Week of Feb 09, 2004 ASIA WHO Bird Flu Study Finds Virus Infects and Kills Humans Quickly The first study of Asia's bird flu cases shows the virus has an alarmingly high fatality rate and that victims typically died 10 days after falling ill with raging fever, coughing and breathing difficulties. The World Health Organization (WHO) survey of 10 human cases of bird flu in Vietnam, where 14 people have died of the disease, found that of the group eight died, one recovered and another remains in a critical condition. On average they fell ill three days after contact with infected poultry including ducks and chickens kept in their household or in neighboring farms. ``Eight of the ten patients had a clear history of direct contact with poultry and there was no definitive evidence of human-to- human transmission,'' it said, referring to fears the virus could mutate and spread among humans. The UN health agency said that the experiences of those studied was not a definitive description of the disease, which was still being investigated. But it said that information about the cases would be useful to healthcare workers attempting to identify bird flu. Until now, all the knowledge scientists have about the deadly H5N1 strain of bird flu has been gleaned from the 18 cases which erupted during a 1997 outbreak in Hong Kong which killed six people. H5N1 has emerged in Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand and Vietnam. Pakistan and Taiwan have reported weaker strains, as has the United States where bird flu has been found in the state of Delaware. In addition to the deaths in Vietnam, Thailand has had five fatalities but none of the other countries have reported human infections. Source: · Utusan Online, Feb 13, 2004, http://www.utusan.com.my/utusan/content.asp?y=2004&dt=0214&pub=Utusan_Express&sec=Discoveries&pg=di_03.htm
UN Says Bird Flu Epidemic Still Not Contained Asia's bird flu epidemic is still not contained despite a cull of more than 80 million chickens, and affected nations must remain vigilant, the United Nations said Friday. ``The spread of the avian influenza virus in several Asian countries is still not under control ... Cambodia, China, Indonesia and Laos continue to report new outbreaks in poultry,'' the UN's Food and Agriculture Organization (FAO) said. It said in a statement that cooperation with regional nations hit by the deadly virus had ``significantly improved'' but that the response to the crisis in some poorer countries had been slow. The FAO's warning came as Taiwan reported two new outbreaks of bird flu, both of the less dangerous H5N2 form. The deadly H5N1 strain of bird flu has left 19 people dead in Asia. The UN's World Health Organization (WHO) has criticized Asian nations for putting economic concerns before public health, drawing denials Friday from Vietnam which insisted that protecting its citizens was its top priority. Several countries including Thailand, Indonesia and Vietnam, have been criticized for attempting to cover up outbreaks in a bid to protect their agricultural sectors and tourism industries. Hong Kong, the scene of a deadly 1997 outbreak of bird flu, said Friday it would cull its entire stock of 2.7 million chickens, ducks and pigeons if even one case of the virus was found among bird or humans. The territory's cull of two million chickens to end the disease's first recorded outbreak among humans, which left six people dead, has been praised by the WHO as a model response. European Union health ministers met in Brussels Thursday to coordinate their response to the epidemic, including plans to stockpile medicines if the virus mutates into a form that could spread among humans and cause a global pandemic. H5N1 has emerged in Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand and Vietnam. Pakistan along with Taiwan has announced an outbreak of the weaker strain, as has the United States where bird flu has been found in the state of Delaware. Thailand on Friday announced two more cases of bird flu, but said both patients have already recovered and been discharged from hospital. Eight confirmed cases of the disease including five fatalities have now been reported in Thailand, in addition to 14 deaths in the worst-hit nation, Vietnam. - AFP Source: · Utusan Online, Feb 13, 2004, http://www.utusan.com.my/utusan/content.asp?y=2004&dt=0214&pub=Utusan_Express&sec=Discoveries&pg=di_02.htm
Avian Influenza A (H5N1) Virus Infection - Global Surveillance Guidelines WHO has issued on its website guidelines for global surveillance aimed at monitoring the spread of avian influenza A (H5N1) virus infection in human and animal populations. The guidelines include the definition of a laboratory-confirmed case of avian influenza A (H5N1) virus human infection, and describe procedures for reporting cases to WHO. The guidelines also provide recommended procedures to monitor changes in transmission patterns and to detect potential human-to-human transmission. The guidelines are intended to improve global vigilance for the further spread of avian influenza A (H5N1) virus infections in humans and animals, and for the first signs that human-to-human transmission may be occurring. Use of standardized procedures and reporting forms will improve the quality of information needed by WHO to advise on the most appropriate control measures. Source: · World Health Organization (WHO), CSR, Disease Outbreaks Report, Feb 11, 2004, http://www.who.int/csr/don/2004_02_11/en/ · WHO Website, Feb 10, 2004, http://www.who.int/csr/disease/avian_influenza/publichealth/en/
Bird Flu Not Transmitted By Humans The World Health Organization says the bird flu virus in Asia has not yet changed into a form capable of human-to-human transmission after further tests on suspect cases in Vietnam. The United Nations agency had earlier said it was "possible" that two Vietnamese sisters had caught the disease from their brother, indicating that the virus had mutated into a far more lethal form. But in a follow-up investigation, the WHO said virologists in Hong Kong had failed to find any human genes in the virus samples taken from the sisters. The WHO has warned the virus could kill millions across the globe if it combined with a human influenza virus to create a new highly contagious strain transmissible among humans. Source: · Radio Australia, Feb 09, 2004, http://www.abc.net.au/ra · Pacific Islands Report, Feb 09, 2004, http://pidp.eastwestcenter.org/pireport/2004/February/02-09-03.htm · News From Bangladesh, Feb 09, 2004, http://www.bangladesh-web.com/view.php?hidDate=2004-02- 09&hidType=RIN&hidRecord=0000000000000000000839
Precautions for Travel to Countries Reporting Avian Influenza A (H5N1) The Centers for Disease Control and Prevention (CDC) within the Department of Health and Human Services has issued precautions for travel to countries that are reporting outbreaks of avian influenza A (H5N1) in humans and animals. The purpose of these precautions is to provide information for travelers on the status of avian influenza A (H5N1) outbreaks, including where outbreaks are occurring, measures to take before travel, precautions to follow while abroad, and what to do if illness occurs during or after travel. Currently, CDC does not recommend that the general public avoid travel to any of the countries affected by avian influenza A (H5N1). CDC has issued the following recommendations for travel to countries reporting human or animal cases of avian influenza A (H5N1): Before you leave: Assemble a travel health kit containing basic first aid and medical supplies. Be sure to include a thermometer and alcohol-based hand rub for hand hygiene. Educate yourself and others who may be traveling with you about influenza. Information about influenza is provided on CDC's influenza website: http://www.cdc.gov/flu/ Be sure you are up to date with all your shots, and see your health-care provider at least 4 to 6 weeks before travel to get any additional shots or information you may need. CDC health recommendations for international travel are provided on CDC's Travelers Health website: http://www.cdc.gov/travel/ You may wish to check your health insurance plan or get additional insurance that covers medical evacuation in the event of illness. Information about medical evacuation services is provided on the U.S. Department of State website: http://www.travel.state.gov/medical.html. Identify in-country health-care resources in advance of your trip. While you are in an area where avian influenza cases have been reported: At this time, CDC recommends that travelers to countries experiencing outbreaks of this disease in poultry should avoid areas with live poultry, such as live animal markets and poultry farms. Large amounts of the virus are known to be excreted in the droppings of infected birds. As with other infectious illnesses, one of the most important and appropriate preventive practices is careful and frequent hand hygiene. Cleaning your hands often, using either soap and water or waterless alcohol-based hand sanitizers, removes potentially infectious materials from your skin and helps prevent disease transmission. Influenza viruses are destroyed by heat; therefore, as a precaution, all foods from poultry, including eggs, should be thoroughly cooked. If you develop respiratory symptoms or any illness that requires prompt medical attention, a U.S. consular officer can assist in locating appropriate medical services and informing family or friends. See this website for more information about what to do if you become ill while abroad: http://www.cdc.gov/travel/other/illness-abroad.htm. It is advisable that you defer further travel until you are free of symptoms. Follow basic health habits outlined on this website to protect against flu. After your return: Monitor your health for 10 days. If you become ill with fever or respiratory symptoms during this 10-day period, consult a health-care provider. Before your visit to a health- care setting, tell the provider about your symptoms and recent travel so that he or she can be aware you have traveled to an area reporting avian influenza. Information for health care providers wishing to test for or report cases of influenza A (H5N1) and SARS can be found at this website: http://www.cdc.gov/flu/han020302.htm. Source: · Centers for Disease Control and Prevention Website, Feb 06, 2004, http://www.cdc.gov/flu/protect/preventing.htm · Promed Mail, Feb 08, 2004, http://www.promedmail.org/pls/askus/f?p=2400:1001:4508280590003214041::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ ID:1010,24419
Bird Flu Update The human death toll from Avian Influenza remains at 18; 5 confirmed cases in Thailand, all of whom have died; and 18 confirmed cases in Vietnam, 13 of whom have died. No confirmed case of avian influenza A (H5N1) virus infection has been reported from any other country in the region. Currently no definitive evidence has been found of human-to-human transmission; no H5N1 infections have been documented among health-care workers. While it is unusual for people to get influenza infections directly from animals, such transmission has been documented several times in recent years. The source of exposure in human cases of H5N1 influenza is under investigation, although most human cases have been linked to direct contact with diseased birds. Outbreaks of H5N1 infection have been detected in the poultry populations of Cambodia, China, Indonesia, Japan, South Korea, Laos, Thailand, and Viet Nam. The virus was also confirmed in a single peregrine falcon in Hong Kong. The co-circulation of human and highly pathogenic animal influenza viruses is of serious concern to the World Health Organization (WHO), CDC, and other health authorities worldwide, since an exchange of genes between the 2 viruses might occur if individuals were co-infected with both human and avian influenza viruses. This gene exchange could give rise to a new influenza virus to which humans would have little or no immunity and which could be transmitted from person to person. Source: · WHO Website, Feb 10, 2004, http://www.who.int/csr/disease/avian_influenza/country/cases_table_2004_02_10/en/ · Centers for Disease Control and Prevention Website, Feb 06, 2004, http://www.cdc.gov/flu/protect/preventing.htm · Promed Mail, Feb 08, 2004, http://www.promedmail.org/pls/askus/f?p=2400:1001:4508280590003214041::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ ID:1010,24419 BANGLADESH Nipah-Like Virus Kills 14 In Bangladesh An infection caused by a virus resembling Nipah virus has killed 14 people in Bangladesh since the start of the new year, the World Health Organization said Thursday. The WHO said it has confirmed the infection among 42 people and is still investigating an additional 45. It said tests by the U.S. Centers for Disease Control and Prevention confirmed the presence of a virus resembling Nipah virus in samples taken from nine patients. The WHO said it believes that the patients contracted the virus from livestock or wild animals, and said the organization is investigating the extent of the infection by surveying the area where the patients came from. The Nipah virus infection, communicable to both humans and animals, is caused by the virus found in fruit bats. Between 1998 and 1999, it killed more than 100 people in Malaysia where they were believed to have caught the virus through pigs, as the majority of the dead had contacts with pigs. The infection's main symptom is encephalitis, causing patients to have high fever, headache, and the loss of sense of direction for a period of three days to two weeks, with serious cases leading to death after falling into coma. Source: · World Health Organization (WHO), CSR, Disease Outbreak News, Feb 12, 2004, http://www.who.int/csr/don/2004_02_12/en/ · Morningstar.com, Feb 14, 2004, http://news.morningstar.com/news/DJ/M02/D12/200402121312DOWJONESDJONLINE001002.html · Japan Today, Feb 14, 2004, http://www.japantoday.com/e/?content=news&cat=7&id=288324 · Promed Mail, Feb 12, 2004, http://www.promedmail.org/pls/askus/f?p=2400:1001:424240::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,24445
Mysterious Disease Remains a Mystery The mysterious disease that claimed 26 lives last month and affected 66 others in Rajbari, Manikganj, Tangail and Joypurhat districts remained an enigma even after the primary diagnosis done by the experts from abroad. The expert report only confirmed that the disease has no link with the bird flu, but it could not come to a conclusion about the nature and origin of the disease which coincided with the spread of bird flu in Asia. The World Health Organization (WHO) and the Center for Disease Control (CDC), Altanta, will be able to diagnose it by next month (March) when the final report will be made before the government. It is believed the disease is due to the Nipah or Hendra virus that causes encephalitis. Bangladesh witnessed similar problems twice in 2001 and 2003. Source: · News From Bangladesh, Feb 12, 2004, http://www.bangladesh-web.com/view.php?hidDate=2004-02- 12&hidType=NAT&hidRecord=0000000000000000000967 CHINA China and Taiwan to Cooperate in Fighting Bird Flu China has agreed to put aside differences with Taiwan and offered to work with Taiwan to control the spread of bird flu. China's cabinet earlier this month pushed for closer links with Taiwan, Hong Kong and Macau over the outbreak that has killed 19 people across Asia. A spokesman for China's Taiwan Affairs Office called for academic exchanges and better communication between the island and the mainland. The two sides cooperated during the Severe Acute Respiratory Syndrome outbreak last year. China has reported a total of 38 cases of bird flu, with 23 confirmed cases and almost half the country's 31 provincial-level regions affected. In Taiwan, a less virulent strain of bird flu has been discovered, leading to a cull of poultry. Source: · Radio Australia, Feb 12, 2004, http://www.abc.net.au/ra · Pacific Islands Report, Feb 12, 2004, http://pidp.eastwestcenter.org/pireport/2004/February/02-12-10.htm HONG KONG Three Girls Latest Suspected SARS and Flu Cases Three young girls are the latest suspected SARS and flu cases to be put in isolation in Hong Kong, where 323 people have been tested for the diseases since early January. The girls, aged three, 11 and 17, were being tested for Severe Acute Respiratory Syndrome (SARS) and bird flu after being admitted to hospital with fever, coughs and runny noses, the Hospital Authority said. All had returned from the mainland in the past 10 days. They were in stable condition in the city's Princess Margaret Hospital. Meanwhile, five patients who developed fever while being treated at the hospital where SARS first spread in Hong Kong were still awaiting the results of SARS and bird flu tests. Since stringent health checks were put in place on January 5 following a resurgence of SARS in China's neighboring Guangdong province, 323 suspected victims had been tested in isolation wards. No cases had been confirmed. In a bid to keep SARS and bird flu from the city, Hong Kong has imposed strict health surveillance on arriving travelers, especially from mainland China. It has also ordered anyone who develops a fever within 10 days of returning from China to immediately report to a hospital. Source: · Utusan Online, Feb 11, 2004, http://www.utusan.com.my/utusan/content.asp?y=2004&dt=0212&pub=Utusan_Express&sec=Discoveries&pg=di_01.htm INDIA Eunuchs Dying From AIDS The large community of eunuchs in Mumbai is falling victim to AIDS. Leaders of the hijras, or eunuchs, say that some 250 of them have already died in Mumbai in the last six years and the figure could be as high as 4,000 in the rest of the country. Nearly 72 percent of the 3,000 hijra community that has been tested in Mumbai in the last four years is HIV positive. Activists view the high prevalence of HIV in the community as a consequence of the prejudices eunuchs face. Once hit by the disease, a majority of them take to begging and prostitution, which in turn makes them more vulnerable to HIV infection. Source: · Keralanext.com, Feb 11, 2004, http://www.keralanext.com/news/index.asp?id=26331 INDONESIA 10 More Dengue Fever Deaths Ten people have died of dengue since January this year. Five died in Indramayu regency, one in Majalengka regency, one in Cianjur regency, one in Depok mayoralty and two in Bogor mayoralty. The dengue outbreak happened as the rainy season hit West Java province. Last year 201 residents of West Java died of dengue, out of total 8,907 residents infected with the disease. To fight the outbreak, the West Java province will intensify fumigation and clean up of places suspected of being breeding grounds for Aedes Aegepty mosquitoes, the carriers of dengue. Source: · The Jakarta Post, Feb 11, 2004, http://www.thejakartapost.com/yesterdaydetail.asp?fileid=20040210.D05
Chikungunya Outbreak In Palu Chikungunya, or Hong Kong flu, has infected hundreds of residents in the Central Sulawesi capital of Palu. Chikungunya had infected about 1,500 residents in 18 villages in four subdistricts in Palu over the past two months. Sufferers are usually confined to bed for several days because the disease attacks the joints and is accompanied by high fever. Over the last month 500 residents had been treated at the hospital and community health centers for the disease. The actual number of people infected by the disease could be twice or three times as high, as many people prefer to receive treatment at home. Source: · The Jakarta Post, Feb 13, 2004, http://www.thejakartapost.com/detaillatestnews.asp?fileid=20040212204931&irec=1 NEPAL Respiratory Disease and Measles Claim 32 in Bajura, 9 in Achham Respiratory disease and measles that are prevalent in Bajura district since last December' have claimed 32 lives to date. Twenty-two deaths were reported from Bidhu, Kuldebmadau, Martadi, Gudukhati, Jugada, and Arichaur VDC during the first phase of epidemics, while 10 succumbed to diseases from Rugin and Bidhu VDC during the second phase of attack. Nine people have succumbed to cough and cold while over 4000 locals have been affected. Of the nine people who died, one was a child while eight others were elderly people from Kuntibandali. Their deaths have been attributed more to the lack of medicines and treatment facility at health posts in the region. The intensity of the disease is increasing but the District Health Office (DHO) in the area has not dispatched medicines to the affected region. Source: · Kantipur Online, Feb 11, 2004, http://www.kantipuronline.com/php/kolnews.php?&nid=7406 PAKISTAN ‘WHO to stop anti-polio campaign by Dec 31, 2004’ The international community will bring to an end the 16 years long anti-polio campaign worldwide by December 31, 2004, said Dr David Heymann, Special Advisor to Director General World Health Organization (WHO). "The international community will stop the (anti-polio) campaign as the countries (still reporting the disease) have committed to eradicate it by December 2004," Heymann told newsmen here at press conference on Thursday. Adding to the Dr Heymann’s disclosure, Dr Khalif Bile, World Representative WHO Pakistan, has, however, said that the world health body would continue surveillance for three years prior certifying a particular country to be poliovirus free. "Once it is established that there is no hidden poliovirus then WHO will certify that country to be polio free," Bile said. The international community started the polio eradication initiative in 1988 and a huge sum of $ 3 billion donated by Japan, Scandinavian countries, Canada and UK has been spent on the campaign. "Pakistan is one of the six countries where the disease is still prevalent," Dr Heymann said. The other five are Afghanistan, India, Egypt, Nigeria and Niger, he added. In Pakistan the highest number of polio cases i.e. 32 have been reported in NWFP in 2003 despite observing the anti-polio days for the last 16 years with much funfair. The international community first set 2000 as deadline for the complete eradication of the disease. "WHO changed the deadline then and set a new one 2005 by which it pledged to eradicate polio at all costs from the world," Dr Heymann said. "The health ministers of the six affected countries at the Geneva meeting then pledged to banish the crippling virus from their respective countries by December 31, 2004," added Dr Heymann. Following the 2004 deadline WHO is planning to ban the administration of oral anti-polio vaccines. "Oral vaccines will be replaced by injectable ones," said Dr Heymann and added the government would then be responsible to ensure continued eradication of the virus. At the press conference a high official of an international organization wishing not to be named said that the international community was now completely exhausted by the years long campaign and wanted to suspend it as early as possible. "It (international community) is really disappointed by the performance of Pakistan in accomplishing the task," he said. Speaking at the press conference NWFP Health Minister Inayatullah renewed his government commitment for achieving the target of total eradication of poliovirus by the end of 2004. "We’ll utilise all our efforts and resources to achieve the target," said Inayat. He said the health department wanted to involve the district coordination officers (DCOs) and district education officers in the polio immunisation campaign. "We’ve planned to arrange seminars for DCOs, EDOs and district nazims to educate them about the severity of the problem," he added. Already the health department has inaugurated its previous campaigns by national level political and religious leaders to enhance its credibility. "My department is thankful to Qazi Hussain Ahmed, Maulana Fazalur Rehman and Begum Nasim Wali Khan for inaugurating the anti-polio campaigns," said the minister. The health department now wanted to involve all the parliamentarians particularly the women parliamentarians in this initiative so that not a single child is left out. To a query the minister admitted that several of the reported cases of poliovirus have been vaccinated in the past. "Yes I know the children who were vaccinated have been affected by the virus," he said. However, Dr Heymann said there might be reasons for this. "The child might be vaccinated while having intestinal problems or diarrhoea," David Heymann said. He also pointed out that the vaccines might have lost its efficacy during the transportation and storage. The representatives of world health body on this occasion appreciated the commitment of the NWFP chief minister and other government leaders in making the anti-polio campaign successful. On this occasion provincial information minister Asif Iqbal, project officer UNICEF Islamabad Rafah Aziz, secretary health, DG health and a number of other officers of WHO and UNICEF were also present at the press conference. Source: · The Daily Jang, Feb 13, 2004, http://www.jang.com.pk/thenews/feb2004-daily/13-02-2004/main/main14.htm
Bird Flu Contained in Pakistan An outbreak of bird flu reported to have killed millions of chickens but affecting no humans has been contained in Pakistan, according to the United Nations. There have been no cases of the H5N1 strain of bird flu that has killed at least 19 people in Asia. However, Pakistan has been hit by the H-7 and H-9 strains less dangerous to humans. According to officials and poultry industry representatives, between 1.5 million and 3.5 million chickens were killed by bird flu and culling in farms in Karachi. The migration of wild birds northwards as winter ends could cause some problems. Authorities have banned the transportation of chickens and other domestic birds inside the country as a precaution. Source: · The News, Feb 13, 2004, http://jang.com.pk/thenews/feb2004-daily/13-02-2004/main/main18.htm THAILAND Storks, leopard reportedly had avian virus in Thai zoo Test results showed three migratory Asian open-billed storks that died in Nakhon Sawan had the H5N1sub-type of avian flu, but authorities said it was unlikely they had carried this virulent strain from abroad. Natural Resources and Environment Minister Praphat Panyachartrak also said a clouded leopard at Khao Khiew Zoo in Chon Buri was confirmed to have died of bird flu, while a white tiger also caught the disease but is recovering and now under close surveillance. ``A study is needed to find if the storks caught the disease from chickens,'' Mr Praphat said on Thursday, insisting his ministry would not order mass culling of this bird species without sound scientific proof that the storks were carriers of the disease. Hundreds of open-billed storks have died at Bung Boraphet swamp in Nakhon Sawan and Bangkok's Lat Krabang district, where poultry infected with bird flu were found. An official said the mass death of storks in Lat Krabang had prompted the Agriculture Ministry to demand that up to 20,000 migratory open-billed storks be killed. Samples of the storks living at Phut Khao bird park in Lat Krabang and at Wang Nam Priew in Chachoengsao province were collected by environment officials on Wednesday for testing. Mr Praphat suspected some of the storks could have been exposed to avian flu in Thailand after their arrival late last year. He said it was unlikely the storks were carriers of the H5N1 variant because they all came from Bangladesh, where there have been no reports about the H5N1 strain so far. ``We'd better tell Bangladesh to keep a close watch on the birds on their return,'' he said. The storks are expected to start their journey again in May. Source: · The Bangkok Post, Feb 14, 2002, http://www.bangkokpost.com/News/14Feb2004_news16.php
Two More Human Cases Confirmed in Thailand The Public Health Ministry yesterday confirmed two more cases of bird flu among humans, taking the total number of such cases in Thailand to eight. Dr Jaral Trinwutthipong, director-general of the Disease Control Department, told a press conference that the seventh and eighth cases were a two-year-old boy in Suphan Buri and 27-year-old woman in Uttaradit, both of whom had recovered and been discharged. The eight confirmed cases had contracted the virus before January 27. There were 21 suspected bird-flu cases -- nine of them have died and 10 have been treated and returned home, while two others are still in the hospital. The Health Ministry is waiting for the results of lab tests on another 109 people who fell ill during the flu outbreak. The official toll stands at: eight confirmed cases, 5 dead, three under observation. Source: · The Nation, Feb 14, 2004, http://www.nationmultimedia.com/page.news.php3?clid=3&id=108237&usrsess=1http://www.nationmultimedia.com/page.news.php3?clid=3& id=108237&usrsess=1 VIETNAM 14th Avian Influenza Death Vietnamese sources state that a 27 year old man has died from avian influenza, bringing to 19 the number of deaths from the illness sweeping Asian poultry. The man is the 14th fatality in Viet Nam, and is believed to have caught the disease at his family's chicken farm. The latest man to die from the illness came from Vietnam's southern Binh Phuoc province. All confirmed human infections and deaths from the H5N1 bird flu have been registered in Viet Nam and Thailand. [Combining these figures with those in the WHO update below, in total there have been 23 confirmed cases in Thailand and Viet Nam, 19 of whom have died.] The virus has so far only jumped from poultry to humans. Health experts are worried that if the virus mixes with a regular human influenza strain, it might create a mutant form that was able to pass between humans, triggering a human flu pandemic. Health officials have also reported a new [suspected] infection in Viet Nam -- a 23 year old man from central Lam Dong province is in hospital in Ho Chi Minh City in a stable condition. Experts are waiting for test results from a Cambodian woman who died in a Vietnamese hospital -- if she is confirmed to have had the disease, she would be the first victim from Cambodia. Tens of millions of chickens and ducks have already been slaughtered across South East Asia as the outbreak also hit Viet Nam, China, South Korea, Cambodia, Taiwan, Indonesia, Pakistan, Laos, and Japan. Source: · BBC News online, Feb 09, 2004, http://news.bbc.co.uk/2/hi/asia-pacific/3471453.stm · Promed Mail, Feb 09, 2004, http://www.promedmail.org/pls/askus/f?p=2400:1001:4508280590003214041::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ ID:1010,24423 Other World News UNITED STATES OF AMERICA Leptospirosis in Hawaii Hawai'i recorded nearly 500 cases of leptospirosis in the past decade and six of those people died of the bacterial disease, an illness suspected in the death of a Big Island college student last month. Simon Hultman went hiking and swimming in Waipi'o Valley, a known source of leptospirosis. He died last month. The disease is transmitted from animals to humans usually when people contact the bacteria through fresh water or mud that has been contaminated by the infected animals — commonly rats or mice — who urinate in the water or soil. People need to be aware of the danger of the bacteria in freshwater ponds, streams and catchment water and be careful to report unexplained fevers or illnesses that develop after such exposure to their doctors. Simon Hultman, 22, of Pahoa, became ill within a week of spending the holidays in Hawai'i. He had returned to college in Maryland where he was a senior in international studies. While he was home, he went hiking and swimming in various places, including Waipi'o Valley, a known source of leptospirosis. A state Health Department report on leptospirosis exposure from 1993 to 2002 indicates 28 cases developed after contact with the Waipi'o River, more than any single source in the survey. Hikers and swimmers most commonly contract the disease through cuts and scrapes. People are known to have reported the disease after swimming, jumping or diving into water, where it is believed the bacteria enters the body through water forced up through the nose. Simon Hultman's mother, Diane Hultman has said that health officials have said they are testing for dengue fever and leptospirosis as possible causes of her son's death. The U.S. Centers for Disease Control and Prevention estimates that half of the nation's annual 100 to 200 recorded cases of leptospirosis occur in Hawai'i. The CDC laboratory is analyzing test results in the Hultman case. The disease is more common in the tropics. People can be treated effectively for the disease with antibiotics if the diagnosis is made early. The number of diagnosed cases in Hawai'i has averaged about 44 annually with a high of 72 in 1997. The disease also has been linked to taro farmers and others who spent much time in the water. People should watch for fever, headaches, backaches, muscle aches after they have been in fresh water. The disease can take two to 30 days to show symptoms. Source: · Honolulu Advertiser, Feb 11, 2004, http://the.honoluluadvertiser.com/article/2004/Feb/11/ln/ln17a.html
Bird Flu Found in Four N.J. Markets A strain of bird flu has been found in four live chicken markets in northern New Jersey, just days after outbreaks at two farms in Delaware led to the destruction of thousands of birds. New Jersey health officials stressed that the findings are not unusual for the state's live poultry markets and said the strain is not known to be harmful to humans. The strain found in New Jersey is the same one found at two farms in Delaware since last week. The strain is not related to the virulent variety of avian influenza that is blamed for the deaths of at least 19 people in Vietnam and Thailand. Source: · CBS News, Feb 12, 2004, http://www.cbsnews.com/stories/2004/02/10/health/main599148.shtml
Breastfed Baby Exposed to Smallpox Vaccine Virus Breastfeeding women who live with someone who has been recently vaccinated against smallpox should take extra precautions to prevent their infants from being exposed to the virus used in the vaccine, according to a new report [Garde V, Harper D, Fairchok MP. Tertiary contact vaccinia in a breastfeeding infant. JAMA 2004; 291: 725-7, 11 Feb 2004 http://jama.ama-assn.org/cgi/content/abstract/291/6/725]. Doctors at the Madigan Army Medical Center in Tacoma, Washington, have documented the case of a breastfed infant who was exposed to vaccinia virus, which is used as the smallpox vaccine. The baby's mother had not been vaccinated against smallpox but her husband, a soldier, was given the vaccine soon before the baby developed symptoms. The Centers for Disease Control and Prevention (CDC) already recommends that women who are breastfeeding should not receive the smallpox vaccine, but there are no guidelines against vaccination of other people living in the same household. Transfer of the vaccinia virus within a household remains extremely rare, but this case demonstrates the need for extra precautions in households where a child is breastfeeding. About 10 days after the husband was inoculated, his wife developed blisters on her nipples. Shortly after, a blister was seen on the baby's upper lip. Testing showed that vaccinia virus was the cause of the lesions for both the mother and the child. Breastfeeding women living with vaccine recipients should be very careful about possible contact. They should always wash their hands prior to nursing, probably not do the laundry of the vaccine recipient, and potentially not sleep in the same bed or have other intimate contact until after the vaccine scab has fallen off. If a breastfeeding woman who lives with a recently vaccinated person develops painful sores on her breasts, she should discontinue breastfeeding until seeing a health care provider to make sure that the sores are not due to infection with the vaccine virus. The infant in the report recovered well, but she could have developed scarring or, if the infection had spread to her eyes, with vision loss. After being monitored in the hospital for 12 days, the child was discharged. Vaccinia virus is related to smallpox virus and produces immunity to smallpox. Smallpox vaccination can cause severe side effects, including brain damage and even death, in a small percentage of people, particularly children and people with weakened immune systems. But even if individuals who are at high risk of side effects are not given the vaccine, there are fears that they might be infected by vaccinia virus that is shed by others during the weeks after vaccination. Source: · Reuters Health, Feb 10, 2004, http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=4329142 · Promed Mail, Feb 12, 2004, http://www.promedmail.org/pls/askus/f?p=2400:1001:6380169991513964843::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ ID:1000,24438 WORLD CDC/WHO Travel Recommendations Regarding SARS The Centers for Disease Control and Prevention (CDC) have been working closely with the World Health Organization (WHO) and other international partners to track cases of severe acute respiratory syndrome (SARS). Since 16 Dec 2003, the Chinese Ministry of Health has reported 4 cases of SARS (3 confirmed and 1 probable). All 4 cases are from Guangdong, the same province where the first case of SARS in 2003 was confirmed in a 32 year old man and where the first cases of SARS were identified in November 2002. All 4 patients have recovered from their illness and have been discharged from the hospital. None of their contacts have developed SARS-like illness. The source of infection of the 4 patients is not known; however, SARS coronavirus (SARS-CoV), the virus that causes SARS, has been collected from cages that housed civet cats in the restaurant where one of the patients worked. The Chinese Ministry of Health continues to work in close collaboration with WHO to broaden the investigation and enhance surveillance throughout China. Currently CDC and WHO do not recommend that the general public avoid travel to any of the countries affected by SARS. Previous SARS research has shown that SARS can be controlled and contained through early detection, isolation of suspect cases, and tracing of their contacts. In addition, based on limited available data, it would be prudent for travelers to China to avoid going to live food markets and having direct contact with civets and other wildlife from these markets. Although there is no evidence that direct contact with civets or other wild animals from live food markets has led to cases of SARS, viruses similar to the SARS-CoV have been found in these animals, and some humans working with these animals have evidence of infection with SARS-CoV, or a very similar virus. Additional information about SARS for clinicians and the public can be found at the CDC SARS website (http://www.cdc.gov/ncidod/sars) and the WHO SARS website (http://www.who.int/csr/sars/en/index.html). Source: · Promed Mail, Feb 12, 2004, http://www.promedmail.org/pls/askus/f?p=2400:1001:6380169991513964843::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ ID:1000,24440 · CDC, Travelers' Health, Feb 10, 2004, http://www.cdc.gov/travel/other/sars_4th_case_021004.htm
Drug to Stop HIV Spread to Babies May be Harmful to Mothers The treatment used in poor countries to prevent the spread of HIV from mothers to their babies may make the women resistant to the AIDS drugs they may need later. In impoverished areas where the risk is greatest, researchers have settled on a simple, one-time treatment for HIV-infected pregnant women to keep them from passing the virus to their newborns. The treatment, using the drug nevirapine, is easy, inexpensive and effective, typically cutting the risk of HIV transmission in half. One study, conducted in South Africa, found that 39 percent of HIV-infected women who get nevirapine during pregnancy go on to harbor virus that is resistant to the drug. Another study, done in Thailand, shows the potential consequence: The mothers who eventually need drug treatment for their infection are much less likely than usual to respond to it. The discovery is not a complete surprise, since earlier studies have hinted at that problem. And for now, there is no alternative or option in most places, either for mothers or babies. The World Health Organization estimates that 40 million people are infected with the AIDS virus, 95 percent of them in developing countries. In some African countries, 40 percent of pregnant women have the virus. Last year, an estimated 700,000 children caught HIV. In the United States and Europe, pregnant women with HIV are routinely given combinations of powerful AIDS drugs throughout their pregnancy. This reduces the risk of passing the virus on at birth to near zero and minimizes the chance of developing resistance. In Africa and other places where this approach is not considered practical, the WHO has recommended giving a single dose of nevirapine when labor starts and then giving a second pill to the baby two days after birth. About 8 percent of babies catch the virus after nevirapine, compared with about 20 percent of those who get no treatment. Source: · CNN.com/Health, Feb 11, 2004, http://www.cnn.com/2004/HEALTH/conditions/02/10/aids.newborns.ap/index.html …………………………………………………………………………………… The Asia-Pacific Disease Outbreak/Surveillance News is meant for informational purposes only. As such, the Center of Excellence in Disaster Management and Humanitarian Assistance (COEDMHA) does not guarantee the accuracy or completeness of the information and of any statements or opinions based thereon. COEDMHA’s Pacific Disaster Management Information Network (PDMIN) team surveys, compiles and disseminates news reports from various publicly available newswires, websites, and health information networks including but not limited to the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and ProMed. Some information is presented in its original version. The information contained herein does not necessarily represent the views of the COEDMHA.