NEWS AND NOTES

(Pages 71-72)

Another Human Case of Equine Morbillivirus Disease in Australia

Another human case of equine morbillivirus (EMV) disease has
occurred in Australia. The patient was a 35-year-old farmer, who
lived near Mackay, in northern Queensland. He died in the Royal
Brisbane Hospital on October 21, 1995 (1). The patient was
probably infected with the novel virus 12 months before his
death approximately the time of the first reported outbreak of
EMV.

A hitherto unknown infectious disease, EMV was first observed in
Brisbane, Queensland, in September 1994, when an outbreak of
acute respiratory disease in horses at three stables in Hendra, a
Brisbane suburb, was reported (2). In a 2-week period, 14
racehorses and two persons at the stable contracted the disease.
One of the human cases and some of the equine cases were fatal. A
total of 21 horses were infected with the virus. Fourteen horses
died as a result of clinical illness (they either died from the
infection or were euthanized). The remaining horses had either
symptomatic or asymptomatic infection and were euthanized.

The cause of infection in the recent case has been confirmed as
EMV at the Australian Animal Health Laboratory in Geelong through
the testing of samples taken from the patient before he died  (I.
Douglas, Australian Communicable Disease Service; PROMED).

The Mackay patient was married to a veterinary surgeon. The
couple bred horses and grew sugar cane. In August 1994 (a month
before the outbreak of EMV in southern Queensland), two horses
died on the couple's property. The veterinary surgeon, assisted
by her husband, performed autopsies on the two animals. The
diagnoses, based on these autopsies, were "avocado poisoning" and
"brown snake bite," respectively (1).

In August-September 1994, soon after the death of the horses, the
husband became ill with a mild meningoencephalitis, which
improved with antibiotics. Cerebrospinal fluid examination showed
a neutrophilic pleocytosis suggestive of a viral infection (1).
Serum collected at the time of the examination and stored was
found to contain a low but significant titer of antibody to EMV.

The patient appeared to have recovered; however, he was admitted
to the hospital 5 weeks before his death with signs of
encephalitis. Evidence of EMV infection included a high serum
neutralizing antibody titer against the virus and a positive
polymerase chain reaction (PCR) test of cerebrospinal fluid
collected before his death. Tests of autopsy specimens confirmed
the infection.

Direct fluorescence antibody and PCR tests of fixed tissue blocks
from one of the horses at the Australian Animal Health Laboratory
have confirmed that it was infected with EMV (I. Douglas,
PROMED). However, it is likely that both horses were infected.
The Mackay patient's symptoms were predominantly neurologic. He
displayed no respiratory symptoms until aspiration pneumonia 
developed. By contrast, the major clinical symptoms of EMV in
Hendra were respiratory.

No recent outbreaks of clinical illness have been reported in the
horses on the Mackay property or elsewhere in Queensland since
the 1994 outbreak. Also, investigation has not shown a link
between the horses on the Mackay property and those in the Hendra
stables. A serologic survey of over 2,000 horses, undertaken in
1994 after the Hendra outbreak, yielded negative results. That
survey included more than 200 horses in the
Mackay/Rockhampton/Townsville areas. Similarly, the Queensland
veterinary authorities  have obtained samples from more than
3,000 animals from 294 populations (including farms, race
meetings, and horse events) since October 23, 1995; 2,349 of the
samples have been tested, all with negative results. Moreover,
blood samples recently taken from all the domestic animals on the
Mackay property, including approximately 90 horses, have been
tested for virus by the Animal Health Bureau, Queensland
Department of Primary Industry and Energy. All results were
negative.

An extensive epidemiologic investigation is being conducted by
the Queensland Department of Health and the Department of Primary
Industry and Energy. All persons who may have had exposure to the
virus in either episode have been tested for EMV infection and
had negative results (1). No serologic evidence of further human
infection has been found.

No human-to-human transmission of EMV has been reported. It is
believed that the disease is spread through contact with the body
fluids of infected sick or dying animals.

References
l. Allworth T, O'Sullivan J, Selvey L, Sheridan J. Equine
morbillivirus in Queensland. Communicable Diseases Intelligence
1995;19:575.
2. Murray K, Rogers R, Selvey L, Selleck P, Hyatt A, Gould A, et
al. A novel morbillivirus pneumonia of horses and its
transmission to humans. Emerging Infectious Diseases 1995;1:31-3.



(Page 72)

Social Science and the Study of Emerging Infectious Diseases

Topics related to emerging and reemerging infectious diseases
attracted a considerable audience at the annual meeting of the
American Anthropological Association, November 15 19, 1995, in
Washington, D.C. The meeting had a separate session entitled
"Emerging and Reemerging Infectious Diseases: Biocultural and
Sociocultural Approaches."

The session brought together anthropologists interested in and
working on emerging infectious diseases from various
subdisciplinary perspectives. Presentations were made on the
following subjects: outline of a research agenda, deforestation
and the emergence of infectious diseases in the rain forests of
Papua-New Guinea, the cholera epidemic in Latin America,
evolutionary aspects of emergent infections, societal impacts of
the test for acquired immunodeficiency syndrome, compliance and
iatrogenesis in tuberculosis treatment in the United States,
patchwork policies that affect long-term treatment of
tuberculosis in Nepal and Uganda, the reemergence of
schistosomiasis in Egypt, dengue control in Latin America,
cultural and political ecologic models of emergent infections,
and the politics of leprosy eradication. Abstracts are available
from the conference organizers, listed below.

Anthropologists interested in international health and the social
science aspects of infectious diseases are organized in a working
group called the International Health and Infectious Disease
Study Group of the Society of Medical Anthropology (American
Anthropological Association). Requests to subscribe to this
group's newsletter can be sent to

Johannes Sommerfeld
Harvard Institute for International Development
Cambridge, Massachusetts, USA
Phone: 617-495-9791
E-mail: jsommerf@hiid.harvard.edu

Sandra Lane
Case Western Reserve University
Cleveland, Ohio, USA
E-mail: sxl45@po.cwru.edu



(Pages 72-73)

WHO Establishes New Rapid-Response Unit for Emerging Infectious
Diseases

The World Health Organization (WHO) has established a new
rapid-response unit to control and prevent the growing incidence
of new and reemerging diseases worldwide. The unit's focus will
be improved containment of disease outbreaks, such as that caused
by the deadly Ebola virus, which struck Zaire in 1995.

The WHO unit will be called the Division of Emerging Viral and
Bacterial Diseases Surveillance and Control (EMC). It will be
capable of mobilizing staff from WHO headquarters in Geneva and
from the organization's regional offices.

In addition to mobilizing WHO's own technical staff and
expertise, EMC will coordinate the activities of the agency's
traditional partners, for example, its international network of
collaborating centers, bilateral donors, expert advisers, and
nongovernmental organizations.

Teams equipped to implement epidemic control measures will be
placed on-site within 24 hours' notification of an outbreak. This
strategy, when implemented in Zaire, not only rapidly contained
the recent Ebola outbreak but also prevented its spread to
Kinshasa, the capital city of 2 million.

Among EMC's goals are 1) to strengthen local surveillance and
disease control so that countries can develop the early warning
systems needed to detect emerging or reemerging diseases through
innovative field epidemiology and public health laboratory
training programs and 2) to continue WHO's activities in
developing a network of public health laboratories to strengthen
regional and international collaboration in outbreak detection
and control.

EMC will continue to expand WHO's network termed WHONET that
detects and monitors antibiotic resistance worldwide. WHO will
use the information collected to continue to advocate research
and development of new antibiotics to replace those that are no
longer effective.

For further information on WHO's rapid-response unit, contact

Philippe Stroot
Health Communications and Public Relations
World Health Organization
Geneva, Switzerland
Phone: 41-22-791-2535
Fax: 41-22-791-4858


(Page 73)

Rotavirus Vaccine Workshop Held

More than 125 participants from at least 15 countries attended
the Fifth Rotavirus Vaccine Workshop at the Centers for Disease
Control and Prevention (CDC) in Atlanta, Georgia, October 16-17,
1995.

Rotavirus has emerged as the most important cause of severe
diarrhea in children worldwide. It is a problem not only in
developing countries, where it kills an estimated 870,000
children each year, but also in the United States, where it
remains the most important single cause of hospitalization or
clinic visits for childhood diarrhea.

Moreover, although studies from many countries indicate that only
four serotypes are predominant worldwide, some strains at every
site studied cannot be serotyped. In some countries such as
India, the diversity of strains is extensive. Further studies are
needed to define the extent of cross-protection against these
strains that is induced by the vaccine to determine whether
additional antigens need to be included in vaccines for such
areas.

This workshop included sessions on epidemiology, virology,
pathogenesis and immunity, and vaccines currently being tested.
Each session had numerous presentations by leaders in the field
of rotavirus research. Researchers reported that several live
oral rotavirus vaccines, based on animal strains of rotavirus
combined with reassortant strains, have been tested in field
trials in children. These appear to protect American children
against rotavirus and are more efficacious against severe
disease. These vaccines like natural protection, are not 100%
protective so many investigators are exploring alternative
approaches to vaccines such as the use of virus-like particles,
native DNA, and microencapsulation of antigens.

No published volume of proceedings from the workshop is planned,
but a supplemental issue of the Journal of Infectious Diseases
scheduled for early 1996 will contain papers from the meeting.

The workshop was held under the auspices of the National
Institutes of Health, Emory University School of Medicine, and
the World Health Organization.

For further information, contact

Roger I. Glass
Global Program for Vaccines and Immunizations
World Health Organization
Geneva, Switzerland
Phone: 41-22-791-2698/2681
Fax: 41-22-791-4860



(Pages 73-74)

International Conference Addresses Preparedness for Emerging
Strains of Pandemic Influenza

An international meeting on pertinent issues related to
recognizing, identifying, and controlling newly emerging strains
of pandemic influenza was held in Bethesda, Maryland, December
11 13, 1995. The conference, "Pandemic Influenza: Confronting a
Reemergent Threat," was sponsored by the National Institutes of
Health, the University of Michigan, the Centers for Disease
Control and Prevention, the Food and Drug Administration, the
U.S.-Japan Cooperative Medical Science Program, and the World
Health Organization.

Epidemic strains of influenza cause infections almost every year
throughout the world because of continuous minor genetic changes
in the virus. However, periodically a major change occurs, such
as reassortment between mammalian and avian strains of the virus.
These pandemic strains are novel to the human immune system and,
therefore, can cause substantial disease worldwide. The
conference concentrated on issues that would be crucial to
controlling an influenza pandemic.

Plenary and workshop sessions examined the following topics: Can
pandemics be predicted? What are the specific approaches for
pandemic control? What are the advantages and limitations of
vaccines and antiviral agents? The workshops also focused on
factors contributing to the emergence of pandemic strains and
various aspects of surveillance, such as the adequacy of current
global surveillance structure for early identification of a
pandemic strain, the use of virologic and epidemiologic
surveillance once a strain is identified, and the rapid exchange
of information globally. The following immunologic and molecular
questions were addressed as well: What basic research advances
would allow us to respond more rapidly after the next human -
pandemic strain is detected? Is the presence of novel influenza A
virus in pigs a predictor of the next influenza pandemic? Is an
H2 influenza virus the next human pandemic subtype or are H7
viruses equally possible? Also discussed were the practical
issues of vaccine needs, production, and distribution.

Conference participants then reviewed international pandemic
plans and the U.S. pandemic plan being prepared by the Federal
Interagency Group on Pandemic Preparedness.

Dominick A. Iacuzio
Division of Microbiology and Infectious Diseases
National Institutes of Health
Bethesda, Maryland, USA



(Page 74)

Course Offered on Clinical and Pathologic Features of Emerging
Infections

The Armed Forces Institute of Pathology (AFIP), Emory University,
and the Centers for Disease Control and Prevention (CDC) are
cosponsoring a course on emerging and reemerging pathogens. The
course will be taught in Atlanta, Georgia, from April 27 to May 1
and will discuss the epidemiology, clinical features, pathology,
and pathogenesis of such diseases as plague, Lyme disease, Kaposi
sarcoma, microsporidiosis, Buruli ulcer, ehrlichiosis, hantavirus
pulmonary syndrome, and Ebola virus infection. Emerging drug
resistance in pneumococci and other streptococcal infections will
also be discussed.

The course is designed for pathologists, epidemiologists,
infectious disease physicians, veterinarians, microbiologists,
parasitologists, and others interested in the pathology as well
as the emergence of infectious diseases. The course, to be held
at the Emory Conference Center Hotel, will provide 38 hours of
Category I CME credit and will consist of 32 hours of lectures
with open discussion periods, 6 hours of glass and color slide
review, and a visit to CDC laboratories. For more information,
contact the course director, Center for Advanced Medical
Education, AFIP, Washington, D.C. 20306-6000 (phone: 800-577-3749
or 301-295-7921; fax: 301-427-5001).

C. Robert Horsburgh, Jr.
Emory School of Medicine
Atlanta, Georgia, USA


(Page 74)

NASA Sponsors Symposium on Remote Sensing and Control of
Insect-Transmitted Diseases 

Health officials and disease control experts met November 28-30
in Baltimore, Maryland, for a symposium on the use of satellites
to monitor and control insect-transmitted diseases.

Sponsored by the National Aeronautics and Space Administration
(NASA) and the Third World Foundation of North America, the 
symposium was held to inform government officials from various
countries of NASA's scientific and technologic capabilities for
detecting, monitoring, and improving the control of diseases.
Health ministers and medical directors from more than 20
countries, including Bangladesh, Belize, China, Ghana, Indonesia,
Kenya, Malaysia, Nigeria, Peru, and Rwanda, attended.

The symposium featured discussions on the economics of disease
surveillance, deforestation, and urbanization. The keynote
address, "The resurgence of vector-borne infectious diseases as
major public health problems in the 1990s," was given by Duane
Gubler, director, Division of Vector-Borne Infectious Diseases,
National Center for Infectious Diseases, Centers for Disease
Control and Prevention (CDC). Participants also discussed
possible joint activities between NASA and interested countries.
Further information can be obtained from NASA's Office of Life
and Microgravity Sciences, Washington, D.C., which manages the
agency's global monitoring and human health research program in
conjunction with the National Institute of Allergy and Infectious
Diseases, National Institutes of Health, and CDC. 

Michael Braukus
National Aeronautics and Space Administration
Washington, D.C., USA

Raj Khanna 
Third World Foundation of North America
College Park, Maryland, USA



(Page 75)

CDC Convenes Meeting to Discuss Strategies for Preventing
Invasive Group A Streptococcal Infections

Since the mid-1980s, the epidemiology of invasive group A
streptococcal (GAS) infections in the United States and worldwide
has changed, and the incidence of invasive infections,
streptococcal toxic shock syndrome (strep TSS), and necrotizing
fasciitis has increased. These changes may be the result of a
shift in GAS M-types and a corresponding increase in strains that
produce certain pyrogenic exotoxins. Recognizing the importance
of monitoring changes in the occurrence of severe group A
streptococcal disease, the Council of State and Territorial
Epidemiologists recommended in April 1995 that invasive GAS
infections and strep TSS be added to the National Public Health
Surveillance System.

Most invasive GAS infections occur sporadically and are acquired
in the community. For these cases, preventing illness and death
depends on improving recognition and treatment. Primary
prevention of invasive GAS disease may be more feasible for
infections that are acquired in institutions (such as hospitals
and nursing homes) and for secondary cases that occur among
contacts of persons with invasive disease. Most nosocomial
infections (for example, wound infections, postpartum
endometritis, and sepsis) occur in surgical or obstetric
settings, or are associated with intravenous catheters. Secondary
invasive disease in the community is uncommon, although studies
of household contacts of those with GAS infectionshave found a
substantially increased risk for infection in this group. GAS
infections spread easily from person to person after contact with
respiratory secretions of an infected person and have
traditionally caused epidemics of pharyngitis, scarlet fever, and
rheumatic fever. Recently, clusters of invasive infections have
been reported in families, hospitals, and nursing homes;
community-wide outbreaks have also been reported.

As state health departments initiate surveillance for invasive
GAS disease and strep TSS, guidelines for prevention will help in
interpreting these data and in formulating a public health
response. CDC convened a meeting of experts from academia and
public health (October 10-11, 1995), to discuss existing data and
strategies for preventing invasive GAS disease in institutions
and the community. Discussions centered on the magnitude of risk
for secondary disease among close contacts of persons with
invasive infection and the potential for preventing disease by
chemoprophylaxis, and on approaches for investigating and
preventing infections in institutions. Recommendations are being
developed, and the conclusions of the participants will be
presented at a later date.

The Working Group on Prevention of Severe Group A Streptococcal
Infections*
National Center for Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia, USA

*The members of the Working Group on Prevention of Severe Group A
Streptococcal Infections are Gus Birkhead, New York State
Department of Health; John Brundage, U.S. Army; Matt Cartter,
Connecticut State Department of Health; Mike Gerber, University
of Connecticut; Walter Hierholzer, Yale University; Ed Kaplan,
University of Minnesota; Kris MacDonald, Minnesota Department of
Health; Dennis Stevens, V.A. Medical Center, Boise, Idaho; Karen
Green and Allison McGeer, Princess Margaret Hospital, Toronto,
Ontario, Canada; Stan Shulman and Ram Yogev, Children's Memorial
Hospital, Chicago, Illinois; Richard Facklam, Julia Garner,
William Jarvis, Orin Levine, Benjamin Schwartz and Jay Wenger,
CDC.


(Pages 75-76)

Regional Conference on Emerging Infectious Diseases Sparks Plan
for Increased Collaboration

The World Health Organization (WHO), the Naval Medical Research
Unit Three (NAMRU-3), and the Centers for Disease Control and
Prevention (CDC) jointly sponsored the first conference in the
region on issues of emerging and reemerging infectious diseases
for members of WHO's Eastern Mediterranean Regional Office
(EMRO). The meeting was held in Cairo, Egypt, November 26-29,
1995. Delegates from the WHO South-East Asia Regional Office and
African Regional Office also participated.

The meeting brought together persons representing key resources
that have begun working together to organize a regional program
of laboratory assistance and enhanced surveillance communications
for infectious diseases. Participants included WHO infectious
disease program officers and key personnel from WHO collaborating
centers, national reference laboratories, national infectious
disease programs, ministries of health, and university public
health programs.  Thirty countries were represented by more than
200 participants. On the final day of the conference, the
participants adopted a regional plan of action for strengthening
surveillance, laboratory capabilities, and communications.

To begin this cooperative effort, a 1-day meeting of WHO-EMRO
collaborating centers was convened on November 30.
Representatives from six EMRO collaborating centers attended as
well as representatives from WHO-EMRO, WHO headquarters, CDC, the
Naval Medical Research Institute in Washington, D.C., and the
Battelle Foundation.

Participants noted that WHO collaborating centers are an
excellent resource for the implementation of programs to address
emerging infections because they represent some of the most
competent and experienced diagnostic and reference capacities in
the region.  However, the representatives agreed that the
relationships among the collaborating centers themselves are not
well developed.  Many were unaware of the existence or
capabilities of most other regional collaborating centers and
most had no regular communications or interactions with other
collaborating centers.  All welcomed closer ties with an increase
in communication, collaboration, and interaction.

The participants unanimously approved a recommendation to
establish an Association of EMRO collaborating centers composed
of representatives from each WHO collaborating center within the
region. Member organizations of the association will work
together, in coordination with EMRO, to address the complex needs
of surveillance, laboratory diagnostics, and disease reporting of
emerging infections at the local and regional level.

Bradford A. Kay
Naval Medical Research Unit 3
PSC 452, Box 112
FPO AE 09835