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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:
- Updates from previous bulletins
- Overview of infectious–disease
information from PRO–MED and other sources
- Notices
- How to add colleagues to the EINet
listserv
1. UPDATES FROM PREVIOUS
BULLETINS
PHILIPPINES– DENGUE 68% INCREASE
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.
ASIA
INDONESIA– DENGUE
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]
PHILIPPINES– LEPTOSPIROSIS ADVISORY
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]
OCEANIA
AUSTRALIA – GONOCOCCAL DISEASE SURVEILLANCE
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]
AUSTRALIA – MENINGITIS, MENINGOCOCCAL: SURVEILLANCE
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]
PAPUA NEW GUINEA (SOUTHERN HIGHLANDS)– HAEMORRHAGIC FEVER
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]
AMERICAS
CANADA (EX BARBADOS)– DENGUE
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]
USA– E. COLI PREVALENCE IN CATTLE & FARM ECOLOGY
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]
USA– LISTERIA CONTAMINATION ADVISORY
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]
USA (NEW YORK)– LEGIONELLOSIS
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]
OTHER
GUIDELINES FOR PREVENTING MOTHER–TO–CHILD HIV TRANSMISSION
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]
EUROPEAN PARLIAMENT DECIDES ON A COMMUNICABLE DISEASE NETWORK
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]
3. NOTICES
ANTHRAX WEBSITE
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.
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