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Vol. II, No. 04 ~ EINet News Briefs ~ February 23, 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 This week's bulletin features several news briefs on vaccines, emphasizing the important role that vaccines play in infectious diseases. The absence or reduced prevalence of certain infectious diseases in this century are largely attributed to the development of vaccines. While vaccines may not have the instant and dramatic effect of curative medicine, they continue to remain a hope for the future in emerging infections. 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 THAILAND– AIDS VACCINE TRIAL IN PROGRESS 2,500 people have volunteered to participate in a phase III trial of the AIDS vaccine in Thailand. Most of the volunteers are young male intravenous drug–users who are at high risk of HIV infection. Trials in Africa and the U.S. are already in progress. The vaccine that is to be tested in Thailand is different from the product used in the U.S. in order to match the various prevailing strains of HIV in that country. The Thai trials are being conducted by the California–based firm VaxGen, and is estimated to cost $6ץ million. Preliminary results on the effectiveness of the vaccine will be available in 30 months. [BBC World Service, Feb. 09, 1999] VIET NAM (KIEN GIANG)– JAPANESE ENCEPHALITIS Eight children between the ages of one to four years have died from suspected Japanese Encephalitis in the southern province of Kien Giang. The diagnosis has been confirmed in at least one child, while blood results for the other children are pending. Four other children have been admitted to the Kien Giang provincial hospital with the illness. [Agence France Presse, Feb. 11, 1999] OCEANIA PAPUA NEW GUINEA– ELEPHANTIASIS 20 to 25 percent of the four million people in Papua New Guinea are affected by the mosquito borne disease, elephantiasis or lymphatic filariasis. The disease causes lymphatic blockage resulting in swelling of the legs and scrotum, and is more prevalent in the coastal regions. An infected person manifests the symptoms only after 10㪬 years. The disease is preventable, but to eradicate it, the whole population has to take the required drug. The Medical Research Institute is staging an eradication program at Bagabag Island in Madang Province where almost 3,000 people are suspected of being infected. [The National, Feb. 1999] PAPUA NEW GUINEA– NEW HIV CASES DOUBLE IN 1998 The number of HIV/AIDS cases in the country almost doubled last year, more than 70% of cases being reported in the National Capital District. A total of 642 new cases of HIV infection, and 185 cases of AIDS were recorded. According to the health department, for every one case that is reported, 10 cases are not reported. The provinces of Enga and Chimbu were included in the Sexual Health Project in 1997, and the rise in the number of new cases in these provinces most likely reflect increased awareness among provincial workers. Facilities for testing for AIDS is limited and very little information is available from provinces like Gulf, Bougainville and West Sepik where there is an apparent lack of awareness of the disease among health staff. [The National, Feb. 23, 1999] AMERICAS DIPHTHERIA VACCINE RECALL Following the detection of a problem with a specific lot (Connaught Lot No. 1694732) of Tripedia Dtap (Diphtheria vaccine), the CDC has asked GeoSentinel to issue an advisory of importance to international travelers in the pediatric age group. The vaccine was distributed only in the U.S., but may have been sent by various multi–national entities to sites overseas. Additional detailed information and a list of high–risk countries is available on the National Immunization Program web page at: http://www.cdc.gov/nip/announce/default.htm USA– FDA WARNS OF TYPHOID RISK Thirteen cases of typhoid fever reported in the U.S. between mid–December and early February may be linked to consumption of frozen mamey, a tropical fruit that was imported from Guatemala. Most of the illnesses occurred in Hispanic communities in South Florida. The FDA (Food and Drug Administration) has advised consumers against consuming drinks made from frozen mamey, or eating the El Sembrador brand of mamey imported from Guatemala. This particular brand of frozen mamey was found in the freezers of homes of individuals who contracted typhoid fever and in restaurants where some of the victims ate the product. Laboratory results are pending on the samples that were collected in conjunction with the Florida Department of Agriculture and Consumer Services, and the Florida Department of Health. [FDA, Feb. 22, 1999] OTHER NEW VACCINE FOR MALARIA A multipronged vaccine to fight malarial parasites at various stages of invasion has been developed by the U.S. Centers for Disease Control and Prevention and Indian researchers. Animal experiments with the vaccine have shown that it has been effective in preventing malarial parasites from invading liver cells, and from replicating in the blood. The report was published in the National Academy of Sciences. The vaccine will next be tested in primates before human trials are commenced. PHRI/SOROS RUSSIAN TB PROGRAM Russian prisons are undergoing an alarming increase in numbers of TB cases, and are expected to have an incidence rate of 4000/100,000 by next year. The civilian population is expected to have an incidence rate of only 50/100,000 in comparison to the prison population. MDRTB is an increasing concerning in Russia. To combat this problem, WHO has endorsed a DOTS–Plus strategy to treat and control the spread of MDRTB. This strategy can only be developed on the foundation of a fully implemented DOTS program which encompasses civilian and prison populations. The Public Health Research Institute, operating under a $12 million grant from the Open Society Institute (Soros Foundation), has developed a TB program that has five major elements: 1) training of personnel to develop sustainable local capacity to manage TB control in Russia; 2) provision of equipment and supplies for diagnostics and treatment; 3) setting up a network of bacteriological laboratories; 4) oversight and quality control of implementation by Russian collaborators; and 5) public advocacy. A basic infrastructure for TB control systems has thus been established with implementation of comprehensive DOTS–based treatment schemes. The Russian federal and local governments, and other Western NGOs are working in collaboration with the PHRI/Soros TB program. Two of PHRI's project sites have been chosen for DOTS–plus project sites. While this TB program is the largest and most significant foreign public health activity on Russian soil, it covers only 2% of the civilian population and 6.5% of total prison population. Major Western funding commitments are required to contain the TB problem in Russia, as the government does not have the resources to address the problem on a national scale. [tbnet INFO, Feb. 21, 1999] 2. UPDATES FROM PREVIOUS BULLETINS MALAYSIA– JAPANESE ENCEPHALITIS State health departments in Malaysia have been ordered to not make any more statements regarding the Japanese Encephalitis outbreak that has claimed 14 lives in 4 months. According to the Health Minister, centralized dissemination of information would avoid confusion and adverse effects on the economy. It has been recommended that an official web site for the ministry would help to educate the public with frequent updates and curb rumors. While Japanese Encephalitis is not unusual in Malaysia at this time of the year, the epidemiology of the disease is unusual, as serological confirmation of the JE virus is lacking, and cases have been reported mainly in adults. [ProMed, Fe. 14, 1999] JAPAN– INFLUENZA While the worst of the flu epidemic seems to be over in Japan, the Ministry of Health continues to issue advisories to national hospitals, sanatoriums, and residential facilities for the elderly. The outbreak has claimed 244 lives, 80% of deaths being among the elderly. This winter's flu epidemic is expected to surpass last year's epidemic of 1.27 million reported flu cases. [CNN custom News, Feb. 16, 1999] 3. NOTICES INFECTION CONTROL FOR VIRAL HAEMORRHAGIC FEVERS– CDC/WHO MANUAL The CDC, in collaboration with WHO has developed a web site for Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting. The site has a teaching manual for infection control for VHF, links to several online resources pertaining to the topic. A virtual tour of the Special Pathogens Branch is also construction. The site can be accessed at: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual.htm 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.