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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 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: Influenza update 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. 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 mid–March. 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 "influenza–like–illnesses". The Department of Health's surveillance program has shown the predominant strain affecting Hong Kong is the influenza A H3N2 Sydney–like 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 16–fold 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 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 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 drinking–water 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 disease–endemic 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 ten–ounce 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 culture–confirmed 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 culture–confirmed 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 HIV–positive 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 HIV–infected 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 2–day 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, Michigan–based 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). Chicago–based 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 co–sponsoring and helping organize major event that will help increase health policy information–sharing 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 health–care 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 safety–related 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, non–government 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 dial–up 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 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.