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Vol. I, No. 14~ EINet News Briefs ~ October 13, 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:
- Updates from the previous bulletin
- Overview of infectious–disease
information from PRO–MED and other sources
- Notices
- How to add colleagues to the EINet
listserv
1. UPDATES
FROM THE PREVIOUS BULLETIN
CHINA (HUBEI): – NOT CHOLERA
It appears that the suspected epidemic of cholera in Hubei may in fact
have been only an epidemic of diarrhoea. Human Resources personnel at
Ford Motor Company visited the affected area to discuss the matter with
employers and providers; and in discussions was told by a local physician
that there was no epidemic of cholera there. No confirmed reports of cholera
have been reported from any region in China inspite of severe flooding
in the country.
[ProMed mail, 17/09/98]
PHILIPPINES – DENGUE/DHF
Dengue fever has claimed 300 lives and affected 19,000 people so far in
the Philippines. Though the peak season of the epidemic (August and September)
has passed, the health department was intensifying its anti–mosquito campaign.
[ProMed mail, 03/10/98]
USA (TEXAS)– VIBRIO PARAHAEMOLYTICUS, FROM OYSTERS
Galveston Bay has reopened for oyster harvesting, but with limitations
as to how they should be packed and marketed. In–the–shell or on–the–shell
oysters popular with consumers of raw oysters will not be sold as yet
and all oysters are to be removed from their shells and labeled "For Cooked
Consumption Only" before being marketed. Vibrio parahaemolyticus, a bacteria
found in raw oysters was identified as the culprit in causing an outbreak
of diarrhoeal illness in 13 states and 296 cases in Texas alone. Though
patient samples have demonstrated the presence of 03:K6 type V.parahaemolyticus,
laboratory testing of oyster samples have not revealed the same. 08:K
type v.parahaemolyticus was found in one of 90 sample batches of oysters,
but has not been implicated in the June outbreak. V.parahaemolyticus 03:K6
type has caused an outbreak out diarrhoeal illness in the U.S. for the
first time, though it has been responsible for illnesses in Japan and
other Asian countries.
[Texas Department of Health, 02/10/98]
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.
ASIA
INDONESIA –TB
Tuberculosis is a leading cause of death in Indonesia's economically active
population. WHO expert estimated that there are 445,000 TB patients per
year and ending fatally 175,000 deaths annually. In 1995, Indonesia joined
the ranks of India and China with an incidence rate of 220/100,000 population
with 436,000 new cases. TB has also been ranked as the second in leading
causes of death, and as the nation's largest single health problem, accounting
for 7.7% of Indonesia's total disease burden. While affecting the most
productive age groups of 15㫉 years, it is also an important cause of
death in women. Currently, only 20% of TB cases are diagnosed and treated
by the Indonesian Tuberculosis Control Programme (NTP) while a coverage
of 70% is needed to achieve high cure rates and prevent development of
resistance. The majority of cases receive treatment elsewhere, and a plan
to incorporate every health centre into the network of Basic Units by
the year 2000 is on the agenda. Basic Units are meant to cover a population
of 50,000 to 150,000, and should be equipped to provide TB microscopy
services including sputum smear examinations. Since a TB patient in Indonesia
can enter the health system in a variety of ways, communication between
different sectors is essential for data collection to study spread of
disease, and impact of control measures. It is also important to trace
patients who move between different sectors. Alternative approaches of
DOTS implementation strategies in different communities would be highly
effective in ensuring treatment compliance and completion.
[Tjandra Y Aditama, Mycobacterial Laboratory Hospital/WHO Collaborating
Center for TB, 04/10/98]
SINGAPORE– DENGUE, RECORD NUMBER OF CASES
The number of Dengue cases so far, surpasses the total number for last
year, which was 4,212. The Environment Ministry (ENV) said that as of
Oct 3, 4,219 cases have been recorded. Though no deaths have been reported
so far, 64 people have had the more severe haemorrhagic fever compared
to last year's total of 88. A study has shown that young people between
the age group of 15 and 34 are more prone to being victims. Additional
findings were that men were slightly more prone to the disease, and landed
property residents were seven times more likely to get infected. Insufficient
effort by residents to keep their homes free of breeding sites has prompted
tougher penalties in the form of fines and jail sentences. Construction
sites are also a focus of this effort to eliminate breeding sites. Increased
travel in the region and Singaporeans' declining immunity levels have
been attributed to the spread of the disease.
[The Straits Times,09/10/98]
SOUTH KOREA– AMEBIC DYSENTERY
606 cases of amoebic dysentery have been reported so far in South Korea,
110 cases alone being reported over the three day "Chusok" holiday. Flooding
caused by typhoon Yanni, and increased traffic of people over the "Chusok"
holiday are some of the cited reasons. Though the source of contamination
has not been traced until now, food sources at school canteens have been
suspected as many children have been affected by the illness. The ministry
expects a reduction in new outbreaks following the peak.
[Digital Chosun, 01/10/98]
[ProMed mail, 08/10/98]
CHINESE TAIPEI – ? NEW OUTBREAK OF ENTEROVIRUS 71
A resurgence of the enterovirus epidemic has affected about 1,000 youngsters
and killing at least seven children. The opening of schools and congregation
of children, and the weather, have been cited as reasons for the outbreak
of the virus which may be related to the EV㫟 outbreak of this summer.
The DOH has not confirmed the etiological agent as yet, though Coxsackie
B3 has been isolated from one fatal case on post–mortem. An ECHO virus
epidemic is also under consideration since they belong to the same group
and present with similar symptoms. The epidemic does not appear to be
confined to the South as other cities and counties have also reported
suspected enterovirus cases. The DOH has resumed its daily reports on
the epidemic and has called on the public to be vigilant against the virus.
[Deutsche Presse Agentur, 30/09/98] [China News Daily, 03/10/98] [ProMed
mail, 04/10/98]
OCEANIA
AUSTRALIA – GONOCOCCAL DISEASE SURVEILLANCE Annual report of the Australian
Gonococcal Surveillance Programme, 1997 –
The Australian Gonococcal Surveillance Programme. Commun Dis Intell 1998;22:212𤫈.
Abstract: The Australian Gonococcal Surveillance Programme (AGSP) examined
2,817 isolates of Neisseria gonorrhoeae in the period 1 January to 31
December 1997, a number similar to that reported in 1996. The biggest
change in incidence of gonococcal disease occurred in New South Wales
and Queensland where a 20% rise in the number of isolates was noted. In
the latter case this was due to improved surveillance, but in the former
represented a real increase. The sites of infection and antibiotic susceptibility
patterns varied considerably between regions reflecting considerable differences
between rural and urban gonorrhoea in Australia. Strains examined in South
Australia, New South Wales and Victoria were predominantly from male patients
and rectal and pharyngeal isolates were common. In other centres the male
to female ratio was lower and most isolates were from the genital tract.
Resistance to the penicillin and quinolone groups of antibiotics were
also highest in urban centres, but penicillins remained suitable for use
in many parts of rural Australia. Quinolone resistance in gonococci continued
to increase. This was particularly so in Sydney where quinolone resistant
N. gonorrhoeae (QRNG) accounted for about 15% of all isolates and spread
of QRNG was predominantly by local contact. QRNG in other centres continued
to be isolated at a lower frequency, mostly from overseas travellers.
All isolates remained sensitive to spectinomycin and ceftriaxone.
[CDI (Australia), Vol. 22 / No. 10, 01/10/98]
AUSTRALIA – MENINGITIS, MENINGOCOCCAL: SURVEILLANCE – Annual report
of the Australian Meningococcal Surveillance Programme, 1997–
The Australian Meningococcal Surveillance Programme. Commun Dis Itell
1998;22:205𤫃. Abstract: The National Neisseria Network (NNN) has undertaken
meningococcal isolate surveillance by means of a collaborative laboratory
based initiative since 1994. The phenotype (serogroup, serotype and serosubtype)
and antibiotic susceptibility of 343 isolates of Neisseria meningitidis
from invasive cases of meningococcal disease were determined in 1997.
Ninety six percent of the invasive isolates were serogroup B or C. Serogroup
B strains predominated in all States and Territories and were isolated
from sporadic cases of invasive disease. Phenotypes B:4:P1.4 and B:15:P1.7
were prominent. Serogroup C isolates were most often encountered in New
South Wales, especially in adolescents and young adults, and in that State
were nearly as numerous as serogroup B strains. C:2a:P1.5 was the most
frequently encountered phenotype and C:2b:P1.2 strains were also distributed
widely. A number of clusters of cases of serogroup C disease were noted,
mainly with phenotype C:2a:P1.5. About three–quarters of all isolates
showed decreased susceptibility to the penicillin group of antibiotics
(MIC 0.06 to 0.5 mg/L). Three isolates showed reduced susceptibility to
rifampicin and one was chloramphenicol resistant.
[CDI (Australia), Vol. 22 / No. 10, 01/10/98]
AMERICAS
USA (MARYLAND)–LEGIONELLOSIS
Three workers at a plastics production facility in a suburb of Baltimore,
Maryland have contracted legionellosis, and one has died. The source of
Legionella organisms has not yet been identified though the Maryland Department
of Health and Mental Hygiene is investigating the air conditioning and
all water systems at the plant. In the meantime, the building in which
the victims worked has been closed. Authorities have learned of nine cases
of respiratory illness among plant workers including six cases of pneumonia.
At the present time it is unclear whether any of these additional cases
are related to the outbreak of legionellosis. [News Media, 08/10/98]
USA (OREGON)–CRYPTOSPORIDIOSIS
An outbreak of cryptosporidiosis in Sellwood, Oregon has afflicted 51
people after attending a swimming party at Sellwood Pool, and a number
of them remain ill from the incident. Four people had symptoms severe
enough to seek treatment from physicians, while others still had diarrhoea,
vomiting and stomach cramps, fever and flulike symptoms. According to
state health statistics, the outbreak eclipses the largest number of cryptosporidiosis
cases ever recorded in one year in Oregon, which was the 33 in 1997. Dr.Gary
Oxman, director of Multnomah County's Health Department, was cited as
suspecting that someone who was carrying the parasite might have relieved
himself in the pool, and that chlorine, the common agent used in swimming
pools to kill bacteria, isn't strong enough to neutralize the parasite.
[FSNET, 29/09/98]
USA –SALMONELLA/E.COLI, ALFALFA SPROUTS, ADVISORY
The FDA issued a warning against consumption of alfa alfa sprouts following
4 outbreaks of salmonella and E.coli 0157:H7 in California this summer.
The FDA warning followed a statewide advisory issued by the California
Health Services Department and was directed towards children under the
age of 10 years, the elderly, pregnant women, and those with certain diseases
like AIDS and cancer. This is the third food item to be included on the
FDA's list of warnings directed towards special populations. According
to the Centers for Disease Control and Prevention, since 1995, outbreaks
of salmonella and E. coli 0157:H7 in alfalfa sprouts in Kansas, Missouri,
Michigan, Virginia and California have resulted in 1300 confirmed cases
of food poisoning and the likelihood of thousands more. There has been
one death. The problem with sprouts does not lie in how they are served
but the way they are grown, and a new decontamination measure with chlorine
is being tried in California for the next year.
[The New York Times, 30/09/98]
USA (TENNESSEE)– DYSENTERY
Dysentery, which is normally an illness found in underdeveloped countries,
was diagnosed in 14 residents of Hickman County in Tennessee. Some of
the affected were students from three different schools in the same county.
It was not stated whether it was amoebic or bacterial dysentery, though
most of the affected have been treated and recovered.
[WSMV E–NEWS, 05/10/98]
USA: UPDATE 30 SEP. 1998– HANTAVIRUS PULMONARY SYNDROME
As of September 30, 1998, the Centers for Disease Control & Prevention
has confirmed a total of 196 cases of Hantavirus Pulmonary Syndrome (HPS)
in 30 states (Nebraska has reported their first case). 15 cases with onset
in 1998 have been confirmed so far.
[ProMed mail, 30/09/98]
OTHER
ANTHRAX, NEW ANTIBIOTIC
A new antibiotic that has shown to be effective against the deadly anthrax
bacteria was presented at the Interscience Conference on Antimicrobial
Agents and Chemotherapy (ICAAC) on 26 Sep 1998 in the University of Michigan
Medical School. The drug, BCTP is made of water, soybean oil, Triton X
100 detergent and the solvent tri–n–butyl phosphate. The drug, while capable
of destroying a wide range of dangerous bacteria and viruses, remains
non–toxic to humans, animals and the environment. BCTP was tested on laboratory
mice injected with Bacillus cereus which is closely related to Bacillus
anthracis, and will now be tested against inhaled anthrax spores, other
bacteria and enveloped viruses.
[The University of Michigan News and Information Services, 26/09/98]
RECOMMENDATION FOR INFLUENZA VACCINE– WHO
In February the World Health Organization (WHO) (1) recommended that influenza
vaccines for use in the northern hemisphere's 1998/99 winter season (November
1998 to April 1999) should contain the following: * an A/Sydney/5/97 (H3N2)–like
virus * an A/Beijing/262/95 (H1N1)–like virus * a B/Beijing/184/93–like
virus WHO has now, for the first time, recommended an influenza vaccine
specifically for the southern hemisphere's winter (May to October 1999).
The reasons are that epidemics of influenza occur at different times of
the year in different parts of the world, the virus is constantly changing,
and vaccine use is increasing worldwide. It has therefore been considered
appropriate that WHO should review its recommendation for the vaccine
components twice a year. The recommended composition of vaccines for the
southern hemisphere is the same as that recommended for the northern hemisphere
this winter. Reporting to the European Influenza Surveillance Scheme (EISS)
of clinical data from sentinel physician networks and virological data
from national virological laboratories by nine European countries – Belgium,
the Czech Republic, England and Wales, France, Germany, Netherlands, Portugal,
Scotland, Spain, and Switzerland – starts this month.
[Eurosurveillance Weekly, 08/10/98]
INFLUENZAVIRUS A EVOLUTION IN SWINE
Although it has long been suspected that the Chinese practice of growing
pigs and ducks together is a source of viruses causing deadly human influenza
epidemics, scientists now believe they have discovered the reason. By
looking closely into the molecular biology of the pig's throat, they find
special proteins, receptors, that allow both avian and mammalian influenza
viruses to enter pig cells. This lets bird viruses cross a natural species
barrier, enter pigs, evolve and then emerge to infect humans. The pig's
strange combination of receptors, gateways for entry into cells, means
swine can serve as mixing vessels, living reaction chambers wherein bird
viruses and mammalian viruses intermingle, swap genes and create new varieties
of flu. Globally, humans pay a terrible price. The 12 member international
team of scientists have stated that this evidence supports the role of
pigs as a source of potentially hazardous influenza A viruses. It also
explains the emergence of pandemic influenza viruses and supports the
need for continued surveillance of swine where, with enough warning, scientists
can prepare to meet a new, emerging strain of influenza.
[The Ottawa Citizen, 08/10/98, & ANIMALNET]
3. NOTICES
PROPOSAL WOULD EXTEND EID NETWORK, HELP FUND INFO TECHNOLOGY The
U.S. government is seeking to extend the reach of the APEC Emerging Infections
Network through a $1 million, five–year plan to fund computer purchases,
training and improved Internet access for health officials and researchers
in four less developed APEC economies. The plan, proposed at the just–concluded
meeting of the APEC Industrial Science and Technology Working Group, would
enable health service officials to take advantage of the vast information–sharing
potential of the Internet locally, regionally and globally. The proposal,
developed by U.S. officials and APEC EINet staff, is co–sponsored by Chile,
Malaysia and Thailand. The APEC EINet project team, through site visits
and survey research, has noted that communicable–disease and other health
officials in a number of economies are enthusiastic about the networking
opportunities available through the Internet, but lack equipment and expertise.
Financial conditions throughout the Pacific Rim are making it difficult
for many health officials to afford new information technology and training.
The U.S., which funds APEC EINet through its Centers for Disease Control
and Prevention, would provide $600,000 for coordination of the new effort,
titled "Enhanced Use of Communications to Strengthen Surveillance and
Control of New Infections in APEC." APEC's budget decision–makers are
being asked to provide $400,000 over the five–year period, to directly
fund computer and networking, training and other activities. An initial
decision could be made as early as March 1999, allowing the project to
begin in late 1999 or early 2000. The funding would come from APEC's special
"Trade and Investment Liberalisation and Facilitation" account. The details
of the process to select the four recipient economies are not yet complete.
APEC EINet News Briefs will provide an update on this project in the near
future, but inquiries are welcome. Please contact Cliff Meyer at cliffm@u.washington.edu
WHO'S ROLE IN RESOLVING TRADE ISSUES RELATED TO HEALTH
Since May 1989 Thailand had resisted bilateral pressures, under Section
301 of the US Trade Act, to open its market for cigarettes, and faced
the imminent threat of retaliation against Thai exports to the United
States, valued at US$166 million. This was due to the fact that the U.S.
cigarette industry has always found means of circumventing advertising
bans, and forcing governments to accept their terms and conditions, undermining
public health efforts and policies. Though Thailand's effort to ban import
of cigarettes was overruled by the GATT decision in 1990, the GATT does
seek to ban advertising of cigarettes and has sought the recommendation
of WHO in this matter to resolve this trade dispute. WHO's role in resolving
this matter is important as it involves a public health issue which has
primacy over commercial interests. WHO will be a participant at a symposium
held by the tobacco industry in Geneva in the next few days.
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.
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