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Vol. II, No. 02 ~ EINet News Briefs ~ January 26, 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: 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. 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 MONGOLIA – INFLUENZA– A The epidemic of influenza–A that struck Northern China in December 1998 and early January 1999 was mirrored in Mongolia with similarities in start dates, peak, and abatement of cases. Descriptive statistics were also similar. Virology studies are currently in progress, and there is strong evidence that the virus in Mongolia was the same as that which struck Northern China. [ProMed, Jan. 14, 1999] JAPAN – VRE IN POULTRY Vancomycin Resistant Enterococcus has been detected in frozen chickens imported from Vietnam. A health alert was issued following this discovery as the chickens were already on the market. The bacteria escaped detection by quarantine inspectors. The Nagoya wholesaler that shipped the poultry from Vietnam decided to inspect its stock after learning that VRE had been detected in shipments in Yokohama and Kobe. This is the first time the bacteria has been detected in poultry after it has cleared customs. VRE was responsible for the death of a 60–year–old man in July 1998. The bacteria can be killed by cooking poultry for five minutes at 80–degree heat. [ASAHI NEWS, Jan. 18, 1999] OCEANIA NEW ZEALAND – NEW MOSQUITO VECTOR Aedes camptorhynchus, an Australian mosquito species has established a local population in a small area north of Napier City. The mosquito is a known vector of Ross River virus. While pest experts consider the eradication of the species to be a simple job, the Ministry of Health and the Agriculture and Forestry Ministry are evaluating a risk assessment strategy which has come under criticism due to the delay in further action being taken. [ProMed, Jan.20 and Jan. 21, 1999] PAPUA NEW GUINEA (NEW IRELAND)– YAWS An outbreak of Yaws in the New Ireland has led to a series of meetings between health officials and doctors. More than 1,000 people are believed to have been affected by this outbreak. Officials are in the process of verifiying the outbreak, and doctors have been alerted in case it becomes an epidemic. [Post Courier Online, Jan. 25, 1999] AMERICAS RESEARCH REPORT – HIGH SALMONELLA RISK WITH ALFALFA SPROUTS Researchers have reported an increased risk of salmonellosis associated with consumption of alfalfa sprouts in the Journal of the American Medical Association this week. Their report was based on salmonella outbreak investigations during 1995� in Oregon, British Columbia, and Denmark. The problem in eliminating the bacteria from seeds lies in the fact that this cannot be achieved without compromising the seed's germination potential. The bacteria resides in the crevice of the seed between the cotyledon and testa, an area that chemical treatments do not penetrate. Seeds are often stored for months or years under cool, dry conditions in which Salmonella bacteria are stable. During the three to five–day sprouting period the bacteria can increase in number three to four times, the report said. Contamination of seeds can occur in a variety of ways before they reach the consumer. It was also reported that more than 20,000 people in North America contracted salmonella infections from alfalfa sprouts in 1995. While irradiation of seeds may be the only solution to prevent salmonella outbreaks, it may be not be well received by consumers. [Nando media, Jan. 13, 1999] CANADA, USA – BOTULISM ADVISORY An advisory has been issued against the bacteria causing botulism following contamination of two lots of Hickory Farms Beef Stick, beef summer sausage. The sausage is sold in a vacuum packed 375g package which does not bear a "keep refrigerated" warning. The packages bear the following codes: EST 222 8255 8258 or EST 222 8255 8257. The product was imported from the United States and distributed throughout Canada. [CFIA press release, Jan. 12 1999] CHILE – NEW HANTAVIRUS OUTBREAK Four people have died from hantavirus infections in the past few days in the Nuble province, and doctors believe the disease is on the resurgence now. All four victims displayed symptoms characteristic of hantavirus disease. The first victim of the disease was a 44–year–old woman. Two infected family members are recovering in a hospital in the city of Chillan. Official confirmation of the disease will follow after investigations by the Public Health Institute. This year's drought has been cited as a reason for the resurgence of the disease as it brings humans into close contact with rodents, which tend to go closer to homes in search of food. The risk of infection for travelers is said to be low as long as precautionary measures are taken. [USA Today, Jan. 13, 1999] [CHIP news, Jan. 15, 1999] USA– LISTERIOSIS AND MEAT RECALLS Three companies in the U.S. have voluntarily recalled meat products following detection of Listeria bacteria by the USDA. Sliced luncheon meat products produced by OSCAR MAYER were traced as the source of contamination in a single case of listeriosis in an elderly gentleman in Kansas City, Missouri. The products were distributed throughout the U.S., Singapore, Bermuda, Aruba, St. Martin, the Dominican Republic, and Puerto Rico. The 10 oz "Oscar Mayer All American Variety Pack" and 6 oz "Oscar Mayer Club Sandwich Variety Pack" have a January 12 production date, and bear the codes "EST 537A" or "P�". The operating plant of Thorn Apple Valley Inc. in Arkansas has been shut down by the USDA due to failure to comply with sanitation requirements. Repeated detection of listeria in hot dogs and luncheon kits produced from July 6 through December 30, 1998 and unsanitary conditions in the plant were cited as reasons for the closure. The products were also sold to companies in South Korea and Russia, and bear the codes "EST 13529" and "EST P�". Bosell Foods, Inc. of Cleveland has recalled 350 pounds of sliced ham following listeria detection. The meat was distributed only in Cleveland and packages are marked with EST 2587, with a sell–by code 2㪪�. OTHER CHINA– AIDS China's growing AIDS problem has been compounded by other difficulties that include a general deficiency of funding and human resources, lack of AIDS education, and unavailability of antiretrovirals. Even if the latter were approved for use in the country, cost would form a barrier to treatment. WHO estimates that there are close to 600,000 HIV infected people in China. Mode of transmission varies by region, and multiple subtypes of HIVם, including A, B, B', C, D, E, and F, as well as a unique recombinant C/B' strain have been isolated. The government is seeking international help to combat the problem. [Scientist, Jan. 04, 1999, Vol 13, No. 1] WHO DIRECTOR GENERAL ON BURDEN OF DISEASE Dr. Gro Harlem Brundtland, the Director General of WHO while speaking on the topic of a burden of disease approach to address health problems, emphasized on six principles that need to be taken into consideration. These include: 1) evaluation of problems based on best available evidence, 2) use of best available information, 3) focus on non–fatal health outcomes, morbidity and disability, 4) focus on inequalities 5) examination of risk factors, and 6) anticipation of future trends. Neuro–psychiatric conditions alone account for 10% of the global disease burden. Tobacco use, under–nutrition, alcohol, unsafe sex and HIV were other major causes of disease burden that were cited. The burden of noncommunicable diseases and neuro–psychiatric conditions is also expected to rise as a result of longer life expectancies and demographic changes. The Global Burden of Disease Study will be refined and elaborated by an innovation of the WHO, a cluster on Evidence and Information for Policy. [Dec. 15, 1998] 2. UPDATES FROM PREVIOUS BULLETINS MALAYSIA– JAPANESE ENCEPHALITIS The outbreak of Japanese Encephalitis in Malaysia appears to be ongoing with four more fatalities being reported in the month of January. Restrictions have been imposed on transport of pigs in Negri Sembilan and Perak, and pig farmers have been asked to co–operate with authorities on reporting new cases and eliminating breeding grounds of mosquitoes. 160,000 people have been targeted for vaccination in Perak and Negri Sembilan, of whom only 15,850 have been vaccinated until now. DNA sequencing of viruses isolated from pigs in Negri Sembilan is under progress to determine whether they belong to the same strain as the those found in Perak. While Japanese Encephalitis is not uncommon in Malaysia during the months of Nov/Dec/Jan, high fatality rates in young adults is unusual as is the case in this outbreak. Mass vaccination of pigs is being carried out in Perak using a vaccine imported from Taiwan that has some similarities to the strain of JE virus circulating in that state. [Promed, Jan. 13 –Jan.18, 1999] USA– MULTIFOCAL LISTERIOSIS The outbreak of listeriosis attributed to contaminated meat products from Bil Mar Foods has claimed 10 lives and resulted in 3 miscarriages. More than 60 illnesses in 13 states have been linked to this outbreak. The Centers for Disease Control has begun releasing daily updates on the outbreak, and a full report is available at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00056169.htm [ProMed, Jan. 21 and 22, 1999] 3. NOTICES  WHO has recently published "Tuberculosis and Air Travel; Guidelines for Prevention and Control", which can be accessed at http://www.who.int/gtb/publications/aircraft/index.html 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.