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Vol. I, No. 16 ~ EINet News Briefs ~ November 10, 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


Florida based Dixie Packers, Inc., is voluntarily recalling 192,553 pounds of lunch meat products, after contamination with Listeria monocytogenes was discovered on subsequent testing of products after the previous recall on 24/10/98. Subject to recall are all sizes of the "W/D Brand" products with establishment numbers 1415M and P�. Sell–by dates include Nov 13, Nov 22, Nov 27 and Dec 06, 1998. USDA began withholding inspection at the plant yesterday; the plant will remain closed while plant management evaluates and reassesses its production processes and controls. The plant will need to provide FSIS with a corrective action plan to control processes at the plant before inspection is re–instituted. FSIS field and district enforcement personnel are assisting the plant in its evaluation to determine how it can adjust its processes and take appropriate corrective actions needed to prevent future problems. Consumers may call toll–free USDA Meat and Poultry Hotline at 1𤴐𤰇� between 10 a.m. to 4 p.m. (Eastern Time) Monday through Friday.
[News media, 05/11/98]

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.


A seven–year–old boy has been diagnosed with the deadly O157 bacterium which killed several people in Japan in 1996. The boy was hospitalised last month for severe vomiting, high fever, and stomach pain. After tests revealed the causative organism, health officials have been on the lookout for more cases at the boy's school. Contaminated and undercooked meat, mainly beef, is a source of infection, as a result of which health officials have issued an advisory against the disease. To prevent further spread of the bacteria, inspections of food products will be improved, and public eating places have been urged to take preventive measures. The public have also been advised to follow hygienic practices. According to health officials, this is the country's first human case of O157 E. coli infection. A TV station (Korea Broadcasting System), claimed that at least 3 known cases of O157 food poisoning were treated at Pusan National University Hospital in 1996.
[Korea Herald daily, 06/11/98 & 09/11/98]

An epidemic of shigellosis among school children in Taoyuan County has led to a warning issued by the Department of Health, stating that all schools in the region should have their water supply examined for the bacteria. 69 students at Taoyuan's Tah Chung and Tah Yung primary schools have been taken ill with diarrhoea and vomiting, and three have been hospitalised. 79 students at Taoyuan's Wu Kung primary school were confirmed to have contracted the disease.
[GPHIN, 09/11/98]

Leptospirosis has claimed the lives of 22 people, and affected more than a hundred in northern Thailand. The northern and northeastern provinces of Prae and Surin have been affected. Diseased rat urine has been cited as the cause for the outbreaks, and health officials are encouraging farmers to wear boots while working in the rice fields to avoid cuts and scratches caused by rice stalks or sharp grass which may be contaminated by rat urine. Officials are also providing free traps, poison and other rat–extermination gear to help capture the rodents.
[Reuters, 04/11/98]
[Associated Press, 05/11/98]

Deaths from dengue fever this year account for more than 50% of dengue deaths from last year. While 159,449 people have been affected by the disease, 321 deaths have been recorded as of October 20. Last year, 226 of the 107,000 people who contracted the virus died.
[CNN Custom News, 02/11/98]


Legionnaire's disease has struck 16 people in the Thomastown –Reservoir area. An additional ten people suspected to have the disease have been hospitalised. Two cooling towers in the Thomastown area have tested positive to Legionella and the owners have received decontamination notices. Officers have tested, disinfected or closed about 12 of more than 25 cooling towers in the area. Those infected either worked in the area north of Mahoneys Rd, or lived in residential areas just to the south, bordering on the Reservoir. No new cases have been reported since 8/11/98, but more can be expecyed as the incubation period for the disease is at least 10 days.
[Herald Sun, 01/11/98]
[News Media, 06/11/98]


Two cases of cholera imported from Pakistan and Equatorial Guinea, have been reported in the month of September in British Columbia and Ontario respectively. The delay in reporting to WHO was due to obtaining all data from provinces.
[Health Canada, 28/10/98]

As of November 3, 27 confirmed cases of measles have been reported to the Alaska Department of Health and Social Services. The first case was a 15 year old high school student, diagnosed on September 16. 11 probable cases, and 7 suspected cases have also been reported. The outbreak is believed to have originated from a young Japanese child who was visiting Alaska with his parents in July. He was diagnosed with measles in mid–August. Though he had numerous contacts while he was infectious, almost all of these contacts had received at least one MMR. It is possible that secondary cases could have been missed between August 19 through 31, and the current outbreak is a result of "third generation" measles. Isolation and analysis of the virus is currently in progress.
[Department of Health, Alaska, 03/11/98]

An outbreak of Salmonella infection in 62 people in 1995 has been traced to a batch of unpasteurised orange juice sold at Disney World. Toads living around the processing plant were found to be the carriers of the organism, and researchers writing in the Journal of the American Medical Association say that the processing plant had cracked walls. The researchers think the orange juice was responsible for many more Salmonella cases than the 62 which were reported. Fruit juices are generally thought not to cause sickness because of their acid content. Taking into account the E.coli outbreak in 1996 which was linked to unpasteurised apple juice, pasteurisation of fruit juices play a role in preventing the transmission of harmful bacteria. The US Food and Drug Administration (FDA) has recently tightened regulations on the labelling of fruit juice, making it illegal for people to sell unpasteurised fruit juices without warning consumers of the dangers of harmful bacteria being present.
[Journal of the American Medical Association, 04/11/98]

The increased virulence of W–variant strain of Mycobacterium tuberculosis has been confirmed by an outbreak of TB among 35 health care workers (20%) exposed to a single AIDS patient in 1992 in Nashville, Tennessee. A total of 172 previously tuberculin–negative healthcare workers had been exposed to the patient during the 96–hour period before tuberculosis was diagnosed and the patient was isolated. Following the diagnosis of tuberculosis, all hospital personnel as well as others who had contact with the patient during the 96 hours before respiratory isolation was instituted were tested for TB exposure. A total of 35 workers were found to have newly recognized tuberculin positivity. The medical receptionists' work area and nurses' section were in close proximity to the source case's hospital room. Four months after exposure, a receptionist who had lupus erythematosus developed respiratory symptoms. Pulmonary tuberculosis was diagnosed by bronchoscopy at another Nashville hospital. In addition, a second patient with AIDS (patient 2) who had been admitted on the same floor one day before the source patient was placed in respiratory isolation developed tuberculosis five months following exposure to the source patient. Isolates from the two AIDS patients and the receptionist all had the same DNA fingerprint, which was assigned the strain number W82. This strain was found to have a similar genetic composition as the MDR W strain from New York City. From January 1990 to August 1993, there were 257 patients in New York City with active tuberculosis caused by the W strain, and nosocomial spread accounted for approximately 25 percent of all multidrug resistant cases reported in the United States during this time period. This report serves to highlight the difficulty in preventing nosocomial transmission of tuberculosis, and emphasizes the need for rapid implementation of infection control, and epidemiological investigation to minimize the risk of nosocomial transmission. More information on this outbreak can be obtained from "Nosocomial Transmission of a Drug–Sensitive W–Variant Mycobacterium tuberculosis Strain Among Patients with Acquired Immunodeficiency Syndrome in Tennessee," Infection Control and Hospital Epidemiology, September 1998;19(9):635𤱯). [Tuberculosis & Airborne Disease Weekly, 02/11/98]


HIV has become the focus of China's attention after a period of downplaying the incidence and prevalence of STDs, and factors leading to STDs in the country. As of October 1, a ban on sale of blood for transfusions has been in place since approximately 17% of HIV cases in the country are a result of tainted blood transfusions. WHO estimates that there may be as many as 400,000 infected people in China, while the government has stated that of the 10 million Chinese tested through March 1998, only 10,000 were positive. Two–thirds of the infections are a result of injection drug use. The government's goal is to keep the number of infected people under 1.5 million by 2010, and reduce the spread of HIV among intravenous drug users by 15 percent. An anti–HIV campaign involving a multi–media exhibition is expected to travel across the nation spreading AIDS awareness.
[Nature Medicine (11/98) Vol. 4, No. 11, P. 1216; Watanabe, Myrna]
[Inside China Today Online, 11/09/98]

Yellow fever in Venezuela In October 1998, Venezuela reported to Pan American Health Organization (PAHO/WHO) an outbreak of yellow fever with 14 cases and 3 deaths. The cases occurred among the Yanomami Indians who live in region of Parima within the Alto Orinoco County in the State of Amazonas, along the border with Brazil. The cases were identified between the epidemiological weeks 30th and 36th. Ten cases (71%) were male and 4 (19%) female. The age distribution of the cases is: 29% over 30 years of age; 50% between 20 and 30 years of age; and 21% between 5 and 19 years. All the cases were confirmed by laboratory testing: 11 had IgM positive and virus was isolated from 3 cases. One of the fatalities also had a liver specimen positive by the immunohistochemical analysis. To prevent new cases a vaccination program was implemented, targeting 177 Indian villages (population of 8,776). The program was able to reach a vaccination coverage of 86%.
[Vigilancia Epidemiologica del Ministerio de Sanidad y Assistencia, 04/11/98]
NOTE Yellow fever is endemic in Brazil and its neighboring countries, namely Bolivia, Venezuela, Columbia, Peru, Paraguay, Ecuador, Guyana and Suriname. Peru had a large outbreak of yellow fever in 1995, primarily in the rural areas. In response, immunization programs were carried out for populations in heavily forested areas. Some of the questions that arise with regard to Public Health are : could urban areas that are now heavily infested with Aedes aegypti be sites of transmission of yellow fever in the future? Are immunization programs going to be effective enough to eliminate the risk of yellow fever in these areas? Where should the health care dollar go for this disease? [D. Brandling– Bennett, Deputy Director of Pan American Health Organization (PAHO)]


The Society for Tropical Veterinary Medicine is holding its 5th Biennial Conference(STVM'99), between June 12㪨,1999 in Key West, Florida. The focus of the conference will be Tropical Diseases: Control and Prevention in the Context of "The New World Order". Extensive details of the conference, linked websites on Key West, and on line registration may be found at http://www.ifas.ufl.edu/~conferweb/stvm.htm or as a brochure through contacting the conference chair at bamt@gnv.ifas.ufl.edu.

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.

November 11, 1998

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