boil their drinking water following the dicovery of parasites in the
city’s water supply. High levels of potentially deadly cryptosporidium
and giardia were detected in the Warragamba Dam which supplies 80% of
the city’s water and even if no new contamination occurs, the crisis is
expected to last six months, and residents are expected to boil their
drinking water for at least a year. Heavy rainfall in the area has been
attributed to the contamination of water. The Cataract Dam has now replaced
the Warragmba Dam in providing the city’s water supply. International
experts were called in to help solve the crisis and are focussing their
attention on the Warragamba catchment area and Prospect filtration plant.
Though clear readings have been obtained from filtration plants, concern
arises due to the fact that crytosporidia are known to live in sediments
for upto two years. There still has been no sign of "any significant increase
of illness" as a result of this contamination. [News Media, 28/08/98,
29/08/98, 30/08/98, 31/08/98]
[ Sydney Morning Herald, 08/09/98]
NEW SOUTH WALES–Q FEVER
A national campaign to encourage beef and dairy farmers, wool growers
and sheep meat producers to undertake voluntary Q fever testing and vaccination
is being mounted by the Cattle Council of Australia following 24 cases
of Q fever among workers at Cooma abbatoir. The Cattle Council's director
of communication and planning, Mr David Inall, was cited as saying that
transmission of the bacteria was generally associated with saleyards,
with producers most susceptible to infection during the "dry, windy period
in August–September. More than 100,000 farmers are at risk and though
those already carrying the bacteria’s antibodies may not need vaccination,
they would still need to be tested which would cost A$40, while the vaccination
costs A$100.
[Sydney Morning Herald, 17/09/98]
PAPUA NEW GUINEA – YAWS, RE–EMERGENCE Port Moresby: 342 people
were treated for Yaws, a curable disease related to Syphilis, two weeks
ago in the Fly River Delta in Western Province. A medical team is now
in the area assessing the re–emergence of this disease which was thought
to have been eradicated in the 1950s. The Ok Tedi Mining Limited (OTML)
and government health officials found traces of the disease in June this
year during a health survey.
[The National, 10/09/98]
AMERICAS
CANADA (ALBERTA) – HANTAVIRUS PULMONARY SYNDROME
Southern Alberta has confirmed its first cases of hantavirus, and the
victim has fully recovered now. Nineteen cases of hantavirus have been
recorded to date in Alberta, all of them from the central and northern
areas. [Broadcast News, 04/09/98 ]
– (ONTARIO)– VRE, CANCER WARD
The cancer ward of an Ottawa hospital has been closed due to a focus of
infection and colonization with vancomycin–resistant enterococci (VRE).
So far, 10 people on the 40 bed ward have been identified as carriers
and one person is infected. As a result, the hospital is not admitting
any new patients on the ward. However, some patients have been able to
go home and visitors are still allowed.
[Ottawa Sun, 11/09/98]
– (ONTARIO) – VANCOMYCIN RESISTANCE According to this report,
two patients have tested positive for vancomycin–resistant enterococci
in the General site of the Ottawa Hospital. The patients occupy beds in
a 28–bed hematology/oncology ward. No additional patients will be admitted
to the ward until such time as all patients on the ward have been tested.
Visitors have been limited to 2 per patient and over the age of 16. The
ward has been thoroughly cleaned to eradicate the organism from any surfaces,
such as bed rails and countertops. All staff are following contact precautions
to contain the spread of the outbreak.
[Ontario Ministry of Health via ANIMALNET, Health Canada, Health Protection
Branch – Laboratory Centre for Disease Control 18/09/98]
MEXICO – ENTEROBACTER
The General Hospital in Tijuana was in a state of alert after an outbreak
Of Enteobacter cloacae was reported by the gynecology–obstetrics ward
on 20 Aug 1998. Military personnel took charge of the situation and stated
that at least 7 children had died, though the subdirector of the hospital
has confirmed only one death. Five other babies were reported to be in
isolation and no further risk to the public is expected as the 4th floor
of the building has been disinfected.
[El Universal, 25 Aug 1998 ]
USA– CJD & BLOOD SUPPLY, REMOVAL OF LEUCOCYTES
Following Britain’s July 17 decision to remove white blood cells from
all donated blood, the United States has decided to adopt the same procedure
to reduce the risk of transmission of viruses and other pathogens. Though
Britain’s decision to filter leucocytes was primarily to reduce the theoretical
risk of spreading the new– variant form of Creutzfeldt–Jakob disease,
the United States has found other compelling health reasons to do the
same. The special fine–mesh filters used to remove white blood cells from
blood cost $15 to $20 each. One filter is needed for each transfusion.
All whole blood and separated units of red blood cells and platelets will
be filtered within the next two to five years to remove leucocytes. Government
and industry representatives will meet on September 18 in Bethesda, MD
to discuss this issue.
[ProMed mail, 29/08/98]
– CALIFORNIA(WILLITIS)– SHIGELLA OUBREAK
Close to 165 people have been affected with shigella–like illness and
four people were hospitalised for severe symptoms. The first case was
reported on 15 Sep 1998 and California’s Mendocino County public health
administrator has linked the oubreak to restaurant dining and improper
hygiene.
[FSNET, 24/09/98]
– (MIDWEST) – LISTERIA CONTAMINATION ADVISORY:
Presence of Listeria monocytogenes in some packages of sprouts has led
to a recall of products by a Michigan company in Michigan, Indiana, Ohio,
Ilinois, and Wisconsin. Listeriosis is fatal in the immunocompromised
, children and the elderly. Products are sold under the brand name of
"Garden of Eatin" and "Living Sprouts". Consumers can call the company
at 616𤮷�.
[Associated Press, 05/09/98]
– (TEXAS) – VIBRIO PARAHAEMOLYTICUS, FROM OYSTERS
The Vibrio parahaemolyticus which caused the recent outbreak associated
with eating raw oysters in Galveston Bay has been identified as "a virulent
strain called 03:K6" This strain has not previously been identified in
U.S. waters but is common in South East Asia. A connection with ballast
water discharged from ships is considered a strong possibility according
to Dr. George Hofkin of the US Food and Drug Administration, who is involved
in the investigation of this outbreak.
[Houston Chronicle, September 6, 1998]
– E.COLI: FEEDING HAY TO CATTLE REDUCES HUMAN RISK
Scientists have suggested a simple way of reducing the risk of getting
infected with E.Coli by changing the diet of cattle from starchy grain
to fibrous hay. More research is called for to look into the consequences
of an abrupt change in the diet of cattle. USDA and FDA authorities have
expressed hope and interest in this new suggestion.
[News Media, 10/09/98]
OTHER
CAMEROON – HIV, NEW STRAIN
A new strain of HIV (designated as YBF30) in a 40–year–old Cameroonian
woman was discovered by French researchers. The strain which is related
to both common HIV and SIV strains belongs to neither group M– the predominant
strain, or group O. The researchers also noticed that the new strain had
hallmarks of SIV. The scientists, who report their findings in the September
issue of Nature Medicine, then tested 700 other frozen blood samples from
people in Cameroon, finding that three other HIV samples matched the woman's.
They have also suggested that the new strain be designated by the letter
‘N’ which falls between M and O. The HIV variant does not appear to have
any selective advantage that would cause it to spread at a different rate
than the predominant strains and does not appear to pose a public health
threat.
[Washington Post, 01/09/98 ProMed mail, 01/09/98]
UK (SCOTLAND)– MYCOBACTERIUM BOVIS, DRUG RESISTANT
Two human cases of Mycobacterium bovis resistant to isoniazid, rifampicin,
and pyrazinamide have been reported to the Scottish Centre for Infection
and Environmental Health (SCIEH) in the past three months. Neither had
any history of previous tuberculosis or of antituberculous therapy. Contact
tracing has identified no links between the cases. M. bovis is usually
resistant to pyrazinamide, but neither isoniazid nor rifampicin is used
in veterinary practice in the United Kingdom (UK). This suggests that
these infections may have been acquired from a human rather than an animal
source, and that they were acquired at some point after isoniazid and
rifampicin were introduced to treat mycobacterial infections in humans.
The incident raises the spectre of transmission of MDR M. bovis to animals;
human to animal transmission is known to occur, and animal isolates are
not tested routinely for antimicrobial susceptibility in the UK at present.
The pathogen has the potential to cause major problems as evident from
an outbreak of MDR M.bovis infection in HIV infected patients in a hospital
in Spain. The strain proved to be resistant to 11 antituberculous drugs
and all cases were fatal. Surveillance of human cases of M.bovis infection
is to be increased in the UK.
[Eurosurveillance Weekly, 10/09/98]
EUROPE: 1997 LEGIONELLOSIS SUMMARY Twenty–four member countries
of the European working group for Legionella infections (EWGLI) contributed
data to the 1997 European dataset. The data were obtained through completion
of a set of reporting forms which have been used annually since 1993,
which represents an overall upward trend since 1995. Five countries reported
more than 100 cases each (Denmark, England and Wales, France, Germany
(area) and Spain). Epidemiological information has increased from 50%
to 70% on the European dataset from 1995 to 1997. While outbreaks linked
to community–acquired infection continue to be underrepresented, travel
associated infections are actively reported due to their consequences
on local tourist economies. In 1997, the proportion of cases which were
due to travel was 22%
[WHO, Weekly Epidemiological Record, Vol. 73, No 34, 23/08/98]
MENINGOCOCCAL RESISTANCE TO CHLORAMPHENICOL–
Bacterial meningitis, the often fatal infection that usually attacks infants,
is becoming more resistant to drugs, researchers reported in Thursday's
New England Journal of Medicine. Doctors in Paris said [that one of the
microorganisms commonly] responsible for the disease [is now exhibiting
resistance to the] antibiotic chloramphenicol. The resistant bacterial
strain was isolated in 11 patients in Vietnam and one in France [according
to] researchers led by Marc Galimand of the National Reference Center
for Antibiotics. The problem is expected to have its greatest impact in
developing countries where chloramphenicol is frequently used to treat
it because the drug is cheap and requires only a single injection, the
researchers said.
[Nando net, 24/09/98]
PAKISTAN– ?O139 CHOLERA EPIDEMIC
An epidemic of cholera has claimed the lives of at least 20 people in
Peshawar in the village of Sufaid Dehri, and over 1000 people have been
struck by the disease. Contamination of drinking water with bacteria–laden
sewerage was the source of the epidemic. Though the government has denied
initials reports of an epidemic of cholera, mass vaccination campaigns
against cholera have been carried out and more than 25,000 people have
been vaccinated. Dera Ismail Khan and Islamabad are other cities where
cholera has claimed the lives of at least 7 people. Official reports,
after testing drinking water supplies now say that the epidemic was gastro–enteritis
and not cholera. There is speculation about these reports in view of the
fact that water samples were tested instead of stool samples, and that
the outbreak may in fact be due to the deadly O139 strain of cholera that
caused a severe outbreak in 1992 in the Bay of Bengal. [Dawn, 10/09/98,
11/09/98, 12/09/98, & 15/09/98 ProMed mail, 26/09/98]
3. NOTICES
MISCAPE: ON–LINE MAGAZINE of the Microscopy UK Web site at: http://www.microscopy–uk.org.uk.
Micscape is a free, non–profit–making magazine for amateur enthusiasts
of microscopic and macroscopic scale. It is written by microscopists and
naturalists from around the world.
4. HOW TO JOIN THE EMAIL
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Pautler at pautler@u.washington.edu.
Further information about the APEC Emerging Infections Network is available at
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