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Vol. II, No. 10 ~ EINet News Briefs ~ May 18, 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– HEPATITIS B VACCINATION ENCOURAGED Health officials in China have called for enhanced efforts to vaccinate newborn babies against hepatitis B, citing this as the most efficient and economical method to curb this contagious disease. The number of HBV carriers are expected to drop below from 10% to 1% percent in 50 years if vaccinations are given to all newborn from now on. Only 30% of infants born in rural areas are vaccinated against the virus compared to over 90% vaccination rate among infants in urban areas. Ignorance and lack of money have been cited as reasons for this disparity. 40% of hepatitis B infections in China are through mother–to–child transmission. Hepatitis B vaccination was included in the EPI program I 1992. Health economists have warned that the country could suffer 3.6 to 6 billion U.S. dollars in extra medical expenditures annually due to the spread of hepatitis. [Xinhua, April 25, 1999] CHINA– STD RISE HIGHEST IN DECADE The Chinese National Sexually Transmitted Disease Control Center reports that cases of sexually transmitted disease rose to 632,512 last year, an increase of 37 percent. In China, STDs have become the third most common infectious disease, preceded only by dysentery and hepatitis. Statistics from the Health Ministry also show that by the end of 1998, 12,580 cases of HIV or AIDS were reported nation–wide. [South China Morning Post, May 07, 1999] HONG KONG– HIV STATUS 46 people were found to be positive for HIV I the first quarter of 1999, bringing the cumulative total number of reported infections to 1,192. 18 new AIDS cases were reported in the same quarter, bringing the total number of confirmed cases to 390. [Xinhua, May 07, 1999] HONG KONG– CHOLERA SUSPECTED A 31–year–old business man who traveled from Bangladesh to Hong Kong last week is believed to be suffering from cholera at Princess Margaret Hospital. The case, if confirmed, would be the third this year. [South China Morning Post, May 12, 1999] KOREA– ADVISORY AGAINST SKIN–DECAYING EPIDEMIC The Health and Welfare Ministry has issued an advisory against Vibrio vulnificus septicemia, a deadly disease which causes severe skin decay in infected persons. The bacterium was discovered in oysters and other shellfish collected from the coastal regions of South Cholla Province on May 13. Abnormally high temperatures this spring have led to the early appearance of this bacteria. Vibrio vulnificus infections generally occur between July and October among residents in coastal areas. High fever, stomachaches, vomiting and diarrhoea are the main symptoms, and 40㫊% of cases, infections can lead to death. Those at highest risk are men in their 40s with diabetes, alcohol addiction, or who have chronic liver, stomach, or kidney problems. People have been advised to eat only fully cooked seafood and to avoid raw fish and oysters. Activities such as swimming and cleaning fish while nursing an open wound are also not recommended. The number of Vibrio vulnificus septicemia infections have increased to 50 this year compared to 23 from last year. [Korea Herald, May 15, 1999] KOREA– JAPANESE ENCEPHALITIS ADVISORY A national warning against Japanese Encephalitis has been issued by the Ministry of Health and Welfare. Mosquitoes in the coastal regions of South Cholla Province were found to be carrying the virus, and the carriers are believed to have appeared early this year due to the abnormally warm weather. Parents having children between the ages of 3 and 15 years have been advised to get their children vaccinated. [Korea Herald, May 14, 1999] PHILIPPINES– MEASLES ON THE RISE A total of 743 cases of measles have been reported in the first three months of this year compared to 264 cases during the same period last year. 60 children have died as a result of measles, and health officials are puzzled at the rise in the incidence of the disease. The Philippine measles Elimination Campaign (PMEC) was launched last year, but it was noted that only 11% of patients were immunized against the disease. Most of the cases were from Metro Manila, and 87% of patients at the San Lazaro Hospital were less than five years old. The PMEC aims to immunize millions of children between nine months and 14 years of age and has been promoting the program in different parts of the country. Incomplete coverage, and inefficacy of the vaccine have been cited as possible reasons for the rise in cases this year. The Department of Health is still confident that measles will be eliminated by the year 2008 in the Philippines. [The Manila Times, May 06, 1999] PHILIPPINES– DENGUE ADVISORY Health authorities have called for greater vigilance following reports of a relatively high number of dengue cases nationwide this year. The peak dengue months are from July to October which are the rainiest months, but the disease is expected to surface earlier this year because of the sudden and unexpected change in the weather. Health officials have issued advisories to the public with special emphasis on elimination of mosquito breeding habitats. Fumigation machines, medicines, diagnostic kits, and blood for transfusion are being prepared for distribution to dengue–afflicted provinces. Most of the dengue cases from previous years were from Metro Manila, Eastern and Central Visayas, Southern Tagalong, Central Luzon, Bicol and Cagayan Valley. 31,780 dengue cases were reported nationwide last year, of which 493 deaths were recorded. [Philippine Daily Inquirer, May 11㪥, 1999] OCEANIA NEW ZEALAND– HIGH RATES OF DISEASE CAUSE ALARM Low immunization rates are blamed for New Zealand's high rates of deadly childhood diseases. Measles and whooping cough account for unacceptably high rates of diseases, and the problem could get worse with a whooping cough epidemic that is expected to sweep the country this winter. Figures, based on the death rate of children aged under five, show New Zealand's health status has got worse in the last 30 years. In the 1960s New Zealand was ranked sixth out of 21 comparable OECD countries, but in the 1990s it ranks 15th, and has child health statistics worse than those of some Third World countries. [The Press, May 11, 1999] PAPUA NEW GUINEA– AIDS DEATHS ON THE RISE The Health Minister Ludger Mond has warned that HIV/AIDS will be the leading cause of death in the National Capital District(NCD)within the next 12 months. The NCD recorded 468 new cases of HIV between January and December 1998, followed by the Western Highlands(37), Morobe(34), and Simbu(22). On the national scale 642 new HIV cases, 185 AIDS and 23 deaths were recorded last year. Papua New Guinea's AIDS statistics remain the highest in the South Pacific region. 50% of affected individuals were men. There has also been an increase in the number of children under two years who have been diagnosed with HIV at the Port Moresby General Hospital. While efforts were being made to improve the situation, an increasing number of AIDS victims are adding to the pressure on existing scarce resources. A comprehensive surveillance system, and a national strategy for HIV/AIDS control are being planned. [Post Courier, May 14, 1999] AMERICAS MEXICO– GNATHOSTOMIASIS Gnathostomiasis, a form of visceral larva migrans, is now an emerging public health problem in Mexico since 1970. The parasitic disease which is highly prevalent in Southeast Asia is caused by Gnathostoma spinigerum, a nematode parasite of dogs and cats. Humans acquire this disease by eating raw or undercooked freshwater fish that are intermediate hosts for the parasite. The symptoms of the disease are not serious, but severe illness or even death may occur if the parasite migrates to vital organs of the host. Between 1993 and 1997, 98 cases of gnathostomiasis were identified in Mexico. [ProMed, May 13, 1999] PERU– YELLOW FEVER Yellow fever has killed 3 individuals and affected 15 people between the towns of Lamas and Moyobamba. A vaccination campaign against yellow fever has been implemented, and will include persons in transit, as the affected communities are located near the Marginal Northern Highway of the Department of San Martin that runs from the coast to the mountains. An increase in the number of insects as a result of the rains has been attributed the spread of the disease. The disease may be newly introduced to the area as it is mentioned in the WHO Diseases subject to regulation. [ProMed, May 09, 1999] USA– HEPATITIS C TESTS NEEDED BY 1 MILLION 1 million Americans who received blood transfusions before 1992 are believed to be infected with the incurable hepatitis C virus. Only 6,500 individuals have been notified of this possibility so far. The chief of the hepatitis branch at the Centers for Disease Control and Prevention has advised individuals to get tested for the virus if they had received a blood transfusion before July 1992. The screening test to detect the virus in blood supply was developed only in 1992, and hence those who received transfusions before this period are considered to be at risk for infection with the virus. The government's "look–back" program was launched in 1997 to identify infected donors and recipients through hospitals and transfusion centers. The FDA had identified 290,000 units of blood donated by people who were later found to infected with hepatitis C. Another 113,000 units are expected to be identified. The Food and Drug Administration has approved the first home test kit for hepatitis C to facilitate testing at home. [Reuters, May 06, 1999] USA (NEBRASKA)– E. COLI, GROUND BEEF RECALL More than 80,000 pounds of ground beef were recalled by an Omaha meat company following detection of E. coli O157:H7 by USDA inspectors. No illnesses linked to the meat have been reported so far. Most of the meat was sold and apparently consumed in Illinois, Indiana, and Michigan. The packages of meat were sold in 10–pound lots, and produced on April 14 with a "sell–by" date of April 28. The establishment code was 20420. [ProMed, May 04, 1999] OTHER RESEARCHERS FIND GENE THAT SWITCHES ON INFECTION FROM BACTERIA A gene that activates bacterial infection in its host has been discovered by researchers in California. The DAM gene was found after a five–year process of examining bacterial genes that are turned on at the start of an infection in an host animal. The work shows how salmonella bacteria, a major source of food poisoning in humans, causes illness. The salmonella DAM gene makes a protein that activates other genes to start a biological cascade that leads to infection. Strains of salmonella that contained a permanently altered DAM gene could not cause disease in mice, and instead facilitated the development of antibodies to the disease. Injection of lethal doses of salmonella into the mice did not produce disease. This finding has important implications for the development of vaccines and new antibiotics. A variety of other bacterial pathogens, including cholera, plague and Shigella, also have DAM genes, raising the possibility that those diseases could also be disabled by blocking DAM. [Associated press, May 07, 1999] US WON'T DESTROY SMALLPOX STOCKS The United States will not destroy the remaining stocks of smallpox virus for reasons that affect scientific, health, and national security interests. The World Health Assembly is scheduled to debate the issue when it meets in Geneva on May 17. The biggest concern is whether all existing stocks of the highly contagious virus have been recorded. Many experts fear that the stocks held by the former Soviet Union may have leaked out of its main biological–weapons facility in Kotsovo. The threat of bioterrorism exists as a result of this possibility. New and important discoveries that have the potential to improve human health is another reason that has been cited by the United States to preserve the stocks. [Inter Press Service, April 26, 1999] 2. UPDATES FROM PREVIOUS BULLETINS MALAYSIA– NIPAH VIRUS OUTBREAK The outbreak of Nipah virus has now spread to five states in Malaysia. Kelantan and Malacca are two states that have recently joined the list following the discovery of the deadly virus in pigs from pig farms. While no new human cases of encephalitis have been reported since April 30, pigs will continue to be slaughtered in affected areas until they are found to be negative for the virus. The World Health Organization has stated that the epidemic is virtually over as a result of mass culling of more than 900,000 pigs. Local authorities in Kuala Lumpur plan to launch a massive rat–killing campaign if rats test positive for the virus. The specificity of the ELISA test for the Nipah virus is being questioned by private veterinarians following positive results in dogs that were not from high–risk areas. In Singapore, 695 out of 706 horses that were tested for the Hendra virus (as a surrogate for Nipah virus) were negative, and results are still pending for the rest. Meanwhile, the ban on movement of horses between Singapore and Malaysia remains in place. [Star Online, May 17, 1999] [Associated Press, May 17, 1999] [Reuters, May 09, 1999] [The Straits Times, May 08, 1999] [ProMed, May 05㪩, 1999] KOREA– DYSENTERY OUTBREAK 29 students from Ponghwa Middle and High Schools were diagnosed with bacillary dysentery after consumption of school lunches. 19 elementary, middle and high schools in Ponghwa County, North Kyongsang Province, decided to temporarily suspend lunches at their school cafeterias for the time being. Investigations to identify the infection route are in progress. Family members, and other individuals connected with the schools are being examined for the disease, and anti–epidemic efforts are also being carried out by the local government. The rise in incidence of dysentery follows a report on unusually warm weather this year that facilitates the spread of foodborne diseases. [Korea Herald, May 07, 1999] MALAYSIA (SARAWAK)– DENGUE PREVENTION The State Health Director has classified nearly all districts in the state as "high risk areas" for dengue outbreaks. The state has recorded 260 cases of dengue as of May 01 this year. The risk of breeding more Aedes mosquitoes is increased during the dry season when people store water in containers. Open burning and other activities that could enhance the possibility of a fresh dengue outbreak have been banned by the state government. The public have been asked to co–operate in preventing an outbreak of dengue by eliminating breeding habitats of the mosquitoes like banana trees and yams within 200 metres of residential areas, and disposing of empty bottles, cans and other refuse that could potentially trap and retain water. [Sarawak Tribune, May 06, 1999] CANADA–SOURCE OF YERSINIA OUTBREAK FOUND An outbreak of Yersinia tuberculosis that affected at least 73 people in British Columbia last fall was traced to a batch of pasteurized whole milk delivered to stores late last October or early November. The B.C. outbreak lasted for the month of November and affected residents in the Vancouver area and Fraser Valley. More than half of the cases occurred in children under the age of three. [ProMed, May 04, 1999] NEW SMALLPOX VACCINE DEVELOPMENT American and Russian researchers are planning to develop a new vaccine against smallpox with the help of genetic engineering. The existing vaccine may prove fatal to AIDS patients due to complications arising from the vaccine. [ProMed, May 04, 1999] 3. 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. 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.