Vol. IV, No. 06 ~ EINet News Briefs ~ April 7, 2001
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In this edition:
- Infectious disease information
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1. OVERVIEW OF INFECTIOUSDISEASE INFORMATION
Below is a bimonthly summary of AsiaPacific emerging infectious diseases.
USA (OHIO) – LEGIONELLOSIS AT AUTOMOBILE PLANT
A Ford Motor Co. plant in Cleveland, OH, closed on March 14 for a fiveday
clean up of several water sources after three cases of Legionnaires’
disease were confirmed among the company’s 2500 employees. The total
number of cases rose to four, two of whom have died of the disease.
The plant has not been confirmed as the source of the infection. Tests
on water samples from the plant revealed that 18 of 153 tested positive
for some type of Legionella bacteria. Two of the samples showed growth
of Legionella pneumophila 1, the isolate that is most commonly associated
with Legionnaire’s disease. These samples were obtained from a stagnant
water pool and a floor furnace tank. The Centers for Disease Control
is continuing to test samples from the plant to see whether the bacteria
in the water matches the strains found in the infected workers.
[ASSOCIATED PRESS 3/28/01, PROMED 3/16/01]
USA (WYOMING) – GASTROENTERITIS
The Wyoming State Department of Health shut down the Big Horn Mountain
Lodge in early March following reports from 64 visitors who complained
of stomach illness between January 1st and March 6, 2001. According
to the health Department Director, the order was issued because of concern
that the water supply may have been contaminated with calicivirus. Caliciviruses
are transmitted by fecaloral contact, and can cause nausea, vomiting,
diarrhea, and stomach cramps. The lodge was shut down because it was
not clear whether the lodge would be able to comply with the Department
of Health’s order requiring only bottled or boiled water be used. The
Department of Environmental Quality’s Water Quality Division further
stated that the lodge did not obtain the county or state permits needed
to ensure the proper construction of its septic and water systems.
RUSSIA –ANTHRAX CONTAMINATION NOT CONFIRMED
Production and marketing were halted at a Novosibirsk meatpacking
plant, the Siberian Food Company, following the suspicion that a
former worker had contracted anthrax while at the plant. The 43yearold
worker was admitted to the “Vektor” Siberian Virology Centre, where
blood tests came back negative for anthrax bacteria. Prior to the
test results, emergency conditions were implemented, and staff who
were in contact with the infected worker were examined. All workrooms
were reported to have been disinfected.
[PROMED 3/19/01, 3/26/01, 3/31/01]
INDIA (NORTH BENGAL)– UNEXPLAINED DEATHS ATTRIBUTED TO MEASLESLIKE
Indian scientists are attributing the mystery disease that has killed
45 people and made at least 66 others ill in February and March to a highly
lethal measleslike virus that causes encephalitis in adults and children.
Scientists investigating the outbreak told the Health Ministry in India
that a mutant measles virus affecting the brain, lungs, or kidneys is
responsible for the disease. Investigators were able to rule out vectorborne
infections such as cerebral malaria, Japanese encephalitis, Hanta, West
Nile, Nipah, and dengue viruses. Tests on tissue samples revealed that
four of 21 samples tested positive for measles IgM antibodies, and 15
of 21 samples tested positive for IgG antibodies. According to epidemiologists,
the spread of the infection has slowed, due in large part to adequate
protection and barrier nursing methods.
[BMJ 2001;322:693, http://www.bmj.com/cgi/content/full/322/7288/693/a;
MEDSCAPE 3/23/01 http://www.medscape.com]
MALAYSIA – CONFIRMATION OF NIPAH VIRUS INFECTION
The University Malaya Medical Centre confirmed that the 22yearold livestock
worker from Bukit Pelanduk who died of a form of encephalitis was infected
with Nipah virus. The Health Ministry Parliamentary Secretary stated that
this case was the result of a prior infection, as the worker had exhibited
symptoms of Nipah virus while culling pigs in the previous outbreak. No
new or recent cases of infection of either Japanese encephalitis virus
or Nipah virus have been reported in the areas.
KAZAKHSTAN – TUBERCULOSIS
The reported incidence rate of TB in the province of Kazakhstan has increased
considerably from 122 per 100,000 in 1998 to 152 per 100,000 recently
reported in the online news source, Russia Today. According to this report,
4000 people infected with TB died last year in Kazakhstan. The article
suggests that the increasing incidence can be attributed in large part
to the low socioeconomic status and lack of awareness among the Kazakh
[RUSSIA TODAY 3/27/01; PROMED 3/29/01]
Ed. comment: The lack of an adequate public health infrastructure and
limited access to appropriate TB medication regimens likely play a role
in the high incidence rates.
20th APEC ISTWG MEETING VIETNAM
The 20th meeting of the APEC Industrial Science and Technology Working
Group (ISTWG) scheduled for April 23rd–27th in Hanoi, Vietnam will include
a side meeting on Health/Emerging Infections on Tuesday, April 24 at the
Melia Hanoi Hotel. Interested persons should contact their APEC delegation
for further information.
WORLD TB DAY – MARCH 24, 2001
Tuberculosis (TB) is the world’s leading curable infectious killer, killing
approximately two million people each year. Developing countries account
for over 90 percent of TB cases worldwide, and the global TB epidemic
increased six percent between 1997 and 1999, largely as a result of a
20 percent increase in African countries heavily affected by HIV/AIDS.
The theme for this year’s World TB Day, commemorated annually on March
24, 2001, was “DOTS: TB Cure for All.” (DOTS is the World Health Organization’s
approved strategy for TB control, and stands for directly observed therapy
short course.) This theme underscores the importance of making treatment
accessible to all people infected with TB. A recent report published by
the WHO stated that only 23 percent of individuals with infectious TB
were treated in DOTS programs. Drug shortages constitute one of the principal
barriers to rapid DOTS expansion. The WHO and the global partnership to
Stop TB announced a new initiative, the Global TB Drug Facility that aims
to increase access to TB drugs for ten million patients, primarily in
Africa, Asia, and Eastern Europe, over the next five years. To view the
WHO’s press release, go to http://www.who.int/infpr/en/pr2001㪥.html.
The WHO’s fifth annual report on Global TB Control can be downloaded
in full or in parts from http://www.who.int/gtb/publications/globrep01/index.html.
This report is based on case notifications and treatment outcome data
provided to the WHO from national control programs. The focus of the report
was to evaluate progress towards the 2005 designated targets of 70 percent
case detection and 85 percent treatment success rates, and to assess the
epidemiological effects of diagnosing and curing large numbers of people.
The WHO has also recently published “Guidelines for establishing DOTSPLUS
Pilot Projects for the Management of MultidrugResistant Tuberculosis,”
which will be available online shortly at http://www.who.int/gtb/publications/TBCatalogue.htm.
POLIO ERADICATION 99% COMPLETE
The Global Polio Eradication Initiative, headed by WHO, Rotary International,
the U.S. Centers for Disease Control and Prevention (CDC), and the United
Nations Children’s Fund (UNICEF), announced that the eradication of poliomyelitis
is 99 percent complete. There were an estimated 350,000 annual cases in
1988 when the initiative began. In 1999, 7141 cases were reported, and
this number was reduced by over half in 2000, during which there were
no more than 3500 cases of polio reported worldwide. The reduction is
attributed to the World Health Assembly’s directive in 1999 for more expeditious
eradication activities, such as increased numbers of National Immunization
Days (NIDs) and housetohouse vaccine delivery strategies. The poliovirus
now circulates in no more than 20 countries, primarily in South Asia and
subSaharan Africa. According to the DirectorGeneral of the WHO, the
program’s principal challenges, acquiring access to all children, sufficient
funding, and maintaining political commitment, still lie ahead.
NEW INITIATIVE TO HALVE MORTALITY OF MEASLES
The WHO and UNICEF announced a new initiative, the Global Measles Strategic
Plan, that aims to reduce global measles deaths by onehalf by 2005. Despite
an effective and inexpensive vaccine that has been available for over
30 years, measles remains a leading childhood killer, with more than 30
million cases and approximately 900,000 annual deaths in recent years.
The high incidence and mortality rates associated with measles are attributed
to the low vaccination rates of infants. In conjunction with WHO and UNICEF,
involved countries would evaluate progress on measles control, identify
reasons for low routine coverage, develop a three to five year plan for
measles mortality reduction, and fully implement the recommended strategies.
According to Dr. Suomi Sakai, UNICEF’s Chief of Immunization Activities,
vaccine coverage levels need to be above 90 percent in order to stop measles
deaths, since a small percent of vaccinated individuals do not develop
immunity. In 1999, fourteen countries reported measles coverage below
50 percent. To view the WHO’s press release, go to http://www.who.int/infpr/en/pr2001㪨.html.
Similarly, the Global Alliance for Vaccines and Immunizations (GAVI)
began its first round of a global schedule of vaccine delivery in Mozambique
on April 6. GAVI, a coalition of public and private organizations including
the Bill and Melinda Gates Children’s Vaccine Program, the WHO, the World
Bank, and UNICEF, among others, was created in 1999 with the aim of increasing
access to vaccines such as diphtheria, measles, tetanus, pertussis and
hepatitis B among children in developing countries. Mozambique is one
of 25 countries to secure support from GAVI subsequent to a review of
[SEATTLE POSTINTELLIGENCER 4/6/01, http://www.seattlepi.com;
GAVI website, http://www.vaccinealliance.org]
SOUTH AFRICA RELEASES DIVISIVE AIDS REPORT
An advisory panel appointed by South African President Thabo Mbeki to
recommend approaches to the HIV/AIDS epidemic in South Africa released
a divided report, reflecting disagreement among the council members. The
council, created in 2000, was comprised of mainstream scientists and revisionist
theorists, many of whom question whether the HIV virus causes AIDS, the
effectiveness of AIDS medication, and whether AIDS really exists. As a
result of the disagreement on the causes of AIDS, the report includes
two different sets of recommendations. The theorists argue for the use
of massage therapy, music therapy, yoga, and the use of supplements such
as ginseng and Echinacea to help prevent AIDS. They urged that HIV testing
and the use of current AIDS medications be stopped. Mainstream scientists
called for increased HIV testing, use of antiretroviral drugs, and increased
emphasis on sex education. AIDS activists have criticized President Mbeki
for involving the dissident theorists, arguing that their views have damaged
prevention efforts. According to South Africa’s Health Minister, the government
will maintain its current AIDS policy, which is based on the premise that
HIV causes AIDS.
[TIMES OF INDIA 4/6/01, http://www.timesofindia.com]
U.S. SUPPLEMENTS ASSOCIATION RECOMMENDS ELIMINATING BOVINE PARTS FROM
The National Nutritional Foods Association (NNFA), the nation’s largest
dietary supplements industry group, has issued recommendations for manufacturers,
encouraging them to eliminate all neurological bovine materials from their
products. The NNFA issued the recommendation in order to minimize the
risk of transmission of bovine spongiform encephalopathy (BSE) to humans,
which has been attributed to the consumption of brain and spinal cord
tissue from infected cows. According to the association, about 200 dietary
supplement products, which represent 0.5% of the total U.S. market, currently
contain bovine glandular material.
[REUTERS HEALTH 3/16/01]
Ed. comment: There have been no confirmed diagnoses to date of vCJD
related to the ingestion of these products.
INTERNATIONAL APPLIED EPI COURSE
The Centers for Disease Control and Prevention (CDC) and Emory University’s
Rollins School of Public Health will cosponsor a course, “International
Course in Applied Epidemiology” from September 24 through October 19,
2001, in Atlanta, Georgia. The course will include discussions of epidemiologic
principles, basic statistical analysis, public health surveillance, field
investigations, surveys and sampling, and discussions of the epidemiologic
aspects of current major public health problems in international health.
Preference will be given to applicants whose work focuses on international
public health issues. For more information, visit Emory’s website at http://www.sph.emory.edu/EPICOURSES
or email firstname.lastname@example.org.
Note to Readers: In this newsletter we have included editorial
comments from Dr. Carrie Horwitch, coinvestigator on the APECEINet Project
and a clinical instructor at the University of Washington School of Public
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