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Vol. II, No. 07 ~ EINet News Briefs ~ April 06, 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: Update on Japanese Encephalitis/hendra–like virus 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. UPDATE ON JAPANESE ENCEPHALITIS/HENDRA–LIKE VIRUS Current situation: MALAYSIA The newly discovered hendra–like virus has been claimed to be the major cause of the viral encephalitis outbreak currently raging in Malaysia. AS of April 2, 84 people have died since October 1998, and a total of 221 people have been affected by the outbreak. So far, only 18 deaths have been confirmed to be caused as a result of infection with the Japanese Encephalitis virus. While experts from the US, Australia, and Taiwan are working with Malaysian authorities on controlling the epidemic, very little is known about the hendra–like virus that was discovered two weeks ago. The only preventive measures recommended until now with regard to the new virus are, hand washing with soap or detergent, and protective clothing and gear for pig farm workers. The CDC has confirmed that this virus is killed by soap and detergent. CDC personnel have established a high–level biohazard laboratory at the University of Malaysia to handle specimens, identify isolates of the paramyxovirus, and conduct studies to determine the mode of transmission of this virus to humans. Transmissibility of the disease is thought to be low for those not associated with pig farming. The illness apparently begins with fever, followed by drowsiness and coma. Fluctuating blood pressure and body temperature occur in the late stages. Ribavirin appears to be effective when given in the early stages of illness. Malaysian authorities have expanded the pig culling campaign to the neighbouring state of Perak, and five buffer zones have been set up to contain the outbreak of the virus. Movement of human beings and livestock will be prevented in these zones by establishment of roadblocks. All pigs in the buffer zones will be slaughtered. Investigations are being conducted to identify the role of intermediary hosts in the transmission of the virus. Malaysia's pork industry, in the meantime has suffered a 70% drop in sales. The Philippine government has imposed a total ban on import of pigs and pork from Malaysia for the next 21 months. Indonesia has tightened control over the inflow of livestock from Malaysia in border areas in Sumatra and Kalimantan. Increased monitoring of the health conditions of the country's livestock, particularly pigs is also in effect in Indonesia. Thailand has also tightened border control along the southern provinces in an effort to prevent the spread of the virus. While there are no official recommendations for travelers to Malaysia other than being aware of the disease, Thailand seems to have benefited from the outbreak. Hotels have reported brisk business, and a larger than usual flood of tourists mostly diverted from Malaysia and Indonesia. While the diversion from Indonesia is due to the prevailing ethnic violence, tourists to Malaysia have been deterred by the viral outbreak. SINGAPORE US experts from the CDC have confirmed that 11 out of 15 blood samples sent to them contained IgM antibodies to the Hendra–like virus. The samples belonged to eight abattoir workers in Singapore. No new cases have been identified, and authorities in Singapore are confident that the situation has stabilized following a ban on import of live pigs from Malaysia. [ProMed, Mar. 25 – April 5, 1999] [Reuters, April 02, 1999] [Bangkok Post, Mar. 29, 1999] 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– SCHISTOSOMIASIS ALERT Health departments in China, especially along the Yangtze River and around Dongting and Poyang lakes have been advised to be on alert for the occurrence of snail fever, otherwise known as schistosomiasis. In spite of last summer's devastating flooding, only 1,888 cases of snail fever were reported throughout the country. [Xinhua, Mar. 30, 1999] CHINESE TAIPEI–LAGGING BEHIND IN ANTI–TB CAMPAIGN The Director General of the Department of Health has stated that Taiwan has a much higher TB rate than the United States (71/100,000 vs. 7.4/100,0000, and lags behind developed countries in its campaign to eradicate the disease. Taiwan had 14,000 TB cases in 1997, accounting for more than 80% of all infectious disease cases, with 1,600 of them fatal, accounting for half of all deaths from infectious diseases. TB is more prevalent in the mountainous areas of eastern Taiwan where its incidence rate is five times more than that of other areas. The mortality rate is also 3.4 times higher than the rest of the island. Only 80% of Taiwan's TB patients are ever fully cured, while 10% succumb to the disease, and 10% are not accounted for, posing a risk to the general public. [China News Agency, Mar. 24, 1999] HONG KONG– AVIAN FLU VIRUS DETECTED IN WATER FOWL Officials have isolated a strain of the H5N1 bird flu virus for the first time from Guangdong geese at a local wholesale market in Hong Kong. While this virus is similar to the 1996 virus that killed 6 people, further tests are needed to confirm the relationship. World–renowned virologist, Professor Robert Webster, has stated that there is no cause for alarm as the chances of human infection from the virus were very small. Poultry workers at the market showed no evidence of infection, and the Agriculture and Fisheries Department will stop importing poultry from contaminated farms on the mainland. It is believed that the emergence of the virus could be related to migrant birds, which are natural carriers of the influenza virus. [South China Morning Post, Mar. 29, 1999] [The Straits Times Interactive, Mar. 27, 1999] HONG KONG– HIV RISK FROM MAINLAND Dr. David Ho Da–I, an AIDS specialist in Hong Kong has warned of the risk of HIV in Hong Kong as a result of growing numbers of mainlanders who are HIV–positive. While the scenario did look grim with the rising volume of traffic in and out of border posts, he believed that Hong Kong was fortunate as it had ample resources to address the problem. [Sea–aids, Mar. 31, 1999] INDONESIA– TB INCIDENCE The incidence of TB in Indonesia is estimated to be 450,000 cases annually, making it the third biggest killer after heart and respiratory ailments. While the government is making an effort to combat the disease, especially with the implementation of DOTS strategy, poor compliance and high cost of treatment are factors that have proven to be an impediment. [Antara, Mar. 27, 1999] JAPAN– SALMONELLA TYPHIMURIUM DT104 Four outbreaks of food poisoning in 1997 and 1998 have been confirmed to have been caused by the antibiotic–resistant serotype of Salmonella known as DT104. A total of 27 people were affected in these outbreaks and none died. Many of the cases contracted the bacteria by eating raw meat. [Asahi Shimbun, Mar. 23, 1999] KOREA– TB DEATH RATE HIGHEST AMONG OECD NATIONS Korea's death rate from TB has been found to be 7.4/100,000, the highest among the 29 members of the Organization for Economic Cooperation and Development. A majority of the estimated 429,000 TB patients fall within the age range of 20㪶 years. In 1997, 3,455 people died of TB, 51.4% in the age range of 15㫘 years, and 48% aged 65 years and older. Approximately, 142,000 people contract the disease every year. [Korea Herald, Mar. 24, 1999] KOREA– SWINE FEVER Japan had has suspended pork imports from Korea beginning April 1, 1999, in an attempt to eliminate hog cholera and declare a cholera–free region before 2001. It has expanded the scope of pork import ban from the present within 2 km radius of the cholera outbreak in Korea to a 10 km radius. In other words, pigs raised within a radius of 10 km of the region where there was an outbreak of hog cholera will not be allowed into Japan regardless of vaccination status. Korean officials are trying to negotiate with Japan with regard to this ban, especially since the nation's pork imports to Japan are expected to reach $350 million worth this year, up from $313 million in 1998. [Korea Herald, Mar. 22, 1999] SINGAPORE– HIV INCIDENCE IN 1998 199 people were infected with HIV during 1998 bringing the total number to 930 at the end of last year. Heterosexual transmission accounted for 72% of all reported cases since 1991. [Reuters, Mar. 27, 1999] SINGAPORE– HUMAN MELIOIDOSIS Melioidosis, a deadly soil disease has claimed 19 lives and infected 114 people in 1998. These numbers are double the number of cases and deaths seen in 1997. Since 1989, there have been 544 cases and 175 deaths making it a bigger killer than dengue and malaria combined. The bacteria causing melioidosis is Burkolderia pseudomallei, and is found in wet soil and on the surface of muddy water. In Singapore, those suffering from the disease appear to have some pre–existing condition like diabetes, cancer, or respiratory problems, and the majority were above the age of 65 years. [The Straits Times, Mar. 30, 1999] THAILAND– ANTHRAX OUTBREAK An outbreak of anthrax has claimed the lives of 20 dairy cows, and 3 people have been infected following consumption of infected meat during the month of March. Cattle smuggled in from Burma are believed to have infected cows at the Thai–Danish Dairy Farm's Co–operative at Ban Huay Sat Yai in Tambon Huay Sat Yai. An advisory has been issued to local farmers about the disease with regard to notification and disposal of infected carcasses. More than 3,500 cows at Co–operatives at Ban Huay Sat Yai, and Ban Pa Teng in Tambon Huay Sat Yai have been vaccinated against anthrax. While authorities have assured the public about the safety of beef sold in markets their main concern is the smuggling of unvaccinated cattle across the border. [Bangkok Post, Mar. 28, 1999] OCEANIA AUSTRALIA– HIV VACCINE READY FOR HUMAN TRIALS A human trial of a vaccine against HIV is expected to commence in early July after approval by scientists and community groups. The vaccine known as Avipox, was shown to be effective in monkeys by protecting them against becoming infected with HIV when exposed to the virus. The vaccine works by producing T–cell immunity. The vaccine is expected to produce only 80% protection against HIV, and hence behavioral modification will still have to be a target for prevention of the disease. The first phase of the trail would involve vaccination of about 40 people in Sydney and Melbourne to check of adverse reactions. The final phase, which could start within a year, would involve vaccination of thousands of people from high–risk groups in Australia and South–East Asia. High risk groups, like IV drug users and the gay community that are potentially exposed to the virus are expected to participate in the trail. [Sydney Morning Herald, Mar. 29, 1999] AMERICAS PERU– CHOLERA ADVISORY Following the detection of a case of cholera in the city of Cuzco, health authorities, and the municipality and national police have implemented a health education campaign in the community. Several cases of cholera have been reported in the provincial capitals of Canchis and La Convencion, and are believed to be a result of improper hygiene in food handling. The Holy Week is a period during which food items are sold without controls, including the clandestine sale of red meat and fish without veterinary examination in the streets. [El Comercio, Mar. 27, 1999] 3. UPDATES FROM PREVIOUS BULLETINS AUSTRALIA– IMPORTED MEASLES The Department of Human Services in Victoria is providing free MMR vaccine to people in the age group of 18㪶 years who do not have documentation of at least one dose of measles vaccine or definite history of measles. 48 laboratory confirmed cases of measles have been reported so far, as a result of one infected returned traveler from Bali, Indonesia. [Victorian Infectious Diseases Reference Laboratory, Mar. 29, 1999] SOUTH KOREA– FOOD POISONING ADVISORY Health authorities in Korea have decided to step up food safety control over meals provided by schools, following an epidemic of bacillary dysentery that has already infected 125 people in the first two months of this year. 4,577 people were diagnosed with food poisoning last year, 30.2% being students infected after having meals at schools. The disease normally occurs in the summer after July. [Korea Herald, Mar. 24, 1999] 4. NOTICES  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. WEBSITES FOR INFORMATION ON OUTBREAK IN MALAYSIA Health information for travelers on the viral encephalitis outbreak in Malaysia can be obtained at the following web sites: http://www.cdc.gov/travel/index.htm http://www.cdc.gov/travel/seasia.htm 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.