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Vol. II, No. 09~ EINet News Briefs ~ May 04, 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/Nipah 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/NIPAH VIRUS Two more pig farm workers from Bukit Pelandok succumbed to viral encephalitis at the Kuala Lumpur Hospital on April 23, though authorities do believe that the epidemic is on the decline following the culling of 900,000 pigs, and expect to see fewer cases. A national anti–mosquito campaign was launched on April 20 to intensify efforts to destroy mosquito–breeding grounds. The mechanism of transmission of the Nipah virus remains unknown, and early indications of test results show that there is low or no human–to–human transmission. Direct contact with pigs appears to be the most plausible explanation for now. Extensive follow–ups for at least a year on discharged patients have been formulated to study the clinical features of the disease. The cause of 259 cases of encephalitis still remains unknown. Health care workers tending to patients have been instructed to practise "barrier nursing", and blood samples from 400 hospital staff members have been collected for testing. The first batch of samples from 183 staff tested negative for the Nipah virus. Pig farm workers have also been advised to wear protective clothing, and the ministry has distributed 800,000 leaflets on precautionary measures to schools and those in the pig industry. New areas in the northern state of Perak (Gopeng and Bidor) were found to have infected pigs and more than 8,000 pigs are expected to be destroyed on the next few weeks. There is confusion as to whether an infected pig was detected at a farm in Seelong in the state of Johor Baru based on conflicting reports given by the Health Minister Dr. Chua and Johor Mentri Besar Datuk Abdul Ghani Othman. Singapore has resumed import of live pigs from Indonesia, and a cold chain system will be incorporated in the country by November 2000, to allow only chilled meat to be made available to the public. This is to minimize contact with live pigs and to facilitate more stringent checks on the meat. 788 stray dogs were killed in Negeri Sembilan following positive tests in at least two dogs in the region. The dogs were believed to have eaten the carcasses of infected pigs. Health authorities advised pet owners to quarantine their dogs and cats, and have them tested for the Nipah virus. Blood samples from goats, horses, birds, turkeys, cattle and wild animals have been collected for testing. Two horses at the Iskander Polo Club in Ipoh found to be positive for the Nipah virus were put down, and the Club was placed under quarantine as it was located very near to pig farms in Tambun, Ampang, and Ulu Piah. 4,500 horses nationwide are to be tested for the Nipah virus, and results of the second batch of samples sent from the club were expected soon from Australia. In summary, it appears that the Nipah virus has spread to other species, and dogs and cats have been confirmed as carriers by the Veterinary Services Department. Taiwan has now added dogs to its list of banned live imports from Malaysia. 164 pig farms in the Kinta district will be closed down by the state government and no new licences will be issued for farms to operate in the area. Farmers outside the buffer zone have asked the government to help cull their pigs the reason being that there was no demand for pork. Coordinated control measures adopted by the Health and Veterinary Services appear to be successful in preventing the occurrence of new cases, and a surveillance programme to survey all of the more than 1000 pig farms in Malaysia for the Nipah virus will soon get underway. This program will be instituted by the Veterinary Research Institute in IPOH, in collaboration with the Centers for Disease Control and CSIRO Australian Animal Health Laboratory. Pig farming activities in Bukit Pelandok will be allowed only at the integrated pig farming area from now on to prevent future outbreaks. This area has a proper system required for clean farming activities and has an oxidation pond and proper drainage. [ProMed, April 21 –May 03, 1999] [Reuters, April 20– 29, 1999] [Associated Press, April 20, 1999] [Xinhua, April 20, 1999] [ Star Online, May 03, 1999] [The Straits Times, May 03, 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 HONG KONG– CHOLERA O139 A 45–year old man has been diagnosed with Vibrio cholerae O139, and health officials have issued an advisory to the public to be on guard against the disease. The man's family members have been given health education, and investigations suggest that cross contamination with raw seafood and cooked food could have resulted in the infection. This is the second case of cholera reported in Hong Kong this year, the first one being an imported case. V. cholerae O139 was first identified as a new serotype during large scale epidemics of severe dehydrating diarrhoea, typical of cholera in India and Bangladesh in late 1992. [ProMed, April 23, 1999] JAPAN– SALMONELLA INFECTION FROM DRIED SQUID Contaminated dried squid has been found to be the cause of food poisoning in at least 453 people in 38 of Japan's 47 prefectures between late March and April. Officials have traced the squid to a factory in Yato, Aomori Prefecture, that used well water contaminated with salmonella. Production was halted on April 6 for an indefinite period by health officials. According to officials, three distributors sold the product under eight different labels. [ProMed, April 16㪳, 1999] KOREA– EPIDEMICS ON RISE Health authorities are on alert following frequent outbreaks of epidemics this year as a result of the unseaonably high temperatures gripping the country. 737 people have been affected by first and second grade epidemics in the first three months of this year marking a 3.2 fold increase from last year. The number of people affected by dysentery, a first grade epidemic, drastically increased to 309 by the end of March from just 6 during the same period of last year. 700 people were diagnosed with food poisoning in the month of April alone. Parotitis, a less severe second grade epidemic is rapidly spreading in South Chungchong Province and the southern resort island of Cheju. Four patients were diagnosed with leptospirosis, a water–borne disease which usually occurs in autumn at harvest time. No cases were reported during the first three months of last year. 35 people have contracted haemorrhagic fever, compared to only 10 from last year. The early arrival of the heat wave this year has facilitated the spread of infectious diseases, and people have been advised to maintain sanitary conditions in preparation for the annual summer rainy spell. [Korea Herald, April 23, 1999] KOREA – KOREAN HEMORRHAGIC FEVER The Health and Welfare Ministry has reported that 35 people have contracted Korean Haemorrhagic Fever this year compared to 10 during last year. This fever is caused by the Hantaaan virus which is a hantavirus belonging to the family Bunyaviridae. The disease is most common during autumn and winter in Kyungkido, Seoul, Chungcheongdo and Kwangwondo. Rates vary from 1 to 4/100,000 per year. [ProMed, April 27㪵, 1999] MALAYSIA– DENGUE ADVISORY The Health Minister, Datuk Chua Jui Meng has warned of a large scale outbreak of dengue/dengue haemorrhagic fever in six states this year, if breeding grounds of the Aedes mosquito are not cleared immediately. The number of cases have increased 20–fold since 1986 (1,408) to 27,373 in 1998. A six percent increase in cases between January and April 10 this year was documented compared to last year. Selangor, Kuala Lumpur, Perak, Pahang, Kedah, and Pulau Pinang have been named as the six states that face the threat of an outbreak. [Bernama, April 28, 1999] VIETNAM– THREAT OF MALARIA EPIDEMIC An epidemic of malaria is looming in many parts of Vietnam with health authorities calling for urgent measures to curb its spread. More than 39,000 people have been reported to be infected nation–wide and 29 recorded in the first two months of this year. It appears that malaria has been reemerging as a major public health problem since 1997. The first signs began to occur in 1997, and in 1998 the number of infectious cases rose by 20% compared to the previous year. Vietnam's National Malaria Prevention Project has developed a plan of action to prevent an epidemic this year with an aim to reduce the number of infectious cases by 10% and deaths by 5%. [Xinhua, April 22, 1999] OCEANIA AUSTRALIA (QUEENSLAND)– DENGUE Two cases of dengue have been reported in Townsville in the Healtley/Cranbrook area. These are the first locally acquired cases in Townsville. The type of dengue virus has not been determined as yet. The last outbreak of dengue in Townsville in 1992� infected 15% of the population, though no dengue haemorrhagic fever was reported. Charters Towers, a rural town, about 110 km inland was also involved in this outbreak, and at least 20% of the adults in this community seroconverted during this outbreak. [ProMed, April 30, 1999] AUSTRALIA– NEWCASTLE DISEASE Australia is currently experiencing the worst outbreak of exotic disease among animals in its history. The highly contagious Newcastle disease that has afflicted chickens at Mangrove Mountain north of Sydney has the potential to spread to other farms, and an additional 300 emergency workers have been deployed from Queensland to help control the outbreak. More than 100,000 chickens are being killed everyday, and though only 2 million chickens were expected to be killed initially, another 3 million chickens may have to be destroyed in the surrounding districts of Peats Ridge and Somersby. [ProMed, May 03, 1999] AMERICAS CANADA– E. COLI, BEEF RECALL An advisory against E. coli has been issued following possible contamination of a beef product produced by Costco Wholesale in Winnipeg. The product known as Kirkland Signature Lean Ground beef, Item No. 21927 has a pack date of April 10, 1999, and is sold in packages of approximately 3 kg. Costco Wholesale is voluntarily recalling this product, and one positive illness has been reported to date. This health alert apples only to this product sold at Winnipeg St. James Costco Wholesale warehouse. [ProMed, April 30, 1999] USA (FLORIDA)– RED TIDE ALERT A red tide bloom off Collier County coast has left beach goers with itchy eyes and runny noses. No fish kills have been reported as yet, and the Department of Environmental Protection has put out an alert. [ProMed, April 22, 1999] OTHER SMALLPOX VIRUS DESTRUCTION DEBATED The United States is seeking to delay the remaining known stocks of the smallpox virus based on the possibility of a natural resurgence of the disease or its use in a terrorist attack. The disease was eradicated in 1980 following a mass vaccination program. In 1996, WHO recommended the destruction of the remaining known stocks of the virus held by the U.S. Centers for Disease Control and Prevention and the Russian State Center of Virology and Biotechnology by June 1999. Some biologists argue that the genetic code of the virus may be useful for developing new vaccines against other diseases, while others fear that a stolen sample could prove to be disastrous in the wrong hands. The United States is expected to push for a delay at the May meeting of the World Health Assembly. If no agreement is reached on the matter, the United Stated would have to decide whether to unilaterally keep its stocks. [ProMed, April 22,1999] UK– LEGIONELLOSIS FROM TRAVEL TO THAILAND A cluster of cases of legionnaire's disease have been identified in the United Kingdom as a result of travel to Thailand. The three individuals diagnosed with the disease were aged 60 years and above, and stayed at the same hotel in Bangkok between one to ten days before they became ill. A cluster alert has been sent to all European Working Group on Legionella Infections collaborators, the WHO, the Thai Ministry of Health, and a collaborator in Australia. While investigations in the hotel are in progress, tour operators from the United Kingdom have been informed and their clients have been withdrawn until further notice. [Eurosurveillance Weekly, April 22, 1999] RUSSIA– TB INCIDENCE The incidence of tuberculosis in Russia has increased by eight percent this year with more than 2.5 million people suffering from various forms of tuberculosis. Last year, 108,000 people were diagnosed with the disease. The Siberian regions account for the bulk of tuberculosis sufferers, and has been explained by their link to social status and poverty. The risk of contracting tuberculosis in prison is 50 times higher, where 4,300 out of every 100,000 are afflicted with the disease. [tbnet, April 22, 1999] USA–LINK BETWEEN CHICKEN POX AND FLESH–EATING BACTERIA An infectious disease specialist at Texas Children's Hospital believes that there is a link between chicken pox and necrotizing fasciitis, as half of all youngsters who contracted the infection had had chicken pox. The flesh–eating bacteria enters the body through breaks in the skin caused by chicken pox lesions. In the United States, 1,000 cases of the disease occur annually, 25% involving children. In preventing children from getting chicken pox, a chicken–pox vaccine eliminates a key risk factor for necrotizing fasciitis. Though the vaccine has been made available since March 1995, only 25% of U.S. children have received them. [Reuters, April 28, 1999] US– SAFE HIV VACCINE TESTED US researchers have successfully tested a new vaccine against HIV that uses harmless fragments of HIV. The only vaccines that previously showed any promise were "live vaccines", that were partially disabled and hence had the potential to mutate and cause infection. The new vaccine was shown to protect monkeys from extremely virulent strains of the virus during tests. While the vaccine did not completely prevent infection, it was contained below the level that could be detected by sensitive tests. This finding has tremendous implications for extending life expectancy, reducing transmission in the process. [Bangkok Post, May 01, 1999] 3. UPDATES FROM PREVIOUS BULLETINS MALAYSIA– CHIKUNGUNYA FEVER An outbreak of chikungunya fever has affected more than 14 people in the Kampung Lindungan Tambahan area. The previous outbreak was in the Port Klang area three months ago. [The Straits Times, April 27, 1999] NEW ZEALAND– INCREASE IN CRYPTOSPORIDIOSIS Canterbury has recorded a 10–fold increase in the number of cryptosporidiosis cases this year. 104 cases have been reported this year, compared to only 10 cases last year. 59 cases were reported in the Waimakariri district, and earlier this year the Kaiapoi aquatic Center was closed for five days as a result of a cryptosporidiosis scare. The increased incidence has been attributed to poor personal hygiene rather than any change in standards by the pools. [The Press, May 01, 1999] 4. NOTICES  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. 1ST INTERNATIONAL CONGRESS OF THE ASIA PACIFIC SOCIETY OF INFECTION CONTROL The Asia Pacific Society of Infection Control (APSIC) was established in March 1998 by representatives from 15 countries in the region. In addition to specialists from the region, a large number of international speakers, particularly from North America and Europe will be present to meet and share experiences at the forum. Then main congress will be held between August 9㪣, 1999. The pre–congress workshop will be held in Macau on August 8th. The deadline for abstract submission is April 30th, 1999. The early registration rate of US$250 is available until May 30th, 1999. Further information can be obtained from; MV Destination Management Ltd. Tel: (852) 2735 8118 Fax: (852) 2735 8282 E–mail:moreview@mvdmc.com 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.