[leish-l] Fwd: PRO> ProMED Digest V2002 #158

[Fred R. Opperdoes]

>Date: Tue, 25 Jun 2002 23:57:35 -0400 (EDT)
>From: promed-digest-Owner at promed.isid.harvard.edu (ProMED Digest)
>To: promed-digest at promedmail.org
>Subject: PRO> ProMED Digest V2002 #158
>Sender: owner-promed at promed.isid.harvard.edu
>Reply-To: promed at promed.isid.harvard.edu
>
>
>ProMED Digest         Tuesday, June 25 2002         Volume 2002 : Number 158
>
>
>
>In this issue:
>
>         PRO> Smallpox outbreak, 1971 - Soviet Union (07)
>         PRO/EDR> Unexplained illness, foodborne? - Canada (Alberta)
>         PRO/AH> Leishmaniasis, visceral, new treatment
>         PRO/EDR> Unexplained illness, foodborne? - Canada (Alb.) (02)
>         PRO/EDR> CJD, iatrogenic dura mater graft - South Africa (02)
>         PRO/EDR> Dengue/DHF updates (24): 24 Jun 2002
>
>See the end of the digest for information on how to retrieve back issues.
>
>----------------------------------------------------------------------
>
>Date: Tue, 25 Jun 2002 11:37:42 -0400 (EDT)
>From: ProMED-mail <promed at promed.isid.harvard.edu>
>Subject: PRO> Smallpox outbreak, 1971 - Soviet Union (07)
>
>SMALLPOX OUTBREAK, 1971 - SOVIET UNION (07)
>***************************************
>A ProMED-mail post
><http://www.promedmail.org>
>ProMED-mail is a program of the
>International Society for Infectious Diseases
><http://www.isid.org>
>
>Date: Sun, 23 Jun 2002 20:11:54 -0600
>From: Alan P. Zelicoff <apzelic at sandia.gov>
>
>
>Re: Dr. Sauri's comments in the ProMED posting of 22 Jun 2002 [see
>ref. below].
>
>In the hope of identifying areas of clear agreement and highlighting
>important areas of disagreement where new policy may be necessary:
>
>First, and most important, I stated many times at the NAS presentation
>that the numbers in the Aralsk outbreak were small, and that even
>though they are statistically worrisome for unusual behavior of the
>virus, they account for only a small percentage of the variance we see
>in Aralsk versus any of the other smallpox outbreaks as regards the
>incidence of hemorrhagic disease or the ease of spread within
>households.
>
>What IS significant about the Aralsk outbreak is that this is the first
>demonstration of aerosol dissemination of smallpox over distances
>greater than tens of meters. Indeed, the apparent "travel distance" of
>smallpox exceeded by 3 orders of magnitude or more any other
>documented airborne propagation of the virus.
>
>Second, the clinical studies of the 1940s, 50s, and 60s (let alone those
>of hundreds of years ago) are devoid of any inferential statistical
>analysis (Fenner's book, for example, has not a single "p" value that I
>can find, and ditto for the work of Rao and many other orthopox
>researchers), and as noted by several of the speakers at the NAS
>meeting, the old data is often difficult to subject to such analysis due to
>problems with stratification (which is to say, mixing of disparate data
>from multiple locations).  This is precisely why I focused on Rao's
>work (it is as homogenous a dataset as we have), and therein lies the
>basis of my statistical calculations.  Weak as they are, they are the best
>we have, and suggest  -- but certain do not prove -- that something was
>odd about the virus in Aralsk.
>
>In addition, given the commentary of Pyotr Burgasov about a "special
>strain" being tested on Vozrozhdeniye Island (Dr. Henderson tells me
>he is a generally credible person despite his [statements] about the
>Sverdlovsk anthrax accident), I  believe it is legitimate to at least ask
>the question: are we dealing with something different than the strains
>that caused the documented outbreaks around the world?  The stakes,
>after all, are very high.
>
>Third, it is quite incorrect to state that the Aralsk data does not change
>the thinking on strategies for countering a terrorist attack utilizing
>aerosolized smallpox.  As every modeler noted at the NAS meeting,
>assumptions about the number of index cases dramatically affect the
>appropriate strategy -- especially if a better vaccine becomes available.
>Even if the virus is merely garden variety, the consequences of an
>aerosol release infecting thousands, and perhaps more, changes
>everything.
>
>Fourth, and most important, in no way did I recommend that current
>policy for acquisition of the 300 million doses of NYBH vaccine be
>changed. Further, after the ACIP announced its recommendation, I
>supported it fully on NPR's "Science Friday" program. It is the best
>hedge we have at the moment; which is another way of saying the
>vaccine is highly problematic and is best kept out of circulation in our
>[immunologically] heterogeneous population.
>
>Fifth, regarding the infants in Aralsk who acquired hemorrhagic
>disease.  In other outbreaks, this is decidedly rare (about 0.03 percent);
>if we really believe that host factors are more-or-less solely responsible
>for the clinical outcome of smallpox, should not infants have a high
>prevalence of hemorrhagic disease?  I don't know the way out of this
>conundrum, but I believe that it is reasonable  to conclude that variola
>biology and pathogenesis are much more complicated than our current
>state of knowledge suggests.
>
>In the end, here is where we disagree: on the one hand, [a position
>that] is comfortable trusting 200-year-old vaccine technology that has
>limited effectiveness (measured in years, at best), results in side effects
>in a substantial portion of the population, requires immobilization of
>large segments of society in the event of an outbreak with all of the
>attendant economic consequences, and which may or may not work if
>individuals inhale (literally) large numbers of virions.  I believe, on the
>other hand, that we can and ought to do better.
>
>Jahrling, Huggins and Daemon have identified several candidate anti-
>viral drugs and a promising animal model is being refined.  There is
>every reason to proceed with this pioneering work.  And, since
>vaccinology has only recently emerged as a science from the mysticism
>that characterized it until only a decade or so ago, I am confident we
>can design (and test) a vaccine that is far less reactogenic, much longer
>lasting, and perhaps even protective after large-scale mucosal exposure.
>
>I am grateful to ProMED-mail for providing a forum to debate the
>difficult questions surrounding smallpox.  This open discussion should
>have begun a long time ago.
>
>- --
>Al Zelicoff. MD
>Senior Scientist
>Centeer for National Security and Arms Control
>Sandia National Laboratories
>Albuquerque, NM
><apzelic at sandia.gov>
>
>[I think the 2 sides of the argument have been fairly stated in this and
>previous posts.  Policy decisions turn on whether we believe that the
>putative index case of the Aralsk outbreak really did become infected
>while on a boat several kilometers from land. There was an outbreak in
>Afghanistan that by October 1970 had spread to Mashad, in Iran, close
>to the (then) USSR border -- see Fig.23.5 on p.1089 in Fenner et al.
>1988, Smallpox and its Eradication, now online on the WHO website
><http://www.who.int/emc/diseases/smallpox/Smallpoxeradication.html>
>. That epidemic spread west all the way to Yugoslavia, so why not
>north also? Mashad has a direct road link to Aralsk. The USSR, having
>declared eradication in 1936, was unlikely to have publicly
>acknowledged any spread to its territory (it did not notify this outbreak
>to WHO).  The statistics of neither the Aralsk outbreak nor Rao's series
>appear to hold up, leaving the question of  the virulence of the Aralsk
>strain in doubt. And while I am sure that science is capable of
>developing smallpox-specific antivirals and a better vaccine, logic
>suggests that bioterrorists are not going to wait around for that to
>happen -- or even for countries (Canada & the UK besides USA, at last
>count) to make up their minds when and whom to immunize with the
>existing vaccine.
>
>This thread is now closed. - Mod.JW]
>
>[see also:
>Smallpox outbreak, 1971 - Soviet Union (06) 20020624.4588
>Smallpox outbreak, 1971 - Soviet Union (03) 20020621.4553
>Smallpox outbreak, 1971 - Soviet Union: revealed      20020615.4508
>Smallpox vaccine, ACIP recommendations - USA (02) 20020621.4560
>Smallpox vaccine, ACIP recommendations - USA      20020620.4542]
>....................................jw/pg/jw
>
>------------------------------
>
>Date: Tue, 25 Jun 2002 14:19:34 -0400 (EDT)
>From: ProMED-mail <promed at promed.isid.harvard.edu>
>Subject: PRO/EDR> Unexplained illness, foodborne? - Canada (Alberta)
>
>UNEXPLAINED ILLNESS, FOODBORNE? - CANADA (ALBERTA)
>******************************************************
>A ProMED-mail post
><http://www.promedmail.org>
>ProMED-mail is a program of the
>International Society for Infectious Diseases
><http://www.isid.org>
>
>Date: Mon 24 Jun 2002
>From: ProMED-mail <promed at promedmail.org>
>Source: Associated Press Online, Mon 24 Jun 2002 [edited]
>[Thanks to the many ProMED readers who forwarded this report]
>
>
>G-8 Summit Meeting: Outbreak of Illness Inside Security Zone
>- ------------------------------------------------------------
>Dozens of Royal Canadian Mounted Police (RCMP) officers working
>at the site of this week's G-8 summit meeting became nauseous early on
>Monday, and some were taken to a Calgary hospital. Constable Rob
>Dunnett of the RCMP said the officers at Nakiska camp, inside the
>security zone established at the Kananaskis resort where the summit
>begins on Wed 26 Jun 2002, "fell ill with symptoms commonly
>associated with food poisoning" during the night. He said 4 were sent
>to a hospital and "approximately 30" were treated at Nakiska camp.
>Those treated at the camp were isolated and their symptoms appeared
>to be improving, Dunnett said.
>
>The cause of the outbreak was unknown, Dunnett said. Doug Fraser, a
>spokesman for the Foothills Hospital in Calgary, about 55 miles east of
>Kananaskis, said 3 people were admitted with flu-like symptoms with
>another possibly on the way. Fraser was unable to confirm that those
>admitted were RCMP officers, due to confidentiality rules regarding
>patients. "From what I understand, they're sick. They've got nausea and
>vomiting," he said.
>
>Thousands of police and soldiers are based in the Kananaskis area for
>the 2-day summit of leaders of the world's industrial powers, including
>President Bush. The security forces have closed off the mountain
>resort, which is accessible by only one paved road. Vehicles entering
>the resort are searched at a series of roadblocks and then escorted by
>police.
>
>- --
>ProMED-mail
><promed at promedmail.org>
>
>[The description of this outbreak suggests that the illness could be the
>consequence of Norwalk-like virus infection, rather than malicious
>intent. NLV-contaminated food doesn't look or smell contaminated, nor
>does the water.  Summit food handlers should take special care not to
>spread infection to the world leaders. Further information would be
>appreciated. - Mod.MPP/JW]
>
>[see also:
>Norwalk-like viruses, control guidelines  20020620.4549
>Norwalk-like virus, decontamination methods (02)  20020617.4519
>Norwalk-like virus, decontamination methods  20020615.4497
>Norwalk-like virus, cruise ship - USA (Alaska) (02) 20020610.4462
>Norwalk-like virus, hospital outbreak - UK (England) 20020607.4434
>Norwalk-like virus, hospital o/b - UK (London) (02)   20020530.4364
>Unidentified fever, Br. troops - Afghanistan (06)    20020524.4313
>...............................mpp/cp/pg/jw
>
>------------------------------
>
>Date: Tue, 25 Jun 2002 15:00:51 -0400 (EDT)
>From: ProMED-mail <promed at promed.isid.harvard.edu>
>Subject: PRO/AH> Leishmaniasis, visceral, new treatment
>
>LEISHMANIASIS, VISCERAL, NEW TREATMENT
>***********************************
>A ProMED-mail post
><http://www.promedmail.org>
>ProMED-mail, a program of the
>International Society for Infectious Diseases
><http://www.isid.org>
>
>Date: 24 Jun 2002
>From: ProMED-mail <promed at promedmail.org>
>Source:  All Africa.com /UN Integrated Regional Information Networks
>[edited] <http://allafrica.com/stories/200206210120.html>
>
>
>New Hope for Treatment of Killer Disease Kala-Azar
>- --------------------------------------------------
>A new treatment has recently been developed for leishmaniasis, also
>known as [kala-azar &] black fever, a disease that each year afflicts
>some 500 000 people globally and kills at least 60 000. The United
>Nations' World Health Organisation (WHO) said in a statement this
>week that scientists had developed a new treatment found to be at least
>95 percent effective in [clinical trials in] patients who developed the
>more lethal "visceral" form of leishmaniasis.
>[see: <http://www.who.int/inf/en/pr-2002-46.html>]
>
>The new drug, Miltefosine, the first oral drug developed against
>leishmaniasis, has already been approved for use in India, which has
>half the global burden of the disease.  Miltefosine was developed
>[through a cooperative effort] by the Indian government, the German
>biopharmaceutical company Zentaris, the [WHO] Tropical Diseases
>Research program, the United Nations Development Programme and
>the World Bank.
>
>WHO Director-General Gro Harlem Brundtland noted "We now have a
>powerful new tool to fight this terrible disease. The combined efforts
>of these partners have opened a new era in the fight against visceral
>leishmaniasis."
>
>Considered one of the world's most neglected diseases, leishmaniasis --
>a parasitic "wasting" disease transmitted through the bite of a sandfly --
>afflicts some of the world's poorest people, with 80 percent of its
>victims earning less than US $2 a day. Until now, all treatments for
>leishmaniasis had had substantial drawbacks, ranging from high cost to
>high toxicity, and even causing irreversible damage such as diabetes,
>the WHO stated this week. The current treatment for one patient
>(Pentostam, antimony, amphotericin B or pentamidine) is prohibitive
>for most Sudanese sufferers from leishmaniasis; it can cost as much as
>250 000 Sudanese pounds (about $97), about 8 times the average
>monthly wage of a Sudanese government employee, according to US-
>based Program for Monitoring Emerging
>Diseases (ProMED-mail).
>
>The disease is found in parts of 88 countries, but about 90 percent of
>all black fever cases occur in 5 countries: India, Brazil, Sudan, Nepal,
>& Bangladesh. In the 1990s, Sudan suffered a crisis with 100 000
>deaths among people at risk, according to the WHO. WHO cited studies
>indicating that in some villages up to half the population succumbed to
>the disease, and said one report suggested that during this decade,
>visceral leishmaniasis claimed 100 000 lives in a population of around
>300 000 in western Upper Nile province.
>[see: <http://www.who.int/emc/diseases/leish/index.html>]
>
>In Sudan, where the visceral form is known as kala-azar, leishmaniasis
>is most common in the conflict-affected Blue Nile, Upper Nile, Jonglei,
>and Kassala regions, as well as in the area north of the capital,
>Khartoum. There are also indications that the disease is present in the
>Nuba Mountains region of Southern Kordofan State, south-central
>Sudan, according to humanitarian sources. Increasing disease activity
>has also been noted in the eastern state of Al-Qadarif, notably along the
>Rahad and Dinder Rivers, while activity -- formerly prevalent -- has
>been decreasing in Sinnar and Sinjah, according to ProMED-mail. The
>international medical organisation Medecins Sans Frontieres
>complained in February 2002 that systematic looting of the village of
>Nimne in oil-rich western Upper Nile had disrupted a kala-azar project
>with 107 patients under treatment and a basic health care unit with 1700-
>2000 consultations per month.
>
>Over 40 000 fatal cases were reported from the western Upper Nile
>between 1984 and 1991, and the death toll among the Nuer and Dinka
>peoples in southern Sudan was estimated at 200 000 between  1988 and
>1995, ProMED-mail added.
>
>- --
>ProMED-mail
><promed at promedmail.org>
>
>[Miltefosine (hexadecylphosphocholine) belongs to the drug family of
>alkyl-lysophospholipids (ALP), which has broad antiparasitic and anti-
>tumor activities. Leishmaniasis disease is often related to environmental
>changes such as deforestation, building of dams, new irrigation
>schemes, urbanisation, and migration of non-immune people to
>endemic areas, according to the WHO.
><http://www.who.int/emc/diseases/leish/leisdis1.html>
>
>The incidence of the disease is also severely underestimated, so that the
>actual health loss associated with it is greater than official figures
>suggest. - Mod.EP]
>
>[see also:
>Leishmaniasis, visceral - Vietnam (Quang Ninh)  20020125.3389
>Leishmaniasis, visceral - Kenya (Wajir) (06)  20000828.1439
>Leishmaniasis, visceral, bloodborne: RFI   19991125.2085
>Leishmaniasis, visceral & HIV - Europe (SW) (03)  19991118.2054
>Leishmaniasis, visceral, fatal - Brazil (Sao Paulo) (02)  19990722.1235]
>...........................mpp/ep/pg/jw
>
>------------------------------
>
>Date: Tue, 25 Jun 2002 15:29:43 -0400 (EDT)
>From: ProMED-mail <promed at promed.isid.harvard.edu>
>Subject: PRO/EDR> Unexplained illness, foodborne? - Canada (Alb.) (02)
>
>UNEXPLAINED ILLNESS, FOODBORNE? - CANADA (ALBERTA)
>(02)                  
>**************************************
>A ProMED-mail post
><http://www.promedmail.org>
>ProMED-mail is a program of the
>International Society for Infectious Diseases
><http://www.isid.org>
>
>Date: Tue 25 Jun 2002 07:11:35 +0000
>From:  "M. Cosgriff" <mcosgriff at hotmail.com>
>Source: ABC Newswire Tue 25 Jun 2002
><http://abcnews.go.com/wire/World/ap20020625_58.html>
>
>
>Police Officers Stricken With Nausea at G-8 Summit Site;
>Officials Rule Out Food Poisoning
>- ------------------------------
>Dozens of Royal Canadian Mounted Police officers working at the site
>of this week's G-8 summit became nauseous early Monday, and 3 were
>taken to a Calgary hospital.
>
>Constable Rob Dunnett of the RCMP said the officers at Nakiska camp,
>inside the security zone at the Kananaskis resort where the summit
>begins Wednesday, fell ill during the night. He said about 30 were
>treated at Nakiska camp. RCMP Constable Charlene Lewis said only 3
>officers were hospitalized, and one had been released while the other 2
>were being treated for dehydration.
>
>The cause of the outbreak was unknown. Officials initially said the
>symptoms were consistent with food poisoning, but authorities later
>ruled that out.
>
>"The regional health authority, the RCMP medical team, and the
>(Department of National Defense) medical team has taken a look at
>what those officers had to eat and they believe they could not find any
>source of contamination there in Kananaskis," Calgary police Insp.
>Murray Stooke said. "And so it's an open question as to where that
>source of contamination arose."
>
>Thousands of police and soldiers are in the Kananaskis area to provide
>security for the 2-day summit of world leaders, including President
>Bush.
>
>Security concerns have brought extraordinary attention to detail in
>planning the summit, with samples of food to be served the 8 heads of
>state being frozen for testing in case any of them get sick.
>
>- --
>ProMED-mail
><promed at promedmail.org>
>
>[The plot thickens. I wonder why they aren't testing the frozen food
>samples before serving -- alternatively, they could irradiate it all. 
>Conspiracy theorists please note; if this was a bioattack, then it was 36
>hours premature & the disability rate was only 30 out of several
>thousand police & soldiers. - Mod.JW]
>
>[see also:
>Unexplained illness, foodborne? - Canada (Alberta)   20020625.4599]
>..................................jw
>
>------------------------------
>
>Date: Tue, 25 Jun 2002 22:14:23 -0400 (EDT)
>From: ProMED-mail <promed at promed.isid.harvard.edu>
>Subject: PRO/EDR> CJD, iatrogenic dura mater graft - South Africa (02)
>
>CJD, IATROGENIC DURA MATER GRAFT - SOUTH AFRICA (02)
>********************************************
>A ProMED-mail post
><http://www.promedmail.org>
>ProMED-mail is a program of the
>International Society for Infectious Diseases
><http://www.isid.org>
>
>Date: Mon, 24 Jun 2002 09:21:06 +0200
>From: "Barry Schoub" <schoub at niv.ac.za>
>
>
>Unfortunately  inaccurate media reports have caused some confusion in this
>case. The patient, a 27-year old male, had received a human cadaveric dura
>mater graft, Lyodura (R), processed by B. Braun Melsungen AG, some 10 years
>ago. This particular brand of dura graft has been associated with a number
>of cases of iatrogenic Cruetzfeldt-Jakob disease in various countries (MMWR
>1987; 36(21) 324-325. MMWR 1989;38(3) 37-38,43) including a collection of 43
>cases from 1979 - 1996 in Japan (MMWR 1997; 46(45); 1066-1069).
>
>The clinical picture in this patient, whose condition is now grave, is
>characterised by severe myoclonic siezures and the EEG picture shows the
>pattern typical of classical CJD of triphasic periodic waves. The 14-3-3
>protein test on the patient's CSF (tested at the National CJD Surveillance
>Unit, Edinburgh) was strongly positive.
>
>There  is therefore nothing to suggest that the patient has nvCJD or that he
>had any exposure to bovine BSE. The evidence to hand suggests that this is a
>case of iatrogenic CJD probably acquired from a cadaveric dura graft 10
>years previously. A definitive diagnosis would need to  await the
>neuropathological report at necropsy.
>
>Finally, it should be pointed out that production of Lyodura was
>discontinued in 1996.
>
>- --
>Professor Barry D. Schoub
>Director
>National Institute for Communicable Diseases
>Private Bag X4
>Sandringham 2131
>South Africa
><schoub at niv.ac.za>
>
>[Many thanks to Dr Schoub for this authoritative clarification. Some
>journalists just can't seem to understand the distinction between classical
>CJD & nvCJD, confusing their readers. - Mod.JW]
>
>[see also:
>CJD, iatrogenic dura mater graft - South Africa: conf 20020625.4594
>CJD, iatrogenic dura mater graft - South Africa:susp  20020623.4576
>CJD risk & dura mater graft withdrawal - Canada 20020412.3943
>CJD risk & dura mater graft withdrawal - France 20020419.3992
>1997
>- -----
>CJD & dura mater transplants - Thailand      19971203.2418
>CJD & dura mater transplants - Japan (02)  19971120.2341
>CJD & dura mater transplants - Japan          19971117.2307]
>.................................jw
>
>------------------------------
>
>Date: Tue, 25 Jun 2002 23:57:35 -0400 (EDT)
>From: ProMED-mail <promed at promed.isid.harvard.edu>
>Subject: PRO/EDR> Dengue/DHF updates (24): 24 Jun 2002
>
>DENGUE/DHF UPDATES (24): 25 JUN 2002
>************************************
>A ProMED-mail post
><http://www.promedmail.org>
>ProMED-mail is a program of the
>International Society for Infectious Diseases
><http://www.isid.org>
>
>In these updates:
>[1] Philippines (Iloilo)
>[2] - [5] El Salvador
>[6] Vietnam
>[7] - [8] Brazil
>[9] Sri Lanka
>[10] Honduras
>[11] Mexico
>*****
>
>[1]
>Date: Mon 17 Jun 2002
>From: ProMED-mail <promed at promedmail.org>
>Source: The Sun Star, Mon 17 Jun 2002 [edited]
>http://www.sunstar.com.ph/news/news_article_affiliate.php3?id=2198
>
>
>Philippines: Dengue Fever Alert in Iloilo Province
>- ------------------------------------------------------
>As of last week dengue hemorrhagic fever has already afflicted 28 in the
>province of Iloilo, prompting health officials and Governor Niel D. Tupas
>Sr. to raise a dengue alert in the province. Tupas also called on residents
>to renew the practice of the "4 o'clock habit". The habit began in 1997
>following the serious spread of dengue hemorrhagic fever that claimed the
>lives of over 50 Ilonggos, mostly children. It calls residents to clean
>their surroundings to prevent the spread of mosquitoes carrying the virus.
>
>Provincial Health Officer Carmen Bayate calls the 4 o'clock habit "operation
>kaya-kulub (upside down)," turning water catchers that are potential
>breeding places upside down or draining them. Dr. Abayate reported to the
>Governor that the disease had already spread to 12 towns in the period from
>2 Jan to 9 Jun 2002. "This is not yet alarming considering that there are no
>deaths and that on the average 2 people only fell ill monthly," noted Tupas.
>During the height of the dengue epidemic 5 years ago, the Provincial
>Government had to use fumigating machines to kill mosquitoes, but this was
>discontinued after local authorities found the practice created more
>problems. It polluted the air and hurt not just mosquitoes but friendly
>organisms and people as well. It also only killed adult mosquitoes, not the
>eggs which subsequently hatched [into mosquitoes to] pester people anew
>within days of from the last fumigation.
>
>- --
>ProMED-mail
>promed at promedmail.org
>
>******
>[2]
>Date: Wed 19 Jun 2002
>From: Pablo Nart <p.nart at virgin.net>
>Source: Orlando Sentinel, Tue 18 Jun 2002 [edited]
>
>
>El Salvador: Sixth Death Reported
>- --------------------------------
>A 2-year-old boy here has died of dengue fever, the sixth victim of an
>epidemic that has spread to 14 of El Salvador's provinces since January
>2002, medical officials reported on Mon 17 Jun 2002. The boy died on Sunday
>morning at a children's hospital in the capital, doctors said. More than
>1200 cases of the mosquito-borne illness, most of them children younger than
>12, have been documented since January 2002, medical officials said.
>
>- --
>ProMED-mail
><promed at promedmail.org>
>
>[Children are most affected because many adults are already immune as a
>result of DEN-1 epidemics beginning in 1978. - Mod.JW]
>
>******
>[3]
>Date: Wed 19 Jun 2002
>From: Pablo Nart <p.nart at virgin.net>
>Source: Xinhua News Agency, Mon 17 Jun 2002 [edited]
>
>
>El Salvador: Assistance Arrives from Mexico
>- -------------------------------------------
>A delegation of doctors from Mexico, with equipment and medicine, has
>arrived in El Salvador to join the government campaign against the dengue
>fever epidemic which has claimed 6 lives and infected 1301 people in the
>Central American country.
>
>The aid group from the Mexican Health Ministry's Epidemiological Vigilance
>National Center, arrived on Sun 16 Jun 2002 in San Salvador, one of the 4
>states which the Salvadorian government declared emergency states earlier
>because of rampaging dengue. Another 27-strong task group, comprising
>physicians, biologists, laboratory specialists and fumigation technicians,
>is set to arrive on Monday [24 Jun 2002?] with fumigation equipment and
>insecticide to be used to eliminate the nesting grounds of the _Aedes
>aegypti_ mosquito, carrier and main transmitter of dengue fever.
>
>Of the 1301 cases of dengue fever reported so far, 101 were classed as
>dengue hemorrhagic fever. Last weekend 700 dengue-infected individuals went
>to the Benjamin Bloom National Children's Hospital to receive medical
>attention, and a similar situation was faced by other state and private
>medical centers.
>
>- --
>ProMED-mail
><promed at promedmail.org>
>
>[The reported 8% rate for dengue hemorrhagic fever seems rather high, (see
>reports from other countries below), but they may be counting anyone with a
>low platelet count & no other hemorrhagic symptoms. - Mod.JW]
>
>******
>[4]
>Date: Thu 20 Jun 2002
>From: Mr. Daniel B. Epstein <epsteind at paho.org>
>Source: Pan America Health Organization (PAHO), Situation Report, Wed 19 Jun
>2002 [edited]
>http://www.paho.org/spanish/hcp/hct/vbd/Dengue-page-spanish.htm
>
>
>Situation Report: Dengue Virus Type 1 Present in El Salvador
>- ------------------------------------------------------------
>To date, 6 deaths caused by dengue hemorrhagic fever (DHF) have been
>registered. Dengue virus type 1 has been identified in the country, which
>increases the risk of a greater number of cases of dengue hemorrhagic fever.
>
>PAHO/ELS is assisting the emergency dengue response system with 2
>professionals and monitoring closely the situation.
>
>- --
>ProMED-mail
>promed at promedmail.org
>
>[There is inconclusive evidence that DEN-1 following on a previous epidemic
>of another dengue virus strain causes a higher rate of DHF than other
>combinations. El Salvador suffered epidemics due to DEN-2 in 1987, DEN-3 in
>1991 & DEN-4 in 1982. The first DHF cases appeared in the country during the
>DEN-2 epidemic of 1987, 9 years after DEN-1 & 5 years after DEN-4 hit. -
>Mod.JW]
>
>******
>[5]
>Date: Tue, 25 Jun 2002 00:10:18 -0700
>From: "Pablo Nart" <p.nart at virgin.net>
>Source Europa Press, 24 Jun 2002 [translated & edited by JW]
><http://www.europapress.es/>
>
>
>The Ministry of Health of El Salvador reports 1584 cases of dengue from 1
>Jan - 22 Jun 2002. This includes 1472 cases of classical dengue & 112 of
>dengue hemorrhagic fever, with 5 deaths.
>
>On Sat 22 Jun 2002 the number of suspected cases fell to 303, which was 97
>less than the day before. The number of households with mosquito larvae fell
>from 69 percent to 17 percent after the recent health education campaign.
>
>El Salvador has declared a state of emergency because of the disease in the
>Departments of Cabanas, La Libertad, Santa Ana & San Salvador. In the
>capital the number of cases has exceeded the capacity of the principal
>hospital that takes care of dengue patients.
>
>- --
>ProMED-mail
><promed at promedmail.org>
>
>******
>[6]
>Date: Wed 19 Jun 2002
>From: Pablo Nart <p.nart at virgin.net>
>Source : Vietnam News Briefs (via Newsline), Mon 17 Jun 2002 [edited]
>
>
>Vietnam: Outbreak of Dengue Fever in Southern Provinces
>- -------------------------------------------------------
>Southern provinces reported 2528 people infected with dengue fever including
>5 deaths in the first 4 months this year [2002], according to the Ministry
>of Health (MoH).
>Ho Chi Minh City and the provinces of Dong Nai, Tien Giang, An Giang, and
>Binh Phuoc recorded the highest number of dengue fever patients. The MoH has
>urged all 19 provinces in the south to work out measures to cope with the
>disease.
>
>- --
>ProMED-mail
><promed at promedmail.org>
>
>******
>[7]
>Date: Tue 18 Jun 2002
>From: ProMED-mail <promed at promedmail.org> via ProMED-PORT
>Source: Goias Agora, Fri 7 Jun 2002 (trans. by Mod.MPP) [edited]
>http://www.noticias.goias.gov.br
>
>
>Brazil (Goias): Number of Cases Down But Transmission Not Interrupted
>- ---------------------------------------------------------------------
>Since Jan 2002, 23 681 cases of classical dengue and 222 cases of dengue
>hemorrhagic fever (DHF) were reported in the state of Goias, of which 49
>were confirmed. There were 8 deaths suspected to be due to dengue -- 3
>deaths were confirmed as due to DHF and 2 were due to classical dengue with
>complications.
>
>In spite of a dry season, various municipalities in Goias continue to have
>transmission of dengue. The Coordinator of the State Dengue and Yellow Fever
>control program, Gediselma Lima Borges, affirmed that while the number of
>cases of dengue was reduced following the end of the rainy season,
>transmission has not been interrupted. "At this moment it is extremely
>important that the municipal directors structure the health units to ensure
>that diagnosis and treatment of cases will occur when there is an increase
>with the return of the rains."
>
>She explained that the tendency, from now onwards, is that there is a
>greater incidence of the more severe forms of the disease, with hemorrhagic
>fever [DHF] and classical dengue with complications. This is due to several
>reasons: an increase in people who have already had a prior infection,
>greater mosquito density and circulation of 3 serotypes [of dengue virus].
>
>The municipalities that continue to have dengue transmission are: Anapolis,
>Aparecida de Goiania, Caldas Novas, Goiania, Guarani de Goias, Minacu, Padre
>Bernardo, Rio Verde, Santa Teresinha de Goias, and Santo Antonio do
>Descoberto.
>- --
>
>ProMED-mail
><promed at promedmail.org>
>
>******
>[8]
>Date: Sat 22 Jun 2002
>From: <ProMED-PORT at promedmail.org>
>Via: Marilda A Kersul de Brito Milagres <mkmilagres at ig.com.br>
>Source: Parana-Online 20 Jun 2002 <http://www.parana-online.com.br>
>[translated & edited by JW]
>
>
>The weekly report of 19 Jun 2002 from the Health Secretary of Parana State
>showed new cases of dengue in Sarandi (75), Iguassu Falls (39), Maringa (37)
>& Londrina (27). These cities are mainly in the north, northwest & west of
>the state.
>
>- --
>ProMED-mail
><promed at promedmail.org>
>
>*****
>[9]
>Date: Thu 20 Jun 2002
>From: Pablo Nart <p.nart at virgin.net>
>Source: Xinhuanet, Mon 17 Jun 2002 [edited]
><http://202.84.17.73:7777/Detail.wct?RecID=4&SelectID=2&ChannelID=6034&Page=
>1>
>
>
>Sri Lanka: Further Spread of Dengue Fever
>- ----------------------------------------
>Dengue fever has spread in Sri Lanka, with over 2000 positive cases
>identified in May and 15 deaths reported, according to the Health Ministry
>as of Mon 17 Jun 2002. A further 3400 suspected cases of dengue fever have
>been reported from different parts of the country since the beginning of
>this year, with 35 cases in Colombo city. The highest numbers of dengue
>cases this year have been reported from the Gampaha district near the
>capital Colombo.
>
>In 2000 the epidemic reached its height when over 6000 suspected cases were
>hospitalized throughout the country, and 35 lives were lost.
>
>A change in weather patterns and heavy rains after a long spell of drought,
>allowing mosquitoes to breed freely, is considered one of the causes for the
>spread of the disease
>
>- --
>ProMED-mail
><promed at promedmail.org>
>
>******
>[10]
>Date: 25 Jun 2002
>From: ProMED-PORT <promed-port at promedmail.org>
>Source: GloboNews 25 Jun 2002 [translated & edited by JW]
><http://globonews.globo.com/GloboNews>
>
>
>The Honduran Minister of Health, Eliaz Lizardo, reported today that around
>3110 cases of classical dengue & 108 of dengue hemorrhagic fever have been
>registered in the first half of 2002. The weekly average of cases of
>classical dengue is now 150, which is a drop from the 215 cases per week
>registered 2 months ago.
>
>- --
>ProMED-mail
><promed at promedmail.org>
>
>*****
>[11]
>Date: Sun 23 Jun 2002
>From: <ProMED-PORT at promedmail.org>
>Via: Pablo Nart <p.nart at virgin.net>
>Source: EUROPA PRESS 21 Jun 2002 <http://www.europapress.es>
>[translated & edited by JW]
>
>
>More than 400 cases of dengue, including 57 of dengue hemorrhagic fever
>(none fatal), have been notified during 2002 in Colima state, 490 km west of
>the Mexican capital, mainly in Manzanillo municipality, as reported by
>Beatriz Torres, District Health Secretary. This is less than the 4881
>reports of classical dengue & 59 of DHF registered in 1997.
>
>An intense campaign has checked 54 895 households, of which 27 785 had to be
>treated because of larvae of the mosquito 'Aedes aegypti'. DEN-3 virus was
>responsible for the epidemics of the last 3 years, but the current strain is
>DEN-2.
>
>Recently the health authorities of the southern state of Chiapas, bordering
>Guatemala & one of the poorest in Mexico, reported that in the first 5
>months of 2002 they had detected 38 cases of dengue, including 9 of DHF.
>
>- --
>ProMED-mail
><promed at promedmail.org>
>
>[see also:
>Dengue/DHF updates (01): 14 Jan 2002 20020115.3265
>Dengue/DHF updates (23): 17 Jun 2002 20020617.4518
>Dengue/DHF - Honduras 20020103.3153
>2001
>- ----
>Dengue/DHF updates (01): 8 Jan 2001 20010108.0064
>Dengue/DHF updates (21): 18 Dec 2001 20011218.3058
>Dengue - Brazil 20011018.2566
>Dengue/DHF - Vietnam 20010527.1033
>Dengue/DHF - Vietnam (02) 20010924.2315
>Dengue/DHF - Vietnam (03) 20011229.3128
>2000
>- ----
>Dengue - Sri Lanka (south): alert 20001102.1914
>Dengue/DHF - Indonesia, Honduras 20000615.0974
>Dengue/DHF - Philippines & El Salvador 20000701.1087
>1999
>- ----
>Dengue, control - Philippines 19990712.1171
>Dengue, control effort - Vietnam 19990711.1167
>Dengue/DHF - El Salvador 19991025.1925
>Dengue/DHF - El Salvador (02): Alert 19991103.1970
>Dengue/DHF - El Salvador (02): COMMENT 19991123.2078
>Dengue/DHF - Honduras 19990318.0406
>Dengue/DHF - Honduras (07) 19991119.2057
>Dengue/DHF - Honduras: background 19991017.1843
>Dengue/DHF - Philippines (Luzon) 19990731.1301
>Dengue/DHF - Philippines (Pangasinan) 19990925.1712
>Dengue/DHF - Philippines: background 19990519.0824, 19990522.0843
>Dengue/DHF - Sri Lanka 19990730.1289
>Dengue/DHF - Sri Lanka (02) 19990809.1384
>Dengue/DHF - Vietnam 1998 summary 19990404.0539]
>......................mpp/cp/pg/jw
>
>------------------------------
>
>End of ProMED Digest V2002 #158
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