February 21, 2003

Infectious Syphilis: Winnipeg
Three cases of infectious syphilis have been diagnosed in Winnipeg between 28 January and 3 February 2003: two males and one female between the ages of 41-47 years. Two of the three cases have been staged as primary syphilis and one as secondary. Case histories indicate that infection was locally acquired through heterosexual transmission, although homosexual transmission has not been ruled out in one case. Seven contacts have been identified, of which four have been located at this time. The two primary cases are directly linked by recent infection with Neisseria gonorrhea, whereas the source of the secondary case is not yet known. Public health investigation is ongoing. Enhanced surveillance has been initiated throughout Winnipeg and Manitoba. Physicians have been alerted to the cluster of cases, reminded of the signs and symptoms of syphilis infection, advised to order appropriate laboratory tests and have been reminded of the recommended treatment guidelines. In Manitoba, the incidence of infectious syphilis has remained at <1case/100000 population. The last reported case of locally acquired infectious syphilis occurred in 1995. Imported cases of infectious syphilis have been reported sporadically.
Source: Winnipeg Regional Health Authority, 18 February 2003

Norwalk-Like Virus (NLV): Canada
Hospitals across Canada have been struggling with outbreaks of viral gastroenteritis caused by the NLV. Nursing homes, schools and hospitals in Alberta, British Columbia, New Brunswick and Ontario have been most affected, with additional outbreaks reported from Manitoba and Quebec. By the end of December 2002, in Edmonton there were 42 outbreaks directly affecting >1000 individuals. Thirty outbreaks of viral gastroenteritis have been reported in Calgary since the beginning of October 2002, with 18 of these in December. In British Columbia from January-June 2002, >30 gastrointestinal illness outbreaks were found to be caused by NLV. These outbreaks, involving both patients and staff, have occurred in various closed and semiclosed populations, including long term care facilities, assisted living sites, schools and acute care facilities. In most of the outbreaks where stool samples have been obtained for testing, NLV has been identified as the causative agent. This kind of outbreak activity usually signals a high amount of illness in the community and suggests that considerable under-reporting is occurring, with a resultant underestimation of the numbers of affected people.
Source: The Canadian Journal of Infectious Diseases, Vol 14, No 1, January/February 2003

Human Papillomavirus (HPV)Infection: Canada
Persistent infection with carcinogenic HPV is linked to high-grade lesions and cervical cancer. To better understand the natural history of HPV, researchers sought to determine the rates of incident and cleared carcinogenic HPV infection, by age, among women aged 15-49 years and to explore risk factors for incident infection. Women enrolled in an earlier HPV prevalence survey were invited to participate in follow-up HPV testing at their periodic health examination one year later. Two hundred and fifty-three (253) previously HPV-negative women and 54 previously HPV-positive women were retested. Results indicated that incident infection with carcinogenic HPV was highest in women aged 15-19 years, and risk factors were consistent with a sexually transmitted infection. A large proportion of the women who were HPV-positive cleared the infection after one year.
Source: Canadian Medical Association Journal, Vol 168, Issue 4, 18 February 2003

Influenza A(H5N1): Hong Kong Special Administrative Region of China
Results from two laboratories have confirmed the presence of an avian influenza virus in a single child in the Hong Kong Special Administrative Region of China (HKSARC). Tests of two samples from this single patient have identified the virus as the strain of influenza A(H5N1). The patient, a 9-year-old boy, became ill on 9 February and was admitted to hospital in HKSARC on 12 February. He was treated, has recovered and is in stable condition. Other members of his family with similar symptoms, including the boy's sister and father, have died. The boy's mother was ill but has recovered. The boy travelled to Fujian Province (China) in January with his mother and his two sisters. An eight-year-old sister became ill in Fujian on 28 January and died in a local hospital on 4 February. The father joined the family on 31 January and became ill on 7 February. He returned to HKSARC on 10 February and was admitted to hospital the following day. He died on 16 February. It is not yet known whether the other family members who fell ill were also infected with A(H5N1). A medical and epidemiological investigation is ongoing.
Source: World Health Organization, Press Release, 19 February 2003

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.