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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:
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.
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. 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%. 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. 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. 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. 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. 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. 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. 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
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.
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. 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. 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. 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. 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
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