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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:

  1. Updates from the previous bulletin
  2. Overview of infectious–disease information from PRO–MED and other sources
  3. Notices
  4. How to add colleagues to the EINet listserv

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]

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]

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.


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]

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]

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]

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]


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]


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]

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]

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]

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]

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]


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]

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]

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]


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

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.

October 14, 1998

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