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Vol. II, No. 06 ~ EINet News Briefs ~ March 24, 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 CHINA– TUBERCULOSIS DEADLIEST DISEASE Tuberculosis has been cited as the deadliest disease in China by the Ministry of Health. About 250,000 Chinese are killed every year by TB. 6 million Chinese suffer from pulmonary TB, and 2 million have highly infectious forms. 1.13 million people are affected by TB annually. Drug–resistance and AIDS have also contributed to the epidemic. Migrations have also increased the risk for metropolises like Shanghai and Beijing. The Ministry of Health plans to educate the public by posters, pamphlets and nationwide contests in newspapers. A national epidemiology survey of TB will be conducted next year to improve control efforts. [Xinhua, Mar. 19, 1999] INDONESIA– SUSPECTED OUTBREAK OF ANTHRAX Consumption of a dead water buffalo may have resulted in an outbreak of anthrax in 268 villagers from the Indonesia's eastern island of Flores. One person has died so far, and two others are in critical condition. The carcass of the buffalo was on the way to a quarantine station and could not be analyzed for anthrax as all the meat had been eaten by the villagers. Investigation of the outbreak is in progress by the Manggarai farming office. [Agence France Presse, Mar. 10, 1999] HONG KONG– FOOD POISONING IN SCHOOL 20 girls from a Kowloon Tong primary school were diagnosed with food poisoning following complaints of diarrhoea, stomach pains, and vomiting. Spanish beef lunch boxes served at the school are the suspected source of contamination and investigations are in progress. [South China Morning Post, Mar. 16, 1999] JAPAN –IMPORTED CHOLERA 8 travelers returning from the Philippines and Thailand were diagnosed with Cholera 01 El Tor Ogawa as of March 05, 1999. These were the only cases of cholera that have been reported in Japan since Jan. 01, 1999. This situation is similar to last year where 54 of 58 cases of cholera in Japan were imported. [Quarantine Division, Narita Airport Quarantine Station, Mar. 18, 1999] SOUTH KOREA– SHIGELLOSIS An outbreak of bacillary dysentery has affected 30 residents in the southern city of Pusan following consumption of meals provided by a church in Samrak–dong on March 04, 1999. An special team is investigating the source of infection, and the city government is carrying out anti–epidemic efforts to prevent further spread of the disease. [Korea Herald, Mar. 16, 1999] OCEANIA AUSTRALIA– INCREASE IN ROSS RIVER VIRUS INFECTION EXPECTED An increase in the number of Ross River virus infections is expected following increased rainfall this summer. 9 cases have been reported so far in south–east Tasmania, mainly in the Sorell municipality. Outbreaks usually peak in mid to late summer or early atumn. [Mercury, Mar. 11, 1999] AUSTRALIA– LEPTOSPIROSIS Higher and prolonged rainfall, and flooding episodes have been cited as reasons for an increase in the number of cases of leptospirosis that have been diagnosed in the first two and a half months of this year. The WHO/FAO Collaborating Centre for Reference and Research on Leptospirosis, Queensland Health Scientific Services, Brisbane, has reported 58 confirmed cases of leptospirosis, compared to 16 cases for the same period in 1998. While the majority of cases involve a range of animal and agriculture based industries, increased awareness of the disease has also resulted in increased testing and diagnosis. Eight different serotypes of leptospiral infection have been recorded, with serotypes "zanoni" and "hardjo" accounting for over 50% of the disease. [WHO/FAO Collaborating Centre for Reference and Research on Leptospirosis, Mar. 22, 1999] NEW ZEALAND– CRYPTOSPORIDIASIS SCARE Several swimming pools in Waimakariri District Council may be closed following the closure of Kaiapoi Aquatic Centre that was linked to five cases of cryptosporidiasis. The pool was closed following an increase in the number of cases of cryptosporidiasis in north–east Christchurch and Kaiapoi. A health warning has been issued to the public with regard to the disease and its potential to spread through public swimming pools. [The Press, Mar. 23, 1999] NEW ZEALAND– MOSQUITO ALERT Two different species of mosquitoes capable of carrying Dengue fever and Japanese Encephalitis, were detected during port inspections of cargo from overseas ships. Two adults and five larvae of Asian tiger mosquitoes, capable of carrying the two diseases were found in old tyres in empty containers that were berthed near a ship from Japan. Aedes japonicus mosquitoes were also seen flying away during the off–loading of a car transporter from Japan. [The Press, Mar. 20, 1999] AMERICAS USA (NEBRASKA)– E. COLI FOOD POISONING An outbreak of E. coli O157:H7 that sickened 10 people has been traced to a restaurant salad bar in Kearney. The suspected source of contamination was lettuce served in the salad bar. At least eight additional cases may be linked to the outbreak. [FSNET, Mar. 11, 1999] USA– TUBERCULOSIS IN DAIRY CATTLE A herd of 115 cows and 8 calves were tested for tuberculosis in Morton County, North Dakota, and 31 positive reactors were found. Histopathological lesions were also found positive for these cattle, and confirmation by culture and PCR is pending. Animals within a 5 mile radius around the dairy will be tested by the North Dakota Agriculture Department, and animals that may have been sold or relocated will be traced. [ProMed, Mar. 11, 1999] USA– FDA REVISING ANTIBIOTIC GUIDELINES FOR ANIMALS Increasing numbers of antibiotic resistant strains of bacteria in animals has resulted in a major revision of guidelines for approval of drugs for animals. Routine use of antibiotics in farm animals have the potential to diminish their effectiveness in humans and foster the emergence of drug–resistant bacteria. One of the most recent class of antibiotics, fluoroquinolone, is of particular concern to scientists who have found Campylobacter in chickens resistant to this drug. The new guidelines require that manufacturers test new livestock drugs for a tendency to foster the growth of resistant bacteria. Testing will be required before and after a drug's approval, and if found to foster bacterial resistance will be banned from use as growth promoters in animals. Older antibiotics are also subject to these guidelines. Drugs used by humans will get special scrutiny. In the US, 6 of the 17 classes of antibiotics given to animals are also used to treat sick people. The prevalence of drug–resistant Salmonella has increased from 0.6% of all specimens from around the country in 1980 to 34% in 1996. Drug–resistant Campylobacter rose from 0 in 1991 to 13% in 1997, and 14% in 1998. Drug–resistance in people as a result of routine antibiotic use in chickens was documented by an increase of nearly 9% in the number of cases from 1992 to 1998 in Minnesota. The sharpest rise began in 1996, a year after fluoroquinolones were approved for use in chickens. [ANIMALNET, Mar. 08, 1999] OTHER USA– TREATING IMMIGRANTS FOR PARASITES A study published in the New England Journal of Medicine suggests that treating all immigrants coming into the US from areas endemic for intestinal parasites, would save lives and reduce healthcare costs. The population at risk has been estimated to be 600,000 annually, and implementation of such a program is expected to prevent 33 deaths, 374 hospitalizations, and $4.2 million in health care costs. The drug, Albendazole, has been recommended for treatment of immigrants from Asia, the Middle–East, sub–Saharan Africa, Eastern Europe, Latin America, and the Caribbean. The current US recommendation of universal screening of all immigrants is considered to be less cost–effective. [The New England Journal of Medicine 1999;340:773𤳻] AIDS VACCINES TESTED IN UGANDA AND THAILAND Researchers have commenced a phase I AIDS vaccine study in Uganda involving 40 healthy, HIV–negative low risk adults. While the vaccine is composed of 3 HIV subtypes commonly found in Europe and the US, the study is designed to determine if the vaccine is safe and can be tolerated by an African population, and if it can generate a measurable immune response. Vaxgen, a private biotechnology company based in San Francisco, will begin the first largescale trial of an AIDS vaccine outside the US, in Thailand. 2500 high risk individuals will participate in the trial designed to protect against two strains of HIV prevalent in Thailand. [British Medical Journal 1999, 318:628] 2. UPDATES FROM PREVIOUS BULLETINS AUSTRALIA– MEASLES 33 cases of measles reported in Melbourne have been linked to a traveler returning from Bali, Indonesia. The outbreak was originally limited to the western suburbs of Melbourne, and has now spread to a wider area. [The Herald Sun, Mar. 19, 1999] AUSTRALIA– SALMONELLA OUTBREAK 127 confirmed cases of Salmonella Typhimurium phage type 135A have been linked to Nippy's orange juice products that were recalled in the past two weeks following the outbreak. The strain of salmonella was found in one container of Nippy's juice in Adelaide, and tests are being carried out to find out whether the bacteria came from the Regency Park Factory where the juice is processed. The Regency Park Factory does export its products to other countries though they are UHT treated fruit juices that carry no risk of transmission of the bacteria. [The Murray Pioneer, Mar. 12, 1999] [ProMed, Mar. 11, 1999] MALAYSIA– JAPANESE ENCEPHALITIS The Ministry of Health has officially reported 154 cases of suspected Japanese Encephalitis in Perak and Negri Sembilan. 42 cases have been confirmed so far, and 56 persons have died from the epidemic. There is now evidence of a new virus involved in the epidemic that has caused widespread panic among pig farmers and their families. The new virus is believed to be a hendra–like virus that belongs to the paramyxovirus family. The hendra virus was first isolated in Brisbane, Australia, in 1994, following the death of 2 individuals and 16 horses. The probable mode of transmission is by direct contact with tissue fluids including urine. The MOH is taking several measures to control the epidemic by mass vaccinations of humans and pigs, health education, restriction of movement of pigs, and mass destruction of more than 300,000 abandoned pigs. Researchers from Australia, and the US (Center for Disease Control) are working in collaboration with the Malaysian Government to investigate the outbreak. In the meantime, the Malaysian economy has been hit hard by a drop in pork sales by seventy percent, and also by import bans by Thailand, the Philippines, and Singapore. Moreover, the government has spent 49 million ringgit so far on vaccinations and other control measures. Singaporean abbatoir workers are also being tested for the disease following the death of one worker. A ban on horses entering Singapore has also been implemented and individuals working with horses will be screened for the hendra–like virus. Victims of the hendra–like virus are being treated with ribavirin at the University Hospital in Malaysia, and the Health Ministry has advised all workers handling pigs or pork to wear protective clothing. More details on the outbreak can be obtained at the following websites: http://dph.gov.my/press/press2/japan_e.htm http://dph.gov.my/press/press2/cases.htm http://www.geocities.com/HotSprings/2188/je.html [ProMed and CNN Custom News, Mar. 11㪮, 1999] MALAYSIA– CHIKUNGUNYA FEVER Two more cases of chikungunya fever have been reported in Taman Kemp, Port Klang in the past few weeks. The District Health Office has been directed to monitor the affected area to prevent an outbreak of the disease. [Bernama, Mar. 15, 1999] 3. NOTICES  TRAINING COURSES ON INFECTIOUS DISEASES A new scientific journal designed for the medical, veterinary and environmental professions is being published this month. A full list of contents can be found on the website : www.idreview.co.uk A limited number of free samples are available on provision of a postal address. The second issue will contain the first ever global survey of postgraduate training courses for doctors and vets in infectious disease whether they be a few days long for Continuing Professional Development, or months or a year long for a Diploma or an MSc degree. The publishers are making every effort to contact all medical and veterinary schools to include all available courses from around the world, and invite such institutions to contact them at the following address: Chris Furley Tamurlane Press Ltd PO Box 10 Littlebourne Canterbury Kent CT3 1GP, UK FAX: +44–(0)1227� e–mail: Zoomed1@aol.com 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.