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Vol. VII, No. 27 ~ EINet News Briefs ~ Dec 24, 2004


*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
- Canada: Six Canadians infected with malaria after visiting the Dominican Republic
- Canada (Alberta): First hantavirus case in two years
- USA (New Mexico): Hantavirus pulmonary syndrome case in Santa Fe
- USA (California): Health officials issue alert about rare sexually transmitted disease
- USA (California): Wound botulism strikes heroin users in the Bay Area
- USA (Florida/California): FDA believes botched botox came from California
- USA (California): Skin infections from pedicures in South Bay still rising
- USA (Colorado): Pueblo man reportedly dies of plague
- Japan: Confirmed human case of avian influenza H5N1, four others suspected
- South Korea: Bird flu confirmed, low pathogenicity avian influenza virus H5N2
- Hong Kong: Dead heron tests positive for bird flu
- Thailand: H5N1 virus strain found in native birds
- Thailand: Bird flu outbreaks detected in two more Thai provinces
- Indonesia: Bird flu virus hits West Nusa Tenggara
- Vietnam: Reports bird flu in six provinces, 11 000 birds destroyed
- China: Health ministry increases efforts to contain brucellosis
- Australia: Ten Human Contacts of Fatal Equine Case Under Surveillance
- Australia: Outbreak of Q fever in South Australia
- Philippines: 3.6 million flood victims threatened by outbreaks of communicable diseases

1. Updates
- Dengue/DHF update
- Viral gastroenteritis update
- West Nile Virus

2. Articles
- Recent publications regarding avian influenza by OIE
- Estimated Influenza Vaccination Coverage Among Adults and Children, US, Sep 1--Nov 30, 2004
- Obtaining flu vaccination among persons in priority groups during a vaccine shortage, US, Oct-Nov 04
- Experiences with ILI and attitudes regarding influenza prevention, US, 2003-2004 influenza season
- Brief Report: Respiratory Syncytial Virus Activity --- United States, 2003--2004
- Recovery of a Patient from Clinical Rabies --- Wisconsin, 2004

3. Notifications
- CDC’S Influenza website
- 2005 National Conference on West Nile Virus in the United States
- International Conference on Emerging Infectious Diseases

4. APEC EINet activities
- APEC EINet teleconference and videoconference

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Canada: Six Canadians infected with malaria after visiting the Dominican Republic
Canadians traveling to the Dominican Republic will be banned from donating blood for six months after they've returned, Canadian Blood Services said. The decision comes after six Canadians contracted malaria after going to the Caribbean nation since October 2004. One of the people that contracted malaria is on life support in a hospital in Toronto. Three others from Toronto have been released from hospital, but two travelers from British Columbia are in serious condition. "Because of recent reports of malaria cases and the fact that the Dominican Republic is a popular destination for many vacationing Canadians, we have decided to add this security measure to help protect the blood supply," said Dr Graham Sher, chief executive officer of the organization. Canadian Blood Services also wants any recent blood donors who were in the Dominican Republic since 1 Oct 2004 to contact them at 1-888-236-6283. (Promed 12/11/04)

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Canada (Alberta): First hantavirus case in two years
The province is alerting Albertans to the risk of hantavirus infection, after a man in the Lloydminster area became infected. He is the first case in Alberta in nearly two years. The virus is carried by mouse droppings, urine, or saliva. The mouse population in the province is high in 2004 because of a wet summer and good food supply. Mice droppings should be cleaned up with rubber gloves and disinfectant. After spending eight days in the hospital, the man has fully recovered. Roughly 30 percent of all hantavirus infection cases are fatal. (Promed 12/13/04)

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USA (New Mexico): Hantavirus pulmonary syndrome case in Santa Fe
The state Health Department says a Santa Fe County man has hantavirus pulmonary syndrome. The man is hospitalized in critical condition at the University of New Mexico Hospital. The state Health Department is investigating to find out where he was exposed to hantavirus. The virus is passed to humans who inhale particles of urine or feces from infected rodents, especially deer mice. Early symptoms include fever and muscle aches, possibly chills, headaches, nausea or vomiting, abdominal pain, and coughing. The symptoms develop one to six weeks after exposure. (Promed 12/13/04)

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USA (California): Health officials issue alert about rare sexually transmitted disease
San Francisco public health officials issued a warning 20 Dec 2004 that a rare and potentially debilitating sexually transmitted disease reported recently in the Netherlands has turned up among a small number of patients in the city. Known as lymphogranuloma venereum (LGV), the disease is a form of the common sexually transmitted infection chlamydia, but this particular strain can cause scarring of the genitals and colon, and can produce a swelling and rupture of lymph glands near the groin. Although the disease is seldom seen outside of poor, tropical nations, doctors in Rotterdam reported 92 cases among gay men during a 17-month period ending in Sep 2004. Isolated cases have also been reported in Belgium, France, Sweden and Atlanta, Georgia (USA). In November 2004, doctors at San Francisco's City Clinic treated a man with the disease, and subsequent tests of stored specimens spotted three other cases that occurred in summer 2004 but had gone undetected by conventional screens. None of the four patients who were found to have the infection in San Francisco had visited the Netherlands, an indication there may be other cases yet to be discovered in the city, said Dr. Sam Mitchell, a Department of Public Health epidemiologist. The four cases in San Francisco were gay men, some of whom also tested positive for HIV. Mitchell said there is no indication that HIV-positive patients are at higher risk for complications of LGV, but there is concern that a patient with the chlamydia infection might be more prone to contract HIV because of the ulceration caused by the bacteria. Treating LGV successfully requires a three-week course of antimicrobial agents, instead of the single dose of medicine used to treat common strains of chlamydia. Because it is difficult to distinguish early infections of LGV from the more benign microbes, Mitchell said the city is recommending that doctors treat all cases of rectal chlamydia with the three week regimen. It is not known at this point whether the Dutch outbreak is related to these cases. Transmission is predominantly sexual. However, transmission by fomites, nonsexual personal contact, and laboratory accidents has been documented. The creation of aerosols has been associated with infection associated with pulmonary symptoms. (Promed 12/22/04)

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USA (California): Wound botulism strikes heroin users in the Bay Area
On 29 Nov 2004, the first of several people wandered into Bay Area county hospitals with slurred speech, drooping eyelids, and difficulty swallowing. By 2 Dec 2004, at least three patients were paralyzed above the waist and required mechanical ventilation. The mysterious, rapidly progressing illness turned out to be wound botulism, a rare disease caused by a toxin in Clostridium botulinum bacteria. Alameda and San Francisco County public health officials immediately notified the California Department of Health Services, which alerted the CDC. Like most recent victims of wound botulism, the six patients are all black-tar heroin users who contracted the toxin-releasing bacteria from a dirty drug batch. Botulism cases always raise alarm, because C. botulinum is not only a bioterrorism agent, but also causes a particularly nasty disease. Exposed victims experience rapid descending paralysis, or gradual loss of muscle control beginning with the smaller muscles in the head and moving downward. By the time three of the six patients made it to San Francisco General Hospital, they were in critical condition. In the coming weeks or months they will need around-the-clock intensive care.

California has 75 percent of the wound botulism cases in the USA, which in turn has 90 percent of the cases reported globally. The illness was virtually unheard of prior to 1988, but since then California has seen a 20-fold increase in infections. Experts at the California Department of Health Services believe the recent surge in cases can be explained by two related developments in the heroin-using community: the increase in popularity of black-tar heroin from Mexico, and the practice of injecting heroin into soft tissue rather than veins. Repeated injections cause abscesses to form, creating a favorable climate for neurotoxin-producing bacteria like C. botulinum. (Promed 12/19/04)

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USA (Florida/California): FDA believes botched botox came from California
The investigation into four cases of botulism poisoning at a Fort Lauderdale, Florida clinic has expanded to a third state: California (two hospitalized in Florida and two in New Jersey; all four acquired in Florida). According to an affidavit filed in USA district court in northern California, Food and Drug Administration investigators believe List Biological Laboratories supplied the botulinum toxin that made four people critically ill. The company's site http://www.listlabs.com/ states that List has been manufacturing bacterial toxins for more than 25 years, including botulinum toxin. List Labs is the supplier for Toxin Research International, a company also under investigation. Allergan, the maker of FDA approved Botox, issued a statement 13 Dec 2004 saying the affidavit reveals its product played no role in the botulism cases. (Promed 12/14/04)

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USA (California): Skin infections from pedicures in South Bay still rising
The number of women who have reportedly developed severe skin infections from pedicures at various Santa Clara County nail salons has more than doubled over the first two weeks of Dec 2004, public health department spokeswoman Joy Alexiou said 16 Dec 2004. There are now 95 total cases being investigated, up from 40 cases reported 2 Dec 2004. Health officials began receiving reports from local doctors as early as May 2004 regarding an influx of patients with boils and skin ulcers on their feet and lower legs. It was determined that the women received pedicures prior to the infections, which likely stemmed from using a whirlpool foot bath, notorious breeding grounds for bacteria. The infection stems from the spread of mycobacteria, microbes that can cause painful open sores that have forced some women in years past to undergo reconstructive surgery to hide the scars. Also rising is the number of salons that women had patronized before noticing the infections, from three to 18. In response to the increasing number of cases, many of the salons have discontinued the use of the foot spas all together. (Promed 12/19/04)

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USA (Colorado): Pueblo man reportedly dies of plague
A 66-year-old Pueblo man died this week from bubonic plague, the Pueblo City/County Health Department announced 10 Dec 2004. The man died 8 Dec 2004 in a local hospital after being infected while rabbit hunting recently in Park County. He was hospitalized 6 Dec 2004. Local health department Director Chris Nevin-Woods said the man had an open wound on one of his hands and probably was exposed while skinning an infected rabbit that he had shot. She said more testing will be done on the rabbit for plague. The case was the first plague-related death in Colorado since 1999 and the state's third case in 2004. Since the first human case was reported in 1957, Colorado has reported 50 cases with eight fatalities. The state averages two cases per year. John Pape, an epidemiologist who specializes in animal-related diseases with the Colorado Department of Public Health and Environment's Disease Control and Environmental Epidemiology Division, explained: "When a rodent becomes infected, the bacteria circulates in the blood. Fleas are infected while feeding on the animal and can transmit the infection to other warm-blooded animals, including humans. People also can be exposed through contact with blood from infected animals. "Plague is found throughout Colorado and cycles from year to year," Pape said. "This summer, we saw an increase in plague activity around the state, including 20 cats, which are highly susceptible to the disease." If sick and dying rodents or other evidence of plague are observed, and a high risk of transmission to humans is determined, affected areas may be temporarily closed to protect the public and to implement control measures. Although plague is a serious illness, it can be readily treated with common antibiotics if recognized early. People will have a very sudden onset of high fever, fatigue and weakness, and a painful, swollen lymph node. Pape said that people can greatly reduce their risk of infection by taking a few simple precautions, including avoiding contact with sick rodents and rabbits. Hunters should use gloves when cleaning and dressing rabbits and other game to avoid blood exposure. (Promed 12/14/04)

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Asia
Japan: Confirmed human case of avian influenza H5N1, four others suspected
Japan confirmed its first human case of avian influenza flu and said four other people were suspected of catching the disease, but none of them have developed symptoms. Four of the five people suspected of catching the disease were employees at a poultry farm near the western city of Kyoto which took few precautions dealing with an outbreak in February, the health ministry stated. The other person was a city official who helped disinfect the farm. All five had tested positive for avian influenza through blood tests since April, and one of them showed an increase in antibodies confirming an infection. The infected male employee, who had taken two tests, suffered from a sore throat for a few days after taking anti-virus medication. The four other people have not been confirmed with bird flu because they took only one test each, but "it is highly possible that they have been infected", the statement said. None of the five developed symptoms peculiar to influenza, and they "are not expected to pose public health problems, as there is no possibility that they will develop such symptoms or infect other people".

Following the outbreak at the poultry farm owned by Asada Nosan Co., some 240 000 chickens and 20 million eggs were destroyed to contain the disease. In August 2004 Asada Nosan's president Hideaki Asada received a one-year jail term, suspended for three years, for failing to report the outbreak, which was only uncovered after suspicious neighbours informed authorities. His father, the chairman of Asada Nosan, and mother were found hanging in an apparent double suicide in early March after coming under intense media scrutiny for continuing to ship produce. The attempt to cover up the outbreak was seen as having led the farm employees to work without wearing sufficient protective clothing or gear.

Japan also banned imports of poultry from South Korea in response to a new outbreak this month at a Korean farm where thousands of ducks were culled. The agriculture ministry said in June that wild migratory birds from the Korean peninsula might have brought bird flu into Japan. In its final report on the outbreak, a ministry research team said RNA samples of the virus isolated in Japan were virtually identical to those from the virus from South Korea. The Japanese government has confirmed four outbreaks of avian influenza, including the Kyoto case, domestically since January--the first in the country since 1925. The health ministry said it had taken several months to determine the human infection because it was being careful due to the lack of established methods to test for the H5N1 bird flu strain. These data emphasizes the need to undertake seroprevalence studies in Thailand and Viet Nam in order to understand the reason for the apparent high fatality rates in these countries compared with elsewhere in East Asia. (Promed 12/22/04)

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South Korea: Bird flu confirmed, low pathogenicity avian influenza virus H5N2
South Korean confirmed the suspect case of a mild strain of bird influenza virus at a duck farm, according to South Korean national news agency Yonhap News. The Ministry of Agriculture and Forestry was quoted by Yonhap as saying a series of DNA tests found that ducks at the farm in Gwangju, about 330 km southwest of Seoul, were infected with the low-pathogenicity avian influenza virus H5N2. Following news of the bird influenza discovery, Japan imposed an import ban on chicken from South Korea. It is the first time that the H5N2 virus has been discovered in the country. Between December 2003 and March 2004, a highly pathogenic H5N1 virus hit South Korean chicken and duck farms, costing the poultry industry as much as 1 trillion won (USD 951 million). Preliminary tests on eggs from the farm had shown that the ducks had the less virulent strain of the influenza that does not spread to humans or mutate into the highly pathogenic subtype. All 9000 ducks on the farm were slaughtered and buried 22 Dec 2004, while a wide quarantine area has been designated around the farm to prevent possible spread.

Until recently, only highly pathogenic avian influenza had to be reported to the OIE. However, in view of the zoonotic aspects of avian influenza, the need for the inclusion of certain strains, even if they demonstrate lower pathogenicity in fowl, has become apparent. The traditional OIE definition of the disease is currently undergoing a revision, the disease becoming known as "notifiable avian influenza." The new definition, included in article 2.7.12.5 (under study) of OIE's Terrestrial Animal Health Code, is as follows:

"For the purposes of this Terrestrial Code, notifiable avian influenza (NAI) is defined as an infection of poultry caused by any influenza A virus of the H5 or H7 subtypes or by any AI virus with an intravenous pathogenicity index (IVPI) greater than 1.2 (or as an alternative at least 75 percent mortality) as described below. NAI viruses can be divided into highly pathogenic notifiable avian influenza (HPNAI) and low pathogenicity notifiable avian influenza (LPNAI). HPNAI viruses have an IVPI in 6-week-old chickens greater than 1.2 or, as an alternative, cause at least 75 percent mortality in 4-to 8-week-old chickens infected intravenously. H5 and H7 viruses which do not have an IVPI of greater than 1.2 or cause less than 75 percent mortality in an intravenous lethality test should be sequenced to determine whether multiple basic amino acids are present at the cleavage site of the haemagglutinin molecule (HA0); if the amino acid motif is similar to that observed for other HPNAI isolates, the isolate being tested should be considered as HPNAI". (Promed 12/23/04)

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Hong Kong: Dead heron tests positive for bird flu
A dead gray heron found near Hong Kong's border with mainland China has tested positive for bird flu, in the third such case in the territory this year, the government said 13 Dec 2004. The heron, found 10 days ago in the Lok Ma Chau area, was confirmed to have been infected by the H5N1 avian flu virus. All 20 poultry farms within 5 km were inspected by health officials, and birds there showed no symptoms of avian flu. In November 2004, another dead gray heron with the H5N1 virus was found in the same area. In January 2004, a dead peregrine falcon tested positive for bird flu. Poultry in Hong Kong have not been hit by the bird flu outbreak this year. An H5N1-infected dead heron was also detected in Cambodia in January 2004. For further details on the two grey herons found infected earlier in Hong Kong, see a recent paper by Ellis, Bousfield et al: Investigation of outbreaks of highly pathogenic H5N1 avian influenza in waterfowl and wild birds in Hong Kong in late 2002; Avian Pathology, Volume 33, Number 5 / October 2004, pp 492 - 505 (abstract at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?md=Retrieve&db=pubmed&dopt=Abstract&list_uids=15545029 ). (Promed 12/14/04)

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Thailand: H5N1 virus strain found in native birds
The H5N1 avian flu virus strain has been found in six types of indigenous birds in five provinces, said Dr. Charal Trinwutthipong, chairman of the center to prevent bird flu, 13 Dec 2004. However, Dr. Charal said only 10 out of a total of 1011 bird samples tested positive for avian influenza. They were three out of six pigeon samples collected from Chachengsao province, Nakhon Sawan and Lop Buri, two out of 15 Asian open-bill storks, one little cormorant and a red-collar dove from Nakhon Sawan, one scaly-breasted munia from Saraburi, and a black drongo from Lop Buri. All the infected birds were native ones. None of migratory birds tested positive.

Currently, there is no evidence of any direct transmission of the H5N1 virus from non-domestic birds to humans in Thailand or in any other country, Dr. Charal said. However, it is possible the virus could spread to humans via carriers such as chickens rather than directly from birds in the wild, he said. The government will make further studies to find out whether the infected sample birds had caught the virus while in close contact with infected poultry, or whether the birds themselves were carriers. Authorities also planned to study the habits and travel routes of various types of birds, as well as their life cycles, in order to draw up effective preventive measures. The government intended to collect up to 6000 samples of wild birds throughout the country by the end of this season for testing. Dr. Charal said the finding of the H5N1 virus in indigenous birds was "not unexpected," since they tended to have close contact with poultry in open farms.

Yukol Limlamthong, chief of the Livestock Development Department, warned poultry raisers to build proper holding pens, as well as to put up nets, to prevent their fowl from coming into close contact with birds in the wild. The number of areas under watch had dropped from 122 spots in 21 provinces to 71 in 19 provinces, including two newly listed ones: Nakhon Si Thammarat and Pattani. Suwit Viboonpolprasert, chairman of an anti-bird-flu working group, said his group was about to finish mapping out a strategy against the disease and expected to forward it for consideration to the national bird flu committee. (Promed 12/14/04)

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Thailand: Bird flu outbreaks detected in two more Thai provinces
Infected backyard chickens were behind the two new outbreaks in the southern provinces of Pattani and Nakon Sri Thammarat, officials said 13 Dec 2004, without indicating how many birds had succumbed to the virus. The Thai livestock department said that since 9 Dec 2004 it had outbreaks in 19 of the 21 affected provinces under control. Thailand's poultry export industry, the fourth largest in the world, had lost up to 80 billion baht [USD 2 billion] in revenue since the start of the outbreak in late 2003, representing a 1.2 percent loss in national earnings. (Promed 12/13/04)

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Indonesia: Bird flu virus hits West Nusa Tenggara
Bird flu has broken out in several parts of West Nusa Tenggara (Nusa Tenggara Barat), killing thousands of birds in the provincial capital of Mataram. The Mataram agriculture and animal husbandry office said that the avian influenza virus had infected more than 20 000 birds, or 43 percent of the poultry population in 10 of the 23 subdistricts in the city. "Currently, bird flu cases are common here. Generally, the birds infected by the virus have died, as there is no cure for the disease," Mataram animal husbandry office veterinarian Dian Diatmiko said. The outbreak was less severe in the other 13 subdistricts, where about 10 percent of the total poultry population was affected. "The virus has only attacked free-range chickens, ducks, geese, pigeons, and Manila ducks, but it has spared chickens raised for their meat," he said. Dian added that it was the first time that bird flu had hit Mataram this year. The virus is believed to have been introduced by poultry from outside West Nusa Tenggara, especially from the neighboring island of Bali. Poultry from Bali was free to enter West Nusa Tenggara before the provincial administration issued a ban. Dian said the virus could also have been carried by birds from Sulawesi.

The Mataram agriculture and animal husbandry office only declared an alert early December 2004 over the spread of the virus, though domestic fowl are believed to have been infected by the virus since last September. To prevent the virus from spreading further, the local husbandry office is providing 250 000 doses of the A1 type vaccine for free. Dian acknowledged that the current rainy season would worsen the spread of bird flu, as the virus could survive longer in the air when temperatures are lower and the soil more moist. "Therefore, we are planning a mass vaccination program," he said. However, there have been no reports that the virus has infected human beings in Mataram. "The virus, carried in the droppings of infected birds, can infect humans. It's advisable that a person who is suffering from human flu stays away from infected birds, because an exchange between human flu and bird flu would cause a mutation of the flu viruses, and this would create a new mutant virus, which would be even more dangerous," he warned.

HPAI H5N1 in Mataram represents further eastern spread of the disease, following its reporting in Bali at the beginning of 2004. According to OIE's statistics summarizing the number of outbreaks accumulated since the beginning of the Eastern-Asia epizootic in early 2004, Indonesia ranks third, with 169 foci, following 1749 in Viet Nam, and 994 in Thailand (see graph at < http://oie.int/downld/AVIAN%20INFLUENZA/graph%20HPAI%2010122004.pdf >). (Promed 12/13/04)

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Vietnam: Reports bird flu in six provinces, 11 000 birds destroyed
Outbreaks of bird flu have been reported in six provinces in Vietnam and 11 000 birds have been culled to try to contain the disease, which has killed 20 humans here in 2004, authorities said. Samples from dead fowls were tested positive to the bird flu virus strain of H5. Drastic measures were needed to prevent these outbreaks from spreading and claiming more lives, an official said. Veterinarians have culled up to 11 000 chickens, ducks, quail, and geese to try to contain the virus, animal health department director Bui Quang Anh said. He was quoted as saying in the English daily Vietnam News, "Local authorities have been asked to monitor carefully the transport and trading of poultry to Vietnam's neighboring countries.” New outbreaks had been reported at a limited number of farms in the southern provinces of Bac Lieu, Long An, Tra Vinh, Hau Giang, An Giang and Can Tho.

The occurrence of the H5N1 strain in wild animals made it difficult to eliminate, the government said. "It exists in the wild and in water birds...It is therefore difficult to completely wipe out the disease," the national steering committee for bird flu control said. Experts say avian influenza has entrenched itself in much of Asia and is unlikely to disappear anytime soon. United Nations health agencies and the Vietnamese government will next month set up a permanent task-force to coordinate efforts against bird flu, including immediate reactions to further outbreaks and long-term surveillance. The bird flu situation is getting serious, since Vietnam is facing potential outbreaks in the northern region this winter whose cold weather favors the disease's spread. "We must closely follow the situation on a daily basis. The busy transport and big sales of poultry during the Lunar New Year Festival (in early February 2005) plus complex weather may result in outbreaks in the northern region," Anh said.

In late March 2004, Vietnam declared an end to the bird flu that had killed 17 percent of its poultry population and claimed 16 human lives during the previous outbreak starting in December 2003. A total of 43.2 million fowl nationwide either died or were culled, causing direct losses of 1.3 trillion Vietnamese dong (USD 82.8 million) to the local poultry industry. (Promed 12/24/04)

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China: Health ministry increases efforts to contain brucellosis
The Chinese Ministry of Health said 17 Dec 2004 that China faces a "serious" brucellosis epidemic and that the country is scaling up efforts to curb it from spreading further. "China reported 5753 human cases of brucellosis in the first half of 2004, which is close to the total number of reported cases last year [2003]," the ministry said. Brucellosis is caused by bacteria of the genus Brucella. These bacteria are spread primarily among animals, including sheep, goats, cattle, deer, pigs and dogs. Humans become infected by coming in contact with animals or animal products that are contaminated with these bacteria. Brucellosis can cause a range of symptoms similar to flu and may include fever, headache, back pain, and physical weakness. Severe infections of the central nervous systems or lining of the heart may occur. Brucellosis can also cause long-lasting or chronic symptoms that include recurrent fever, joint pain, and fatigue.

The Ministry of Health noted that it has issued a notice, together with the Ministry of Agriculture, ordering local health and agricultural departments to take rigorous quarantine and disinfecting measures, and, to conduct strict animal culls on sick livestock to halt the spread of the disease. The two ministries asked local agencies to improve health education to raise people's awareness of the disease and also asked local agencies to enforce efforts in disease monitoring. Brucellosis is considered to be a Category B bioterrorism agent. (Promed 12/21/04)

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Australia: Ten Human Contacts of Fatal Equine Case Under Surveillance
About 10 people in northern Queensland are being tested for symptoms of the potentially fatal Hendra virus. A horse near Townsville died from the virus recently. The horse's handlers and vet staff are being monitored for symptoms. Last month a Cairns vet contracted a mild case while conducting an autopsy. The vet has since recovered. The virus is spread to people through body fluids. Symptoms in horses include breathing difficulties, high fever and a blood-tinged foamy discharge from nose and mouth as the virus attacks blood vessels and causes pulmonary oedema - lungs filled with fluid. Hendra virus produces both lung and brain disease, consistent with related viruses such as canine distemper and measles.

The virus was initially called equine morbillivirus, but genetic analysis of the entire virus showed that its most appropriate classification is a new genus within the family Paramyxoviridae. The name Hendra virus originates from the Brisbane suburb in which the original outbreak occurred. The genus now includes the two virus species Nipah virus and Hendra virus and has been assigned the name Henipavirus. Fruit bats (also known as flying foxes) are the natural host of the virus. There is infection, but no disease in fruit bats. Hendra virus does not appear to be highly contagious, but if an infection occurs in humans or horses, it can be fatal. Antibodies to Hendra virus have been found in four species of fruit bats. Approximately 25% of the bats surveyed had antibodies to the virus. Of 13 wildlife species tested, only bats had antibodies to Hendra virus. (Promed 12/14/04)

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Australia: Outbreak of Q fever in South Australia
South Australia is dealing with its largest outbreak of Q fever in more than a decade. It has been confirmed that nine farmers in the state have the disease, with another six suspected cases. Dr. Jack Shephard says anyone who comes into contact with sheep, cattle, goats, or kangaroos could contract the disease. He said, "We've had people racing in demanding to be tested straight away, but testing is not simple…It's been excellent publicity to make people realize they should really come and be tested if they're going to handle sheep or goats or any other animals like them in the future." Dr. Rod Givney, from the Department of Health, says the people who have Q Fever have all had contact with sheep, but the department still does not know what the exact link is. Q (query) fever, caused by Coxiella burnetii, the "query" fever bacterium, is the only common rickettsia to be transmitted usually by aerosol rather than through an arthropod vector. Most aerosol exposures are direct from animal to human. Worldwide, this zoonosis is primarily found in cattle, sheep, and goats, but many mammals and birds may also be infected. The diagnosis is usually serological, and the illness is most commonly either a self-limited febrile illness lasting up to two weeks, or, pneumonia with, or without, hepatitis. (Promed 12/14/04)

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Philippines: 3.6 million flood victims threatened by outbreaks of communicable diseases
Communicable diseases including malaria and diarrhoeal diseases threaten the lives of 3.6 million victims of recent storms and landslides in the Philippines. To tackle these health threats and to meet pressing relief needs, a "Flash Appeal" to raise US$6.4 million was launched by the Government of the Philippines and the UN Economy Team in the Philippines. Four consecutive typhoons and tropical storms in late November and early December left 1,060 people dead, 1,023 injured and 559 missing in the Philippines, while affecting an additional 3.6 million people.

Dr Jean-Marc Olivé, WHO Representative in the Philippines, said, "The priority now, from WHO's perspective, is to safeguard the health of survivors and to rehabilitate public health services…" The Philippine Department of Health has mobilized medical teams for rapid health assessments, surveillance, psychosocial services, and environmental health. Emergency drugs and medicines have been provided. Health education and public information in all affected areas have been intensified. However, the health of the affected population continues to be at risk.

Diarrhoeal diseases and upper respiratory infections require urgent attention. Survivors lack adequate access to safe drinking water and sanitation facilities. There is an increased risk of an outbreak of malaria, as it is endemic in the Philippines and standing water increases the likelihood of an outbreak of vector- and water-borne diseases. The nutritional status of the affected population needs to be closely monitored. Health facilities have suffered US$ 1.1 million in damages. Key equipment and medicine stocks were washed away or buried in mud. The remaining facilities are unequipped to meet the escalated needs of the affected population. The cold chain for the storage of vaccines and other essential medicines has been damaged by electricity outages. Many essential drugs and priority medical supplies need to be replaced.

WHO, at the request of the Department of Health, is focusing on malaria preparedness and outbreak control in the northern Philippines. Interventions will target a population of 200 000, for the possibility of 80 000 cases of malaria (estimates based on previous experiences). Additional WHO activities are in the area of emergency response coordination and support to health authorities. These include: provision of medicines and supplies; water purification; technical assistance (forensic pathology, health services management, environmental health, and psychosocial care), health promotion activities and rapid response logistics. (WHO 12/15/04)

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1. Updates
Dengue/DHF update
Singapore
On-the-spot fines will soon be issued to homeowners who allow mosquitoes to breed on their properties, after dengue infections reached a 10-year high, Singapore's Environment Ministry announced. This year 8597 infections of the potentially fatal disease have been reported, nearly double the 4788 in 2003 and the highest in a decade, the National Environment Agency said. Starting in February 2005, homeowners whose properties have become breeding grounds for mosquitoes will be fined Singapore $100 (US $80) on the spot. Fines will be doubled for subsequent offences, said the agency. Earlier this year, a Singapore man was fined $S6000 for leaving a water-filled plastic pail lid outside his house. (Promed 12/23/04)

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Viral gastroenteritis update
Canada (British Columbia)
British Columbia's Children's Hospital recently joined St Paul's Hospital in closing a ward to new patients. Children's Hospital officials said that 13 patients and 30 staff members have exhibited norovirus-like symptoms since late November. All but two children have recovered, but the hospital couldn't say how many staff members are still sick. "There has been no serious illness related to this outbreak," said Dr Eva Thomas of microbiology, virology and infection control at Children's. Noroviruses can remain on surfaces for up to 48 hours, Thomas said, so "enhanced cleaning and dedicated [to one area only] staff members" have been put in place. Signs remind everyone in the hospital to be vigilant about handwashing. Thomas said the hospital is "cautiously optimistic" the worst is over. 70 hours without any new cases is traditionally the amount of time required before a ward gets a clean bill of health. (Promed 12/10/04)

Canada (Regina)
Six wards at the Wascana Rehabilitation Centre are locked down, after a virus sickened a number of long-term care residents. Tania Diener, medical health officer for the Regina Qu'Appelle Health District, says a sample from one of the sick residents came back positive for norovirus, and precautions were taken to close the wards. She said the health district has determined the virus is not food-related, but likely just came in from the community. Diener doesn't know how many people fell ill in total, but she says the situation seems to be improving. In the meantime, staff are keeping close watch to make sure patients who fall ill don't get dehydrated, especially since most are elderly or have serious pre-existing health conditions. (Promed 12/22/04)

USA (Vermont)
The Vermont Veterans Home is under a health lock down to contain a highly contagious stomach virus that has stricken 60 persons. Admissions have been temporarily halted and visitors are being asked to stay away for at least a week, after a sudden outbreak of norovirus hit the 169-bed facility 7 Dec 2004. About 20 of the 208 staffers, and at least 40 residents, have already become ill. The outbreak began in the home's dementia wing and spread to other resident halls quickly, said Commandant Earle Hollings II. Because the virus is so contagious, it is not uncommon for it to "recycle" and infect someone again and again, Hollings said. As a precaution, residents have also been restricted to their wings and the building is being thoroughly disinfected. Initially, people who get the virus are likely to vomit, have diarrhea and stomach cramping, which can be quite severe; the symptoms can last up to three days.

Noroviruses are a group of viruses that cause "stomach flu," or gastroenteritis. Norovirus infection is not usually serious, nor is there long-term health effects. The most potentially serious side effect is dehydration, which is more common in the very young and the elderly, according to the CDC. Noroviruses are present in the stools and vomit of infected people; it can be transmitted through contaminated foods and drinks, touching surfaces or objects contaminated with norovirus, or having direct contact with a person who is infected and showing symptoms. The virus is not treatable with medications. The best prevention is frequent hand-washing and eating only carefully washed fruits and vegetables. (Promed 12/22/04)

USA (Michigan)
It was reported 10 Dec 2004 that seniors at a Troy (Michigan) nursing home had fallen ill as a result of a mysterious outbreak. Officials have now identified a norovirus among some of the ill patients. One death occurred during the outbreak, but the cause is still undetermined. Three samples tested from the 15 people who fell ill came back positive for the gastrointestinal virus. (Promed 12/22/04)

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West Nile Virus
Mexico
As of 9 Dec 2004, the cumulative total of human tests carried out in Mexico remains at 387, and no additional seropositive individuals have been detected: in total, 387 individuals resident in 29 of the 32 states have been tested for evidence of West Nile virus infection; 386 were seronegative and asymptomatic, and one individual in the state of Sonora exhibited signs of disease. (Promed 12/24/04)

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2. Articles
Recent publications regarding avian influenza by OIE
Recent publications regarding avian influenza by OIE can be viewed at: http://www.oie.int/eng/AVIAN_INFLUENZA/pub.htm

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Estimated Influenza Vaccination Coverage Among Adults and Children, US, Sep 1--Nov 30, 2004
“Because of the unexpected reduction in the amount of available inactivated influenza vaccine for the 2004--05 influenza season, on October 5, 2004, the Advisory Committee on Immunization Practices (ACIP) recommended that the vaccine be reserved for persons in certain priority groups and asked others to defer or forego vaccination. To assess the use of influenza vaccine and the primary reasons reported for not receiving vaccine, beginning November 1, questions were added to the ongoing Behavioral Risk Factor Surveillance System (BRFSS) survey. This report analyzes data collected during December 1--11 on self-reported vaccination during September 1--November 30, which indicated that persons in nonpriority groups had largely deferred vaccination and that, among unvaccinated adults in priority groups, one fourth tried to get vaccine but were unable to do so. Vaccination coverage was suboptimal for persons in all assessed priority groups. Because influenza activity peaks in February or later in most years, persons in priority groups should continue to seek vaccination.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5349a1.htm (MMWR December 17, 2004 / 53(49);1147-1153)

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Obtaining flu vaccination among persons in priority groups during a vaccine shortage, US, Oct-Nov 04
Experiences with obtaining influenza vaccination among persons in priority groups during a vaccine shortage, US, Oct-Nov 2004
“After the announcement that the supply of inactivated influenza vaccine available to the U.S. public for the 2004--05 influenza season would be reduced by approximately one half, the Advisory Committee on Immunization Practices (ACIP) recommended that the remaining vaccine supply should be reserved for 1) certain groups of persons at high risk for serious health problems from influenza, 2) health-care workers involved in direct patient care, and 3) close contacts of children aged <6 months. To determine what proportion of persons at increased risk for influenza complications had been vaccinated as of the day of the survey, what proportion sought vaccination but did not receive it because of the shortage, and what factors might be dissuading persons at high risk from seeking influenza vaccination, Harvard School of Public Health (HSPH), in collaboration with International Communications Research, conducted a national survey. This report summarizes the results of that survey, which indicated that approximately 63% of persons aged >65 years and 46% of chronically ill adults who tried to get the influenza vaccine were able to do so. More than half of adults at high risk did not try to get the influenza vaccine. Because available supplies of inactivated influenza vaccine are targeted to high-risk groups, persons in these groups should continue to pursue vaccination.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5349a2.htm (MMWR December 17, 2004 / 53(49);1153-1155)

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Experiences with ILI and attitudes regarding influenza prevention, US, 2003-2004 influenza season
Experiences with Influenza-Like Illness and Attitudes Regarding Influenza Prevention --- United States, 2003--04 Influenza Season
“Despite advances in medical treatment, influenza results in approximately 36,000 deaths each year in the United States. Vaccination has been a mainstay of influenza prevention, with annual vaccination recommended for adults and children at high risk; efforts to interrupt person-to-person transmission are also important. In October 2003, CDC recommended that health-care facilities implement a Universal Respiratory Hygiene Strategy, including providing masks or facial tissues in waiting rooms to persons with respiratory symptoms. To gather information on influenza-like illness (ILI) and attitudes regarding prevention of ILI (including use of vaccine and respiratory hygiene), CDC and 11 Emerging Infections Programs (EIPs) conducted a random-digit--dialed telephone survey of noninstitutionalized U.S. civilian adults in February 2004. This report summarizes the results of that survey, which determined that 43% of adults and 69% of children aged 6 months--17 years with ILI visited a health-care provider for the illness. Eight percent of adults with ILI reported having been asked by a health-care provider to wear a mask; 82% said they would wear a mask if requested. With the limited availability of influenza vaccine this season, the use of masks by persons with cough illnesses in health-care settings, a component of the Universal Respiratory Hygiene Strategy, might be a helpful and acceptable method for decreasing influenza transmission.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5349a3.htm (MMWR December 17, 2004 / 53(49);1156-1158)

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Brief Report: Respiratory Syncytial Virus Activity --- United States, 2003--2004
“Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections (LRTIs) (i.e., bronchiolitis and pneumonia) among young children, resulting in an estimated 51,000--82,000 hospitalizations annually. RSV causes severe disease among older adults and persons of all ages with compromised respiratory, cardiac, or immune systems, and can exacerbate chronic cardiac and pulmonary conditions. In temperate climates, RSV infections occur primarily during annual winter season outbreaks. This report summarizes trends in RSV activity reported to the National Respiratory and Enteric Virus Surveillance System (NREVSS) during July 2003--June 2004 and presents preliminary data from the weeks ending July 3--December 4, 2004, indicating the onset of the 2004--05 RSV season. Health-care providers should consider RSV in the differential diagnosis for persons of all ages with LRTIs, implement appropriate isolation precautions to prevent nosocomial transmission, and provide appropriate immune prophylaxis to eligible children, including certain premature infants or children and infants with chronic lung and heart disease.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5349a4.htm (MMWR December 17, 2004 / 53(49);1159-1160)

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Recovery of a Patient from Clinical Rabies --- Wisconsin, 2004
“Rabies is a viral infection of the central nervous system, usually contracted from the bite of an infected animal, and is nearly always fatal without proper postexposure prophylaxis (PEP). In October 2004, a previously healthy female aged 15 years in Fond du Lac County, Wisconsin, received a diagnosis of rabies after being bitten by a bat approximately 1 month before symptom onset. This report summarizes the investigation conducted by the Wisconsin Division of Public Health (WDPH), the public health response in Fond du Lac County, and the patient's clinical course through December 17. This is the first documented recovery from clinical rabies by a patient who had not received either pre- or postexposure prophylaxis for rabies.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5350a1.htm (MMWR December 24, 2004 / 53(50);1171-1173)

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3. Notifications
CDC’S Influenza website
CDC’S comprehensive influenza website (http://www.cdc.gov/flu) contains information targeted to health professionals, as well as CDC influenza fact sheets and health education materials intended for the general public. An updated 2004-05 Flu Vaccine Information site with expanded recommendations is now available. (CDC 12/22/04)

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2005 National Conference on West Nile Virus in the United States
San Jose, California - February 8-9, 2005. Organized by the Division of Vector-Borne Infectious Diseases, CDC. Discounted registration deadline is January 7, 2005, advanced registration deadline January 24, 2005. Housing Deadline is January 16, 2005. For details visit: http://www.wnvconference.org/ (CDC)

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International Conference on Emerging Infectious Diseases
Al Ain, United Arab Emirates, 26 Feb - 1 Mar 2005 Deadline for abstract submission: 7 Jan 2005; deadline for early registration: 15 Jan 2005

The Conference will be held in Al Ain, United Arab Emirates. Topics and invited speakers:
- Emerging Infectious Diseases - Introduction (B.W.J. Mahy, CDC, Atlanta)
- Influenza (R.G. Webster, Memphis)
- Emerging flavi- and paramyxoviruses (J.S. Mackenzie, Brisbane)
- Crimean-Congo hemorrhagic fever, Rift Valley fever, and Hantavirus
infections (S.T. Nichol, CDC, Atlanta)
- HIV / AIDS (M.A. Martin, NIH, Bethesda)
- Smallpox and other poxvirus infections (J.J. Esposito, CDC, Atlanta)
- Tick-borne encephalitis virus (F.X. Heinz, Vienna)
- Rotaviruses (H.B. Greenberg, Stanford)
- Hepatitis viruses (R.H. Purcell, NIH, Bethesda)
- SARS and Ebola (H.-D. Klenk, Marburg)
- New developments in prion research (A. Aguzzi, Zurich)
- Enterohemorrhagic Escherichia coli (H. Karch, Muenster)
- Antibiotic resistance (S.G.B. Amyes, Edinburgh)
- Polysaccharide vaccines (A. Lindberg, Karolinska, Stockholm)
- Malaria (R.L. Coppel, Victoria)
- Emerging fungal infections (M.G. Rinaldi, San Antonio)

In addition to the areas covered by the invited speakers there will be short oral presentations, which will be selected from the submitted abstracts, and poster presentations, on all areas of emerging infectious diseases. For further details, please visit http://www.iceid-uae.com. Prof. Norbert Nowotny, Chair, Organizing Committee, Department of Medical Microbiology, Faculty of Medicine and Health Sciences, United Arab Emirates University. P.O.Box 17666 Al Ain, United Arab Emirates. (Promed 12/21/04)

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4. APEC EINet activities
APEC EINet teleconference and videoconference
The University of Washington's APEC EINet team held a teleconference with the U.S. Department of Health and Human Services on December 20, 2004 and a videoconference with Hawaii’s Tripler Army Medical Center (TAMC) on December 22, 2004. Our new APEC EINet website will be made available to the public January 1, 2005.

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5. To Receive EINet Newsbriefs
APEC EINet email list
The APEC EINet email list was established to enhance collaboration among academicians and public health professionals in the area of emerging infections surveillance and control. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe (or unsubscribe), contact apec-ein@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://depts.washington.edu/apecein/.

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 apecein@u.washington.edu