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Vol. VIII, No. 14 ~ EINet News Briefs ~ Jul 08, 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 health agencies have plan to fight avian flu
- South East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
- East Asia: Current level of pandemic alert remains unchanged
- Viet Nam: Culls more bird flu-infected poultry; nationwide poultry vaccination
- China: Avian influenza in wild waterfowl has run its course; recommendations
- Japan (Ibaraki): H5N2 avian flu outbreak may have been more extensive
- North Korea: Declares its H7 bird flu outbreak over
- Cambodia: Flu Outbreak Kills 2 Infants
- Viet Nam: Japanese encephalitis spreads in northern Viet Nam
- China: No epidemic encephalitis outbreak in Gansu
- China: Company's Hepatitis A vaccine banned
- China (Jilin): More than 200 Students Hospitalized with Suspected Influenza
- China: Plague in Tibet brought under control
- Indonesia: Rabies spreads in Jambi
- Indonesia: Poliomyelitis update
- China: Research into genes causing fatal outcome of Schistosoma infection
- South Korea: Outbreak of rare bacterial infection (Arcanobacterium haemolyticum)
- Russia (Komi): Outbreak of botulism
- Russia (Buryatiya): Trichinellosis, from bear meat
- Canada: Exceeds BSE Testing Target for 2005
- USA: USDA announces new BSE testing protocol; diseased animal from Texas
- USA: Years away from mad cow trace-back system
- USA (Idaho): Health officials say syphilis outbreak worsening
- USA (Texas): Texas Man Mysteriously Gets Q fever
- USA (multi-state): Cold Stone ice cream linked to salmonella
- USA (New York): Listeriosis outbreak in Syracuse area
- Cholera, diarrhea & dysentery
- West Nile Virus
- Avian flu: H5N1 virus outbreak in migratory waterfowl, H. Chen et al.
- Human Tuberculosis Caused by Mycobacterium bovis--New York City, 2001--2004
- Wildlife Trade and Global Disease Emergence
- Conference of the Southern African Society for Veterinary Epidemiology and Preventive Medicine
- Beginning and Intermediate/Advanced Courses in Epi Info
- Epidemiology in Action Course
- Satellite Broadcast on Immunization Update 2005
4. APEC EINet activities
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Global health agencies have plan to fight avian flu
International health organizations have come up with a plan to control H5N1 avian influenza within a decade. The strategy was drawn up at a conference in Malaysia, attended by experts from Asia, and by senior representatives of the UN Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE) and the WHO. The plan will be the basis for urgent actions by affected states and will be made available to the international community to help donors focus on the areas of highest need. The plan calls for spending USD 102 million to fight the disease in animals over the next 3 years. Joseph Domenech, the FAO's chief veterinary officer, said donor countries have pledged less than USD 30 million so far for containing avian flu over the next 3 years. He said the EU has pledged another 50 million euros for 2007-2011. H5N1 has so far infected 108 people in Asia, killing 54 of them, and has also led to the slaughter of over 140 million chickens.
Delegates concluded that priority should be given to the situation in small-scale and backyard farms, the scene of the majority of human cases. Recommendations included:
1. To educate farmers and their families about the dangers of high-risk behaviour and how to change their farming practices.
2. To ensure the segregation of different species, including chickens, ducks and pigs, and to eliminate intermingling between these animals and humans.
3. To provide adequate compensation and/or rewards for farmers to encourage them to report suspected avian influenza outbreaks in their flocks and to apply control measures.
4. To pursue the vaccination of poultry flocks as part of a multi-element response to the avian influenza threat in high-risk areas.
Another area of concern is wet markets, where animals are often slaughtered in unsanitary conditions. These activities constitute a high risk to people and increase the danger of an interspecies transmission of avian viruses, with the risk of the emergence of a new virus that could endanger human health. Under the plan, initial efforts would focus on Southeast Asia, East Asia, and South Asia, but efforts in the rest of Asia and in Africa, Europe, and America would begin Oct 2005.
Experts say vaccinating poultry for avian flu viruses can sometimes backfire by turning birds into asymptomatic carriers. The FAO said, however, "in some countries or part of countries, such as in Viet Nam, where the virus is widely spread, massive vaccination could be the only way to reduce infection in poultry to protect humans." Dr Dewan Sibartie, Deputy Head of the Scientific and Technical Department of OIE, said: ''The acceptance of vaccination by WHO and the international scientific community as an important additional tool in the control of the disease in animals is particularly welcome, provided that the vaccine used complies with OIE standards and that vaccination is carried out under the supervision of OIE and veterinary services.'' Also, Domenech called on China to be more open about its efforts to control avian flu and urged the country to curb the use of human antiviral drugs in poultry.
The conference agreed that implementing the recommended measures would be beyond the financial means of most of the affected countries and called on the international community to help with funding. ''What this action plan will cost is nothing compared with the financial and economic consequences of an influenza pandemic,'' said Dr Sibartie. An FAO and OIE strategy for the control of avian influenza in Asia will cost around USD 100 million to support surveillance, diagnosis and other control measures, including vaccination. WHO estimates the cost of an effective response on the public health front at USD 150 million, mainly for capacity building in affected countries, including emergency support in the areas of laboratory diagnosis, vaccine development, surveillance and public education.
South East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
Cumulative number of confirmed human cases of avian influenza A/(H5N1), 16 Dec 2004 to present:
Economy / Unofficial (Official) Cases / Unofficial (Official) Deaths
Indonesia / 1 (0) / 0 (0)
Cambodia / 4 (4) / 4 (4)
Thailand / 0 (0) / 0 (0)
Viet Nam / 64 (60) / 19 (18)
Total / 69 (64) / 23 (22)
Cumulative number of confirmed human cases of avian influenza A/(H5N1), 3 Dec 2003 to present:
113 (108) / 55 (54)
East Asia: Current level of pandemic alert remains unchanged
At the request of the Ministry of Health, WHO sent a team of international experts to Viet Nam to assess data on recent cases and determine whether the present level of pandemic alert should be increased. Team members came from Australia, Canada, Hong Kong, Japan, the UK, and the US having extensive experience in the testing of avian influenza viruses in human clinical specimens. The team found no laboratory evidence suggesting that human infections are occurring with greater frequency or that the virus is spreading readily among humans. The current level of pandemic alert, which has been in effect since Jan 2004, remains unchanged. The experts were asked to search for evidence that could substantiate concerns raised at a WHO consultation of experts held May 2005. That consultation considered suggestive findings, largely based on epidemiological observations, that the H5N1 virus had changed its behavior in ways consistent with an improved, though not yet efficient, ability to spread directly from one human to another. The observations considered included milder disease across a broader age spectrum and a growing number of clusters of cases, closely related in time and place. More recently, testing of clinical specimens by international experts working in Viet Nam provided further suggestive evidence of more widespread infection with the virus, raising the possibility of community-acquired infection. These findings have not been confirmed by the team. Firm evidence of improved transmissibility would be grounds for moving to a higher level of pandemic alert. Because of the huge consequences of such a change, WHO is following a cautious approach that combines heightened vigilance for new cases with immediate international verification of any suggestive findings.
While these first results are reassuring, further retesting of clinical specimens will continue to provide the most reliable possible foundation for risk assessment. On one hand there is a collective sigh of relief that the predicted pandemic of influenza due to H5N1 is not felt to be as imminent as earlier prediction were citing. On the other hand there is the caution that a pandemic is long overdue, and the H5N1 may still be the candidate virus for this, just not in the very imminent future. That being said, it is clear that prediction of where, when and what will be the next influenza pandemic is still speculative and some might feel, hazardous (remembering the predictions of swine flu in 1976 as the next pandemic strain). The team recommended that Viet Nam increase its surveillance of the virus in both animals and humans, and advised the Vietnamese to share samples from future suspected cases with a WHO reference laboratory outside Vietnam for independent confirmation. Good disease surveillance including laboratory support is still of primary importance, coupled with the capacity to respond with new vaccine production and antivirals to which the pandemic strain will be susceptible.
(Promed, WHO 6/30/05)
Viet Nam: Culls more bird flu-infected poultry; nationwide poultry vaccination
Over 7000 ducks infected with bird flu viruses in Viet Nam's Quang Tri province were culled, according to the Viet Nam News Agency, 6 Jul 2005. The country decided to cull all infected waterfowl raised on a large scale, and to isolate areas having sick poultry bred on a small scale, in order to prevent bird flu from spreading, since some 10 million out of 40 million waterfowl in the country, mainly ducks, face a high risk of being infected with bird flu. The Health Ministry has also called on a campaign to raise public awareness and clean up the environment between now and December to combat the poultry virus.
Also, vaccinations will begin 1 Aug 2005 at commercial poultry operations and smaller household farms in northern Nam Dinh province and southern Tien Giang province in the Mekong Delta, said Bui Quang Anh, head of Vietnam's animal health department. Vaccinations will be expanded to another 40 high-risk provinces in the next 2 years. An initial 20 million doses of vaccines will be imported from the Netherlands and China. Since late 2003, bird flu has killed or forced the slaughter of more than 45 million birds in Viet Nam. The 2-year poultry vaccination program will cost 35 million USD, said To Long Thanh, with Vietnam's Department of Animal Health. The government will subsidize 29 million USD and the rest will come from fees charged to large commercial operators. Household farmers will get their chickens vaccinated for free, he said. If the plan outlined above is realised, Viet Nam will become Asia's third country which officially applies vaccination against HPAI, following China and Indonesia.
(Promed 7/6/05, 6/30/05)
China: Avian influenza in wild waterfowl has run its course; recommendations
The Chinese Ministry of Agriculture said 1 Jul 2005 that the bird flu outbreak in Qinghai Province has been "brought under control". Jia Youling, the director general of the ministry's Veterinary Bureau, said the number of migrant birds killed by the disease has dropped to about 20 a day since 8 Jun 2005. Thus far, more than 6000 migratory birds have died since the disease was reported 4 May 2005. Jia said the ministry has reported the latest developments to relevant international organizations.
The central government has agreed to test more species of migratory birds for avian flu in Qinghai Province. Samples of 12 dead birds have been sent to the national laboratory for testing. The local government has culled domestic birds and vaccinated all poultry, 2-3 million in the province, and closed all live poultry markets. The public has been forbidden to get within 6 miles of the site. China has not carried out a cull of the birds because they are rare and protected species. The WHO is alarmed that the more the virus spreads, the greater the chances it could combine with the human flu virus and trigger a flu pandemic. Each summer, 189 species of birds flock to Qinghai Lake, a mating ground for migratory birds, before heading south and west. Qinghai Lake has become a popular tourist attraction. So far, Chinese authorities have tested only 12 dead birds and 2 people, with the people coming up negative. The biggest danger could be from infected birds that show no symptoms. The birds might spread avian flu when they fly south this summer, the WHO warned. The investigation conducted by the WHO-FAO team was accompanied by the Chinese Ministry of Health, Ministry of Agriculture and the State Forestry Administration.
Some of the recommendations made by the team are:
• For birds: Testing as many species as possible; Tagging and tracking for early warning; Testing "resident" species; Environmental sampling and decontamination.
• For domestic animals: Protection from wild birds; testing of horses and pigs
• For humans: All samples should be sent to Beijing for more advanced tests.
(Promed 6/28/05, 6/29/05, 7/2/05)
Japan (Ibaraki): H5N2 avian flu outbreak may have been more extensive
Japanese agricultural officials said 28 Jun 2005 they suspect that cases of avian flu at a farm in northeastern Japan may have been part of a larger outbreak that has since receded. The Agriculture Ministry said that some of the more than 800 chickens that died since Apr 2005 at a farm in Mitsukaido City, Ibaraki prefecture had been infected with the H5N2 strain of avian flu, considered less dangerous than the H5N1 strain. Lab tests found that chickens at the 5 farms closest to the infected farm had developed antibodies to the virus in their blood, ministry official Hiroaki Ogura said. Blood tests were conducted on chickens at all 16 farms within a 5km radius of the farm with the outbreak, which are banned from shipping any birds or eggs until officials can confirm there are no further infections. Chickens at the remaining 11 farms tested negative, Ogura said. The blood tests indicated that some chickens at nearby farms were exposed to avian flu but survived, Ogura said. The tested birds no longer had the virus, he said, indicating that the outbreak could have been more widespread at one point but later receded. With no virus found at the other farms, officials believe there is no need for culling at the 5 farms where birds have avian flu antibodies. The H5N2 strain has not been known to infect humans. The US CDC have said the risk of human infection from H5N2 is likely to be low. Examinations of workers at farms in the affected area showed no signs of human infection, Ogura said.
North Korea: Declares its H7 bird flu outbreak over
North Korea has confirmed that a bird flu outbreak that began Feb 2005 had been stamped out, 3 months after a UN body declared the outbreak over. The culling of 218 000 chickens and vaccination of 1.1 million poultry had ended the outbreak, a director of the North's Central Anti-Epizootic Centre said. International organisations and South Korean agricultural agencies provided medicine and technical expertise to help contain the outbreak. The UN's Food and Agriculture Organisation (FAO) said in April that North Korea had contained the outbreak and that the bird flu outbreak in North Korea was caused by an H7 strain, which causes severe disease in chickens but is not directly related to the H5N1 strain.
Cambodia: Flu Outbreak Kills 2 Infants
A flu outbreak has hospitalized more than 1000 children in the Cambodian capital, killing 2 babies. The victims were boys aged 9 months and 14 months, Dr. Kdan Yuvatha, chief of the technical department at the state National Pediatric Hospital, said. Both died from severe lung infections. The etiological agent responsible for the deaths could not be determined as samples were not collected. Influenza types A or B viruses cause epidemics annually around the world. Influenza B is the less common of the 2 types, but the symptoms are the same. The outbreak has strained a grossly inadequate health care system that serves a population in which about 40 percent survive below the poverty line. Flu vaccines are rarely given. Influenza B is currently also circulating in New Zealand, where 3 young people have died in 2005.
In mid-June 2005, clinicians from 2 pediatric hospitals in Phnom Penh raised the alert that they were observing an increase in the number of outpatients and admissions with ARI. Preliminary results suggest the outbreak of ARI began in the second week of June in the major urban areas of Cambodia. Data from the National Paediatric Hospital indicates that there had been a gradual increase in ARI outpatient consultations since early May but there was a peak in the week beginning 5 Jun 2005 and the number of cases are currently returning to baseline. Admissions also peaked in the week beginning 5 Jun 2005, but remained at this level for 2 weeks before starting to decline to baseline. Since the outbreak began 5 Jun 2005, nearly 90 percent of outpatients and all admissions have been in children under age 5. A total of 43 samples have been collected from pediatric hospitals in Phnom Penh and Siem Reap and 27 have already been completely tested at Pasteur Institute. Of the samples processed, 13 have tested positive for influenza B. In Siem Reap and Phnom Penh, several co-infections of influenza B and RSV have been found as well as isolated infection with RSV.
(Promed 7/3/05, 7/5/05)
Viet Nam: Japanese encephalitis spreads in northern Viet Nam
The number of children in Viet Nam's northern region hospitalized for Japanese encephalitis has increased by 20 to 30 per cent compared with 2004’s same period, reported Hanoi's Central Hospital of Pediatrics 19 Jun 2005. The number of infected cases has risen to 200 patients since the start of May 2005, said the hospital. More than 10 children are hospitalized a day on average. About 80 per cent of the total admitted cases are for type-B Japanese encephalitis, said the hospital. Children under 5 are usually most vulnerable to the virus, but the hospital said it still received a number of older children. Symptoms include sudden fevers, headaches, vomiting and unconsciousness. The provinces with the highest infection rate have all been supplied with vaccines, according to the Ministry of Health.
China: No epidemic encephalitis outbreak in Gansu
The recent encephalitis outbreak among children in Tianshui, Gansu Province, was neither epidemic encephalitis nor encephalitis B [Japanese encephalitis], but a sort of viral encephalitis, according to Wang Jian, director of the city's disease control and prevention center. Wang said from 4 Mar to 23 Jun 2005, 2 hospitals in Tianshui received 153 ill children aged between 1 and 13 with fevers and headaches. 53 boys and 30 girls were diagnosed as having viral encephalitis. Of the remaining 70 cases, 23 were suspected and 47 were ruled out as having encephalitis. Currently, there are still 42 children under observation and medical treatment, of whom 13 have been diagnosed as having viral encephalitis. Earlier reports suggested the encephalitis breakout had something to do with an encephalitis B vaccine injection in some kindergartens in Tianshui. The cause of the breakout remains unknown, and samples have been sent to the China Disease Control and Prevention Center for virus separation.
China: Company's Hepatitis A vaccine banned
The State Food and Drug Administration has banned the use and sale of a Hepatitis A vaccine produced by a company that has been linked to the death of a student and more than 300 ill pupils. The administration will also check other vaccines across the country. Health Minister Gao Qiang said that the accident could be the result of psychosomatic factors, however. Because the students received the vaccine together and talked about it afterwards, they may have brought on the ill effects themselves. The vaccines have been sent to Beijing for further testing. Medical experts with the China Centre for Disease Control and Prevention said they believed the illness had no direct link with the vaccines. Mao Jiangsen, president of Pukang Biotechnology Co, the firm at the centre of the row, argued the vaccine would not lead to the symptoms displayed by the pupils. Mao also answered claims that the incident was caused by the method of transporting of the vaccine, which was not shipped in a refrigerated truck. "Even if they were not cool, the vaccines would lose its effectiveness, but would not kill people," Mao added. The incident happened when 2444 students aged between 3 and 16 in Sixian County, Anhui Province received vaccines 16 - 17 Jun 2005. Among those vaccinated was a 6-year-old girl who died 23 Jun 2005. A post-mortem examination showed that she suffered from respiratory failure and serious infection. The local government has agreed to pay the girl's family 190 000 yuan (USD 10 840) in compensation.
(Promed 6/26/05, 6/30/05)
China (Jilin): More than 200 Students Hospitalized with Suspected Influenza
Since 29 Jun 2005 onwards, some students of the Tenth Middle School in Taonan (Jilin Province) came down with fever and sore throat. By 1 Jul 2005, a total of 223 students had these symptoms. 207 students were admitted to hospital for treatment. The Provincial Health Bureau rushed epidemiologists and specialists in infectious disease, respiratory, nervous and digestive disorders to conduct investigations. The illness was diagnosed as influenza. At present, ill students are in Taonan Municipal Hospital, Shizhong Hospital, and Shibaojian Hospital. After receiving treatment for symptoms, the temperature of 171 students has returned to normal and symptoms have resolved. They remain hospitalized in isolation for observation. The cause of the students' illness has not been determined. Most of the affected pupils are first and second year boarding students. The school started school-wide vacation 30 Jun 2005 and has established a "School Guard Team". The abruptness of onset, the predominance of sore throats, and the rapid resolution of symptoms do not suggest influenza.
China: Plague in Tibet brought under control
The plague in Zhongba, a county in Xigaze Prefecture of China's Tibet Autonomous Region, has been brought under control, the Chinese Ministry of Health said. 2 people died of plague, and 3 others were hospitalized. The 5 migrant road workers became ill after eating marmot 11 Jun 2005 in Zhongba County. Doctors treated the 5 workers for an unspecified form of plague. Health officials quarantined 75 people who had contact with the infected workers, but none showed plague-like symptoms. Police were also trying to trace a woman who had contact with the infected people but crossed the border into Nepal 21 Jun 2005. The health ministry reported the infections to WHO and Nepal 25 Jun 2005. The ministry asked the epidemic areas to beef up publicity about prevention and to urge local people to report suspect cases to health departments as soon as possible. Smaller outbreaks of bubonic plague are frequently reported in remote areas of north western China and Mongolia. In 2004, plague outbreaks linked to marmot hunting killed 8 and infected at least 11 others in Qinghai province.
Indonesia: Rabies spreads in Jambi
Dozens of residents have contracted rabies in Marosebo District, Muarojambi Regency, over the past month, resulting in one death. Most of the victims have been elementary school students between the ages of 7 and 12. Of the 14 people infected with the virus, 7 lived in the Tanjungkatung subdistrict and the rest lived in the neighboring Setiris subdistrict. Some of the victims were treated at the hospital, while others sought treatment at community health centers. The Regency health office has said it will kill wild dogs in the area to stop the spread of the virus.
Indonesia: Poliomyelitis update
22 new polio cases were confirmed in Indonesia, bringing the total number of cases to 122. The new cases are from West Java province. Recently confirmed cases in Sumatra and Central Java occurred outside the area where two emergency vaccination campaigns were held 31 May and 29 June 2005. A large outbreak response immunization targeting 78,000 children aged less than 5 years was held from 26 June around the case in Central Java. Sumatra and Central Java will be included in the next phase of the large-scale immunization campaigns, which will start August 2005.
(WHO http://www.who.int/csr/don/2005_07_08/en/index.html 7/8/05)
China: Research into genes causing fatal outcome of Schistosoma infection
China expects to decode in 5 years a snail-fever-susceptibility gene that may help to improve diagnosis and prevent the disease--which currently plagues 843 000 Chinese--from developing into the final stage. "The gene will help doctors find out who, of all the snail fever sufferers, will end up [being] a terminal patient," said Dr. Li Yuesheng, director of the Hunan Institute of Parasitic Diseases. Among the sick, only about 1.8 to 3 percent will reach the final stage, which is characterized by a protuberant belly filled with a build-up of fluid in the abdomen. Dr. Li has just won an international research scholar award for infectious diseases and parasitology at the U.S. Howard Hughes Medical Institute and will be getting USD 422 900 in research grants in the coming 5 years. Snail fever, or schistosomiasis, is a parasitic disease that slowly eats away at the liver, intestines and spleen. It is second only to malaria in the number of cases it causes. WHO estimates that 200 million people worldwide are infected and that 120 million display symptoms, while another 600 million people are at risk of infection. In central China and particularly in Hunan--home to 66 million people--snail fever poses a major health risk, said Dr. Li. According to the provincial health department, Hunan makes up almost 25 percent of China's total infections. The disease also plagues Hubei, Jiangxi, Anhui, Jiangsu, Sichuan and Yunnan provinces. It has been estimated that 65 million Chinese live in areas with risk of Schistosoma infections.
South Korea: Outbreak of rare bacterial infection (Arcanobacterium haemolyticum)
According to the Korea Center for Disease Control and Prevention (KCDC), a total of 142 school students in the city of Guri were infected with Arcanobacterium haemolyticum starting 20 May 2005. The non-lethal pathogen can cause tonsillitis, chronic skin ulcers and other illnesses and is known to affect animals as well as humans. "The infection of 142 students was discovered when the KCDC was conducting epidemiological tests on 10 patients at a Guri hospital suffering from unknown causes," said an official. The KCDC said that it has confirmed the infection by A. haemolyticum from samples taken from 8 patients. It is the first reported case of a mass infection by the bacteria in South Korea.
A. haemolyticum is resistant to antibiotics, the center said. Health authorities have said the bacteria could be dangerous to the immuno-compromised. Most students reported symptoms similar to those associated with scarlet fever, including fevers and rashes. In severe cases, students' blood pressure dropped, and doctors say their livers could have been damaged. "Of the patients, 90.8 percent are students at the same school in Guri," said Park Gi-dong, director general of the center. The disease is thought to have spread through dormitories and classrooms where the students spend time together. A. haemolyticum was first described in 1946 as the pathogenic agent causing pharyngitis and cutaneous infections among US servicemen and indigenous peoples of the South Pacific in 1946. The spectrum of diseases caused by A. haemolyticum has been expanded to include invasive infections. Epidemiologically, A. haemolyticum is likely spread through an unknown route by human contact with people who are infected.
Russia (Komi): Outbreak of botulism
5 people were hospitalized with botulism in Komi. The cause of the intoxication was consumption of domestically prepared canned food. The cases were reported in Uhta city. The food was consumed by a family and family friends. After the food was consumed, 5 people became ill and sought care. Physicians quickly recognized the infection and injected serum [presumably antitoxin]. They are in stable condition.
Russia (Buryatiya): Trichinellosis, from bear meat
12 inhabitants of the Severobajkalskiy district of the Republic of Buryatiya, including 7 children, have contracted trichinellosis. The patients had all eaten meat from a bear, which had not been properly cooked, stated the territorial management of the Russian consumer supervision of the Republic of Buryatiya. Children and relatives of one hunter have been infected and are now hospitalized in the infectious branch of the Severobajkalsk station hospital. The bear was killed without the hunter having obtained a hunting licence and was not submitted for veterinary inspection. Bear meat is a classical source of Trichinella, and the infection could have been prevented by thoroughly cooking the meat.
Canada: Exceeds BSE Testing Target for 2005
Canada has surpassed its testing target established for 2005 for bovine spongiform encephalopathy (BSE) surveillance. The target for this year was 30 000 cattle and, as of 17 Jun 2005, there have been 32 363 samples tested through the provincial and federal laboratory network. The level and design of BSE testing in Canada is in full accordance with the guidelines recommended by the World Organisation for Animal Health (OIE). The evidence continues to demonstrate that the prevalence of BSE in Canada is extremely low and continuing to decline. In 2004, a BSE Surveillance Reimbursement Program was implemented that provides payments to producers for their services when eligible samples are submitted to the national program. These payments assist producers in covering a portion of the veterinary examination fees and carcass disposal costs. Many provinces have also demonstrated their commitment by providing additional support to the reimbursement program through increased laboratory capacity, education and awareness campaigns, sampling assistance and financial supplements to the federal payments. This collective effort is critical to a successful national surveillance program and to the continued demonstration of vigilance in animal and public health and food safety in Canada. The target was designed to detect one diseased animal out of one million healthy animals, making its surveillance program equivalent to that of the US. The agency will continue to test as many samples as it receives from veterinarians and farmers.
Canada had a record 15.8 million cattle as of 1 Apr 2005, Statistics Canada data shows. The herd has grown by more than 15 per cent since Canada found its first BSE case because of trade bans on live animal shipments. Canada relied on exporting about 1 million head of live cattle per year to US slaughter plants before the bans, and does not have enough capacity to slaughter all the livestock it produces.
(Promed 6/26/05, 6/28/05)
USA: USDA announces new BSE testing protocol; diseased animal from Texas
Substantial changes in the nation's mad cow testing system were ordered after British tests on a cow slaughtered Nov 2004 confirmed that it had the disease even though the American "gold standard" test said it did not. Agriculture Secretary Mike Johanns directed USDA scientists to work with international experts to develop a new protocol that includes performing dual confirmatory tests in the event of another "inconclusive" screening test. "We are currently testing nearly 1000 animals per day as part of our
BSE enhanced surveillance program, more than 388 000 total tests, and this is the first confirmed case resulting from our surveillance," Johanns said.
Effective immediately, if another BSE rapid screening test results in inconclusive findings, USDA will run both an IHC and Western blot confirmatory test. If results from either confirmatory test are positive, the sample will be considered positive for BSE. The Agriculture Department has been using a rapid test called an ELISA (enzyme-linked immunosorbent assay) and confirmed any positives with a slower immunohistochemistry test, which it calls the "gold standard." The Europeans and the Japanese use those tests, but routinely add a confirmatory western blot test, which is more sensitive. Johanns described several errors in the testing process in the US: (1) The brain samples were frozen, which makes some tests harder. (2) Parts from 5 carcasses were temporarily mixed up. (3) No written records were kept. But he also defended the safety of American beef, stating that the animal had been incinerated rather than being ground into hamburger, as the first one was in late 2003. Interestingly, the animal's disease strain did not closely resemble the British-style strain found in the first mad cow, which was born in Canada and raised in Washington State. Instead, it was closer to a strain found in France.
The USDA stated that the cow that tested BSE positive came from Southeast Texas. The animal was born before the 1997 ban on feeding ruminant protein to ruminants, it was raised for beef, and it was too crippled to walk when it was killed. The animal was delivered to Champion Pet Foods; a livestock hauler brought in the cow, which was dead when it arrived at Champion. The company buys "downers," that are barred from human consumption, and animals a few hours dead. The company said it sent a sample of the infected cow to Texas A&M University, where a test for BSE was inconclusive. No part of the animal made it into the company's products. A "hold order" was issued by the Texas Animal Health Commission to the owner of the cow, to prevent any other cattle from moving from the immediate premises. The USDA is now testing the herd that the cow originated from and tracing back the feed supply the cow ate.
(Promed 6/26/05, 6/28/05, 7/1/05)
USA: Years away from mad cow trace-back system
The government is years away from fielding a system to track down herdmates of cattle diagnosed with BSE, making the US "a food safety laggard" in the eyes of a consumer group. The Bush administration embraced the trace-back system as a vital part of BSE control but now expects a Jan 2009 operational date. Within days of reporting the first US case late 2003, the Bush administration said it would speed up creation of the trace-back system. It is a daunting task, involving a million livestock producers and tens of millions of animals, and has moved slower than expected. The goal of the national animal identification system is to find the home farm and herdmates of ailing cattle, hogs, and poultry within 48 hours of a disease outbreak. Caroline Smith DeWaal, food safety director of the Center for Science in the Public Interest, said that with no trace-back system until 2009, "the US is lagging even farther behind many of our trading partners on food safety issues." Canada adopted mandatory cattle ID early this decade. CSPI counts Australia, Japan, and Europe with mandatory ID programs.
Besides the cost of running a livestock identification program, estimated around $100 million a year, and the additional work of reporting every time animals leave the farm or change ownership, some producers worry they will lose control of information. Questions about confidentiality are among the reasons that progress is lagging on a government-run trace-back system, said 2 livestock industry sources. Funding has not been large enough, they said, and there are ever-changing ideas over the system and the equipment. By contrast, said Jay Truitt of the National Cattlemen's Beef Association, the livestock industry can assemble a less expensive and more flexible system faster than the government. NCBA is spearheading a private-sector database. But just as some producers doubted the government could keep their records confidential, there was skepticism about trusting a private database. "We need to take the profit incentive out of animal ID," said president Dave Frederickson of the National Farmers Union.
There have been cattle identification programmes in place for decades, starting with ranch/farm branding; government ear tags in disease control programmes; some 30 years ago Australia had a cheap and effective ranch/station identification system based on numbered plastic tail-tags for all animals leaving the station/farm; and dairies have had microchips for some time tied to milk production and individual feeding. Where the industry has supported such a programme or been persuaded by the threat of withholding of subsidies, their implementation has been rapid and fairly effective.
USA (Idaho): Health officials say syphilis outbreak worsening
A syphilis outbreak that started in 2003 is worsening in Canyon County and parts of southern Idaho, health officials say. 38 case were confirmed in 2003 and 46 in 2004. So far, 20 cases have been confirmed in 2005. In 2003, the CDC reported a syphilis infection rate of 3.4 per every 100 000 people in Idaho. Since the outbreak began, the Southwest District Health Department has found 104 cases of the disease in its region. The cases have been spread evenly among men and women. Half of those infected have been jailed in the past, and 70 percent admitted to being users of methamphetamine. 7 babies have been born with the disease in the district since 2003, making Idaho the state with the sixth-highest rate of congenital syphilis in the nation. During 2003 4 babies were born with syphilis in Idaho. Health officials said in 2004 that the outbreak began with a case in Homedale and was quickly spreading among the young Hispanic population. The district increased the number of staffers and assigned case managers to each pregnant mother who tested positive for syphilis. The district also teamed up with the Idaho Migrant Council and Terry Reilly Health Services to educate the public. The efforts had some success. Still, the outbreak is rapidly spreading among drug users, and health officials are focusing education efforts on bars and organizations that deal with addicts.
USA (Texas): Texas Man Mysteriously Gets Q fever
Texas State health officials are looking into how a man contracted a rare bacterial disease that typically is tied to the livestock industry. The Moore County man does not work around livestock or in a lab or slaughterhouse and is not a veterinarian, circumstances normally associated with getting Q fever, said Dr. James Alexander, a vet with the Department of State Health Services. It's possible the man might have caught the disease, which can spread from animals to humans, from contaminated soil, Alexander said. Cattle, sheep, and goats are the primary carriers of the bacteria that cause Q fever, known as Coxiella burnetii. It's extremely rare for the disease to spread from human to human, said Dr. Steven
Berk, regional dean for Texas Tech University Health Sciences Center School of Medicine. Those who get infected experience high fever, chills and sweating, a general feeling of sickness and loss of appetite. Q fever does respond to antibiotics. Patients usually recover promptly when treatment is started without delay. A person was diagnosed with Q-fever in mid-May 2005. The person responded well to doxycycline and appears to have recovered. His source of exposure remains unknown at present.
USA (multi-state): Cold Stone ice cream linked to salmonella
5 people in Washington have contracted food poisoning after eating cake batter-flavored ice cream from Cold Stone Creamery stores. The victims were infected with salmonella bacteria (Salmonella enterica serotype typhimurium), according to the state Department of Health. Cold Stone Creamery is voluntarily recalling the ice cream from its stores throughout the country. A teenage girl was hospitalized briefly, but has recovered. A total of 15 cases of salmonellosis related to the ice cream shops have been reported in 4 states, the others being Oregon, Minnesota and Ohio, during June 2005.
USA (New York): Listeriosis outbreak in Syracuse area
3 Syracuse-area residents have been diagnosed with listeriosis--a rare and potentially fatal bacterial disease caused by eating contaminated food. Health officials say the 3--ages 48, 70, and 77–have been hospitalized and one is ill. Officials have yet to determine the source of the infection. Listeria is found in soil and water. The disease is not contagious and can be treated with antibiotics. L. monocytogenes has been associated with raw milk, supposedly pasteurized fluid milk, cheeses , ice cream, raw vegetables, fermented raw-meat sausages, cold cuts, raw and cooked poultry, raw meats (all types), and raw and smoked fish. Its ability to grow at temperatures as low as 3 C permits multiplication in refrigerated foods.
Seasonal influenza activity for the Asia Pacific and APEC Economies, 30 Jun 2005
Australia . The levels of influenza-like illness remain within normal seasonal activity for this time of year. Viruses of both influenza A subtypes and both lineages of influenza B have been identified.
Canada . Localized activity was reported from 1 province, while flu activity remained low elsewhere for weeks 23-24. An influenza outbreak was reported in a cruise ship leaving Alaska for Vancouver.
Hong Kong . Influenza activity remained high in the 14th week, with large numbers of influenza viruses isolated, the majority of which were influenza A(H3N2). In week 24, 545 influenza viruses were isolated.
New Zealand . Influenza B virus continued to cause epidemics in children and young adults. The consultation rate of influenza-like illness continued to increase in week 24.
Mexico . Low influenza activity was detected (H3).
(WHO 6/30/05 http://www.who.int/csr/disease/influenza/update/en/)
Influenza Activity, 2004--05 Season--United States and Worldwide, summary
During the 2004--05 influenza season, influenza A (H1), A (H3N2), and B viruses cocirculated worldwide, and influenza A (H3N2) viruses predominated. In addition, several Asian countries continued to report widespread outbreaks of avian influenza A (H5N1) among poultry; in Vietnam, Thailand, and Cambodia. Influenza activity in the US was moderate and occurred at low levels from Oct to mid-Dec, steadily increased during Jan, and peaked in mid-Feb. Influenza A (H3N2) viruses predominated overall, but influenza B viruses were more frequently identified than influenza A viruses during late Mar through May. A small number of A (H1) viruses were also identified. Worldwide, during Oct 2004--May 2005, influenza A viruses circulated widely. Influenza A (H3N2) viruses predominated in most countries, whereas influenza A (H1) and B viruses circulated at low levels in most parts of the world.
(MMWR July 1, 2005 / 54(25);631-634)
Cholera, diarrhea & dysentery
China's Ministry of Health asked for higher vigilance against intestinal infectious diseases, particularly cholera. Statistics of the ministry show 42 epidemics of 3672 cases of intestinal infectious diseases, which included cholera, dysentery, typhoid, paratyphoid and infectious diarrhea, occurred from 1 Jan to 25 May 2005. 37 of these cases were cholera. Compared with 2004, cholera epidemic occurred earlier. The incidence of intestinal infectious disease has been kept at a relatively low level in recent years. The MOH urged various localities to beef up work at medical departments of infectious diseases and strictly abide by the epidemic reporting system. It called for closely monitoring epidemic among catering service workers, schools and urban areas that accommodate large numbers of migrant population and construction sites and beefing up sample checks of marine and aquatic products.
At least 329 people are struggling against diarrhea. Since the epidemic hit 8 Jun 2005 the Sepatan and Pakuhaji districts in Tangerang regency at least 16 children and one adult have died from the disease. The head of communicable diseases prevention at Tangerang Health Agency, Yuliah Iskandar, showed that Escherichia coli and Vibrio cholerae bacteria, the latter being the cause of cholera, were found to be the cause of diarrhea. The germs, she said, are commonly found in unhygienic environments and can contaminate food and water. The patients interviewed said that they got the disease after consuming snacks and orson syrup mixed with ice sold on the streets. The health agency asked heads of the 2 district administrations to halt production of street snacks and syrup.
Cases of dengue fever in Iloilo City dropped to 13 in the first half of 2005, from 80 cases during the same period 2004. The reported cases are distributed, based on the City Health Office statistics, as follows: City Proper and Arevalo have 4 cases each; Molo 2; and Mandurriao, La Paz, and Jaro, one each. Though the cases decreased this year, it is no reason to be complacent, City Health Officer Urminico Baronda said. Baronda advised Ilonggos to always keep their surroundings clean. He also suggested coordination between barangay officials and residents in the campaign against dengue fever.
The number of dengue cases has gone up in June 2005 due to warmer weather. On average, there were about 300 cases per week, more than double the weekly average in the last 3 months. March, April and May saw a weekly average of 136 cases. To curb the rise, the National Environment Agency (NEA) has extended its campaigns to MRT stations and trains. About 900 posters have been up since early June to educate commuters about Aedes mosquitoes. About 50 SMRT trains will be carrying the message till the middle of August. NEA has said that for the first 3 weeks of June, there were about 610 cases, compared to 611 for May. According to the NEA, the number of dengue cases from the start of 2005 to the third week of June stands at nearly 5000, more than double the same period of 2004. In the first 5 months of 2005, NEA carried out more than 170 000 inspections of premises for breeding grounds. It is also working with town councils to flush out breeding grounds on roof tops and pump rooms. Mosquito breeding in homes also went up and more owners were fined. From Jan to 14 May, there were 3552 cases of dengue fever and 94 cases of dengue haemorrhagic fever. 1 death has been reported so far.
Vietnam's southern Mekong Delta has, so far in 2005, detected 8300 dengue fever cases, including 10 fatalities, according to thePasteur Institute. Most of the sufferers are from southern localities such as Soc Trang, An Giang, Dong Thap and Tien Giang provinces. Health workers are encouraging residents to kill mosquitoes and their larvae more actively. More chemicals used to kill the insects are being given to the residents. Vietnam reported 73 300 cases of dengue fever infections, including 101 fatalities in 2004, up 108 percent and 74 percent against the previous year, respectively (case fatality rate at 138 per 100 00).
West Nile Virus
USA (Kansas, California, Arizona, Colorado, New Mexico)
Kansas has reported this year's first human case of West Nile virus in the US. The virus has been found in birds, mosquitoes or horses in 14 states, the CDC said. Since it was first reported in New York in 1999, the virus has made nearly 17 000 Americans ill and killed more than 650. In 2004, 2535 human cases and 98 deaths were reported to the CDC. It has wiped out populations of crows, jays, and similar birds and spread to every U.S. state except Alaska and Hawaii, as well as parts of Canada and Mexico.
A 47-year-old Tulare County man has become the first person in California to test positive for West Nile virus in 2005. The California case is the second reported in the nation for 2005. The man sought medical care for fever and headache in early June and is recovering. So far this year, the virus has been detected in 34 of the state's 58 counties, mostly in dead birds. In 2004, the state logged 830 human cases of the disease, including 28 deaths. 80 percent of people infected will not experience any symptoms, which include headache, fever, and muscle aches. Only 1 percent of those infected will experience the most serious consequences of the illness, including encephalitis or meningitis. Health officials are urging California residents to take precautions against mosquito bites, including wearing insect repellent and keeping doors and windows well-screened.
A man in his 50s who contracted West Nile virus is the first human case confirmed in Arizona in 2005. The man was treated for mild symptoms and was not hospitalized. The man is from Mesa, but that doesn't necessarily mean he contracted the disease there. Officials were sure, however, he contracted the virus in Arizona. There were 355 human cases of West Nile in 2004 in the county, including 14 people who died.
2 people contracted West Nile virus, the first reported cases of the illness in Colorado in 2005. A 17-year-old Fort Collins boy got sick 5 Jun 2005 and was hospitalized. He has recovered. A 50-year-old Weld County woman developed fever 24 May 2005 from a West Nile virus infection. She was not hospitalized. Colorado is the third state this year to report human infections. In 2004, Colorado had 291 reported human cases of West Nile virus, including 4 deaths. In 2003, 2947 people got sick and 63 died. Health officials urged people to wear insect repellents containing DEET, picaridin, or lemon eucalyptus.
New Mexico announced that it has confirmed the first 2 cases of West Nile Virus in the state in 2005. A 44-year-old man has contracted a mild form of the infection, while a 37-year-old man has been hospitalized with a more invasive form. In 2003, New Mexico experienced its first case of West Nile Virus and ended the year with 209 confirmed cases. In 2004, there were only 88 confirmed cases.
(Promed 6/26/05, 7/2/05)
Avian flu: H5N1 virus outbreak in migratory waterfowl, H. Chen et al.
“A worrying development could help to spread this dangerous virus beyond its stronghold in southeast Asia. The highly pathogenic H5N1 influenza virus has become endemic in poultry in southeast Asia since 2003 and constitutes a major pandemic threat to humans. Here we describe cases of disease caused by H5N1 and transmission of the virus among migratory geese populations in western China. This outbreak may help to spread the virus over and beyond the Himalayas and has important implications for developing control strategies….”
(Nature 7/6/05 http://www.nature.com/nature/journal/vaop/ncurrent/index.html)
Human Tuberculosis Caused by Mycobacterium bovis--New York City, 2001--2004
“In March 2004, a U.S.-born boy aged 15 months in New York City died of peritoneal tuberculosis (TB) caused by Mycobacterium bovis infection. M. bovis, a bacterial species of the M. tuberculosis complex, is a pathogen that primarily infects cattle. However, humans also can become infected, most commonly through consumption of unpasteurized milk products from infected cows. In industrialized nations, human TB caused by M. bovis is rare because of milk pasteurization and culling of infected cattle herds. This report summarizes an ongoing, multiagency investigation that has identified 35 cases of human M. bovis infection in NYC. Preliminary findings indicate that fresh cheese (e.g., queso fresco) brought to NYC from Mexico was a likely source of infection. No evidence of human-to-human transmission has been found. Products from unpasteurized cow's milk have been associated with certain infectious diseases and carry the risk of transmitting M. bovis if imported from countries where the bacterium is common in cattle. All persons should avoid consuming products from unpasteurized cow's milk….”
(MMWR June 24, 2005 / 54(24);605-608)
Wildlife Trade and Global Disease Emergence
William B. Karesh, Robert A. Cook, Elizabeth L. Bennett, and James Newcomb
“The global trade in wildlife provides disease transmission mechanisms that not only cause human disease outbreaks but also threaten livestock, international trade, rural livelihoods, native wildlife populations, and the health of ecosystems. Outbreaks resulting from wildlife trade have caused hundreds of billions of dollars of economic damage globally. Rather than attempting to eradicate pathogens or the wild species that may harbor them, a practical approach would include decreasing the contact rate among species, including humans, at the interface created by the wildlife trade. Since wildlife marketing functions as a system of scale-free networks with major hubs, these points provide control opportunities to maximize the effects of regulatory efforts….”
(MMWR EID Volume 11, Number 7—July 2005)
Conference of the Southern African Society for Veterinary Epidemiology and Preventive Medicine
Pretoria, South Africa; 11-12 Aug 2005
The Fifth Annual Conference of the Southern African Society for Veterinary Epidemiology and Preventive Medicine (SASVEPM) will take place at Leriba Lodge, Centurion. For details on the venue, visit <http://www.leriba.co.za/home.html>.Following the successful recipe of the past few years, the conference will consist of scientific paper presentation sessions combined with a practical, hands-on continuing education (CE). This year, the CE program will be on the subject of "One Medicine" and will be presented by Esther Schelling from the Swiss Tropical Institute, Basel, Switzerland. Dr. Schelling is an authority on the interface between human and animal health and modeling of disease transmission at that level. For more information, contact: Wilna Vosloo (PhD), Team leader: Exotic Animal Health, Exotic Diseases Division Private Bag X05, Onderstepoort 0110, South Africa. Tel: 27-12-5299592; Fax: 27-12-5299595; Mobile: 0823391879; email@example.com
Beginning and Intermediate/Advanced Courses in Epi Info
Emory University's Rollins School of Public Health and CDC's Office of Workforce and Career Development will cosponsor Epi Info training August 10--12, 2005, for beginning level students and August 15--17, 2005, for intermediate/advanced level students. These courses are designed for practitioners of epidemiology and computing who wish to develop software applications using Epi Info. The beginning level course will cover MakeView, Analysis, Enter, Epi Map and Epi Report. The intermediate/advanced level course will cover importing and converting other data formats; creating relational databases; advanced check-coding and use of Epi Info functions; advanced analysis; special topics regarding Epi Map and Epi Report; and issues related to students' own projects. For more information: Emory University, Rollins School of Public Health, International Health Department, 1518 Clifton Road, N.E., Room 746, Atlanta, Georgia, 30322; fax 404-727-4590; http://www.sph.emory.edu/epicourses; firstname.lastname@example.org.
(MMWR July 1, 2005 / 54(25);634)
Epidemiology in Action Course
The Rollins School of Public Health at Emory University and CDC's Office of Workforce and Career Development will cosponsor the course, "Epidemiology in Action," October 31--November 11, 2005, at the Emory University campus. The course is designed for state and local public health professionals. The course emphasizes the practical application of epidemiology to public health problems and consists of lectures, workshops, classroom exercises (including actual epidemiologic problems), and roundtable discussions. Topics include descriptive epidemiology and biostatistics, analytic epidemiology, epidemic investigations, public health surveillance, surveys and sampling, Epi Info training, and discussions of selected prevalent diseases. For more information: Emory University, Department of Global Health, 1518 Clifton Road, N.E., Room 746, Atlanta, Georgia, 30322; telephone 404-727-3485; fax 404-727-4590; website http://www.sph.emory.edu/epicourses; e-mail email@example.com.
(MMWR July 8, 2005 / 54(26);659-660)
Satellite Broadcast on Immunization Update 2005
CDC's National Immunization Program and the Public Health Training Network will present a live satellite broadcast, "Immunization Update 2005," July 28, 2005, from 9:00 to 11:30 a.m. EDT, and a rebroadcast of the same program that day from 12:00 to 2:30 p.m. EDT. Both broadcasts will include a live question-and-answer session. This program is intended for physicians, nurses, nurse practitioners, physician assistants, pharmacists, residents, medical and nursing students, and their colleagues who either administer vaccinations or set policy in the workplace. Anticipated topics include recommendations for influenza vaccination and an update of the influenza vaccine supply, meningococcal conjugate vaccine, acellular pertussis vaccine for adolescents, and revised varicella vaccination recommendations. The program can be viewed at http://www.phppo.cdc.gov/phtn/webcast/immup2005. For more information: http://www.phppo.cdc.gov/phtn/immup2005/default.asp.
(MMWR July 1, 2005 / 54(25);636)
4. APEC EINet activities
RiSci videoconference and upcoming events
APEC-EINet took part in a multi-point video conference on pandemic preparedness 6 July 2005. The virtual workshop was organized by RiSci (The Royal Institution World Science Assembly). Participants included teams from New York IBM and Columbia University, Washington, D.C., CDC Atlanta, London WHO, Brussels EU, Taipei, and individuals from Ottawa, Seattle APEC EINet, Paris OIE, Johannesburg, and others. The goal of RiSci’s Global Virtual Workshop is to develop one to three specific draft action plans for activities that will demonstrably improve global preparedness for a potential pandemic, and that are feasible for RiSci to pursue in partnership with existing institutions.
The EINet team is planning to launch in August 2005 the updated “Emerging Infections of International Public Health Importance” course. The course will include new lectures and are being made available without charge by the APEC EINET project. In late fall 2005 EINet will host a virtual symposium on biopreparedness. All APEC economies are welcome to participate. Details will be forthcoming.
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 firstname.lastname@example.org. Further information about APEC EINet is available at http://depts.washington.edu/einet/.