Login   

Vol. VIII, No. 12 ~ EINet News Briefs ~ Jun 10, 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: AIDS Pandemic Racing Faster Than Means To Stop It
- South East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
- Viet Nam: Avian influenza update, additional 3 human cases
- China: Avian Influenza and Foot and Mouth Disease Control Measures
- Indonesia: Poliomyelitis update
- Japan: Confirms 20th case of mad cow disease
- Japan: Japanese encephalitis vaccinations halted
- Australia (South Australia): Rickettsial spotted fever identified in Adelaide
- Malaysia (Malacca): Boy died of lung infection, not SARS
- China (Heilongjiang): Mystery infection is HIV
- China: Government reveals plan to combat AIDS
- Taiwan: Enterovirus Infections Under Control
- Russia: Hepatitis A Outbreak Expanding in Tver Region
- Canada: Rare STD lymphogranuloma venereum confirmed
- Canada (British Columbia): H3 influenza virus found
- USA (Florida): Source of Cyclospora infection probably identified
- USA (South Carolina): Under cooked turkey most likely cause of salmonella outbreak
- USA (Oregon): Drinking water found to be likely Camp Yamhill disease source
- USA (Arizona): 2 cases of 'rabbit fever' (tularemia) reported
- USA (Illinois): Second Case of Hantavirus Infection Confirmed
- Canada (Quebec): First Case of Hantavirus Pulmonary Syndrome in Province Confirmed

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

2. Articles
- Surveillance for Laboratory-Confirmed, Influenza-Associated Hospitalizations--Colorado, 2004--05 Influenza Season
- Human Exposure to Mosquito-Control Pesticides--Mississippi, North Carolina, and Virginia, 2002 and 2003
- Travel-Associated Dengue Infections--United States, 2001--2004
- Reporting of Chlamydial Infection--Massachusetts, January--June 2003
- WHO/FAO to consult consumer associations on how to promote their involvement in food safety

3. Notifications
- International APEC conference on avian influenza, 22-23 Jun 2005
- Gordon Conference on New Antibacterial Discovery & Development
- New Edition of "Health Information for International Travel"
- Launch of BMC Veterinary Research
- Nationwide Recall of Pet Treats Due to Salmonella Contamination

4. APEC EINet activities
- EINet article on Seattle Times' Editorials/Opinion section

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Global: AIDS Pandemic Racing Faster Than Means To Stop It
Money available to fight AIDS has soared to an all-time high of US$8 billion but the pandemic is racing faster than the means to stop it, especially among women and girls, says a report prepared for a high-level U.N. forum 2 Jun 2005. Programs have succeeded in Brazil, which has the most successful AIDS program among developing nations. Cambodia and Thailand have shown substantial progress and several African nations as well as the Bahamas have slowed the rate of infection, says the report. But only 12 percent of those who need treatment are receiving it. Effective prevention programs, counseling and testing services are the exception to the rule and drugs still cost too much, the report said. And despite the many programs and money spent, the epidemic has not been reversed. The 4.9 million infections and 3.1 million AIDS deaths in 2004 were the highest to date. Nearly half of the estimated 39.4 million people living with HIV are women and girls, whether married or single, promiscuous or faithful.

"The trend is that more young women are being infected than young men," Thoraya Obeid, the head of the U.N. Population Fund, said. "If they are married, they can't abstain. They are faithful but the husband is not faithful," Obeid said. Women, she said, need information, including how to use a female condom to protect themselves. Obeid released a survey done by young people in a dozen countries, most of whom said they had no voice in their nation's AIDS policies. Others said programs needed to be comprehensive; abstinence and sex education, young people talking to other adolescents as well as to intravenous drug users. The world's largest donor for fighting AIDS is the US, which spent $2.4 billion in 2004. But it is being pressured by conservative groups toward abstinence-only programs and away from vulnerable groups like prostitutes, homosexuals and drug addicts. Worldwide, some $8 billion will be available in 2005 to implement programs in 135 low- and middle-income countries, a dramatic 23 percent increase over 2004. Of this amount, rich countries have contributed some $6.7 billion. (Promed 6/3/05)

^top


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.

Cumulative number of confirmed human cases of avian influenza A/(H5N1), 16 Dec 2004 to present:
Economy / Unofficial (Official) Cases / Unofficial (Official) Deaths
Cambodia / 4 (4) / 4 (4)
Thailand / 0 (0) / 0 (0)
Viet Nam / 52 (52) / 18 (18)
Total / 56 (56) / 22 (22)

Cumulative number of confirmed human cases of avian influenza A/(H5N1), 3 Dec 2003 to present:
100 (100) / 54 (54)
(CIDRAP, 6/8/05 http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html)

^top

Viet Nam: Avian influenza update, additional 3 human cases
The Ministry of Health in Viet Nam has confirmed an additional 3 human cases of infection with H5N1 avian influenza. The most recently detected case was reported 26 April 2005. In the same communication, an additional death from the disease was confirmed. The newly confirmed cases bring the total, in Viet Nam, since mid-December 2004 to 52 cases. Of these patients, 18 have died and two are currently being treated in hospital. "All the 3 were infected in relation to sick poultry," Trinh Quan Huan, head of the Health Ministry's Preventive Medicine Department, said. "Their condition is not serious and by now the 30-year-old man has been discharged." The government anti-avian influenza committee was told that poultry in the northern province of Nam Dinh and the southern province of Tien Giang would be vaccinated later in Jun 2005 on a trial basis. In August, vaccination of waterfowl and chickens would become mandatory in the regions facing a high infection risk, the Tuoi Tre newspaper reported. (WHO 6/8/05 http://www.who.int/csr/don/2005_06_08a/en/index.html; Promed 6/9/05)

^top

China: Avian Influenza and Foot and Mouth Disease Control Measures
China has halted the spread of avian influenza and foot-and-mouth disease (FMD), which were recently discovered in animals and birds. FMD was discovered in 4 regions in China during April and May 2005. FMD is highly contagious among cattle and other cloven-hoofed animals. On 27 May 2005, Chinese chief veterinarian Jia Youling from China's Ministry of Agriculture said the government has been successful in preventing any further spread of FMD. "We immediately closed off affected spots and surrounding regions…Scientists from the national lab then collected samples for further epidemiological studies..." In total, over 4000 cattle have been killed or culled. Though they had no symptoms of the disease, the virus was found in the herd. All the cattle in these regions have been vaccinated, and feeding cattle in the coming 6 months are forbidden on farms discovered with FMD. Farmers whose animals are killed or culled are compensated 4000-6000 yuan [USD 483-725] per cow. This is the first time Asian type I FMD has been discovered in China. The virus cannot be transmitted to humans. The source of the virus has not been traced.

An outbreak of avian influenza killed more than 1000 wild birds in Qinghai province. The chief veterinarian said, "There are 3 major migrating routes for birds in China. The recent outbreak appeared in the western route, from south and central Asian countries to the northern part of the Indian Peninsula then over Tibet and the Himalayas to Qinghai province. Because the bar-headed geese that were killed most in this outbreak were only found on this route, so other parts of China won't be affected." The causal agent was reported to the OIE as highly pathogenic avian influenza virus type H5N1. The government ordered all ducks, geese and other poultry in the province to be vaccinated. All nature reserves in the province were closed, and farms near bird migration routes elsewhere were ordered to vaccinate poultry. (Promed 6/4/05, 6/8/05)

^top

Indonesia: Poliomyelitis update
On 9 June 2005, six new polio cases were confirmed in Indonesia, bringing the total number of cases to 34. Five of these cases are from neighbouring districts as the index case (Lebak, Cianjur and Bogor districts), while one of these new cases is from the same district as the index case (Sukabumi district). For more information: http://www.polioeradication.org/content/pressreleases/Indonesiapolio9June2005.pdf (WHO 6/9/05 http://www.who.int/csr/don/2005_06_09/en/index.html)

^top

Japan: Confirms 20th case of mad cow disease
Japan has confirmed its 20th case of mad cow disease in a Holstein from northern Japan, the government said 6 Jun 2005. The accumulated number of mad cow disease cases in 2005 is 6. The 4-year, 9-month-old cow from Hokkaido prefecture was found to be infected with the brain-wasting illness after analyzing samples taken in June 2005. "All meat, internal organs and parts from this [cow] will be incinerated, and there is no danger that they will be circulated in the market," the Agriculture ministry said. Since Japan’s first case was detected in 2001, Tokyo has since checked every slaughtered cow before it enters the food supply. Japan has banned American beef imports since Dec 2003, immediately after the US's first case of mad cow disease was confirmed. Under U.S. pressure, a Japanese government panel in May 2005 took a step toward partially lifting the ban, but the decision still has to be approved by the government. In Feb 2005, Japan confirmed its first case of variant Creutzfeldt-Jakob disease in a man who died Dec 2004. Japanese health authorities believed the man contracted the disease during a month long visit to Britain--where mad cow disease first surfaced--in 1989. (Promed 6/6/05)

^top

Japan: Japanese encephalitis vaccinations halted
The Japanese government has announced it is suspending the Japanese encephalitis (JE) vaccination program which uses the inactivated mouse brain-derived JE vaccine, the only vaccine currently licensed in Japan. The license for the vaccine is not suspended, and vaccines are still available on an individual basis. In addition, 2 new cell culture-derived vaccines are in advanced stages of development in Japan, and licensure is expected 2006. On 30 May 2005, Japan's Health, Labor and Welfare Ministry had asked municipal governments to stop recommending vaccinations for minors against JE after a female junior high school student in Yamanashi Prefecture fell into critical condition after receiving an inoculation against the disease in 2004. The student was diagnosed as suffering acute disseminated encephalomyelitis (ADEM), a disease causing a nerve disorder, and doctors suspected it was a side effect of the vaccination. The ministry's decision is also based on the fact that the number of JE patients has been reduced to 10 or less a year. More than 4 million young Japanese annually receive the vaccinations. The ministry has recognized cases of more than 10 people suffering ADEM linked to the vaccination since 1994.

JE is a disease transmitted via mosquitoes that suck pig blood containing the virus. It cannot be transmitted between humans. JE circulates in the environment, with birds and pigs as the principal amplifying hosts, and thus it cannot be eradicated. One to 0.1 percent of people who contract the virus develop JE, and the rate of death among the patients is about 15 percent. Some 45 to 70 percent of survivors suffer complications. Regular studies ascertaining the prevalence of antibodies in humans and seroconversion in pigs demonstrate the virus is still circulating in Japan. The low number of cases of JE seen in Japan is a result of their immunization program, not a lack of circulating virus.

Recognition of adverse events after immunization with the inactivated vaccine, including the very rare but known cases of ADEM, has been a major factor spurring the development of new JE vaccines with improved safety profiles. The other JE vaccine currently available is the SA 14-14-2 live, attenuated vaccine. It has an excellent safety record, and, in studies to date, no severe adverse events have been reported. Over 200 million children have been vaccinated with this vaccine, and the vaccine is now licensed in China, Nepal and South Korea. (Promed 6/1/05, 6/3/05)

^top

Australia (South Australia): Rickettsial spotted fever identified in Adelaide
A potentially fatal disease not previously seen in mainland Australia has been identified in Adelaide's southern suburbs and Fleurieu Peninsula. 4 people have been confirmed with the disease, which may be linked to climate change or living close to native fauna where there may be a greater risk of tick bite. The disease, rickettsial spotted fever, causes headache, muscle ache, lethargy and high fever. The infection is also known as Thai tick typhus in Southeast Asia. The infection is caused by the bacterium Rickettsia honei, found in ticks that infest reptiles. If the tick bites a human, the bacterium can spread. A spotted rash usually appears on the limbs and torso several days after the first symptoms, and victims can become very sick, very quickly, with the possibility of death.

The 4 confirmed cases since 2001--unrelated women aged 65 and 44 and men aged 74 and 58--suffered fever, headache and muscle pain, then saw a rash appear. All responded to antibiotics and made a full recovery. Previous confirmed cases were only reported from Flinders Island in Bass Strait, although there may also have been cases in Tasmania. FMC head of Microbiology and Infectious Diseases Professor David Gordon said it was important doctors knew the disease was now in the community. "It is quite likely this illness has been in our community for some time; it just has not been recognized," he said. "There are probably many more cases that have not been diagnosed.” (Promed 6/6/05)

^top

Malaysia (Malacca): Boy died of lung infection, not SARS
The public was assured 31 May 2005 that a 14-year-old boy who died of an infection of the lungs 29 May 2005 was not a victim of Severe Acute Respiratory Syndrome (SARS). The assurance came in the wake of widespread speculation that the boy had died of SARS. The boy was admitted to Malacca Hospital late May 2005, about the same time as two 20-year-olds with similar symptoms. State Health, Consumer Affairs and Human Resource Committee chairman Datuk Seah Kwi Tong said the 3 cases were not related. The youths are being monitored in the hospital's Intensive Care Unit. The boy died of suspected melioidosis, also called Whitmore's disease, an infectious disease caused by Burkholderia pseudomallei. Melioidosis is a bioterrorism category B disease, and B. pseudomallei is a soil/water bacterium found primarily in Southeast Asia and northern Australia. Severe pneumonia with sepsis syndrome is the most common cause of death and usually occurs in the compromised host, particularly the diabetic. (Promed 6/1/05)

^top

China (Heilongjiang): Mystery infection is HIV
At least 16 people have been affected by HIV after contaminated blood was used for transfusions at a hospital in Bei'an county, Heilongjiang Province. An ongoing investigation by the county court and other officials has disclosed at least 5 farm workers received contaminated blood from 1999 to 2004. Four others were infected by the original 5 with the "mysterious" disease at the farm 330 km north to provincial capital Harbin. But there could be as many as 16 infected by HIV. A statement from the Ministry of Health confirmed that 9 victims "were infected" because 5 received tainted blood from a supply at Workers' Hospital. "We have admitted 16 AIDS patients from the farm since last September," said a nurse in the hospital, affiliated with the Heilongjiang General Bureau of State Farms in Harbin. "Now 9 patients are still hospitalized and their status is stable," the nurse said. A farm official with Bei'an Farm, who identified himself as Li, said the Harbin hospital has been treating those patients, and their medical expenses, totaling around 1 million yuan (US$121,500), were covered by the farm. An official with the Bei'an farm court said he was not sure how much in reparation each victim might receive. (SEA-AIDS eForum 2005: sea-aids@eforums.healthdev.org 6/7/05)

^top

China: Government reveals plan to combat AIDS
AIDS/HIV are to be fought on 3 fronts--prevention, intervention and treatment, announced the central government. The strategy is part of a 5 year plan. Wang Longde, vice-minister of the Ministry of Health and the director of the Office of the Working Committee for HIV/AIDS Prevention and Control under the State Council, said the government had devised a wide range of measures for its second 5-year plan to bring infection under control. "First and foremost will be the emphasis on raising public awareness of HIV/AIDS prevention, which is vital to prevent the disease from spreading wider," he said.

The second part of the strategy "is to identify as many HIV carriers as soon as possible," said Wang. China has an estimated 840,000 HIV/AIDS recorded cases. But only 7.4 per cent of those infected have been reported. The figure in 2004 was 12.4 per cent while the rate of reported cases around the world is 11 per cent of estimated sufferers. "Without knowing who the carriers are, how can governments provide the sufferers with a comprehensive care project?" asked Wang, who said the government wanted a holistic approach. China made extensive efforts last year to identify victims, especially in high-risk groups, said Wang. Thousands have been tested for HIV in Henan and other major provinces and regions where illegal and unsafe blood donations for cash and other forms of transmission were rampant in the 1990s, the minister said. A survey in Henan last year showed that 25,000 of 280,000 blood donors in the last decade tested positive for HIV. Three high-risk groups which are targeted for prevention and intervention are prostitutes, homosexuals and prisoners. "The nation had 190 State-level surveillance and monitoring sites last year and 57 will be added this year," Wang said.

The third part of the strategy is to strengthen the "four free charges and one care" project, said Wang. The care scheme offers free medicine for HIV carriers, free and anonymous HIV tests, free education for orphans of HIV/AIDS victims and free prenatal treatment of infected pregnant women. Elderly people who have lost children to AIDS receive free care. The central and provincial governments will continue to increase spending on HIV/AIDS control and prevention.

Also, Beijing will build an AIDS prevention and control network said Vice Mayor Niu Youcheng. The three grade network includes the municipal and district disease prevention and control mechanisms, the community health service centers and the sanitation stations in townships and villages. Beijing will intensify AIDS-related education in eleven districts and counties, together with 20 communities this year. All the second level and top level hospitals in Beijing are ordered to establish HIV checking center. The government will also continue to increase auto condom vending machines in public places, methadone treatments and needle exchange services. (SEA-AIDS eForum 2005: sea-aids@eforums.healthdev.org 6/7/05)

^top

Taiwan: Enterovirus Infections Under Control
The current enterovirus outbreak, which has infected 50 children and claimed 5 lives, has been brought under control, Department of Health Minister Hou Sheng-mao said 4 Jun 2005. As the outbreak is expected to peak in 2 week's time, Hou urged medical personnel and parents with young children to keep alert to prevent any further spread of the disease. Noting that enteroviruses are transmitted via direct contact with secretions from an infected person or contact with contaminated surfaces or objects, Hou said practicing good personal hygiene is critical to preventing infections. (Promed 6/5/05)

^top

Russia: Hepatitis A Outbreak Expanding in Tver Region
The continuing spread of hepatitis A in the Tver region has prompted urgent measures to decontaminate sewage waters near the Moskva River, Russian chief sanitarian Gennady Onishchenko said 9 Jun 2005. The city of Rzhev in the Tver region has been most affected. Epidemiologists have arranged additional control of catering services and trade services, the water supply and sewage systems. Workers in the catering sector will be vaccinated in Rzhev. Moscow's Central Institute of Epidemiology, St. Petersburg's Pasteur Institute of Epidemiology, and the Gabrichevsky Institute of Epidemiology have sent specialists to Rzhev. A decision has been made to clean the city to prevent contamination of the Moskva River and measures have been taken to treat sewage. The incidence of hepatitis A is growing in the southwestern Tver region, having reached 352 cases. 67 more people were hospitalized with symptoms of infection 8 Jun 2005. Outbreaks of hepatitis A have occurred throughout Russia recently due to breakdowns in sewage disposal facilities, contamination of general water supplies, and inadequacies in the provision of drinking water. Although improvements in social infrastructure are being given priority, anti-hepatitis A virus vaccination is advisable for all visitors to Russia. (Promed 6/9/05)

^top


Americas
Canada: Rare STD lymphogranuloma venereum confirmed
There have been 22 cases of lymphogranuloma venereum (LGV) reported in Canada in recent months, all in men who have sex with men with high-risk sexual practices, according to a report published 31 May 2005 (Kropp RY, Wong T: Emergence of lymphogranuloma venereum in Canada. Canad Med Assoc J 2005; 172:1674-76: http://www.cmaj.ca/cgi/rapidpdf/cmaj.050621v1). In fact, the way LGV is spreading--among men who have anonymous sex in bath houses (and encounters arranged via Internet)--is similar to the beginnings of the HIV-AIDS epidemic. Unlike HIV-AIDS, however, LGV, a bacterial infection, is easily treatable with antibiotics. But the symptoms--small painless lesions on the genitals and swollen glands--are probably not familiar to most doctors. What's more, an infection with LGV increases the risk of contracting and spreading HIV-AIDS and hepatitis. Dr. Thomas Wong of the Public Health Agency of Canada said the arrival of a new sexually transmitted disease (STD) reflects an upsurge in risky sexual behavior that stems from "safer-sex fatigue," the popularity of party drugs, and the increasingly common practice of anonymous sex. "LGV isn't the only sexually transmitted disease we're seeing. The number of cases of syphilis, gonorrhea, chlamydia are all increasing," he said.

LGV is a form of chlamydia, a common STD that can cause infertility in women. Left untreated, it can cause destructive swelling of the genitals and rectum and even lead to meningitis, encephalitis and death. The infection is common in the tropics, e.g. Africa, Asia, South America and the Caribbean. Until recently, it was virtually unknown in industrialized countries. That changed in 2003, when a cluster sprang up in the Netherlands among sex tourists. The disease then spread to Belgium, France, Germany, Sweden, Britain, and now the USA and Canada. Dr. Wong said the rapid spread reflects the increasing globalization of infectious diseases in an era of easy air travel and frequent trips for work and pleasure.

None of the men infected with LGV in Canada had traveled abroad recently, but all had the same strain of the disease that is circulating in the Netherlands. What distinguishes those who have been LGV-infected is that few of them could identify their recent sexual partners, and their propensity for high-risk sexual activity. Dr. Wong said the Public Health Agency of Canada is stepping up surveillance for LGV and will try to educate physicians to spot symptoms early. The US CDC has expressed similar concerns. It has warned men who have sex with men who practice unprotected sex to look out for symptoms of LGV. (Promed 6/1/05)

^top

Canada (British Columbia): H3 influenza virus found
The Canadian Food Inspection Agency (CFIA) has quarantined a turkey layer farm in Abbotsford, British Columbia based on preliminary results from the British Columbia Ministry of Agriculture, Food and Fisheries (BCMAFF) indicating the presence of the H3 influenza virus in the flock. The turkey farm is near a swine farm that recently experienced an H3 influenza infection, and the virus is suspected to have originated from swine. Transmission of this influenza strain between swine and turkeys has been documented previously. This low pathogenic H3 virus is a milder form of virus and has not been known to mutate into high pathogenic avian influenza as the H7N3 strain did in 2004 in the Fraser Valley. This is not related to the avian influenza outbreak in 2004, and all testing by BCMAAF to date is negative for the H5 or H7 strains. During the investigation, every biosecurity measure was implemented. (Promed 6/1/05)

^top

USA (Florida): Source of Cyclospora infection probably identified
Contaminated fresh basil is suspected as the most likely cause of an outbreak of the parasitic illness cyclospora, which has sickened 300 Floridians, state health officials said 3 Jun 2005. Officials don't know where the basil came from or where it is being sold, said state Health Secretary John O. Agwunobi. A spokesman for the Florida Health Department said the federal Food and Drug Administration has agreed to try to trace the product and find out where it came from. The disease can cause severe diarrhea and other painful symptoms. Cases have been reported in 32 Florida counties in all regions of the state going back to April 2005. Health officials say people should wash fresh produce to prevent food-borne illnesses. "As always, we're recommending to people that they wash their fruits and vegetables, and, while it may not eliminate cyclospora infection, it's just good common sense. Cyclospora is easily treated with antibiotics, and there have been no deaths from cyclospora," said the spokesman. (Promed 6/4/05)

^top

USA (South Carolina): Under cooked turkey most likely cause of salmonella outbreak
Laboratory analyses of turkey samples has identified Salmonella enterica serotype Enteritidis as the probable cause of the food borne outbreak in Camden, South Carolina, the SC Department of Health and Environmental Control said 3 Jun 2005. 20 specimens collected from ill patrons also have tested positive for the same bacterium, a bacteria that lives in the intestinal tracts of animals and birds and that is transmitted to humans by contaminated foods of animal origin. Salmonella can take up to 72 hours to cause such symptoms as nausea, vomiting, diarrhea and fever. "Results of the epidemiological investigation…found turkey to be significantly associated with illness," said Jerry Gibson, MD, state epidemiologist and director of DHEC's Bureau of Disease Control. "But smaller contributions of other food items cannot be ruled out, possibly due to cross-contamination during cooking or serving." To date, there have been 304 confirmed and suspected cases, with 56 hospital admissions for people reportedly exposed between 19 and 22 May 2005. Additionally, the Kershaw County coroner has attributed one death from the outbreak to sepsis related to salmonella infection. Deaths attributed to salmonella have been rare in South Carolina. DHEC reported just 2 deaths in the past 7 years.

DHEC's investigation of the outbreak in Camden associated with the Old South restaurant identified several factors that may have contributed to the large number of cases. In addition, an inspection of the facility did identify some equipment that was not functioning properly, which may have led to under cooking of products. The owners are in communication with DHEC environmental health personnel and are discussing training opportunities for the kitchen staff. The training will include ServSafe, a certification program developed by the National Restaurant Association, trains foodservice managers about general food safety principles and Hazard Analysis Critical Control Point (HACCP) concepts. (Promed 5/27/05, 5/30/05, 6/3/05)

^top

USA (Oregon): Drinking water found to be likely Camp Yamhill disease source
Contaminated water is the likely source of a disease outbreak at a Yamhill County camp that sickened more than 50 people, public health officials said 31 May 2005. The camp's water treatment system, which draws water from the North Yamhill River, may have been overwhelmed by surface water run-off caused by recent heavy rainfall, said Dr. Mel Kohn, state epidemiologist. Lab tests confirmed the water was contaminated not only with E. coli O157 but also Campylobacter, both of which cause diarrhea. No food items have been implicated. Campers at the Christian outdoor school camp were exposed 17 to 20 May 2005, and included 6 students and an adult chaperone from Eugene Christian School. The camp is planning to upgrade its drinking water treatment system. (Promed 6/2/05)

^top

USA (Arizona): 2 cases of 'rabbit fever' (tularemia) reported
A Coconino County adult and child were diagnosed with tularemia, also known as rabbit fever, in May 2005 after coming into contact with a skinned rabbit. The adult had skinned the rabbit and the child had contact with the tissues of the rabbit during skinning and dressing. They have both since recovered from the bacterial disease. Tularemia, also called deer fly fever, is a bacterial disease that infects rabbits and other mammals. It can be transmitted to humans by skinning and cleaning, usually of rabbits, or via deer fly and tick bites. Symptoms include a sore where exposed, swollen lymph nodes, fever, chills, headache, and nausea and usually occur from 1 to 14 days after exposure. Outdoor enthusiasts are advised to avoid swimming in or drinking untreated water from ponds that infected wild animals could use. Francisella tularensis, the bacterium that causes tularemia, is considered a category A bioterrorism agent. Large outbreaks, especially in Eastern Europe or Asia, can be associated with water exposure. (Promed 6/9/05)

^top

USA (Illinois): Second Case of Hantavirus Infection Confirmed
A man has been diagnosed with only the second known Illinois case of hantavirus pulmonary syndrome, a rare rodent-spread disease that also killed an Illinois man in 1996, state health officials said. The 22-year-old developed hantavirus pulmonary syndrome while working at a greenhouse, said Jennifer Williams, a spokeswoman for the state Department of Public Health. The man first experienced symptoms 1 May 2005, and was hospitalized shortly afterward with chest pain, difficulty breathing and bleeding from the nose, but has since been released. Rodent droppings where found in both the greenhouse and the infected man's home, but neither location had a severe infestation of mice. The CDC has confirmed that the man was infected with hantavirus. Officials warned the public to be cautious when cleaning areas infected with rodent droppings because hantavirus infection can be contracted from airborne dust.

Hantavirus pulmonary syndrome is a severe respiratory infection that can be deadly if it isn't treated quickly. Hantaviruses belong to a family of viruses named after a river in Korea, where the first strain infected 3000 U.S. soldiers during the Korean War, killing 190 of them. It is spread by rodent urine, feces or saliva, typically making people ill about 2 weeks after they breathe virus particles stirred up in a rodent-infested space. The illness usually starts like influenza, with symptoms including muscle aches and fever, then shortness of breath and coughing. Fewer than 400 Americans have been diagnosed with hantavirus infection since it was first identified in the US in 1993 in the Southwest. (Promed 5/27/05)

^top

Canada (Quebec): First Case of Hantavirus Pulmonary Syndrome in Province Confirmed
Health authorities are dealing with Quebec's first case of hantavirus infection. A man from Nicolet contracted the disease in a forest just north of Trois-Rivieres in 2004. Health Canada has confirmed that the man has hantavirus pulmonary syndrome. Hantavirus pulmonary syndrome is a viral disease carried by wild rodents, especially deer mice. They are the principal animal reservoirs of the virus in Canada. Humans can only be infected when they inhale the virus, usually through dust containing mouse feces. Quebec public health authorities considered this first case a serious matter, but said people could take simple precautions. People reopening their cottages should clean up well using a broom, not a vacuum, and wear gloves and a mask clearly marked NIOSH N95 or NIOSH N100, which are standards of the National Institute for Occupational Safety and Health. Additional information concerning hantaviruses, deer mice and hantavirus pulmonary syndrome in Canada can be accessed at the CBC website: http://www.cbc.ca/news/background/health/hantavirus.html and the Public Health Agency of Canada website: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/00vol26/dr2608ea.html. (Promed 5/27/05)

^top


1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies, 2 Jun 2005
In week 20, 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 20. Localized activity was reported in 2 provinces, while in the rest of Canada activity remained low.

Hong Kong.Influenza activity remained high in the previous 10 weeks, with large numbers of influenza viruses isolated each week, the majority of which were influenza A(H3N2). In week 20, a total of 411 influenza viruses were isolated.

Other reports. During week 20, low influenza activity was detected in Chile (A and B), Japan, Mexico (A), and the USA (H3, A and B). Australia reported no influenza activity. (WHO 5/27/05 http://www.who.int/csr/disease/influenza/update/en/)

^top

Cholera, diarrhea & dysentery
USA
Contaminated carrots served on several flights out of Honolulu likely caused 45 people to suffer food poisoning across 22 US states, Japan, Australia and American Samoa. The outbreak has sparked one lawsuit against airline caterer Gate Gourmet Inc., which included the carrots in meals served 22-24 Aug 2004. The company was sent a warning letter by the FDA 21 Apr 2005 citing violations found in a Feb 2005 inspection of its Honolulu facility. Gate Gourmet provides meals for Northwest, Delta, United, Hawaiian and Aloha airlines. The company, which has locations in 30 countries, says it responded quickly to the Apr 2005 letter and contends the investigation of the Aug 2004 illnesses has not been able to definitely identify the source of the contamination. While an investigation by the state Health Department and the FDA narrowed the likely source to carrots contained in salads served by Gate Gourmet, investigators don't know when, where or how the carrots were contaminated. According to the lawsuit, a man became ill with nausea, diarrhea, cramps, fever and tremors 3 days after a Northwest Airlines flight from Honolulu to Minneapolis. He tested positive for Shigella sonnei bacteria. (Promed 5/27/05)

^top

Dengue/DHF
Thailand
A 26-year-old woman is the country's latest fatal case of dengue haemorrhagic fever, only a week after the death of a 13-year-old boy, increasing the country's death toll to 16. In Thailand dengue has so far infected 10 390 people in 2005. Arun Taengsingtrong, director of Uthai Thani Hospital, said the patient was admitted to the intensive care unit; she had serious symptoms of dengue shock syndrome and died a day later. During 2004, 38 000 people contracted the mosquito-borne disease and 40 died, most in the 10-14 year age group. Dengue fever tends to strike urban areas because they have the highest concentrations of Aedes aegypti mosquitoes, which carry the virus. "Dengue fever this year has a tendency to be more severe than last year, possibly because of the cycle of the outbreaks, erupting every 2 years, is reaching its peak this year," Health Minister Suchai haroenrattanakul said.

The Thai government plans to launch a major campaign across the country to increase public awareness of dengue fever. The campaign against dengue fever will be launched 29 May 2005, said Dr. Suchai Charoenratanakul. The campaign will target schools, hospitals and households and encourage them to protect themselves by helping prevent an outbreak of dengue fever. The Thai public will be encouraged to use mosquito nets and mosquito traps, and destroy mosquito breeding grounds. Health officials and volunteers will act as "Mr. Dengue Fever" and visit targeted areas throughout the country, giving advice on dengue fever prevention. "There will be about 800 000 'Mr. Dengue fevers' to support the campaign," the minister said. The 10 provinces with the highest records of dengue fever cases are: Ranong, Surat Thani, Petchburi, Satun, Prachuap Khiri Khan, Trang and Nakhon Si Thammarat in the South; Rayong and Sa Kaew in the East; and Nakhon Nayok in the central region.

Also, Thailand's island resort of Phuket launched a concerted campaign 24 May 2005 to destroy Aedes aegypti mosquitoes, after a discovery of a 2-fold rise in the number of dengue cases since 2004. Led by Deputy Phuket Governor Suphachai Yuwaboon and the chief provincial public health official, the campaign kicked off with pleas to the public to help in the fight against the Aedes aegypti mosquito. Members of the public taking part in the launch held banners and stated their commitment to destroying mosquito larvae. According to Dr. Wanchai Satyawuthiphong, the province's chief public health official, there are currently 68 confirmed cases of dengue fever on the island, with another 340 patients waiting diagnosis. No one has yet died of the condition in Phuket. (Promed 6/2/05)

Indonesia
Dengue fever is still widespread in West Java, with 101 having succumbed to the illness by 16 May 2005. West Java Health Office head Yudi Prayudha said the latest data shows that 5515 people have suffered from dengue fever in 25 regions from Jan to May 2005. Despite the high number of victims, cases of dengue fever are still half the number reported in the same period 2004, when 177 people out of 17 200 sufferers died of the disease. Yudi, however, cautioned against complacency, saying not all regencies and municipalities had reported their fever cases to the health office. In the first 5 months of 2005, the most reported cases happened in February, with 2018 cases and 27 dead. In January, 41 people died of dengue fever out of a reported 1043 sufferers. In Jakarta, 7339 dengue hemorrhagic fever (DHF) cases and 40 deaths have been reported between Jan 2005 and 22 May 2005. A local newspaper quoted the Health Department as saying that the number of DHF cases would reach its peak in May and June, when climatic changes take place with intermittent rain. (Promed 5/29/05)

Philippines (Zambo)
Despite the city government's continuing anti-dengue campaign, the number of cases continues to increase, and health officials are alarmed that the number of dengue fever cases is already reaching "outbreak" proportions. City Health Officer Rodel Agbulos said 30 May 2005 that 289 dengue cases were registered in his office between Jan and 1 May 2005, up from 40 cases over the same period in 2004 (increase of 298 percent). He will re-activate the barangay dengue brigade to intensify the anti-dengue campaign. In June 2004, a total of 2332 dengue cases were admitted to sentinel hospitals nationwide from 1 Jan to 15 May 2004, with 16 deaths. The DOH National Epidemiology Center (NEC) reported a 58 percent decrease in the number of cases in 2005 compared with the same period in 2003. According to the NEC's mid-year report in 2004, the ages of cases ranged from one month to 75 years, with 46 percent (535) of the cases belonging to the 1-to-9-years age group. Dengue fever is an acute viral infection caused by a bite from the Aedes aegypti mosquito. The primary form of dengue fever is characterized by a skin rash and a high fever with severe headache and muscle pain. Other symptoms may include chills, diarrhea and vomiting. Bouts of extreme exhaustion may last for months after the initial symptoms. (Promed 6/2/05)

Australia
Health inspectors have discovered large numbers of dengue mosquitoes in the Currajong area. Staff from the Townsville and Thuringowa city councils are working closely with mosquito control experts from the Tropical Public Health Unit to conduct house-to-house inspections and mosquito eradication. 3 cases have been confirmed in Currajong and one in Kirwan. There are also 2 suspected cases in Kirwan and Railway Estate. Acting director of environmental health with Queensland's Tropical Public Health Unit Damien Farrington said it was vital that twin cities residents took immediate steps to prevent the outbreak from escalating. Mr. Farrington said that, to protect themselves, residents had to check their yard for mosquito breeding and use insect repellent. The serious form of the disease, dengue hemorrhagic fever, can be fatal. (Promed 5/29/05)

^top


2. Articles
Surveillance for Laboratory-Confirmed, Influenza-Associated Hospitalizations--Colorado, 2004--05 Influenza Season
“The number of annual hospitalizations for influenza and pneumonia associated with influenza viruses in the United States is estimated at 95,000; however, no state-based or national surveillance system exists to monitor these events in all age groups, and population-based numbers of laboratory-confirmed, influenza hospitalizations are unknown. Certain existing surveillance systems provide population-based national estimates of influenza-related hospitalizations based on sampling methodology (i.e., the National Hospital Discharge Survey) or sentinel surveillance; however, these systems are not timely, population-based for all ages, and available at the state level. The Emerging Infections Program (EIP) conducts population-based surveillance for laboratory-confirmed, influenza-related hospitalizations of persons aged <18 years in 11 metropolitan areas, and the New Vaccine Surveillance Network (NVSN) provides population-based estimates of laboratory-confirmed influenza hospitalization rates among children aged <5 years who were prospectively enrolled and tested for influenza in three sentinel counties. The U.S. Department of Health and Human Services recommends that states develop strategies to monitor influenza-related hospitalizations. This report describes a surveillance system for laboratory-confirmed, influenza-associated hospitalizations in all age groups in Colorado that was implemented for the 2004--05 influenza season. The findings indicate that implementation of statewide, population-based surveillance for influenza-associated hospitalizations is feasible and useful for assessing the age-specific burden of serious influenza-associated morbidity and the relative severity of influenza seasons…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5421a3.htm (MMWR June 3, 2005 / 54(21);535-537)

^top

Human Exposure to Mosquito-Control Pesticides--Mississippi, North Carolina, and Virginia, 2002 and 2003
“Public health officials weigh the risk for mosquito-borne diseases against the risk for human exposure to pesticides sprayed to control mosquitoes. Response to outbreaks of mosquito-borne diseases has focused on vector control through habitat reduction and application of pesticides that kill mosquito larvae. However, in certain situations, public health officials control adult mosquito populations by spraying ultra-low volume (ULV) (<3 fluid ounces per acre [oz/acre]) mosquito-control (MC) pesticides, such as naled, permethrin, and d-phenothrin. These ULV applications generate aerosols of fine droplets of pesticides that stay aloft and kill mosquitoes on contact while minimizing the risk for exposure to persons, wildlife, and the environment. This report summarizes the results of studies in Mississippi, North Carolina, and Virginia that assessed human exposure to ULV naled, permethrin, and d-phenothrin used in emergency, large-scale MC activities. The findings indicated ULV application in MC activities did not result in substantial pesticide exposure to humans; however, public health interventions should focus on the reduction of home and workplace exposure to pesticides…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5421a1.htm (MMWR June 3, 2005 / 54(21);529-532)

^top

Travel-Associated Dengue Infections--United States, 2001--2004
“Dengue is a mosquito-transmitted, acute viral disease caused by any of the four dengue virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4). Dengue is endemic in most tropical and subtropical areas of the world and has occurred in U.S. residents returning from travel to such areas. CDC maintains a laboratory-based passive surveillance system for travel-associated dengue among U.S. residents. The system relies on voluntary reports submitted to state health departments by clinicians; patient specimens are then forwarded to CDC for diagnostic testing. This report summarizes information about travel-associated dengue cases among U.S. residents during 2001--2004. The risk for dengue infection among travelers can be reduced by use of repellents and by avoiding exposure to mosquitoes…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5422a2.htm (MMWR June 10, 2005 / 54(22);556-558)

^top

Reporting of Chlamydial Infection--Massachusetts, January--June 2003
“Chlamydia trachomatis infection is the most commonly reported sexually transmitted disease (STD) in the United States. An estimated 2.8 million infections occur annually. In 2002, a total of 834,555 cases in the United States, including 10,914 cases in Massachusetts, were reported through the National Notifiable Disease Surveillance System (NNDSS). Chlamydial infection is most often reported in females, particularly those aged 15--24 years, reflecting a higher level of screening in females but also important risk factors. Although the majority of infections are asymptomatic, complications are potentially severe in women and include pelvic inflammatory disease, which can lead to tubal pregnancy, infertility, and chronic pelvic pain. Chlamydial infection during pregnancy can cause illness in the infant (e.g., conjunctivitis and pneumonia). Infection in men can manifest as urethritis and epididymitis. Timely, documented diagnosis and treatment of chlamydial infection are critical to prevent both complications and transmission. Since 1996, a progressive increase has occurred in the number of reported cases of chlamydial infection in Massachusetts, in part because of an increase in screening and use of more sensitive tests. This report summarizes an evaluation of chlamydial-infection reporting in Massachusetts during January--June 2003. The results underscore the need for improvement in both completeness and timeliness of reporting chlamydial infection in Massachusetts…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5422a3.htm (MMWR June 10, 2005 / 54(22);558-560)

^top

WHO/FAO to consult consumer associations on how to promote their involvement in food safety
In a new effort to broaden the technical advice it receives in advance of framing policy recommendations to its Member States, the WHO and the UN Food and Agriculture Organization (FAO) are inviting consumer associations from 25 countries to meet with them from 8-10 June 2005at WHO headquarters in Geneva. The meeting is organized in collaboration with Safe Food International, a project of the Center for Science in the Public Interest (CSPI), an international non-governmental organization that seeks to establish a common platform for consumer groups in advocating for stronger national food safety standards. Representatives of consumer associations will discuss how they can contribute to their countries' efforts to improve the quality and safety of food.

Sub-standard food is a potential danger to every human being on this earth and there are already an estimated two billion annual cases of foodborne illness. It is also the cause of frequent trade rejections with the resulting economic drawbacks. At the meeting, WHO and FAO will work with consumer groups to devise means of identifying and prioritizing the largest risks to human health in food. The aim is for consumer organizations to have the information they require to both communicate the most important food-related health concerns to their constituencies and advocate for improvements in the efficiency of food safety systems. Consumer groups from Armenia, Belgium, Benin, Bolivia, Brazil, Bulgaria, Cameroon, Canada, China, Estonia, India, Korea (Republic of), Lebanon, Malaysia, Nepal, New Zealand, Peru, Poland, Senegal, Seychelles, Uganda, UK, USA, Uruguay and Zimbabwe have been invited. (WHO http://www.who.int/mediacentre/news/notes/2005/np12/en/print.html)

^top


3. Notifications
International APEC conference on avian influenza, 22-23 Jun 2005
Taichung, Taiwan, National Chung Hsing University

The aim of this conference is to bring together leading national and international experts in both human and veterinary medicine to discuss the threat of an imminent influenza pandemic in humans from the current avian influenza in East Asia. We welcome registration from all interested parties. Registration is free of charge, except for accommodations, for all participants. The conference's main topics include:

- The Roles, Responsibilities and Activities of an International Reference Laboratory for Avian Influenza
- Application of Real Time RT-PCR to Detect Avian Influenza Virus
- Clinical Laboratory Diagnosis of Influenza Virus Infection in Human[s], Taiwan
- Vaccination and Control of Avian Influenza in Italy
- Surveillance and Genetic Analysis of Avian Influenza in Taiwan
- Avian Influenza in Thailand
- The Swine Influenza in Taiwan
- Control of Avian Influenza in Hong Kong
- Characterization of Monoclonal Antibody against HA Protein of H5 and H7 Subtypes of Avian Influenza Virus and its Application to Rapid Detection of H5- and H7-Specific Antibody by Blocking ELISA
- Control of Avian Influenza in Australia
- AI control in Indonesia: Charoen Pokphand Indonesia experience in genetic analysis and control of AI
- Surveillance and Genetic Analysis of Human Influenza in Taiwan (1996-2005)

For further information on the program, speakers, venue, registration details and instruction on submission of posters, visit the conference website at: <http:// www.vm.nchu.edu.tw/avian_influ.htm> (in Chinese) or contact directly by e-mail: Dr. David Suarez, USDA-ARS, Southeast Poultry Research Laboratory, USA. dsuarez@seprl.usda.gov or Dr. Happy K. Shieh, D.V.M., Ph.D. hkshieh@dragon.nchu.edu.tw (Promed 6/1/05)

^top

Gordon Conference on New Antibacterial Discovery & Development
Location: Ventura, California, USA
Dates: 5-10 Mar 2006

This Gordon Research Conference will bring together industry, academic and government leaders involved in the discovery and development of novel antibacterial agents. Antibacterial resistance has spread globally at an alarming rate, continues to increase, and presents a tremendous global health challenge. Multi-drug resistance has become commonplace in many disease-causing bacteria. Infections that were once easy to treat are becoming difficult, and in some cases, impossible to treat, and people are suffering severe illness or dying as a consequence. There is an acute need for novel antibacterials to combat this growing resistance.

Antibacterials are unique compared to most other classes of drugs due to the fact that resistance eventually renders these agents less efficacious with continued use. New, effective antibacterial agents and therapies will be needed on a continuing basis. Unfortunately, this new generation of antibacterials has proven extremely difficult to discover and develop. The pipeline of new antibacterials is drying up, industry has been exiting the field, and regulatory issues have made it harder and more expensive to get approvals. Future progress in the discovery and development of efficacious antibacterials will require the intense collaboration of researchers from many disciplines in academia, and the biotech and pharmaceutical industries, as well as the involvement of policy makers and regulators. This Conference will focus on the problems that stand in the way of successful sustained antibacterial discovery and development as well as the innovation necessary to deliver these much needed new drugs to patients.

For more information, contact: Dr. Trevor Trust, Infection Discovery, AstraZeneca R & D
Boston, 35 Gatehouse Drive, Waltham, MA, 02451, USA.
Tel: +1781 839 4502; Fax: +1781 839 4690; trevor.trust@astrazeneca.com
http://www.grc.org (Promed 6/1/05)

^top

New Edition of "Health Information for International Travel"
CDC announces the availability of the 2005--2006 edition of "Health Information for International Travel" (i.e., the Yellow Book). This edition, which has been completely revised, updated, and reorganized, now includes references listed at the end of each section. New sections have been added on air travel, norovirus infection, SARS, and legionellosis. Copies can be ordered through: http://www.cdc.gov/travel. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5421a8.htm (MMWR June 3, 2005 / 54(21);540)

^top

Launch of BMC Veterinary Research
BMC Veterinary Research has been launched in response to many requests that BioMed Central create an open access journal within which to publish veterinary articles. This will allow free and universal access via the Internet to the latest results in important areas concerning animal health and welfare. The journal is supported by an international editorial board composed of leaders in the field. BMC Veterinary Research will consider original research articles in all aspects of veterinary science and medicine, including the epidemiology, diagnosis, prevention and treatment of medical conditions of domestic, companion, farm and wild animals, as well as the biomedical processes that underlie their health. The BMC Veterinary Research website is live, and the journal is now accepting submissions at <http://www.biomedcentral.com/bmcvetres>. (Promed 6/3/05)

^top

Nationwide Recall of Pet Treats Due to Salmonella Contamination
T.W. Enterprises of Ferndale, Wash. alerted consumers that it is recalling certain dog and cat treats it markets because they may be contaminated with Salmonella Thompson. People handling these treats can become infected with Salmonella Thompson, especially if they have not thoroughly washed their hands after having contact with any the treats or any surfaces exposed to these products. Salmonella Thompson can cause serious infections in small children, frail or elderly people, and others with weakened immune systems. Healthy people may only suffer short-term symptoms, such as high fever, severe headache, vomiting, nausea, abdominal pain, and diarrhea.

T.W. Enterprises Inc. manufactured these pet treats and distributed them throughout the US under its name and the Aron Pet Food name. Aron Pet Food of British Columbia imported raw materials from T.W. Enterprises into Canada for use in products that were sold there under the Aron Pet Food label. That firm is also conducting a recall of these products. FDA, the Washington State Department of Agriculture and the Public Health Agency of Canada became aware of the problem after 5 cases (3 in Canada and 2 in the US) of Salmonella Thompson infection developed among people who may have handled these pet treats. Follow up analysis indicated that the illnesses were linked to these pet treats. Consumers who have these pet treats should not feed them to their pets, but should instead dispose of them in a safe manner. Anyone who is experiencing the symptoms of Salmonella Thompson infection after having handled one of these pet products should seek medical attention, and report their use of the product and illness to the nearest FDA office. People should thoroughly wash their hands after handling any pet treat. (FDA 6/8/05 http://www.fda.gov/oc/po/firmrecalls/tw06_05.html)

^top


4. APEC EINet activities
EINet article on Seattle Times' Editorials/Opinion section
APEC-EINet’s Drs. Ann Marie Kimball and Louis Fox recently wrote an article for the Seattle Times: “Infectious-disease network needs money to keep microbes at bay”. This special column is on the Editorials/Opinion section, and we invite you to read the article: http://seattletimes.nwsource.com/html/opinion/2002319477_kimball07.html. (note:, the statement, "Fifty-three human cases, with 21 deaths, have occurred to date" refers only to the third wave of clusters that occurred since mid December 2004.)

^top


5. To Receive EINet Newsbriefs
APEC EINet email list
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/.

^top

 apecein@u.washington.edu