Geographical genetic structure within the human lung fluke, Paragonimus westermani, detected from DNA sequences

Nucleotide sequences were obtained for the second internal transcribed spacer of the ribosomal gene repeat and for part of the mitochondrial-cytochrome c oxidase subunit I gene from geographical isolates of Paragonimus westermani from Japan, China, Korea, Taiwan, the Philippines, peninsular Malaysia and Thailand. Sequences were obtained from several other species of Paragonimus for comparative purposes. Two groups were recognized within P. westermani: an NE group (China, Japan, Korea, Taiwan) which was relatively uniform and included both diploid and triploid forms, and a southern group (Malaysia, Thailand, Philippines), members of which were genetically distant from one another. According to both ITS2 and COI data, genetic distances among P. westermani isolates equalled or exceeded those between some distinct species of Paragonimus. The ITS2 sequences were conserved relative to COI sequences. Substitutions among the latter may be approaching saturation within the genus Paragonimus.

Molecular epidemiology of rubella by nucleotide sequences of the rubella virus E1 gene in three East Asian countries

Twenty-six strains of rubella virus were compared with each other for a molecular epidemiologic study of the virus in three East Asian countries, using the E1 gene of 1443 nucleotides and the following 41 nucleotides in a noncoding region. Nucleotide substitution rates among strains were 0.0-9.4/100 nucleotides. A phylogenetic tree drawn indicated that 2 of 3 Chinese strains were quite different from the other 24 strains; all isolates in the 1960s were classified into a single group independent of the place of isolation, which includes isolates from Japan, the United States, and the United Kingdom; 11 strains of Japanese isolates collected during 1976-1991 made one subbranch derived from the 1960s group; and 2 isolates from the northeast part of Japan in 1990 made a third but minor unique branch. Therefore, at least two groups of the virus cocirculated in Japan around 1990. Antigenic variation of the virus was very small among these strains.

Incidence of dogs possessing red blood cells with high K in Japan and East Asia

The phenotype of high K (HK) red blood cells, which is an autosomal recessive, was found in dog groups from 10 of 13 breeds or populations in Japan. The incidence of HK was 26 to 38% in the San'in-Shiba, Shinshu-Shiba and Akita breeds, and the gene frequencies of HK ranged from 0.513 to 0.612. The highest incidence (42%) was found in the Jindo breed from Korea, and the gene frequency was 0.652. Two other groups from Korea also possessed this HK variation. However, although HK cells were not found in dogs from Taiwan, Indonesia, Mongolia and Sakhalin, Russia, the HK phenotype is clearly distributed now throughout Japan and Korea.

Hepatolithiasis: epidemiology and classification

Hepatolithiasis or intrahepatic stone is more common among East Asian countries than in Western world. The relative incidence (i.e. hepatolithiasis cases against all cases with gallstone disease) in the Western countries is approximately 1% whereas in Taiwan, South Korea, the People's Republic of China it has been reported to be 20%, 18% and 38-45% respectively. There are two types of hepatolithiasis and in East Asian countries one usually finds pigmented stone. The disease appears to be more common among people with low socio-economic status. No single worldwide accepted classification of hepatolithiasis exists at present.

Poliomyelitis eradication in the Western Pacific Region

Polio eradication activities in the Western Pacific Region (WPR) have reduced the transmission of wild poliovirus to one remaining focus of endemic transmission in the Mekong Delta area of South Vietnam and Cambodia. There has been a high level of government commitment for national immunization days in all WPR countries in which poliomyelitis was previously endemic and for continuous improvement in acute flaccid paralysis (AFP) surveillance quality. The total number of reported confirmed poliomyelitis cases in 1995 (as of June 1996) was 432, only 7% of the total of 5825 cases reported in 1990. In 1995, wild poliovirus was isolated from only 19 of 4800 AFP patients from whom specimens were collected and analyzed. There has been one importation of wild poliovirus type 1 into China from a neighboring country. An international Regional Commission for the Certification of Poliomyelitis Eradication in the WPR has been formed and met for the first time in April 1996.

Coinfection and genetic recombination between HIV-1 strains: possible biological implications in Australia and South East Asia

It has been recognised that human immunodeficiency virus (HIV) mutates rapidly and that nucleotide substitutions, deletions, insertions, and rearrangements resulting from recombination events are the main factors that result in variation of the HIV-1 genome. Together, these processes are actively contributing to the diversity and virulence of viral forms comprising the acquired immune deficiency syndrome (AIDS) pandemic. There are 9 HIV-1 subtypes recognised (A-H and O), based on the envelope region segments. Inter-subtype recombination has been already described, whereas intra-subtype recombination has been difficult to detect. In this study, we have identified in vivo genetic recombination between HIV-1 strains belonging to subtype B in a patient who presented both intravenous drug use (IVDU) and homosexual sex as risk factors. Genetic analysis of viral strains in the hypervariable V3 region of the envelope gene indicated the presence of three distinct sequence groups categorized according to their respective tetrapeptide motifs-GPGR, GLGR and GPGK. Detailed genetic and phylogenetic analyses suggested the recombination occurring only between sequence groups with GPGR and GPGK tetrapeptide motifs. These data suggest that coinfection with closely related strains can occur in vivo, and the generation of hybrid HIV-1 genomes via genetic recombination between subtype B strains can result in further antigenic diversity which may thwart diagnosis and future vaccine efforts. Since HIV-1 subtype B is still the most commonly found subtype around the globe, the hybrid genomes between different subtype B strains may result in epidemiologic shifts and altered pathogenesis.

Exposure to environmental chemicals relevant for respiratory hypersensitivity: global aspects

Trends of air pollutant concentrations that influence the incidence of respiratory diseases and might be influential for respiratory hypersensitivity are presented and discussed. Data for these trends are collected in UNEP/WHO's Global Environmental Monitoring System GEMS/Air which recently has been revitalized and redirected to become a tool for providing the information necessary for rational air quality management. Data are interpreted with respect to WHO's most recent air quality guidelines, which are an update of the air quality guidelines for Europe published in 1987. A WHO study on the global disease burden and the contribution of air pollution to it is discussed and global estimates of mortality resulting from air pollution through sulphur dioxide and suspended particulate matter, by different economic regions, are given. Starting from the air quality guidelines still valid at the time of publication of the update, about 460,000 excess deaths globally are due to suspended particulate matter and about 370,000 to sulphur dioxide.

Genotype analysis of hepatitis C virus among blood donors and inmates in Metro Manila, The Philippines

Antibodies against hepatitis C virus (HCV) were detected in 18 (2.3%) of 800 sera from commercial blood donors and 23 (4.6%) of 502 sera from inmates in Metro Manila, the Philippines. The difference in the antibody prevalence between the two groups was statistically significant (P < 0.05). HCV RNA was detected in 14 (78%) of the 18 antibody-positive sera from blood donors and 19 (83%) of the 23 antibody-positive sera from inmates. Genotype analysis revealed that HCV-2a (7%). Among inmates, on the other hand, HCV-1a (68%) was most common, followed by HCV-1b (11%), HCV-2a (5%) and HCV-2b (5%). Overall, HCV-1a and HCV-1b appeared to be predominant among them. Thus, the genotype prevalence in the Philippines was distinct from those in other Southeast Asian countries such as Thailand, Vietnam and Indonesia, and also distinct from those in the Far East including Taiwan, Mainland China and Japan.

Viral hepatitis in East Asia

Viral hepatitis has a high prevalence in East Asia and is an important problem. Identification of the individual hepatitis viruses. A-E, has enabled researches to investigate the epidemiology and pathogenesis of viral hepatitis and its sequelae, and possible means of prevention. Because of improvement in hygiene in East Asia in recent decades, hepatitis A virus infection has decreased markedly. However, this has resulted in the younger population being susceptible to hepatitis A. Fortunately, effective active immunization for hepatitis A has become available. Hepatitis B is still rampant, especially in the southern part of East Asia where chronic infection is common. Patients who are chronic hepatitis B virus carriers are reservoirs for the virus and have a much higher risk of chronic liver disease and hepatocellular carcinoma (HGC). Currently, hepatitis B infection is being brought under control in East Asia through mass immunization. Serologic and molecular epidemiologic studies have also revealed that Hepatitis C is prevalent in the region. Hepatitis C virus also contributes to the development of cirrhosis and HCC. No effect immunization is currently available, and hepatitis C can only be controlled by preventative measures. The epidemiology and pathogenesis of viral hepatitis is discussed in this review, including new viral hepatitis agents possibly responsible for non-A-E hepatitis.

Public health issues and clinical and neurological characteristics of the new variant of Creutzfeldt-Jakob disease and other human and animal transmissible spongiform encephalopathies: memorandum from two WHO meetings

The transmissible spongiform encephalopathies (TSEs) include bovine spongiform encephalopathy (BSE), which was first described in 1986 in cattle in the United Kingdom, but has occurred subsequently also in other countries, and Creutzfeldt-Jakob disease (CJD) in humans, which is rare but with a worldwide distribution. Recently a new variant form of CJD, with a characteristic clinical and pathological phenotype, has been identified in the United Kingdom in a series of 11 young patients. This Memorandum reports the findings of two WHO Consultations. The first, held on 2-3 April 1996, issued conclusions and recommendations on certain animal products in order to protect the health of consumers. The second, held on 14-16 May 1996, examined, inter alia, the findings associated with the new variant of CJD, compared these findings with those for other TSEs, and proposed a protocol for the diagnosis and surveillance of CJD and related diseases.

Hypertension in East Asia

Asians comprise the largest single ethnic group in the world and the fastest growing minority ethnic group within the United States. The prevalence of hypertension in most Asian groups is similar to that of non-Asians. The associations with hypertension are similar to those seen in Western populations. Body mass index is a surprisingly strong predictor of blood pressure, even in very lean Asian populations. Studies in Asian groups suggest that the prevalence of target organ disease as related to hypertension are dependent on other cardiovascular disease risk factors. Stroke is more common than heart disease in Asia. Hypertension treatment data in East Asia is sparse, and treatment methods vary widely. Hypertension control among the world's largest ethnic group remains a challenge.

Predominance of a single genotype of Mycobacterium tuberculosis in countries of east Asia

Analysis of the population structure of Mycobacterium tuberculosis strains from the People's Republic of China showed that the vast majority belong to a genetically closely related group. These strains shared the majority of their IS6110 DNA-containing restriction fragments, and also, the DNA polymorphism associated with other repetitive DNA elements, like the polymorphic GC-rich sequence and the direct repeat, was very limited. Because the majority of these strains originated from the province of Beijing, we designated this grouping the "Beijing family" of M. tuberculosis strains. Strains of this family were also found to dominate in neighboring countries such as Mongolia, South Korea, and Thailand, whereas a low prevalence of such strains was observed in countries on other continents. These data indicate that strains of the Beijing family recently expanded from a single ancestor which had a selective advantage. It is speculated that long-term Mycobacterium bovis BCG vaccination may be one of the selective forces implicated in the successful spread of the Beijing genotype.

[Transmissible and natural infections in Siberia and the Far East]

The common and specific features in the time course and structure of morbidity as regards tick-borne rickettsiasis, tick-borne encephalitis, and Lyme disease in Siberia and Far East are discussed. The differentiation of nosological areas of tick-borne rickettsiasis and encephalitis is demonstrated and 9 variants of ratios of epidemiological zones of different hazard of infection established. The subject of comparative epidemiology of focal infections is formulated. General conceptual approaches to epidemiologic survey as the basis for optimizing preventive measures are outlined.

DNA haplotype analysis of Huntington disease reveals clues to the origins and mechanisms of CAG expansion and reasons for geographic variations of prevalence

This study of allelic association using three intra- and two extragenic markers within 150 kb of the Huntington disease (HD) mutation has provided evidence for linkage disequilibrium for four of five markers. Haplotype analysis of 67 HD families using markers in strong linkage disequilibrium with HD identified two haplotypes underlying 77.6% of HD chromosomes. Normal chromosomes with these two haplotypes had a mean number of CAG repeats significantly larger than and an altered distribution of CAG repeats compared with other normal chromosomes. Furthermore, haplotype analysis of five new mutation families reveals that HD has arisen on these same two chromosomal haplotypes. These findings suggest that HD arises more frequently on chromosomes with specific DNA haplotypes and higher CAG repeat lengths. We then studied CAG and CCG repeat lengths in the HD gene on 896 control chromosomes from different ancestries to determine whether the markedly reduced frequency of HD in Finland, Japan, China and African Blacks is associated with an altered frequency of DNA haplotypes and subsequently lower CAG lengths on control chromosomes compared to populations of Western European descent. The results show a highly significant inverse relationship between CAG and CCG repeat lengths. In populations with lowered prevalence rates of HD, CAG repeat lengths are smaller and the distribution of CCG alleles is markedly different from Western European populations. These findings suggest that, in addition to European emigration, new mutations make a contribution to geographical variation of prevalence rates and is consistent with a multistep model of HD developing from normal chromosomes with higher CAG repeat lengths.

The Hypertension Optimal Treatment (HOT) Study--patient characteristics: randomization, risk profiles, and early blood pressure results

The Hypertension Optimal Treatment (HOT) Study is a prospective, randomized, multicenter trial being conducted in 26 countries. Its main aim is to evaluate the relationship between three levels of target diastolic blood pressure (< or = 90, < or = 85 or < or = 80 mmHg) and cardiovascular morbidity and mortality in hypertensive patients. In addition, the study will examine the effects on morbidity and mortality of a low dose, 75 mg daily, of acetylsalicylic acid (ASA, aspirin) or placebo. In the HOT Study, basic antihypertensive treatment is initiated with the calcium antagonist felodipine at a dose of 5 mg daily. If target blood pressure is not reached, additional antihypertensive therapy with either an angiotensin converting enzyme (ACE) inhibitor or a beta-adrenoceptor blocking agent is given. Further dosage adjustments are made in accordance with a set protocol. As a fifth and final step, a diuretic may be added. Inclusion of patients was stopped on April 30, 1994. At that time 19,196 patients had been randomized. There were 9,055 (47%) women and 10,141 (53%) men with an average age of 61.5 +/- 7.5 (SD) years. At enrollment, 52% of patients were receiving antihypertensive treatment. These patients entered a wash-out period of at least 2 weeks before randomization. The average randomization blood pressure in untreated patients was 169 +/- 14/106 +/- 3 mmHg and in the treated patients 170 +/- 14/105 +/- 3 mmHg. On August 15, 1994, blood pressure data were available for 14,710 and 10,275 patients, who had completed 3 and 6 months treatment, respectively. The average reduction in diastolic blood pressure was 22 mmHg after 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinicopathologic study of 208 patients with early gastric cancer in Taiwan: a comparison between Eastern and Western countries

To investigate whether there are any differences between the clinicopathologic characteristics of early gastric cancer (EGC) patients in Eastern and Western countries, 208 Taiwanese patients with EGC were reviewed between 1964 and 1992. The incidence of cancer has increased slightly over the 29-year period. Men were diagnosed with EGC frequently than women, and their mean age was 56 years. Epigastralgia (58.2%) was the most common symptom, whereas 5.8% of cancers were incidentally detected by endoscopy. Physical signs and laboratory tests were of limited value in making the diagnosis. Endoscopy was a better diagnostic aid than radiology. Tumours were frequently located in the lower third (53.2%) and middle third (43.3%) of the stomach. Cancers of the elevated type (17.8%) were less frequent than the depressed type (82.2%). Type IIc (31.2%) was the most common macroscopic type. The frequency of mucosal carcinoma (51.0%) was similar to submucosal carcinoma (49.0%). Mucosal carcinoma had less lymph node metastases (3.1%) than submucosal carcinoma (12.2%; P < 0.05), with an overall frequency of metastases of 7.5% (14/186). The 5-year survival rate was 90.8%. The clinicopathologic characteristics of EGC in Taiwan were similar to those of Western countries and other Eastern countries. Improvement of diagnostic examinations and endoscopic surveillance of asymptomatic subjects may lead to early diagnosis and thus ensure a more favourable outcome.

Distribution of mouse mammary tumor virus in Asian wild mice

Several groups of wild mice (Mus musculus) were captured from eight different locations in Asia and bred for several generations in a facility free of any laboratory strains of mice carrying mouse mammary tumor virus (MMTV). The distribution of endogenous MMTV proviral sequences in the liver tissues of these mice was investigated by using Southern blot hybridizations. Four categories of mice were identified. Mice originating from Bogor, Indonesia (Cas-Bgr); He-mei, Taiwan (Cas-Hmi/1); and Malaysia (Cas-Mal) were found to carry an endogenous MMTV provirus consisting of the env, gag-pol, and long terminal repeat sequences. Mice captured from Kojuri, Republic of Korea (Sub-Kjr); Nagoya, Japan (Mol-nag); and three Chinese provinces, Shanghai (Sub-Shh), Beijing (Sub-Bjn), and Jiayuguang (Sub-Jyg/1), appeared to carry defective proviruses. Some mice originating from He-mei (Cas-Hmi/2) and Jiayuguang (Sub-Jyg/2) were found to be completely free of endogenous MMTV. Interestingly, however, the Sub-Jyg/2 mice, after several generations of inbreeding, were found, unlike all of the other subspecies that we examined in the present study, to develop mammary tumors at a high incidence (80 to 90%) with a short period of latency. Electron microscopic examination of the mammary glands and mammary tumors of these mice revealed the presence of numerous intracytoplasmic A, immature, budding, and mature B particles. Furthermore, the mammary tumors were found to contain MMTV proviral sequences. It seems, therefore, that Sub-Jyg/2 mice carry an exogenous MMTV which contributes to their developing mammary tumors.

Geographical distribution of hepatitis C virus genotypes in blood donors: an international collaborative survey

The frequency of infection with the six classified major genotypes of hepatitis C virus (HCV) was investigated in 447 infected volunteer blood donors from the following nine countries: Scotland, Finland, The Netherlands, Hungary, Australia, Egypt, Japan, Hong Kong, and Taiwan. Viral sequences in plasma from blood donors infected with HCV were amplified in the 5'-noncoding region and were typed by restriction fragment length polymorphism analysis. Electrophoresis of DNA fragments produced by cleavage with HaeIII-RsaI and ScrFI-HinfI allowed HCV types 1 (or 5), 2, 3, 4, and 6 to be identified. Further analysis with MvaI-HinfI allowed sequences of the type 5 genotype to be distinguished from sequences of the type 1 genotype. Types 1, 2, and 3 accounted for almost all infections in donors from Scotland, Finland, The Netherlands, and Australia. Types 2 and 3 were not found in the eastern European country (Hungary), where all but one of the donors were infected with type 1. Donors from Japan and Taiwan were infected only with type 1 or 2, while types 1, 2, and 6 were found in those from Hong Kong. HCV infection among Egyptians was almost always by type 4. Donors infected with HCV type 1 showed broad serological reactivity with all four antigens of the second generation Chiron RIBA-2 assay (Chiron Corporation, Emeryville, Calif.), while infection with divergent HCV genotypes elicited antibodies mainly reactive to c22-3 and c33c. Reactivities with antibodies 5-1-1 and c100-3 were infrequent and were generally weak, irrespective of the geographical origin of the donor. Because the envelope region of HCV is even more variable than the NS-4 region, it is likely that vaccines based on these proteins need to be multivalent and perhaps specifically adapted for different geographical regions.

Progress toward global eradication of poliomyelitis, 1988-1991

The report of the last case of smallpox from Somalia in 1977 demonstrated that an infectious disease could be eradicated globally. Because polioviruses have no animal reservoir and do not survive for long periods of time in the environment, and because lifelong immunity to paralytic poliomyelitis is conferred by existing, effective vaccines, poliomyelitis has been considered a candidate for eradication. In 1985, the Pan American Health Organization (PAHO) initiated a regional poliomyelitis eradication program. Based on the success of this program and high vaccination levels achieved worldwide by the Expanded Program on Immunization (EPI), in May 1988, the World Health Assembly of the World Health Organization (WHO) adopted a resolution to eradicate poliomyelitis globally by the year 2000. This report summarizes progress of the global poliomyelitis eradication initiative from 1988 through 1991.