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  Press Summaries

April 9, 1999

MMWR articles are embargoed until 4 p.m. Eastern time on Thursday.

MMWR Synopsis
  1. Outbreak of Hendra-like Virus — Malaysia and Singapore, 1998-1999
  2. Aldicarb As a Cause of Food Poisoning — Louisiana, 1998
  3. Frequency of Vaccine-Related and Therapeutic Injections — Romania, 1998
Fact Sheets:
  1. Hendra Virus

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Synopsis April 9, 1999

Outbreak of Hendra-like Virus — Malaysia and Singapore, 1998-1999
A new Hendra-like virus has been identified in humans in Malaysia and Singapore.

Division of Media Relations
CDC, Office of Communication
(404) 639-3286
Between September 29, 1998 and April 4, 1999, 229 cases of febrile encephalitis (111 resulting in death) were reported to the Malaysian Ministry of Health. These cases primarily occurred in adult men who had close contact with pigs. Initially, Japanese encephalitis virus was considered the likely cause for this outbreak, and specimens from some patients were positive for infection with that virus. However, viral isolates and serum samples from some of the patients, sent to CDC for testing, indicated the presence of a new virus that was related, but not identical, to the Hendra virus. The same virus has also caused illness among 11 abattoir workers (all had handled imported pigs from Malaysia) in Singapore. Hendra virus was first recognized in 1994 after an outbreak affecting racehorses and people in Australia; 13 horses and one person died. Travelers to Malaysia should be aware of this outbreak which, thus far, has involved only those closely associated with pig farms. No travel restrictions are indicated at this time.

  Aldicarb As a Cause of Food Poisoning — Louisiana, 1998
Store all pesticides exclusively in containers that are clearly and correctly labeled and secured by safety caps.
Kim Blindauer, D.V.M., M.P.H.
CDC, National Center for Environmental Health
(770) 488-7350
In July, 1998, 20 employees participated in a company lunch, and shortly after eating, several people developed neurological and gastrointestinal symptoms. Ten people visited a hospital emergency room and two were hospitalized; there were no deaths. The Louisiana Department of Health and Hospitals investigated and discovered that improperly stored and labeled aldicarb had been mistakenly used as pepper during the preparation of one of the food items. Aldicarb is used primarily by cotton farmers in Louisiana to control infestation by mites, nematodes, and certain insects. Because aldicarb is highly toxic, the U.S. Department of Agriculture requires that applicators be certified. In this incident, a person who had not been trained or certified in the use of aldicarb, had improperly stored the aldicarb in a used black pepper container.

  Frequency of Vaccine-Related and Therapeutic Injections — Romania, 1998
In many countries, unsafe injections are an important cause of transmission of bloodborne pathogens such as hepatitis B.
Catherine Dentinger, R.N., F.N.P., M.S.
CDC, National Center for Infectious Diseases
(404) 639-3048
In Romania, health-care workers give approximately 120 million therapeutic injections annually. Previous studies indicate that the reasons for the high-demand for such injections is a belief that pain of the injection is a marker of efficacy, that injections are more effective, and that injections represent advanced technology. In Romania, adults preferred injected medications for treatment of conditions that generally do not require injections; fever, respiratory tract infections, vitamin supplements, and diarrhea. Therapeutic injections have been associated with the transmission of hepatitis B and C viruses, HIV, and other bloodborne pathogens. Programs to improve injection safety should focus on reducing the number of therapeutic injections which increase the likelihood of improper use of injection equipment.

Hendra Virus

April 9, 1999
CDC, Division of Media Relations
(404) 639-3286

Hendra virus was first recognized in 1994 after an outbreak affecting racehorses and humans occurred in Queensland, Australia. Infection appear to have been acquired from intimate contact with infected horses via probable exposure to blood or other body fluids or excretions.

Hendra virus can infect more than one species of animal. Scientists believe fruit bats (also known as flying foxes) are the natural 'host' of the virus. This means the virus is carried by fruit bats, but has little effect on them. However, when it is transmitted to humans, horses, and other animals its effect can be lethal. Experimental studies have shown that in horses and cats the virus can cause fatal pneumonia.

Animals infected with Hendra excrete the virus in their urine.

CDC has developed a serological test for Hendra IgM. The virus has been classified as a genus with the Paramyxovirinae family and is being studied at Biosafety Level-4 ("Hot Zone").

Hendra-like illness in Malaysia and Singapore
This first cluster of cases began in Malaysia in late September 1998. Thus far, the majority of case-patients have been men working on pig farms.

Hendra virus in swine is not well defined but appears to begin with respiratory symptoms that include rapid and forced respiration and an explosive non-productive cough, poor appetite, and decreased movements. In some cases, the animal may become restless, develop muscle tremors, and exhibit aggressive behavior such as biting the bars of the pen.

Specific routes of transmission have yet to be determined but close contact with pigs appears to be necessary for human infection.

Studies are underway to determine the risk of human-to-human transmission and to define specific risk factors associated with infection.

Persons anticipating travel to Malaysia should follow CDC regional recommendations for Southeast Asia. The recommendations are on-line at

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