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Vol. II, No. 12 ~ EINet News Briefs ~ June 15, 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: Agenda for APEC Industrial Science and Technology Working Group meeting, Seattle, August 16, 1999. 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. AGENDA FOR APEC INDUSTRIAL SCIENCE AND TECHOLOGY WORKING GROUP MEETING The tentative agenda for the August 16th meeting of the APEC ISTWG includes the following: Session I – Public and Private Infrastructure for Safety and Trade in APEC – Current APEC trends and the APEC framework – Consumerism, resource consumption and health care – Increased teleconnectivity, communications, and use of antibiotics – New molecular "fingerprinting" techniques – New awareness in APEC Session II – Update on New Trade and Travel Related Outbreaks – Nipah virus – Enteric and E. coli – MDRTB – Influenza surveillance Session III – Action Agenda for the Asia–Pacific Roundtable Public Health and Policy Roundtable – Surveillance Networking Field Epidemiology Training Programs CISET Initiative 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 CHINESE TAIPEI– FOOT–AND–MOUTH DISEASE IN CATTLE 65 cows that were found infected with the deadly foot–and–mouth disease virus were destroyed in the island of Kinmen. The Council of Agriculture has ordered the destruction of all infected cattle, and vaccination of all 3,000 cows and 2,000 sheep on Jinmen Island to avoid further infections. Officials believe that the type "O" virus could have been imported from mainland China as this strain was completely different from an islandwide outbreak of foot–and–mouth disease among hogs two years ago. A ban on movement of livestock from Jinmen to Taiwan or other Taiwan–held islands is in effect. Russia has banned imports of meat and meat products from China, citing the mainland's problems with foot–and–mouth disease. [ProMed, June 13, 1999] [Reuters, June 13, 1999] HONG KONG– FOOD BACTERIA LEVELS UNACCEPtable Alarming levels of E. coli have been discovered in a variety of foods sold in major Chinese restaurant chains. According to the Health Department, an E. coli count of 100 per gramme of food is unsatisfactory, and a level beyond 10,000 is an unacceptable potential health hazard. Sampling done by the Consumer Council revealed E. coli counts ranging from 240,000 to 430. Prosecution of restaurateurs is possible after an inquiry by the Urban Services or Regional Services Department. [South China Morning Post, June 15, 1999] KOREA– MALARIA ON THE INCREASE According to health authorities, the number of malaria cases is rapidly increasing among residents of northern Kyonggi Province. 41 malaria patients have been discovered so far in this month, and authorities fear that the number will increase further between July and August, when malaria–carrying mosquitoes multiply. Malaria had not been reported in South Korea since 1979, when the epidemic mysteriously appeared again in 1993 when a soldier stationed in Paju City, near the Demilitarized Zone, came down with the disease. While civilians have been affected, health authorities say that they are residents who frequently visited the front line areas or those who were recently discharged from the military. [Korea herald, June 11, 1999] PHILIPPINES– MALARIA RESURGENCE The Department of Health has warned of a resurgence of malaria, disease which health authorities claimed to have fought successfully in at least 13 provinces nationwide in 1996. The number of malaria cases substantially decreased from 95,778 in 1992 to 40,535 in 1996, but the number of cases started to pick up again in the past two years. There is no data available on the number of deaths recorded from 1996 to 1998. 90% of malaria cases were recorded in the Cagayan Valley, Southern Tagalog, Cordillera Autonomous Region, Caraga Region and the Autonomous Region in Muslim Mindanao. The resurgence was attributed mainly to inadequate facilities and finances. [Philippine Daily Inquirer, June 12, 1999] VIETNAM– HEPATITIS B EPIDEMIC An estimated 100 people a day are expected to die prematurely from the effects of hepatitis B if an international campaign is not launched to gain sufficient supplies of an available WHO–approved vaccine. Vietnam currently has about eight million HBV carriers. [Vietnam News, June 08, 1999] OCEANIA AUSTRALIA– TYPHOID FEVER VIA PAPUA NEW GUINEA At least five passengers of a cruise ship, the Fair princess, have been diagnosed with typhoid following possible contamination of food eaten while on a Kokoda Trail tour in Papua New Guinea. The ship, which failed to meet requirements to inform health or quarantine authorities of an outbreak of illness on the ship before it docked in Sydney on May 25 1999, had 120 out of 900 passengers on board afflicted with severe diarrhea, abdominal cramping and vomiting, and a range of other symptoms. Health authorities are working through passenger lists to contact 153 people who were on the cruise and may have been exposed to typhoid while on the Kokoda Trail tour. 36 New Zealanders were also on the ship, and the New Zealand Ministry of Health has issued an urgent health warning with regard to the illness. [ProMed, June 8㪢, 1999] [The Press, June 10, 1999] [Nation, June 10, 1999] AMERICAS CANADA– MRSA PLAGUES HOSPITALS The prevalence of methicillin–resistant Staphylococcus aureus (MRSA) in 22 hospitals in Canada has tripled in the past years making it the biggest single public health problem in this century. The bacteria is expected to become resistant to vancomycin, the only drug to which it remains vulnerable. Vancomycin–resistant Staphylococcus aureus has already been documented in Japan and the United States. In Ontario alone, 8,100 cases, 1,000 infections, and 50𤩔 deaths due to MRSA were recorded last year. 200,000 infected people and 9,000 deaths have been predicted over the next year. MRSA accounts for 5㪬% of staphylococcus infections in hospitals. Controlling its transmission with private rooms, screenings and special nursing practices has become a costly battle that infectious–disease specialists often consider giving up. A new vaccine against Staphylococcus aureus is the best hope for now. In addition to MRSA, VRE (vancomycin–resistant enterococcus) is moving into Canadian hospitals. This co–existence has heightened fears that the vancomycin–resistant genes of enterococci could jump to the more virulent staphylococcus aureus. Scientists have demonstrated the possibility of this gene transfer. While Canada's rates of microbial resistance are still enviably low compared with those in the United States and other parts of the world, the recent trend of acceleration indicates that there is a small window to get it under control. [Globe and Mail, June 08, 1999] PERU– YELLOW FEVER 7 cases of yellow fever, including 3 fatal cases, have been reported in Junin since the beginning of this year through May. A health team has been vaccinating approximately 500 people a day, and a total of 64,500 vaccinations have been carried out. Since 1997, vaccination is obligatory for all persons who do not have a certificate of vaccination from another centre in the country. [ProMed, June 10, 1999] USA–SALMONELLOSIS Two separate outbreaks of salmonellosis in two different states have been reported. State officials in Hawaii are trying to determine the source of an outbreak of salmonellosis at a Honolulu school among 50 people, mostly fourth graders. 40 confirmed cases of salmonellosis have been traced to a pancake eatery in Henrico County, Virginia. The eatery has been closed, and the number of affected individuals have been reported to be more than 120. [ProMed, June 9㪢, 1999] USA– PLAGUE ADVISORY (COLORADO) The Colorado Department Of Public Health has issued an advisory against bubonic plague following 2 cases of secondary pneumonic plague in May–June. One individual succumbed to the disease. The mild winter and plentiful food sources are at the root of the recent increase of reported plague cases in Colorado. This facilitates an increase in the rodent population that carry fleas responsible for the spread of the disease. [ProMed, June 07, 1999] OTHER RECOMMENDATION FOR TWO DRUGS IN MALARIA TREATMENT An international group of malaria experts have advised the use of two drugs in treatment for malaria. The increasing prevalence of drug resistant strains of malaria necessitate the two–drug combination of chloroquine or pyrimethamine–sulphadoxine coupled with artemisinin or an artemisinin derivative as first–line therapy. While the two–drug combination would increase the cost of treatment upfront, the long term savings are expected to make up for this initial expenditure. [The Lancet 1999;353: 1965�] RICE MAY HELP TREAT DIARRHEA A substance known as RF factor in boiled rice has been shown to block a diarrhea–related chloride channel thereby reducing the morbidity associated with diarrhea. A study conducted by Canadian scientists has demonstrated an inhibitory effect of RF factor on intestinal cells, reducing chloride secretion. The International Centre for Diarrheal Disease Research in Bangladesh, has been using boiled rice in rehydration packets, and the volume of stools have been shown to be reduce significantly. The molecular basis of the RF factor is not known, but the study strongly supports a concept which could have practical value in the future. [Gastroenterology 1999;116:1342�] MDRTB THREAT TO WESTERN NATIONS Western Europe and North America face the threat of a TB epidemic from Russia, where squalid and overcrowded prisons have become the world's biggest source of MDRTB. Every year, about 300,000 people are released from Russian prisons, and an estimated 89% are infected with TB, including about 10,000 infected with MDRTB. The Russian threat is great because Russian people with TB have easy access to Western Europe and North America. It has been estimated that more than $475 million is needed to contain this epidemic in Russia. Prison reform is another alternative that has been experimented by Mr.Soros, an American financier and philanthropist. The tuberculosis rate in the armed forces has also doubled since the collapse of the Soviet Union. [Globe and Mail, June 10, 1999] [tbnet Info, June 06, 1999] 3. UPDATES FROM PREVIOUS BULLETINS MALAYSIA– NIPAH VIRUS Three more people have died from infection with the Nipah virus in Selangor. The second round of testing of pigs in 600 farms in low–risk areas is to be completed by July 20. In Sarawak, the State Government has lifted a ban on movement of pigs, dogs and cats to and out of Kuching, Serain and Sibu Districts following negative results from the second round of tests. [ProMed, June 6, 1999] [Borneo Bulletin, June 14, 1999] KOREA– DYSENTRY ADDED TO LIST OF RAPIDLY SPREADING EPIDEMICS 660 people nationwide have been affected by bacillary dysentery so far this year, up 3.7 times from 179 reported during the same period of last year. The most recent outbreak occurred at an elementary school in Nonsan, South Chungchong Province, earlier this month. So far, 22 people including young students and residents have come down with the epidemic. National Institute of Health officials are conducting inspections, and attribute partial blame to recent unseasonably hot temperatures. Poor sanitation at cafeterias and other collective feeding centers are another reason. [Korea Herald, June 15, 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. THE INTERNATIONAL SURVEILLANCE NETWORK FOR THE ENTERIC INFECTIONS Salmonella and VTEC 0157 (Enter–NET) has just launched its own internet website. The site is intended to provide information those wishing to find out more about Enter–NET. Quarterly reports and associated information can be accessed at: http://www.enter–net.org.uk 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.