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Vol. I, No. 17~ EINet News Briefs ~ November 24, 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. A focus on "W" strain of Mycobacterium tuberculosis
  2. Overview of infectious–disease information from PRO–MED and other sources
  3. E. coli outbreaks
  4. Listeria contamination advisories
  5. Updates from previous bulletins
  6. Notices
  7. How to add colleagues to the EINet listserv

he W strain of Mycobacterium tuberculosis was identified during the peak of an outbreak of multiple–drug–resistant TB in New York in 1992. This strain alone accounted for nearly one fourth of the cases of MDRTB in the United States during a 43–month period between January 1990 to August 1993. Retrospective studies revealed an outbreak of the same strain in a correctional facility in New York among 7 inmates and 1 employee who died from MDRTB in 1991. The W strain is known to be resistant to isoniazid, rifampin, streptomycin, ethambutol, rifabutin, kanamycin, and ethionamide. Several subtypes of this strain have been documented suggesting evolution from a single clone that has undergone several mutations. Identification depends on the characteristic IS6110 RFLP fingerprint or drug resistance pattern, though multiple PCR analysis permits more rapid and specific identification. The W strain is a highly virulent organism, and its importance in nosocomial transmission has been well established, as evident from development of infection mostly in HIV patients and health care workers. A single patient from New York was able to transmit the W strain to 8 patients, through a contaminated bronchoscope in a hospital in South Carolina in 1995. Five US states, and at least three major cities have documented spread of the W strain. These facts hold important implications for control of MDRTB, and re–emphasizes the need for effective DOTS, and infection control measures both in the community and hospital.

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.


Japanese encephalitis is suspected in an [disease] outbreak among pig breeders in a town in northern Perak state, Malaysia. 6 deaths and 15 other cases have been reported as a result of the outbreak. Of a total of 20 cases documented since October, 19 persons were workers in pig farms. According to a preliminary report, the victims showed similar symptoms of high fever and headaches for five to seven days, followed by drowsiness and coma a day or two later before their sudden deaths. The Institute of Medical Research is conducting investigations and the Ministry of Health has vaccinated 142 pig farm workers since the 23rd of Nov, and affected areas have been fogged.
[Agence France–Presse, 22/11/98]


Hepatitis C has reached epidemic proportions in New South Wales affecting more than 200,000 people. Prison inmates form a substantial percentage of the infected population as a result of intravenous drug use and tattoo practices. Studies confirmed hepatitis C infection rates of between 40% and 60% for male inmates and 70% and 80% for female inmates. A parliamentary inquiry has found that one new person contracts the disease every 3 hours in New South Wales. 10,000 new infections occur every year in Australia, with almost half of them in New South Wales. Urgent government intervention is needed to combat this crisis, and recommendations were made for this purpose in the parliamentary inquiry.
[The Sydney Morning Herald, 12/11/98]


Reports of an increase in cases of Mycoplasma pneumonia have been documented in the states of Kansas, Illinois, and Washington over the past few months. The disease is characterized by fever, cough and often, pharyngitis, with an incubation period of 2ן weeks. Rare complications include prolonged respiratory problems, anemia, joint pain, and neurological problems. Diagnosis is based on rise in IgM antibodies for Mycoplasma between acute and convalescent sera. The level of cold agglutinins though nonspecific, may reflect the severity of the disease. The disease responds well to antibiotics belonging to the macrolide or tetracycline groups. In Seattle, Washington state, the outbreak involved 26 students in a private school and may be an early indicator of a nationwide outbreak. Epidemic mycoplasma pneumonia activity is known to occur in cycles of 4ף years, and the last epidemic in Washington state was reported in 1992㫵. In Kansas, 20 cases of suspected or documented cases of pneumonia have been diagnosed at Whiteman Air Force Base, near Kansas City, Missouri. A cluster of cases were reported at a clinic in Peoria, Illinois, this summer. Persistence of the disease is due to a combination of factors, some of which are a long incubation period and persistence of nasopharyngeal carriage after antimicrobial treatment.
[ProMed, 16/11/98]
[Seattle Times, 20/11/98]


Flesh–destroying bacteria have been in the news lately in two different countries (U.S.A., and Australia) causing considerable concern among the public. Mycobacterium ulcerans has been implicated in cases that have occurred in the Australian state of Victoria. Buruli's ulcer, as it is otherwise known, was first detected in Australia in 1948 and is an endemic disease. The mode of transmission is unknown and environmental factors are known to play a role in transmission. The disease starts as a painless swelling and progresses to form deforming ulcers which if left untreated, can result in amputation of limbs and loss of organs. Surgical excision is the only known treatment. An 8 year–old boy in Washington state, USA continues to struggle with necrotizing fasciitis, for nearly a month after contracting the disease. Amputation of a limb and extensive removal of tissue were necessary to prevent the infection from spreading further. Though Group A streptoccus is the most common organism that causes necrotizing fasciitis, other bacteria can also produce the same disease. Prompt diagnosis and treatment are critical in preventing death, and limb and skin loss. [Seattle Times, 15/11/98]
[ProMed, 10/11/98]

Three cohort studies conducted among healthcare workers in Hong Kong reveal that there was insufficient evidence to show that man–to–man transmission may have occurred during the outbreak of avian flu in 1997. The results were based on low seroprevalence of antibodies to H5N1 among 154 exposed, and non–exposed health care workers. The primary mode of transmission is believed to be from poultry to man, and most probably through contact with faeces of poultry. Implementation of effective infection control measures like hand washing and use of masks would reduce any man–to–man transmission that might take place. A detailed report of these studies can be found at http://www.info.gov.hk/dh/new/index.htm
[Pacific Public Health Surveillance Network, 14/11/98]

CDC's research on contamination of raspberries by Cyclospora in Guatemala was terminated after epidemiologists detected Cyclospora in children of raspberry pickers. This may suggest acquired immunity to the disease while maintaining the potential to be a carrier. According to a U.S. Food and Drug Administration scientist, many questions about Cyclospora remain unanswered. Infective dose, reservoir hosts, vectors, seasonality of the disease, source of contamination, and inactivation parameters are some of the many questions that researchers are trying to answer. Sampling difficulties, lack of enrichment methods, geographical variations, and limitations in PCR diagnosis are other problems that have been cited.
[Inside Laboratory Management, AOAC Inter., 11/98]

The 29th World Conference of International Union Against Tuberculosis and Lung Disease, "Global Congress on Lung Health" is being held from Nov. 23㪲 in Bangkok, Thailand. Dr. Gro Harlem Brundtland, the Director–General of WHO called for more effort and focus on dealing with TB in Asia which has been declared the epicentre of the world's TB. Six high–burden countries which account for over 50 percent of the TB epidemic are in Asia. According to WHO estimates, 4.5 million of the eight million new cases that occur each year are in India, China, Bangladesh, Pakistan, Indonesia and the Philippines. HIV, MDRTB, and the prevailing economic crisis in Asia are risk factors that predict more problems in the global spread of TB. A new "Stop TB" initiative that will focus on a global charter to improve TB control, was introduced at the conference. Global TB research, global access to quality fixed dose combination TB drugs, widespread use of DOTS, and increased focus on high burden countries, MDRTB and HIV, are components of the "Stop TB" initiative. More information on the conference is available at http://www.atat.th.com/
[tbnet, 23/11/98]


Three elderly people have died after being infected with the O𤪍 strain of E. coli bacteria at a home for the elderly in the town of Tabuse, Yamaguchi Prefecture. A total of 21 people associated with the home are believed to be infected with the bacteria, but none of them are seriously ill. Two of the deaths were a result of hemolytic uremic syndrome (HUS) caused by the bacteria. Officials of the prefectural health department suspect that food served at the home between Nov. 9 and Nov. 13 could have been the source of the outbreak.
[Asahi Shimbun, 23/11/98]

The U.S. Department of Agriculture's Food Safety and Inspection Service announced the recall of frozen ground beef patties by a Chicago meat processing firm, Glenmark Industries Ltd., as a result of contamination with E.coli. The recall involves approximately 601,000 pounds of frozen ground beef, 366,000 pounds of which were sold, and 80%㫭% are expected to have been already consumed. Production dates were between June 24 and July 10, 1998. The contamination was discovered after a customer was taken ill and the bacteria was isolated from an open packet of beef patties in the freezer. Boxes or cartons of patties subject to recall can be identified by consumers from a list of product names and codes which are available on the USDA web site at http://www.fsis.usda.gov/OA/news/rc98㪭.htm Product packaged for retail sale may have been distributed nationwide. Consumers with questions about the recall may phone the toll–free USDA Meat and Poultry Hotline at 1𤴐𤰇�. The Hotline can be reached from 10 a.m. to 4 p.m. (Eastern Time) Monday through Friday.
[USDA Food Safety & Inspection Service website news release FSIS㫺–RC㪭, 21/11/98]
[CNN Custom News, 23/11/98]

An advisory against drinking unpasteurised apple cider has been issued by the health unit in Haliburton–Kawartha in central Ontario. This follows a number of E.coli cases that were linked to drinking unpasteurised cider. Unpasteurised cider has the potential to be contaminated by faeces of livestock that roam in orchards.
[FSNET & News release, 13/11/98]


Contamination of food products with Listeria monocytogenes seems to be an emerging problem in the U.S. this year as evident from several advisories against the organism, and recall of food products by companies. The Michigan Department of Agriculture issued an advisory on 11/13/98 against Herrud franks produced by Thorn Apple Valley Inc., which were found to be contaminated with Listeria monocytogenes. Customers have been told to return packages marked Nov 21 2A4 Est. No. P� and with UPC code 7470000902. Routine testing by the New York State Department of Agriculture & Markets revealed the presence of Listeria in smoked shad produced by Royal Baltic Ltd., of New York. The smoked shad was distributed in vacuum packaging or as unpackaged and unlabeled whole fish in retail stores in New York, California, Illinois, Oregon, and Washington states. No illnesses have been reported so far in both cases of Listeria contamination. The product recall includes codes 2710, 2810, and 2910. Consumers have been advised to return the product to the place of purchase for a full refund and can also contact Royal Baltic of Brooklyn, N.Y., directly at 718𤭱�.
[FSNET, 16/11/98]
[News media, 16/11/98]

Listeria contamination has led to the vouluntary recall of a cheese product in Quebec by La fromagerie Fritz Kaiser Inc., in Noyan. The surface ripened soft cheese commonly known as Empereur or Reblochon was sold between October 26 and 31, 1998 only at the counter of its manufacturing plant in Noyan, Quebec in unlabelled bulk units. Consumers have been advised to dispose of the product, or return it to the plant in Noyan, Quebec for a refund. Consumers can contact La fromagerie Fritz Kaiser Inc. for further information at (450) 294�.
[ANIMALNET & CFIA Press Release, 13/11/98]


A record number of 4,628 cases of dengue fever have been recorded so far this year in Singapore. A Chinese construction worker has been reported to have died from the disease. The Ministry of Environment continues to remind the public to adopt preventive measures to eliminate mosquito breeding spots. Singapore's rainfall is expected to increase by more than 20% in the months ahead, according to the Meteorological Service.
[The Straits Times Interactive, 06/11/98]
[ProMed, 19/11/98]

The recent outbreak of leptospirosis in Thailand was mostly due to L. batavia. This organism was most commonly isolated from sporadic cases in the Bangkok area and at Chulalongkorn University Hospital. Due to lack of availability of simple bed–side slide tests, laboratory diagnosis was delayed.
[ProMed, 19/11/98]


The 16th APEC Industrial Science and Technology Working Group Meeting will be held in Hong Kong from 2נ March, 1999 at the Hong Kong Convention and Exhibition Centre. The first day will be devoted to side meetings, while the official meeting will be held from 3נ March. An optional technical tour will be organized for the 5th of March. The 17th ISTWG Meeting will be hosted by the United States in Seattle, Washington in mid August, 1999. This will facilitate the ISTWG to meet before the Leader's Meeting in New Zealand in September. More details will be available at a later date.

U.S.– JAPAN COOPERATIVE MEDICAL SCIENCES PROGRAM will hold the International Conference on Emerging Infectious Diseases in the Pacific Rim from March 2ס, 1999 in Bangkok. A final agenda is still being developed, but the two major themes of the meetings of the meeting – influenza and parasitic diseases have been set. More details will follow at a later date.

Vietnam, Russia and Peru were admitted as full members at the 10th APEC Ministerial Meeting in Kuala Lumpur on Saturday, the 14th of November. It takes membership of the regional grouping to 21. Malaysia's International Trade and Industry Minister Rafidah Aziz, who chaired the Kuala Lumpur meeting, formally announced the admission of the three nations at the opening ceremony.

The November issue of the WHO Western Pacific Region STD, HIV and AIDS surveillance report(no 12)features short articles on: * New requirements for HIV and AIDS reporting * HIV and AIDS case reports: trends in the Western Pacific Region (WPRO) * Trends in proportions of HIV reported by risk exposure category * STD, HIV and behavioural surveillance among sex workers and their clients * Which data should be collected on sex workers and clients? This publication can be accessed at the WHO/WPRO website: http://www.who.org.ph/technical/programme/std.htm or copies may be requested from std@who.org.ph

7. 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 25, 1998

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