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Vol. IX, No. 13 ~ EINet News Briefs ~ Jun 30, 2006


*****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:
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- Avian influenza epidemiology of human H5N1 cases reported to WHO
- Top level push to tackle priorities in sexual and reproductive health
- WHO updates aviation guidelines for TB prevention
- France: Excerpts from the OIE report on avian influenza H5N1
- Russia (Siberia): Bird flu outbreaks in Tuva Republic and Tomsk
- Ukraine: Excerpts from the OIE report on avian influenza H5N1
- Russia: 50 cases of Crimean-Congo Hemorrhagic Fever so far in 2006
- China: Probing report of 2003 human avian influenza H5N1 case
- China: Excerpts from the OIE report on avian influenza H5N1
- Malaysia: Excerpts from the OIE report on avian influenza H5N1
- Australia (South Australia): Salmonellosis associated with raw pasta
- China (Shaanxi): 60 students and teachers develop febrile illness
- China (Guangdong): Undiagnosed mild respiratory illness reported
- Hong Kong/China: Undiagnosed pneumonia cases detected through active surveillance
- Japan: End of BSE-based ban on US beef again
- Malaysia (Sarawak): 11th death in hand, foot & mouth disease epidemic
- South Korea: Food poisoning in more than 1500 students
- Viet Nam: Paralytic shellfish poisoning in over 100 tourists
- USA: USDA releases 180-day report on avian influenza efforts and spending
- USA: Report faults USDA's avian influenza surveillance
- Canada (British Columbia): Latest BSE case probably feed-related
- Canada: Expansion of feed ban to prevent BSE
- Canada (British Columia): Boy dies from hantavirus pulmonary syndrome
- USA: Soldier's death possibly linked to shots for smallpox and influenza
- USA (Massachusetts): Latest measles case brings total cases to 14
- USA (Massachusetts): 23 confirmed cases of salmonellosis in school
- USA: HHS to buy 20,000 courses of anthrax antitoxin
- Niger: Excerpts from the OIE report on avian influenza H5N1
- Democratic Republic of the Congo: Erratum—19 deaths from plague

1. Updates
- Avian/Pandemic influenza updates
- Cholera, diarrhea & dysentery
- Dengue
- Viral gastroenteritis
- West Nile Virus

2. Articles
- Influenza in 1918: Recollections of the Epidemic in Philadelphia
- Detection of influenza viruses resistant to neuraminidase inhibitors in global surveillance during the first 3 years of their use
- Planning for Avian Influenza
- The health care response to pandemic influenza
- IOM: Emergency health system unprepared for disasters
- ABARE report: Avian influenza: potential economic impact of a pandemic on Australia
- Biosecurity: A comprehensive action plan
- Prevention and Control of Influenza: Recommendations of ACIP
- Eastern Equine Encephalitis--New Hampshire and Massachusetts, August-September 2005
- Travel-Associated Dengue --- United States, 2005
- Human salmonellosis associated with animal-derived pet treats--United States and
- Rapid HIV Test Distribution --- United States, 2003--2005
- Methicillin-resistant Staphylococcus aureus skin infections among tattoo
- Kuru study implies risk of waves of vCJD cases

3. Notifications
- Proposals: Surveillance and Response to Avian and Pandemic Influenza
- National HIV Testing Day--June 27, 2006

4. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)

2003
Viet Nam / 3 (3)
Total / 3 (3)

2004
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)

2005
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 17 (11)
Thailand / 5 (2) Viet Nam / 61 (19)
Total / 95 (41)

2006
Azerbaijan / 8 (5)
Cambodia / 2 (2)
China / 11 (7)
Djibouti / 1 (0)
Egypt / 14 (6)
Indonesia / 34 (28)
Iraq / 2 (2)
Turkey / 12 (4)
Total / 84 (54)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 228 (130).
(WHO 6/20/06 http://www.who.int/csr/disease/avianinfluenza/en/ )

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Avian influenza epidemiology of human H5N1 cases reported to WHO
WHO has set out results from the first analysis of epidemiological data on all 205 laboratory-confirmed H5N1 cases officially reported to WHO by onset date from Dec 2003 - 30 Apr 2006. Data used in the analysis were collected for surveillance purposes. Quality, reliability and format were not consistent across data from different countries. A more standardized collection of epidemiological data by countries and timely sharing of these data are needed to improve monitoring of the situation, risk assessment, and the management of H5N1 patients. Despite this limitation, several conclusions could be reached.

The number of new countries reporting human cases increased from 4 to 9 after Oct 2005, following the geographical extension of outbreaks among avian populations. Half of the cases occurred in people under age 20 years; 90% of cases occurred in people under age 40 years. The overall case-fatality rate was 56%. Case fatality was high in all age groups but was highest in persons aged 10 - 39 years. The case-fatality profile by age group differs from that seen in seasonal influenza, where mortality is highest in the elderly. The overall case-fatality rate was highest in 2004 (73%), followed by 63% to date in 2006, and 43% in 2005. Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the 3 years. Cases have occurred all year round. However, the incidence of human cases peaked, in each of the 3 years in which cases have occurred, during the period roughly corresponding to winter and spring in the northern hemisphere.
(WHO 6/30/06 http://www.who.int/csr/don/2006_06_30/en/index.html )

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Top level push to tackle priorities in sexual and reproductive health
Leaders of WHO and UNFPA, the UN Population Fund, are coordinating action to reverse the global trend of deteriorating levels of sexual and reproductive health and reduce the adverse impact on mothers, babies and adolescents. Inadequate sexual and reproductive health services have resulted in maternal deaths and rising numbers of sexually transmitted infections (STIs). WHO estimates that 340 million new cases of bacterial STIs occur annually in people aged 15 – 49 years. Many are untreated because of lack of access to services. In addition, millions of cases of viral infection occur every year. Around 8 million women who become pregnant each year suffer life-threatening complications as a result of STIs and poor sexual health. Annually, an estimated 529 000 women die during pregnancy and childbirth from largely preventable causes. More than 100 million curable STIs occur each year and a significant proportion of the 4.1 million new HIV infections occur among 15-to-24 year olds. In sexually active adolescents, sexual and reproductive health problems include early pregnancy, unsafe abortion, STIs, and sexual coercion and violence.

Leaders agreed the agencies will coordinate action in countries to ensure programmes are more effective and accountable for results. The aim is to scale-up work to put a number of global proposals and initiatives into action in countries. A number of priority areas were identified:

• A coordinated action plan to implement the Global STI Prevention and Control Strategy;
• Support to countries to increase skilled health attendants in target countries;
• Coordinated workplans on improving reproductive, maternal, newborn and adolescent health;
• Advocacy for inclusion of sexual and reproductive health in national economic planning such as Poverty Reduction Strategies (PRSPs);
• Strengthening the linkages between HIV and sexual and reproductive health through coordinated action in HIV prevention, care and treatment;
• Joint training of country teams on the process for planning and working together at country level and joint competency reviews;
• Coordinated work in countries addressing: Female genital mutilation/cutting, obstetric fistula, violence against women, a pilot programme in 2 countries to introduce the Human Papilloma Virus (HPV) vaccine, and human resources for health.
(WHO 6/20/06 http://www.who.int/mediacentre/news/releases/2006/pr34/en/index.html )

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WHO updates aviation guidelines for TB prevention
WHO issued updated guidelines for the airline industry that will further minimise the risk of tuberculosis (TB) and other infectious diseases being passed from passenger to passenger on board aircraft. The 'Tuberculosis and Air Travel' guidelines stipulate that people with infectious TB must postpone long-distance travel, while those with multidrug-resistant tuberculosis (MDR-TB) must postpone any air travel.

To date, no case of active TB has been identified as a result of exposure on a commercial aircraft. The quality of the air on board commercial aircraft is high and under normal conditions cabin air is cleaner than the air in most buildings. Prolonged journeys of more than 8 hours in a confined aircraft cabin may involve an increased risk of transmission, but the risk should be similar to that in other circumstances where people are together in other confined spaces. The guidelines also advise that aircraft ventilation systems should continue to operate when the aircraft is delayed on the ground and the doors are closed. If not in operation, ground delays should be kept to less than 30 minutes. The International Air Transport Association (IATA) and its partners, including WHO, are actively looking at ways to improve the accuracy and availability of passenger information. As an interim measure, a locator card has been developed. If there is a suspected case of a communicable disease of international importance on board, designated passengers would be asked fill it out. The card records the name, seat number and emergency contact information.
(WHO 6/28/06 http://www.who.int/tb/features_archive/aviation_guidelines/en/index.html )

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Europe/Near East
France: Excerpts from the OIE report on avian influenza H5N1
Information received 19 Jun 2006 from Dr Monique Eloit, deputy director general, General Directorate for Food (DGAL), Ministry of Agriculture, Food, Fisheries and Rural Affairs: On 25 Feb 2006, the French veterinary authorities notified the European Commission and the OIE of an outbreak of highly pathogenic avian influenza in a turkey farm in the municipality of Versailleux, in the Ain department. All the measures required by European regulations were implemented and successfully prevented the spread of the virus. All investigations carried out in compliance with European regulations and with the provisions of the OIE Terrestrial Animal Health Code were favorable. As a result, the restriction measures set up 23 Feb 2006 were lifted 27 Mar 2006. No other outbreaks of highly pathogenic avian influenza in domestic poultry farms have been discovered in France. OIE states that a country may regain its status as an avian influenza-free country 3 months after a stamping-out policy is applied, providing that [proper] surveillance has been carried out during that 3-month period. Culling operations were completed 23 Feb 2006. The final cleaning and disinfection operations of the establishment were completed 18 Mar 2006. Surveillance practiced around the area of the outbreak since Feb 2006 has shown no other outbreak of highly pathogenic avian influenza. France, therefore, regains its status as a highly pathogenic avian influenza-free country 18 Jun 2006.
(Promed 6/26/06)

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Russia (Siberia): Bird flu outbreaks in Tuva Republic and Tomsk
The Siberian office of the Russian emergencies ministry said 27 Jun 2006 that the outbreak of the H5N1 strain of bird flu in the constituent Tuva Republic was intensifying. The emergencies ministry first reported 23 Jun 2006 that 169 dead wild birds had been collected from the Ubsu-Nur Lake in the Ovyursky district of the Tuva Republic, and the presence of H5N1 in their blood samples had been confirmed by the Kemerovo veterinary laboratory. A 27 Jun 2006 statement said wild bird deaths were continuing, with 371 new deaths reported by 25 Jun 2006. A total 1622 birds have died since the first dead birds were found on the lake 15 Jun 2006. The emergencies ministry warned further outbreaks were likely towards the end of Jul 2006 among young wild birds, as their immunity to the disease was weak.

A new outbreak of bird flu has hit the West Siberian region of Tomsk, the local administration said 27 Jun 2006. Reportedly laboratory analysis of fancy pigeons that died in a village revealed the virus. "All the pigeons and chickens from the courtyard have been culled," a representative said. "The owner, who had refused to vaccinate poultry, will receive no compensation." Governor Viktor Kress ordered vaccination as a preventive measure against the disease. According to the Agriculture Ministry, bird flu was registered in 10 villages in 3 West Siberian regions in late May 2006.
(Promed 6/28/06)

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Ukraine: Excerpts from the OIE report on avian influenza H5N1
Information received 15 Jun 2006 from Dr. Ivan Yuriyovych Bisyuk, Head and Chief Veterinary Officer, State Department for Veterinary Medicine, Ministry of Agricultural Policy: Identification of agent: highly pathogenic avian influenza (HPAI) virus subtype H5N1. Date of start of event: 25 Nov 2005. New outbreak: An outbreak in Sumy province in a village, Piski, resulted in 335 cases, all of which died. There were 10 127 susceptible animals, and 7000 were destroyed. Description of affected population: 68 hens, 23 ducks and 244 geese. Results from the Central state laboratory of veterinary medicine, Kiev: PCR positive for H5N1 on 11-12 Jun 2006. Origin of infection: contact with wild birds.
(Promed 6/25/06)

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Russia: 50 cases of Crimean-Congo Hemorrhagic Fever so far in 2006
As of 8 Jun 2006, 50 cases of Crimean-Congo hemorrhagic fever (CCHF) have been registered in the Southern Federal District of Russia, including 4 fatal cases. 8 cases of CCHF have been registered in the Stavropol region, 21 in the Republic of Kalmykia, 14 in the Rostov region, 3 in the Astrakhan region and 4 in the Volgograd region. The first cases of CCHF were registered Apr 2006 in Stavropol region, and in May 2006 in the Republic of Kalmykia and the Rostov region. In 2006 there has been a marked expansion in the distribution of CCHF cases: new cases have been detected in the Zymovnikovskiy, Tsymlyanskiy and Tselinniy districts of the Rostov region where no cases have been observed in recent years. Consequently late recognition of the disease and late referral for medical attention have resulted in severe manifestation of the disease. Most cases occurred during care of agricultural animals in private facilities.
(Promed 6/24/06)

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Asia
China: Probing report of 2003 human avian influenza H5N1 case
The Chinese Ministry of Health (MOH) is conducting its own investigation into the report of a man who died of H5N1 avian influenza late 2003. The case was first described by 8 Chinese researchers in the Jun 22 issue of the New England Journal of Medicine (NEJM). The MOH said it was conducting its own tests to try to confirm the case, Roy Wadia, WHO spokesman in China, said. The date given for the case, Nov 2003, was 2 years before China officially reported any human H5N1 cases to WHO. The MOH said it was unaware of the case until the researchers' report appeared in NEJM. He said WHO has asked the MOH to determine where the man caught the H5N1 virus and whether there were other deaths. He also said it was unclear why the scientists, who work at state institutions, did not report their findings to the MOH. Adding to confusion about the case, the NEJM reported last week that the authors had e-mailed the journal requesting that the report be withdrawn, but the request was too late. However, the authors responded that they stood by their report and none of them said they had e-mailed a request to withdraw it. The Nov 2003 death of a Beijing man attributed last week to avian influenza was originally thought to be from severe acute respiratory syndrome (SARS), according to the NEJM report. The case is significant because, if confirmed, it revises the timeline and geographic pattern of human cases of avian flu.
(CIDRAP 6/28/06 http://www.cidrap.umn.edu/ )

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China: Excerpts from the OIE report on avian influenza H5N1
Information received 19 and 20 Jun 2006 from Mr. Jia Youling, Director General, Veterinary Bureau, Ministry of Agriculture: Identification of agent: highly pathogenic avian influenza (HPAI) virus subtype H5N1. Date of first confirmation of event: 7 Jun 2005. New outbreaks: Multiple outbreaks involving a large but unreported number of susceptible birds have occurred in Shanxi province in the following villages: Shijiazhuang, Nanchuanzhuang, Beili, Dongchang and Xixhang. [Over a million birds (1 470 000) were depopulated. There were 2600 cases and 2400 deaths.] Description of affected population: poultry. Laboratory results from the Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences (national reference laboratory for avian influenza): hemagglutination inhibition test, RT-PCR, hemagglutination inhibition test-RT-PCR and virus isolation were all positive.
(Promed 6/25/06)

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Malaysia: Excerpts from the OIE report on avian influenza H5N1
Information received 18 Jun 2006 from Dr Hawari Bin Hussein, director general, Department of Veterinary Service, Ministry of Agriculture: Identification of agent: highly pathogenic avian influenza virus H5N1. Date of start of event: 6 Feb 2006. An outbreak of highly pathogenic avian influenza H5N1 was confirmed in Wilayah Persekutuan State in Peninsular Malaysia 19 Feb 2006. Subsequently, 4 more outbreaks were confirmed in the states of Perak and Pulau Pinang. A policy of stamping-out with full compensation was adopted and implemented immediately. The last culling and disinfection were completed 22 Mar 2006. Since then, clinical and virological surveillance, conducted intensively within a 10 km radius around the outbreaks as well as nationwide, have found no positive cases. Therefore, 90 days have elapsed without any evidence of highly pathogenic avian influenza H5N1 infection being detected. In accordance with the Terrestrial Animal Health Code, Wilayah Persekutuan, Perak, and Penang States in Peninsular Malaysia are no longer considered highly pathogenic avian influenza-infected zones. Malaysia declares that it has regained its highly pathogenic avian influenza-free country status.
(Promed 6/26/06)

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Australia (South Australia): Salmonellosis associated with raw pasta
The South Australian Health Department says an egg company has a possible link to a salmonella food poisoning outbreak. The source of 6 cases of Salmonella food poisoning was first traced back to the Buono Pasta Company at Klemzig. The Health Department says the pasta company does not appear to be at fault because the people who became sick reportedly ate the pasta raw. Now the department says a further 11 people who have not eaten the pasta have become sick with the same strain of salmonella. Department Director Kevin Buckett says eggs used as an ingredient could be the source of the contamination. "But in this case the eggs are still just a working hypothesis," he said.
(Promed 6/17/06)

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China (Shaanxi): 60 students and teachers develop febrile illness
Students and teachers at Liujiamao Primary School in Qiaohecha Village, Mizhi County, Shaanxi Province have been coming down with febrile illness since 12 Jun 2006. As of 18 Jun 2006, there were already 33 students with febrile illness. 3 teachers also became infected. The school suspended classes from 14 Jun 2006. Another 30 students at Qiaohecha Central Primary School, not far from Liujiamao Primary, have also developed febrile symptoms, and 1 teacher has been infected. Ill students are concentrated in the pre-school class which has now also suspended classes. At the Pediatrics Department of Mizhi County Hospital, it appears that most students developed respiratory infections because of the high temperature and dry air. According to the Mizhi County Center for Disease Control, the outbreak is basically under control. From analysis of symptoms, the preliminary determination is acute viral influenza. Because health care in the county is limited, no lab tests have been carried out, and the identity of the pathogen is not yet known.
(Promed 6/21/06)

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China (Guangdong): Undiagnosed mild respiratory illness reported
Between 11 and 22 Jun 2006, a total of 136 cases of influenza-type illness of Guangzhou University in University City contracted an influenza-type illness. Guangzhou University has taken measures to prevent the further spread of the influenza-type illness. Reportedly influenza-type illness cases have also occurred in other schools in University City. The vast majority of patients were students who reside in dorms, as well as a smaller number of employees. The list reveals that the earliest 2 cases occurred 11 Jun 2006. Starting 17 Jun 2006 the number of new cases quickly increased. The Guangdong Provincial Hospital of Traditional Chinese Medicine University City Branch says that students have recently been coming for treatment. The main symptoms are fever. Symptoms are reportedly not severe among the vast majority of patients and many have already fully recovered. Guangzhou University requested that dormitory management strengthen supervision over students, to report influenza cases immediately, and to clean the dorms. The Guangzhou outbreak may be one among many influenza outbreaks in the southern part of mainland China. Guangdong province usually has an influenza peak in the summer. Outbreaks of this size are common.
(Promed 6/24/06)

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Hong Kong/China: Undiagnosed pneumonia cases detected through active surveillance
In response to the report of a human case of H5N1 infection in a person in Shenzhen, Hong Kong has implemented active surveillance for pneumonia of unknown etiology in people with a history of travel to the Chinese mainland. Public hospitals should report to the Authority's e-Flu system all patients fulfilling the case definition of having pneumonia (all types) of unidentified etiology and who had travelled in the 7 days before the onset of symptoms, to affected areas/ countries with confirmed human cases of avian influenza infection in the past 6 months. So far a total of 70 cases (39 male, 31 female, aged 2.5 months to 89 years) have been received. These patients had visited Guangdong, Hunan, Hubei, Fujian and Zhejiang before the onset of symptoms. (The baseline rate of pneumonia of unknown etiology is in Hong Kong is not stated.)
(Promed 6/22/06)

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Japan: End of BSE-based ban on US beef again
Japan has conditionally agreed to resume importing US beef, long banned from the country because of concern about bovine spongiform encephalopathy (BSE). Japan will send inspectors to the US to check beef processing plants and, if they find no problems, will then allow shipments to resume. The US Department of Agriculture (USDA) said the Japanese inspectors will finish their work by Jul 21, 2006. Japan closed its ports to American beef when the first US case of BSE was found Dec 2003. Shipments resumed Dec 2005, but they were stopped again a month later when pieces of backbone, a banned item, were found in a shipment of veal. Only beef from cattle up to the age of 20 months, with higher-risk tissues such as spinal cords removed, can be exported to Japan, the same rules that governed the previous resumption of imports in Dec 2005. Japanese officials will inspect all 35 US beef-processing plants authorized by the USDA to ship products to Japan. After trade resumes, Japanese officials will be allowed to accompany USDA officials on spot inspections of the plants. US beef exports to Japan were worth about $1.4 billion in 2003.
(CIDRAP 6/21/06 http://www.cidrap.umn.edu/ )

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Malaysia (Sarawak): 11th death in hand, foot & mouth disease epidemic
Another child has died from the hand, foot and mouth disease (HFMD) in Sarawak. The 16 month old toddler from Kpg Dagang in Marudi succumbed to the disease 27 Jun 2006. His death brings the death toll from HFMD in the state to 11. Deputy chief minister Tan Sri George Chan said 27 Jun 2006 the death had dealt a setback to plans to declare the epidemic over. The last HFMD death was 7 May 2006. Dr Chan said before the epidemic could be declared over, it had to register "incident free" for 2 incubation periods (about 28 days). The incident free status is defined as under 40 new cases daily and no deaths. The disease has afflicted 10 861 children in the state, with 43 new cases reported as of 27 Jun 2006. Of the 43 new cases reported, 11 were admitted to hospitals with the rest given outpatient treatment. Sibu has the highest number of sufferers, with 2604 cases reported, followed by Miri with 2006 cases, Kuching (1456), Bintulu (1333), Sarikei (920), and Mukah (770). The majority of children afflicted with the disease were under age 4 years.
(Promed 6/28/06)

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South Korea: Food poisoning in more than 1500 students
More than 1500 students at 22 schools in the cities of Seoul and Inchon and the province of Kyonggi have gotten sick after eating school meals supplied by the nation's biggest food provider, CJ Food System. The number of victims is the largest ever in school-lunch related illness in South Korea. The education authorities ordered 68 schools in the region to stop providing students with foods delivered by CJ 21 Jun 2006. Thus, about 70 000 students of the schools now have to take lunch from home. Some 930 elementary, middle and high school students in Seoul, 500 in Inchon, and 57 in Kyonggi Province have shown symptoms of nausea, vomiting, fever and diarrhea since 16 Jun 2006. The symptoms have spread rapidly, and some students received treatment at hospitals. Authorities suspect the mass sickness resulted from the same food ingredients supplied by CJ. The company delivers foods to all the schools except 2 in Kyonggi Province. Reportedly 7 schools in Inchon had pork supplied by the company. The Korea Food and Drug Administration (KFDA) and the Korea Center for Disease Control and Prevention (KCDC) dispatched inspectors to the affected schools to examine students, banning the provider from delivering food ingredients until the inspection result comes out. CJ is also examining the case independently. (No information is given regarding the potential incubation period or length of illness.)
(Promed 6/23/06)

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Viet Nam: Paralytic shellfish poisoning in over 100 tourists
Over 100 tourists were hospitalized in Viet Nam with food poisoning 19 Jun 2006, after eating seafood at a restaurant in the central resort town of Nha Trang. Most had dizziness, headache, nausea, vomiting, diarrhea, and numbness of the limbs, with 20 suffering from cardiac arrest. They were part of a large Vietnamese tour group. An hour before they took ill, the group had soups and shrimp for dinner at Trong Com restaurant. Earlier in Jun 2006, 2 similar food poisoning cases occurred in the city, with 68 tourists hospitalized, many of whom said they had seafood at the same restaurant. A preliminary investigation confirmed seafood to be the cause. The Nha Trang's Oceanography Institute concluded that 2 of 5 food samples obtained from a meal eaten by the victims 19 Jun 2006 could kill if consumed in sufficient quantity. Samples of crab soup and prawns from the restaurant tested positive for Paralytic Shellfish Poisoning (PSP). 500 grams of the soup or 100 grams of the prawns could kill a healthy person. Authorities have closed the restaurant temporarily.

There are a number of different types of shellfish poisoning: Paralytic shellfish poisoning (PSP), Neurologic shellfish poisoning (NSP), Diarrheal shellfish poisoning (DSP), and Amnestic shellfish poisoning (ASP). Often, these are all grouped collectively as paralytic shellfish poisoning. The toxins responsible for these are water-soluble, heat and acid-stable, and are not inactivated by ordinary cooking methods. PSP has been known to have a death rate of 1-12 percent.
(Promed 6/21/06)

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Americas
USA: USDA releases 180-day report on avian influenza efforts and spending
The U.S. Department of Agriculture released its 180-day report on avian influenza (AI) efforts and the use of $91 million appropriated in the Emergency Supplemental Appropriation to Address Pandemic Influenza 6 months ago. The report details USDA's efforts to combat highly pathogenic H5N1 avian influenza (HPAI H5N1). USDA is working closely with the World Organization for Animal Health (OIE), the UN Food and Agriculture Organization (FAO) and WHO to assist HPAI H5N1 affected regions with disease prevention, management and eradication activities. USDA maintains trade restrictions on the importation of poultry and poultry products from regions currently affected by H5N1 HPAI. USDA is working cooperatively with the poultry industry to conduct surveillance at breeding flocks, slaughter plants, live-bird markets, livestock auctions and poultry dealers. USDA has implemented a reporting system to answer calls and inquiries from the public regarding dead or sick wild birds. USDA is conducting AI surveillance in wild migratory birds in Alaska and 10 other states. Initial AI screening tests are performed by the National Animal Health Laboratory Network (NAHLN). The National Wildlife Health Center also performs initial screening tests. USDA has developed the National Avian Influenza Response Plan to ensure a quick and decisive response when any surveillance system detects any serious poultry disease.
(USDA 6/29/06; http://www.pandemicflu.gov/ )

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USA: Report faults USDA's avian influenza surveillance
The US Department of Agriculture (USDA) does not have adequate measures in place to test for and monitor avian influenza in commercial poultry, an audit by the department's inspector general said. The inspector general said the USDA relies too much on voluntary testing and reporting from the states and the poultry industry. In addition, testing varies from state to state. The voluntary reporting makes it difficult for the USDA Animal and Plant Health Inspection Service (APHIS) to reach valid conclusions, know the level of surveillance in each state, or track the disease. The audit, however, preceded Congress' approval in Dec 2005 of $91 million in supplemental funding to help the USDA battle avian flu. The money was part of funds to prepare for the threat of a flu pandemic associated with the H5N1 avian flu virus.

The inspector general detailed how one state fully tests chickens, turkeys, and eggs, while another tests only flocks covered by a federal-state-industry disease-control program. The audit said that other countries wonder why the US—the world's largest producer and exporter of poultry—can't provide the number of tests by state, advise whether all types of commercial poultry are tested, or say whether backyard flocks are examined. USDA spokeswoman Hallie Pickhardt reportedly said the agency "agreed with everything in the report, and we're either doing it or going to be doing it". She reportedly added, however, that the USDA has no plans to make voluntary industry testing mandatory. Pickhardt said the USDA is confident in the testing program that poultry producers are implementing. Instead, the agency will augment voluntary testing with its own checks, Pickhardt said.
(CIDRAP 6/21/06 http://www.cidrap.umn.edu/ )

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Canada (British Columbia): Latest BSE case probably feed-related
Canada's latest case of bovine spongiform encephalopathy (BSE) probably resulted from contaminated feed, which might have linked the case with the nation's previous one, according to the Canadian Food Inspection Agency (CFIA). The BSE case, Canada's fifth, was discovered Apr 16, 2006. In announcing the closing of its investigation of the case Jun 16, 2006, CFIA said the case fell within the same "geographic cluster" as the other 4. It involved a 6-year-old purebred Holstein dairy cow in southwestern British Columbia. CFIA said it had identified 148 animals linked with the infected cow, including its herd mates and recent offspring. Of those, 22 live animals were located; all tested negative for BSE. 1 additional cow is pregnant and will be tested once it has calved. Of the remaining cows, 77 had died or been slaughtered, 15 were exported to the US, and 33 were untraceable. The US Department of Agriculture said Apr 2006 it had found 1 of the animals exported to the US and was looking for the 14 others.

CFIA examined records concerning feed to which the infected animal would have been exposed early in its life, when cattle are most likely to contract BSE. ". . .investigators determined that vehicles and equipment used to ship and receive a variety of ingredients likely contaminated cattle feed with the BSE agent," the agency said. "Investigators also identified a feed ingredient supplier common to this case and Canada's fourth BSE animal. . .This potential link suggests that all of Canada's BSE cases fall within the same geographic cluster, which is reflective of feed sourcing, production, and distribution patterns." Given its age, the cow was born after Canada in 1997 banned putting protein from cows and other ruminants into cattle feed. But the investigation found high compliance with the ban. "Such findings—which have been observed during other investigations and regular inspections of feed mills, renderers, and retailers across the country—confirm the presence of limited opportunities for contamination during feed manufacture, transportation, storage, and use," CFIA said.
(CIDRAP 6/20/06 http://www.cidrap.umn.edu/ )

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Canada: Expansion of feed ban to prevent BSE
Canada announced it will ban cattle parts that could spread bovine spongiform encephalopathy (BSE) from all animal feeds, pet foods, and fertilizers. The new rules will take effect Jul 2007, but smaller businesses will get an additional 6 months to comply, the Canadian Food Inspection Agency (CFIA) said. The rules apply to "specified risk materials" (SRMs) from older cattle—the brain, spinal cord, and certain other tissues that are likely to contain the infective agent if an animal has the disease. Canada, like the US, currently bans the use of protein from cattle and other ruminant animals in ruminant feeds. But cattle protein can be used in feed for nonruminants such as horses, swine, and poultry. (Both countries also ban the use of SRMs in human food.) The aim of keeping SRMs out of all animal feeds is to prevent contamination of cattle feed with other feeds containing potentially infective materials, CFIA said. Removing SRMs from pet food and fertilizers is intended to lower the chance that misuse of these products would expose cattle and other susceptible animals to BSE.

The US Food and Drug Administration (FDA) is currently working on a more limited feed-ban expansion: banning older cattle's brains and spinal cords from all animal feeds and pet foods. The rule would not apply to other SRMs, such as the tonsils, eyes, and certain nerve bundles, and it would not cover fertilizer. The full list of SRMs covered by the new Canadian rule includes the skull, brain, eyes, tonsils, spinal cord, trigeminal ganglia (nerves attached to the brain), and dorsal root ganglia (nerves attached to the spinal cord) of cattle aged 30 months or older, plus the distal ileum (part of the small intestine) of cattle of all ages.
(CIDRAP 6/27/06 http://www.cidrap.umn.edu/ )

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Canada (British Columia): Boy dies from hantavirus pulmonary syndrome
A 14-year-old boy has died of hantavirus infection 16 Jun 2006 in Okanagan, British Columbia. Medical Health Officer Dr. Rob Parker says the boy was most likely infected in his home, which was in a semi-rural area and had an infestation of mice. Hantavirus infection is associated with a respiratory ailment caused by inhaling air contaminated with a virus from deer mouse droppings. He says there is no increased risk to the general public because hantavirus is not transmitted from person to person. Canada has documented 62 hantavirus pulmonary syndrome (HPS) cases. All but one of these cases were identified in the provinces of Manitoba, Saskatchewan, Alberta, and British Columbia. The other case was identified in Quebec, the only patient ever identified east of Manitoba (despite the fact that infected deer mice have been found from British Columbia to Newfoundland). All cases appear to have been associated with Sin Nombre virus.

Elsewhere, A third case of hantavirus pulmonary syndrome (HPS) has been confirmed in Washington this year. Cases have been reported from Whatcom, Yakima, and Okanogan counties; 2 were fatal. Cases have also been reported in neighboring British Columbia and Oregon. An increase in HPS cases across Western States was reported in a recent CDC MMWR.
(Promed 6/22/06, 6/26/06; Washington State Dept of Health 6/27/06)

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USA: Soldier's death possibly linked to shots for smallpox and influenza
A panel of military physician experts found that a combination of smallpox and injectable influenza vaccines might have caused the death of a 26-year-old Army soldier, the Department of Defense (DoD) announced. The soldier, Pfc. Christopher "Justin" Abston, died suddenly, 16 days after he received the vaccines Nov 18, 2005, DoD said. At autopsy, Abston was found to have myocarditis. Myocarditis is known to be a potential side effect of smallpox vaccination. Test results ruled out the presence of the vaccinia virus, the main ingredient of smallpox vaccine, in Abston's heart muscle. However, parvovirus B19 was found, which can also cause cardiac inflammation and death. The medical panel stated that the findings "do suggest the possibility that the vaccines may have caused Abston's death." According to the DoD's Smallpox Vaccination Program, of 1,028,000 military and support personnel who have received the smallpox vaccination since Dec 2002, 120 subsequently had myopericarditis. The DoD has investigated 8 deaths due to disease after smallpox vaccination. 1 other death besides Abston's may have been related to vaccination. In that case, Spc. Rachel Lacy of the Army Reserve died in 2003 from a severe inflammatory process consistent with systemic lupus erythematosus (SLE) about a month after receiving a combination of vaccines that included smallpox, anthrax, typhoid, hepatitis B, and measles-mumps-rubella.
(CIDRAP 6/26/06 http://www.cidrap.umn.edu/ )

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USA (Massachusetts): Latest measles case brings total cases to 14
The measles outbreak in Boston is showing how the global economy opens opportunities for one of the world's most contagious viruses. Investigators say a computer programmer from India brought the virus to Boston's tallest office tower. The Massachusetts Department of Public Health confirmed an additional case of measles in a Boston resident/worker. According to the Boston Public Health Commission (BPHC), the total of confirmed measles cases is 14 in Boston (12 in Boston workers and 2 in Boston residents). The newly confirmed case, a women in her early 20's, is a worker at Hill Holiday, a communications company located in the Hancock Tower, where the outbreak began. The case was suspected early Jun 2006. Lab tests conducted at the State Laboratory Institute were negative for measles, however, specimens were sent for more sensitive testing at CDC. The newly confirmed case has recovered from her illness and is back at work. The incubation period ends 20 Jun 2006, and no additional suspect cases have been identified within Hill Holiday. Officials continue to work with the company to monitor the health of all other employees. Clusters of measles are rare, because most people in the US are vaccinated. However, health officials say the illness is a reminder for people to check whether they are properly immunized against measles, particularly for those immunized in between 1963 and 1968, when an ineffective vaccine was used.
(Promed 6/21/06)

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USA (Massachusetts): 23 confirmed cases of salmonellosis in school
The state continues to scrutinize a pet turtle and owl pellets while trying to nail down the cause of a salmonella outbreak at Jefferson Elementary School in Franklin, Massachusetts. As of 27 Jun 2006, 23 confirmed cases of salmonella, mostly among fifth-grade students, had been reported to the state Department of Public Health. The DPH launched an investigation 16 Jun 2006, when several Jefferson fifth-graders were diagnosed with the bacterial infection. The DPH is interviewing students to determine their relationships and how they might have been exposed to the bacteria. Rheaume said the state is closely examining water in a pet turtle's aquarium and owl pellets, which were dissected in a fifth-grade science experiment. Salmonella outbreaks have been linked to owl pellets, a summer 2005 report of the Minnesota Department of Health shows. According to the Minnesota DPH, the failure to sanitize a cafeteria table after dissecting the owl pellets led to 40 cases of salmonella. Salmonella can also be spread by reptiles.
(Promed 6/21/06, 6/28/06)

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USA: HHS to buy 20,000 courses of anthrax antitoxin
The federal government announced plans to buy 20,000 treatment courses of an experimental anthrax antitoxin, ABthrax, from Human Genome Sciences Inc. (HGS) for $165 million. No product for blocking anthrax toxin is currently available. The disease can be prevented with a vaccine and treated with antibiotics. But antibiotic treatment for inhalational anthrax must begin fairly early in the course of illness, because antibiotics are not effective after Bacillus anthracis has released its toxin into the blood. ABthrax (raxibacumab) is described as a human monoclonal antibody to protective antigen, a component of the anthrax toxin. "HGS has demonstrated the efficacy of ABthrax in multiple preclinical studies in relevant animal models, and its safety and tolerability in a Phase 1 clinical trial in healthy adults," said H. Thomas Watkins, HGS president and CEO. Under the contract, HGS said it must complete additional laboratory and clinical testing to support a license application to the FDA and to support the use of ABthrax in patients with inhalational anthrax if the need arises before licensing.
(CIDRAP 6/20/06 http://www.cidrap.umn.edu/ )

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Africa
Niger: Excerpts from the OIE report on avian influenza H5N1
Information received 15 Jun 2006 from Dr. Seini Aboubacar, Director for Animal Health, Ministry of Animal Resources: Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 13 Feb 2006. Details of outbreak (updated): Outbreaks have been identified spanning 3 villages: Boko-Maigao, Najiko, Tabadama in Maradi province 25 Apr 2006. There were 8000 poultry involved, 700 cases with 530 deaths and 1308 birds destroyed. Description of affected population: backyard chickens. Laboratory results from OIE Reference Laboratory for avian influenza and Newcastle disease: RT-PCR (genes M, H5 and N1) positive for H5N1; amino acid sequence at cleavage site reveals HPAI profile.
(Promed 6/25/06)

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Democratic Republic of the Congo: Erratum—19 deaths from plague
***Erratum: WHO said Jun 14 that it had received reports of 100 deaths due to suspected pneumonic plague in the DRC (as reported in EINet’s 16 June 2006 Newsbrief). However, WHO revised the statement to say that 100 suspected cases had been reported in the Ituri district, with 19 deaths. See http://www.who.int/csr/don/2006_06_14/en/index.html. ***

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1. Updates
Avian/Pandemic influenza updates
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.ht ml. Read the FAOAIDEnews, a situation update on avian influenza outbreaks throughout the world (as of 19 Jun 2006).
- OIE: http://www.oie.int/eng/en_index.htm. Read about the upcoming animal health conferences.
- US CDC: http://www.cdc.gov/flu/avian/index.htm.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Now available: “Second Report on Pandemic Planning Released by Health and Human Services”.
- CIDRAP: http://www.cidrap.umn.edu/. Frequently updated news and scholarly articles.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- American Veterinary Medical Association: http://www.avma.org/public_health/influenza/default.asp.
- US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp. Very frequent news updates.
(WHO; FAO, OIE; CDC; CIDRAP; PAHO; AVMA; USGS)

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Cholera, diarrhea & dysentery
Malaysia
A wedding feast landed some 60 people, including a 3-year-old girl, in a hospital. The guests, who were among 300 who attended the wedding 31 May 2006 in Kampung Lepai, Langgar, have been diagnosed with cholera. They are now quarantined in hospitals in Jitra and Yan. The bridal couple and their parents were spared, as their food was prepared separately from that for the guests. Authorities were alerted after 2 guests sought treatment for signs of food poisoning at hospital 1 Jun 2006. They tested positive for cholera non-O1, a mild strain of the infection. Health Ministry disease control department director Datuk Dr Ramlee Rahmat said measures were being taken to contain the spread of the disease, such as dispatching medical teams to trace the guests at their homes.
(Promed 6/17/06)

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Dengue
Viet Nam
Ho Chi Minh City Preventive Medicine Centre has reported nearly 2700 cases of mosquito-borne dengue fever in the city since the beginning of 2006, twice the number reported during the same period in 2005. The Dengue Fever Department of Children's Hospital 1 has treated 1167 children suffering from dengue fever this year, said Nguyen Thanh Hung, director of the hospital. Dengue fever, a tropical disease is transmitted by mosquitoes carrying the virus. The disease can be fatal for children and the elderly or weak. A 1-year-old child died of the disease May 2006. The number of children receiving treatment at another paediatric facility also increased this week. Reports from the city's Pasteur Institute said dengue fever had killed 3 people so far in 2006 in the Mekong Delta province of Hau Giang.
(Promed 6/24/06)

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Viral gastroenteritis
Australia (New South Wales)
An epidemic of norovirus gastroenteritis has emerged in New South Wales. Early cases occurred Feb 2006 in a children's hospital outbreak involving 102 individuals, 26 of whom were patients. The increasing number of cases of acute gastroenteritis amongst adults and children presenting to acute facilities prompted increased surveillance for norovirus. In May 2006, norovirus was detected in 95 of 405 stool samples received from patients treated at 5 different hospitals within the South Eastern Sydney and Illawarra regions as well as referred samples from private labs. A preliminary investigation has shown the predominance of variants closely related to the Farmington Hills/02/US (GII.4) and Sydney C14/02/AU (GII.3) strains.
(Promed 6/26/06)

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West Nile Virus
USA
As of 13 Jun 2006 avian, animal or mosquito WNV infections have been reported to CDC ArboNET from the following states: Arkansas, California, Florida, Idaho, Illinois, Indiana, Michigan, Missouri, New York, Tennessee, Texas, Utah, West Virginia, and Wyoming. Human cases have been reported in Colorado, Mississippi, and Texas. Of the 4 cases, 4 (100 percent) were reported as West Nile meningitis or encephalitis (neuroinvasive disease), 0 (0 percent) were reported as West Nile fever (milder disease), and 0 (0 percent) were clinically unspecified at this time. For more information, see: http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount06_detailed.htm. Maps detailing county-level human, mosquito, veterinary, avian and sentinel data: http://westnilemaps.usgs.gov/.
(Promed 6/23/06)

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2. Articles
Influenza in 1918: Recollections of the Epidemic in Philadelphia
Starr I. Ann Intern Med. 2006 Jun 26; [Epub ahead of print]
http://www.annals.org/cgi/content/full/0000605-200607180-00132v1
Abstract: “When the great influenza epidemic struck Philadelphia in 1918, the author was just starting his third year at the University of Pennsylvania School of Medicine. After a single lecture on influenza, classes for the third and fourth year students were suspended while he and his mates manned an emergency hospital, in which they worked under little or no medical supervision and in the presence of an alarming patient mortality. This essay describes what happened in the hospital, and in the city as a whole, during the pandemic. Certain features of the clinical course of most patients permit the hope that modern therapy will prevent a repetition of the horrendous mortality.”
(CIDRAP http://www.cidrap.umn.edu/ )

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Detection of influenza viruses resistant to neuraminidase inhibitors in global surveillance during the first 3 years of their use
Monto AS et al. Antimicrob Agents Chemother. 2006 Jul;50(7):2395-402.
http://aac.asm.org/cgi/content/abstract/50/7/2395
Abstract: “Emergence of influenza viruses with reduced susceptibility to neuraminidase inhibitors (NAIs) develops at a low level following drug treatment, and person-to-person transmission of resistant virus has not been recognized to date. The Neuraminidase Inhibitor Susceptibility Network (NISN) was established to follow susceptibility of isolates and occurrence of NAI resistance at a population level in various parts of the world. Isolates from the WHO influenza collaborating centers were screened for susceptibilities to oseltamivir and zanamivir by a chemiluminescent enzyme inhibition assay, and those considered potentially resistant were analyzed by sequence analysis of the neuraminidase genes. During the first 3 years of NAI use (1999 to 2002), 2,287 isolates were tested. Among them, 8 (0.33%) viruses had a >10-fold decrease in susceptibility to oseltamivir, 1 (0.22%) in 1999 to 2000, 3 (0.36%) in 2000 to 2001, and 4 (0.41%) in 2001 to 2002. 6 had unique changes in the neuraminidase gene compared to neuraminidases of the same subtype in the influenza sequence database. Although only 1 of the mutations had previously been recognized in persons receiving NAIs, none were from patients who were known to have received the drugs. During the 3 years preceding NAI use, no resistant variants were detected among 1,054 viruses. Drug use was relatively stable during the period, except for an approximate 10-fold increase in oseltamivir use in Japan during the third year. The frequency of variants with decreased sensitivity to the NAIs did not increase significantly during this period, but continued surveillance is required, especially in regions with higher NAI use.”
(CIDRAP http://www.cidrap.umn.edu/ )

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Planning for Avian Influenza
Bartlett JG. Ann Intern Med. 2006 Jun 26; [Epub ahead of print]
http://www.annals.org/cgi/content/full/0000605-200607180-00133v1
Abstract: “Avian influenza, or influenza A (H5N1), has 3 of the 4 properties necessary to cause a serious pandemic: It can infect people, nearly all people are immunologically naive, and it is highly lethal. The Achilles heel of the virus is the lack of sustained human–human transmission. Fortunately, among the 124 cases reported through 30 May 2006, nearly all were acquired by direct contact with poultry. Unfortunately, the capability for efficient human–human transmission requires only a single mutation by a virus that is notoriously genetically unstable, hence the need for a new vaccine each year for seasonal influenza. Influenza A (H5N1) is being compared to another avian strain, the agent of the "Spanish flu" of 1918–1919, which traversed the world in 3 months and caused an estimated 50 million deaths. The question is if we are ready for this type of pandemic, and the answer is probably no. The main problems are the lack of an effective vaccine, very poor surge capacity, a health care system that could not accommodate even a modest pandemic, and erratic regional planning. It's time to get ready, and in the process be ready for bioterrorism, natural disasters, and epidemics of other infectious diseases.”
(CIDRAP http://www.cidrap.umn.edu/ )

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The health care response to pandemic influenza
Position paper from American College of Physicians:
http://www.acponline.org/college/pressroom/as06/pandemic_policy.pdf
Executive Summary: “Substantial epidemiological research and medical evidence in recent years have highlighted the necessity of planning to safeguard the American public against the threat of pandemic influenza. Although no new strain of influenza virus has yet achieved the capacity for easy transmission between humans, experts are concerned that one will in the near future. The morbidity and mortality that could occur as a result of this development is not precisely predictable, but the impact would be felt by all human populations around the world. . .The American College of Physicians (ACP) supports the U.S. Government’s foresight in developing a national strategic response plan and the efforts of state and local leadership in addressing this threat to public health. A comprehensive health care response to this threat is necessary to save lives, decrease illness, and avoid disruption to the economy. In order to achieve these goals, ACP believes that physicians in all health care settings will have to be fully integrated into plans for the health care response. On November 2, 2005, the U.S. Department of Health and Human Services (HHS) issued the HHS Pandemic Influenza Plan as a blueprint for preparing for pandemic influenza. It is in consideration of the assumptions, strategy and details of the HHS plan, which incorporates guidance to state and local leaders and public health authorities, that ACP offers the following public policy positions. . .”
(CIDRAP http://www.cidrap.umn.edu/ )

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IOM: Emergency health system unprepared for disasters
The US emergency medical care system is woefully inadequate and unprepared for a pandemic, bioterrorist attack, natural disaster, or other national crisis, 3 recent reports from the Institute of Medicine (IOM) conclude. The nation's emergency care system, the reports say, is overburdened, underfunded, and too fragmented to communicate and cooperate effectively across levels and geographic areas. It has little surge capacity to deal with a disaster. In addition, emergency care staff members are often not adequately trained to respond to large-scale disasters or to work with pediatric patients. To remedy this situation, the committee that wrote the reports recommends that:

- Congress appropriate at least $325.5 million toward shoring up the emergency care system—plus funding for readying the system for potential disasters.
- The emergency care system be "regionalized" so that neighboring hospitals, emergency medical services, and other agencies work together to provide care for all the people in their region.
- The Veterans Health Administration (VHA) be integrated into civilian disaster planning and management.
- Guidelines on overcrowding and redirecting ambulances away from packed emergency departments (EDs) be enforced, and coordination and communication between facilities improved.
- Streamlining tools, such as queuing theory, dashboard systems, and 23-hour observation units, be used to optimize patient treatment and flow.

Also, the Department of Homeland Security (DHS) on Jun 16, 2006 assessed the nation's preparedness for catastrophes. Among the key findings in the Nationwide Plan Review for states and urban areas are: Most planning processes are not adequate as defined in the National Response Plan (NRP); A common deficiency in state and urban areas is the absence of a clearly defined command structure; The ability to give the public accurate, timely information should be strengthened; Significant weaknesses in evacuation planning are of profound concern; Resource management is the "Achilles heel" of emergency planning.

Among the key findings for the federal government are: Clear guidance needs to be developed on how state and local governments can coordinate operations with federal partners according to the NRP; Collaboration between government and non-governmental organizations should be strengthened at all levels; Federal, state, and local governments should work with the private sector to optimize transportation of people with disabilities before, during, and after an emergency; The federal government should provide leadership, guidance, and resources necessary to build a shared national homeland security planning system.
(CIDRAP 6/20/06 http://www.cidrap.umn.edu/ )

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ABARE report: Avian influenza: potential economic impact of a pandemic on Australia
An influenza pandemic would reduce the gross domestic products of the world's major economies by amounts ranging from 9% in China to 3% in Canada, according to a recent report by the Australian Bureau of Agricultural and Resource Economics (ABARE). In its analysis, ABARE assumed a medium-scale pandemic with a global death toll of around 80 million. The authors also assumed that healthy adults aged 19 to 45 would be particularly hard hit, as was true in the severe flu pandemic of 1918-19. Predicted decreases in gross domestic product are as follows: China, 8.7%; Southeast Asia, 7.1%, Australia, 6.8%; Republic of Korea, 6.7%; Japan, 6.1%; US, 3.5%; European Union, 3.7% and Canada, 3%. The report predicts that the economic impact on developing countries will be even larger than the effect on developed countries. Fear of the disease could cause panic and chaos that might disrupt the food supply, basic services, financial services, and public order. “It is more efficient for Australia and other countries to continue to be active in international efforts aimed at eradicating, preventing or containing the influenza virus at its source before it reaches international boundaries," they concluded. "A collective approach in dealing with the spread of the virus may be more effective and efficient than individual or unilateral efforts."
http://www.abareconomics.com/interactive/AC_june_2006/htm/paper1.htm
(CIDRAP 6/28/06 http://www.cidrap.umn.edu/ )

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Biosecurity: A comprehensive action plan
New report from Center for American Progress
From the Executive Summary: “Biological weapons and infectious diseases share several fundamental characteristics that the United States can leverage to counter both of these threats more effectively. Both a bioweapons attack and a natural pandemic, such as avian flu, can be detected in similar ways, and the effectiveness of any response to an outbreak of infectious disease, whether natural or caused deliberately by terrorists, hinges on the strength of the U.S. public health and medical systems. . .The Biological Incident Annex--the portion of the U.S. government’s National Response Plan (NRP) that addresses biological threats--recognizes the commonalities between natural and deliberate outbreaks. But having an emergency plan on paper is no guarantee that it will work in practice, as the federal government’s faulty response to Hurricane Katrina demonstrates. The Biological Incident Annex is premised on the assumption that state, local, and tribal entities can, as a practical matter, assume primary responsibility for detecting and responding to major outbreaks of infectious disease. Unfortunately, the reality is that they cannot. . .”
(CIDRAP http://www.cidrap.umn.edu/ )

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Prevention and Control of Influenza: Recommendations of ACIP
Summary: “This report updates the 2005 recommendations by the Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine and antiviral agents. . .Principal changes include 1) recommending vaccination of children aged 24--59 months and their household contacts and out-of-home caregivers against influenza; 2) highlighting the importance of administering 2 doses of influenza vaccine for children aged 6 months--<9 years who were previously unvaccinated; 3) advising health-care providers, those planning organized campaigns, and state and local public health agencies to a) develop plans for expanding outreach and infrastructure to vaccinate more persons than the previous year and b) develop contingency plans for the timing and prioritization of administering influenza vaccine, if the supply of vaccine is delayed and/or reduced; 4) reminding providers that they should routinely offer influenza vaccine to patients throughout the influenza season; 5) recommending that neither amantadine nor rimantadine be used for the treatment or chemoprophylaxis of influenza A in the United States until evidence of susceptibility to these antiviral medications has been re-established among circulating influenza A viruses; and 6) using the 2006--07 trivalent influenza vaccine virus strains: A/New Caledonia/20/1999 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens. . .”

CDC projects that about 100 million doses of influenza vaccine will be available this season—about 16% more than in 2005-06. If a new vaccine is licensed in 2006, an additional 15 million to 20 million doses might be available. Besides children aged 6 months through 4 years, groups for whom flu immunization is recommended include the following:

- Children and adolescents (6 months through 18 years) who are receiving long-term aspirin therapy
- Women who will be pregnant during the flu season
- Adults and children who have asthma, other chronic respiratory or cardiovascular conditions, or any condition that can impair respiratory function
- Adults and children under treatment for chronic metabolic disorders, kidney problems, hemoglobinopathies, or immunodeficiency
- Residents of nursing homes and other chronic-care facilities
- People age 50 and older.

CDC also recommends immunization for healthcare workers and household contacts and caregivers of children aged 0 to 59 months and people at high risk for severe flu complications.
(MMWR June 28, 2006 / 55(Early Release);1-41 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr55e628a1.htm ; CIDRAP 6/29/06 http://www.cidrap.umn.edu/ )

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Eastern Equine Encephalitis--New Hampshire and Massachusetts, August-September 2005
“During August--September 2005, the New Hampshire Department of Health and Human Services reported seven cases of human eastern equine encephalitis virus (EEEV) disease, the first laboratory-confirmed, locally acquired cases of human EEEV disease reported from New Hampshire in 41 years of national surveillance. Also during August--September 2005, the Massachusetts Department of Public Health reported 4 cases of human EEEV disease, 5 times the annual average of 0.8 cases reported from Massachusetts during the preceding 10 years. 4 of the 11 patients from New Hampshire and Massachusetts died. EEEV is transmitted in marshes and swamps in an enzootic bird-mosquito-bird cycle primarily by the mosquito Culiseta melanura. Bridge mosquito vectors (e.g., Coquillettidia perturbans, Aedes vexans, or Aedes sollicitans) transmit EEEV to humans and other mammals. This report summarizes the investigations of cases in New Hampshire and Massachusetts conducted by the two state health departments and CDC. The findings underscore the importance of surveillance for, and diagnostic consideration of, arboviral encephalitis in the United States and promotion of preventive measures such as local mosquito control and use of insect repellent. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5525a1.htm
(MMWR June 30, 2006 / 55(25);697-700)

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Travel-Associated Dengue --- United States, 2005
“Dengue is a mosquito-transmitted, acute viral disease caused by any of 4 dengue virus serotypes (DEN-1, DEN-2, DEN-3, or DEN-4). Dengue is endemic in most tropical and subtropical areas of the world and has occurred among U.S. residents returning from travel to such areas. In collaboration with state health departments, CDC maintains a passive surveillance system for travel-associated dengue among U.S. residents. . .This report summarizes information regarding 96 travel-associated dengue cases, including 1 fatality, among U.S. residents during 2005. Travelers to tropical areas can reduce their risk for dengue by using mosquito repellent and avoiding exposure to mosquitoes. Health-care providers should consider dengue in the differential diagnosis of febrile illness in patients who have returned recently from dengue-endemic areas. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5525a2.htm
(MMWR June 30, 2006 / 55(25);700-702)

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Human salmonellosis associated with animal-derived pet treats--United States and
“During 2004--2005, contact with Salmonella-contaminated pet treats of beef and seafood origin resulted in nine culture-confirmed human Salmonella Thompson infections in western Canada and the state of Washington. This is the third published report of an outbreak of human illness associated with pet treats in North America and the first to describe such an outbreak in the United States. This report highlights the investigation of the outbreak by U.S. and Canadian public health officials and provides recommendations for reducing the risk that Salmonella-contaminated pet treats pose to humans. Public health practitioners should consider pet treats a potential source for Salmonella transmission. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5525a3.htm
(MMWR June 30, 2006 / 55(25);702-705)

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Rapid HIV Test Distribution --- United States, 2003--2005
“At the end of 2003, an estimated 1 million persons in the United States were living with. . .HIV infection, including those with. . .AIDS; approximately one fourth of these persons had not had their infections diagnosed. In 2003, CDC implemented a new initiative, Advancing HIV Prevention (AHP), focused, in part, on reducing the prevalence of undiagnosed HIV infection by expanding HIV testing and taking advantage of rapid HIV tests that enable persons to receive results within 30 minutes, instead of the 2 weeks typically associated with conventional tests. In support of AHP strategies, during September 2003--December 2005, CDC purchased and distributed rapid HIV tests to expand testing and assess the feasibility of using rapid tests in new environments. . .This report summarizes the results of this rapid HIV-test distribution program (RTDP), in which CDC distributed tests to 230 organizations in the United States and identified 4,650 (1.2%) HIV infections among 372,960 rapid tests administered. The results suggest that RTDP helped scale up rapid HIV-testing programs in the United States and enabled diagnosis of HIV in persons who might not have had their infections diagnosed otherwise. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5524a2.htm
(MMWR June 23, 2006 / 55(24);673-676)

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Methicillin-resistant Staphylococcus aureus skin infections among tattoo
“Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have emerged as a major cause of skin disease in the United States. . .This report summarizes investigations of six unlinked clusters of skin and soft tissue infections caused by CA-MRSA among 44 recipients of tattoos from 13 unlicensed tattooists in three states (Ohio, Kentucky, and Vermont); use of nonsterile equipment and suboptimal infection-control practices were identified as potential causes of the infections. Clinicians should consider CA-MRSA in their differential diagnosis for staphylococcus diseases, including skin infections. Clinicians can contact their local health departments to determine the prevalence of CA-MRSA in their community and whether the disease is reportable. MRSA infections should be added to education and prevention campaigns highlighting the risks of unlicensed tattooing. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5524a3.htm
(MMWR June 23, 2006 / 55(24);677-679)

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Kuru study implies risk of waves of vCJD cases
Current estimates of how many people could die of variant Creutzfeld-Jakob disease (vCJD) may be too low, because the disorder may have a prolonged incubation time in some people, according to a study in the The Lancet. Variant CJD is a prion disease linked to eating meat infected with bovine spongiform encephalopathy (BSE). The report deals with kuru, another human prion disorder, which arose from cannibalistic funerary practices among the Fore tribe in Papua New Guinea. The authors of the study, John Collinge et al., identified 7 men and 4 women in the South Fore tribe who were born between 1933 and 1949 and fell ill with kuru between 1996 and 2004. All of the patients were born before cannibalism had been outlawed and had been exposed to the practice. The analysis of disease onset dates revealed that the minimum estimated incubation period for kuru among these patients was between 34 and 41 years. The likely incubation times in men were between 39 and 56 years and could have been up to 7 years longer, according to the report. Kuru is thought to have an average incubation time of 12 years, based on data from more than 2,700 kuru cases.

The study may have implications for individuals who have eaten BSE-infected beef and are at risk for vCJD. The authors state that because of the genetic basis for vCJD susceptibility, the cases identified so far may represent people who are genetically predisposed to have the shortest incubation period. The investigators suggest that the vCJD epidemic may be multiphasic and that recent estimates of its size, based on an assumption of uniform genetic susceptibility, could be substantial underestimations. A human epidemic, they say, will be difficult to model accurately until modifier genes are identified and their frequencies in the population are known. However, not all experts agree with the expectation of many more cases of vCJD. They observed that kuru is a human disease and that human-to-human transmission is more efficient than cross-species transmission such as cow-to-human, as occurs with vCJD.

Reference: Collinge J, Whitfield J, McKintosh E, et al. Kuru in the 21st century—an acquired human prion disease with very long incubation periods. Lancet 2006 Jun 24;367(9528):2068-74.
(CIDRAP 6/29/06 http://www.cidrap.umn.edu/ )

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3. Notifications
Proposals: Surveillance and Response to Avian and Pandemic Influenza
The US CDC has issued a request for proposals to strengthen national surveillance and response to avian and pandemic influenza—“Surveillance and Response to Avian and Pandemic Influenza by National Health Authorities outside the United States”. Foreign governments are eligible to apply for these funds. Applications deadline is 7 August 2006. For more information, see CDC-RFA-C106-607 on the CDC website:
http://www.cdc.gov/od/pgo/funding/CI06-607.htm.

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National HIV Testing Day--June 27, 2006
June 27 is National HIV Testing Day. National HIV Testing Day serves to increase awareness of HIV/AIDS and to encourage all persons in the US to get tested for HIV. Locations of HIV test sites by postal code are available at: http://www.hivtest.org/index.htm. Persons who know they have HIV infection often can receive antiretroviral treatment at an early stage of disease, when more treatment options are available. Knowing HIV status also has the potential to reduce transmission. In 2003, CDC began its Advancing HIV Prevention initiative, which aims to increase the prevalence of persons who know their HIV status by making HIV testing more available and by encouraging more people to take advantage of the tests.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5524a1.htm
(MMWR June 23, 2006 / 55(24);673)

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