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Vol. II, No. 05 ~ EINet News Briefs ~ March 10, 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 TRADE, TRAVEL AND EMERGING INFECTIONS, THE CHALLENGE FOR APEC The impact of infectious diseases on trade and travel while well known, continues to be evident from reports available from countries in the Asia–Pacific region. In this news brief, we have two articles pertaining to this effect. While travel and trade are important for the economic development of a country, they are also facilitated by a population that is relatively free of communicable diseases. Bans on trade imports as a result of disease, and contracting diseases during travel, are examples of how economic development can be hindered by ill health. The changing ecology of disease as a result of travel was evident in a previous news brief, where infected Canadian tourists who had visited dengue–endemic areas posed a public health problem in their home country. An outbreak of measles in Alaska in Nov. 1998 was linked to a young Japanese tourist, once again indicating how infectious diseases can be introduced into a non–immune population thereby altering the existing state of health in a country. HIV/AIDS introduction and transmission has been facilitated through travel between North America, Africa and Asia. Thus the linkages between travel and trade and emerging infections remain an important point of research and action. 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 CHINA– IMPORT BAN TO PREVENT FOOT AND MOUTH DISEASE As of February 4, China has banned the import of pigs, cattle and goats as well as their products from Middle Eastern countries which have been hit by an outbreak of foot and mouth disease. Imports from Malawi have also been suspended. [News Agency, Feb. 26, 1999] SINGAPORE– DENGUE/DHF SUMMARY FOR 1998 The resurgence of dengue in Singapore continued in 1998 with a total of 5,183 cases of dengue fever and 75 cases of dengue haemorrhagic fever. 153 cases were imported, and one fatal case involved a 2–month–old foreigner. The age–specific incidence rate was highest in young adults between the ages of 25 and 34 years. Males and Chinese predominated in the various categories. The incidence rate was highest among residents of landed properties. While disease transmission continued throughout the year, the majority of cases were reported between June and September. The majority of dengue viruses isolated were dengueמ. Discarded receptacles were found to be the most common breeding sites for the Aedes mosquitoes. Less than 2 percent of premises that were checked were positive for breeding Aedes mosquitoes. [Epidemiological News Bulletin, Singapore, Jan. 1999] OCEANIA AUSTRALIA– MEASLES ADVISORY A cluster of measles cases in Victoria have been linked to a 21 year old returned traveler from Bali, Indonesia. The first case was notified on March 01, 1999, and four other individuals have been confirmed by laboratory diagnosis. The infecting virus is believed to have the same genotype D5 virus as the measles strain that was isolated from a Victorian returned traveler from Bali in January 1999. An advisory has been issued to individuals traveling to Bali with regard to being vaccinated against measles. [Victorian Infectious Disease Reference Laboratory, Mar. 03, 1999] AUSTRALIA– RARE TYPE OF SALMONELLOSIS 74 people have been infected by a rare strain of salmonella typhimurium phage type 135A in Adelaide. The outbreak started in January with cases reaching epidemic proportions in mid–February. Initially, takeaway foods containing chicken were suspected to be the source of the outbreak, especially since this particular strain of salmonella has a historical association with chicken feed. Laboratory tests on Nippy's fresh–chilled orange juice products revealed the presence of this strain of salmonella. A public warning has been issued by health authorities regarding consumption of these juices, and a range of 48 Nippy's fruit juice products have been taken off shelves nationwide. The source of contamination is not known as yet, and is the first of its type in Australia. Researchers are trying to determine whether the strain of salmonella found in the fruit juices was responsible for the widespread illness. All 74 reported cases were below the age of 30 years, and included several children. [The Advertiser, Mar. 08 and Mar. 09, 1999] [News media, Mar. 06, 1999] AMERICAS CANADA– INCREASE IN INVASIVE GROUP A STREPTOCOCCUS INFECTIONS The Ontario Group A Streptococcal Study has documented an increase in the number of invasive Group A streptococcal infections in Ontario this winter. The number of invasive cases of GAS in January and February 1999, have been higher in comparison to any two month period since 1992. An average of 79 cases have been reported in these two months in contrast to an average of 44 cases per month period in previous years. An increase in the number of toxic shock syndrome cases (STSS) has also been striking, with 21 cases in Jan/Feb 1999, unlike previous years where the average was 8㪣 per 2 month period. While there is no marked clustering of the cases across the province, the increase was sufficient enough to be noticed by hospitals and health units. The STSS cases were found to be of varying strains. Polyclonal intravenous immunoglobulin has been recommended for treatment of STSS, and a case–control study of the use of this immunoglobulin will be published in Clinical Infectious Diseases in April, 1999. [Ontario Group A Streptococcus Study, Mar. 02, 1999] USA– EMERGENCE OF VANCOMYCIN RESISTANT STAPHYLOCOCCUS The first three cases of vancomycin resistant Staphylococcus aureus infections in the U.S. were reported by researchers. The findings show that prolonged exposure to vancomycin led to cellular modification that was responsible for development of resistance. This finding was common to the four strains of S. aureus that have been documented worldwide. The clinical course of the three patients have been reported in two separate articles in the New England Journal of Medicine. All three patients had histories of long term treatment with vancomycin linked with dialysis. [BMJ 1999; 318:557, Feb. 27, 1999] USA– MULTISTATE SALMONELLOSIS, UNUSUAL SEROTYPES Unusual serotypes of salmonella have been isolated in the U.S. since November 1998. Alfalfa sprouts distributed in Oregon and Washington were recalled following an outbreak of salmonellosis that was linked to the sprouts. Serotype Mbandaka was isolated from 13 confirmed cases in these states. Salmonella baildon infections were confirmed in 67 cases since mid–December 1998. 3 deaths were associated with this outbreak, and was linked to fresh produce items in restaurants. [The Infectious Diseases News Brief, Health Canada, Feb. 19, 1999] OTHER WHO RECOMMENDATION FOR COMPOSITION OF INFLUENZA VACCINE FOR 1999� The WHO recommended that influenza vaccines for the 1999�season contain the following: –an A/Sydney/5/97 (H3N2)–like virus –an A/Beijing/262/95 (H1N1)–like virus –a B/Beijing/184/93–like virus * or a B/Shangdong/7/97–like virus *The most widely used vaccine is virus is B/Harbin/7/94 More details can be accessed at WHO's Weekly Epidemiological Record website at: http://www.who.int/wer/pdf/1999/wer7408.pdf RESEARCH NEWS– DRUG RESISTANT UTI ON THE INCREASE A five–year study of women with urinary tract infections has found that more than 20% of women were resistant to penicillin–type antibiotics, and required longer periods of treatment with multiple drugs. The prevalence of resistance to two other commonly used drugs, trimethoprim and trimethoprim–sulfathoxazole rose from more than 8% in 1992 to more than 16% in 1996. Lesser–used drugs like nitrofurantoin, gentamicin and ciprofloxacin may become more logical choices in the future, as resistance to these drugs has not increased over this period. The study was done by the University of Washington, Seattle. [JAMA, March, 1999] MEKONG COUNTRIES DISCUSS WAYS TO REDUCE MALARIA MORTALITY China, Myanmar, Thailand, Laos, Cambodia, and Vietnam, met in Hanoi to discuss ways to reduce the severe impacts of malaria at a three–day meeting. A decision taken jointly by these countries was to halve the number of malaria deaths in the region by 2010. The Mekong Roll–back Malaria Initiative aims to bring together all concerned organizations, promote joint efforts and break down barriers. Malaria places a constraint on development, and deprives families of much needed income and food. A total of 130 million inhabitants of the six countries are at risk, and more than 15,000 die as a result of the disease each year. [Xinhua, Mar. 05, 1999] 2. UPDATES FROM PREVIOUS BULLETINS MALAYSIA –DENGUE, 1998 The incidence of dengue in 1998 in Malaysia has increased fourfold since 1990. The incidence rate was 120/100,000 in 1998 in comparison to 27.5/100,000 in 1990. Compared to the previous year, there was an overall increase of 42% in the incidence of dengue. [ProMed, Feb. 23, 1999] MALAYSIA– JAPANESE ENCEPHALITIS Japanese Encephalitis continues to be a source of concern in Malaysia as more fatalities have been reported in Negri Sembilan. The number of people who have died from suspected Japanese Encephalitis in Negri Sembilan has been reported to be ten now, as of Mar. 07. There have been 52 suspected cases of Japanese Encephalitis since October 1998,though only 13 cases have been confirmed by laboratory diagnosis. The Health Ministry is taking steps to contain the outbreak, and foreign experts, including those from the United States' Centers for Disease Control may be called in to tackle the situation. Pig farms in Bukit Pelandok, Ulu Piah, Tambun and Jalan Ampang in Ipoh, Perak and a farm in Sikamat, Seremban have been affected so far. The Malaysian Government has ordered authorities to vaccinate all pigs in the country, and the Health Department is expected to enforce this order under the Destruction of Disease Bearing and Insects Act. The Veterinary Services Department plans to kill thousands of pigs in Negri Sembilan to stem the spread of the disease. Pork consumption in Malaysia has fallen between 30㫀% since the beginning of the outbreak. [ProMed, Feb. 23, Mar. 03, Mar. 05, Mar. 07, 1999] [CNN Custom News, Mar. 03, 1999] 3. NOTICES  US–JAPAN COOPERATIVE MEDICAL SCIENCE PROGRAM MEETS IN BANGKOK The 4th International Conference on Emerging Infectious Diseases in the Pacific Rim will be held at the Montien Riverside Hotel, Bangkok, Thailand, from March 2נ, 1999. The agenda of the meeting includes: "State of the Science" presentations Helminthiasis: Approaches to Control Influenza: Challenge for the 21st Century Updates: Dengue Hemorrhagic Fever Pathogenesis of DHF: New Insights Regional perspectives on helminthiasis with a focus on schistosomiasis, filariasis, and malaria Regional perspectives on influenza with a focus on opportunities for research collaboration Working group meetings and reports Subject: Dengue Fever, a menace at the doors of the year 2000 Location: City of Havana Dates: August 23 – September 3, 1999 WHO COURSE OFFERED ON DENGUE– DENGUE FEVER, A MENACE AT THE DOORS OF THE YEAR 2000 The WHO Collaborating Center for the Study of Viral Diseases at IPK, considering the dramatic increase in the incidence of dengue fever and hemorrhagic dengue in the Americas since the beginning of the decade of the 80's, along with the spread of the causative agent and the vector mosquito, and as part of continental efforts to face this emergency convenes this course, co–sponsored by the Panamerican Health Organization (PAHO). Applications should be sent to: Prof. María G. Guzman Instituto "Pedro Kourí" P.O.Box 601 – Marianao 13, Ciudad Habana, Cuba Teléfono: 53ף� 53ף� Fax: 53ף� 53ף� e–mail: lupe@ipk.sld.cu Additional information is available at the IPK's Web site: http://infonew.sld.cu/instituciones/ipk/in 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.