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Vol. II, No. 18 ~ EINet News Briefs ~ September 10, 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:

  1. APEC cooperation on emerging infectious diseases
  2. Overview of infectious–disease information from PRO–MED and other sources
  3. Updates from previous bulletins
  4. How to add colleagues to the EINet listserv

1. ASIA PACIFIC ECONOMIC COOPERATION AND EMERGING INFECTIOUS DISEASES The Asia–Pacific Economic Cooperation (APEC) was founded in 1989 to improve the 21–member economies through free and open trade. The potential impact of infectious disease outbreaks on trade and travel activities was apparent during the "bird flu" epidemic in Hong Kong that left 6 dead and the destruction of more than a million chickens. In response to similar threats on health and security, the APEC Science and Technology Ministers endorsed an initiative to improve cooperation on emerging infectious diseases. The APEC Industrial Science and Technology Working Group (ISTWG) was named to coordinate relevant actions and projects.

Internet technologies continue to be utilized as the bridge of discussion and coordination among collaborators from opposite sides of the Pacific. An initiative to evaluate the capacities of APEC economies for further collaboration on infectious disease prevention, surveillance, and research was raised following a meeting in Seattle last month, where presentations ranged from government efforts in viral outbreaks to global childhood immunization programs. The University of Washington currently maintains an ISTWG–approved project on emerging infections: an Internet–based network that provides up–to–date information on infections, prevention, and control. The APEC Emerging Infections Network (see: www.apec.org/infectious) is particularly valuable because national and international public health–disease reporting structures are not tailored to the needs of the new economic cooperation of APEC.

The control and treatment of infectious diseases can cost billions of dollars. Prevention efforts can save lives and money, and only cost little. Thus, the vision to increase collaboration and cooperation among APEC member countries will not only help safeguard public health in the Pacific Rim, but the member economies as well.

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 protoype 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.


JAPAN – TOXIC SHOCK SYNDROME The results of an epidemiological study has revealed the possibility of Toxic Shock Syndrome (TSS) – associated deaths during an influenza outbreak early this year, at which time 19 patients died. Although a causal relationship between the bacteria that causes TSS, Methicillin–resistant Staphylococcus Aureus (MRSA), and the deaths was not found, the center that conducted the survey was able to conclude the role of TSS in some of the deaths. According to the Ministry's Infectious Disease Division, several studies have revealed patient experience with TSS upon influenza infection. There is a possibility that TSS may be caused by the invasion of bacteria into the respiratory tract after membrane damage from influenza.
[Dr. Hiroshi Takahashi, National Infectious Disease Surveillance Center, Tokyo, Japan]


AUSTRALIA (MELBOURNE) – MENINGOCOCCAL DISEASE A third case of deadly meningococcal disease has been reported in Melbourne. The 16–year old girl appeared to have the septicaemia form of the disease. The report was made shortly after two 14–year old girls with the same disease were taken off the critical list at Royal Children's Hospital. It is still unclear whether a connection between the three cases exists.
[Canberra Times August 30, 1999]


USA (NEW YORK) – E.COLI OUTBREAK The New York State Health Department has confirmed 33 cases of E. coli in what may be considered one of the country's worst outbreaks since 1993. To date, one child has died, another is in critical condition, and 155 others appear to be infected, 45 of which, remain hospitalized. The victims are children between the ages of 3 and 14, or elderly, that attended the Washington County Fair on August 28 and 29. The Health Department believes that water contaminated with manure from the dairy barns on the site is the likely cause of E. coli contamination. The E. coli–infected water may have then been used to make ice, drinks, wash lettuce, and prepare various foods. Although many strains of E. coli are considered harmless, the strain, 0157: H7, identified in many of the victims infected at the Washington County Fair, is deadly. Health officials have not yet discovered a pattern among those who have become ill. Individuals at greatest risk for spread and infection include child care, health, and food service workers.
[ProMED September 6 & 7, 1999]

USA (WASHINGTON) – E. COLI OUTBREAK Since August 1, twenty–nine culture confirmed cases of E. coli 0157:H7 have been reported in Washington State. The Southwest Washington Health District and the Washington State Department of Health have confirmed 4 cases among children, and continue to investigate 20 others, associated with an outbreak at Battle Ground Lake. Interviews revealed that three cases swam in the lake, and the other was a secondary case linked to a sibling swimmer. The Washington State Public Health Laboratory is currently conducting DNA fingerprinting by pulse–field gel electrophoresis (PFGE) on lake isolates. The results to date demonstrate a consistent "outbreak" pattern. Although the lake is the primary suspect source, other possibilities have not yet been ruled out.
[ProMED August 31 & September 5, 1999]

USA (NEW YORK) – ST. LOUIS ENCEPHALITIS The New York Department of Health has confirmed 5 cases of St. Louis Encephalitis (SLE) in Queens, NY. Approximately 34 other possible cases in the area are currently being investigated. A potentially fatal disease in the elderly and infants, SLE is a mosquito–borne viral disease. Symptoms range in severity from a slight headache or fever, to paralysis or death. The New York City Health Department has issued an advisory to residents of Queens to take necessary precautions to avoid mosquitoes. The city of New York has also contributed to public health efforts by spraying the insecticide, Malathion, on potential breeding grounds of the mosquitoes that carry SLE.
[ProMED August 5 & 7, 1999]

USA (NEW YORK) – MALARIA Two 11–year old boys were infected with the parasitic disease malaria at a Boy Scout camp on Long Island between August 1ף, 1999. The boys did not exhibit any symptoms until they returned home, as a result of the two–week incubation period of the disease. Although it is extremely rare that malaria is contracted within the United States, the New York State Health Department believes that these cases were acquired in the country. A search of the 200–acre camp uncovered mosquitoes carrying the disease. Residents have been asked to take the necessary precautions to avoid mosquitoes. The most recent cases of locally acquired malaria occurred in Queens in 1993.
[ProMED September 2, 1999]

USA (SAN FRANCISCO) – SYPHILIS ON THE WEB A recent outbreak of syphilis has been tracked to an America Online (AOL) chat room. Six cases in the San Francisco Bay Area traced their most recent sexual encounters to partners met in a chat room created by AOL member, San Francisco Men 4 Men (SFM4M). Since the infected only knew their multiple partners by their computer nicknames, or "handles", and AOL could not divulge the participants' real names, the San Francisco Health Department was put in touch with Planet Out, a worldwide online service for homosexuals. The service contributed to public health efforts by posting messages to people in chat rooms, and training volunteers to visit chat rooms to talk to people about the outbreak. Of the 99 men directly exposed to syphilis, 33 have been tested so far. It is estimated that another third contacted their own physicians, and the remaining are still unaware of their exposure.
[ProMED August 25, 1999]

BLOOD DONATION BAN A ban on blood donations has been issued to American and Canadian travelers to Britain during the country's mad–cow disease crisis. The ban applies to anyone who has traveled or lived in Britain for at least 6 months since 1980. The donor ban was issued as a precaution to the human brain–destroying illness associated with mad–cow disease. Although there is no evidence of transmission through human blood transfusions, scientists do not want to rule out the possibility of harm from infected blood. The restriction could have a large impact on the blood supply during a critical time of shortage.
[ProMED August 21, 1999]


RUSSIA – BOTULISM Botulism has claimed the lives of 4 residents of the Southern Siberian Buryat autonomous republic. Approximately 48 persons have been affected, 24 of which were taken to the hospital. Doctors believe that the source of poisoning was fish from Lake Baikal. Botulism, which results from the ingestion of food containing toxins produced by Clostridium botulinum, affects the human nervous system. This is the second outbreak in Ulan–Ude in less than half a month, when two men died after eating poorly cooked fish. The botulism toxin can be inactivated with heat (>100 degrees C) and refrigeration (of fish) prior to consumption.
[ProMED September 7, 1999]

GLOBAL HEALTH GAP According to researchers at the World Bank, the global health gap between rich and poor countries continues to widen. As a result, problems in poor countries are masked by the increasing rates of non–communicable diseases among the elderly. It was asserted that the impact of communicable diseases among the poor is far greater than what is suggested by global averages, and that non–communicable diseases are correspondingly less important. The research team used the 1996 global burden of disease study (WHO) to compare communicable and non–communicable diseases among the poor and the rich.

Communicable diseases included parasitic diseases, respiratory infections, maternal and perinatal conditions. Major non–communicable diseases were defined as malignant neoplasms, diabetes, and cardiovascular and digestive conditions.
[ProMED August 19, 1999]


USA (TEXAS) – DENGUE Texas health officials have stepped up efforts to rid the city of Laredo of the mosquito responsible for the spread of dengue fever. In the past two weeks, 15 people have been treated for the viral illness. Across the river from Laredo, in Nuevo Laredo, Mexico, at least 106 cases of dengue have been confirmed. According to the Texas Department of Health, of the 5 dengue cases in Webb County (the county in which Laredo is located) , 4 had traveled to Nuevo Laredo. The other case denies travel in the two weeks prior to becoming symptomatic. Other suspect cases continue to be investigated.
[ProMED August 27, 1999]

MALAYSIA – NIPAH VIRUS During efforts to contain the Nipah virus outbreak, 13 employees from the Veterinary Services Department tested positive for the viral disease. The infected included laboratory workers and those involved with the pig culling operations. Currently, they are undergoing counseling and regular medical examinations as a precautionary measure.
[ProMED September 7, 1999]

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 Laura Schubert at lschub@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://www.apec.org/infectious.