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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 AsiaPacific 
        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 infectiousdisease 
          information from PROMED and other sources
Notices
How to add colleagues to the EINet 
          listserv
 
         
          
  1. UPDATES FROM PREVIOUS 
        BULLETINS  
      USA LISTERIA CONTAMINATION ADVISORY 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. Sellby 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 reinstituted. 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 tollfree 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 INFECTIOUSDISEASE
        INFORMATION FROM PROMED    Here is our regular summary of 
        relevant AsiaPacific 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), cosponsored by WHO. 
 ASIA
 
 SOUTH KOREA (SEOUL) E.COLI (EHEC) A sevenyearold 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]
 CHINESE TAIPEI SHIGELLOSIS 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]
 THAILAND LEPTOSPIROSIS 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 ratextermination 
        gear to help capture the rodents.
 [Reuters, 04/11/98]
 [Associated Press, 05/11/98]
 VIETNAM DENGUE/DHF 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]
 
 OCEANIA
 
  AUSTRALIA (MELBOURNE)LEGIONELLOSIS 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]
 AMERICAS
 
 CANADA CHOLERA, IMPORTED  EX EQUATORIAL GUINEA, PAKISTAN
 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]
 USA ALASKA  MEASLES IMPORTED 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 midAugust. 
        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]
 USA ORLANDOSALMONELLA JUICE OUTBREAK TRACED TO TOAD 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]
 USA  TENNESSEE NOSOCOMIAL TRANSMISSION OF W2 STRAIN OF TB The increased virulence of Wvariant 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 tuberculinnegative healthcare workers had been exposed 
        to the patient during the 96hour 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 DrugSensitive WVariant 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]
 OTHER
 
 CHINA HIV PREVENTION 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. Twothirds 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 antiHIV campaign involving a multimedia 
        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]
 VENEZUELA YELLOW FEVER 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)]
 
         
          3. NOTICES
 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 AsiaPacific 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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