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
MALAYSIA – SUSPECTED JAPANESE ENCEPHALITIS
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]
OCEANIA
AUSTRALIA–HEPATITIS C SWEEPS NEW SOUTH WALES
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]
AMERICAS
USA –MYCOPLASMA PNEUMONIA, OUTBREAK?
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]
OTHER
NECROTIZING SKIN INFECTIONS
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]
INFLUENZAVIRUS A H5N1, COHORT STUDIES
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]
QUESTIONS ABOUT CYCLOSPORA
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]
REPORT: GLOBAL CONGRESS ON LUNG HEALTH
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]
3. E.
COLI OUTBREAKS
JAPAN– E. COLI O157 OUTBREAK CLAIMS 3 LIVES
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]
USA – GROUND BEEF RECALL – E. COLI CONTAMINATION
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]
CANADA (ONTARIO)– E. COLI IN APPLE CIDER
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]
4. LISTERIA
CONTAMINATION ADVISORIES
USA – LISTERIA CONTAMINATION ADVISORY
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]
CANADA (QUEBEC)– LISTERIA CONTAMINATION ADVISORY
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]
5. UPDATES FROM PREVIOUS
BULLETINS
SINGAPORE –DENGUE/DHF
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]
THAILAND– LEPTOSPIROSIS
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]
6. NOTICES
ISTWG MEETINGS:
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.
NEW MEMBERS OF APEC
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.
