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Vol. I, No. 15 ~ EINet News Briefs ~ October 27, 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 previous bulletins
  2. Overview of infectious–disease information from PRO–MED and other sources
  3. Notices
  4. How to add colleagues to the EINet listserv


Dengue fever continues to take its toll in the Philippines with a nationwide total of 19,000 cases and 300 deaths. The Department of Health expects a record number of cases (72,000) this year, and an epidemiologist at San Lazaro Hospital has warned that 2% of dengue patients would die unless bold preventive actions were taken. This brings to attention the fact that Philippine cases are up by more than 68% for 1992㫸 (32,344 cases) or over thrice that combined for the periods 1982㫮 (5,373) and 1986㫲 (4,674). The 1998 figure (19,000) is over half the total cases reported for the 5–year period, 1992㫸. [Manila Standard, 25/09/98]
[ProMed mail, 07/10/98]

SOUTH KOREA: CORRECTION – BACILLARY DYSENTERY Shigella sonnei has been identified as the causative agent of the epidemic diarrhoeal disease in South Korea. Earlier reports of an outbreak of amebic dysentery were a result of misinterpretation by a journalist of the Ministry of Health's reports. [ProMed mail, 14/10/98]

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.


The Ministry of Health has appealed to the public to be on the alert even though the number of cases of dengue fever have declined in comparison to previous months. Forty–seven deaths were recorded during August and September. There were 1,484 cases in August, and 514 cases in September.
[Xinhua news agency, 20/10/98]

The Department of Health has issued an advisory against leptospirosis following flooding in storm–ravaged areas. The public have been cautioned about wading in flood waters that might be contaminated with the disease–causing microorganism found in the urine of carrier rats. A total of 28 leptospirosis cases and 3 deaths were reported since January this year. Public health experts expect to see more cases by next month, as a result of the recent flooding. The Health Secretary, Alberto Romualdez has also expressed concern about epidemics of diarrhoeal and respiratory diseases that could strike children in provinces where flood and sea waters have seeped into drinking water.
[The Philippine Star, 27/10/98]
[The Philippine Inquirer, 24/10/98]


The following background information on gonorrhea and gonococcal ophthalmia
– 10,000 to 20,000 cases of gonorrhea were reported yearly during 1917 to 1929.
– The male/female ratio was 2.4/1.0 in 1991; 2.6/1 in 1992; 1.8/1 in 1996.
– 126 cases of gonococcal ophthalmia (nonvenereal gonococcal conjunctivitis) were reported during 1917 to 1929. Over 50 cases of gonococcal ophthalmia were reported most years during 1950 to 1969. 432 cases were reported among Central Australian Aboriginals in 1991; 447 from Northern Territory, Western Australia and South Australia during February to June 1997. 13 cases were confirmed in the Northern Territory and Western Australia during January to March 1998.
– In 1995, 15.8% of strains of Neisseria gonorrhoeae were penicillin–resistant, 8.1% were penicillinase–producing (PPNG), and 1.9% were quinolone–resistant. In 1996, 16% were penicillin–resistant, 5.8% PPNG and 2.6% quinolone–resistant.
Year––––– ––––––– Cases of gonorrhea
1982 to 1983 ––– 6,599
1984 –––––––––––– 8,894
1990 –––––––––––– 2,321
1991 –––––––––––– 2,530
1992 –––––––––––– 2,908
1993 –––––––––––– 2,811
1994 –––––––––––– 2,971
1995 –––––––––––– 3,259
1996 –––––––––––– 4,173
1997 –––––––––––– 4,331
[ProMed mail, 13/10/98]

The following background data on meningococcal meningitis in Australia wereextracted from the GIDEON software program:
– Bacterial meningitis was the eighth–ranked cause for infectious disease mortality during 1979 to 1981, and the tenth–ranked during 1992 to 1994.
– Highest attack rates are recorded among children below age 5 years, particularly in Aboriginal communities in central and northern Australia.
– The peak reporting year for 'meningitis' was 1942 (2,371 cases – group A meningococcus predominant).
– Rates for meningococcal disease rise in June and peak in October.
– An epidemic of type A meningococcal disease during 1971 to 1973 affected primarily Aboriginal communities. An additional outbreak of type A disease was registered during 1987 to 1991 in central Australia. In other years, type B has predominated.
– In 1994 type C meningococci predominated in New South Wales and North Queensland and type B in Queensland. In 1996, type B accounted for 63% of strains and type C for 29% However, types B and C each accounted for 44% of isolates in the Northern Territory.
Year––––––– Cases (fatal)
1990––––––– 295
1991––––––– 285
1992––––––– 292
1993––––––– 378 (25)
1994––––––– 383 (26)
1995––––––– 382 – 66% group B
1996––––––– 426 – 63% group B
1997––––––– 496 – 64% group B
[ProMed mail, 13/10/98]

An unidentified haemorrhagic fever has killed about 60 Bogaia people in the Southern Highlands Province of Papua New Guinea over the past 7פ years. The total population in this region is estimated to be 262, and in the cases that were recorded, all victims were said to have died within 24㫈 hours of onset of symptoms. The symptoms described were generalized swelling, fever, jaundice, and bleeding primarily from the ears, eyes, and mouth. The households worst affected by this disease were situated at lower altitudes, below 800𤵴 meters. Currently, the PNG Institute for Medical Research has no funds to investigate the disease. [Nicole Haley, Dept of Anthropology, RSPAS, Australian National University via ProMed, 23/10/98]


Dengue fever is emerging as a public health problem in many countries in the American tropics (e.g., the Caribbean, Mexico, Central America, and northern South America) commonly visited by Canadian tourists. An increase in the number of serologically diagnosed cases in this decade confirms this report. Data from the National Arbovirus Laboratory, Laboratory Centre for Disease Control, Ottawa, and the Ontario Provincial Laboratory, Toronto show that an average number of 29.5 cases were diagnosed annually in this decade, in comparison to an average of 17 cases in the last decade. A recent outbreak of dengue was reported in a group of 13 tourists who shared the same holiday accommodation in Barbados, 11 of whom were Canadian. The attack rate was as high as 77% and most of the tourists were sick within 4 days. This outbreak points to an increasing health risk for tourists in popular vacation destinations of the Americas. The risk of acquiring classic dengue is subsequent susceptibility to a second attack of dengue, dengue haemorrhagic fever (DHF)and dengue shock syndrome (DSS) as a result of an antibody–dependent enhancement of viral infection. Education of tourists with regard to prevention, and the subsequent risks of acquiring classic dengue especially if they return to dengue endemic areas, is necessary to reduce the threat of dengue becoming a public health problem in other countries.
[Canada CDR,Vol.24/No.10, 17/10/98]

Researchers at Washington State University (WSU) are studying the efficacy of adding propionic acid to wet feeds for cattle, which appears to have an inhibitory effect on growth of E.coli, thereby arresting its replication. Water troughs are also seen as a source of contamination and long–term reservoirs; E.coli is known to survive for long periods here and replicate during the summer months to infectious doses. The importance of this role and sanitation methods to arrest this progression are under consideration. The validity of a study published by Cornell University in Science magazine on September 11 is under question by researchers at WSU. Studies contrary to the Cornell report have been cited which essentially show that changing the diet of cattle have no effect on E.coli prevalence in the intestine, or on the acid pH of the rumen. Animal hides have been cited as the source of contamination in their critique, unlike Cornell University's claim that intestinal tracts of cattle were the source of contamination. The WSU group also expressed concern that a rapid switch in diets will cause metabolic distress and may even set the stage for colonization of the animal's gut by salmonella, another potential source of food poisoning.
[Hoard's Dairyman, 25/10/98]
[ANIMALNET & Farm & Country, 19/10/98]

Potential Listeria contamination has led to the recall of packages of franks and cheeseburgers by Florida–based Dixie Packers Inc., and Hormel Food Corporation. The bacteria were discovered during routine testing. The recalled cheeseburger sandwiches come in a 4.8–ounce package with lot number 09248E. Some of the franks were also distributed to the Bahamas. The recalled franks have a sell–by date of 13 Nov 1998 and a label inside the USDA inspection seal that reads either "Est. 1415M" for beef products or "P�" for poultry products.
[News Media, 24/10/98]

Eleven Ellenville area residents have [been] diagnosed with Legionnaires' disease. Three of the five people who died in the recent pneumonia outbreak had the disease, health officials confirmed yesterday.All are among more than 30 cases of pneumonia to hit the Ellenville area since mid–September. In addition, 30 to 40 Ellenville Community Hospital workers were diagnosed with flu–like symptoms that health investigators said was Pontiac Fever, a weaker form of Legionnaires' disease, but caused by the same bacteria. Water samples from the hospital's cooling tower tested positive for Legionella, while the hospital's hot water system, which delivers water used for patients, tested negative. That has led investigators to speculate exposure could have occurred as people were coming in and out of the hospital, for anything from lab tests to visiting hours.
[The Times Herald Record online, 17/10/98]


The Weekly Epidemiologic Record (WER) of the World Health Organization (vol. 73, no. 41, 313𤬰, October 9, 1998) provides useful recommendations for persons working in high HIV prevalence countries in Asia. The authors describe the 51% reduction that occurred in Thailand with a short course of twice–daily oral zidovudine (AZT) used from 36 weeks' gestation until delivery. They further point out that adherence to the short AZT course was very good in Thailand, offered in medical settings with counseling and access to free infant formula. Besides infants, the article comments about identifying discordant parents (i.e., one positive and the other negative) and the importance of offering advice to both about ways to avoid additional HIV transmission. Finally, the WHO publication notes that simple and rapid same–day tests are becoming available, reported to be both acceptable and accurate. Such tests will be more fully described in the October 16th WER (i.e., vol. 72, no. 42). The feasibility of HIV testing and AZT therapy in Asian countries should be assessed with regard to problems that are specific to these countries. While financial and organizational difficulties form the main barriers, other aspects of testing, like acceptability and disclosure should also be taken into consideration. Compliance and involvement of spouses in treatment are other issues in question.
[Sea–aids, 14/10/98]

On 24 September the European Parliament and Council, with the help of the Commission, decided to set up a network for epidemiological surveillance and an early warning and response system for the prevention and control of communicable diseases in the European Community (EC) (1). A network committee, representing the member states and the Commission, will consider measures proposed by the Commission before they are adopted. The Commission, with the member states, have been called upon to ensure that this network is consistent with and complementary to the relevant EC public health programmes and interchange of data between administrations (IDA) telematic projects. The decision comes into effect on 3 January 1999. Scientists continue to debate whether surveillance, prevention, and control of infectious diseases should be carried out by and from a European centre for infectious diseases akin to the Centers for Disease Control and Prevention (CDC) in the United States or through a virtual centre based on electronic networks. The European Parliament had favoured a central institution and the Commission a network with national surveillance centres acting as nodes. To date specific disease networks, such as the European Centre for the Epidemiological Monitoring of AIDS, the EuroTB programme, ENTER–NET, and EWGLI (European Working Group on Legionella Infections), the development of telematics for effective communication about outbreaks, and an inventory of communicable disease surveillance, have produced European data sets and enabled effective action for the public health to be taken without a European centre (2,3). The debate now appears to have been overtaken by the decision of the European Parliament.
[Eurosurveillance Weekly, 22/10/98]


A new website for anthrax reports utilising OIE, FAO, and private and public information can be found at http://www.vetmed.lsu.edu/whocc/ MODERATING tb.net The tb.net e–mail discussion will be moderated from now on, and messages, queries, responses should be sent to tbnet@mos.com.np tb.net is a network of organisations and individuals interested in TB control and are involved in the development of a global resource centre for TB control on the World Wide Web, an email discussion group, a newsletter, and an annual conference on NGOs and TB control.

INTERNATIONAL COURSE IN DENGUE FEVER An international course in Dengue fever will be held from August 23rd – September 3, 1999 at the Institute of Tropical Medicine "Pedro Kouro" (IPK) in La Habana, Cuba. The WHO Collaborating Center for the Study of Viral Diseases at IPK, considering the dramatic increase in the incidence of Dengue Fever and Hemorrhagic Dengue noticed in the Americas since the beginning of the decade of the 1980s, with an expansion of the distribution of the causative agent and the vector mosquito and as part of continental effors to face this emergency convenes this course in co–sponsorship with the Pan American Health Organization (PAHO). Professors from Cuban and non–Cuban scientific Institutions will participate, as will others from various PAHO/WHO Collaborating Centers, in conferences, seminars, group discussions and practical sessions. Additional information is available at the IPK's Web site: http://infonew.sld.cu/instituciones/ipk/cdengue.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.

October 28, 1998

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