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Vol. VII, No. 11~ EINet News Briefs ~ May 14, 2004

****A free service of the APEC Emerging Infections Network*****

The EINet list serve was created to foster discussion, networking, and collaboration in the area of emerging infectious diseases (EID's) among academicians, scientists, and policy makers in the Asia-Pacific region. We strongly encourage you to share your perspectives and experiences, as your participation directly contributes to the richness of the "electronic discussions" that occur. To respond to the list serve, use the reply function.

In this edition:
  1. Infectious Disease Information

    - Viet Nam (Mekong Delta): No H5N1 virus found in dead poultry
    - Thailand: New bird flu outbreak delays announcement of all-clear
    - China: Test developed for simultaneous diagnosis of subtypes exhibited by highly pathogenic avian influenza virus strains
    - China: SARS investigation continues
    - China: SARS situation update
    - Viet Nam: Care for HIV-infected rises 10%
    - Hong Kong: EV-71-associated case of hand, foot & mouth disease
    - Taiwan: Cases of Acute Enterovirus Infection
    - Australia (Perth): Record numbers of Ross River virus cases
    - Malaysia: Signs of food poisoning in orang asli children
    - Guam: Leptospirosis cases traced to Sigua Falls
    - India (West Bengal): Hepatitis E virus outbreak in Dum Dum district
    - India (Karnataka): 26 cases of monkey-fever reported
    - India (Ahmedabad): Outbreak of undiagnosed jaundice
    - India (Calcutta): Tests point to cholera outbreak
    - Canada (British Columbia): Discovery of new avian flu strain closes BC school
    - USA: Mad cow testing to expand, agriculture chief says new cases wouldn't surprise her
    - USA (Colorado): First suspected human case of West Nile virus in 2004
    - Mexico: National alert declared in response to outbreak of measles
    - Venezuela (Zulia): Second rabies death in Zulia state this year
    - Ecuador (Chimborazo): Fatal human cases of plague

  2. Updates

    - Dengue/DHF
    - Diarrhea and dysentery
    - Viral gastroenteritis

  3. Articles

    - Measles deaths drop dramatically as vaccine reaches world's poorest children
    - Lyme Disease — United States, 2001–2002
    - Evaluating public health surveillance systems for early detection of outbreaks — Recommendations from the CDC Working Group
    - Malaria Surveillance — United States, 2002
    - Recommended childhood and adolescent immunization schedule — United States, July–December 2004
    - Prevention and control of influenza — Recommendations of the Advisory Committee on Immunization Practices (ACIP)
    - Responding to detection of aerosolized Bacillus anthracis by autonomous detection systems in the workplace
    - Outbreak of varicella among vaccinated children — Michigan, 2003
    - Creutzfeldt-Jakob Disease not related to a common venue — New Jersey, 1995–2004
    - The World Health Report 2004 — changing history

  4. Notification

    - FAO/WHO Regional Conference on Food Safety for Asia and the Pacific: Practical actions to promote food safety
    - Fifty-seventh World Health Assembly
    - Public Library of Science (PLoS) to launch international open-access medical journal, Call for Papers
    - EcoHealth: New scientific journal

  5. How to join the EINet email list

Below is a semi-monthly summary of Asia-Pacific emerging infectious diseases.


Vietnam ( Mekong Delta) — No H5N1 virus found in dead poultry
The H5N1 strain of avian influenza virus was not found in dead poultry in the Mekong Delta province of Dong Thap , but the H5 virus was, a veterinary official has confirmed. In early May 2004, it was rumored that bird flu had reoccurred in the province. In fact, there was an outbreak of bird flu in the province's Cao Lanh Township , after the province had declared itself free from the virus. Although it was contained right afterwards, Bui Quang Anh, Director of the Ministry of Agriculture and Rural Development's Veterinary Department, said that bird flu might reoccur unless strict measures are taken to control the import, trading, and slaughtering of poultry. Veterinary workers are checking the remaining poultry in the areas.

Viet Nam declared itself free from H5N1 virus 30 Mar 2004 . The bird flu epidemic caused a total loss of more than USD 82 million, of which the mass culling of poultry in bird flu-affected areas cost more than USD 63 million. In addition, the epidemic has caused an increase in food prices in the domestic market and environmental pollution in the bird flu-hit areas. On top of the economic losses, Viet Nam suffered at least 16 fatalities in human patients. A Vietnamese program for the testing of all breeding farms — requiring compliance before they may once again begin supplying chicks to the sector, and, also, requiring a three-month delay before allowing depopulated farms to restock — was made public in early Apr 2004. These farms were said to be being monitored for at least three weeks after their restocking.
(Promed 5/7/04, 5/12/04)

Thailand — New bird flu outbreak delays announcement of all-clear
Thai authorities announced a new outbreak of bird flu, forcing them to delay for the fourth time an announcement that the kingdom is free of the deadly virus. Thailand was expected to declare the all-clear 27 Apr 2004 but the discovery last week of bird flu in Uttaradit province meant it had to be postponed until next month, deputy agriculture minister Newin Chidchob said. Newin said outbreaks in two other provinces reported earlier this month, which dashed hopes that Thailand had put the crisis behind it, were either cleaned up or in the process of being eradicated. "Uttaradit is the only province which currently still has a problem and must be under surveillance," he said, adding that the 21-day monitoring period there were to expire 10 May 2004 .

Thailand slaughtered at least 36 million poultry and slapped quarantine regulations on affected zones in an effort to halt the spread of the disease which hit 41 of its 76 provinces. The kingdom has reported 12 bird flu infections in humans, including eight deaths. Bird flu has swept through 10 countries in Asia and also killed 16 people in Vietnam . Thai authorities have been anxious to end the crisis which decimated its massive poultry industry, but UN health officials cautioned against a premature announcement that the virus has been eradicated. Thailand originally planned to declare itself free of the disease by the end of February 2004, but was forced to backtrack when nine more cases were announced 16 Feb 2004 . A similar announcement was then put off 16 Mar when fears surfaced that bird flu had re-emerged in 11 provinces.
(Promed 4/27/04)

China — Test developed for simultaneous diagnosis of subtypes exhibited by highly pathogenic avian influenza virus strains
A multiple real-time fluorescent test re-agent kit has been successfully developed for testing H5, H7, and H9 subtypes of avian influenza virus in Shenzhen , Guangdong province. A reverse transcriptase polymerase chain reaction (RT-PCR) test, the reagent kit is able to test for three haemagglutinin antigen subtypes of avian influenza virus simultaneously, instead of only one subtype at a time, said Tian Bo, head of the appraisal team at the Chinese Academy of Sciences. Experts from the team held that the test re-agent kit is efficient and easy to use. It is suitable for use in poultry quarantine, human disease control, and epidemiological investigation.

Avian influenza is an infectious disease of waterfowl and poultry that has jumped to humans. Blessed with a dense water network, Shenzhen is a transient home to migrant birds and a major supplier of live poultry for adjacent Hong Kong . As early as in August 2002, the local quarantine bureau began to employ the fluorescent RT-PCR test approach to examine poultry to be supplied to Hong Kong ; the test took about 4 hours. To lower the test cost and raise test efficiency, researchers from the bureau have worked with Shenzhen Taitai Gene Co, Ltd. to develop a new-type fluorescent RT-PCP reagent kit. The scientific outcome, with independent patent, has met the world standards, according to Liu Shengli, head of the local entry and exit quarantine bureau.

This test may prove useful in monitoring avian influenza virus infection in the current epidemiological situation in East Asia , provided that the test is authenticated by external evaluation and its production, testing, and use are subject to strict regulation and quality control by a relevant governmental agency. It does not identify any other of the 15 haemagglutinin subtypes of avian influenza virus currently recognized, which potentially could initiate disease outbreaks in domestic poultry. Nor does the test identify any of the nine recognized neuraminidase antigenic subtypes, which can be relevant in distinguishing epidemic strains.
(Promed 4/29/04)

China: SARS investigation continues
Investigation of the source of the current outbreak — first reported 22 Apr 2004 — continues to focus on the National Institute of Virology in Beijing . The institute is known to have conducted experiments using the live SARS coronavirus during Feb and Mar 2004. Two researchers at the institute developed SARS late Mar and mid-Apr 2004. However, neither is known to have conducted research using the live virus, suggesting some other source of infection within the laboratory or, possibly, elsewhere. Members of a joint WHO-Chinese investigative team, wearing full personal protective equipment, entered the institute 30 Apr and again 4 May 2004 . Initial findings indicate that the investigation will be complex, as no single infectious source, or single procedural error, appears likely to explain the infection in the two researchers. Continuing investigation is needed to determine the source of infection and to ensure that conditions, equipment, and bio-safety procedures within the institute do not pose an ongoing risk of SARS infection. A large number of samples from various locations within the institute were taken for analysis at the WHO SARS laboratory in Hong Kong .

WHO has strongly recommended that work using the live SARS virus be conducted in bio-safety level 3 facilities in order to minimize the risk of laboratory-acquired infections. Further investigation of the institute is needed to ensure that any work using the live virus fully complies with the strict requirements for physical containment of the virus. The National Institute of Virology was closed 23 Apr 2004 , and most of its staff was quarantined for medical observation.
(Promed 5/5/04)

China: SARS situation update
Beijing has reported the confirmation of three previously reported suspected cases of SARS. During this period there have been no reports of other cases from other provinces. The three cases are the father of the nurse who cared for the index case from Anhui , a patient on the same ward as the nurse, and a visitor of this latter patient. Confirmation was made through IgM and IgG antibody testing and the combined clinical and epidemiologic histories of these cases. The first case in Beijing (the nurse who cared for the index case from Anhui) is in good condition, with 18 consecutive days without fever and will be discharged from the hospital shortly. The other six cases in Beijing will remain in isolation at the Ditan Hospital ; 99 close contacts have been released from observation. The index case in Anhui has now had 11 consecutive days without fever and will shortly be discharged from the hospital; 89 close contacts have been released from observation. Since 22 Apr 2004 , Anhui province has reported two cases of SARS and Beijing has reported seven cases. Confirmation of these laboratory results by an independent outside reference laboratory is pending.
(Promed 5/4/04)

Viet Nam — Care for HIV-infected rises 10%
A five-year project designed to help people with HIV/AIDS receive better medical care has begun in HCM City . The number of AIDS patients getting access to specialized medical treatment will increase by 10 per cent every year with the program. "The project aims to increase community-based health care and information services for infected people including children and pregnant women in areas with high annual growth rates of HIV/AIDS," Dr Trinh Quan Huan, director of the project, said. The 20 targeted areas include HCM City , Quang Ninh, Hai Phong and An Giang. High-risk group members like drug addicts and sex workers will continue to get regular health checks, with 90 per cent of those receiving rehabilitation at detoxification centers and camps to be encouraged to carry out voluntary HIV testing, he said. "To make the services available for the patients, authorities and health agencies in these cities and provinces will establish good community-based care and counseling systems, and at least 80 per cent of hospitals and medical centers will be installed with basic equipment for detecting the virus and protecting health workers from the disease," Huan said. Prevention techniques for mother-to-child transmission will continue to intensify at seven obstetrics hospitals nationwide alongside the establishment of medical treatment centers for child patients at the Ha Noi-based Pediatric Institute and Pediatric Hospital 1 in HCM City . As many as 230 million condoms will be distributed over five years, with five million going out free. In addition, condom marketing and research programs will be supported under the project. The project will launch a major public relations campaign to increase public awareness about the proper use of condoms to effectively prevent sexually transmitted diseases including HIV/AIDS. In addition to funding from the Vietnamese Government, the program has received financial support from the World Health Organization and the Global Fund to Fight AIDS, Tuberculosis and Malaria. http://vietnamnews.vnagency.com.vn/2004-04/22/Stories/11.htm
(SEA-AIDS 4/29/04)

Hong Kong — EV-71-associated case of hand, foot & mouth disease
The Department of Health confirmed 26 Apr 2004 a case of Enterovirus-71 (EV-71) infection. The case is a 2-year-old boy who became ill 10 Apr 2004 with fever and rash over hands and mouth. He was admitted to Queen Elizabeth Hospital 14 Apr, discharged 15 Apr, and recovered. He had not traveled recently. The Department of Health urged the public to stay alert to the threat of EV-71 infection and take preventive measures: wash hands before eating and after going to toilet and changing diapers; cover mouth and nose when coughing and sneezing; maintain good ventilation; clean thoroughly toys or appliances which are contaminated by nasal or oral secretions. Parents are advised to seek medical advice if their children develop symptoms of hand, foot and mouth disease. Children suffering from the infection should stay at home and avoid contacting other children until the illness is over. Cumulative Total in 2004: 3 imported and 0 local cases. The total number of cases in previous years: 60 in 1998, 22 in 1999, 6 in 2000, 30 in 2001, 5 in 2002, 1 in 2003. For more information on EV-71, members of the public can browse the Central Health Education Unit website <http://www.cheu.gov.hk>.

Hand, foot and mouth disease (HFMD) is a generally benign form of enterovirus 71 (EV-71) infection which produces superficial rashes on the mouth and extremities of the limbs of children. HFMD is relatively rare in Europe , North America , and Australasia , but since 1997 there has been a significant increase in EV71 epidemic activity throughout the Asia-Pacific region, often associated with severe encephalitis and high case fatality rates. The emergence of large-scale epidemic activity in the Asia-Pacific region has been associated with the circulation of three genetic lineages that appear to be undergoing rapid evolutionary change.
(Promed 4/27/04)

Taiwan — Cases of acute enterovirus infection
Seven cases of acute enterovirus infection have been reported in Taiwan so far in 2004, all of them in central and southern Taiwan . Wu Ping-huei, from the Health Department's Center for Disease Control, said that the first six cases occurred in central Taiwan , while the latest one was in Tainan County in southern Taiwan at the end of April — a four-year-old boy who suffered from fever, ulcers at the corners of his mouth, and vomiting and rashes. He has since recovered and has been released from hospital. Wu said that compared with the same period of 2003, which saw 41 serious enterovirus cases in Taiwan , the number so far in 2004 is low. The reason that northern Taiwan has no enterovirus cases might be because this year the weather has been cool so far. Tseng Shu-hui, Director of the Health Department's Center for Disease Control branch in southern Taiwan , said that health officials still don't know why the serious cases of enterovirus infection converged in central Taiwan . These cases may be indicative of the seasonal epidemic of hand, foot and mouth disease expected in children in Taiwan at this time of year.
(Promed 5/11/04)

Australia (Perth) — record numbers of Ross River virus cases
Western Australian health authorities are alarmed at record numbers of cases of Ross River virus infection in Perth so far in 2004. Over 1400 people have been infected, prompting them to consider more aggressive health campaigns warning about the virus. In the metropolitan area, 466 cases have been reported, confirming the theory that Ross River virus disease has become more urbanized, because domestic mosquitoes are spreading the virus. It was once thought that cases recorded in Perth were the result of people visiting the south west. With two months of the season still to go, the number of cases of Ross River virus has now surpassed Western Australia 's large outbreak in 1995–96, when about 1400 people were infected. By the end of last week ( 23 Apr 2004) over 750 cases had been reported in the south west, many from the hot spots of Busselton and Capel. Case numbers were rising in the Kimberley , Pilbara, and Central Wheatbelt . Health Department scientist Sue Harrington said infection rates had dropped off in southern areas where the nights were getting cold and mosquitoes were less active. Ms Harrington said public health officials would look at ways to create more awareness.
(Promed 4/27/04)

Malaysia — Signs of food poisoning in orang asli children
Tests have shown that one of the four orang asli (the indigenous minority peoples of Peninsular Malaysia) children who died under mysterious circumstances had salmonella infection, one of the commonest causes of food poisoning. "One child who died tested positive for salmonella. We are still waiting for the other results from the Institute of Medical Research . They could have suffered from amoebic dysentery, cholera or typhoid," said health minister Datuk Dr Chua Soi Lek. Apparently four orang asli children died between 9 and 12 Apr 2004 . Chua said blood and urine samples had been collected from children suffering from diarrhea and vomiting in Kampung Pos Terisu and Kampung Jarik Baru in Cameron Highlands . Dr Chua said the ministry had received 17 reports of such cases involving children in those two villages. In Kuantan, Pahang Mentri Besar Datuk Seri Adnan Yaacob said a lack of hygiene and contaminated water were believed to have caused the deaths of the children. Water samples taken from the area showed the presence of bacteria and parasites. He said it was too early to conclude the causes of the deaths, but a medical team led by state Health Department director Datuk Dr Sarah Yaacob would investigate the cases. Adnan said no new cases were reported and 12 children, aged between 8 months and 4 years old, were still in hospital. He said such deaths had occurred many times in the orang asli community. It is unclear at this time whether the cases are related in etiology and whether the case number represents an upswing in the endemic rate of gastroenteritis and diarrhea illnesses.
(Promed 4/27/04)

Guam — Leptospirosis cases traced to Sigua Falls
Medical staff at the Naval Hospital has determined that the three Air Force members who came down with symptoms of leptospirosis Mar 2004 are likely to have gotten the disease near Sigua Falls . In early April 2004, it was reported that military officials were cautioning their personnel about hiking and swimming in the Sigua Falls and Lost Pond areas after potential leptospirosis cases arose. Further investigation seems to have determined that the hikers may have come down with the bacterial illness at Sigua Falls , said Lt. Karen S. Corson, the department head of preventative medicine at Naval Hospital . Corson stated that the hospital has had one confirmed case and two suspected cases. Two of the cases had been hiking in the Sigua Falls area, and all three had cuts on their hands or legs from hiking. She said the hospital cautions hikers from swimming if they have cuts or open sores, as leptospirosis is known on the island.

Dr. Robert Haddock, Guam 's territorial epidemiologist, has said that leptospirosis is found in water affected by waste from wild animals that carry the bacteria. He has said that about two cases are reported each year, and because its symptoms are similar to that of influenza, mild cases of leptospirosis are often mistaken for the other illness. Symptoms of leptospirosis can include fever, severe headaches, chills, muscle aches, vomiting, stomach pain, jaundice (yellow skin and eyes), red eye, diarrhea or a rash. Untreated, a leptospirosis patient can develop kidney damage, meningitis, liver failure, respiratory problems and, in rare cases, may die.
(Promed 4/27/04)

India (West Bengal) — Hepatitis E virus outbreak in Dum Dum district
More than 800 persons have been infected with hepatitis E virus in South Dum Dum in West Bengal, India, during the past three weeks. The affected areas are Chasipara, Lalgarh, Moyrapara, Azadgarh, Burmanpara, Sethbagan, Chasirmat, Goalabagan, Basakbagan, and Swamiji colony of the Municipal areas of South Dum Dum . The outbreak appears to be due to contamination of the water supply. The main manifestation was jaundice. Although at least 15 relapse cases were reported in Moyrapara, Azadgarh, and Goalabagan areas, there was no report of any death from the disease. It has been observed that about 30 percent of the cases have already been cured. Virologists attached to the School of Tropical Medicine , Kolkata have examined 20 blood samples from the affected persons, out of which 15 samples were positive for hepatitis E virus IgM antibody. At present, drinking water is being supplied by 12 large tankers, halogen tablets are being distributed, and health workers have already visited at least 280 houses. Municipality engineers are now planning for the replacement of 1000 meters of asbestos water supply pipeline--where contamination was suspected — with iron pipes.

Hepatitis E virus is transmitted via the fecal-oral route. It is responsible for an acute self-limited infection characterized as acute hepatic inflammation. It has been claimed, however, that in endemic areas in India , hepatitis E virus may be a common cause of acute liver failure. The earliest documented cases of hepatitis E virus infection occurred in India (Dehli) in 1955 after heavy flooding. Subsequently sporadic outbreaks have been recorded throughout Asia , Africa , and Central America , usually in association with contaminated drinking water. Pigs, rats, deer, and some other animals may act as alternate hosts. No vaccine is available at present.
(Promed 4/23/04)

 India (Karnataka) — 26 cases of monkey-fever reported
Monkey-fever ( Kyasanur Forest disease) has made a comeback in some parts of the State of Karnataka this summer, prompting the district to go on a vaccination drive. Shimoga District Health Officer, Dr. S.H. Satish, said that vaccination is given free to all villagers in the Malnad area of Shimoga, Chikmagalur, parts of Uttara and Dakshina Kannada. "The disease would prove fatal only when it affects the brain (viral encephalitis). Once a person realizes that he has been bitten by a tick, vaccination should be sought at the earliest opportunity. This lessens the severity of the disease," he said. "Irritation, red rashes, and formation of patches appear immediately after the tick bites. Some people are found to be allergic, which makes it very obvious," Satish said.

According to health officials, the number of people affected and killed by this disease has come down drastically. So far in 2004, only one fatal case was reported — the remaining 26 recovered. "We had vaccinated 28 000 villagers belonging to the Malnad area. The patient who died had refused to be vaccinated," Satish said. The disease normally appears around November with the onset of the dry season and declines with the first rainfall. High fever, accompanied by body-ache and bleeding of gums and intestines, are some of the symptoms. In extreme cases, the disease obstructs the normal functioning of the brain, from which there is no recovery. The disease that originated in 1954, in the Malnad areas of Karnataka, is found only in forest areas; it has not been detected anywhere else in the world. Satish said that monkeys living in forest areas spread the disease to others through ticks. Others who are prone to be bitten by the ticks are cattle and humans frequenting forest areas. "The disease was first discovered among monkeys, hence the term monkey-fever. It is restricted to rural and forest areas," Satish said. He said that the chances of getting the disease is greater if a man is bitten by monkey.

The causative virus, Kyasanur Forest disease virus, was first isolated in 1957 during a fatal epizootic affecting free-living monkeys in the region of India formerly known as Mysore (now Karnataka). Human infection has occurred frequently among forest workers with a mortality reaching 10 percent. The principal tick vector is the species Haemaphysalis spinigera. An effective inactivated vaccine is available for protection of those at risk and for post-exposure treatment to moderate the course of illness.
(Promed 4/24/04, 4/25/04)

India (Ahmedabad) — Outbreak of undiagnosed jaundice
Jaundice has claimed three lives in Ahmedabad, and more than 120 cases have been registered in the eastern suburbs, where this water-borne disease has assumed near-epidemic proportions. Sources in the Health Department of the Ahmedabad Municipal Corporation (AMC) have confirmed the death of a resident of Gayatrinagar. Two deaths had already been reported from New Bhavaninagar and Gayatrinagar of the Amraiwadi area, and as many as 14 cases have been registered from the Nava Vadaj area. Four more cases were reported in Ahmedabad 5 May 2004. AMC officials also suspect that many cases in the eastern part of the city may be going unreported, as those afflicted may be going to private practitioners. It is believed that the contamination of drinking water supplied to Amraiwadi and other eastern suburbs is the main cause of the disease.

AMC Health Officer Dr P K Makwana said, "The problem is getting serious with each passing day, and efforts are on in full swing to contain the disease." However, that does not seem to have helped with the disease spreading to newer areas, something that AMC officials refused to comment on. "We are making efforts to replace damaged pipelines in affected eastern areas, where it was discovered that residents had made holes in the supply pipeline. Besides, we are supplying drinking water to these areas by tankers." AMC officials are also reported to have contacted NGOs working in these areas to create awareness about personal hygiene.

Water-borne hepatitis can usually be attributed to infection by either hepatitis A virus or hepatitis E virus, two unrelated enteric viruses, as a result of fecal contamination of water-supplies. Hepatitis A virus infection generally resolves without complication, and effective vaccines are available for prevention and control of epidemics. Hepatitis E virus, which was first isolated in India , has been responsible for outbreaks throughout the sub-continent (and elsewhere) and, although usually associated with acute self-limiting disease, can be more threatening, particularly for women in late pregnancy. No vaccine is available at present.
(Promed 5/4/04, 5/11/04)

 India (Calcutta) — Tests point to cholera outbreak
Tests conducted by the National Institute of Cholera and Enteric Diseases have revealed that nearly all the patients admitted to the Infectious Diseases (ID) Hospital at Beleghata following the gastroenteritis outbreak in several parts of Calcutta were victims of cholera. As many as 99 per cent of the over 1500 patients admitted to the ID Hospital between 5 and 17 Apr 2004 — the period during which the spate of casualties was highest — were suffering from cholera. Hundreds of residents in the congested slum areas of Narkeldanga, Rajabazar, Tangra, and Beniapukur had to be rushed to the hospital with symptoms of severe dehydration and stomach upset following consumption of contaminated piped water. Doctors at the ID hospital pointed out that most of the patients admitted got the infection through polluted water. Sewage water, leaking through damaged pipes, had mixed with filtered drinking water. Health department officials said cholera is usual in Calcutta with the onset of summer, and the number of admissions was coming down.
(Promed 4/28/04)


Canada (British Columbia): Discovery of new avian flu strain closes BC school
A new strain of avian flu has been found in the Fraser Valley , one that is different from anything that has been seen in the area before. The discovery of the new strain, among geese and ducks at the Abbotsford farm, has prompted officials to close a school across the road. Scientists could not rule out the possibility that the strain is the H5 virus responsible for the deaths of people in Asia , though they urged people not to panic. "We don't know what it is," said Sally Greenwood, a spokeswoman for the BC CDC. "It's not the H7 we have seen in BC, we don't know what it is. There's a possibility it could come back as being an H5 subtype. But, even if it does, it doesn't mean it's going to be the same virus as the one in Asia . Let's wait until we get the test results back." Some 19 millions chickens and turkeys in the Fraser Valley are being culled after an especially aggressive strain of H7 avian flu began killing off birds in Mar 2004. But, unlike that outbreak, the geese and ducks aren't showing any symptoms.

Greenwood said the mystery virus was discovered when blood tests of the birds showed antibodies, indicating they had been exposed to it at some point in the past. No children or staff at the nearby school showed any signs of illness. While the H7N3 virus was especially deadly to birds, it was not considered dangerous to humans; two farm workers came down with pink eye. However, the industry has been hard hit. Several Asian countries closed their borders to Canadian or BC chicken products. During the first week of May 2004, Agriculture officials estimated that it could take until next Mar 2005 before the industry is up and running in the province again.
(Promed 5/12/04)

USA — Mad cow testing to expand, agriculture chief says new cases wouldn't surprise her
Nearly six months after the first-ever case of mad cow disease was discovered in a Holstein at a Washington State dairy farm, the Agriculture Department is finally expected to launch an expanded testing program June 2004. Agriculture Secretary Ann Veneman, along with other Agriculture Departmental and industry officials, insist that the nation's meat supply is safe despite critics who say the government still isn't doing enough. Nevertheless, on April 7, Veneman said that she wouldn't be surprised if the expanded testing program ended up finding more infected animals. Current plans call for testing up to 400 000 animals over a period of 12 to 18 months for bovine spongiform encephalopathy (BSE). That is 10 times as many inspections as the department planned to conduct prior to the discovery of the infected cow in December 2003. Some lawmakers, however, have suggested that as many as three to four million of the 35 million cattle slaughtered every year must be tested to assess the health of the nation's herds.

BSE was first discovered in Britain in the 1980s. Since then, more than 181 000 cases have been reported in two dozen countries. Humans can get a form of the disease, variant Cruetzfeldt-Jakob disease, by eating contaminated meat. The human form of the disease is fatal, and more than 150 people, most of them in Britain , have died. Though Japan and some European countries test all of their cattle for BSE before slaughter, Veneman said there was no scientific justification for such a comprehensive program in the United States . But the chief executive officer of a major Kansas cattle operation said Veneman, and the Bush administration, were under pressure from the industry not to expand testing any further and have used science as a "cover" to hold down costs. John Stewart, of Creekstone Farms Premium Beef, said the tests would cost only USD 20 per animal and add only 4 cents to the price of a pound of ground beef. And, Stewart said, consumers would be willing to pay a premium for meat from tested cattle. In Apr 2004, the department blocked Creekstone's plan to test all of its cattle for mad cow disease, saying the tests did not offer any guarantee that animals weren't infected with BSE, noting that a panel of international experts said a total testing program wasn't called for scientifically.

Veneman also said the department had launched an investigation into the alleged violation of BSE testing procedures involving a suspect cow in Texas sent to a rendering plant before samples could be taken. Department officials said no part of the animal had entered the human food chain. Under established procedures, the animal should have been held until tissue samples were taken. "We quickly admitted it should have been tested," Veneman said. "There was some miscommunication. We are investigating this to the fullest extent."
(Promed 5/11/04)

 USA ( Colorado) — First suspected human case of West Nile virus in 2004
Weld County could once again have the first human case of West Nile virus infection in Colorado . The news took Weld health officials by surprise, and Mark Wallace, director of the Weld County Department of Health and Environment, said many thought the first human case wouldn't come for a few weeks. The Colorado Department of Agriculture reported the first equine West Nile case for the state 10 May 2004 . Blood from a Weld County resident tested positive for West Nile virus infection, Wallace said, although it still needs to be confirmed by the state health department and the CDC. The person was not hospitalized but had symptoms consistent with West Nile , leading to the reason for the test. In 2003, 402 residents were diagnosed with West Nile virus infection, and of those, five died. Weld County has had the first human cases in the state in the past two years. Usually dead birds are the first sign of the disease, followed by equine cases, and, finally, humans. But in 2004, Wallace said dead birds had been reported, but he wasn't aware of a bird testing positive for the virus in 2004 by the Weld County health department.
(Promed 5/12/04)

Mexico — National alert declared in response to outbreak of measles
Mexican health authorities have declared a state of national alert due to an outbreak of 59 cases of measles in the central part of the country. They have also announced a vaccination campaign in the whole territory aimed at preventing transmission. Miguel Angel Nakamura, technical director of the National Center for Child and Adolescent Health, commented that the transmission of measles in Mexico had already been eliminated and that the detection of even one case is cause for alert. Since 2 Jan 2004 , 59 cases of the disease have been reported, the highest number since 2000, when an outbreak caused by a virus that originated in Asia was reported. Of the cases registered to date, 39 have occurred in the capital, 17 in the neighboring state of Mexico , and three in the state of Hidalgo . In all of the cases the H1 virus was isolated, and Nakamura said that it might have been introduced by one of the members of the Korean community in the capital.

Nakamura also explained that the first action taken to manage the outbreak was the vaccination of all susceptible individuals residing in the areas where the cases were detected. Next, all Mexicans between the ages of 13 and 39 will be vaccinated. Cases have occurred in young adults because this is the susceptible population; they did not receive a second dose of measles vaccine, as the two dose policy did not exist when they were younger. Children between age one and nine have been protected with the two-dose vaccination series. Nakamura commented that in Mexico there are currently more than 7 million doses of the vaccine available and that it is expected that more will be purchased, to reach 16 million doses. Throughout the country, 2.5 million doses of the vaccine have already been distributed.

Nakamura explained that the last indigenous case of measles in Mexico was reported in 1996. In 2000, 30 cases of the disease, imported from Asia , were reported. During 2001, three cases were registered, none during 2002, and 44 during 2003. A CDC report summarized the epidemiology of measles in the Americas during 2002-2003 and highlights progress toward measles elimination (MMWR 2004: 53(14): 304-6, 16 Apr <http://www.cdc.gov/mmwr/PDF/wk/mm5314.pdf>).
(Promed 4/29/04)

Venezuela (Zulia) — Second rabies death in Zulia state this year
On 25 Apr 2004 , the Head of the Epidemiology Department of the Venezuelan Ministry for Health and Social Development reported the death of a boy from Maracaibo from rabies. In a 13-year period, there have been 21 rabies deaths in the state of Zulia, two of which occurred this year (2004). The Head of Epidemiology commented that this situation indicates deficiencies in the regional health system. He also placed special emphasis on the need for immediate vaccination of people who have been bitten by dogs or cats.

This report implies, but does not confirm, that the victim was bitten by a rabid dog or cat. A recent report implicated vampire bats in the transmission of rabies in an Amazonian town in the state of Para . Vampire bat attacks on humans in Venezuela have been documented (e.g. Caraba, Rev Salude Publica 30; 483-484, 1996), and it is likely that both vampire and insectivorous bats play a role in the maintenance of rabies infection in Venezuela and in other Latin American countries. Genetic characterization and antigenic analyses of isolates from human cases of rabies in Venezuela (de Mattos et al., J Clin Microbiol 34; 1553-1558, 1996) have revealed considerable diversity and identified several antigenic variants. Recognition of the source of outbreaks of dog-transmitted rabies may be necessary to achieve satisfactory control of rabies.
(Promed 5/2/04)

Ecuador (Chimborazo): Fatal human cases of plague
A 55-year-old woman and her 22-year-old daughter died of bubonic plague in the locality of Guamote in the province of Chimborazo . The mother and daughter raised guinea pigs for sale, which are a common food in the Andean region. A third person presenting similar symptoms is hospitalized in the isolation unit of a teaching hospital in Riobamba . Five hundred persons were treated to prevent spread of the disease, and according to authorities a containment circle has been established and high risk areas will be fumigated. The health department in Chimborazo Province advised local medical personnel that patients admitted from the town of Guamote presenting fever, cough, enlargement of the lymph nodes, weakness and malaise, should be considered as suspected cases of bubonic plague. Dr. Adela Vimos, Director of Epidemiology, Chimborazo Province , said the disease is endemic in the region, and explained why the new re-emergence of human cases is a dangerous threat to the community health. The health authorities of the Province of Chimborazo have prohibited the consumption of guinea pigs and rabbits. On April 29th an alert was issued for the provinces of Cotopaxi , Tungurahua, Bolívar, Azuay and Chimborazo . No new cases have been detected.
(Promed 5/13/04)


Dengue/DHF update

Sri Lanka
Over 180 cases of Dengue have been detected within the Colombo metropolis, giving rise to a fear that the disease could assume epidemic proportions. "The numbers detected so far reveal an increase of over 90 percent over 2003", Dr. Pradeep Kariyawasam, Chief Medical Officer of the Colombo Municipal Council said. He said that in 2003, it was possible to avert a crisis because the CMC had carried out a dengue awareness campaign and conducted house-to-house visits to detect dengue breeding sites in March, before the peak season. "We also imposed fines and warned all householders who had dengue breeding sites that we would take stern action if they did not clean their surroundings at our next visit", he said. Emphasizing the importance of a sustained campaign to create awareness on the prevention of dengue, he said the public tended to forget that environmental cleanliness was the most effective way of eliminating dengue. Currently the CMC is carrying out fogging and spraying of chemicals in high-risk areas, but because the dengue carrying mosquito is a low-flying insect, these activities have not proved highly effective. The CMC hopes to conduct a large campaign involving CMC, medical students of the Colombo medical faculty, and Rotarians who will inspect houses in the city, distribute leaflets and enlist the support of the public to maintain a mosquito-free environment.

Australia (Queensland)
Health authorities in Townsville are encountering opposition to their efforts to control dengue fever. The dengue fever outbreak has now reached 47 cases, with the latest cases in North Ward, Gulliver and Aitkenvale. John Piispanen from the Tropical Public Health Unit says some residents in North Ward have been resisting efforts to eradicate mosquito breeding sites in and around their homes.
(Promed 5/6/04)

Diarrhea and dysentery update

A total of 211 156 cases of diarrhea have been reported in Argentina so far this year (2004), 105 292 of them in children under five years old. Most cases have been reported in Buenos Aires (48 565), followed by the provinces of Salta (31 067), Cordoba (13 954), Mendoza (13 711), Santa Fe (11 856), Neuquen (11 391), and Jujuy (11 385). In addition, 44 cases of typhoid fever have been reported — 31 cases reported in Entre Rios, 9 in Corrientes , 2 in Formosa , 1 in Catamarca, and 1 in Salta . For this period, no cholera cases have been reported.

The diarrhea situation is alarming, with hospitals and clinics struggling to cope with the increasing number of patients. Around 400 patients a day were admitted in the last two weeks to the International Centre for Diarrhoea Disease Research, Bangladesh (ICDDR,B), the sole hospital for treatment of waterborne diseases at Mohakhali. About 70 to 80 per cent of the patients coming were children, hospital sources said. ICDDR,B treated around 8000 diarrhea patients in Mar 2004. In Feb 2004, the number was 4881 and in Jan 2004 it was 5857. The monthly number had already crossed 10 000 mark before 25 Apr. Like the ICDDR,B, Dhaka Shishu Hospital , Dhaka Medical College Hospital (DMCH), Suhrawardy Hospital , National Hospital , and Mitford Hospital are also facing rising number of diarrhea patients, who occupy more than 20 to 25 per cent of beds in these hospitals. ICDDR,B sources said most of the patients being treated there belong to the city's slum areas and low-income group. The contaminated water supplied by the Water and Sewerage Authority (WASA) is also adding greatly to the situation, a diarrhea patient from Shantinagar alleged. Rotavirus and enterotoxigenic _E. coli_ are the two germs mainly responsible for diarrhea, which leads to the patient having frequent loose motions followed by dehydration, the severity of which may result in death in some cases.

The diarrhea epidemic in Bagahi village of Rautahat which broke out 23 Apr 2004 has affected over 100 people. News reports blamed contaminated food and water as well as rising temperatures. The VDC health post had repeatedly informed the District Public Health Office about shortage of necessary medicines to counter the epidemic, but no action was taken. The Himalayan Times newspaper quoted Dr Shobhendra Karna, chief of the District Public Health Office, as denying any knowledge of the epidemic.

Ninety four people, including 22 children, were in the hospital in northern China after falling ill at a funeral dinner, probably from salmonella poisoning. Around 160 people fell ill at the dinner 6 May 2004 , in the Inner Mongolia village of Zhenghao . Of those in the hospital in the Dalad district 8 May 2004 , 20 were in serious condition.
(Promed 4/30/04, 5/11/04)

Viral gastroenteritis update

Canada (Vancouver)
A norovirus outbreak has made dozens of people sick, and judges, lawyers, inmates in the jail, and several people in the courthouse cafeteria have come down with the intestinal virus. Health officials believe the virus was spread through the courthouse cafeteria, Vancouver Coastal Health Authority spokeswoman Viviana Zanocco said. Zanocco said an environmental health officer is monitoring the cleanup daily. No one has been seriously ill.

USA (Wyoming)
At least 62 patients and staff at the Shepherd of the Valley Care Center have a stomach sickness that health officials think is due to norovirus infection. Karen James, the center's director of nursing, said that 50 of the 172 residents, and 12 staff members, have an illness that can cause vomiting and diarrhea. She said the first people became sick 26 Apr 2004 , but everyone, at this point, has made a full recovery. City of Casper-Natrona County Health Department spokesman Marty Thone said that the outbreak is worrisome, since most of the center's residents are older than 70 and may have suppressed immune systems.

USA (Caribbean/Philadelphia)
Passengers on a Norwegian Cruise Lines ship that left Bermuda 1 May 2004 said their journey was fraught with problems, including a stomach bug that sickened more than 30 people. The company flew 39 of the cruise liner's 1111 passengers home after paying for their hotel stays. Norwegian Cruise Lines spokeswoman Susan Robison said tests had determined that the stomach bug was not linked to food. She said that the crew was taking steps to disinfect the ship to eliminate the virus. Noroviruses — which include Norwalk virus and related viruses — can cause diarrhea, stomach pain and vomiting for 24 to 48 hours. They are spread through food, water and close contact with infected people or with things that they have touched.

USA (Alaska)
Public health workers are investigating an outbreak in Fairbanks of highly contagious norovirus infection. Eighteen people have fallen ill with norovirus-like symptoms, which are diarrhea, nausea, and vomiting, according to Marc Chimonas, a physician with the Alaska Division of Public Health. Two public places believed to have been contaminated with the virus have been disinfected. Five of the 18 norovirus cases are extremely mild, Chimonas said. Noroviruses are spread person-to-person, typically by eating food or by drinking water contaminated by the feces of an infected person. Symptoms typically last about two days. Chimonas is working with local public health workers and officials with the Alaska Department of Environmental Conservation to distribute information about how to prevent the spread of the virus. "Hand-washing is key," Chimonas said. The virus commonly makes its way to Alaska via cruise ships. The virus has not yet been confirmed through lab testing, but the symptoms point almost beyond doubt to norovirus, Chimonas said.

Cruise ship operator P and O blamed poor personal hygiene among some passengers for an outbreak that forced a ship to return. The company's Pacific Sky luxury liner returned to Sydney 9 May 2004 after 140 passengers became sick, suffering attacks of nausea, vomiting, and diarrhea. It was the second time the ship had been affected by illness recently, with a similar gastrointestinal virus outbreak attacking 200 passengers Dec 2003. Disgruntled passengers were reported to be demanding refunds, but the cruise company denied responsibility, saying a passenger probably brought the virus — a norovirus — on board, and spread it by personal contact. The company said it would consider refunds, or credits, for future cruises on a case by case basis.
(Promed 5/3/04, 5/11/04)



Measles deaths drop dramatically as vaccine reaches world's poorest children
The WHO and the United Nation's Children's Fund (UNICEF) announced a global reduction of 30% in deaths from measles between 1999 and 2002. At 35%, the reduction in measles deaths was even greater in Africa , the region with the highest number of people affected by the disease. This progress demonstrates that collectively countries can achieve the United Nations goal of cutting global measles deaths in half by the end of 2005.

Despite the availability of a safe, effective, inexpensive vaccine for over 40 years, measles remains the leading vaccine-preventable killer of children. In 1999, some 869 000 people, mostly children, died of measles. In 2002, measles killed an estimated 610 000 people, a decline of 30%. Recent progress is due to the adoption by the most affected countries of the comprehensive WHO/UNICEF strategy for sustainable measles mortality reduction. At a WHO/UNICEF meeting in October 2003, Ministry of Health representatives from 45 high-burden countries agreed that this strategy was highly effective in reducing measles deaths in a sustainable fashion. The strategy is based on achieving at least 80% routine measles immunization coverage in every district, and ensuring that all children get a second opportunity for measles immunization either through routine services or periodic Supplemental Immunization Activities (SIAs) every three to four years, whereby every child from nine months to five years of age is immunized over a one to two week period. “Countries have proven that routine immunization and supplemental measles immunization will reduce measles deaths. This is an extremely important step. Now WHO encourages all high-burden countries to implement these strategies, and stands ready to help," said Dr Lee Jong-wook, WHO Director-General. “However success also requires more resources, and a long-term commitment of leaders to permanently reducing measles deaths."

The estimated annual cost for measles mortality reduction activities in the 45 high burden countries is approximately US$ 140 million. An important factor in the 35% decrease in measles deaths in Africa has been the support of the Africa Measles Partnership which has implemented the WHO/UNICEF strategy. Starting in 2001, this partnership, with core membership of national governments, WHO, UNICEF, the American Red Cross, the CDC and the United Nations Foundation, committed itself to funding and implementing large-scale measles SIAs. Other key partners include the governments of Australia , Canada and Japan as well as the International Federation of Red Cross and Red Crescent Societies and the Bill and Melinda Gates Foundation. http://www.who.int/mediacentre/releases/2004/pr30/en/
(WHO 4/27/04)

Lyme Disease — United States, 2001–2002
“Lyme disease (LD) is caused by the spirochete Borrelia burgdorferi and is transmitted through the bite of Ixodes spp. ticks. CDC began LD surveillance in 1982, and the Council of State and Territorial Epidemiologists designated LD a nationally notifiable disease in 1991. This report summarizes the analysis of 40,792 cases of LD reported to CDC during 2001–2002. The results of that analysis indicate that annual LD incidence increased 40% during this period. The continued emergence of LD underscores the need for persons in areas where LD is endemic to reduce their risk for infection through integrated pest management, landscaping practices, repellent use, and prompt removal of ticks.

For surveillance purposes, a case of LD is defined as physician-diagnosed erythema migrans (EM) >5 cm in diameter or at least one objective manifestation of late LD (e.g., musculoskeletal, cardiovascular, or neurologic) with laboratory confirmation of B. burgdorferi infection using a two-tiered assay. National, state, and age-specific incidence was calculated by using U.S. Census Bureau data for 2001 and 2002; incidence by county was calculated by using U.S. Census data for 2000.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5317a4.htm
(MMWR May 7, 2004 / 53(17);365-369)

Framework for evaluating public health surveillance systems for early detection of outbreaks — Recommendations from the CDC Working Group
“The threat of terrorism and high-profile disease outbreaks has drawn attention to public health surveillance systems for early detection of outbreaks. State and local health departments are enhancing existing surveillance systems and developing new systems to better detect outbreaks through public health surveillance. However, information is limited about the usefulness of surveillance systems for outbreak detection or the best ways to support this function. This report supplements previous guidelines for evaluating public health surveillance systems. Use of this framework is intended to improve decision-making regarding the implementation of surveillance for outbreak detection. Use of a standardized evaluation methodology, including description of system design and operation, also will enhance the exchange of information regarding methods to improve early detection of outbreaks. The framework directs particular attention to the measurement of timeliness and validity for outbreak detection. The evaluation framework is designed to support assessment and description of all surveillance approaches to early detection, whether through traditional disease reporting, specialized analytic routines for aberration detection, or surveillance using early indicators of disease outbreaks, such as syndromic surveillance.” http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5305a1.htm
(MMWR May 7, 2004 / 53(RR05);1-11)

Malaria Surveillance — United States , 2002
“Problem/Condition: Malaria is caused by any of four species of intraerythrocytic protozoa of the genus Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae). These parasites are transmitted by the bite of an infective female Anopheles species mosquito. The majority of malaria infections in the United States occur among persons who have traveled to areas with ongoing transmission. In the United States , cases can occur through exposure to infected blood products, by congenital transmission, or by local mosquitoborne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers.

Period Covered: This report covers cases with onset of illness in 2002.

Description of System: Malaria cases confirmed by blood film are reported to local and state health departments by health-care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS). Data from NMSS serve as the basis for this report.

Results: CDC received reports of 1,337 cases of malaria with an onset of symptoms in 2002 among persons in the United States or one of its territories. This number represents a decrease of 3.3% from the 1,383 cases reported for 2001. P. falciparum, P. vivax, P. malariae, and P. ovale were identified in 52.3%, 25.4%, 2.8%, and 2.8% of cases, respectively. Eleven patients (0.8% of total) were infected by >2 species. The infecting species was unreported or undetermined in 213 (15.9%) cases. Compared with 2001, the number of reported malaria cases acquired in Asia (n = 171) and Africa (n = 903) increased by 4.3% and 1.9%, respectively, whereas the number of cases acquired in the Americas (n = 141) decreased by 41.2%. Of 849 U.S. civilians who acquired malaria abroad, 317 (37.3%) reported that they had followed a chemoprophylactic drug regimen recommended by CDC for the area to which they had traveled. Five patients became infected in the United States , one through congenital transmission, one probable transfusion-related, and three whose infection cannot be linked epidemiologically to secondary cases. Eight deaths were attributed to malaria. All deaths were caused by P. falciparum.

Interpretation: The 3.3% decrease in malaria cases in 2002, compared with 2001, resulted primarily from a marked decrease in cases acquired in the Americas , but this decrease was offset somewhat by an increase in the number of cases acquired in Africa and Asia . This limited decrease probably represents year-to-year variation in malaria cases, but also could have resulted from local changes in disease transmission, decreased travel to malaria-endemic regions, fluctuation in reporting to state and local health departments, or an increased use of effective antimalarial chemoprophylaxis. In the majority of reported cases, U.S. civilians who acquired infection abroad were not on an appropriate chemoprophylaxis regimen for the country in which they acquired malaria.

Public Health Actions: Additional information was obtained concerning the eight fatal cases and the five infections acquired in the United States . Persons traveling to a malarious area should take one of the recommended chemoprophylaxis regimens appropriate for the region of travel, and travelers should use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and who subsequently experiences a fever or influenza-like symptoms should seek medical care immediately and report their travel history to the clinician; investigation should include a blood-film test for malaria. Malaria infections can be fatal if not diagnosed and treated promptly. Recommendations concerning malaria prevention can be obtained from CDC by calling the Malaria Hotline at 770-488-7788 or by accessing CDC's Internet site at http://www.cdc.gov/travel.”

(MMWR April 30, 2004 / 53(SS01);21-34)


Recommended Childhood and Adolescent Immunization Schedule-- United States , July–December 2004
“CDC’s Advisory Committee on Immunization Practices (ACIP) periodically reviews the recommended childhood and adolescent immunization schedule to ensure that the schedule is current with changes in manufacturers’ vaccine formulations and reflects revised recommendations for the use of licensed vaccines, including those newly licensed. Recommendations and format of the childhood and adolescent immunization schedule for January–June 2004 were approved by ACIP, the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics (AAP) and published in January 2004. This report updates that schedule with the recommendation that, beginning in fall 2004, children aged 6–23 months, as well as household and out-of-home caregivers for such children, receive annual influenza vaccine. This change is reflected in the revised childhood and adolescent immunization schedule for July–December 2004. A catch-up immunization schedule for children and adolescents who start late or who are >1 month behind remains unchanged from that published in January 2004.”

( April 30, 2004 / 53(16);Q1-Q3)

Prevention and Control of Influenza--Recommendations of the Advisory Committee on Immunization Practices (ACIP)
“This report updates the 2003 recommendations by the Advisory Committee on Immunization Practices (ACIP) on the use of influenza vaccine and antiviral agents (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2003;52[No. RR-8]:1--34) . The 2004 recommendations include new or updated information regarding 1) influenza vaccine for children aged 6–23 months; 2) vaccination of health-care workers with live, attenuated influenza vaccine (LAIV); 3) personnel who may administer LAIV; 4) the 2004–05 trivalent inactivated vaccine virus strains: A/Fujian/411/2002 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Shanghai/361/2002-like antigens (for the A/Fujian/411/2002 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/Wyoming/3/2003 [H3N2] virus, and for the B/Shanghai/361/2002-like antigen, manufacturers may use the antigenically equivalent B/Jilin/20/2003 virus or B/Jiangsu/10/2003 virus); and 5) the assessment of vaccine supply and timing of influenza vaccination. A link to this report and other information regarding influenza can be accessed at http://www.cdc.gov/flu.”http://www.cdc.gov/mmwr/preview/mmwrhtml/rr53e430a1.htm
(MMWR April 30, 2004 / Volume 53;1-40)

Responding to Detection of Aerosolized Bacillus anthracis by Autonomous Detection Systems in the Workplace
“Autonomous detection systems (ADSs) are under development to detect agents of biologic and chemical terror in the environment. These systems will eventually be able to detect biologic and chemical hazards reliably and provide approximate real-time alerts that an agent is present. One type of ADS that tests specifically for Bacillus anthracis is being deployed in hundreds of postal distribution centers across the United States . Identification of aerosolized B. anthracis spores in an air sample can facilitate prompt on-site decontamination of workers and subsequent administration of postexposure prophylaxis to prevent inhalational anthrax. Every employer who deploys an ADS should develop detailed plans for responding to a positive signal. Responding to ADS detection of B. anthracis involves coordinating responses with community partners and should include drills and exercises with these partners. This report provides guidelines in the following six areas: 1) response and consequence management planning, including the minimum components of a facility response plan; 2) immediate response and evacuation; 3) decontamination of potentially exposed workers to remove spores from clothing and skin and prevent introduction of B. anthracis into the worker's home and conveyances; 4) laboratory confirmation of an ADS signal; 5) steps for evaluating potentially contaminated environments; and 6) postexposure prophylaxis and follow-up.” http://www.cdc.gov/mmwr/preview/mmwrhtml/rr53e430-2a1.htm
(MMWR April 30, 2004 / 53(Early Release);1-11)

Outbreak of varicella among xaccinated children — Michigan , 2003
“On November 18, 2003 , the Oakland County Health Division alerted the Michigan Department of Community Health (MDCH) to a varicella (chicken pox) outbreak in a kindergarten–third grade elementary school. On December 11, MDCH and Oakland County public health epidemiologists, with the technical assistance of CDC, conducted a retrospective cohort study to describe the outbreak, determine varicella vaccine effectiveness (VE), and examine risk factors for breakthrough disease (i.e., varicella occurring >42 days after vaccination). This report summarizes the results of that study, which indicated that 1) transmission of varicella was sustained at the school for nearly 1 month despite high vaccination coverage, 2) vaccinated patients had substantially milder disease (<50 lesions), and 3) a period of >4 years since vaccination was a risk factor for breakthrough disease. These findings highlight the importance of case-based reporting of varicella and the exclusion of patients from school until all lesions crust or fade away. Information about recognizing vaccinated patients with mild cases should be disseminated to health-care providers, school administrators, and parents.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5318a4.htm
(MMWR May 14, 2004 / 53(18);389-392)

Creutzfeldt-Jakob Disease Not Related to a Common Venue — New Jersey, 1995–2004
“Beginning in June 2003, the New Jersey Department of Health and Senior Services (NJDHSS) and CDC were notified of a suspected cluster of deaths caused by Creutzfeldt-Jakob disease (CJD) in persons reportedly linked to Garden State Racetrack in Cherry Hill , New Jersey . Concerns were raised that these deaths might have resulted from consumption of meat contaminated with the agent causing bovine spongiform encephalopathy (BSE, commonly called "mad cow disease") served at racetrack restaurants during 1988–1992. Consumption of BSE-contaminated cattle products has been linked to a new variant form of CJD (vCJD) in humans. This report summarizes the results of an investigation that determined the deaths were not linked causally to a common source of infection. The findings underscore the need for physicians to arrange for brain autopsies of all patients with clinically suspected or diagnosed CJD.”
(MMWR May 14, 2004 / 53(18);392-396)

The world health report 2004 — changing history
WHO launches The world health report 2004 – changing history, which chronicles the global spread of HIV/AIDS and details the need for linking prevention, treatment, care and support for people living with the virus. The report concludes that coordinated efforts now to control one of the worst global epidemics, could change the course of history. At a crucial moment in the pandemic's history, the international community has an unprecedented opportunity to alter its course and simultaneously fortify health systems for the enduring benefit of all. http://www.who.int/whr/en/
(WHO 5/11/04 )


FAO/WHO Regional Conference on Food Safety for Asia and the Pacific: Practical actions to promote food safety — Seremban, Malaysia, 24-27 May 2004
This conference is part of a series of regional meetings to meet the needs of Member countries for policy guidance and capacity building in food safety. The delegates at the 13th session of the Codex Coordinating Committee for Asia ( Kuala Lumpur , September 2002) recommended that the Food and Agriculture Organization of the United Nations (FAO) and the WHO convene a Regional Conference on Food Safety for Asia and the Pacific in 2004 at the invitation of the Government of Malaysia. This recommendation is in line with the suggestion made by the participants at the first Joint FAO/WHO Global Forum of Food Safety Regulators in Marrakech , Morocco , January 2002 encouraging FAO and WHO to convene regional food safety conferences/fora in all the regions of the world.This Asian and Pacific Conference will work to:

  • Address and facilitate discussion on issues important to all countries of the Asian and Pacific region and identify practical actions and capacity building recommendations in support of food safety;
  • Identify opportunities for regional cooperation related to agriculture, agribusiness, post-harvest production, food processing, food trade, public health, and consumer protection;
  • Provide a platform for broad co-operation and mutual understanding;
  • Promote increased exchange of information at all levels to improve transparency and capacity building and to more effectively communicate with consumers, producers, and industries to improve food safety.


Fifty-seventh World Health Assembly, 17-22 May 2004
The fifty-seventh World Health Assembly, bringing the 192 Member States of the World Health Organization together, is set to consider several critical health issues. The Health Assembly is the supreme decision-making body for WHO, and runs this year from 17–22 May. It will discuss actions needed to fight HIV/AIDS, to increase safety on the world's roads, a proposed strategy on diet, physical activity and health, a proposed strategy for reproductive health, a resolution on family health, and will receive updates on progress in eradicating polio, controlling measles and SARS. Keynote addresses will also be given by former Presidents Kim Dae-jung of the Republic of Korea , and Jimmy Carter of the United States of America . http://www.who.int/mediacentre/notes/2004/np14/en/

Public Library of Science (PLoS) to launch international open-access medical journal, Call for Papers
PLoS, a non-profit organization whose mission is to make reliable scientific and medical literature a public resource, formally announced that it will publish PLoS Medicine, an open-access, international, general medical journal, beginning this fall. Dr. Harold E. Varmus, Nobel laureate, former National Institutes of Health Director, is one of the co-founders of the Public Library of Science (PLoS). A "call for papers" has been issued, indicating that the journal is now accepting submissions. PLoS Medicine will publish important peer-reviewed advances in all areas of medical research, including epidemiology and public health, together with summaries of all research articles written for non-specialists and features about international developments in medicine, controversial medical topics, neglected diseases, and other health-related subjects. All content in the journal will be freely available online and allowed to be reproduced worldwide for teaching, promoting awareness of new discoveries, and other purposes.

PLoS was founded in 2000 by Dr. Varmus and colleagues Patrick O. Brown of Stanford University and Michael B. Eisen of Lawrence Berkeley Laboratory and the University of California , Berkeley . In October 2003, the organization launched its first open-access journal of peer-reviewed scientific research, PLoS Biology, whose content has been favorably reviewed by the New York Times, Le Monde, and countless other media outlets around the world. PLoS Medicine will be overseen by PLoS Senior Editors Barbara Cohen, former editor of Nature Genetics and former executive editor of the Journal of Clinical Investigation, and Virginia Barbour, a physician and haematologist and former executive editor of the Lancet. Working closely with members of the editorial board and in consultation with the wider medical and health research community, they will develop an open-access forum for important studies and for discussion of medical research and practice in the broader context of global health and social responsibility. For more information about the Public Library of Science, see http://www.plos.org For more information about PLoS Medicine, see http://www.plosmedicine.org
(Promed 5/10/04)

EcoHealth: New scientific journal
A new journal, EcoHealth issued part 1 of volume 1 in Mar 2004:

Publisher: Springer-Verlag , New York , LLC
ISSN: 1612-9202 (Paper) 1612-9210 (Online)
Issue: Volume 1, Number 1
Date: Mar 2004

Introduction: pp. 1-2, Bruce A. Wilcox, A. Alonso Aguirre, Peter Daszak, et al.

Editorial Overview: EcoHealth: A Trans-disciplinary Imperative for a Sustainable Future, pp. 3-5, Bruce A. Wilcox, A. Alonso Aguirre, Peter Daszak, et al.

Editorial: Biocomplexity and a New Public Health Domain, pp. 6-7, Rita R. Colwell

Cover Essay: Out of the Forest , pp. 8-9, David Waltner-Toews

Profiles: Medical Geology: Emerging Discipline on the Ecosystem-Human Health Interface, pp. 15-18, Joseph E. Bunnell


1) Mosquito-borne Diseases as a Consequence of Land Use Change, pp. 19-24, Douglas E. Norris

2) Henipaviruses: Gaps in the Knowledge of Emergence, pp. 25-38, Alex D. Hyatt, Peter Daszak, Andrew A. Cunningham, et al.

3) Trade-related Infections: Global Traffic and Microbial Travel, pp. 39-49

4) Ann Marie Kimball, Bruce Jay Plotkin, Tabitha A. Harrison, et al.

Original Contributions:

1) Ecosystem Approach to Community Health Planning in Ghana , pp. 50-59, Crescentia Dakubo

2) Impact of West Nile Virus on American Crows in the Northeastern United States and Its Relevance to Existing Monitoring Programs, pp. 60-68

3) Wesley M. Hochachka, Andre A. Dhondt, Kevin J. McGowan, et al.

4) Global Politics and Multinational Health-care Encounters: Assessing the Role of Transnational Competence, pp. 69-85, Peter H. Koehn

5) Ecosystem Approach to Rapid Health Assessments among Indigenous Cultures

6) Optimal Investment in Multi-species Protection: Interacting Species and Ecosystem Health, pp. 101-110, Stefan Baumgartner


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