Combating Infectious Disease & Toxin Outbreaks,

Natural & Man-made, through the Internet

Jack Woodall

Dept. of Medical Biochemistry

Institute of Biomedical Sciences

Federal University of Rio de Janeiro

ProMEDProgram for Monitoring Emerging Diseases<www.promedmail.org>

e-mail list & website, began 1994 free subscribing 30,000 subscribers (as of Nov.2004) 150+ countries 20,000+ archives (full text search)

SARS, first report, 2003************************* To: ProMED Date: 10 Feb. 2003

“Have you heard of an epidemic in Guangzhou? ... An acquaintance... lives there & reports that the hospitals ... have been closed & people are dying.”

-- Stephen O. Cunnion, MD, PhD, MPH

ProMED: Pneumonia, pediatric China (Shanghai): RFI

Date: 2 Nov 2004my son Rahim Muhammad was transferred from Shnghai Childr HOsp (Beijing Road) to Fudan Hosp ICU even though the day b4 it was said he was too weak and critical to move. Now 5 children died in the same unit.

My child hasnt been able to get over his pneumonia, even though he has been receiving the best treatment possible after my US embassy got involved… We had traveled on country bus to arrive in Shangh from Guandong the fews days prior to his hospitialization.

ProMED: Pneumonia, pediatric China (Shanghai): (02)

Date: 3 Nov 2004 From: Yang Li yangli@neuro-hemin.com Sources: Strait News, Sohu.com, Sina.com.cn, Kantianxia.com, 2 & 3 Nov 2004 [in Chinese, edited]

I did a Google search... 5 children died in Shanghai Children's Hospital (SCH), Beijing Road … no test results have been reported as of yet. The hospital has been under guard since the incident.

ProMED: Pneumonia, pediatric China (Shanghai): (02) - more

All the children had been transferred to SCH from other hospitals in Shanghai or other cities (not named). Autopsy results might take 10 days.

The hospital declared that the children were mostly premature [infants] and seriously ill when transferred to SCH, but the parents denied this.

One news report said there were 20 more children under close monitoring.

ProMED: Mexico: West Nile Virus Infection Surveillance Data as of

Thu 28 Oct 2004 Date: Thu 4 Nov 2004 Source: National Center for Epidemiologic Surveillance of Mexico web-site, Resumen Epidemiologico, Thu 28 Oct 2004

Humans: 225 seronegative and asymptomatic, one sick (Sonora state).

Horses: 3065 horses from all 32 states tested: 2272 seronegative and 793 (25.9%) seropositive, all asymptomatic.

Birds: 171/4660 (4%) seropositive, 2 sick (Sonora, Baja California), rest asymptomatic.

CDC: West Nile virus Activity – Arizona, USA

to Tue 2 Nov 2004 Date: Thu 4 Nov 2004 Source: Morbidity and Mortality Weekly Report, Fri 5 Nov 2004 / 53(43);1022-1023

Neuroinvasion 128 Fever w/o neuroinvasion 70 Insufficient clinical data 183 Total 381 Deaths 10

CDC: West Nile virus Activity – Arizona, USA:

to Tue 2 Nov 2004 - more

Blood donors: 38 presumptive West Nile viremic blood donors

Horses: 109 (ca. 33% mortality)(New Mexico: 24, Texas: 67)

Birds: 94 confirmed positive

Squirrels: 6

UNDIAGNOSED DEATHS – INDIA******

Date: 7 Nov 2004

From: ProMED

Source: India Express, 30 Oct 2004

6 more lives were claimed by the mystery disease

stalking [children in] western Uttar Pradesh,

taking the death toll to 98… all cases appeared to be

of viral encephalitis…

UNDIAGNOSED DEATHS – INDIA (cont.)***********

ProMED moderator comment:[…While Japanese encephalitis is the most likely etiology, one should not forget that henipavirus hasbeen responsible for unusual encephalitis outbreaksin Bangladesh and North Bengal in India, andChandipura virus has been implicated elsewhere inIndia. A lack of a definitive diagnosis of Japaneseencephalitis now 6 weeks following the 1st newswireposting might be considered cause for concern.- Mod.MPP]

Dengue - China (Zhejiang)

Date: 30 Oct 2004

From: ProMED-mail

Source: Xinhua, CEIS, 27 Oct 2004

The dengue fever epidemic in Cixi, a city of east

China's Zhejiang Province, has been brought under

control… To date, 80 of the 83 dengue fever patients

detected have been discharged from the hospital.

Dengue - China (Zhejiang) (cont.)

ProMED moderator comment:[According to the Cixi town website, the town has37 414 children in school, which translates to a total population of around 100 000. It seems ratherremarkable that an outbreak of dengue could becontrolled in just 2 weeks after only 83 cases, unless there is only a very small focus of the mosquitovector, or all the cases were acquired elsewhere.- Mod.JW]

Dengue - China (Zhejiang) (02)Date: Tue 2 Nov 2004 14:40:29 +1100From: Laurent Guillaumot lguillaumot@pasteur.nc

… the climatic conditions also should be taken intoaccount… if [Cixi] has a semi-temperate climate, itcould be that the decreasing temperatures in Octoberhelped a lot in controlling dengue fever.

Below a certain temperature, the reduced activity ofthe vector(s?), and even more the extension of theextrinsic incubation make virus transmission muchmore difficult.

Yellow Fever - Bolivia*******************

From: ProMED 23 Mar 2002 Source: El Deber (Bolivia) 23 Mar 2002 <http://www.eldeber.net/20020323/> [in Spanish]

“The first death was registered in the Yapacani Hospital 27 Feb 2002 ...”

Yellow fever - Bolivia - more******************

From: Outbreak Verification List, WHO, Geneva 27 Mar 2002

Source: ProMED [23 Mar 2002] Media reports of 4 confirmed cases

including 2 deaths ...

Diphtheria - Paraguay ****************** To: ProMED 15 May 2002 [posted 17 May] In Paraguay 3 weeks ago an outbreak of

Diphtheria began.... -- Antonio Arbo, MD, MSc Chief of Pediatric Department Tropical Medicine Institute, Asuncion, Paraguay

Unknown - Paraguay***************** From: Outbreak Verification List,

WHO, Geneva 22 May 2002

Source: ProMED [17 May 2002] 10 cases including 3 deaths... None of

the cases had received DPT...

Measles - Papua New Guinea*********************** From: Outbreak Verification List, WHO, Geneva 22 May 2002

Source: ProMED [4 May 2002] 1200 cases including 102 deaths (Jan-Apr 02)

were reported by the media. MoH is vaccinating children aged 3 - 59 months...

Unidentified fever, British troops - Afghanistan ************************ From: ProMED 15 May 2002 Source: BBC News Online, 15 May 2002 “Eighteen British soldiers serving in

Afghanistan have been struck down with a mystery fever. The Ministry of Defence (MoD) has confirmed that two are "seriously ill".

Unidentified Fever, British Troops - Afghanistan ************************* To: ProMED Sat. 18 May 2002 “The epidemiological and viral results confirm

Norwalk-like virus as the major cause...” --

Dr Angus Nicoll, Director Dr Dilys Morgan, Dr Olof Horstick Communicable Disease Surveillance Centre, UK

Acute Respiratory Syndrome- Bosnia & Herzegovina*******************

From: Outbreak Verification List, WHO, Geneva 3 Apr 2002

Source: ProMED [27 Mar 2002] 28 suspected cases of Q Fever were

reported... 14 of them among UN staff...

Anthrax, mail-borne - USA********************** To: ProMED 18 Nov 2001

“ProMED-mail with CNN was our main source for information through most of the recent anthrax outbreak! Keep up the good work.”

-- D.A. Henderson, Director Office of Public Health Preparedness,

DHHS, Washington, D.C.

Typhus - Sri Lanka ****************

To: ProMED 4 Sep 2001 “We would like to propose our help to the

victims of the typhus epidemic ...” -- Didier Raoult, Pierre-Edouard Fournier Unité des Rickettsies Faculté de Medecine, Marseille, France

Spin-off Networks

APIC-list (Association for Professionals in Infection Control)

Brazil - LISAS Korea - K-ProMED Netherlands - Inf@ct

ProMED: Asia/OceaniaNo. reports of outbreaks by country 1994-2003

0 1 0 0 2 0 0 3 0 0 4 0 0 5 0 0 6 0 0 7 0 0

A u s t r a l i a

I n d i a

C h i n a

R u s s i a

J a p a n

I n d o n e s i a

S . K o r e a

ProMED: Top 21 diseases, No. of reports, 1994-2003

180 Newcastle279 Malaria474 Anthrax

181 Hepatitis308 Salmonella557 Rabies

182 Meningitis329 Influenza578 BSE

183 SARS332 CJD578 Cholera

195 Legionella340 Hantavirus597 FMD

209 Unknown422 E.coli O157728 West Nile

265 Yellow fever424 Ebola749 Dengue

ProMED Sponsors

Bill & Melinda Gates Foundation Oracle Corporation

The Rockefeller Foundation Harvard School of Public Health

Anonymous Individual subscribers

The ProMED Team

Editor Lawrence C. Madoff

ISID Program Director

Timothy Brewer

Associate Editors Stuart Handysides Donald Kaye Marjorie P. Pollack Daniel S. Shapiro Jack Woodall

The ProMED Team (cont.)

Moderators Peter Cowen Tam Garland Richard I. Hamilton Martin Hugh-Jones Larry I. Lutwick

Luiz Jacintho da Silva(PORT)

Eskild Petersen Craig R. Pringle Michael Service Arnon Shimshony

Jaime Torres (ESP)

PRO-RUS: ProMED in Russian

Moderators & Correspondents:Nilufar Rakhmanova – Uzbekistan

Natalia Pechnikova – Russia

Alexander Vadim -

Sponsored by:

NTI - Nuclear Threat Initiative

ProMED-mail<www.promedmail.org>

is a program

of the International Society

for Infectious Diseases

END

Yellow fever, 2003 Comparative reporting speed

Nov.14Nov.14Cote d’Ivoire

June?July 8Colombia

Nov.11Oct.10Cameroon

Oct.10Oct.8Burkina Faso

--May 8Brazil

Jan.Jan.Brazil

Official dateProMED dateCountry

Yellow fever, 2003 (cont.)Comparative reporting speed

--?Aug.23Venezuela

May 27May 23Sudan

Aug.19Aug.19Sierra Leone

Jan.Jan.10Senegal

--?Aug.17Peru

--?Sep.2Guinea

Jan.20Jan.9Guinea

Official dateProMED dateCountry

ProMED: No. subscribers, 10 most populous countries by rank, 2003

zero10. Nigeria 4645. Brazil

19.Bangladesh 234. Indonesia

48. Pakistan 20 7963. USA

4007. Japan 472. India

476. Russia 841. China

No.CountryNo.Country

ProMED: No. items postedPORT=Portuguese, ESP=Spanish

1 0 0

1 0 0 0

1 0 0 0 0

1 9 9 4 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3

P r o M E DP O R TE S P

ProMED Top 10 subscribers

473Netherlands

......601Germany

346Italy961U.K.

400Japan1387Canada

461France1541Australia

464Brazil20 796USA

USA 1430Australia 619UK 99Brazil 87Singapore 77Taiwan 64Israel 58Malaysia 45Argentina 26

S.Africa 20China 17Colombia 7Slovenia 5Turkey 3Philippines 3Jamaica 3UAE 3Venezuela 2

Papua NG 2Botswana 2Malta 1Vanuatu 1Caymans 1Ireland 1Fiji 1ChristmasIsland 1

National Government Subscribers May 20022581 from 26 countries