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Vol. II, No. 03 ~ EINet News Briefs ~ February 09,
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 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:
- Influenza update
- Overview of infectiousdisease
information from PROMED and other sources
- Updates from previous bulletins
- Notices
- How to add colleagues to the EINet
listserv
1. INFLUENZA UPDATE
Hong Kong is preparing for a major outbreak of influenza before the Chinese
New Year holiday which falls on Feb. 16 and lasts until midMarch. 8807
suspected cases of influenza were admitted over one weekend and samples
have been sent to WHO for confirmation of the strain of influenza virus.
The Department of Health has announced that 11 Holiday Clinics would remain
open during the first three days of the Chinese New Year to tackle the
rising trend of "influenzalikeillnesses". The Department of Health's
surveillance program has shown the predominant strain affecting Hong Kong
is the influenza A H3N2 Sydneylike strain. Doctors in Singapore confirmed
that there was an increase in the number of influenza cases by 20㫊%
when compared to previous weeks in 1998. Patients are also taking a longer
time to recover (10㪦 days) than normal (3נ days). No new or unusual
strains of influenza have been isolated in Singapore. The isolated strains
were influenza A H1N1, influenza A H3N2 and influenza B. Japan is experiencing
a widespread epidemic of influenza this winter that has already left 96
people dead. 85% of them were elderly people, a substantial number of
them living in nursing homes or residential facilities located in Iwate,
Miyagi, Niigata, Gunma and Saitama prefectures. The Health and Welfare
Ministry has instructed prefectural governments to vaccinate residents
in such facilities and to take other preventive measures. According to
the National Institute of Infectious Diseases, the disease is more prevalent
in adults than in children possibly due to a lower percentage of adults
having immunity against this winter's virus. 761 schools have been forced
to suspend some or all classes because of low attendance. As of January
16, a 16fold increase in influenza cases was recorded among schoolchildren
in 10 days. A total of 62,500 schoolchildren are believed to have been
affected by the outbreak. Influenza B, influenza A (H3N2)/Sydney, and
influenza A (H1N1) strains have been isolated in Japan.
Regions in Canada continue to report sporadic, localized or widespread
influenza activity, and as of January 15, 1999, influenza B, influenza
A (H3N2), and influenza A (H1N1) have been identified. The United States
is also experiencing a worsening of the flu season wherein more than 30
states have reported outbreaks. Influenza A (H1N1)/Bayern, influenza A
(H3N2)/Sydney, and influenza have been reported. An upsurge in type A
flu was seen during the second half of January.
[CNN Custom News, Jan. 30, Feb.01, 1999]
[ProMed, Jan. 27㪶, Feb. 03, 1999]
[The Straits Times Interactive, Jan. 27, 1999]
[WHO, Jan. 28, 1999]
More details on influenza activity can be accessed at WHO's web site at
http://oms.b3e.jussieu.fr/flunet/
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
CHINA TRANSIENTS SUSCEPTIBLE TO HIV/AIDS
Health experts predict that the number of HIV positive cases in mainland
China could be more than the estimated 1 million by the year 2000. This
is largely due to the fact that the transient/floating population of China
is 80 million to 120 million. 80 million of this population are rural
migrants, 96% being in the "sexually active" category. A 1997 survey conducted
by a southern province revealed that most HIV carriers were migrants from
other provinces, and more than 79% were drug addicts. The Chinese Association
of Prevention and Control of STDs and AIDS plans to set up a network including
public health and family planning personnel, and the media to increase
public awareness and strengthen control of HIV/AIDS among floating populations.
[South China Morning Post, Feb. 01, 1999]
[China Daily, Jan. 29, 1999]
CHINA TTV VIRUS IN LIVER CANCER PATIENT
Chinese doctors have discovered a new type of hepatitis virus in a liver
cancer patient. While infection with the B or C type hepatitis virus has
been related to liver cancer, discovery of this seventh hepatitis virus
in a liver cancer patient might indicate a new direction for liver cancer
research. The Transfusion Transmitted Virus was first discovered in a
Japanese hepatitis patient in December 1997, and is believed to be transmitted
through blood transfusions and possibly other ways.
[China Daily, Jan. 28, 1999]
MALAYSIA DENGUE
The number of dengue cases recorded in 1998 showed a 42.4% increase from
1997. A total of 27,370 dengue cases and 58 deaths were documented. This
increase has been attributed to inappropriate storage of water as a result
of drought that in turn facilitated breeding grounds for mosquitoes. Construction
and factory sites that failed to eliminate breeding grounds for mosquitoes
are additional reasons for an increase in the mosquito population. The
province of Sabah did see a marked decrease of 25.8% in the number of
dengue cases in 1998 when compared to 1997, unlike some states that had
increases even up to 200%. The Ministry of Health has decided to adopt
the Cuban strategy in high risk areas to contain dengue. The Cuban method
aims at eradication of the vector involving total community effort combined
with a structural organisation. Legislative measures to encourage household
compliance, health education, biological control and chemical control
were instituted in Cuba along with reduction of larval habitats and modification
of drinkingwater storage tanks. Dengue transmission was not detected
between 1981 and 1996 in Cuba and reemerged only in 1997. This reemergence
was attributed to various factors including increased migration of people
from diseaseendemic areas, and a breakdown of eradication measures.
[BERNAMA, Jan. 27, 1999]
[ProMed, Feb. 02, 1999]
MALAYSIA (PORT KLANG) CHIKUNGUNYA FEVER
An outbreak of chikungunya fever in Port Klang has affected 27 people
since December 1998 resulting in 10 hospital until now. 80% of the patients
were adult females. The predominant symptoms were fever, maculopapular
rash, and migratory polyarticular arthralgia predominantly affecting the
small joints of the hands, wrists, ankles and feet. The outbreak followed
flooding in the locality resulting in an increase in the vector, the Aedes
aegypti mosquito which is also the vector for dengue fever. In collaboration
with the Western Australian Centre for Pathology and Medical Research,
Perth, Australia, causative organisms like rubella, dengue, and other
alphaviruses were ruled out. 6 out of 6 tested samples were IgM positive
for chikungunya virus. The WHO Collaborating Centre for Arbovirus Reference
and Research (DF/DHF) in Kuala Lumpur, with the help of Australia, will
have the test available locally soon. [WHO CCRR (DF/DHF)Malysia, Feb.
06, 1999]
OCEANIA
NEW ZEALAND E. COLI O157:H7 DETECTED IN CARRIER
The potentially dangerous strain of E. coli O157:H7 was found in a person
in Timaru. This is the first time that the strain has been found in the
South Island. The case was reported to Crown Public Health, and the Medical
Officer of Health has issued a warning against the organism.
[The Press, Jan. 12, 1999]
AMERICAS
USA (MULTISTATE) LISTERIA, MILK RECALL
Suspected listeria contamination has led to a recall of Land O'Lakes 2%
milk produced by Kohler Mix Specialties Inc., a subsidy of Michael Foods
Inc. The milk is sold in tenounce cartons dated Feb. 10 and Feb. 11 and
has been recalled in Minnesota, Wisconsin, Iowa, North Dakota, South Dakota,
Nebraska, Illinois and Indiana. The plant code 27𤮐 is printed on the
top seal of the carton. No illnesses have been reported so far. Consumers
are advised not to drink the milk and to return it instead for a refund.
They may call Kohler Mix at 800𤫨 or Land O'Lakes at 800𤬸
for further information.
[Nando Net, Feb. 04, 1999]
USA (MULTISTATE) VIBRIO PARAHAEMOLYTICUS
Between July 21 and September 17, 1998, 23 cultureconfirmed cases of
Vibrio parahaemolyticus were reported in Connecticut, New Jersey, and
New York. 22 of the 23 ill persons had eaten or handled oysters, clams,
or crustaceans. Oysters or clams eaten by 11 of the 16 patients were traced
to Oyster Bay, off New York's Long Island. The mean surface water temperature
measurements from 15 Oyster bay stations was cooler than measurements
in 1997 and 1996. Following a decline in temperature, no additional cultureconfirmed
cases of Vibrio parahaemolyticus were reported. While this was the fourth
multistate outbreak of V. parahaemolyticus infections in the U.S. since
1997, this is also the first associated with shellfish harvested from
the northeast Atlantic Ocean. More details on this outbreak can be accessed
at http://www.cdc.gov/epo/mmwr/mmwr_wk.html
USA TB OUTBREAK IN CALIFORNIA PRISON
Outbreaks of TB were reported in two California prisons in which 32 people
were infected. Of those sickened, nine were former inmates on parole and
another was the HIVpositive wife of one of the inmates who was infected
after visiting her husband. In addition, 12 prison employees had positive
TB skin tests but did not come down with the disease. According to a corrections
spokeswoman, this was the fastest and largest documented spread of the
disease in the prison system's history. Since the outbreak, California
has placed HIVinfected inmates in respiratory isolation and started them
on multidrug therapy for TB even when another pulmonary process is diagnosed.
[Associated Press, Feb. 05, 1999]
OTHER
HIV SURVIVES FOR A MONTH IN SYRINGES
The scientific basis behind syringe exchange programs and used syringe
disposal schemes has been further strengthened by the finding that HIV
can survive at room temperatures for more than a month. Researchers at
Yale University were able to recover viable and proliferating HIVם from
syringes that had been maintained at room temperature for more than 4
weeks. They specifically modeled and tested for the small amount of blood
that typically remains in syringes after use by injection drug users.
[Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
1999; 20:73㫨]
RISK OF TB THROUGH TRAIN TRAVEL
The risk of acquiring TB through train travel though minimal, has been
documented in two passengers who traveled with a man who had active tuberculosis.
The CDC was able to track nearly half of the 479 passengers who were on
one of the two passenger trains that the infected man traveled on over
a 2day period in January 1996. Of those passengers who were traced, the
two who were infected had relatively close contact with the man: one had
been seated near the ill passenger, and the other had engaged in a brief
conversation with him. The risk of transmission is considered to be low
in spite of the prolonged duration of travel in a shared space for two
reason: the train's ventilation system may have limited transmission,
and the number of droplets expelled into the air by the infected man by
his efforts to cough into the hood of his sweatshirt. While there are
a significant number of people traveling in trains and subways, and if
there does exist a substantial risk of acquiring TB through travel, the
results would have been obvious.
[Clinical Infectious Diseases 1999;28:52㫐, 57㫒]
3. UPDATES FROM PREVIOUS
BULLETINS
REVISON OF THE IHR PROGRESS
The International Health Regulations are being revised in order to adapt
to the epidemiology of communicable diseases and international traffic
in the 21st century. According to the revisions, all disease outbreaks
of international importance will be notifiable, while regularly occurring
endemic diseases will not be notifiable, unless an outbreak has special
features and poses an international threat. Other steps in the revision
process include, an international survey on current aircraft disinfection
practices, organization of health/trade seminars in selected countries,
and continuing discussion with the WTO Sanitary Phytosanitary Committee.
Issues requiring further study and consultation have also been listed.
The next progress report is due in July 1999. It was also decided by the
World Health Organization's ad hoc Committee on orthopox virus, to destroy
the last stocks of smallpox and other poxvirus infections in the Russian
Federation and the United States. 91% of the Member States were in agreement
with the implementation of the destruction. More details are available
at http://www.who.int/wer/pdf/1999/wer7404.pdf
USA LISTERIOSIS (MEAT RECALL)
An additional 200,000 pounds of meat have been recalled by Sara Lee Corp.
following its earlier recall in December 1998. The additional brands being
recalled were sold by Grand Rapids, Michiganbased Gordon Food Service,
which operates about 70 stores; Allen Foods, which has one outlet store
in St. Louis; Sara Lee's PYA Monarch food service unit, which runs two
stores in Montgomery, Alabama; and a Bil Mar Country Store outlet in Zeeland,
Michigan. Researchers form the CDC are trying to determine whether dust
from a construction event could have been the source of contamination
at the Bil Mar plant.
[FSNET, Feb. 01,1999]
USA LISTERIA ADVISORY: AIRLINE PASSENGERS
Culinary Foods Inc. has recalled thousands of chicken burritos following
the detection of listeria bacteria in this product in Detroit. The recall
affects 78,000 burritos supplied to American Airlines at the end of last
year (1998). Chicagobased Culinary Foods Inc., a unit of Tyson Foods,
is a supplier to airlines and also makes foods for restaurants, totaling
about 50 million meals per year.
[Nando Net, Feb. 07, 1999]
4. NOTICES
UPCOMING APEC MEETING HAS SPECIAL FOCUS ON HEALTH
The APEC Industrial Science and Technology Working Group (ISTWG), which
helps set APEC policies and efforts on health issues, is continuing its
focus on emerging infectious diseases at its next meeting, in Hong Kong.
The 16th gathering of ISTWG delegates will include on March 2 a "side
meeting" to discuss activities linked to the APEC Action Plan on Emerging
Infections. The Action Plan was approved by the ISTWG in 1998 to create
a framework for projects and collaboration on E.coli, TB and other emerging
infections. The "side meeting" is expected to examine ongoing projects
as well as the future of the Action Plan, and is open to any registered
delegate. For more information contact APEC EINet Communications Manager
Cliff Meyer at cliffm@u.washington.edu. You may also wish to visit the
ISTWG Web site, at http://www.apecst.org
SEATTLE TO HOST APEC MEETING ON HEALTH, BIOTECH
Health issues will be an even more prominent part of the 17th meeting
of the ISTWG, which will be hosted by the United States in Seattle, Washington,
on Aug. 16㪬, 1999. The APEC Emerging Infections Network and the University
of Washington are proud to be cosponsoring and helping organize major
event that will help increase health policy informationsharing and cooperation
by policymakers, officials and others throughout the APEC economies. In
addition to the regular business sessions, this ISTWG meeting will feature
a special daylong seminar and set of sessions dealing with emerging infections,
biotechnology and other related topics. The activities will also include
site visits to internationally known healthcare institutions and corporations
based in the Seattle area.
We urge you to set aside the dates Aug. 16㪬 so that you or colleagues
in your economy can attend this event, which will help set the stage for
collaboration into the new century. Those people who do not wish to become
delegates to the full ISTWG meeting will be welcomed at the separate health
and biotech events. More information about the tentative agenda and expected
speakers will be forthcoming, through EINet News Briefs and on the EINet
Web site (http://www.apec.org/infectious). For further information, contact
APEC EINet Communications Manager Cliff Meyer at cliffm@u.washington.edu.
WHO/WPRO WEB SITE
The STD & HIV/AIDS World Health Organization (WHO) Western Pacific Office
(WPRO) Web site is now offering access to STD and HIV prevalence data
from the region that can be accessed at http://www.who.org.ph/technical/programme/std.htm
The site also features
Selected documents published by the office on STD , HIV and AIDS (section
epidemiology and publications)
Access to the latest HIV/AIDS reported data in the region (section epidemiology)
Set of selected slides on HIV /AIDS and STD in the region (section epidemiology)
Resolutions of the Regional Committee (general information)
Budgetary information (general in formation)
Related sites
FOOD SAFETY WEB SITE
A new food safety site has been developed for the public to find food
safety information more readily on the web. The site provides links to
food safetyrelated web sites from federal, state and local government
agencies. This site was developed by FDA's Center for Food Safety and
Applied Nutrition (CFSAN) in consultation with USDA's Food Safety Inspection
Service (FSIS). The site can be accessed at:
INFECTIOUS DISEASE WEBLINK
A new infectious disease site is now available on the Web at http://pages.prodigy.net/pdeziel
This site is billed as an Infectious Disease Specialty Supersite and provides
the user a portal for locating infectious disease (ID) information. It
contains many links to governmental, nongovernment university ID sites,
medical, microbiology, images and travel medical sites, Medline, many
other links too numerous to list. This free site is updated regularly
and loads quickly from a dialup connection. Visitors are invited to sign
in the guest book and submit new links.
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 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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