Login   

Vol. VIII, No. 3 ~ EINet News Briefs ~ Feb 04, 2005


*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
- Chile (Puerto Montt): Vibrio parahaemolyticus, 327 cases of infection
- USA (Maryland): Third case of Legionnaires' disease in Ocean City, Maryland
- USA: Two New York City residents diagnosed with LGV
- WHO Latest Situation Reports on South-East Asia Earthquake and Tsunami (4 Feb 2005)
- Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1)
- East Asia: FAO Update on the avian influenza situation, as of 28 Jan 05
- East Asia: Bird flu remains a constant threat and could worsen
- Cambodia: Avian Influenza Virus Not Found in Relatives of Dead Woman
- Cambodia: First Cambodian human case of infection with A/H5 avian influenza
- Viet Nam: Cases under investigation
- Viet Nam: Eight Suspected Avian Influenza Cases Reported
- Vietnam: Seeking International Assistance to Fight Bird Flu
- Vietnam: To halt poultry raising in bird flu-hit areas
- Vietnam: Ho Chi Minh City to kill ducks in bird flu fight
- Viet Nam: Increased Surveillance for Suspected Avian Influenza Virus Cases
- Thailand: Bird flu hits two more provinces
- Indonesia: Disease surveillance, tsunami-related
- Thailand (Phangnga): Melioidosis risk among survivors of tsunami
- Malaysia: 14 die in measles outbreak in Sarawak
- China: Meningococcal disease outbreak
- Philippines: Meningococcal disease
- Philippines: Typhoid fever cases
- Australia: Goats may be tested for BSE; goat in France tests positive for BSE
- Australia (Victoria): Salmonellosis, dodgy dips blamed for food poisoning
- Australia: Gardeners warned of deadly potting mix
- Russia: Animal rabies is spreading in Chelyabinsk
- Russia (Far East): Yersiniosis cases in kindergarten children

1. Updates
- Influenza
- Cholera, diarrhea & dysentery update
- Dengue/DHF update
- Viral gastroenteritis update
- West Nile Virus

2. Articles
- The New England Journal of Medicine: avian influenza articles
- CDC EID Journal, Volume 11, Number 2-February 2005
- Lack of H5N1 Avian Influenza Transmission to Hospital Employees, Hanoi, 2004.
- Dengue haemorrhagic fever after living donor renal transplantation
- Rapid Health Response, Assessment, and Surveillance After a Tsunami --- Thailand, 2004--2005
- HIV Transmission Among Black Women --- North Carolina, 2004
- Outbreaks of Pertussis Associated with Hospitals --- Kentucky, Pennsylvania, and Oregon, 2003
- Outbreak of Invasive Pneumococcal Disease --- Alaska, 2003--2004

3. Notifications
- National Black HIV/AIDS Awareness and Information Day --- February 7, 2005
- International Meeting on Microbial Epidemiological Markers (IMMEM7)
- Third European meeting on viral zoonoses

4. APEC EINet activities
- Access Grid node videoconference: EINet, Philippines, Japan, and Australia

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Chile (Puerto Montt): Vibrio parahaemolyticus, 327 cases of infection
Owners of food establishments stated that they are complying with all of the regulations requested by authorities to protect their customers. Mr. Dagoberto Duarte, Ministry Regional Secretary, said that the number of Vibrio parahaemolyticus infections had risen to 327 in the past few days. "People living in Puerto Montt are conscious that if they eat raw seafood they might get sick, but the important issue is to actively inform tourists coming for the summer holidays that they might get in trouble if they eat raw seafood. Thus, next week, we will re-launch the prevention campaign, Mr. Duarte stated. On the other hand, the coordinator of The Province Sanitary Action Program, Mr. Pedro Villar, stated that the specific places where possibly contaminated seafood is being sold have not yet been identified. (Promed 1/26/05)

^top

USA (Maryland): Third case of Legionnaires' disease in Ocean City, Maryland
The Worcester County Health Department is reporting a third case of Legionnaires' disease associated with an Ocean City (Maryland) condominium. As with the two previous cases, this case is associated with the Braemar Tower condominium complex. The first two patients stayed in separate units in the complex, and one of them died. The condition of the person in the latest case isn't known, but health officials say the person is alive. While health officials can't confirm the patients contracted Legionnaires' at the condo, water samples from several locations inside tested positive for the bacterium. The condominium owners treated the water. The health department will do follow-up testing in the next few days. What may be very important about these cases is that, as holiday condominiums and possibly time-share ones, there may be other cases associated with the complex, perhaps residing outside of Maryland. It should be noted that the isolation of L. pneumophila from water samples does not immediately identify the source, as the human strains may be a different legionella from the water strain. (Promed 2/2/05)

^top

USA: Two New York City residents diagnosed with LGV
Health officials announced 2 Feb 2005, that two New Yorkers have been diagnosed with a rare form of Chlamydia known as lymphogranuloma venereum, or LGV. In the past few decades, LGV has been uncommon in industrialized nations, although several cases have recently been found in the Netherlands and the UK. To date, CDC has confirmed six recent cases in the USA, including these two and cases in San Francisco and Atlanta. CDC is also investigating other potential cases. The illness appears to have primarily affected gay and bisexual men. Among cases identified thus far, most have also had HIV/AIDS infection. Most people infected report having multiple sex partners and engaging in unprotected anal intercourse and other high-risk practices. Symptoms of LGV include painful, bloody rectal infection that may be confused with inflammatory bowel disease. Genital ulcers can occur, as can painful, draining lymph nodes in the groin area. If identified early, LGV can be treated with antimicrobial agents. Untreated LGV can cause permanent damage to the bowels and disfigurement of the genitals (elephantiasis). LGV can also fuel the spread of HIV/AIDS. Health Commissioner Thomas R. Frieden said, "LGV is a serious condition and its emergence in New York City reflects continuing high levels of unsafe sexual activity among men who have sex with men. Medical providers who care for gay and bisexual men should be alert for symptoms of LGV. It is also critical for gay and bisexual men to minimize risky sexual behaviors and practice safer sex--including limiting the number of sex partners and using condoms every time you have sex--to help prevent the spread of this illness and HIV/AIDS. Unprotected anal intercourse, in particular, is extremely risky in terms of spread of LGV as well as HIV." (Promed 2/3/05)

^top


Asia
WHO Latest Situation Reports on South-East Asia Earthquake and Tsunami (4 Feb 2005)
Relief and rehabilitation continue to progress simultaneously. For WHO, the relief work primarily means being vigilant for outbreaks and improving water and sanitation facilities in order to promote health security. No disease outbreaks have been reported. The rehabilitation work is proceeding rapidly. WHO is supporting local communities and governments in planning for reconstruction of sustainable and equitable health systems. For more information: http://www.who.int/hac/crises/international/asia_tsunami/en/ (WHO 2/4/05)

^top

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1)
Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) since 28 January 2004 (WHO), as of 2 Feb 2005: total cases, deaths in parentheses
Cambodia: 1 (1)
Thailand 17 (12)
Viet Nam 37 (29)
Total 55 (42)
(WHO http://www.who.int/csr/disease/avian_influenza/country/cases_table_2005_02_02/en/)

^top

East Asia: FAO Update on the avian influenza situation, as of 28 Jan 05
Outbreaks of H5N1 Highly Pathogenic Avian Influenza (HPAI) in poultry were reported in Thailand and Viet Nam, and human cases were reported in Viet Nam during the preceding month. Having lunar New Year day on 9 February, movement of poultry and poultry products will increase in the region. The need for biosecurity of domestic poultry to prevent infection and enhanced early warning in order to detect every additional case are highest during this season to avoid new cases of HPAI in poultry and to minimise the risk to humans. To read the report: http://www.fao.org/ag/againfo/home/en/home.html. Economy situations are reported for: Thailand, Vietnam, Hong Kong, Pakistan, Lao PDR, Cambodia, China, and Malaysia. Topics include: Latest information on Avian Influenza, Recommendations on the Prevention, Control and Eradication of HPAI in Asia, Surveillance and Post-epidemic rehabilitation activities, Related issues, Actions taken – follow-up, and Resources available. (Promed 1/30/05)

^top

East Asia: Bird flu remains a constant threat and could worsen
Countries need to step up control efforts, more emphasis on animal health issues needed
The new wave of Avian Influenza outbreaks in Vietnam and Thailand clearly shows that the avian virus remains endemic in Asia and that affected countries need to do more to keep it under control, FAO and the World Animal Health Organisation (OIE) said in a joint statement 2/1/05. Recent experience shows that it may be impossible to eradicate the virus soon. "The disease will be present for several years in the countries that experienced outbreaks during 2004", the two agencies said. “Avian Influenza is an on-going emergency disease that spreads across borders. It has serious implications for the public and animal health sector in the affected countries,” FAO/OIE said. “The international community has to realize that some poor countries in Asia living with the bird flu virus must receive more support to intensify precautionary measures and to contain the risks associated with the disease,” the two agencies said.

The immediate challenge is to control Avian Influenza at source in the infected countries and stop the possible spread of the virus to other regions. “The battle against bird flu can only be won if more efforts and resources are directed to containment of the virus in animals in rural areas,” FAO/OIE said. Water birds, particularly ducks, are considered as a reservoir of infection. The chances for spillover from ducks inhabiting the vast wetlands to poultry production units in villages or on commercial farms need to be significantly decreased. Strict biosecurity measures need to be applied throughout the poultry production chain, from farms and smallholdings to distribution channels, markets and retailers. In order to contain the bird flu epidemic, infected countries such as Viet Nam and Indonesia need the support of the international community to strengthen the veterinary infrastructure and implement effective control strategies, based on better biosecurity, modernised industry practices and, where appropriate, vaccination, FAO/OIE said. Since February 2004, donors have provided around $18 million for emergency activities and capacity building, but much more resources are urgently needed.

FAO/OIE warned that the tsunami disaster may worsen the bird flu situation in Asia due to the large-scale movement of poultry. FAO is sending an expert mission to Indonesia , Sri Lanka and The Maldives this week to assess the loss to the livestock sector and future rehabilitation needs. A regional FAO/OIE meeting on Highly Pathogenic Avian Influenza will be held in Ho Chi Minh City, Viet Nam (23-25 Feb 2005) to discuss the status of bird flu and future control efforts. An international conference drawing together renowned scientists and risk managers will be organized in Paris (7-8 Apr 2005) at OIE Headquarters to discuss the global dimension of bird flu. The meeting is jointly organized by FAO and OIE in collaboration with WHO and is expected to propose new international guidelines for better controlling Avian Influenza in animals, based on the latest scientific information. (OIE/FAO 2/1/05)

^top

Cambodia: Avian Influenza Virus Not Found in Relatives of Dead Woman
No avian influenza A (H5N1) virus was found among seven relatives of the avian influenza virus-positive woman who died in a Viet Nam hospital, an official said 3 Feb 2005. "The tests from the Pasteur Institute here showed that they are negative for avian influenza virus infection," said Ly Sovann, of the Health Ministry's infectious disease department. The 25-year-old woman from Cambodia's Kampot province on the border of Viet Nam died 30 Jan 2005, two days after undergoing treatment in Viet Nam's Kaing Eang provincial hospital. The authorities have taken blood samples from seven of the woman's relatives as well as the family's fowl, but none of them was found infected with the H5N1 virus, he said. The woman's 14-year-old brother also died 21 Jan 2005 after exhibiting avian influenza-like symptoms, and other members of the family were also suffering from high fever and respiratory problems. Moreover, some chickens and fowl fell ill and died in the area in recent months. The Cambodian government has banned the import of poultry and poultry products from Viet Nam and Thailand from 31 Dec 2005. And officials were asked to be extra careful when examining livestock and related products. (Promed 2/3/05)

^top

Cambodia: First Cambodian human case of infection with A/H5 avian influenza
The Ministry of Health in Viet Nam reported one further laboratory confirmed case of human infection with H5 avian influenza. The 25-year-old woman was from Kampot Province in Cambodia, where she developed respiratory symptoms 21 Jan 2005. She sought medical care in neighbouring Viet Nam 27 Jan and died in Kien Giang Provincial hospital in Viet Nam 30 Jan. Tests undertaken at the Pasteur Institute, Ho Chi Minh City, Viet Nam 1 Feb were positive for influenza A/H5. She is the first human case of H5 infection reported from Cambodia. A joint mission of the Cambodian Ministries of Health and of Agriculture and of WHO is in Kampot Province, investigating the circumstances surrounding this case. (WHO 2/2/05)

^top

Viet Nam: Cases under investigation
Three more people are reported to have died of H5N1 avian influenza in Viet Nam. Among them, figure the 13-year-old and 10-year-old girls announced previously. Both children resided in different southern provinces. The third death occurred on 27 January in a man in his 30's from the northern province of Phu Tho. If confirmed by the Ministry of Health, these latest three cases will bring the total number of human H5N1 cases in Viet Nam, excluding the case from Cambodia reported above, identified since mid-December to thirteen. Twelve of these cases have been fatal. (WHO 2/2/05)

^top

Viet Nam: Eight Suspected Avian Influenza Cases Reported
Eight people from Viet Nam's northern region have been hospitalised with avian influenza symptoms, while Viet Nam and Cambodia have pledged provincial cooperation in fighting the disease, according to the local newspaper "Youth" 3 Feb 2005. The eight patients were admitted to the Tropical Disease Institute in Hanoi, raising the total number of confirmed and suspected cases under treatment there to 21, according to the Vietnamese News Agency. Of the patients, three have been confirmed to have contracted avian influenza A (H5N1) virus infection. Since late December 2003, Viet Nam has detected seven local H5N1 carriers from the northern region and 10 others from the southern region, of whom 12 have died. Viet Nam and Cambodia have discussed measures to effectively curb the spread of avian influenza among poultry and from fowl to humans. They agreed to establish an anti-bird flu team to prevent and fight the disease in border areas of the two provinces. Avian influenza has affected 33 out of 64 cities and provinces in Viet Nam since January 2005, killing or leading to the forced culling of nearly 1.2 million poultry. According to the country's Department of Animal Health, four provinces have detected no new outbreaks for 21 days, meeting the criteria for declaring an end to the disease. (Promed 2/3/05)

^top

Vietnam: Seeking International Assistance to Fight Bird Flu
Vietnam appealed for international assistance 2 Feb 2005 as bird flu continued to spread among people and poultry. Acting Agriculture Minister Cao Duc Phat, the chairman of the national steering committee for avian influenza, sent a letter to the WHO and the FAO asking those agencies, as well as foreign governments, to provide technical aid for fighting the disease. The A(H5N1) strain of the virus has devastated poultry in Vietnam and killed 13 of the 14 people who were infected in the last five weeks. Anton M. Rychener, the FAO's chief representative in Vietnam, said the country's officials wanted help from foreign epidemiologists, pathologists, toxicologists, veterinarians and lab technicians, as well as lab equipment for diagnosing the disease. Vietnam has lifted the many restrictions it imposed on the much more limited foreign assistance it accepted during a bird flu outbreak a year ago.

Flu experts have warned that if the virus develops the capacity to pass readily from person to person, it could cause a global influenza pandemic. The vice director of the department, To Long Thanh, said blood tests on ducks in Vietnam had shown the virus to be increasingly widespread in small farms where poultry is often close to people. The government is considering a plan to shut down all duck breeding quickly, with a gradual halt by June to the keeping of ducks, the main poultry industry in southern Vietnam. The industry would then be restarted using more sanitary conditions to prevent infections of poultry and people. Vietnam wants international advice on how to do this, Bui Quang Anh, the director general of Vietnam's department of animal health, added.

In interviews here and in neighboring Hatay Province recently, veterinarians, doctors, farmers and market vendors had varying assessments of whether the spread of the avian influenza virus was worse than it was last winter. "The disease is spreading too quickly," said Nguyen Huy Dang, the chief veterinarian of Hatay Province. "We all recognize how dangerous bird flu is, because the virus keeps evolving." But other experts question whether the risks have increased. The rate of confirmed human cases this winter, two or three a week, is similar to the rate last winter, said Dr. Peter Horby, a WHO epidemiologist. There was one case of probable human-to-human transmission in Thailand in Aug 2004, and two clusters of cases in families in Vietnam since late Dec 2004 are now under investigation. But most cases still appear to be caused by close personal contact with live, infected poultry.

Many of patients of bird flu this winter, as last winter, have been treated at the Tropical Disease Institute here, which is an elite hospital by Vietnamese standards but with limited equipment by Western standards. Dr. Nguyen Thi Tuong Van, the deputy director of the emergency department and the head of bird flu treatment, said local labs were unable to analyze samples quickly. Faster analysis of samples, if Western countries donate lab equipment and technicians, would help the hospital decide whom to isolate and when to provide family members of patients with medicine in case they had also been exposed to the disease, Dr. Van said. Even more important, she said, is an immediate effort to understand how the disease spreads. Vietnamese doctors are still struggling to understand why some contract the disease while others in contact with the same infected poultry are unaffected. (Promed 2/3/05)

^top

Vietnam: To halt poultry raising in bird flu-hit areas
Vietnam is instructing localities nationwide to temporarily cease the raising of poultry in bird flu-stricken areas, in a move to stop the spread of the disease, according to local newspaper Youth 1 Feb 2005. Minister of Agriculture and Rural Development Cao Duc Phat has just asked bird flu-hit cities and provinces to halt the raising of fowls in communes or districts stricken by the disease, and to cease the development of waterfowls, mainly ducks, in unaffected areas. He has also urged local research institutes to vaccinate poultry on a trial basis. Two major reasons are cited for the minister's decision: bird flu has so far in 2005 spread to 32 cities and provinces nationwide, killing and leading to the forced culling of more than one million fowls, and many ducks, especially in the southern Mekong Delta, are infected with the bird flu virus strain of H5, but still look healthy. In response to the decision, the municipal authorities in Ho Chi Minh City have decided to stop the raising of ducks in the city for one year, starting from early Feb 2005. The city will slaughter healthy ducks, freezing them, and cull all others infected with H5 by 7 Feb 2005. Raisers are to receive financial assistance of 15 000 Vietnamese dong for each duck culled. Regarding chickens, the municipal authorities have banned the raising of the fowls in the inner city. The city will keep closer surveillance on chicken farms, and offer interest-free loans to local companies so that they can turn live chickens into frozen meat. (Promed 2/1/05)

^top

Vietnam: Ho Chi Minh City to kill ducks in bird flu fight
Ho Chi Minh City will slaughter all its ducks to try to stop the renewed spread of bird flu, which has infected poultry in half the country. The southern city, home to 10 million people, is next door to the Mekong Delta where a third wave of bird flu outbreaks erupted Dec 2005. Of the 12 deaths since then, 10 were southerners and 9 of them lived in the delta. They took the death toll from the Asian bird flu since the end of 2003 to 44, 32 in Vietnam and 12 in Thailand. Nguyen Thien Nhan, deputy chairman of the Ho Chi Minh City government, ordered officials to slaughter 150 000 ducks while a private firm will process 60 000 ducks for consumption. The city has around 210 000 ducks, which can carry the H5N1 virus without showing symptoms. Half are raised outdoors on small farms, allowing a potentially rapid spread of the virus. Animal health officials said last week 31 of 148 samples taken from ducks in the city showed the presence of the virus. Health workers and market inspectors will ensure no ducks are raised locally for a year and all ducks being transported into Ho Chi Minh City will be seized for destruction, often by burning. By 30 Jan 2005, the H5N1 virus had killed or resulted in the slaughter of more than 1 million poultry in 31 of Vietnam's 64 provinces, the Agriculture Ministry said. During 2004, the epidemic wiped out 17 percent of Vietnam's poultry stock of 250 million. Vietnam, FAO, and OIE will hold a three-day regional meeting on bird flu in Ho Chi Minh City starting 23 Feb 2005. (Promed 2/1/05)

^top

Viet Nam: Increased Surveillance for Suspected Avian Influenza Virus Cases
Epidemiologists and doctors will begin supervising suspected avian influenza patients across the country starting 29 Jan 2005 to fight avian influenza. Director of the Central Institute of Hygiene and Epidemiology Dr Nguyen Tran Hien said 26 Jan 2005 that the supervision programme will take and test phlegm samples from all patients who show symptoms of respiratory disease. The tests will help provide timely treatment for patients infected with avian influenza as well as help with epidemiological investigations and vaccine production. The supervision effort will be conducted by the WHO, the Central Institute of Hygiene and Epidemiology and the Pasteur Institutes from the central, southern and Tay Nguyen areas. The Health Ministry has proposed that international organisations support Viet Nam in building safe laboratories for medical research institutes to prevent lab technicians from contracting infectious diseases. Deputy Director of the Hospital for Tropical Diseases in Ho Chi Minh City, Tran Tinh Hien, urged the establishment of a fund to help support poor avian influenza patients. He explained that most patients are from poor rural provinces and that treatment costs in urban areas are very high. Thailand, worried that the disease will spread from Viet Nam, has offered to help Vietnam contain its outbreaks. Vietnamese and Thai scientists will meet February 2005 to share information on battling the virus, said Nguyen Tran Hien, director of Viet Nam's National Institute of Hygiene and Epidemiology. (Promed 1/28/05, 1/31/05)

^top

Thailand: Bird flu hits two more provinces
Bird flu has broken out in two more provinces in northern Thailand, bringing to eight the number of provinces affected by the disease. "We detected the virus during our re-examination of every part of the country," Saravudh Suvannababba of the National Avian Influenza Center said. In the northeastern province of Nong Khai, along the Laos border, the virus was found in the districts of Thabor and Sri Chiang Mai, where 208 chickens had died of the disease. Another 73 of the birds were culled to prevent the disease from spreading. Bird flu was also detected in Pichit province, about 350 km north of Bangkok, where 20 chickens died of the disease and 27 more were culled. Thailand has been under high alert for bird flu since the deadly H5N1 strain of the virus was detected in chickens and fighting cocks in the provinces of Nakhon Pathom, Nakhon Sawan, Phitsanulok, Rayong and Uttaradit. The disease was also detected in pigeons in the central Thai province of Uthai Thani, where more than 400 pigeons were culled. Thailand's cabinet has endorsed 4.8-billion-baht (124.7-million USD) scheme to fight bird flu. (Promed 2/3/05)

^top

Indonesia: Disease surveillance, tsunami-related
An email from Dr Tony Stewart, an Australian Medical Epidemiologist, to Promed: “I was in Indonesia from 3 to 22 Jan 2005, where I had been working with the WHO and Indonesian MoH on disease surveillance in the tsunami-affected areas of Aceh Province. Surveillance in the provincial capital of Banda Aceh and the surrounding districts includes active and passive surveillance in the IDP [internally displaced persons] camps as well as hospital and laboratory surveillance. Several public health labs with the capacity to confirm cholera, typhoid, shigella, measles, malaria, dengue, Japanese encephalitis, hepatitis A & E and other pathogens are fully operational in Banda Aceh.

The system is being replicated in the Meulaboh area on the West Coast of Aceh Province, along with the establishment of a lab this week. Some areas of the west coast are cut off except for helicopter access, due to the destruction of more than 50 bridges along that coast; however, the surviving population in these hardest-hit areas is generally quite low. In some areas the mortality due to the tsunami was greater than 90 percent. Medical teams working in all affected areas (including the isolated areas of the West coast) have been provided with syndromic case definitions of diseases of epidemic potential, including measles, bloody diarrhea, acute watery diarrhea, suspected malaria, acute jaundice syndrome and others. Epidemiologists are based in Aceh and Meulaboh, and some agencies providing medical services have epidemiologists on staff. Suspected cases and rumours/gossip (e.g., reports from the press and lay people) are being investigated. Appropriate specimens are being collected and transported to public health labs. Standard treatment protocols have been distributed on paper and electronic format.

As of 24 Jan 2005, there have been no confirmed outbreaks of cholera in any part of the province. Rumours of cholera in an area adjacent to Meulaboh have not been confirmed, but there were cases of uncomplicated diarrhea, without deaths or severe dehydration. Shigellosis has been [diagnosed in] 10 patients. Speciated specimens were all Shigella flexneri. No S. dysenteriae has been found. Water and sanitation have been strengthened in the area most affected, and there has been no further bloody diarrhea there since 19 Jan 2005. Bloody diarrhea has also been reported from other areas of the province. There have been sporadic cases of measles. A province-wide program of measles immunization (from ages 6 months to 15 years) and vitamin A distribution (6 months to 5 years) is in process, with priority given to the areas where the surveillance has detected cases. Risk of outbreaks of malaria and dengue remains high, due to a substantial increase in the potential breeding sites for Anopheles sundaicus, Aedes aegypti and Ae. albopictus. A comprehensive program of vector control, early diagnosis and treatment, and training for management of complicated malaria has commenced. As of 24 Jan 2005, more than 90 patients at hospitals in Banda Aceh, Meulaboh (west coast), and Sigli (northeast coast) were diagnosed with tetanus. All seem to be the result of injuries sustained on the day of the tsunami, with the peak being passed on 12 Jan 2005. Hospitals are equipped to manage cases, and there is a preventive program for workers involved in the clean-up campaign (protective clothing and tetanus toxoid immunization). New cases are on the decline. 2 patients with suspected cases of melioidosis are hospitalized in Meulaboh. The cases are being investigated.” (Promed 1/25/05)

^top

Thailand (Phangnga): Melioidosis risk among survivors of tsunami
Takuapa Hospital in Phangnga, Southern Thailand, was one of the major referral centers for people injured during the tsunami, and saw approximately 1000 patients 26 Dec 2004. On 30 Dec 2004, a patient who had suffered aspiration developed severe pneumonia, and two blood cultures taken on that day were positive for Burkholderia pseudomallei, the causative agent for melioidosis. A further four patients have since been diagnosed with B. pseudomallei pneumonia. All had aspirated during the tsunami. Their age ranged from 24-65 years. Two individuals had known risk factors for melioidosis (diabetes mellitus). All patients are currently responding to antimicrobial treatment. Melidiosis occurs most commonly in Northeastern Thailand and Northern Australia. The causative organism is present in soil and water in melioidosis-endemic areas where human exposure is commonplace; infection is acquired via inhalation (including near-drowning) or contamination of breaks in the skin.

During the last six years, a total of nine cases of melioidosis have been diagnosed at Takuapa Hospital (none of which were during the preceding 12 months). The variable and sometimes extended period of incubation prior to clinical symptoms means that those affected by the tsunami in Thailand may have a higher long-term risk of disease. Case reports of melioidosis in returning travelers or indigenous peoples from Indonesia, Sri Lanka, and India indicate that people affected by the tsunami in these areas should also be considered at increased risk. A melioidosis surveillance team has been formed, and active clinical and serological surveillance is now underway in the Phangnga area. Previous soil sampling has demonstrated that a small proportion of sites contain B. pseudomallei. A longitudinal study of soil sampling is now underway to examine the presence of B. pseudomallei in tsunami-affected and -unaffected soil in the Phangnga area. (Promed 1/27/05)

^top

Malaysia: 14 die in measles outbreak in Sarawak
13 children and an adult from a remote tribe have died in a measles outbreak in the Malaysian state of Sarawak, on the Island of Borneo, a report in the Sunday Star 23 Jan 2005. The outbreak started about three weeks ago, with the last death recorded a few days ago. The paper, quoting Sarawak State Deputy Chief Minister George Chan, said 66 cases had been recorded, with 14 deaths and some other serious cases. "We are trying to find out whether this is a new strain of the virus and why the outbreak is so serious," Chan was quoted. The 13 dead children, aged three months to five years, and the man were from the Penan tribe who lived in a communal longhouse in Belaga, near the Bakun hydroelectric dam project site. Chan said the Penans in Belaga had never been exposed to measles. However, one of the tribe members married a woman from outside the area, and the couple returned to the settlement recently. Now, the central and interior regions of Bakun in Sarawak have been declared as areas under quarantine beginning 23 Jan 2005 following the measles outbreak, the Health Ministry's Communicable Disease Control Director, Dr. Ramlee Rahmat, said 23 Jan 2005. He said the quarantine order was issued by the Sarawak Health Department to prevent spread of the disease and to assess the situation. Dr. Ramlee assured the public that the situation was under control and that the Sarawak Health Department had been monitoring the situation closely since the start of the outbreak. A case fatality rate of 21 percent is similar to the measles case fatality rates that are seen in areas with high levels of malnutrition and have been reported in outbreaks among previously unexposed isolated populations. (Promed 1/23/05)

^top

China: Meningococcal disease outbreak
The Deputy Bureau Chief of Anhui Province announced 29 Jan 2005 a serious outbreak of meningococcal meningitis affecting at least five counties/cities of the Province: Wuhu, Chuzhou, Anqing, Chaohu, and Hefei. The disease appeared to be spreading to other parts of the Province. The Provincial epidemiology figures include reports of 61 cases of meningococcal disease from 30 Dec 2004 to 28 Jan 2005. 77 percent of patients were primary or secondary school children, with ages ranging from 13 to 18 years. Anhui has seen the circulation of meningococcus type A in the past. In Sep 2003, type C meningococcal disease was first found in Qinyang County. This reached epidemic proportions recently. Eight patients have died, and 49 have recovered. The National Ministry of Health announced 31 Jan 2005 that there had been 546 reported cases of type C meningococcal disease since Nov 2004 nationwide. The monthly figure for Dec 2004 was 215, twice the Nov 2004 number; in Jan 2005 258 cases were reported. Because a period of massive movement of people returning home for Chinese New Year holidays is approaching, the authorities warned that the disease might spread with the crowded conditions of trains and other transport services. 24 provinces out of 31 cities/provinces are affected by the disease; the most serious are Anhui, Henan, Hebei, Jiangsu, and Xichuan provinces. The provinces that reported zero figures are Tibet, Hainan, and Fujian, Cities not affected are Zhongqin, Shanghai, Beijing and Tienjing. (Promed 2/1/05)

^top

Philippines: Meningococcal disease
From 1 Oct 2004 to 28 Jan 2005, a total of 98 cases (74 from Baguio City, 22 from Mt. Province and 2 from Ifugao) of meningococcal disease and 32 deaths (case fatality ratio, 33 percent) has been reported. The Department of Health, Philippines and the local government health authorities, assisted by a team from the Global Outbreak Alert and Response Network (WHO), have established provincial multidisciplinary operations centers in Mountain and Benguet provinces to contain the outbreak. Laboratory capacity for the collection and detection of meningococcal disease and management of cases has been strengthened. Intensive surveillance and contact tracing in the community have also been carried out, while further epidemiological studies are ongoing. (Promed 1/28/05)

^top

Philippines: Typhoid fever cases
Contaminated water sickened 39 residents of a barangay in Pasay City, triggering a probable outbreak of typhoid fever in the area, the Department of Health (DOH) said 31 Jan 2005. A team from the DOH National Epidemiology Center (NEC) and the Pasay City health office made the rounds of barangay 123 on 29 Jan 2005 and found 39 people showing symptoms of typhoid fever. Dr. Tony San Juan of the DOH-NEC said rectal swabs from 39 residents of El Facundo, Medina and Alfonso Isidro streets were sent to the Research Institute for Tropical Medicine for culture. A spot examination of the water source of barangay 123 and its neighboring barangays showed that the residual chlorine level in the water supply was zero. The normal residual chlorine level is .2 to .5 mg/liter, San Juan said. San Juan said that nearby Barangay 124, which has the same water source, has had a history of typhoid outbreaks in the past two years. If all 39 cases are confirmed, this would be the first typhoid outbreak in Barangay 123, which had less than 10 cases of typhoid in 2004. San Juan said the water company had reported that it had chlorinated the water source of the concerned barangays. Maynilad had set up a water rationing station in the affected barangay. Meanwhile, tests made by the city's sanitation office said that human waste had found its way to the faucets in Barangay 123 in Pasay City. "six samples taken from different households showed coliform organism and zero chlorine," said Neil Sabino of the Pasay City sanitation office. The DOH advised residents to boil water used for drinking, cooking and washing kitchen utensils.

Also, local officials reported an outbreak of typhoid fever in Sibulan, Negros Oriental, where 133 residents had fallen ill since mid-Jan 2005. Sibulan Mayor Antonio Renacia sent a letter to the DOH 2 Feb 2005, requesting that experts be sent to his town to determine the cause of the outbreak. 16 typhoid cases were reported by 29 Jan 2005. The number rose to 133 within a span of four days. Most of the patients came from Barangays Looc, Poblacion and Ajong. Other cases were from Barangays Cangmating, Balugo, Maslog and Magatas. The mayor said health and town officials suspected that a leak in the main pipeline of the Sibulan Water District might have caused the typhoid fever outbreak. (Promed 2/2/05)

^top

Australia: Goats may be tested for BSE; goat in France tests positive for BSE
Australian goats could be tested for BSE, after confirmation that a goat in France has contracted the disease. It's taken three years to confirm that mad cow disease -- normally found in cattle -- has jumped species. Dr Greg Curran, from the National Disease Outbreak Response team, says increased testing may be needed to protect Australian markets. "Certainly with cattle and with sheep there is a surveillance program, and that's been going on for quite a few years now, but we haven't been able to look at the problems in goats. We might add goats to the group of animals that's checked for BSE, now that this discovery's been made in Europe."

Current science finds no link between goat meat and meat product consumption and variant Creutzfeldt Jakob Disease (vCJD). Following the discovery, a group of scientists at the European Food Safety Authority (EFSA) are now recommending that more information is needed to assess the significance of the single French case. The EFSA panel on biological hazards (BIOHAZ) underlined the need to carry out a quantitative risk assessment concerning BSE-related risks associated with the consumption of goat meat and goat meat products. They expect to complete the assessment by July 2005. BSE belongs to the group of diseases that also include CJD in man and scrapie in sheep and goats. These diseases lead to a degeneration of brain tissue. BSE has affected the entire beef food chain, from producer to consumer. A recent report from the European Association of Animal Production estimates the cost of BSE to EU15 (prior to accession) member states at more than 90 billion Euros (USD 117 billion). In addition, the BSE crisis has had a significant impact on public trust in government and governmental scientific advice. The feeding of meat-and-bone meal, linked to BSE development in cattle, is under discussion as the possible cause of the only confirmed case of BSE infection in the goat. The goat in question was already born before the ban on the feeding of meat-and-bone meal. It was slaughtered in 2002. Other animals in the herd were also examined, but they all tested negative. Before cattle remains were banned in animal feed, French goats might have run a higher risk of acquiring BSE than sheep or goats elsewhere in Europe. Cattle remains were used as a protein supplement, which is needed mainly by animals that are heavily milked. Goat's cheese is a huge industry in France. (Promed 2/3/05)

^top

Australia (Victoria): Salmonellosis, dodgy dips blamed for food poisoning
Turkish dips have been blamed for a salmonella outbreak at a Brunswick restaurant that left hundreds of people ill. Health authorities have detected salmonella in two dips from the Alasya Restaurant -- hummus and eggplant dip. Hummus is usually made from ground chickpeas and sesame paste flavored. More than 720 people have told health authorities they fell ill after eating at Alasya Restaurant or Alasya 2 in Sydney Rd between 8 and 19 Jan 2005. The confirmed number of ill stands at 173, but will increase as more tests are completed. So far at least 25 people have needed to be taken to hospital for treatment, while many more have been treated in emergency departments. At least 50 victims have tested positive for Salmonella sp. The strain of salmonella found in the dips is the same strain found in one patient. Authorities are awaiting further test results to confirm that the rest of the victims have the same type of Salmonella. Isolation of the organism from two separate food sources suggests a common ingredient; cross-contamination of one from the other or both being contaminated by a food handler. Previous outbreaks of salmonellosis have been associated with food produced from sesame seeds. (Promed 1/25/05)

^top

Australia: Gardeners warned of deadly potting mix
Victorian Health Minister Bronwyn Pike said three Victorians died in 2004 from Legionella longbeachae, a bacterium commonly found in potting mix. In at least two of the cases, the victims had been exposed to potting mix before their deaths, and 24 other cases of related illness were reported, she said. In a third fatal case, potting mix was the likely cause of death, but this is yet to be fully confirmed. Acting chief health officer John Carnie said different types of legionella bacteria all caused a rare form of pneumonia, and early symptoms included fever, chills, headaches, shortness of breath, dry cough and muscle aches and pain. Ms. Pike said gardeners using potting mix should wear a mask to avoid breathing in dust, wear eye protection and wash hands and work clothes afterwards. Gardeners should not shake a potting mix bag, and should moisten the contents of a bag before opening it at arm's length. Potting mix should be stored in a cool location and cleaned up while the product is damp. L. longbeachae has been associated with lower respiratory infection in normal and immunocompromised individuals. The organism, especially in Australia, appears to be associated with pneumonia after exposure to soil. The organism has been found in soil and potting mixes from Australia but not from potting mix made in Europe. Cases of L. longbeachae associated with potting soil have been described in the USA and Japan as well. (Promed 1/23/05)

^top

Russia: Animal rabies is spreading in Chelyabinsk
An emergency situation has been announced in Chelyabinsk. The number of animals with rabies is rapidly on the rise. The main animals involved in the dissemination of rabies in this outbreak are foxes. Their population is scattered throughout the Nagabskiy rayon. Rabid foxes are said to come to Chelyabinsk from Kazakhstan. Currently, Southern Ural is considered to be a natural focus of rabies, with one out of every 10 foxes affected. Hunters kill foxes to stop the spread of the disease. No human cases of rabies have been registered there so far. An epidemic of rabies among foxes has been registered in many areas bordering Kazakhstan. (Promed 2/2/05)

^top

Russia (Far East): Yersiniosis cases in kindergarten children
Russia (Far East): Yersiniosis cases in kindergarten children An outbreak of Yersinia pseudotuberculosis has been reported in kindergarten children from the Sakhalin region. 33 children fell ill during the period from 25 Jan to 1 Feb 2005. 15 persons have been hospitalized. As a result of epidemiological investigation, it was established that the outbreak was foodborne and connected to the use of salads made from fresh and fermented cabbage, with the addition of fresh onions. The island of Sakhalin is located on the Far East coast of Russia. Infection with Y. pseudotuberculosis is a zoonosis, with reservoirs in many animals, including rodents, rabbits, deer and a variety of birds. Most individuals affected are children or young adults. The most common presentation of this infection is mesenteric lymphadenitis presenting with fever and right lower quadrant abdominal pain which can be confused with acute appendicitis. The diagnosis of infection with this bacterium can be made by isolation of the organism from lymph node or stool. Serological tests can be helpful, but cross-reactions are found between yersinae and other enteric organisms. (Promed 2/2/05)

^top


1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies 2005, 19 Jan 2005
During week 3, influenza activity continued to increase and was reported as widespread in North America. The overall levels of influenza activity remained medium-low in most parts of the world.

Canada: the total number of regions reporting widespread and localized influenza activity continued to increase, while the number of influenza viruses detected and overall influenza-like illness (ILI) consultation rate remained similar to those of last week. Of the influenza viruses detected during the week, 97% were influenza A and 3% were B viruses.

Japan: Influenza activity remained localized since week 51, 2004. The number of influenza B viruses detected continued to increase.

Russian Federation: Influenza activity started to increase in week 3 and was reported as localized.

United States: Influenza activity continued to increase in week 3. The overall ILI consultation rate was above the national baseline. During this week, both influenza A (89%) and B (11%) viruses were detected. A third influenza-associated paediatric death this season was reported during week 3.

Hong Kong: During week 3, low influenza activity was detected in (H1, H3 and B).

Chile: reported no influenza activity. (WHO 2/2/05)

^top

Cholera, diarrhea & dysentery update
Indonesia
The number of people suffering from diarrhea is on the rise in Surabaya, with Dr. Mohammad Soewandi Hospital treating over 65 children in the first week of January 2005 and 49 more in the second week. The January 2005 figure was higher than in December 2004, but less compared to the October-November 2004 period when the hospital treated 1540 patients with diarrhea. Out of the 1540 patients, 1121 of them were children. Most diarrhea patients were treated and released after 2-3 days. In Dr. Soetomo Hospital, an average of 13 diarrhea patients have been admitted each day in January 2005. (Promed 1/23/05)

Indonesia (Sumatra)
Thousands of refugees in flood-hit areas in Sumatra are contracting serious diseases because of inadequate shelter and a lack of clean water. In Lampung, more than 1500 people were treated by doctors during the weekend with about 6500 recorded to be suffering from a series of ailments ranging from skin rashes to dysentery and cholera. In Ryacudu Hospital in North Lampung, at least 40 children have been treated during the past few days for dysentery and cholera. Children were most at risk from these life-threatening illnesses, while adults more often contracted skin and respiratory infections. Officials were concerned the number of ill could rise, because clean water being distributed by provincial and regental governments had still not reached all the affected areas 23 Jan 2005. The flooding in Lampung has affected every region except the Metro municipality and Tanggamus regencies, which have better irrigation and sewage systems. In South Sumatra, a government official estimated that hundreds of people in the province were also sick from flood-related illnesses. Five regencies in the province have been affected, including Ogan Komering Ilir, Ogan Ilir and Musi Banyuasin. (1/28/05)

Indonesia (East Nusa Tenggara)
An outbreak of dysentery has killed at least 12 people and affected hundreds of others in eastern Flores. East Flores health agency head Eduard Kleruk said dysentery had affected six subdistricts in the regency, with East Adonara the worst-hit. "In East Adonara alone, 11 people died from the disease and more than 100 are still being given serious treatment," he said. Many of the victims were babies and the elderly. Kleruk blamed poor domestic sanitation for the outbreak. (1/28/05)

^top

Dengue/DHF update
Indonesia (Jakarta)
The number of dengue fever cases in Jakarta jumped from 263 cases 18 Jan 2005 to 400 cases 22 Jan 2005. The Jakarta health agency spokesman, Evy Zelfino, said 22 Jan 2005 that the total number of cases since December 2004 was 835, while two patients have died. "The number of dengue fever cases always increases in the rainy season. After the floods in the coming weeks, the figure can jump to an alarming level, because the standing water is a breeding place for the [mosquitoes]," she said. Evy explained that it is in the pattern of the disease that it increases every December to March when Jakarta is heavily inundated with water. The health agency recorded around 18 000 cases of dengue from December 2003 to March 2004, with about 82 deaths, mostly children. The highest number of cases occurred in February and March, in which over 5000 people contracted the disease. The agency's data also showed that during the same period, dengue cases in Greater Jakarta hit a high of 15 360 in 1998, 3998 in 1999, 8729 in 2000, 8820 in 2001, and 5750 in 2002. (Promed 1/31/05)

East Timor (Timor-Leste)
As of 1 Feb 2005, WHO has received reports of 95 cases of dengue infection and 11 deaths (case fatality ratio, 11.6 percent). Out of the 95 cases, 61 had clinical features compatible with dengue haemorrhagic fever (DHF) and 34 were diagnosed as suspected dengue fever (DF) using WHO standard case definitions. Districts reporting DF/DHF cases are Baucau, Dili, Liquica, Maliana and Manatuto with 89.9 percent of the cases reported from Dili. The Ministry of Health, with the assistance of WHO is organizing a seminar for case management of dengue and DHF for clinicians and nurses. WHO is providing support to the Dili National Hospital in the management of dengue and DHF and in targeting interventions in high-risk areas. Other control activities include assistance with vector control and health promotion. (Promed 2/3/05)

Malaysia
The dengue epidemic has claimed seven lives (four of them children) in four weeks. Health Minister Datuk Dr Chua Soi Lek said: "My concern is the upcoming long school holidays due to the festive season. He reasoned that, during this period, there may not be any upkeep of school grounds, and this could result in more breeding areas. "When the children return, they may become victims…Parents must also play an important role in not only helping to keep the schools clean but also their houses and immediate surroundings," he said. He warned Malaysians that the dengue epidemic was not over despite the drop in the number of people suffering from the disease. "The decrease could be due to the concerted effort by all to search and destroy Aedes breeding grounds," he added. Since 1 Jan 2005, more than 3500 people, mostly children and workers, have been hospitalized with suspected dengue fever. (Promed 1/31/05)

Malaysia (Sarawak)
12 dengue cases have been detected in Sarawak so far in 2005, down 25 percent from the same period last year, the state health department said, according to Bernama. They were reported in Kuching [capital] district from 45 clinical cases received state-wide from 1-24 Jan 2005. Although dengue was endemic in Sarawak, there was no outbreak in 2004, with only one death of dengue hemorrhagic fever in Bintulu. In 2004, 141 dengue fever cases were confirmed from 586 clinical cases that occurred sporadically, especially in urban districts. There were 58 cases in Kuching, 24 in Bintulu, 19 in Miri and 2 in Sibu. (Promed 1/31/05)

Malaysia (Selangor, Negeri Sembilan)
The Putrajaya Hospital is preparing a report for the Health Ministry on the death of a 5-year-old girl who died of dengue 26 Jan 2005. The girl was rushed to the Putrajaya Health Clinic 21 Jan 2005. She was one of the five patients who have died of dengue fever. On the same day, an 8-year-old student from Sekolah Kebangsaan Taman Tuanku Jaafar 2 in Seremban [Negeri Sembilan State], died at the Seremban Hospital after being admitted to the Emergency Unit 23 Jan 2005. (Promed 1/31/05)

Malaysia (Pahang)
The dengue outbreak in Pahang has struck a second deadly blow--a 16-year-old girl died 24 Jan 2005. The first death was reported early January 2005, a 46-year-old housewife from Maran. Students made up nearly 30 percent of the 1500 suspected dengue cases over the first three weeks of 2005. About 53 percent of 621 confirmed cases in 2004 comprised children and youths under 24. This has prompted the Health Ministry to increase checks on Aedes mosquito breeding grounds in schools, parliamentary secretary to the Health Ministry Lee Kah Choon said 24 Jan 2005. Lee said the ministry and health departments had conducted fogging and gotong-royong programs to clean up schools. "Parents can also play their part by encouraging their children to use mosquito repellent," he said. A total of 33 203 suspected dengue cases were reported in 2004. Lee said Penang's northeast district recorded the highest number of suspected dengue cases over the first three weeks of 2005. (Promed 1/31/05)

Singapore
In what could be the first fatal dengue case of 2005, a 10-year-old pupil has died in the KK Women's and Children's Hospital from the mosquito-borne disease. If he is confirmed to have died from dengue, he would be the tenth casualty of dengue in Singapore since 2003. It is not known where the boy contracted the virus. On 24 Jan 2005, Environment and Water Resources Ministry officers inspected the school and found no mosquito breeding areas, the school's letter said. The school was also fogged 22 Jan 2005. The death comes during a period when dengue infections in Singapore are running high. For the first three weeks of 2005, there have already been 29 DHF cases, 21 more than in the same period in 2004. (Promed 1/31/05)

Thailand (Nongkhai)
A boy died from dengue in the province of Nongkhai along the Mekong River, third week of January 2005. He was the fourth reported case of dengue fever in the province since the beginning of 2005. (Promed 1/31/05)

^top

Viral gastroenteritis update
Japan
A total of 7821 people, mainly in homes for the elderly, have shown symptoms of "stomach flu" in Japan since November 2004, of whom 12 have died, according to an interim report released by the Ministry of Health, Labor and Welfare 12 Jan 2005. Among the patients, 5371 are suspected to be infected with noroviruses, known to cause stomach flu or gastroenteritis in humans, or have had the viruses. (Promed 1/23/05)

Russia
39 persons have been hospitalized in Novodvinsk during January 2005 with a diagnosis of rotavirus infection, according to the press-service of the city administration. Most patients are children. They have been admitted to the hospital in relatively serious condition. Most have responded to treatment and are being discharged now. Rotavirus has been detected in water samples obtained from the city potable water supply. All citizens have been warned to boil water for drinking and food preparation. Beginning on 25 Jan 2005, the water supply system of the city of Novodvinsk will undergo thorough cleaning. (1/30/05)

Chile
The Ministry Regional Secretary (SEREMI) ordered a summary sanitary procedure for the Norwegian Crown cruise liner, because its crew did not report a diarrheal disease outbreak on time. The SEREMI for Health Affairs in the Valparaiso region, Anibal Vivaceta, stated 14 Jan 2005 when the ship was in the Puerto Montt area, a diarrheal disease outbreak occurred, that it was not declared to the sanitary authorities, and that therefore "there was a violation of the maritime, airway and land border sanitary regulations." There were more than 200 persons on board who developed diarrhea, vomiting, and fever, and the duration of symptoms was 1-2 days. Since this situation was not reported, a summary sanitary procedure was performed on board when the ship entered Valparaiso bay. The ship was maintained under surveillance, and inspected by a team including professionals from the Public Health and Sanitary Actions departments. This team examined the affected passengers and performed an epidemiological analysis of this information, and the likelihood of cholera was ruled out. Clinical samples were taken from the patients affected and sent to the Public Health Institute. The SEREMI stated: "Our task as sanitary authorities for strengthening tourism is to be quite strict with the compliance of national and international regulations. In this case, although we are almost certain that an outbreak of norovirus infection is responsible for the disease situation, which does not pose risks for the population outside the ship, we must take all precautions, especially in this case where the ship intended to avoid controls." (Promed 1/23/05)

USA (Oregon)
Prison physicians suspect an outbreak of norovirus infection beginning 25 Jan 2005 has sickened at least 128 inmates at Oregon State Penitentiary and at a neighboring minimum-security facility in Salem. To prevent the spread of the illness, prison health officers are looking into possible causes and urging inmates to give greater attention to personal hygiene. The first inmates showed symptoms, including stomach cramps, nausea, vomiting and diarrhea, 25 Jan 2005 said Steve Shelton, Department of Corrections medical director. Stool samples from inmates have been sent to a lab for testing. But there may be no way to determine how the virus was introduced into the inmate population, officials said. (Promed 1/30/05)

USA (Florida)
An outbreak of gastroenteritis affected more than 90 passengers and crew during a Caribbean voyage, Princess Cruises said. The outbreak of the highly-contagious norovirus started aboard the Sun Princess on the second day of a 10-day Caribbean cruise that departed Fort Lauderdale, Florida 8 Jan 2005 and returned on schedule on 18 Jan 2005. "In our investigation to discover the source of the illness, we found that the first passenger who reported ill had falsely filled in her health status form prior to boarding," the statement said. Over the course of the cruise, 89 passengers and five crew were affected by the illness. It is the second incident of its type in less than two weeks on a vessel sailing from Fort Lauderdale, after 116 passengers and crew became sick with a stomach virus on a Royal Caribbean vessel. (Promed 1/23/05)

USA (Florida)
A Tampa-based cruise ship returned to port 12 hours early 28 Jan 2005, after a viral gastroenteritis outbreak made 204 passengers sick. A Holland America Line spokeswoman said that the MS Veendam returned to port so it could undergo rigorous cleaning before the next departure. All 1220 passengers were offered USD 125 to USD 250 in compensation. Rose Abello, Holland America Line Spokesperson, stated that: "Some people on the ship are sick, but this is not a sick ship." Before boarding, passengers say they were warned some customers on the previous sailing had become ill. According to Abello, 77 passenger and crew got sick on the last sailing. Samples are being sent to the CDC for testing. (Promed 1/30/05)

Canada
Cases of norovirus infection have jumped an astounding 15-fold in Canada in the past seven years. Part of the increase may be attributed to more people reporting the illness to their doctors. It is not a reportable disease, meaning health authorities do not need to be notified of cases, making it difficult to track. Since 2004, outbreaks have been reported on cruise ships in the Caribbean, resorts in the Dominican Republic, as well as less exotic locales like nursing homes, hospitals and day-care centers in Canada. The problem is that noroviruses are highly infectious; it takes just 10 virus particles to initiate infection. Since the virus spreads from hand to mouth, it can be picked up from shaking hands, touching contaminated surfaces or eating contaminated food. Dehydration from the virus can be serious in the very old and very young, but most people recover after a few days. There is no vaccine and no treatment for the illness; the best way to protect yourself is frequent hand washing. (Promed 1/30/05)

Dominican Republic/Canada/USA
The Public Health Agency of Canada (PHAC) is aware of reports of gastrointestinal illness (GI) in returning travelers from two geographical regions in the Dominican Republic. The first report involves Canadian travelers returning from Puerto Plata and the second report involves American travelers returning from Punta Cana. PHAC has recommended that Canadian medical health professionals act with increased vigilance with regard to investigating and reporting GI illness in returning Canadian travelers from the DR. The US CDC notified the PHAC of a group of 20 tourists from Ohio who returned home with GI illness from Punta Cana. To date, preliminary laboratory results indicate norovirus as being the causative organism. PHAC is collaborating closely with the Pan American Health Organization (PAHO) in the DR. An epidemiological investigation is currently on-going and has confirmed that there is a gastrointestinal illness outbreak occurring. While the organism has not yet been confirmed, it appears to be viral in nature, possibly norovirus. PAHO has advised the PHAC that multiple measures have been implemented in resorts, including reinforcing hygiene measures related to the handling of food, water chlorination, and education for food handlers regarding hand washing. The epidemiological investigation is ongoing, and PAHO will continue to monitor the situation and the impact of the measures taken. (Promed 1/23/05)

^top

West Nile Virus
Russia
Frozen samples from dead birds collected in the Far Eastern Region of Russia during 2003-2004 were analyzed by an anti-West Nile virus MAb-modified immunoenzyme assay for antigen detection and by RT-PCR. Four positive samples from cinereous vultures (Aegypius monachus) and two positive samples from the cattle egret (Bubulcus ibis) were found. The samples were positive in ELISA and RT-PCR. Additionally, four positive samples from other species of birds (Ixobrychus eurhytmus, Pica pica, Corvus macrorhynchos, Falco tunnuncules) collected during the autumn of 2004 were found during screening with anti-West Nile virus MAb-modified ELISA. These results confirm that WNV is circulating in the Far Eastern region of Russia at present.

In addition, samples from three patients from Novosibirsk and Novosibirsk district have tested positive for WNV infection by anti-West Nile virus IgG immunoenzyme assay and RT-PCR and virus isolation. The testing was carried out at the State Research Center of Virology and Biotechnology. Case 1 was a patient with severe fever syndrome; case 2 had very severe meningoencephalitis; and case 3 had three days of mild fever after contact with birds and mosquitoes. These are the first confirmed cases of WNV infection in humans in West Siberia, where WNV has been detected in birds from 2002 to the present. (Promed 1/31/05)

^top


2. Articles
The New England Journal of Medicine: avian influenza articles
To coincide with a symposium on pandemic influenza, these articles have been published early at www.nejm.org, January 24, 2005. They will appear in the January 27 issue of the Journal.
• Original Article: Probable Person-to-Person Transmission of Avian Influenza A (H5N1). K. Ungchusak et al. http://content.nejm.org/cgi/content/full/352/4/333
• Editorial: Avian Influenza and Pandemics - Research Needs and Opportunities. K. Stoehr http://content.nejm.org/cgi/content/full/352/4/405
• Perspective: The Threat of an Avian Influenza Pandemic, A.S. Monto http://content.nejm.org/cgi/content/full/352/4/323

^top

CDC EID Journal, Volume 11, Number 2-February 2005
CDC Emerging Infectious Diseases Journal, Volume 11, Number 2-February 2005 issue now available at: http://www.cdc.gov/ncidod/eid/index.htm. Includes the xpedited article: Recurring Methicillin-resistant Staphylococcus aureus Infections in a Football Team, D.M. Nguyen et al.

^top

Lack of H5N1 Avian Influenza Transmission to Hospital Employees, Hanoi, 2004.
N. T. Liem et al. ”To establish whether human-to-human transmission of influenza A H5N1 occurred in the healthcare setting in Vietnam, we conducted a cross-sectional seroprevalence survey among hospital employees exposed to 4 confirmed and 1 probable H5N1 case-patients or their clinical specimens. Eighty-three (95.4%) of 87 eligible employees completed a questionnaire and provided a serum sample, which was tested for antibodies to influenza A H5N1. Ninety-five percent reported exposure to >1 H5N1 case-patients; 59 (72.0%) reported symptoms, and 2 (2.4%) fulfilled the definition for a possible H5N1 secondary case-patient. No study participants had detectable antibodies to influenza A H5N1. The data suggest that the H5N1 viruses responsible for human cases in Vietnam in January 2004 are not readily transmitted from person to person. However, influenza viruses are genetically variable, and transmissibility is difficult to predict. Therefore, persons providing care for H5N1 patients should continue to take measures to protect themselves.” http://www.cdc.gov/ncidod/EID/vol11no02/04-1075.htm

^top

Dengue haemorrhagic fever after living donor renal transplantation
The following is the summary of a Case Report by Felicia Li-Sher Tan, Dale L. S. K. Loh and K. Prabhakaran of the Department of Pediatric Surgery, National University of Hospital, Singapore. It describes an unusual route of transmission of dengue hemorrhagic fever:
“The transmission of infection from donor to recipient in solid organ transplantation can result in loss of the allograft and in severe cases, death of the recipient. The occurrence of dengue virus infection in an immunocompromised renal transplant patient can have many detrimental effects, the most life-threatening of these is development of dengue shock syndrome. We present a case of possible transmission of dengue infection from donor to recipient after living donor renal transplantation, resulting in a fulminant course of dengue haemorrhagic fever (DHF).” (Promed 1/30/05)

^top

Rapid Health Response, Assessment, and Surveillance After a Tsunami --- Thailand, 2004--2005
“On December 26, 2004, an earthquake triggered a devastating tsunami that caused an estimated 225,000 deaths in eight countries (India, Indonesia, Malaysia, Maldives, Seychelles, Somalia, Sri Lanka, and Thailand) on two continents. In Thailand, six provinces (Krabi, Phang-Nga, Phuket, Ranong, Satun, and Trang) were impacted, including prominent international tourist destinations. The Thai Ministry of Public Health (MOPH) responded with rapid mobilization of local and nonlocal clinicians, public health practitioners, and medical supplies; assessment of health-care needs; identification of the dead, injured, and missing; and active surveillance of syndromic illness. The MOPH response was augmented by technical assistance from the Thai MOPH--U.S. CDC Collaboration (TUC) and the Armed Forces Research Institute of Medical Sciences (AFRIMS), with support from the office of the World Health Organization (WHO) representative to Thailand. This report summarizes these activities. The experiences in Thailand underscore the value of written and rehearsed disaster plans, capacity for rapid mobilization, local coordination of relief activities, and active public health surveillance.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5403a1.htm (MMWR January 28, 2005 / 54(03);61-64)

^top

HIV Transmission Among Black Women --- North Carolina, 2004
“In 2003, women constituted 28% of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) cases in the United States; approximately 69% of those cases were among non-Hispanic black women. Heterosexual transmission is now the most commonly reported mode of HIV transmission among women. In North Carolina, black women make up a growing proportion of newly reported HIV infections and, in 2003, the HIV-infection rate for black women in North Carolina was 14 times higher than that for white women. Despite this disparity, few epidemiologic studies have examined HIV transmission among black women in the United States, particularly those residing in southern states. In August 2004, the North Carolina Department of Health (NCDOH) invited CDC to assist in an epidemiologic investigation of HIV transmission among black women in North Carolina. This report summarizes the results of that investigation, which indicated that the majority of HIV-positive and HIV-negative sexually active black women in North Carolina reported HIV sexual risk behaviors. These findings underscore the need for enhanced HIV-prevention strategies in this population.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5404a2.htm (MMWR February 4, 2005 / 54(04);89-94)

^top

Outbreaks of Pertussis Associated with Hospitals --- Kentucky, Pennsylvania, and Oregon, 2003
Outbreaks of Pertussis Associated with Hospitals --- Kentucky, Pennsylvania, and Oregon, 2003 “Pertussis outbreaks have been reported in various settings, including sports facilities, summer camps, schools, and health-care facilities. Mild and atypical manifestations of pertussis among infected persons and the lack of quick and accurate diagnostic tests can make pertussis outbreaks difficult to recognize and therefore difficult to control. Outbreaks among health-care workers (HCWs) are of special concern because of the risk for transmission to vulnerable patients. This report describes three pertussis outbreaks among HCWs and patients that occurred in hospitals in Kentucky, Pennsylvania, and Oregon in 2003. These outbreaks illustrate the importance of complying with measures to reduce nosocomial infection when evaluating or caring for patients with acute respiratory distress or cough illness of unknown etiology.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5403a3.htm (MMWR January 28, 2005 / 54(03);67-71)

^top

Outbreak of Invasive Pneumococcal Disease --- Alaska, 2003--2004
“In Alaska, statewide laboratory-based surveillance revealed an increase in invasive pneumococcal disease (IPD) in a rural region during 2003--2004. This report summarizes the outbreak, regional trends in serotype-specific pneumococcal carriage, and an assessment of use of standing orders for vaccination. The results of this analysis underscore the preventability of IPD and the importance of vaccination. Since 1986, the Arctic Investigations Program (AIP) at CDC has conducted laboratory-based surveillance for IPD in Alaska. Laboratories throughout Alaska are requested to send to AIP any isolate of Streptococccus pneumoniae recovered from a normally sterile site. AIP confirms the identity, determines the serotype and antimicrobial susceptibility of each isolate, and collects epidemiologic information for each case.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5403a5.htm (MMWR January 28, 2005 / 54(03);72-75)

^top


3. Notifications
National Black HIV/AIDS Awareness and Information Day --- February 7, 2005
National Black HIV/AIDS Awareness and Information Day --- February 7, 2005 National Black HIV/AIDS Awareness and Information Day is observed each year on Feb 7 to call attention to the disproportionate impact of HIV/AIDS on the black population in the USA. The event is sponsored by a coalition of nongovernment organizations, with support from CDC. During 2000--2003, more than half of new HIV/AIDS diagnoses in 32 states were among blacks, although blacks represented only 13% of the population of those states. CDC is working to reduce new HIV infections among blacks by developing interventions tailored to the cultural needs of this population. This combination of behavioral and biomedical approaches includes expanded access to voluntary HIV counseling and testing, behavioral interventions for at-risk and HIV-positive persons, and screening and treatment for sexually transmitted diseases, which can facilitate HIV transmission and acquisition. Visit http://www.cdc.gov/hiv. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5404a1.htm (MMWR February 4, 2005 / 54(04);89)

^top

International Meeting on Microbial Epidemiological Markers (IMMEM7)
Victoria, British Columbia, Canada; 11-14 May 2005
Co-sponsored by the American Society for Microbiology (ASM) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The "premier" international meeting on the epidemiological analysis of problem infectious agents, held for the first time in North America. http://www.asm.org/Meetings/index.asp?bid=27725 Major topics include:
• The impact of genomics on molecular epidemiology
• Molecular epidemiology of sexually transmitted diseases
• Healthcare-and community-associated MRSA
• Pneumococci and other Streptococci
• Fungi
• Molecular epidemiology of viruses
• Epidemiology of foodborne and diarrheal diseases
• Tracking genes, phages, and integrons
• New technologies for molecular epidemiology
• Chips, arrays, and SNPs
• Using DNA sequence data for strain typing; MLST and beyond
• PulseNet goes global
(Promed 2/2/05)

^top

Third European meeting on viral zoonoses
Third European meeting on viral zoonoses
St. Raphael, France, 28-31 May 2005
As a continuation of the successful European meetings on viral zoonoses in St. Raphael in 2001 and 2003, the third meeting similarly covers research on ecology, epidemiology, virology and the prevention of zoonotic viral diseases. Abstracts for oral and poster presentations are invited. St. Raphael is situated on the Mediterranean coast between Saint-Tropez and Cannes. Invited speakers include:
• CJ Peters (USA): Keynote address - Emerging viral zoonoses and their lessons;
• Esteban Domingo (Spain): Population dynamics of RNA viruses: strategies for adaptation and survival;
• Otto Haller (Germany): Interferon antagonists and the conquest of the mammalian host;
• Yoshi Kawaoka (USA): Influenza: a continuing threat for catastrophe;
• Gary Nabel (USA): Vaccines against zoonotic viruses;
• Sarah Randolf (UK): Climatic impacts on the emergence of zoonoses: lessons from tick-borne flaviviruses.

Organizing committee: Noel Tordo (chair), Richard Elliott, Ake Lundkvist, Alexander Plyusnin, Olli Vapalahti. More information is available from: http://www.euroviralzoon.com, info@euroviralzoon.com\ Deadline for abstracts: 15 Feb 2005. Registration Fee: EUR 300 (USD 390); after 15 Feb 2005, EUR 350 (USD 455). For more information, contact: Olli Vapalahti, Professor of Zoonotic Virology, 00014 University of Helsinki, Finland. olli.vapalahti@helsinki.fi (Promed 1/30/05)

^top


4. APEC EINet activities
Access Grid node videoconference: EINet, Philippines, Japan, and Australia
The University of Washington's APEC EINet team held an Access Grid (AG) node videoconference with the Philippines, Japan, and Australia, for the Philippines’ first Access Grid Inauguration program. Dr. Ann Marie Kimball, Director of EINet, gave a presentation of usability of AG technology for public health preparedness purposes, specifically for emerging infectious diseases. Australia and Japan also shared their own experiences with AG, such as multi-campus lecturing, interactive presentations, and even Karaoke grid.

^top


5. To Receive EINet Newsbriefs
APEC EINet email list
The APEC EINet email list 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), contact apec-ein@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://depts.washington.edu/einet/.

^top

 apecein@u.washington.edu