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Vol. I, No. 13~ EINet News Briefs ~ September 29, 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

Dengue continued to make the headlines all around the Asia Pacific region in the last month. In Laos, Champassak Province has reported the highest incidence of dengue in 11 years. The annual death toll in northern Indonesia was reported at 32; in Vietnam it was at 214 (almost double that of 1997, according to Health Ministry report); and in the Philippines, it was at 276. In the Philippines, the DOH expects the peak of the dengue season in October, though it has noted a decrease in number of dengue hot spot areas in the country from 18 early this month to two. An area is declared as a "hot spot" when an increasing number of cases is observed for at least two consecutive weeks. According to the DOH, there have been 15,650 dengue cases this year compared to 12,600 dengue cases in all of 1997. In Malaysia, three persons from Australia and New Zealand who were associated with teams participating in the Commonwealth Games in Kuala Lumpur, Malaysia, have been diagnosed with Dengue fever. Commonwealth Games medical committee chairman Abu Bakar Suleiman denied there was an outbreak but also urged athletes to take extra care against mosquito bites. New Zealand chef de mission Les Mills said every precaution was being taken and the team had asked for a thorough check of the team quarters for potential mosquito breeding sites. In the last month, the Chinese Taipei Department of Health (DOH) confirmed the first case of dengue haemorrhagic fever, which was apparently imported from Thailand. In addition, the the first case of inland dengue fever was reported on Aug 11 in the Kaohsiung area. The DOH has reported that an inland dengue virus is currently is circulating, though DOH officials have failed to find any trace of dengue–fever carrying mosquitoes in the area. In the Pacific, dengue type II has been reported to predominate in New Caledonia and Wallis and Futuna. In New Caledonia, the number of dengue cases recorded since the beginning of 1998 is beginning to reach the endemic pattern of this area; the count was at 2,541 cases (up to first week in Sept). Of 1,360 new cases, 1,354 were of type 2. In Wallis and Futuna, 6 cases of Dengue type 2 have been confirmed in the islands since the beginning of August. The last dengue epidemic in the area (1989) was of type 3 and type 2 Dengue was last reported only in 1971.
[AAP, Australia, Agence France Presse, AP Worldstram, 14/09/98]
[Central News Agency, 18/08/98]
[China News, 25/08/98]
[Kompas Daily on Nando net, 04/09/98]
[Media reports, 09/09/98]
[Media Reports (CNN, Reuters), 08/09/98]
[Pacific Public Health Surveillance Network, 27/08/98 & 01/09/98]
[Pacific Public Health Surveillance network, 10/09/98]
[Philippine Daily Inquirer, 01/09/98, 04/09/98, 16/09/98]
[Vientiane Times, 01 to 03/09/98]
[ Xinhua via CNN Internet News, 23/09/98]

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.


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]

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]

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]

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]

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]

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]

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]

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]

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 ]


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]

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]


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 ]

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]

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 ]

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]

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]

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]

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]

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]


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]

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]

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]

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]


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 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.

September 30, 1998

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