Late Breakers at the ASTMH Meeting
CONFERENCE COVERAGE
By Michele Barry, MD
Poliomyelitis-Like Illness Due to Japanese Encephalitis Virus
Source: Solomon T, et al.
A new neurologic presentation of Japanese encephalitis virus (JEV) was reported by Solomon et al from the Wellcome Trust Clinical Research Unit, which was complemented by a video of children with a newly described polio-like presentation of acute infection with JEV. All JEV-positive patients were febrile and had clinical signs of JEV myelitis suggestive of viral destruction of the anterior horn cells. CSF IgM was elevated, and a CSF pleocytosis was noted. The video presentation revealed children with typical atalgic gait and muscular atrophy very similar to polio-victims. This late breaker emphasized that although the WHO initiative for eradication of polio has been successful in Vietnam, the incidence of acute flaccid paralysis remains high, and now JEV has been added to the differential of viral etiologies for this entity.
Epidemic Typhus Outbreak in Cuzco, Peru
Source: Olano J, et al.
Epidemic typhus is still a frequent cause of hemorrhagic fever in some areas of the world. Olano and colleagues reported on an epidemic of typhus in Cuzco, Peru. Patients mostly presented with fever (90%), headache (100%), exanthem (44%), cough (100%), epistaxis (18%), and petechiae (9%). One patient died. Sera were tested by IFA using R. typhi and R. prowazekii as antigens.
Tolerance to Mefloquine
Source: Kolton T, et al.
Kolton and colleagues from Toronto reported on tolerance of loading doses of mefloquine in order to achieve a steady protective level of mefloquine more rapidly than the usual dosing. A double-blind, randomized study of 500 adults was reported using a three-day loading dose of 250 mg daily mefloquine and then weekly dosing. The study was continued for 28 days. There was only one clinically severe adverse reaction in the mefloquine group with minor sleep disturbances and GI upset seen in both the active drug group and mefloquine group. The presenters concluded that loading dose achieved earlier steady state levels and predicted identification of mefloquine intolerant travelers prior to travel.
Prevalence of Schistosoma haematobium Among Somali Refugees in Mombasa, Kenya
Source: Miller JM, et al.
Varicella Outbreak among Barawan Somali Refugees, Mombasa, Kenya, July 1997
Source: Seward J, et al.
The Rubella Boat: Oceanic Cruising with a Vaccine-Preventable Disease
Source: Zanc S, et al.
The CDC Quarantine Division reported on three recently investigated infectious disease outbreaks in confined populations. The first presentation involved both symptomatic and asymptomatic S. haematobium among Somali refugees encamped in Mombasa, Kenya. Age- specific seroprevalence indicated that most S. haematobium infections occurred in Somalia before encampment in 1992 (no children < 8 years were seropositive vs 34% seropositivity of refugees > 40 yrs). Single-dose praziquantel was administered to untreated seropositive refugees. A varicella outbreak in this group of Somalian refugees right before migration to the United States in 1997 prompted cancellation of flights and mass vaccination with varicella vaccine. The presenters reminded attendees that adult immunity to varicella differs in tropical and temperate climates, with adult immunity in a tropical setting often less prevalent.
Lastly, Zanc and colleagues presented a rubella outbreak among crew members of two cruise ships sailing between Florida and the Bahamas. Although no transmission to passengers occurred, an official recommendation was made that crew members from countries without routine rubella vaccination be immunized if they do not document immunity.
No Difference in Hepatitis A Boosters
Source: Connor BA, Phair J.
Connor presented data that both HAVRIX and VAQTA were effective and interchangeable for boosting at 6-12 months after an initial dose of HAVRIX.
A Survey of Hydatid Disease (Echinococcosis) in Tibetan Populations in China
Source: Schantz P, et al.
Schantz and associates reported on a survey of hydatid disease in two regions of China of Tibetan populations. Among 1251 participants in Sichuan, 8.1% had a cystic image visualized by abdominal ultrasound or chest radiograph compatible with cystic or alveolar echinococcosis. Rates increased with age, with 20.2% of persons 54 and older identified as being infected. Herdsman were at particular occupational risk. A similarly high rate of echinococcosis was identified in a Tibetan population in Qinghai after 1263 persons were screened by ultrasound and chest x-ray (9.6% had presumptive cyst diagnosis). These results suggest one of the highest prevalence rates of echinococcosis in the world.
Studies of the Emergence of Human Monkeypox in the Democratic Republic of Congo
Source: Stewart J, et al.
Stewart and colleagues presented a timely description of the recent outbreak of monkeypox (MPV) in the Katako-Kombe health zone of Zaire. More than 511 possible cases were identified from 78 villages, with village attack rates varying from 20-113/1000. Case fatality was 1.5%. Although person-to-person transmission can occur, recent cases far from the 1996 epicenter suggested introduction of MPV through animal contact. Pictures that were presented of a vesicular rash very similar to smallpox engendered a lively discussion. Had we created a population more susceptible to MPV by cessation of smallpox vaccination? In the past, MPV outbreaks have resulted in short sporadic outbreaks with clearcut animal contact. This outbreak, which extended for more than one year, raised the question of whether transmission of MPV could be sustained within a susceptible population without continual reintroduction from infected monkeys.
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