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Vol. VIII, No. 11 ~ EINet News Briefs ~ May 27, 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:
- Global: World Health Assembly adopts new International Health Regulations
- Global: Highlights from the 58th World Health Assembly
- South East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
- South East Asia: WHO Inter-country consultation--Influenza A/H5N1 in Humans in Asia
- South East Asia: FAO information on avian influenza and guide for paravets
- Viet Nam: Second Human Case of Avian Influenza in Thanh Hoa Province
- Thailand: Pigs declared free from avian flu
- Indonesia: H5N1 strain bird flu found in pigs, intensified human surveillance
- China: Rushes in vaccine after bird flu found
- China: Development of poultry vaccines for Avian influenza
- China: Food-borne parasitic infections increase
- China: Foot and mouth disease reports
- New Zealand: Foot and Mouth Disease, hoax
- Indonesia: 8 Polio cases confirmed
- Taiwan: CDC issues warning against outbreak of Enterovirus 71
- Thailand: Embargo on ice production after hepatitis outbreak
- Thailand: Trichinellosis--Boar meat kills man
- USA: CDC lifts recommendation for malaria prophylaxis in resort areas in Dominican Republic
- Canada (Ontario): Salmonella outbreak in Burlington
- Canada (Alberta): Precautions urged after woman dies of hantavirus
- Canada (Saskatchewan): Indian Reserve Concerned About Hantavirus
- USA (New Mexico): Second Hantavirus Patient Being Treated in Albuquerque
- USA (Nebraska): Man Dies From Hantavirus Pulmonary Syndrome
- USA (Colorado): Plague cases may rise; wetter weather aiding increase in rodents, fleas
- USA (Indiana): E. coli hits day-care center

1. Updates
- Influenza
- Cholera, diarrhea & dysentery
- Dengue/DHF

2. Articles
- CDC EID Journal, Volume 11, Number 6-June 2005
- Rubella outbreak in an unvaccinated religious community in the Netherlands spreads to Canada
- Lymphocytic Choriomeningitis Virus Infection in Organ Transplant Recipients--Massachusetts, Rhode Island, 2005

3. Notifications
- 73rd Annual General Session of the International Committee of the OIE
- Recreational Water Illness Prevention Week--May 23--30, 2005

4. APEC EINet activities
- EINet article on trade related infections

5. To Receive EINet Newsbriefs
- APEC EINet Newsbriefs


Global
Global: World Health Assembly adopts new International Health Regulations
The World Health Assembly approved a new set of International Health Regulations (IHR) to manage public health emergencies of international concern. The new rules will "prevent, protect against, control and provide a public health response to the international spread of disease." The need for new rules and operational mechanisms for a more coordinated international response to the spread of disease has been most clearly shown during the recent outbreaks of SARS in 2003 and avian influenza in 2004-2005. The regulations govern the roles of countries and WHO in identifying and responding to public health emergencies and sharing information about them. WHO country offices around the world, together with the Global Outbreak Alert and Response Network (GOARN), provide operational support to countries in identifying and responding to disease outbreaks.

The original IHR in 1969 were designed to help monitor and control four serious infectious diseases - cholera, plague, yellow fever and smallpox. The new rules will govern a broader range of public health emergencies of international concern. Under the revised regulations, countries have much broader obligations to build national capacity for routine preventive measures as well as to detect and respond to public health emergencies of international concern. These routine measures include public health actions at ports, airports, land borders and for means of transport that use them to travel internationally.

The purpose of the IHR is to ensure the maximum protection of people against the international spread of diseases, while minimizing interference with world travel and trade. They include a list of diseases such as smallpox, polio and SARS whose occurrence must be notified to WHO. The regulations also include a matrix for countries to decide whether other incidents constitute public health events of international concern. Consideration is made of whether an outbreak is serious, unusual or unexpected, whether there is a significant risk of international spread and whether there is a significant risk of international travel or trade restrictions. Now that the regulations have been adopted by the World Health Assembly, countries will have to assess their capacities to identify and verify events, as well as to control them. The regulations identify specific capacity requirements that must be in place in each country within a fixed timeframe. The rules also provide a code of conduct for how to notify and respond to public health events of international concern. The regulations will formally come into force in 2007. (WHO 5/23/05 http://www.who.int/mediacentre/news/releases/2005/pr_wha03/en/index.html)

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Global: Highlights from the 58th World Health Assembly
In addition to the new International Health Regulations, other key resolutions were adopted by the World Health Assembly. The Assembly adopted a resolution urging countries to develop and implement national plans for pandemic-influenza preparedness and response. This involves improving surveillance so that a flu pandemic can be detected and responded to early. The resolution also calls on WHO to work with partners to reduce the global shortage of influenza vaccines. It adopted a resolution calling upon the international community to continue its support to areas in crises, especially those affected by the tsunami of Dec 2004. The resolution also calls for WHO to intensify its support for people living in affected areas, by focusing on disease-surveillance systems, access to clean water, sanitation, and health care, including mental health. The Assembly welcomed the Global Immunization Vision and Strategy (GIVS) – a ten-year strategy to fight vaccine-preventable diseases, which currently kill more than two million people every year. GIVS aims to immunize more people against more diseases, introduce a range of newly available vaccines and technologies, and provide more interventions, such as mosquito nets and vitamin A, along with immunization services. For more information on these highlights from the 58th World Health Assembly, visit: http://www.who.int/features/2005/wha58/en/index.html (WHO 5/25/05 http://www.who.int/mediacentre/events/2005/wha58/en/index.html)

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Asia
South East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) compiles up-to-date figures of avian influenza cases and deaths in East Asia. The WHO revised its official numbers for confirmed human cases of H5N1 May 19, 2005, adding a number of cases in response to reports from the Vietnam Ministry of Health. A press release regarding the WHO updates is available at http://www.who.int/csr/don/2005_05_19/en/index.html. WHO is updating its table showing cumulative numbers of human cases of H5N1 avian influenza broken down according to phases in the outbreak (http://www.who.int/csr/disease/avian_influenza/country/cases_table_2005_05_19/en/index.html).

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO mid-Dec 2004 to present are:
Economy / Official Cases (Deaths)
Cambodia 4 (4)
Thailand 0 (0)
Viet Nam 49 (17)
Total 53 (21)

Cumulative number of confirmed human cases of avian influenza A/(H5N1), 3 Dec 2003 to present:
Total 97 (53)
(CIDRAP, 5/19/05 http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html; Promed 5/19/05; WHO 5/19/05 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2005_05_19/en/index.html.)

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South East Asia: WHO Inter-country consultation--Influenza A/H5N1 in Humans in Asia
The H5N1 avian influenza virus is evolving and poses "a continuing and potentially growing pandemic threat," say experts who were convened recently by the WHO to study the pathogen. Changing patterns of cases, particularly in northern Vietnam, may indicate the virus is becoming more infectious for humans, the WHO said in a report on an international meeting held 6 and 7 May 2005 in Manila. Genetic analysis indicates that H5N1 viruses are becoming more antigenically diverse. The report cites several differences between epidemiologic features of human cases in 2005 in northern Vietnam and those in southern Vietnam this year and overall in 2004: (1) Northern Vietnam has had 8 case clusters this year, versus only 2 in the south. (2) Case clusters in northern Vietnam this year have lasted longer than did clusters last year. (3) The average age of infected people in northern Vietnam rose from 17 to about 31 years between 2004 and 2005, but it stayed about the same in southern Vietnam (15 to 18 years). (4) The case-fatality rate has dropped to 34 percent this year in the north but is 83 percent in the south.

In addition, the report says the recent discovery of 3 asymptomatic cases in Vietnam suggests that milder infections are occurring. A few asymptomatic cases also were found in Japan and Thailand in the past year. The report says the longer duration of recent clusters may signal a growing number of ways in which people contract the virus, including exposure to sick birds, environmental infection, lengthy exposure to asymptomatic birds that are shedding virus, and person-to-person transmission. At the same time, it says that in places where the disease in poultry has been controlled or eliminated, human cases have stopped. For now, "Prevention of H5N1 avian influenza in humans is best achieved by controlling infection in poultry…As already recommended by FAO and OIE, control strategies for this disease should consider vaccination of poultry, which has been used successfully before."

The 14 recommendations include the following: (1) WHO should convene its Pandemic Task Force to meet regularly, assess the data, and determine the risk for pandemic flu. (2) All nations should move as quickly as possible to complete "practical operational pandemic preparedness plans." (3) WHO should explore "all possible mechanisms" to make H5N1 vaccine available to the Asian countries affected before a pandemic. It should bring together technical experts, countries, manufacturers and possible donors to find ways to boost global H5N1 vaccine production. (4) Coordination of animal and human surveillance and viral information must be improved from the ground level to the national and international level, and data must be exchanged quickly. (5) The WHO should complete a handbook on how to investigate possible H5N1 clusters. (6) The WHO should explore building a stockpile of antiviral drugs that could be used to respond to early signs of a potential pandemic. (7) Countries needing funding and agencies that may provide funding must coordinate their efforts to avoid redundancy and eliminate gaps.

The report also reveals some strains of the H5N1 virus may be developing resistance to oseltamivir, the drug wealthy nations are flocking to stockpile as fears of a pandemic mount. Dr. Keiji Fukuda, a flu specialist from the U.S. CDC who helped draft the report said it's meant to convey the message that the level of anxiety regarding the virus has risen. Oseltamivir (sold as Tamiflu) is one of only 2 antiviral drugs known to work against H5N1 and is the first choice for pandemic planners, because it is easier to use than the alternative, zanamivir. Dr. Frederick Hayden, an antiviral expert at the University of Virginia, insisted it wasn't necessarily disturbing to find limited resistance to the drug, because it has also been documented in a small percentage of infections with human flu strains. Still, the finding raises the specter of a resistant strain of the virus becoming dominant and spreading among people. Read report: <http://www.who.int/csr/disease/avian_influenza/H5N1%20Intercountry%20Assessment%20final.pdf> (Promed 5/19/05, 5/22/05)

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South East Asia: FAO information on avian influenza and guide for paravets
An FAO update of avian influenza by country (Cambodia, Viet Nam, Thailand, Indonesia) is available at: http://www.fao.org/ag/againfo/subjects/documents/ai/AVIbull030.pdf. VSF-CICDA (Agronomes et Veterinaires sans Frontieres, or Agronomists and Veterinarians without Borders) in Viet Nam and Cambodia, in cooperation with FAO, prepared a new guide for village animal health workers (paravets) titled "Prevention and Control of Avian Flu in small-scale poultry: A Guide for veterinary paraprofessionals". The manual is expected to be translated in several South East Asian countries and will be distributed to veterinary para-professionals. This practical guide should enable paravets to better deal with avian influenza in backyard or small-scale poultry units. The full English text is available at <http://www.fao.org/ag/againfo/subjects/documents/ai/AI-paravets-guide.pdf>. (Promed 5/15/05)

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Viet Nam: Second Human Case of Avian Influenza in Thanh Hoa Province
Viet Nam has detected the second case of a human infected with avian influenza virus in a week as it struggles to combat the virus, officials said. A 58-year-old man from northern Thanh Hoa province tested positive for the H5N1 virus, said Nguyen Dang Ngoan, director of the provincial Preventive Medicine Centre. Ngoan said there were dead chickens reported in the man's neighbourhood a month ago and his family also slaughtered chickens for meals. The man had avian influenza-like symptoms of high fever, coughing and breathing difficulties 20 Apr 2005 and tested positive for the virus 15 May 2005, Ngoan said. Last week, a 52-year-old man from northern Vinh Phuc province also tested positive for avian influenza infection. Both men remained in stable condition at Bach Mai Hospital in Hanoi. Meanwhile, initial tests on a 20-year-old Cambodian woman suspected of contracting bird flu showed that she did not have the virus, said Phan Van Tu, chief virologist at the Pasteur Institute. The woman from Kampot province was admitted to a hospital in southern Viet Nam after showing avian influenza-like symptoms. (Promed 5/17/05)

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Thailand: Pigs declared free from avian flu
The Ministry of Agriculture confirmed 15 May 2005 that no cases of avian flu had been found among Thai pigs, pointing to strict measures to ensure that the virus did not spread from poultry to other animals. Speaking in response to the discovery of the H5N1 virus among pigs in Indonesia, Dr. Charan Trunwuttiphong, vice minister for agriculture and agricultural cooperatives, stressed that Thailand had been carefully monitoring for signs of the disease in pigs but had not found any instances of the virus. Under Ministry of Agriculture rules, farmers are told not to raise chickens and pigs together and to inform district livestock officers immediately if they discover any animal dying of unknown causes. Thailand could be declared free of the disease within a matter of weeks. However, the government is insisting that careful monitoring for the disease, which is notoriously hard to eradicate, will continue. In June 2005, agriculture and public health officials will hold a joint meeting to exchange information and views on how to control the disease and prevent its spread to both animals and humans. (Promed 5/16/05)

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Indonesia: H5N1 strain bird flu found in pigs, intensified human surveillance
Bird flu has infected pigs in Indonesia, the Agriculture Ministry said, raising fears of a wider outbreak in South East Asia's biggest economy. The ministry conducted tests on pigs after local scientists reported that pigs in several farms on Java were infected. So far there have been no reports of people in Indonesia being infected with the H5N1 virus. Pigs can carry human flu viruses, which can combine with the avian viruses, swap genes, and create virulent new strains, health experts say. They fear the virus could mutate into a form which can pass easily among humans and trigger a global pandemic. 6 specimens from Indonesian poultry workers have been sent for tests in Hong Kong. Earlier, at least 77 more samples were sent for the same purpose, in March and April 2005. "At the moment, the government doesn't have an effective way to prevent the disease being transmitted from fowl to pigs. There is no vaccination yet for pigs," said Tri Satya Putri Naipospos, director of animal health at the ministry. New cases of H5N1 have re-emerged on a relatively small scale in some parts of Indonesia since it was first found in late 2003. Since late 2003, Indonesia has lost around 8.9 million fowl.

After the latest bird flu outbreak in South Sulawesi province, the Indonesian Ministry of Health is intensifying surveillance in case of human infection by the H5N1 virus. The province was hit by avian flu in Mar 2005. Ministry of Health Director for Eradication of Diseases Transmitted by Animals Hariadi Wibisono said that his office had been intensifying bird flu monitoring in South Sulawesi, after the outbreak in Mar 2005, by monitoring clinical symptoms in hospitals and health centers as well as conducting campaigns on safety procedures for poultry workers, such as the use of masks and disinfectant sprays after entering livestock areas. (Promed 5/14/05, 5/15/05)

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China: Rushes in vaccine after bird flu found
China has rushed more than 3 million doses of bird flu vaccine to a remote western province, after migratory birds were found dead from the H5N1 strain, state media said 23 May 2005. Poultry across Qinghai province had become the "target of a compulsory vaccination campaign," the China Daily newspaper said. Scientists had proved that the virus killed 178 wild geese in Qinghai in early May 2005, media said. The area where the dead geese were found had been sealed off for 10 days. "This is the first report of H5N1 virus detected in China since the country successfully brought 50 cases of bird flu under control last year [2004]," Xinhua news said. In China, mass vaccinations in poultry are widely applied, preventing infections or suppressing clinical manifestation of the disease. The Agriculture Ministry had required the whole country to take emergency measures, Xinhua said. Those measures included basic quarantine and disinfection steps, keeping people out of migratory bird habitats and limiting contact between humans and domesticated birds. There had been no reports of the virus spreading to humans or domestic fowl in Qinghai, the Beijing News said. Though avian influenza virus has been isolated from geese in various countries, clinically manifested disease is not common in this species. (Promed 5/22/05, 5/23/05)

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China: Development of poultry vaccines for Avian influenza
China has developed vaccines that block the spread of the deadly H5N1 strain of bird flu among birds and mammals, Xinhua news agency reported. "Experiments show the efficiency rate of the newly developed vaccines in preventing infection by the H5N1 virus is 100 percent," Chen Hualan, director of the China National Bird Flu Reference Laboratory, was quoted as saying. China's Ministry of Agriculture had given its approval, and a sales permit, for the vaccines, Xinhua said, without mentioning whether the treatments had been evaluated outside the country. The agency said supplies of the new vaccines had already been sent to far-flung western Qinghai province, where China has been scrambling to contain its first breakout since late 2004. China was willing to provide technical anti-epidemic support to other countries, and poultry farms in Vietnam had begun experimenting with the Chinese vaccines, it said. Health departments in Xining and prefectures around the province had been mobilised to prevent the spread of the disease, Xinhua quoted Ai Keyuan, an official with the provincial health bureau, as saying. Local departments were being told how to dispose of bird droppings, and hospitals in the affected county had opened separate departments for screening patients with fever and to observe people who had close contact with the birds. "All hospitals have been told to set up a task force and put aside medication and facilities for the treatment of any avian flu cases that might be detected," Ai said. (Promed 5/26/05)

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China: Food-borne parasitic infections increase
The infection rate of food-borne parasitic diseases has climbed dramatically in China in the past 10 years. The incidence of liver flukes, the leading food-borne parasitic worm, has increased by 75 percent over the period, according to a survey conducted by the Ministry of Health throughout China's 31 provinces and autonomous regions from Jun 2001 to 2004. It is estimated that more than 12 million Chinese have been infected with liver flukes through food, and have gone on to develop hepatic distomiasis. Humans are often infected by ingesting small water snails living on water cress, water caltrop and other aquatic plants. Guangdong Province, the Guangxi Zhuang Autonomous Region and Jilin Province have the highest rates of hepatic distomiasis, recording a 182, 164 and 630 percent growth, respectively, compared with a similar survey conducted 1988 - 1990. The survey attributed the increasing incidence of liver fluke-caused disease to people's growing penchant for raw food, especially those living in coastal regions. Liver fluke found in seafood can cause severe distomiasis in human beings, said Xu Longqi, a researcher with the National Institute of Parasitic Disease under the Chinese Centre for Disease Control and Prevention. Symptoms of the disease include diarrhea, malnutrition and hepatocirrhosis. Eating raw or semi-raw pork and beef can also trigger parasitic diseases, proven by the high infection rate in Yunnan Province, where such food abounds.

However, land-borne parasitic diseases that infect human beings are well under control, said Hao Yang, an official with the Disease Control and Prevention Division of the Ministry of Health. On a national level, the infection rate of this kind of parasitic disease is 64 percent lower, compared with the first survey. In 1990, there were 536 million patients with verminosis. By the end of 2004, this figure had dropped to 136 million. Hookworm, roundworm and whip worm, the most common land-borne parasitic diseases, are in sharp decline. "Rural hygiene campaigns have helped eliminate the worms, and lower the infection rate," said Hao. He also called for vigilance against diseases passed to humans through pets, and suggested pregnant women stay away from domesticated animals. (Promed 5/18/05)

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China: Foot and mouth disease reports
The Chinese Agriculture Ministry said 25 May 2005 it was checking reports of an outbreak of foot and mouth disease (FMD) in a dairy area near Beijing. Residents of Dabailou village said up to 2000 cattle had been slaughtered since the disease was found at the end of Apr 2005. Agriculture Ministry officials have told foreign experts they are worried that news of an outbreak might harm Beijing's reputation in the lead-up to the 2008 Olympics. As a signatory to international agreements on disease control, China is required to report any FMD outbreaks to the UN Food and Agriculture Office (FAO). FAO China representative Noureddin Mona said he had heard about the outbreak near Beijing, but "not from official sources". It is commonly accepted in the livestock industry that FMD erupts regularly in China, yet Beijing made its first report to an international body on the disease earlier in May 2005, when it told the World Organisation for Animal Health [OIE] of 2 small outbreaks in Jiangsu and Shandong provinces. Meat and Livestock Australia's China manager Leith Tilley said consumer demands and the desire to develop meat and livestock export markets were driving a push towards greater transparency. According to the terrestrial animal health code, China should forward to the OIE weekly reports on FMD following its first report of 13 May 2005, until eradication of the disease or its becoming endemic. Although humans are not susceptible to FMD, lack of transparency in reporting FMD leads to doubts about the reporting of human and other animal diseases. (Promed 5/26/05, 5/24/05)

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New Zealand: Foot and Mouth Disease, hoax
The official post to OIE from New Zealand regarding the foot and mouth disease threat reads as follows:
“Further update on letter received threatening release of foot and mouth disease (FMD) virus on a New Zealand offshore island: A second letter has been received, via media, stating that the original letter sent last week claiming release of "a vial of FMD virus on an off-shore island" was a hoax and that no FMD virus was released in New Zealand. A police assessment has confirmed that the letter is highly likely to have come from the same source as the first one. Intensive surveillance on the island and extensive investigations over the past week have shown no evidence of clinical signs of FMD or factual substance to the original letter. As a result of this additional information and the surveillance results thus far, New Zealand now intends to remove the legal restrictions covering the movement of animals and other goods off Waiheke Island by 5 p.m. on Tue 17 May 2005.” (Promed 5/19/05)

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Indonesia: 8 Polio cases confirmed
As of 14 May 2005 Indonesia has detected 2 new polio cases, bringing the total number of infected patients in the country's first polio outbreak in a decade to 8 children. All cases so far come from villages near Sukabumi. Indonesia is the sixteenth country previously believed to be polio-free to be re-infected in the past 2 years. Polio mainly hits children under 5 and can cause irreversible paralysis, deformation and sometimes death. The outbreak occurred April 2005 in Girijaya village near Sukabumi. Bogor Health Agency is testing feces and urine samples of an additional 5 children believed to have contracted polio. Around 5000 children in West Java have been vaccinated in recent weeks. Preparations are under way for a major program to vaccinate 5.2 million children at the end of May 2005 across the provinces of West Java, Banten and the city of Jakarta. WHO has said the Indonesian cases are almost identical to a strain circulating in parts of Africa and that the disease may have reached the country from Africa via the Middle East. Health officials said it may have been carried by a migrant worker or a Haj pilgrim who visited Saudi Arabia before returning to Indonesia.

Muhammad Nadirin, head of epidemiology surveillance at the health ministry, said, "In less than 72 hours after the first case, we conducted an outbreak response immunization in 15 villages around the original location." He said 12 800 children under the age of 5 in the area have been immunized against the disease. Another key factor is Indonesia's years of experience which have left more than 80 percent of its children already immunized. Support from international agencies, especially the WHO and UNICEF, was also crucial. John Budd of the UN children agency said that Indonesia was quick in setting up a reporting mechanism for cases of paralysis, which enabled them to target other areas at risk. (Promed 5/16/05)

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Taiwan: CDC issues warning against outbreak of Enterovirus 71
Officials are advising the public to wash their hands frequently—the enterovirus epidemic has already claimed the lives of 3 young children in Taiwan in 2005. The disease is especially dangerous when contracted by children under age 3. Wu Ping-hui, an official from the Taiwan CDC, said, "As the virus is spread by physical contact, before parents and older children touch younger children, they are advised to take showers or wash their hands when coming home from the outdoors". Wu also suggested that parents avoid exposing their young children to public places. According to CDC, the 3 died of infection with Enterovirus 71, which often presents like other enterovirus infections and can have no symptoms, or the patient may show signs of hand, foot & mouth disease (HFMD), rashes, meningitis, and/or encephalitis. It may also come with unusual symptoms, such as hemorrhage and acute flaccid paralysis. There are still 29 children with severe Enterovirus infections; 15 of the 29 cases are infected by EV71 virus.

Taiwan is currently facing the annual outbreak season for HFMD. Enterovirus 71 has been associated with sporadic outbreaks globally, including the USA, Brazil, Europe, Australia and Malaysia. It caused a large outbreak in Taiwan in 1998, with 78 deaths, and smaller outbreaks recurred in 2000 and 2001. HFMD is usually characterized by tiny blisters on the inside of the mouth and the palms of the hands, fingers, and feet. Most cases occur in the summer and fall. Outbreaks may occur in child care centers or nursery schools. Symptoms usually appear 3 to 5 days after exposure. People can spread the disease when they are shedding the virus in their feces. It is also spread by the respiratory tract from mouth or respiratory secretions. The virus has also been found in the fluid from the skin blisters. There is no specific treatment for the virus that causes HFMD. Prevention and control are strengthened by: washing hands well, especially after going to the bathroom, changing diapers and/or handling diapers or other stool-soiled material; covering the mouth and nose when coughing or sneezing; washing toys and other surfaces that have saliva on them; excluding children from child care or school settings if there is a fever, or ulcers in the mouth and the child is drooling. For reviews, see Epidemiology and Disease Control Program (EDCP) Fact sheet: <http://edcp.org/factsheets/handfoot.html>. With public awareness campaigns, the frequency of reporting outbreaks of Enterovirus 71 or HFMD has been reduced. (Promed 5/23/05)

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Thailand: Embargo on ice production after hepatitis outbreak
The Ministry of Public Health announced 25 May 2005 strict control measures for ice factories, following a major outbreak of hepatitis A in Lampang and Chiang Rai, which health officials have traced to contaminated ice. The Permanent Secretary for Public Health, Dr. Vichai Tienthavorn, said that initial inspections pointed to an ice factory in Chiang Rai Province which drew its water from local artesian wells. Samples taken from the water show it to be contaminated with coliform bacteria. The first victims of the outbreak were discovered 7 Apr 2005 in Lampang's Wieng Pa Pao district, and the number of cases surged during early May 2005. There are now 906 people being treated for the disease, of whom 11 are in Chiang Rai's Mae Saruay district, 531 in Wieng Pa Pao and 264 in Wang Neua. Local hospitals are still seeing 10-50 patients a day, although none of the cases are serious. Dr. Vichai urged members of the public to avoid the disease by also paying attention to food hygiene. Mobile medical teams are now going around the northern provinces to take blood samples from anyone thought to be at risk from the virus.

Iced water and ice cubes are frequently contaminated with potentially pathogenic viruses and microorganisms where there are lapses in hygiene, or where a contaminated water source is used in their preparation. Where there is fecal contamination of water supplies, the concentration of hepatitis A virus can be high, because the virus replicates in the liver and is released into the environment in abundance via bile fluid. Fortunately, jaundice caused by hepatitis A virus is a self-limiting disease. There is a good vaccine, and outbreaks can be contained by vaccination. (Promed 5/25/05)

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Thailand: Trichinellosis--Boar meat kills man
A 43-year-old man died while receiving treatment at a local hospital and his 27-year-old wife is in a respirator after they ate undercooked boar meat earlier in May 2005. 2 neighbours who shared the food were also hospitalised, but their conditions were not serious. Dr Pongthep Pirawit, who treated the 4 patients, said they all suffered trichinellosis. Trichinosis is infestation of trichina larvae, which are transmitted by eating inadequately cooked meat, especially pork. Larvae migrate from the victim's intestinal tract to the muscles, where they become cysts. Dr Pongthep warned people to eat only well-cooked food, saying that trichinosis could be fatal, as in this case. The patient and other local residents hunted and killed a boar 13 May 2005. They then shared the meat, some of which was only partly cooked. Wild boar is a well-known source of Trichinella infections. This was ProMED's first report from Thailand, which underlines the ubiquitous distribution of the parasite. (Promed 5/25/05)

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Americas
USA: CDC lifts recommendation for malaria prophylaxis in resort areas in Dominican Republic
The US CDC has lifted the outbreak notice for travel to La Altagracia Province, Dominican Republic, including the resorts at Punta Cana. No new malaria cases in travelers have been reported from the area since Jan 2005; the numbers of malaria cases in the Dominican Republic have returned to what is normal for this province. The outbreak notice for Duarte Province was lifted 23 Feb 2005. 20 cases of malaria were reported in people who had traveled to resort areas in La Altagracia Province from 3 Nov 2004 to 10 Jan 2005, and a single case in a traveler to Duarte Province who returned in early Nov 2004. 5 of the travelers were from the US, 6 from Canada, and 10 from Europe. (These resort areas had previously been malaria-free). In response to the outbreak, CDC recommended taking an antimalarial drug to all travelers to the 2 provinces, including resort areas. The Ministry of Health of the Dominican Republic increased surveillance, increased mosquito spraying and elimination of breeding sites, and ensured that any malaria cases found were promptly treated. PAHO and CDC provided assistance and advice to the Ministry.

Since malaria continues to be a risk in rural areas of the Dominican Republic (but not in cities or resort areas), travelers to these rural areas should take an antimalarial drug. Chloroquine is the recommended drug for the Dominican Republic. Because antimalarial drugs are not 100 per cent protective, other measures to prevent mosquito bites should also be used, such as insect repellents that contain the ingredients DEET or Picaridin. Travelers who become ill with a fever or flu-like illness while traveling in the Dominican Republic or after returning home (up to one year) should immediately seek medical care. http://www.cdc.gov/travel/other/malaria_dr_2004 (Promed 5/15/05)

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Canada (Ontario): Salmonella outbreak in Burlington
At least 81 people became sick after a salmonella outbreak at the Royal Botanical Gardens in Burlington, Ontario. 4 people had to be put in the hospital; 2 have since been released. The restaurant is still open after it was cleared by the Halton Health Department, but officials still want to talk to anyone who attended the Mother's Day buffet or anyone who may have been sick between 1-12 May 2005. None of the food handlers have displayed symptoms, but investigators are looking at how food was prepared. Officials believe salmonella bacteria is the cause. About 190 people of the 300 who attended the event have been contacted by phone and given questionnaires about what they ate in order to determine the source of the outbreak. Salmonella causes severe diarrhea, vomiting, fever, nausea, headaches and abdominal pain, usually 12 to 36 hours after exposure. Symptoms can last from 4 to 7 days and can lead to severe dehydration. The elderly, infants and those with weakened immune systems are more likely to suffer more severe symptoms. At least one person has developed septicemia, a form of infection in which the bacteria spreads from the intestines to the blood. The concern now is to prevent secondary contamination. Of the 81 people who are sick, 29 are from Hamilton and 16 live in Halton region. The rest are from the Greater Toronto Area, Niagara, Waterloo, London and Buffalo. (Promed 5/16/05)

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Canada (Alberta): Precautions urged after woman dies of hantavirus
A woman from central Alberta has died--and her daughter and another relative are in hospital--after contracting hantavirus. One person in hospital is listed in serious condition, while the other is in stable condition. Doctors believe the 3 were cleaning the garage about a week ago when they were exposed to mouse droppings. "There is a need for the public to take precautions when they are exposed to mice or mouse droppings," deputy provincial health officer Dr Karen Grimsrud said, adding testing shows that there are infected mice in all areas of the province. "You for sure don't want to sweep or vacuum the mouse droppings. By putting that virus into the air and breathing it in is how you are infected. You need to dampen it with disinfectant, then either mop it up or wipe it up with paper towels and dispose of the paper towels in double bags, and seal them." Health officials also recommend wearing rubber gloves.

Hantavirus is a respiratory illness spread by infected deer mice through their droppings, urine or saliva. It is commonest in spring, when people are outdoors or spring-cleaning and breathe in the airborne particles. People first get flu-like symptoms, including fever and body aches, which progress to breathing problems. Since 1989, there have been 31 cases of hantavirus in Alberta, and 9 deaths. Health officials are warning the public to dispose of mouse droppings carefully, and to thoroughly clean areas where mice have been. Further information can be found from the following websites: Alberta Health and Wellness: Hantavirus http://www.health.gov.ab.ca/public/diseases/Hantavirus.html. Public Health Agency of Canada: Hantavirus <http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/00vol26/dr2608ea.html> (Promed 5/14/05)

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Canada (Saskatchewan): Indian Reserve Concerned About Hantavirus
A northern First Nation is taking precautions after a deadly case of hantavirus infection. A woman from Pelican Narrows fell ill April 2005 and died from the disease, which is spread by deer mice. Chief Ron Michel of Peter Ballantyne Cree Nation is asking people in the region to take steps to prevent the spread of hantavirus. "I've been telling my people...to try and clean up their yards where these rodents populate," he said. Michel has also ordered inspections for all public buildings operated by the first Nation. One school with a history of mouse problems has been temporarily shut down at Deschambault Lake. Health officials are also urging calm, saying the disease is rare. The Pelican Narrows case is the province's sixteenth case of hantavirus in 10 years. It is also the fifth fatality from the disease. (Promed 5/17/05)

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USA (New Mexico): Second Hantavirus Patient Being Treated in Albuquerque
The University of New Mexico Hospital was treating its second hantavirus patient of the month 29 Apr 2005. The 32-year-old woman from southern Colorado admitted to the hospital was in satisfactory condition. A 29-year-old man from northeastern Arizona, admitted earlier this month with hantavirus, remained in critical condition. Experts have warned the wet weather of winter and early spring could mean higher populations of mice this year in the West. "The increase in moisture and increase in vegetation can lead to an increase in rodent population," said Dr. Bernadette Albanese, a medical epidemiologist with the New Mexico Department of Health. Albanese said about 10 percent of the deer mice in New Mexico are infected with hantavirus. New Mexico has recorded a total of 63 cases of hantavirus. 27 of those cases have been fatal, according to numbers released by the state in Dec 2004. Hantavirus is passed to humans when they inhale particles of dried urine or feces from infected rodents. The illness is marked by fever, headache and muscle ache, possibly with chills, nausea and vomiting, and progresses rapidly to severe difficulty in breathing and, in some cases, death. Symptoms develop one to 6 weeks after exposure. Anyone entering a building that may be infested by mice should wear a face mask and gloves and use a bleach solution to wet and clean up any mouse nests or droppings. (Promed 5/17/05)

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USA (Nebraska): Man Dies From Hantavirus Pulmonary Syndrome
A western Nebraska man in his early 50s died April 2005 after being infected with hantavirus, a virus which is spread through the urine, droppings or saliva of infected rodents. The man worked in a rural agricultural setting. He saw his doctor after becoming ill and was hospitalized the next day in North Platte, then transferred to the Nebraska Medical Center in Omaha. The man is the fourth person in Nebraska to die of the disease. 9 cases have been confirmed since the virus was first reported in the state in 1998. 2 possible cases have not been resolved. Hantavirus pulmonary syndrome attacks the lungs, destroying air sacs and preventing the movement of oxygen into the body, Safranek said. (Promed 5/17/05)

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USA (Colorado): Plague cases may rise; wetter weather aiding increase in rodents, fleas
Bubonic plague has sickened one Colorado woman May 2005. The woman, who lives in La Plata County, is recovering in a hospital. She probably got plague from a flea from her cat, say epidemiologists. People visiting rural campgrounds, picnic spots and wilderness areas also should be cautious. Bubonic plague is a highly infectious bacterial disease of rodents that is spread by their fleas. Human cases are infrequent and can be treated easily with common antibiotics when recognized early. Otherwise, they can be life-threatening. Symptoms emerge 2 to 6 days after infection: sudden onset of high fever; muscle pain; malaise or a general feeling of being ill; nausea and vomiting; a large swollen, painful lymph node. Globally, the WHO reports 1000 to 3000 cases of plague every year. Plague bacillus is considered a Category A bioterrorist agent by CDC.

The wetter weather, combined with the 5- to 10-year cycle of plague in the western US, means Colorado could see more plague this year 2005, said John Pape, an epidemiologist who specializes in animal-related diseases for the health department. The damper weather gave rise to more plants for rodents to eat, so their numbers grew. Lower temperatures also allow fleas to survive longer on their rodent hosts, Pape said. Earlier in 2005, a plague-positive cat was reported in Douglas County. A positive squirrel was found in El Paso County and, most recently, a positive rabbit was found in Jefferson County. Rapid die-offs of rodents and rabbits, a telltale sign of plague, have been reported from several areas of the state, Pape said. (Promed 5/18/05)

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USA (Indiana): E. coli hits day-care center
Escherichia coli O157:H7 has struck at least 9 children in a Fort Wayne day-care center, Allen County. Commissioner of Health Dr. Deborah McMahan confirmed 18 May 2005. One child was taken to Riley Hospital for Children in Indianapolis. Tests on food and water consumed at the day care have all been negative. "It looks like this was spread person-to-person," McMahan said, noting day cares are common sites of outbreaks. An estimated 73 000 cases and 61 deaths from the infection occur annually, according to the U.S. CDC. Many more cases likely occur because some people carry the infection but have no symptoms. Usual symptoms include abdominal cramping, severe diarrhea, and blood in the stool. Vomiting may occur, but there is normally little or no fever in those who have it. In young children and the elderly, the illness can be especially serious, leading to hemolytic uremic syndrome. 2-7 percent of infections lead to kidney failure. The bacterium can be found in undercooked meat, sewage-contaminated lakes and streams, and contaminated drinking water. Although symptoms may be gone after 5-10 days, young children can shed the bacteria in their feces for another week or 2. In most cases, the infection must run its course. Antibiotics are not considered effective. Anti-diarrheal agents also are discouraged in favor of the body naturally ridding itself of the bacteria. (Promed 5/21/05)

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies, 27 May 2005
In week 19, influenza activity worldwide remained similar to that of the previous few weeks, with the exception of Hong Kong, where medium-to-high levels of influenza activity continued. Activity was low in most parts of both the northern and southern hemispheres.

Canada. Overall influenza activity continued to decline in week 19. Localized activity was reported in 3 provinces, while in the rest of Canada activity remained low.

Hong Kong. Influenza activity remained high in the previous 9 weeks, with large numbers of influenza viruses isolated each week, the majority of which were influenza A(H3N2). In week 19, a total of 156 influenza viruses were isolated.

Other reports. During week 19, low influenza activity was detected in USA (H3, A and B). Australia, reported no influenza activity. (WHO 5/27/05 http://www.who.int/csr/disease/influenza/update/en/)

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Cholera, diarrhea & dysentery
Malaysia
More than 100 pupils and a cook in the Semporna district have been admitted to hospital after they showed signs of cholera. Semporna Hospital authorities urged the public to practice better hygiene. Residents in the district have been advised to drink boiled water and eat home-cooked food. The cholera outbreak was first detected 6 May 2005 when a cook at the SK Bubul II, who was suffering from fever, diarrhea, and vomiting was rushed to the hospital. Since then, 106 pupils from the school and 7 students from the nearby SMK Kabongan II, had also be admitted. Authorities in the district have ordered the canteens in the 2 schools to close. The health department confirmed the cholera outbreak 10 May 2005. They were now taking preventive measures through public education. The Sabah Health Department deputy director said a health team was sent to Semporna to help local health officials investigate and help in prevention. Semporna hospital director Dr Norazam Kamaruzaman said they have admitted the carriers and also those who were in contact with them, to isolate them from further interaction with other people. (Promed 5/13/05)

Philippines (Mindanao)
At least 12 persons were confirmed to have been afflicted with cholera in 2 barangays in the boundary of Zamboanga City and Zamboanga Sibugay province. City Health Officer Dr. Rodel Agbulos said 21 May 2005 the cholera victims are confined at the emergency lying-in hospital in Barangay Vitali. Agbulos said 7 of the patients are from Barangay Sinaburan, Tungawan, Zamboanga Sibugay while the 5 are from Licomo. He said drinking contaminated water was the cause of cholera. Residents of the affected barangays get their drinking water from deep wells. Agbulos sent health personnel to Licomo to prevent the further spread of the disease by chlorinating the deep wells. He also asked residents to boil the water. (Promed 5/24/05)

Philippines (Leyte)
Acute gastroenteritis downed at least 145 residents of Baybay town in Leyte as of 20 May 2005, 4 days since the outbreak started. Baybay Mayor said most of the victims were aged 7 years and under, and only 13 were aged at least 30 years. As of 20 May 2005, he said 65 were confined at the Western Leyte District Hospital, while 30 others were in various private hospitals. 50 were treated as outpatients. Cari said the cause of the outbreak was traced to contaminated water from one of the wells located in the Poblacion, the reason most of the victims were Poblacion residents. Sanitary inspectors found the presence of E. coli bacteria in the water supply from this well. It was also found that the water district failed to put chlorine in the well's water system for a few days before 16 May 2005. (Promed 5/24/05)

Malaysia (Sabah)
A cholera outbreak has hit Pulau Gaya, just off Kota Kinabalu [capital of Sabah state on Borneo], with 17 islanders warded at the Queen Elizabeth hospital. Tanjung Aru state assemblyman Edward Yong Oui Fah, said the 17 patients included men, women and children. They were admitted to hospital 21 May 2005. All those affected were responding well to treatment. Thise cholera outbreak comes just 3 weeks after a similar outbreak in the east coast district of Semporna, where 118 students from 2 schools were affected. (Promed 5/24/05)

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Dengue/DHF
Thailand
Dengue has infected 7200 people as of 7 May 2005, of whom 12 have died, up from 7 deaths in the same period last year, Department of Disease Control chief Thawat Suntrajarn said. The outbreak usually peaks between late June and July. The disease--which killed 176 of 114 800 infected people in 2002–is characterized by high fever, rash, headaches, and severe muscle and joint pain. Recently, thousands of people queued at hospitals in Bangkok to donate blood for a 13 year old sufferer. The boy died 11 May 2005 after suffering internal bleeding. His parents donated his body to Mahidol University's Vaccine Development Center for research. "The center will analyze which strain of the dengue virus killed the boy. We'll also be looking to see if it's a new strain, even though we know mutations are extremely rare," center director Dr Suthee Yoksan said. Dr Suthee described it as the world's most in-depth study on dengue fever in 25 years. Dr Suthee said he hoped the study would eventually lead to the development of an effective vaccine. He said the center would coordinate with other international organizations that are trying to develop a vaccine. Also, the Department of Disease Control has set up a 24-hour telephone helpline in the fight against dengue fever, with information on symptoms of the illness and how to control it. In its early stages, dengue fever is easy to confuse with ordinary influenza, but within a few days, a patient may be experiencing internal hemorrhaging. (Promed 5/15/05)

Australia
A dengue fever outbreak has struck Townsville. After a Currajong man in his 40s was found ill with dengue 13 May 2005, all homes within 200 meters of his home were inspected. Health authorities said the man had been bitten in Townsville. Dengue does not naturally occur in North Queensland, but the dengue mosquito is common, and outbreaks can occur when the virus is transmitted to the local mosquito population by infected international travelers. Queensland Health Tropical Public Health Unit Environmental Health Service Acting director Damien Farrington urged residents to take immediate action to eradicate dengue. "There is no medical cure for dengue fever and no vaccine…The serious form of the disease, dengue hemorrhagic fever, can be fatal, especially in young children." There were 58 cases in Townsville in the 2003-04 outbreak. There are 4 types of dengue viruses: 1, 2, 3 and 4. Anyone infected with one type of dengue will only be immune to that type and will be at risk of developing severe symptoms if they contract another type. (Promed 5/15/05)

Philippines
Provincial health officials expressed alarm over the abrupt increase of dengue cases. The upsurge in dengue cases in the province came shortly after health authorities in Koronadal, South Cotabato also raised an alert after 159 dengue cases hit. The Kidapawan Medical Specialist Center has admitted 86 patients, while the Madonna General hospital has also recorded 7 cases. The Makilala Medical Specialist Center in neighboring Makilala has admitted 14 patients in April 2005. Dr. Renan Sungcad, assistant chief of the North Cotabato Provincial Hospital, urged residents in the 17 towns of North Cotabato to implement the 4 o'clock habit. The habit involved cleaning surroundings, draining of water accumulated in tires, bottles, flower bases, and roof gutters to prevent mosquitoes from breeding. He also recommended the use of mosquito nets. (Promed 5/19/05)

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2. Articles
CDC EID Journal, Volume 11, Number 6-June 2005
CDC Emerging Infectious Diseases Journal, Volume 11, Number 6-June 2005 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. The following expedited article is available online: Avian Influenza H5N1 and Healthcare Workers, C. Schultsz et al.

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Rubella outbreak in an unvaccinated religious community in the Netherlands spreads to Canada
Susan Hahné et al.
“There are indications that the rubella outbreak that started in September 2004 among members of a religious community in the Netherlands, first reported in Eurosurveillance on 3 March 2005, has spread to Canada. This outbreak is specifically affecting some unvaccinated groups within the Gereformeerde Gemeente in Nederland (Netherlands Reformed Community in the Netherlands, a Christian community). Up to 17 May, 214 laboratory confirmed cases of rubella have been reported in southwest Ontario. Five of these cases have been in pregnant women. The Canadian Christian community where the cases occurred has historical and social links with the affected groups within the Gereformeerde Gemeente in Nederland, and individuals frequently travel between the two communities. A definitive source for the Canadian patient with the earliest date of onset reported (mid-February 2005) has not yet been identified. An isolate has been obtained from the outbreak in Canada and is currently being genotyped. Attempts are being made to isolate rubella virus in the Netherlands so as to genetically link the respective outbreaks. The World Health Organization has recently published a standardised rubella virus genotyping protocol…” (Eurosurveillance weekly releases 2005, Volume 10 / Issue 20 http://www.eurosurveillance.org/ew/2005/050519.asp)

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Lymphocytic Choriomeningitis Virus Infection in Organ Transplant Recipients--Massachusetts, Rhode Island, 2005
“On May 3, 2005, CDC received a report of severe illness in four patients who had received solid organ transplants from a common donor. All four organ recipients subsequently were found to have evidence of infection with lymphocytic choriomeningitis virus (LCMV), a rodent-borne Old World arenavirus. Preliminary findings from the ensuing investigation indicate the source of infection likely was an infected hamster in the donor's home. This report summarizes the ongoing investigation and provides information on exposure risks and possible prevention measures…Within 3 weeks after transplantation, the four persons who received the liver, lungs, and two kidneys had abnormalities of liver function and blood coagulation, and dysfunction of the transplanted organ. Signs, symptoms, and clinical laboratory test results varied in these patients and included fever, localized rash, diarrhea, hyponatremia, thrombocytopenia, hypoxia, and kidney failure. Three of the four organ recipients died, 23--27 days after transplantation. The fourth patient, a kidney recipient, survived…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm54d526a1.htm (MMWR May 26, 2005 / 54(Dispatch);1-2)

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3. Notifications
73rd Annual General Session of the International Committee of the OIE
The 73rd Annual General Session of the International Committee of the World Organisation for Animal Health (OIE), was held 22 to 27 May 2005. Some points of interest dealt with were:
- Within the framework of its usual standard-setting work, the Committee adopted or updated international standards aimed at providing better safeguards for the sanitary safety of world trade in terrestrial and aquatic animals and their products
- Standards on animal welfare were adopted, (i.e. slaughter for human consumption, land and sea transport of animals, and humane killing of animals for disease control purposes).
- Special attention was given to updating the chapter on BSE in the Terrestrial Animal Health Code. New scientific knowledge has been incorporated leading to a new classification of the categories of BSE status of Member Countries and to a new list of several animal products without risks for consumers;
- A new chapter on avian influenza in the Terrestrial Animal Health Code, was adopted, so as to improve transparency and control methods of the disease, protection of human health and provide greater protection for countries importing poultry and poultry products while eliminating unjustified barriers to trade.

The OIE IVth Strategic Plan (for the period of 2005-2010) was adopted and includes:
- Development and influence of the OIE in the field of the design and implementation of animal health related policies, as well as of veterinary research and sanitary governance;
- Reinforcement of capacity building, notably of the veterinary services in developing countries to allow them to better participate in the global fight against diseases; (OIE 5/27/05 http://www.oie.int/eng/press/en_050527.htm)

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Recreational Water Illness Prevention Week--May 23--30, 2005
The first National Recreational Water Illness Prevention Week will be held May 23--30, 2005 to raise awareness of the potential for spread of infectious disease at swimming venues and to help improve prevention efforts. Each year, U.S. residents make an estimated 360 million visits to recreational water venues. However, recreational water use also can be associated with drowning, injury, and the spread of infectious diseases. Recreational water illnesses (RWIs) are spread by swallowing, breathing, or having contact with contaminated water from swimming pools, spas, lakes, rivers, or oceans. The most commonly reported RWI is diarrhea caused by pathogens such as Cryptosporidium, Giardia, Shigella, and Escherichia coli O157:H7. Children, pregnant women, and persons with compromised immune systems are at greatest risk from infection with these pathogens. Other RWIs can cause various symptoms, including skin, ear, eye, respiratory, and neurologic infections. A steady increase in reported diarrheal RWI outbreaks during 1984--2002 has resulted in approximately 19,000 illnesses. This increase is likely the result of a combination of increased water usage, improved outbreak detection, and increased disease transmission. The spread of RWIs is facilitated by emergence of chlorine-resistant pathogens such as Cryptosporidium, poor pool maintenance, and low public awareness of the problem. Recommendations for public swimming pools include improved operation, training, and public education. For more information visit: http://www.cdc.gov/healthyswimming. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5419a7.htm (MMWR May 20, 2005 / 54(19);489)

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4. APEC EINet activities
EINet article on trade related infections
The APEC EINet website now allows for automatic subscription at: http://depts.washington.edu/einet/?a=subscribe. The EINet team’s latest study is available in the newly launched journal, “Globalization and Health”. The article, “Trade related infections: farther, faster, quieter”, by Kimball et al., is available at http://www.globalizationandhealth.com/content/1/1/3.

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5. To Receive EINet Newsbriefs
APEC EINet Newsbriefs
The APEC EINet email list was established to enhance collaboration among health, commerce, and policy professionals concerned with emerging infections in APEC member economies. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe, go to: http://depts.washington.edu/einet/?a=subscribe or contact apecein@u.washington.edu. Further information about APEC EINet is available at http://depts.washington.edu/einet/.

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 apecein@u.washington.edu