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Vol. II, No. 11 ~ EINet News Briefs ~ June 02, 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 CHINESE TAIPEI– VIBRIO PARAHAEMOLYTICUS CONTAMINATION IN SHELLFISH 49% of shellfish imported fresh shellfish in Taiwan was found to be contaminated with Vibrio parahaemolyticus between July 1997 and April 1998. 37% of non–shellfish seafood was similarly found to be contaminated with the organism. As no epidemic of Vibrio parahaemolyticus has been reported in Taiwan, the government has taken no steps to crack down on the import of contaminated shellfish. [ProMed, May 26, 1999] HONG KONG– FATAL ENTEROVIRUS 71 The first fatal case of Enterovirus㫟 in Hong Kong was reported on May 14 following the death of a two–year old boy at a hospital. The Department of Health confirmed the diagnosis by laboratory results on May 27. Gene sequencing showed that the virus was similar to a strain previously seen in Malaysia and Taiwan. The boy's sister and four other classmates were also found to be infected with the virus. Three of them, including the sister have recovered without complications. The Department of Health has called upon the public to maintain strict personal hygiene and to seek medical care if symptoms of the disease develop in children. Control measures have been initiated b the Department of Health at the boy's nursery and his home. Public swimming pools, entertainment and amusement parks are being monitored by the Provisional Urban Services Department to prevent further spread of the disease.Prior to this four cases of EV㫟 have been reported in Hong Kong since the beginning of 1999. [Dr. KH Mak, Department of Health, May 24㪳, 1999] [Hong Kong Standard, May 25 and June 02, 1999] [South China Morning Post, May 28, 1999] OCEANIA AUSTRALIA– VANCOMYCIN–RESISTANT ENTEROCOCCI The incidence of vancomycin–resistant enterococci infections has risen by 37% since last year compared to the previous three years. 134 people were diagnosed with the infection in four Melbourne hospitals since last year, while only 16 cases were reported in the previous three years. [ProMed, May 30, 1999] PAPUA NEW GUINEA– OUTBREAK OF MALARIA FEARED An outbreak of malaria is expected in the Middle Fly and Lake Murray areas in the Western Province following floods in the region. Most of the lowlands are still under water, and these form good breeding grounds for mosquitoes. A medical team that was sent into the region reported that many people in the affected villages were suffering from skin irritations, upper respiratory tract infections, upper abdominal pains, diarrhea with blood and vomiting. The signs are suggestive of typhoid, and laboratory tests are yet to be conducted to confirm the diagnosis. Authorities have denied reports of 15 deaths due to typhoid. [Post–Courier, May 26, 1999] NEW ZEALAND– E.COLI ALERT Health officials in Waikato are at a loss to explain a huge upsurge in cases verotoxogenic Escherichia coli (VTEC) in children. At least 18 confirmed cases have been reported so far this year, compared to 22 for the whole of 1998. Fourteen cases were children aged 5 and under, and nearly half were hospitalized. Officials suspect that the widepsread habit of drinking raw milk directly from the vat may be the source of infection in a primarily dairy farming community. [New Zealand Herald, May 26, 1999] AMERICAS USA– OUTBREAK OF HANTAVIRUS FEARED Following the death of four New Mexicans as a result of hantavirus infection, experts fear that this could be the beginning of an outbreak of the dreaded mouse–borne disease. In all of last year, the state had a total of six cases, compared with two in 1997 and one in 1996. There were four deaths in all of 1998 and none in the previous two years. All of this year's cases have been from the northwestern part of the state where the virus was first recognized in 1993. [Associated Press, June 01, 1999] USA– RISK OF SALMONELLA FROM RAW MILK PRODUCTS Consumption of cheese made from unpasteurized milk carries the risk of transmission of salmonella as evident from three studies published in The Journal of the American Medical Association. Three salmonella outbreaks occurring mainly in Hispanic children in California and Washington State were traced to cheese products made from unpasteurized milk. Salmonella typhimurium DT104 was isolated in all three outbreaks. This serotype of salmonella is resistant to five common antibiotics, and accounts for 30% of all salmonella cases in the United States. Both states have launched public health interventions about the dangers of consuming raw milk products. [JAMA, May 19, 1999] USA– DRUG RESISTANT CAMPYLOBACTER INCREASING A study conducted among residents of Minnesota between 1992� showed an increase in proportion of quinolone–resistant Campylobacter jejuni isolates from 1.3% in 1992 to 10.2% in 1998. The increase has been attributed largely to infections acquired during foreign travel. However, the number of number of quinolone–resistant infections acquired domestically has also increased, as a result of resistant strains found in poultry. The use of fluoroquinolones in poultry, which began in the United States in 1995, has created a reservoir of resistant Campylobacter jejuni. [ProMed, May 24, 1999] OTHER ORAL MEDICATION FOR HEPATITIS B TO GO ON SALE Glaxo Wellcome Korea will begin to sell the world's first oral treatment for Hepatitis B in Korea from next month. The pill called Zeffix, was approved for sale by the Korean Government on May 08, after successful clinical trials on humans at local hospitals from September last year until February this year. The cost is $3.8 per pill, and has better potential to reduce the progression of hepatitis B virus–related liver diseases to cirrhosis than the relatively expensive interferon injection that costs $50 per shot. [Korea Herald, May 27, 1999] MUTATIONS FOUND IN TB VACCINE STRAINS Repeat breeding of Mycobacterium bovis in the laboratory may explain the varying efficacy of the BCG vaccine against infection with Mycobacterium tuberculosis. Genetic mutations in the bacteria as a result of repetitive breeding might have resulted in adaptability to the laboratory environment thus moving away from its original target which is the tuberculosis bacterium. Nine genetic regions that correspond to Mycobacterium tuberculosis were found to be absent in Mycobacterium bovis. Instead, five additional regions were found in the vaccine strain. [Science 1999; 284:1520�] 2. UPDATES FROM PREVIOUS BULLETINS MALAYSIA– NIPAH VIRUS OUTBREAK The state of Penang is on a red alert after pigs at a farm in Kampung Luar Valdor were found to be positive for Nipah virus. A farm worker in Sungai Buloh, Selangor, was admitted to the hospital on May 14, and fell into a coma. No other new cases have been reported. Culling operations in Selangor, Perak, and Johor have been delayed as the government has prohibited the use of military forces for this purpose. Bats are being considered to be the reservoir of the virus following detection of antibodies in two species of fruit bats. The virus itself has not been isolated from bats, and this would be necessary to confirm them as reservoirs. Researchers at the CDC are in the process of developing a vaccine and a drug against the virus. [ProMed, May 21㪯, 1999] [Star Online, May 21㪰, 1999] [Reuters, May 19, 1999] HONG KONG– NEW VIRUS MAY POSE RISK The recently discovered H9N2 virus is much more complicated than the H5N1 virus, posing a greater threat to Hong Kong. Recent medical analysis showed H5N1 carried an amino acid which was similar to an amino acid found in the human influenza virus. This finding may explain the influenza outbreak in 1997. A central abbatoir to segregate ducks and geese from chickens has been suggested, as the former are natural carriers of the virus. [South China Morning Post, May 26, 1999] HONG KONG– IMPORTED CHOLERA One more imported case of cholera from the mainland has been reported in a 16–year old girl following consumption of contaminated seafood. The girl's father was also diagnosed with the disease earlier. [Hong Kong Standard, May 31, 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.