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Vol. II, No. 01~ EINet News Briefs ~ January 12, 1999 ****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: Focus on influenza activity Overview of infectious–disease information from PRO–MED and other sources Updates from previous bulletins Notices How to add colleagues to the EINet listserv 1. FOCUS ON INFLUENZA ACTIVITY Northern China is gradually easing from the effects of an epidemic of influenza that struck the region in mid–December, 1998. The virus has been identified as the particularly virulent type A H3N2, that has the propensity to mutate making preventive measures more difficult to implement. The strain has been named the Harbin variant reflecting a mutation of the virus. The Sino–Japanese Friendship Hospital in Beijing experienced a four–fold increase of patients due to the epidemic, and statistics from hospitals in Tianjin reveal more than 10,000 people who have been affected by the epidemic. The Ministry of Health has taken preventive measures to prevent further spread of the epidemic by seeking the co–operation of health and education departments. Mass vaccinations were given in Beijing to 20,000 people, mostly children, elderly people and company employees. The vaccine, imported from France is against the A3 virus strains (Sydney), and the A1 and B (Beijing) strains. Abnormal weather may have contributed to the spread of the virus, this being the warmest winter in Beijing in 50 years. One newspaper reports states that more than 1,800 people have been cremated in Beijing since December 5, 1998, a 40% increase over the same period in 1997. More than 80% of those dead, were above the age of 60 years with most dying of pneumonia, or respiratory and heart disease. There are conflicting reports about the actual number of deaths attributed to influenza, and it may be that the numbers are low considering the severity of symptoms. Fears that the epidemic will spread further south are said to be groundless, according to the chief of the National Flu Centre. Health officials in Hong Kong are monitoring the situation for an increasing trend of the epidemic, but believe that the people of Hong Kong are at less risk as they must have at least partial immunity to the virus from previous epidemics. Reports of influenza activity in Europe have also been noted recently, though sharp increases have been seen only in England and Wales until now. The Sydney and Beijing strains of influenza A and influenza B are circulating in England, but the outbreak has not officially reached epidemic proportions. An epidemic is declared only when 400 cases per 100,000 of the population are confirmed to have the disease in a given week. The Royal College of General Practitioners(RCGP) is monitoring the situation. According to reports from individual countries and the World Health Organization, influenza activity has been relatively slow to start this season in Europe. [Xinhua news agency, Dec. 15, 1998] [Agence France Presse, Dec. 17, 1998] [South China Morning Post, Jan. 06, 1999] [ Wenweipo Daily newspaper, Jan. 08, 1999] [ProMed, Jan. 07, 1999] [Hong Kong Standard, Jan. 06, 1999] [China Daily, Dec. 14, 22, & 31, 1998] [Eurosurveillance Weekly, Jan. 07, 1999] [BBC, Jan. 08, 1999] 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 CAMBODIA (PHNOM PENH)– SUSPECTED JAPANESE ENCEPHALITIS 600 fatal cases of suspected Japanese Encephalitis have been reported in Phnom Penh, mostly involving children. Further information will be available at a later date. [ProMed, Jan. 05, 1999] CHINA (HONGKONG)–CLOSTRIDIUM PERFRINGENS Improper food handling has been identified as the cause of an outbreak of Clostridium perfringens among school children who ate school lunches last week. 774 children who ate the lunch–box meal were traced by the Department of Health, and 493 students with symptoms were identified. The gravy used in the meal had been stored at room temperature for a night allowing the multiplication of bacteria. Intestinal colic followed by diarrhea, and nausea are common symptoms associated with the organism. [South China Morning Post, Dec. 13, 1998] PHILIPPINES (AKLAN)– GASTROENTERITIS EPIDEMIC FEARED An epidemic of gastroenteritis is feared in the province of Aklan following a series of flash floods as a result of heavy rains and typhoons last month. Records at the government–owned Dr. Rafael S. Tumbokon Memorial Hospital (DRSTMH) here showed that 423 persons afflicted with the waterborne disease were admitted from Dec. 1 to 31. Nine deaths have been reported as of Dec. 28. Health authorities mainly attributed the spread of the disease to contaminated water sources. Doctors also blame poor sanitation in Aklan households, improper waste disposal and unsanitary food preparation as among the factors that contributed to the spread of the disease. [Philippine Daily Inquirer, Jan. 05, 1999] SINGAPORE –LEPTOSPIROSIS Cases of leptospirosis are on the rise in Singapore following an increase in the population of rats that carry the disease. 14 cases were reported in the first eight months of this year, while an average of only 9 cases a year were reported between 1993 and 1997. Normally, only 5% of market and food centers were found to have a problem with rats, but this was not the case last year where 50% of the places surveyed had rats. In the first nine months of this year, rats were found 16 per cent of the time (35 out of 211 places). [The Straits Times Interactive, Dec. 7, 1998] VIETNAM– HIV CARRIERS DETECTED IN ALL PROVINCES OF VIETNAM HIV carriers have been reported in all 61 provinces of Vietnam resulting in a total number of 11,301, 2,071 of whom account for AIDS patients. The National AIDS Committee met in Hanoi to work out a plan to accelerate dissemination of information on HIV/AIDS in 1999. [NHANDAN Newspaper, Dec. 31, 1999] OCEANIA AUSTRALIA– ROSS RIVER VIRUS INFECTION While the total number of reported cases of Ross River virus infection has remained significantly lower than in 1997, the number of cases (198)during November and December of 1998 were higher than the corresponding period in 1997 (67). [The Australian, Jan. 01, 1998] AUSTRALIA– OUTBREAK OF SHIGELLA An outbreak of shigellosis at a funeral lunch in Adelaide has been attributed to contamination of ham served at the lunch by a food handler on the previous night. This person had recently recovered from a diarrheal illness, the cause of which was unknown. The attack rate for those who ate the ham was 62% (8 out of 13). Person to person transmission has also been considered a possibility following the use of a single hand towel in the bathroom that had become sodden from hand wiping. A total of 13 people became ill with diarrhea, and Shigella sonnei biotype G was grown from three of the cases. Shigella dysenteriae type 2 was also cultured from one individual who had acquired the infection before attending the funeral from elsewhere. S. sonnei biotype G has been the commonest Shigella identified during 1997 and 1998, in contrast to S. dysenteriae type 2 which was last notified only in 1990. [FSNET & Communicable Diseases –Australia Vol. 22; No.13, Dec. 31, 1998] PAPUA NEW GUINEA– TYPHOID 600 cases of typhoid and 40 deaths were reported in the Western Highlands Province during the past year. Typhoid was listed as the number one cause for admissions in Mount Hagen Hospital. Unhygienic food and contaminated water were cited as causes for the rise in incidence. An outbreak of typhoid in New Ireland Province in November 1998 affected more than 30 people and is on the decline now. [ProMed, Jan. 11, 1999] AMERICAS USA– LISTERIOSIS, MULTIFOCAL Contamination with Listeria monocytogenes has accounted for 50 cases of listeriosis and 8 deaths in 11 states since early August 1998. Hot dogs produced by Sara Lee Corporation's Bil Mar Foods unit in Zeeland, Michigan, were the source of contamination, and specific production lots of hot dogs and other meat products were recalled on Dec. 22, 1998. The establishment numbers are EST P261 and EST 6911. LM isolates from the hot dogs and cases belonged to serotype 4b and shared an unusual DNA pattern called Pattern E. More details are available on MMWR at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00056024.htm [Nando net, Dec. 18, 1998] [FSNET, Dec. 22 & 24, 1998] [MMWR, Dec. 23, 1998] [CNN Custom News, Jan. 08, 1998] USA (NEW MEXICO)–UNDIAGNOSED FEVER Researchers in New Mexico are trying to find the cause of an unknown illness since 1993 characterized by fever, chills,, nausea, vomiting, abdominal pain, diarrhea, and loss of appetite. The most prominent symptom is severe muscle pain. Low platelet and white blood cell counts are other features of the illness. While all patients have recovered, the diagnosis remains unknown inspite of aggressive investigations conducted by five labs from around the country. 80 unsolved cases have collected since 1993, and similar cases have been detected in Colorado, Texas, Arizona, and Utah. The illness appears to be related to rural areas, and peaks in August. [Albuquerque Journal, Dec. 13, 1998] USA– EPIDEMIC OF SEXUALLY TRANSMITTED DISEASE Latest figures reveal that the incidence and prevalence of sexually transmitted diseases in the United States are among the highest in the industrialised world. The United States had 15.3 million new cases of sexually transmitted disease in 1996 and more than 68 million Americans now have an incurable sexually transmitted disease such as herpes, human papillomavirus infection, hepatitis B, or HIV infection. Teenagers and young adults are most affected by sexually transmitted diseases. By the age of 24, one in three sexually active people in the United States has had a sexually transmitted disease. While the CDC estimated 12 million cases a decade ago, the latest figure of 15.3 million may also reflect more sensitive tests and screening procedures. Sexually transmitted infections now cost the US economy $8.4 billion (5.25 billion) each year for medical treatment. [BMJ, Dec. 12, 1998;317:1616] OTHER TUBERCULOSIS ADVISORY, AIR TRAVEL – WHO The World Health Organization has issued an advisory about the risk of acquiring TB by air travel from fellow air passengers on long flights. The risk, though small, is real and cases have been documented where passengers have been infected with the bacterium. Poor ventilation, flights over 8 hours long, and crowding on airplanes facilitate the spread of the bacterium. WHO estimates that a third of the world's population carries the bacterium. The organization has issued guidelines to airlines to help limit exposure by barring those with known disease from air travel. While WHO admitted that it would be difficult to have complete airline records, it recommended airlines trace and inform passengers and crew who were on a flight of more than eight hours with an infectious person. [ProMed, Dec. 17, 1998] USA – LYME DISEASE VACCINE PROGRESS The first vaccine against Lyme disease has been approved by the Food and Drug Administration. It is indicated for people between the ages of 15 and 70, and is given in three doses over a one–year period. Since it is not 100% effective, the FDA recommends alternate methods of protection from ticks while spending time outdoors. Safety and efficacy were shown when the vaccine doses were given between January and April, shortly before the peak tick season in the northeast US. The duration of protection, and safety data on the use of the vaccine in pregnancy or in patients with chronic joint and neurological disease is limited. The vaccine contains a genetically engineered protein from the surface of Borrelia burgdorferi bacteria, which causes Lyme disease. For this reason, the vaccine is effective only against B. burgdorferi s.s., and not against other variants that are found outside the U.S. [ProMed, Dec. 22 & 23, 1998] 3. UPDATES FROM PREVIOUS BULLETINS AUSTRALIA (MELBOURNE) –LEGIONELLOSIS Three cooling towers in Thomastown have been identified as possible sources of the Legionella outbeak in October. DNA testing of samples from infected patients and the cooling towers were supportive of this conclusion. [Herald Sun, Dec. 24, 1998] MALAYSIA– JAPANESE ENCEPHALITIS VACCINATION The outbreak of Japanese Encephalitis in the state of Perak has been contained following effective vaccination and education of residents in pig farm areas, and fogging residences and pig farms. No new cases have been reported since 30 Nov. 1998, and the final count is 11 cases, including 4 deaths. 70, 000 people living near pig farms in seven states are considered to be at risk, and the Ministry of Health has decided to ask the Federation of Livestock Farmer's Association to pay for vaccination of this population. High–risk groups living outside these areas will fall under the responsibility of the Ministry. Free vaccinations are currently being given to residents in the affected areas, targeting a total of 6,864 people. The Ministry has also requested the Veterinary Research Institute to produce a cheaper local vaccine for pigs, since the vaccine currently used is imported from Japan and costly. Mandatory vaccinations are being given to 10,000 residents in the town of Shah Alam, 25 km west of Kuala Lumpur, a high–risk area due to the number of pig farms. [The Straits Times, Dec. 18, 1998] [Bernama– The Malaysian National News Agency, Dec. 17, 1998] [Borneo Bulletin, Dec. 29, 1998] 4. NOTICES  The 2nd Australasian Conference on Hepatitis C: HCV – the Evolving Epidemic will be held from 17㪫 August 1999 at Christchurch, New Zealand. This conference is intended to provide a forum for all those involved with hepatitis C to present and discuss their perspectives on the evolution of this global epidemic and their responses to it. The programme will include keynote addresses as well as concurrent streams on basic sciences, clinical sciences, epidemiology and social research, community support and self management, and prevention and public health. Abstracts are invited for presentation in all streams and the abstract deadline is 1 March 1999. For more information e–mail: cindy@conference.co.nz Or visit their website at: www.cae.canterbury.ac.nz/hcv/hcv99.ht 5. 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.