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Vol. Vol. IX, No. 14 ~ EINet News Briefs ~ Jul 14, 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)
- Spain: First Case of Bird Flu in a Wild Bird in Spain
- Denmark: Culling of Ducks and Pheasants in response to LPAI H5 Virus
- Russia: Crimean-Congo hemorrhagic fever
- Russia (Bashkortostan): Hemorrhagic Fever with Renal Syndrome
- Indonesia: Undiagnosed Poultry Deaths
- Indonesia: Suspected 41st Human Death from H5N1 Avian Influenza
- Thailand (Phayao): Outbreak of Botulism from Deer Meat
- China: Signs of Recovery in China's Most Recent Human Case of H5N1
- New Zealand: Outbreak of Norovirus from Korean Oysters
- USA: Smuggled Poultry Products from China
- USA (California): Plague, Septicemic
- USA (Tennessee): Day Care Outbreak of E. coli 0157
- USA (California): Norovirus outbreak affects 772 people in healthcare facilities
- USA (Iowa): Norovirus Infection Caused Outbreak at Special Olympics
- USA: USDA and FAO Launch Animal Disease Crisis Management Center
- USA: FDA warns Sanofi About Problems at Flu Vaccine Plant
- USA (Massachusetts): Outbreak of Salmonellosis from Owl Pellets
- Canada (Manitoba): 15 Year Old Cow Tests Positive for BSE
- Canada (Alberta): 4 Year Old Cow Tests Positive for BSE
- Peru: Six People Infected with Anthrax
- Egypt: Human death from H5N1

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

2. Articles
- The Underrecognized Burden of Influenza in Young Children
- Influenza Control
- Prevention and Control of TB in Correctional and Detention Facilities: Recommendations from CDC
- WHO WER, Volume 81, Number 27—June 30, 2006
- Family tragedy spotlights flu mutations
- Emerging Infectious Determinants of Chronic Diseases
- Triple Reassortant H3N2 Influenza A Viruses, Canada, 2005
- Orientia tsutsugamushi in Eschars from Scrub Typhus Patients
- Leptospirosis in Squirrels Imported from United States to Japan
- Blood test for silent phase of prion disease reported

3. Notifications
- Group of Eight Summit to Focus on Global Health
- XVI International AIDS Conference
- CDC’s Advisory Committee Recommends Human Papillomavirus Virus Vaccination


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 / 35 (29)
Iraq / 2 (2)
Turkey / 12 (4)
Total / 85 (55)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 229 (131).
(WHO 7/04/06 http://www.who.int/csr/disease/avian_influenza/en/index.html)

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Europe/Near East
Spain: First Case of Bird Flu in a Wild Bird in Spain
Europe's biggest tourism destination by revenue, confirmed its 1st case of bird flu. The National Laboratory at Algete near Madrid found the H5N1 virus in a sample taken from a grebe found in the province of Alava. Avian influenza has spread across the European Union, prompting some consumers to spurn poultry. The World Health Organization has said there's no risk in eating poultry or eggs that are properly cooked. The World Tourism Organization said it's safe to travel to countries that have reported bird flu as long as tourists avoid close contact with birds. Germany, Greece, Italy, Hungary, Slovenia and Austria are among countries that have reported outbreaks, mostly in swans.
(Promed 7/07/06)

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Denmark: Culling of Ducks and Pheasants in response to LPAI H5 Virus
Danish authorities have ordered thousands of ducks and pheasants culled at a breeding farm for wild birds after detecting that some were infected with the bird-flu virus. The Danish Veterinary and Food Administration (DVFA) said the strain was the H5 virus. Unlike H5N1, the H5 strain is not viewed as potentially lethal to humans but the culling was a precautionary measure, said the agency.
(Promed 7/07/06)

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Russia: Crimean-Congo hemorrhagic fever
Already 40 laboratory-confirmed cases of Crimean-Congo hemorrhagic fever (CCHF) have been recorded in the Rostov region according to Vladimir Ryzhkov, head of the Department of Epidemiological Surveillance in Rostov-on-Don. 10 patients have been admitted to hospital. 16 patients have been registered in the district of Zavetninskiy and 5 each in the districts of Salskiy, Tselinskiy, and Proletarskiy district (one of whom died). Additionally, 2 cases of CCHF were diagnosed in each of districts of Orlovskiy, Tsimlyanskiy, and Peschanokopskiy, and single cases were found in the districts of Zomovnikovskiy, Dubovskiy, and Remontnenskiy and the city of Volgidinsk. In total 2264 persons (including 418 children) have received treatment for tick bites, and 124 were admitted to hospital following CCHF diagnosis. Previously (in April-May 2006), 14 cases of CCHF were diagnosed and 1300 people had received treatment for tick bite, compared with 2000 during the whole of 2005.
(Promed 7/08/06)

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Russia (Bashkortostan): Hemorrhagic Fever with Renal Syndrome
Hemorrhagic fever with renal syndrome (HFRS) has been diagnosed in 306 patients (including 9 children) since the beginning of 2006. This is 26 per cent more than for the same period of 2005, according to Leonid Korobov of the Bashkortostan Centre for Hygiene and Epidemiology. All affected persons had contracted infection during visits to the countryside involving forest walks or fishing trips in. The patients are predominantly inhabitants of the cities of Ufa, Ufimskiy, Iglinskiy, Blagoveshchenskiy, Birskiy and Nurimanivskiy in the Gafurijskiy district located along the course of the rivers Belaya and Ufa. All affected individuals have been admitted to hospital for appropriate treatment. An increase in HFRS cases in the Republic had occurred at the end of June [2006] as predicted from the increased density of the red field vole population in comparison with the same period in the preceding year. Early initiation of rodent control measures around dwellings and adjacent land had contained the vole population to some extent. However, natural and climatic conditions in 2006, including the absence of spring floods, had reduced the effectiveness of rodent control measures in reducing the vole population. Deciduous woods occupy 37 per cent of the territory of Bashkortostan and act as natural foci of HFRS infection. Over the past 52 years, the peak of HFRS infection occurred in 1997 when 9500 cases were diagnosed and treated; there were 30 fatalities that year. In 2005 more than 2300 persons were infected and 5 patients died.
(Promed 7/07/06)

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Asia
Indonesia: Undiagnosed Poultry Deaths
More than 2000 poultry have died in 4 tambons [local government units in Thailand; below district (amphoe) and province (changwat), they form the 3rd administrative subdivision level] in Wang Sai Phun district in the past few days. The district has been declared an animal disease infection area. Local livestock officials warned local residents not to eat the meat of poultry that died suddenly. They were running laboratory tests on samples from the dead poultry. E. coli infection is suspected as the cause of the mass poultry death.
(Promed 7/04/06)

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Indonesia: Suspected 41st Human Death from H5N1 Avian Influenza
A 3-year-old Indonesian girl who died this week has tested positive for bird flu, a Health Ministry official said on Friday [7 Jul 2006], citing a local test. If confirmed by a World Health Organization (WHO) laboratory, the girl from Jakarta's western suburbs will be the 41st bird flu death in Indonesia. "The child had had contact with sick fowl, the neighbour's chickens," Runizar Ruesin, head of the Health Ministry's Bird Flu Information Centre. Human cases generally stem from contact with infected birds. "She died on Thursday, 9 hours after being admitted to hospital".

According to the WHO, the H5N1 avian flu virus has killed 131 people across the globe since 2003. In Indonesia, 40 people are confirmed by WHO tests to have died from the virus, endemic in poultry in nearly all the country's 33 provinces. On Thursday a senior Indonesian government official said the country's poultry death rate from bird flu was worsening, possibly due to poor vaccination coverage. Mathur Riyadi, director general of livestock production at the agriculture ministry, said one million fowl, half of them quail, died of bird flu in the first 3 months of 2006. In 2005, deaths for the year as a whole were 1.2 million. The government has so far shied away from mass culling, citing lack of funds and impracticality, with vaccination a preferred method to prevent the spread of bird flu among poultry.
(Promed 7/07/06)

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Thailand (Phayao): Outbreak of Botulism from Deer Meat
Another large northern Thailand botulism outbreak occurred on 30 Jun 2006, affecting 83 of the 192 people who were exposed to raw deer meat and gut. Of these, 3 developed respiratory failure, 3 developed impending respiratory failures, and 83 developed fatigue and diarrhea after ingestion of raw dear meat and gut on 26-28 Jun 2006. One patient was referred to hospital for respiratory failure. Physical examination of 3 patients in the ICU of Chiang Kum General Hospital revealed ocular, respiratory and proximal peripheral muscle weakness. The electrophysiologic findings supported diagnosis of pre-synaptic neuromuscular dysfunction and respiratory weakness; botulism is the most likely diagnosis.

After treatment with botulinum antitoxin (mixed-type botulinum antitoxin 3 patients in ICU showed improvement in overall clinical outcome. Active surveillance was carried out by the Ministry of Public Health of Thailand and CDC-USA to identify the high-risk patients who may develop respiratory failure. This may be the 2nd outbreak of botulism in northern Thailand, but fewer severe cases were observed.
(Promed 7/11/06)

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China: Signs of Recovery in China's Most Recent Human Case of H5N1
China's most recent human case of bird flu in south China's Guangdong Province has been showing signs of recovery. X-rays showed the shadow on the patient's lungs had diminished, but he was still critically ill, said the Health Bureau of Shenzhen City. The 31-year-old man was confirmed by the Ministry of Health to have contracted bird flu on June 15, bringing China's total human infections to 19. The man had been undergoing treatment for 8 days in a local hospital, which had the most advanced intensive care unit in the city, said the bureau. Meanwhile, medical observation of 98 people who had close contact with him had found no suspected symptoms, such as pneumonia or bird flu-like symptoms. Bird flu has killed 12 Chinese since 2005.
(Promed 7/13/06)

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New Zealand: Outbreak of Norovirus from Korean Oysters
Chefs failing to read the labelling on boxes of Korean oysters have been blamed for hundreds of cases of food poisoning at a rugby test match at Auckland's Eden Park last month. About 352 people developed norovirus-associated gastroenteritis resulting in nausea, vomiting, diarrhoea, stomach cramps, fever and chills, from eating the oysters, a report released by Auckland Regional Public Health Service today said. The report said the caterers ran out of New Zealand-reared oysters and served the imported ones, which they believed were safe to eat raw. Although labelling on the packaging indicated the oysters should be cooked, this was not heeded by the chefs preparing them. New Zealand Food Safety Authority spokesman Gary Bowering said oyster imports from Korea have been put on hold until the authority was satisfied they were safe. "We have asked the Government to suspend imports until we have confidence in the Korean Government's processes of certification. That is the standard international approach for incidents like this." The report also revealed that subsequent to the Eden Park outbreak there were 2 further foodborne illness incidents implicating imported Korean oysters. One was in Porirua and involved 3 cases with confirmed norovirus infection and one was in Auckland where there was a case with symptoms consistent with norovirus infection. The latter involved consuming oysters from the same batch as those implicated at Eden Park.
(Promed 7/14/06)

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Americas
USA: Smuggled Poultry Products from China
Several boxes of smuggled poultry products have gone missing from a Michigan warehouse amid government surveillance activities to prevent illegal imports from countries known to have suffered outbreaks of highly pathogenic bird flu, a U.S. Department of Agriculture spokesman said. After the discovery and destruction of about 2000 pounds of poultry products smuggled into Troy, Mich., from China -- a country battling the deadly H5N1 form of bird flu -- in early June, USDA officials were called back by Michigan authorities later that month. On 27 Jun 2006, USDA spokesman Ed Loyd said, federal and state officials detained 150 pounds of smuggled poultry and pig carcasses. The next week, when USDA returned to the location in Genesee County, 4 boxes of smuggled goose intestines had disappeared and been replaced with "chicken parts." Loyd said, "An investigation is being conducted into the criminal violation related to the goose intestines."
(Promed 7/14/06)

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USA (California): Plague, Septicemic
A 79 year old woman presented to a community hospital with an abrupt decline in mental status over 2 days without fever. Clinical findings were suggestive of disseminated intravascular coagulation. API biochemical testing suggested Yersinia pestis; an anti-F1 antigen monoclonal antibody test performed by the San Diego County Public Health Laboratory presumptively confirmed the biochemical analysis; a PCR test confirmed the identification. The patient is recovering from the illness with persistent anuria, having been definitely treated with gentamicin, doxycycline (for a question of meningitis) among other empiric broad-spectrum antibiotics.

The patient lives between Mammoth and Bishop in Mono County, where numerous small rodents (including ground squirrels) were observed on her property. Rodent droppings were found in the house. The California State Health department is currently carrying out epizootic investigation activities. Post-exposure prophylaxis was offered to hospital personnel, family and other close contacts.
(Promed 7/01/06)

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USA (Tennessee): Day Care Outbreak of E. coli 0157
Six confirmed cases of a serious Escherichia coli infection and 4 additional "suspected" cases are being looked into by the Tennessee Department of Health. All of the infected children, ages 5 and under, attended the same day care facility, west of Lafayette. "Most of the 6 children with confirmed cases have been released from Sumner Regional Medical Center or treated by their family doctor and sent home with their parents". Two children, a girl aged 3 and a 16 month old boy, remain in Vanderbilt Children's Hospital where they are receiving treatment. An additional 4 young children have shown symptoms but have not become dangerously ill from the E. coli strain of infection, which can lead to serious complications including damage to the kidneys. The day care center closed voluntarily for the time being. One child became ill nearly a week before other children at the facility began to show symptoms. Officials speculate that the 1st child may have infected toys, linens or other items from which the other children were infected. The bacterial infection is so aggressive that simple hand washing is not enough to prevent its spread, especially if hand-to-mouth activity immediately follows the initial exposure.
(Promed 7/01/06)

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USA (California): Norovirus outbreak affects 772 people in healthcare facilities
In a recent outbreak, the number of cases of norovirus infection has risen to 772, according to the Sonoma County Public Health Department. Since the outbreak began in mid-March 2006, 16 care facilities have reported patients with symptoms of norovirus infection, but the county has refused to name them until 48 hours pass without a new case being reported, when the outbreak will be considered over.
(Promed 7/05/06)

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USA (Iowa): Norovirus Infection Caused Outbreak at Special Olympics
Samples from individuals who became ill during the Special Olympics USA National Games in Ames, Iowa have tested positive for norovirus. At least 30 people were treated yesterday [7 Jul 2006] for vomiting, nausea and diarrhea. The Special Olympics held its closing ceremonies 7 Jul 2006. Officials are concerned that people heading home this weekend will bring the sickness with them. More than 30 000 people from across the country attended the 6-day event in central Iowa.
(Promed 7/09/06)

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USA: USDA and FAO Launch Animal Disease Crisis Management Center
The U.S. Department of Agriculture (USDA) will send four veterinary specialists to Rome to assist the United Nations' (UN) Food and Agriculture Organization (FAO) in launching a new crisis management center that will enhance worldwide response to animal disease. The Center will begin operations by end-July at the FAO headquarters in Rome, Italy. The Crisis Management Center, a facility run by the FAO in close collaboration with the OIE (World Organization for Animal Health) will provide animal disease analysis and information and deploy international resources to prevent and contain dangerous animal diseases. The current focus will be on highly pathogenic H5N1 avian influenza that continues to spread throughout the world. The United States will provide $1.8 million to FAO to create the Center. Other contributors include France, Germany, Italy, the Netherlands and the United Kingdom.
(USDA 7/14/06 http://www.usda.gov)

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USA: FDA warns Sanofi About Problems at Flu Vaccine Plant
The Food and Drug Administration (FDA) on Jun 30 sent a warning letter to Sanofi Pasteur, Inc., about contamination in a component of Fluzone, the influenza vaccine the company is preparing for the 2006-07 season. Both the FDA and the company said they did not expect the problems to significantly limit production of the vaccine for this season. The company has said it plans to make about 50 million doses, which could be roughly half the US supply. The warning letter discusses contamination of one of the monovalent concentrates, a preparation of one of the three strains of killed flu virus used in the vaccine. The monovalent concentrates are mixed to make the trivalent vaccine, which protects against the three viral strains, the FDA said. The Centers for Disease Control and Prevention said last week that vaccine manufacturers expect to make about 100 million doses of vaccine for US distribution in the upcoming fu season. After production problems with Chiron's influenza vaccine in 2004, which led to serious vaccine shortages, the FDA instituted annual inspections of vaccine manufacturers in 2005. Following its inspection of the Sanofi Pasteur facility last year, the FDA recommended a list of corrective actions. During its recent inspection the FDA determined that some of the problems remained, along with additional concerns.
(CIDRAP 7/05/06 http://www.cidrap.umn.edu)

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USA (Massachusetts): Outbreak of Salmonellosis from Owl Pellets
A 5th-grade science experiment made 50 students sick in Jun 2006, the Massachusetts Department of Public Health said yesterday, 6 Jul 2006. The students were asked to dissect owl pellets at Jefferson Elementary School. According to a DPH spokeswoman, 28 were infected with salmonella bacteria, while another 22 reported experiencing nausea, diarrhea, or stomach pains following the experiment. Because of the outbreak, the state plans to update its guidelines for handling the pellets for the upcoming 2006-7 school year. The new DPH guidelines will instruct teachers and students to wear protective gloves and to wash their hands and work areas following the experiments. A similar 2005 salmonella outbreak in Minnesota was linked to owl pellets when 40 students fell ill after dissecting them on a cafeteria table.
(Promed 7/14/06)

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Canada (Manitoba): 15 Year Old Cow Tests Positive for BSE
Final test results have confirmed bovine spongiform encephalopathy (BSE) in a mature cross-bred beef cow from Manitoba. The Canadian Food Inspection Agency (CFIA) is conducting a comprehensive investigation. Officials have confirmed the animal was purchased by the owner as part of an assembled group of cattle in 1992. This means that the animal was at least 15 years of age and would have been born well before the 1997 introduction of Canada's feed ban. As a priority, investigators are attempting to locate the birth farm, which will provide the basis needed to identify the animal's herd-mates and feed to which it may have been exposed at a young age. Given the animal's age, investigative efforts may be constrained by few surviving animals and limited sources of information, such as detailed records. A calf born to the affected animal in 2004 is also being traced. The detection of this case demonstrates the ongoing effectiveness of Canada's surveillance program, which targets cattle most at risk of BSE. Based on the over 115 000 animals tested since Canada's 1st case in 2003, the CFIA is confident that the level of BSE in the national cattle herd is very low.
(Promed 7/06/06)

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Canada (Alberta): 4 Year Old Cow Tests Positive for BSE
The Canadian Food Inspection Agency has confirmed bovine spongiform encephalopathy (BSE) in a 50-month-old dairy cow from Alberta. The animal was first reported on Monday, 10 Jul 2006, based on preliminary test results. The entire carcass has been incinerated and did not enter the human or animal feed systems. The CFIA has located the birth farm, and investigators are tracing other cattle born on the premises within 12 months before or after the birth of the affected animal. Given its age, the affected animal was exposed to BSE after the 1997 implementation of Canada's feed ban. This scenario, as well as the animal's age, is consistent with the experiences of most countries reporting cases of BSE. Nonetheless, a full accounting and determination of how this animal was exposed to BSE will be the primary focus of the CFIA's investigation. This is the 7th case of BSE found in Canada and the 2nd case identified in the past week.
(Promed 7/14/06)

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Peru: Six People Infected with Anthrax
At least 6 people got infected with anthrax after being in close contact with infected cattle in Monsefu district (northwest Peru) as reported by SENASA, the Agricultural Ministry. The chief of SENASA (Esmilda Arevalo) in Lambeyeque said that 6 people were observed with anthrax signs after a screening in 2 towns in the area. The outbreak was detected 30 Jun 2006, after SENASA workers were warned about cattle dead due to anthrax by residents of Pompape and Villa Hermosa de Monsefu. Arevalo said that the outbreak is very contagious and could be passed to farmers if they don't follow SENASA recommendations to bury dead animals at 7 meters deep in the ground. She also stated that SENASA experts have gone to those towns in order to detect other cases in cattle and that vaccination has started in the cattle.
(Promed 7/10/06)

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Africa
Egypt: Human death from H5N1
In Egypt, a 7th person has died as a result of H5N1 infection. An 18-year-old woman died at the general hospital of Qena, in southern Egypt, several days after her hospitalization. The report didn't say when the woman died.
(Promed 7/07/06)

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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.html.
- OIE: http://www.oie.int/eng/en_index.htm.
- US CDC: http://www.cdc.gov/flu/avian/index.htm.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/.
- 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/diseaseinformation/avianinfluenza/index.jsp. Very frequent news updates.
(WHO; FAO, OIE; CDC; CIDRAP; PAHO; AVMA; USGS)

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Cholera, diarrhea & dysentery
China (Hong Kong)
A Tai Po Hui Market fish stall has been closed after V. cholerae was found in a sample taken from its fish tank. The sample was collected 26 Jun 2006 as part of the Food & Environmental Hygiene Department's routine surveillance program. The stall will remain closed until the department is satisfied with its overall hygiene condition and that there is no immediate health hazard.
(Promed 7/11/06)

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Dengue
Philippines
As of press time, the dreaded dengue fever already claimed 3 lives in Iloilo City. However, the City Health Office (CHO) said it is far from alarming. There were already 10 reported cases of dengue fever in the city from January to June 2006.The number is lower compared to the same period of 2005, when there had been 40 cases. There remained many similar cases, but they were not yet confirmed. While there were no deaths caused by dengue fever during Jan-Jun 2005, there were already 3 dengue-related during the first half of 2006. These include a girl, age 5, of Barangay Gustilo, La Paz, a boy, age 15 of Barangay Lanit, Jaro and the recently reported death of a girl from Calaparan, Molo. The district which has the most number of confirmed dengue cases was Jaro (5), La Paz (2), and one each for Molo, Arevalo and City Proper areas. Instead of being alarmed, City Mayor Jerry P. Trenas urged city residents to do massive cleanup activities in their areas to avoid the breeding of mosquitoes carrying dengue fever. He also asked village officials to initiate cleanup programs. Meanwhile, the province of Iloilo already has reported 27 dengue cases. The Provincial Health Office (PHO) revealed that the towns of San Dionisio and Sara have the largest number of confirmed dengue cases with 5. Estancia and San Joaquin with 3 confirmed cases each; Duenas, Pototan and Zarraga with 2 each and Concepcion, Miag-ao, Oton, San Enrique and San Miguel with one case each.
(Promed 7/13/06)

Viet Nam
Ho Chi Minh City has so far in 2006 reported some 3000 cases of mosquito-borne dengue fever with 2 people reportedly perishing, leaving the southern hub ranked as the city hit hardest by the pandemic. In the first 6 months of the year, Vietnam recorded around 20 000 cases of dengue fever, up 54 percent from the corresponding period last year, according to figures released by the Bureau of Preventive Health. The disease is most common during the peak rainy season (May-November) in the Mekong Delta provinces such as Kien Giang, An Giang, Ca Mau, Tien Giang and Ho Chi Minh City. The Ministry of Health recently instructed affected provinces and cities to deploy necessary movements such as cleaning up the environment and training medical personnel to curb the pandemic.
(Promed 7/13/06)

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West Nile Virus
USA
As of Tue 27 June 2006 avian, animal, or mosquito WNV infections have been reported to CDC ArboNET from the following states: Arkansas, California, Florida, Idaho, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New York, North Dakota, Ohio, Oklahoma, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, and Wyoming. Human cases have been reported in Colorado, Mississippi, and Texas. All of the 4 cases were reported as West Nile meningitis or encephalitis (neuroinvasive disease), none was reported as West Nile fever (milder disease), and none was clinically unspecified at this time. Please refer to state health department web sites for further details regarding state case totals. For more details, 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 7/01/06)

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2. Articles
The Underrecognized Burden of Influenza in Young Children
Abstract: "BACKGROUND The disease burden of influenza infection among children is not well established. We conducted a population-based surveillance of medical visits associated with laboratory-confirmed influenza. METHODS Eligible children were younger than five years of age, resided in three U.S. counties, and had a medical visit for an acute respiratory tract infection or fever. Nasal and throat swabs were tested for the influenza virus by viral culture and polymerase-chain-reaction assay. Epidemiologic data were collected from parental surveys and chart reviews. Children who were hospitalized were enrolled prospectively from 2000 through 2004. Population-based rates of hospitalizations associated with influenza were calculated. Children who were seen in selected pediatric clinics and emergency departments during two influenza seasons (2002–2003 and 2003–2004) were systematically enrolled. The rates of visits to clinics and emergency departments associated with influenza were estimated. RESULTS The average annual rate of hospitalization associated with influenza was 0.9 per 1000 children. The estimated burden of outpatient visits associated with influenza was 50 clinic visits and 6 emergency department visits per 1000 children during the 2002–2003 season and 95 clinic visits and 27 emergency department visits per 1000 children during the 2003–2004 season. Few children who had laboratory-confirmed influenza were given a diagnosis of influenza by the treating physician in the inpatient (28 percent) or outpatient (17 percent) settings. CONCLUSIONS Among young children, outpatient visits associated with influenza were 10 to 250 times as common as hospitalizations. Few influenza infections were recognized clinically.

Reference: Poehling KA, Edwards KM, Weinberg GA., et al. New England J of Medicine. 2006. July 6; 355(1):31-40.

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Influenza Control
Influenza is an uncontrolled epidemic disease that occurs every winter. Epidemics, which vary in severity, are measured by excess mortality, but influenza is always the leading cause of acute respiratory tract infections that lead to health care visits or hospitalization. Therefore, when an epidemic is classified as "mild," this comparison is only with other flu epidemics; even mild flu epidemics result in the highest rates of health care encounters for the season. The effect on health care facilities is magnified by the usual sharp seasonality of influenza outbreaks.

Reference: Glezen WP. New England J of Medicine. 2006. July 6; 355(1):79-81.

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Prevention and Control of TB in Correctional and Detention Facilities: Recommendations from CDC
Summary: "Tuberculosis (TB) control can be particularly problematic in correctional and detention facilities, in which persons from diverse backgrounds and communities are housed in close proximity for varying periods. This report provides a framework and general guidelines for effective prevention and control of TB in jails, prisons, and other correctional and detention facilities. Recommendations were developed on the basis of the most recent set of published guidelines and a review of the scientific literature. Effective TB-prevention and -control measures in correctional facilities include early identification of persons with TB disease through entry and periodic follow-up screening; successful treatment of TB disease and latent TB infection; appropriate use of airborne precautions (e.g., airborne infection isolation, environmental controls, and respiratory protection); comprehensive discharge planning;, and thorough and efficient contact investigation. These measures should be instituted in close collaboration with local or state health department TB-control programs and other important partners. Continuing education of inmates, detainees, and correctional facility staff is necessary to maximize cooperation and participation. To ensure TB-prevention and -control measures are effective, periodic program evaluation should be conducted."
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5509a1.htm
(MMWR Recommendations and Reports July 7, 2006 / 55(RR09);1-44)

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WHO WER, Volume 81, Number 27—June 30, 2006
WHO Weekly Epidemiological Record, volume 81, number 26 (page 266–267) is now available at:
http://www.who.int/csr/disease/avian_influenza/guidelines/wer8126/en/index.html
This issue discusses the validation of neonatal tetanus elimination in Viet Nam by lot quality-assurance cluster sampling.

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Family tragedy spotlights flu mutations
Summary: "A strain of avian flu that spread through a family in Indonesia, killing seven of the eight people infected, was accumulating mutations as it spread from person to person, according to confidential sequence data seen by Nature. The functional significance of the mutations isn't clear — most of them seem unimportant. But influenza researchers say the finding reiterates the need for sequence data to be made more widely available, if the virus is to be better understood."

Reference: Butler D. Nature. 2006. July 14; 442(7099): 114-115

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Emerging Infectious Determinants of Chronic Diseases
Summary: "Evidence now confirms that noncommunicable chronic diseases can stem from infectious agents. Furthermore, at least 13 of 39 recently described infectious agents induce chronic syndromes. Identifying the relationships can affect health across populations, creating opportunities to reduce the impact of chronic disease by preventing or treating infection. As the concept is progressively accepted, advances in laboratory technology and epidemiology facilitate the detection of noncultivable, novel, and even recognized microbial origins. A spectrum of diverse pathogens and chronic syndromes emerges, with a range of pathways from exposure to chronic illness or disability. Complex systems of changing human behavioral traits superimposed on human, microbial, and environmental factors often determine risk for exposure and chronic outcome. Yet the strength of causal evidence varies widely, and detecting a microbe does not prove causality. Nevertheless, infectious agents likely determine more cancers, immune-mediated syndromes, neurodevelopmental disorders, and other chronic conditions than currently appreciated."
http://www.cdc.gov/ncidod/EID/vol12no07/06-0037.htm
(Emerging Infectious Diseases July 2006 / 20(7): 1051-7)

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Triple Reassortant H3N2 Influenza A Viruses, Canada, 2005
Summary: " Since January 2005, H3N2 influenza viruses have been isolated from pigs and turkeys throughout Canada and from a swine farmer and pigs on the same farm in Ontario. These are human/classical swine/avian reassortants similar to viruses that emerged in US pigs in 1998 but with a distinct human-lineage neuraminidase gene. "
http://www.cdc.gov/ncidod/EID/vol12no07/06-0268.htm
(Emerging Infectious Diseases July 2006 / 20(7): 1132-5)

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Orientia tsutsugamushi in Eschars from Scrub Typhus Patients
Summary: "To verify the value of eschars for the diagnosis of scrub typhus and to characterize genotypes of Orientia tsutsugamushi in patients, we examined eschars and blood specimens of 7 patients from Shandong Province, People's Republic of China, for O. tsutsugamushi by polymerase chain reaction targeting the Sta56 gene. All 7 eschars and acute-phase blood samples were positive, while no specific DNA amplicons were obtained from the 7 convalescent-phase blood samples collected after antimicrobial drug therapy. The findings indicate that patients' eschars can be used for detection and genetic characterization of O. tsutsugamushi during the convalescent phase."
http://www.cdc.gov/ncidod/EID/vol12no07/05-0827.htm
(Emerging Infectious Diseases July 2006 / 20(7): 1109-12)

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Leptospirosis in Squirrels Imported from United States to Japan
Summary: Leptospirosis was diagnosed in 2 patients exposed to southern flying squirrels imported from the United States to Japan. Patients worked with exotic animals in their company. Leptospira isolates from 1 patient and 5 of 10 squirrels at the company were genetically and serologically identical and were identified as Leptospira kirschneri.
http://www.cdc.gov/ncidod/EID/vol12no07/06-0370.htm
(Emerging Infectious Diseases July 2006 / 20(7): 1153-5)

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Blood test for silent phase of prion disease reported
Abstract: "Prions are thought to be the proteinaceous infectious agents responsible for transmissible spongiform encephalopathies (TSEs). PrPSc, the main component of the infectious agent, is also the only validated surrogate marker for the disease, and its sensitive detection is critical for minimizing the spread of the disease. We detected PrPSc biochemically in the blood of hamsters infected with scrapie during most of the presymptomatic phase of the disease. At early stages of the incubation period, PrPSc detected in blood was likely to be from the peripheral replication of prions, whereas at the symptomatic phase, PrPSc in blood was more likely to have leaked from the brain. The ability to detect prions biochemically in the blood of infected but not clinically sick animals offers a great promise for the noninvasive early diagnosis of TSEs."

Reference: Saa P, Castilla J, Soto C. Science 2006 Jul 7;313(5783):92-4

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3. Notifications
Group of Eight Summit to Focus on Global Health
15–17 July 2006, St. Petersburg - Russia
Through its focus on global health at this year's summit in St Petersburg, Russia, the Group of Eight is helping to ensure that existing and emerging disease threats are tackled at the very highest level. The G8 leaders have long recognized that AIDS, tuberculosis, malaria, polio and other vaccine-preventable diseases slow economic development, perpetuate poverty, and threaten security in large parts of the world. The recent threat of an influenza pandemic has focused international attention on the need for all countries to be better prepared, in order to reduce the potential death, illness, social and economic consequences of a pandemic.
(WHO http://www.who.int/en )

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XVI International AIDS Conference
Date: 13–18 August 2006
Place: Toronto
The theme of the XVI International AIDS Conference, "Time to Deliver" emphasizes that – while research to expand and improve our understanding of HIV is ongoing – the scientific knowledge and tools to prevent new infections and prolong life already exist. In over 400 sessions, meetings and workshops, delegates will explore the latest developments in HIV science, policy and practice, and look at the progress made to scale-up treatment, care and prevention.
(WHO http://www.who.int/en )

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CDC’s Advisory Committee Recommends Human Papillomavirus Virus Vaccination
CDC’s Advisory Committee Recommends Human Papillomavirus Virus Vaccination Vaccine considered highly effective in preventing infections that are the cause of most cervical cancers. The Advisory Committee on Immunization Practices (ACIP) voted Thursday to recommend that a newly licensed vaccine designed to protect against human papillomavirus virus (HPV) be routinely given to girls when they are 11-12 years old. The ACIP recommendation also allows for vaccination of girls beginning at nine years old as well as vaccination of girls and women 13-26 years old. HPV is the leading cause of cervical cancer in women.
(CDC http://www.cdc.gov )

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 apecein@u.washington.edu