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Vol. II, No. 20 ~ EINet News Briefs ~ November 4, 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. Overview of infectious–disease information from PRO–MED and other sources
  2. Updates from previous bulletins
  3. Notices
  4. How to add colleagues to the EINet listserv

1. OVERVIEW OF INFECTIOUS–DISEASE INFORMATION FROM PROMED   Below is a bi–weekly summary of 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 WHO.


MALAYSIA–UNDIAGNOSED ILLNESS An investigation is currently underway after a 15–year–old boy died, and 44 others were admitted to Beaufort District Hospital for an undiagnosed illness between October 13– 22. All cases reported contact with a stream near the village, Kampung Kebatu. The infective cause has not been confirmed. The fatal case suffered from severe haemoptysis and hypotension. The 44 children and teenagers were admitted for fever, cough, headache, and vomiting. A local microbiology lab will perform serology on thirty blood samples for leptospirosis, meliodosis, scrub typhus, and hantaviruses. Water samples from the stream were also collected for analysis.
[ProMED October 21 & 25, 1999]

CHINA (HONG KONG)–INFLUENZA TRANSMISSION The Department of Health has confirmed a case of swine flu A H3N2. The virus was isolated from a throat sample of a 10–month old girl who has since fully recovered. The girl's family reported no previous contact with pigs. This is the first case of its kind reported in Hong Kong. Patients infected with swine flu H3N2 fully recover without complications. Normal measures to prevent influenza have been advised.
[South China Morning Post October 19, 1999; Department of Health Press Release October 26, 1999]

THAILAND–LEPTOSPIROSIS The Public Health Ministry has reported 136 deaths and more than 2300 illnesses from the waterborne disease, Leptospirosis. This is the highest toll from the disease since it was identified in Thailand in 1985. The source of infection has been traced to water contaminated with rat urine. Leptospirosis cannot be transmitted from person–to–person, but other animals (i.e. pigs, cows, buffalo, and horses) can carry bacteria that cause the disease. Symptoms include severe headache, fever, muscle pain, and red eyes. Infection is fatal in approximately 5㪬%.
[ProMED October 24, 1999; Bangkok Post October 24, 1999]

KOREA–EFFORTS FOR SOUTH–NORTH PROBE INTO MALARIA The Health and Welfare Ministry in South Korea has proposed a joint inter–Korean probe into malaria epidemics. A request was submitted to the National Assembly to allocate funds to support a probe into the causes of malaria and the ecology of the demilitarized zone between South and North Korea; it was recently denied. The Ministry continues to seek funding from other sources, including the South–North Korea Cooperation Fund (managed by the Unification Ministry). An additional budget has also been requested to cover costs for treatment and pesticides (for mosquito control). Health officials believe that the prevalence of malaria in North Korea is relatively high, based upon the country's request for 100kg of an anti–malaria drug (sufficient for 40,000 patients) in 1997 (WHO). Malaria reappeared in South Korea in 1993, after a 14–year absence. The number has since increased three to five–fold each year.
[Korea Times October 8, 1999; The Korea Herald October 9, 1999]

SINGAPORE–MUMPS RESURGENCE WITH RUBINI VACCINE The resurgence of mumps in Singapore has been associated with the Rubini strain of the measles, mumps, and rubella (MMR) vaccine. Since the vaccine was first introduced to the national childhood immunization program in 1990, the incidence of mumps has increased, while the incidences of measles and rubella have declined. From 1997 to 1998, mumps cases increased from 674 to 1183, respectively. It has been estimated that by the year's end, the incidence will reach 200 per 100,000 persons. The Ministry of Health deregistered the Rubini vaccine (May 1999) amid reports that the strain offered poor protection. The ineffectiveness of the strain has also been noted in other countries.
[Eurosurveillance Weekly October 21, 1999]

ASIA–ECONOMIC CRISIS EFFECT ON AIDS EPIDEMIC According to a report at the 5th International Congress on AIDS in Asia and the Pacific, Asia's economic crisis has contributed to a hastened spread of AIDS in Indonesia, and a decreased incidence in Thailand. The increased spread of HIV in Indonesia has been attributed to behavior modifications associated with the economic downturn and political upheaval. Strong prevention programs have been credited for the decline in AIDS incidence in Thailand; a lower incidence has been shown among all groups except intravenous drug users. Such opposing trends have made it difficult to determine the overall effect of the economic crisis on HIV infection in Asia. The 5th International Congress on AIDS in Asia and the Pacific (October 23㪳) was hosted by the Malaysian AIDS Council, in collaboration with sponsors such as the Joint UN Programme on HIV/AIDS (UNAIDS), and the AIDS Society of Asia and the Pacific. The aim of the biannual event is to advance collaboration among developed and developing countries on all aspects that encompass HIV/AIDS. For more information about the conference, please see: www.icaap99.org.my [REUTERS October 26, 1999; www.icaap99.org.my]


AUSTRALIA–SALMONELLA TYPHIMURIUM PT8 Food–related illness has been reported by 60 patrons of a large hotel restaurant in Queensland. Fecal sample serotypes revealed Salmonella typhimurium, subsequently phage–typed as phage type 8.

Bacteria were found in seafood, pre–prepared egg–based desserts, and leftovers served.
[ProMED September 28, 1999]


USA–E. coli OUTBREAK IN ILLINOIS In another major outbreak of E.coli, over 300 attendees of a party in a cow pasture in Petersburg, IL have reported illness. Twenty–two people have required hospitalization. The two secondary infections reported tested negative for toxigenic E. coli. About 1800 people from across the country attended.

Beef has been identified as the source of infection through DNA fingerprinting; however, it is still unknown how it was contaminated.
[ProMED September 23, 1999; Environmental Health News, September 1999]

USA–UNIDENTIFIED RESPIRATORY INFECTION The Massachusetts State Department of Health and the Center for Disease Control and Prevention (CDC) are trying to identify a respiratory infection that has already claimed 6 lives in a pediatric nursing home. The illness manifested over two weeks ago when a 12–year old girl was taken to the hospital for illness, and died the next day of complications. The illness has since been diagnosed in 25 residents of the nursing home, and 3 employees have sought medical attention.

The residents of the pediatric ward are described as very sick, who typically suffer from chronic respiratory problems and head injuries to cancer. As a result, many are particularly vulnerable to such infections.

The latest victim, a 16–year old girl, died last Tuesday.
[ProMED September 29, 1999]

USA–BLASTOMYCOSIS Minnesota state health officials have confirmed 12 cases of Blastomycosis, a rare fungal infection, in Mountain Iron. Approximately a dozen more cases are currently being investigated. The outbreak manifested about a month ago, when 7 people were sent to the hospital for severe pneumonia. All 7 have since been treated and released.

Symptoms usually occur 45 days upon inhalation of spores from the fungus, Blastomyces dermititidis. Commonly found in wood and soil, it is suspected that the fungus was unearthed during mid–summer construction activities. A team of epidemiologists and public health officials are currently testing construction sites and river beds, and drawing blood samples from residents to pinpoint the source of infection.

Blastomycosis infection only occurs upon inhalation of the spores; it is not contagious.
[ProMED September 23, 1999]

USA–ESTIMATES OF FOODBORNE DISEASES According to the journal, Emerging Infectious Diseases (CDC), food causes an estimated 325, 000 serious illnesses, which results in hospitalizations, 76 million cases of gastrointestinal illnesses, and 5000 deaths. The data were obtained from new and existing surveillance systems, death certificates, and published studies.

Since 1993, the Clinton Administration has expanded food safety programs to ensure the safety of the U.S. food supply. New safety standards for meat, poultry, and seafood products, and increased surveillance of food–borne diseases through FoodNet, has improved the report of outbreaks. Last year, the CDC launched PulseNet, a collaborative interagency initiative, to better identify food–borne illnesses. With a network of over 35 laboratories across the country, E. coli can be fingerprinted in less than 24 hours today, a process that took days or weeks in the past.

The update can be accessed at http://www2.foodonline.com/content/news/article
[CDC FoodOnline September 17, 1999; ProMED September 17, 1999]

USA–IMMUNIZATION RATES The Centers for Disease Control and Prevention (CDC) has reported a record–high immunization rate (80.6%) among America's toddlers last year. The percentage was comprised of youngsters between 19 and 35 months who had completed the recommended vaccinations for diphtheria/tetanus, polio, and measles.

The remaining 20% not immunized are believed to be of minority groups and the poor.
[AP Wire September 23, 1999]


USA–OUTBREAK IN NEW YORK CITY RECLASSIFIED The encephalitis outbreak in New York City first believed to be St. Louis Encephalitis (SLE) has been reclassified as West Nile Virus (WNV), a mosquito–borne illness that has never been reported in the Western Hemisphere. The strain was identified in isolates of human brains and birds that died near the Bronx Zoo. WNV is transmitted to humans from mosquitoes that have bitten infected birds.

Health experts have attributed the misdiagnosis to the genetic and antigenic similarity between SLE and WNV, and to the fact that scientists did not expect to identify the WNV strain (since it has never been reported in the Western Hemisphere).

To date, 31 cases have been confirmed, which include 4 fatalities. About 165 additional cases in New York City are currently being investigated. The virus may in fact be more prevalent than originally suspected, as a result of the reclassification.

The city continues to spray for mosquitoes to control and prevent new infections.
[ProMED September 29 & 30, 1999; NY TIMES September 28, 1999]

USA–E.coli OUTBREAK AT A COUNTY FAIR IN NEW YORK The source of contamination in one of the worst recorded E.coli outbreaks in the United States has been traced to a non–chlorinated well. A high level of the potentially fatal strain was found in well water at the Washington County Fairgrounds. Investigators believe the water was contaminated by manure that seeped into the well from a nearby dairy barn after a torrential downpour.

Approximately 1013 cases have been reported; of those, 122 have been culture–confirmed. Over the course of the outbreak, 65 people have been hospitalized and two have died. Eleven children have developed Hemolytic Uremic Syndrome (HUS), a severe complication of E.coli infection. Stool cultures have yielded co–infection of C.jejuni in 13 patients, and Campylobacter in 32 additional patients.

Case report illnesses continue to be received.
[ProMED September 16 &17, 1999; NYDOH News September 17, 1999]

USA–E.coli OUTBREAK IN SOUTHWEST WASHINGTON STATE Laboratory findings have implicated Battle Ground Lake as the source of E.coli contamination in the outbreak in August. The genetic fingerprint of the sediment isolate was an identical match to the fingerprint pattern of the outbreak strain.

Of the 32 culture–confirmed cases, 27 were swimmers, and 5 were contacts of the swimmers. Seven children were hospitalized, 3 for Hemolytic Uremic Syndrome (HUS).

Human feces is the suspected source for lake contamination.
[ProMED September 15, 1999]

USA (TEXAS)–DENGUE FEVER OUTBREAK Twelve cases of dengue fever have been confirmed in the worst dengue outbreak in Texas in 4 years. More than 100 cases have been reported across the Rio Grande, in Nuevo Laredo, Mexico.
[ProMED September 27, 1999]


WHO–NEW PUBLICATIONS The WHO––Western Pacific Regional Office––has released two new documents on sexually transmitted infections (STIs). One, entitled, "Sexually Transmitted Infection Prevalence Study Methodology", provides guidelines for the implementation of prevalence surveys of STIs. The other, entitled, "The Role of Public Policy in Prevention and Control of Sexually Transmitted Infections: A Guide to Laws, Regulations and Technical Guidelines", describes principles of public policies and the operational considerations for preparation.

Both documents can be viewed at the WHO/WPRO website (under Publications) at http://www.who.org.ph/technical/programme/std.htm Hard copies and electronic versions are available upon request to STI@who.org.ph
[WHO October 4, 1999]

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 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.