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Vol. II, No. 08 ~ EINet News Briefs ~ April 20, 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:

  1. Update on Japanese Encephalitis/Nipah virus
  2. Overview of infectious–disease information from PRO–MED and other sources
  3. Updates from previous bulletins
  4. Notices
  5. How to add colleagues to the EINet listserv

1. UPDATE ON JAPANESE ENCEPHALITIS/NIPAH VIRUS   The official death toll from the ongoing epidemic in Malaysia has now reached 98, though researchers from the US Centers for Disease Control and Prevention believe that it is close to 117. A total of 256 cases have been officially reported until now. Ribavirin is being given both as a curative and preventive form of treatment to those exposed to the new virus that has been named as the Nipah virus. While it is believed mortality has peaked, cases continue to be reported. Human–to–human transmission of the virus has still not been documented, and until now the virus has only been detected in pigs. The role of fruit bats in transmitting the virus to pigs is being studied, and other vectors like mynah birds are also under speculation. Horses were also suspected of carrying the Nipah virus, but have been found to be free of the virus following testing of 1400 race horses by the Veterinary Services Department. Farmers in Bukit Pelanduk have been informed that 1,200 goats are to be culled as goats were found to be positive for the Nipah virus. Blood samples from cows, chickens, dogs, and cats that died mysteriously are also being analyzed, though no link to the virus has been made. In spite of advisories issued about the virus, health authorities are frustrated by the attitude of pig farmers and workers who are reluctant to wear protective gear when handling animals.
The case fatality rate for those infected with the Nipah virus is 38%, while those infected with the Japanese Encephalitis virus have a case fatality rate of 36%. The mortality rate for combined infection with both viruses was estimated to be 52%. The Nipah virus is said to have killed less than 5% of infected pigs proving to be more deadly in humans. The number of pig farms included in culling activities has been increased in Perak, and the buffer zone has been expanded by another 10 km. Smuggling of pigs from the affected areas continues to be a problem, as evidenced by the discovery of the Nipah virus in Sungai Siput, a new area in Perak. Experts from Japan are expected to join researchers in Malaysia, though their focus will be on Japanese Encephalitis. A third virus is being suspected in cases that have not been explained by either the Nipah or Japanese Encephalitis virus. The actual number of patients infected by the Nipah virus is not known as there were cases of patients who were infected by both the Japanese Encephalitis virus and Nipah virus.
The epidemic has affected 40% of the country's 2,100 pig farms, and pig farmers have lost RM250 million ($114 million) in export earnings. 16 hotels in the Port Dickson area are expected to retrench 1,200 workers as a result of falling profits. Occupancy rates have fallen from an average of 55% to 12㪧% on weekdays, and 15㪱% on weekends. The hotels used to enjoy 70㫨% occupancy during the weekends before the outbreak. The situation is made worse as government officials had cancelled bookings to hold functions at the hotels. Indonesia may lose at least $20.8 million from cancelled hog exports to Malaysia and Singapore. Monitoring of hog flows from Malaysia along the borders in Indonesia is still in process. Thailand has banned imports of live pigs, horses and cats, as well as pork from Malaysia, Australia and New Zealand in an effort to prevent the outbreak of the viruses.
[ProMed, April 7㪫, 1999]
[Xinhua, April 14, 1999]
[Reuters, April 08㪫, 1999]
[The Straits Times Interactive, April 08, 1999]
[The Star, April 19, 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.


HONG KONG– AVIAN FLU (H9N2)   A new strain of influenza A (H9N2) was isolated from 2 hospitalized children early March in Hong Kong, who recovered completely without complications. This is the first time that an avian influenza virus has been isolated from humans in Hong Kong. The results were confirmed by the WHO Influenza Collaborating Reference Laboratories in the United Kingdom and the United States. The virus was found to be sensitive to amantadine and remantadine. The isolated viruses are also genetically closely related to influenza A/quail/Hong Kong/GI/97 (H9N2) detected during the outbreak of 1997. The mode of transmission to humans is under investigation, and the potential for global impact of this discovery is also being assessed. Aerosol transmission is under consideration as one of the patients had contact with poultry. The clinical presentation of illness caused by this virus is similar to other influenza viruses. While health authorities in Hong Kong are confident about monitoring and taking control of the situation due to experience gained from the last outbreak of avian flu in 1997, it appears that five (China) mainlanders were infected with the new virus in August 1998. This brings the total number of infected individuals to seven. The five cases were not reported to WHO as there were no signs of an outbreak. They were believed to have been infected through contact with poultry in Guangdong province in China.
In the meantime, health officials in Hong Kong are trying to track the source of infection, and the Education Department has issued advisories to kindergartens. Poultry vendors and wholesales have reported a drop in business in spite of an assurance from health experts that the virus cannot be transmitted through cooked poultry. Test kits for H9N2 have been developed in the United States, and are to be used in Hong Kong hospitals to track the spread of the virus to humans. The virus was previously found in 5% of chickens in 1997 before they were slaughtered. It was first detected in mainland poultry in 1970s, and by the 1990s had spread to Asia and the Middle East. The Special Investigation Group on Avian Flu is speculating the public health threat posed by this virus. Investigations to detect the presence of H9N2 infections in other people in Hong Kong, mode of transmission, risk factors for contracting the virus, are some recommendations that have been suggested.
[Xinhua, April 11, 1999]
[South China Morning Post, April 08, 1999]
[Associated Press, April 09, 1999]
[Promed, April 08㪧, 1999]

SINGAPORE– ANTIBIOTIC RESISTANT STREPTOCOCCUS PNEUMONIAE  The number of antibiotic resistant Streptoccus pneumoniae bacteria in 1997 increased to 47% in comparison to 2% in 1991. Resistance to penicillin and new classes of antibiotics was reported. It is not clear as to whether this number was for one hospital or whether it represented a Singapore–wide trend.
[ProMed, April 16, 1999]


AUSTRALIA– AEDES ALBOPICTUS   An extensive program of fumigation and trapping is to be carried out in port areas in New South Wales following the discovery of the dreaded disease–carrying Asian tiger mosquito (Aedes albopticus) in Sydney. The mosquito, most probably came from a ship carrying tyres from Japan, and was caught in a surveillance trap set by quarantine officers last month. Dengue and yellow fever are some of the deadly diseases that are spread by this species of mosquito. Health authorities are particularly worried as the city is the venue for the Olympic Games in the year 2000.
[Agence France Presse, April 09, 1999]

NEW ZEALAND– WHOOPING COUGH EPIDEMIC PREDICTED  An epidemic of whooping cough has been predicted later in the year as a result of low child–immunization rates. The Immunization Advisory Centre said that the last outbreak was in 1996, when more than 500 people were hospitalized. Nearly 70% of the victims were under the age of 2 years. Since 1980 there have been 2 deaths in New Zealand from whooping cough. Doctors are advising parents to make ensure that their children's whooping cough vaccinations are up to date.
[The Press, April 13 & 16, 1999]


USA– E.COLI OUTBREAK, MEAT RECALL  E. coli 0157:H7 was found to be the cause of illness among six people visiting a Maine ski resort. The illness was traced to contaminated ground beef produced at a Minnesota meat processing plant. Genetic fingerprints from the six individuals matched a strain of E.coli in samples of meat from Rochester Meats in Minnesota. The company has recalled 170,780 pounds of product produced on December 01, 1998. The products are marked with the Julian code 83365 and Establishment 8999 in the inspection mark. All six individuals have recovered, and the CDC is investigating the occurrence of illness in other states that may be linked to this outbreak. [ CNN Custom News, April 06, 1999] [ProMed, April 05, 1999]


NEW RESEARCH IN SEARCH FOR MALARIA VACCINE   A family of genes that enable survival of malarial parasites in a hostile environment may become the target of vaccine research. British researchers, in a letter to the science journal Nature, have identified the family of genes as p235. The parasite uses the gene family to adapt to changes ensuring its survival within red blood cells. By developing a vaccine or drug that dictates red cell selection, fulminant infection can be avoided if infection is restricted to immature red cells resulting in a more benign infection. The ability of the merozoites to replicate effectively can be inhibited by suing a vaccine that targets this gene. Malaria kills up to 3 million people each year, 90% being children.
[Reuters, April 14, 1999]

MOSQUITO BITES AFTER 10 P.M. MORE DANGEROUS  Australian researchers at the University of South Australia's Mosquito Research Laboratory, have reported that it is more dangerous to be bitten by a mosquito after 10 p.m. than earlier in the night. They found that mosquitoes carrying viruses are more likely to be in search of a blood meal at night. The researchers were studying Culex annulirostris or the banded mosquito, which is the most dangerous species in Australia as it carries all of the deadly viruses in the country, including Ross River Virus, Japanese Encephalitis, and Murray Valley Encephalitis. It was found that older mosquitoes were more likely to feed late at night after 10 p.m. as they do not need to mate, unlike younger mosquitoes that fed early in order to mate later. Older mosquitoes are also more likely to have fed on animals or birds picking up diseases in the process.
[Xinhua, April 14, 1999]

PLASMA PRODUCT RECALL– PARVOVIRUS B19 CONTAMINATION   Seven lots of PLAS+SD dating from June and July 1998 were recalled on April 16 by V.I. Technologies, following the detection of high levels of parvovirus B19 DNA. A new screening procedure has also been instituted to ensure that the virus remains below specified laboratory levels. In the next 2 weeks, the company will implement testing of production to date to assess the need, if any, for an additional recall. Pregnant women and immunosuppressed individuals are seriously affected by infection with this virus, and hence physicians have been asked to exercise caution when using this product in these patients. PLAS+SD uses a viral inactivation procedure that eliminates the risks of HIV, Hepatitis B and Hepatitis C transmission by plasma.
[ProMed, April 17, 1999]


AUSTRALIA– SALMONELLOSIS, RARE TYPE Following the outbreak of salmonellosis caused by the rare phage type 135A, Nippy's fruit juice products have been ordered to be pasteurised before packaging. The source of contamination has been traced to fruit supplied to Nippy's, by the Riverland packaging shed. The packaging shed tested positive for salmonella. The South Australian Health Commission has banned the packaging shed and its associated orchard from moving or selling oranges. Health authorities in Victoria are on alert as fresh oranges from this packaging shed were distributed to an outlet there.
[The Advertiser, April, 10, 1999]
[ Business Intelligence Australia, April 13, 1999]

AUSTRALIA– LEPTOSPIROSIS   99 confirmed cases of leptospirosis have been reported in Queensland, Australia, for the first three and a half months of this year by the WHO/FAO Collaborating Centre for Reference and Research on Leptospirosis. Microscopic Agglutination Test and culture were used to diagnose the cases. The rarely reported serotype "ballum" has been recently diagnosed in several cases, while serotypes "hardjo" and "zanoni" continue to account for the majority of cases in the state.
[ProMed, April 17, 1999]


APEC ISTWG MEETINGS – SEATTLE, AUGUST 15㪬   The APEC Working Group on Industrial Science and Technology will meet in Seattle, August 15㪬. Organizers have planned a seminar for Monday, August 16, on emerging infections in the region, and a side meeting of delegates to consider progress under the APEC Initiative on Emerging Infections (adopted 1997) will be held on Tuesday, August 17. Colleagues in Health and Science in APEC economies are advised to contact their ISTWG delegation heads for further information, or to contact Laura Schubert (lschub@u.washington.edu) for further information.

EMERGING INFECTIOUS DISEASES JOURNAL  Vol. 5, No.2 (March–April 1999) of Emerging Infectious Diseases journal is now available on the Web under Current Issue on the journal's homepage. The articles can be accessed at: http://www.cdc.gov/ncidod/EID/current.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.