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Vol. II, No. 17 ~ EINet News Briefs ~

August 26, 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:

  2. Infectious disease information from ProMED and other sources
  3. Updates from previous bulletins
  4. How to join the EINet listserv

The APEC Working Group on Industrial Science and Technology met in Seattle, August 15㪬. A seminar was scheduled on Monday, August 16 to address emerging infections in the region. Below is a summary of the reports on New Trade and Travel Related Outbreaks within APEC.

MALAYSIA – NIPAH VIRUS The Nipah Virus has claimed the lives of approximately 105 Malaysians. Contracted from pigs, human infection leads to respiratory and heart failure. The disease causes morbidity and mortality among animals and humans, as well as places economic costs on the pig industry. Current public health interventions include placing limitations on the movement of pigs between farms and human evacuation from high–risk areas and farms.
[Dr. Mohamad Taha Arif, Disease Control Division, Ministry of Health, Malaysia]

INFLUENZAE SURVEILLANCE – HONG KONG The recent influenzae outbreak among chickens has generated increased attention towards Hong Kong's techniques for influenzae surveillance. Control measures and surveillance on chicken farms must occur simultaneously with efforts to increase the availability of information about the disease to public and private sectors. Issues related to trade, economics, and politics must also be addressed. The development of a robust public health infrastructure is necessary to enhance prevention efforts.
[Dr. Mak Kwok Hang, Community Medicine, Department of Health,
Hong Kong]

ENTERICS AND E. COLI – JAPAN Frequent travel and trade activities contribute significantly to the rapid spread of EHEC in Japan. Improved surveillance techniques and increased information exchange among countries can largely influence the occurrence of disease. Prevention and further spread of disease will require that government agencies work together in response to public health emergencies.
[Dr. Ken Osaka, National Infectious Disease Surveillance Center, Japan]

GONORRHEAL RESISTANCE SURVEILLANCE – APEC The severity of gonorrheal–associated complications (i.e. increased HIV transmission with infection) is preventable through early and appropriate treatment. Approximately one half of the estimated 60 million cases were diagnosed in the Western Pacific and South East Asian regions. Epidemiological and lab based surveillance are reliable guides in selecting treatment guidelines. The WHO WPR GASP systems is an effective long running surveillance system with multi–country involvement. [Dr. John Tapsall, WHO Western Pacific Region Collaborating Center for STD and HIV, Australia]

GLOBAL CHILDHOOD IMMUNIZATION FOR THE 21st CENTURY – RATIONALE FOR THE BILL AND MELINDA GATES FOUNDATION The Children Vaccine Program was founded by Bill and Melinda Gates in response to the International Declaration of the Rights of the Child that "every child has the right to the timely receipt of the needed life saving vaccines without regard to their socioeconomic status or country". Millions of children in need of newer vaccines are dying today as a result of increased costs and trade agreements. The foundation aims to upgrade and improve the global expanded immunization program (EPI) to achieve immunization equity. Advocacy is important in the development of an effective vision and strategy. Activities to date include cooperative agreements with WHO and UNICEF, and support for Hepatitis B and Hib vaccine activities.
[Dr. James Maynard, Senior Vice President and Medical Director, PATH; Technical Director, Bill and Melinda Gates Children's Vaccine Program, USA]

PULSENET Decreased costs and mass distribution in food production has led to an increased number of widespread food–borne disease outbreaks. Techniques to investigate these situations are necessary to prevent further spread. Pulse Net, a food safety network, links public health laboratories and state health departments with investigators at the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and Agriculture Department so that outbreaks of food–borne diseases are identified more quickly. Its use has been successful, specifically with the early and rapid detection of E. Coli 0157 outbreaks in Seattle, Alpine, WY, and Canada. The combination of technology and thorough field investigation is vital to minimizing the impact of similar adverse events.
[Dr. John Kobayashi, Head of Communicable Disease Epidemiology, Washington State Department of Health, USA]

SUMMARY Public Health is important from a biological to an economical standpoint. Increased funding to battle emerging infections is necessary to prevent further spread of disease. As a result, politicians must be informed about the nature of some outbreaks. The use of technology for rapid testing, the dissemination of information, the need for accurate and timely information and sound epidemiology training all must occur simultaneously to battle infectious diseases.
[Dr. James Leduc, Associate Director for Global Health, CDC, USA]

2. OVERVIEW OF INFECTIOUS–DISEASE INFORMATION FROM PROMED   Below is our bi–weekly summary of relevant Asia–Pacific EID issues based on postings to the ProMED Electronic Network and other sources. ProMED is the prototype for a communications system that monitors emerging infectious diseases globally, an initiative of the Federation of American Scientists (FAS), and co–sponsored by the WHO.


TUBERCULOSIS INFECTION A study conducted by the WHO has revealed that more than half of the new tuberculosis (TB) cases reported in 1997 occurred in five southeast Asian nations. The finding was attributed to poor control strategies and weakened immune systems. Southeast Asia accounted for the largest number of TB cases, with 44% of the area's population infected. The countries with highest incidence were India, China, Indonesia, Bangladesh, Pakistan, and the Phillipines. The study estimated that in the 212 countries monitored, 1.86 million people, or 32% of the global population, carry the TB bacterium today.

SOUTH KOREA – CHOLERA IMPORTED The NIH has confirmed that a 24 year–old man from Naju has contracted cholera. The man was infected with the disease after he visited Bangkok, Thailand during August 5㪢. Cholera was detected in his stool sample after a medical check–up for a diarrheal condition. The institute is currently tracing the 258 passengers on the man's flight for any other afflictions. Officials have issued an advisory to overseas travelers to pay extreme caution to personal hygiene (i.e. wash hands after being outdoors), to drink boiled water, and to avoid raw fish in coastal areas.
[ProMED, August 21, 1999]

HONG KONG – VANCOMYCIN RESISTANCE A new strain of Staphylococcus aureus with partial resistance to vancomycin was recently found in Hong Kong. Vancomycin is considered the last killer of some bacteria strains resistant to other antibiotics. The discovery may have identified as a result of Hong Kong's high consumption of vancomycin per capita (among Asian countries), and/or a good surveillance system. Physicians have been asked to prescribe antibiotics with extreme caution.
[ProMED, August 11, 1999]


AUSTRALIA – ANTIBIOTIC ABUSE A medical specialist strongly recommends that Australia ban the use of avoparcin in animals. An antibiotic that belongs to the same group as the drug used to treat human staph, vancomycin, avoparcin is used to fatten chickens, calves, pigs, beef, and dairy cattle. The physician reports that many people are developing a resistance to vancomycin through the food chain. The use of avoparcin has been recently banned in Europe.
[ABC ONLINE NEWS, August 2, 1999]


USA – HEPATITIS C Approximately 27 million people in the United States are chronically infected with HCV. Persons between the ages of 30 and 49 account for 65% of those infected. Among subjects between 17 to 59 years of age, the strongest factors independently associated with HCV infection were illegal drug use and high–risk sexual behavior. Other factors included poverty, education (<12 years), and divorce or separation. Neither sex nor ethnicity were independently associated with HCV. The results were determined by the third National Health and Nutrition Examination Survey, conducted between 1988 and 1994.
[NEJM 1999, 341: 556㫖]

USA (TEXAS) – DENGUE The Texas Department of Health has confirmed Dengue in two Laredo residents. Currently, other suspect cases are being investigated. The use of PCR to determine the circulation of any other serotypes has revealed DEN ן in one specimen to date. Dengue has also been reported in Nuevo Laredo, located just inside the Mexico border. The last outbreak of Dengue in Texas occurred in 1995, when 29 cases, mostly travelers, were reported.
[ProMED, August 18, 1999]

USA (N. CAROLINA) – ALERT: HEPATITIS A Health officials have issued a warning to patrons of the Texas Steakhouse in Smithfield (Johnston County) on July 24, 25, 25, 31, and August 1, 2, 7, 8, 1999 after 3pm about possible exposure to Hepatitis A. An employee that worked during those times was recently diagnosed to with Hepatitis A. It is possible that 3000 diners were exposed. For more information, please call the Johnston County Health Department at (919) 989 – 5200.
[ProMED, August 20, 1999]


RUSSIA – BUBONIC PLAGUE The first known death of plague in the Central Asian state of Kazakhstan was reported on August 8, 1999. A 13 year–old boy fell ill from septic bubonic plague two days after a flea bite in the Kyzyl–Orda region. The 20 people in contact with the boy have been isolated. Plague is more commonly transmitted to man by a flea that carries the organism, Yersinia pestis.
[ProMED, August 9, 1999]

RUSSIA – ANTHRAX A quarantine was imposed in Nizhnecheremoshnoya Village upon the hospitalization of four residents with anthrax. It was determined that all the individuals had cut carcasses of slaughtered animals prior to infection. Anthrax was found in at least 20 cows. Before word about the cows' illness was known, meat was sold to neigboring villages. At least 14 cases of Anthrax in another eastern Russian region were reported last month.
[ProMED, August 16, August 21, 1999]


JAPAN – Q FEVER OUTBREAK A Health and Welfare Ministry Research Team in Japan has reported the first widespread outbreak of Q Fever in the country. The bacterium responsible for the fever condition was discovered in 8 patients. The similarity of symptoms between the disease and influenza has raised concern about misdiagnosis. Insufficient knowledge about the disease has generated increased efforts to inform hospitals about proper testing methods, criteria for diagnosis, and effective treatment procedures. The last and only case in Japan was reported in 1988.
[ProMed, August 10, 1999]

USA (OHIO) – COLESLAW TAINTED WITH E. COLI Coleslaw served at four Kentucky Fried Chicken restaurants in the Ohio Valley between July 5㪳 have been linked to 30 reported cases of E coli. The source of contamination was traced by the FDA to the improper preparation of the coleslaw (washing of cabbage). As a result, KFC restuarants received a clean bill of health.
[ProMed, August 15, 1999]

USA (MASSACHUSETTS) – SHIGELLOSIS Over the past couple of weeks, cases of Shigellosis have skyrocketed from 24 to nearly 100 in cities and towns in Hampden County. The potential of the intestinal disease to rapidly spread has prompted health officials to issue an advisory about the importance of proper hand washing, particularly after toilet use. A similar outbreak in 1991 sickened more than 1000 people in the county.
[ProMed August 17, 1999]

4. JOIN THE E–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 material with colleagues in the Asia–Pacific Rim. To subscribe (or unsubscribe), please contact Laura Schubert at lschub@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://www.apec.org/infectious