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Vol. IX, No. 15 ~ EINet News Briefs ~ Jul 28, 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)
- Global: Agencies launch warning system for animal diseases
- Global: WHO advisory committee urges quick action on emerging infectious diseases response
- Russia: Increasing Number of Cases of Crimean-Congo hemorrhagic fever in the Southern Federal District
- Bulgaria: Suspected avian influenza in domestic fowl
- Thailand: 1st case of human avian influenza in 7 months
- Japan: More than 41 000 Cases of Pharyngoconjunctival Fever Nationwide
- China (Xinjiang): Avian influenza in poultry
- Malaysia: New HFMD cases in Sarawak
- Thailand: Avian flu disease returns after 8 months, H5N1 virus outbreak confirmed in Phichit
- Laos: Suspected avian influenza
- USA (California): Trypanosomiasis, organ transplant
- USA (2 New Mexico, 1 Colorado): Human bubonic plague
- USA (Minnesota): Salmonellosis, frozen chicken
- USA (Virginia): Chlamydia pneumonia, seniors community
- USA (Colorado): Hantavirus pulmonary syndrome
- USA: USDA to cut back BSE testing program
- USA: HHS adds Relenza to state stockpile program
- USA: Roche criticized for marketing Tamiflu to businesses
- USA: GlaxoSmithKline says its H5N1 vaccine works at low dose
- USA: Reopening of the Japanese market to US beef
- USA (Oregon, Washington, New York) /Canada (British Columbia): Vibrio parahaemolyticus, oysters
- Canada (Saskatchewan, Manitoba): Saskatchewan man develops anthrax in quarantine area, several animals dead
- Canada: Avian cholera
- South Africa: Highly pathogenic avian influenza in South Africa in ostriches (H5N2)
- Sudan: Update on avian influenza in poultry

1. Updates
- Influenza
- Dengue
- West Nile virus

2. Articles
- Bordetella Pertussis infections in vaccinated and unvaccinated adolescents and adults, as assessed in a national prospective randomized Acellular Pertussis Vaccine Trial (APERT).
- Control of Avian Influenza in Poultry
- Mental Status after West Nile Virus Infection
- Prevention and Control of Influenza
- Duck hunters may face risk of avian flu infections

3. Notifications
- Second International Congress on Infectious and Tropical Diseases
- Fifth Annual Systems Integration in Biodefense: Building a Blueprint for Policy and Preparedness
- International Meeting on Emerging Diseases and Surveillance (IMED 2007)

4. To Receive EINet Newsbriefs
- JOIN THE E-LIST AND RECEIVE NEWSBREIFS REGULARLY


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 / 37 (31)
Iraq / 2 (2)
Thailand / 1 (1)
Turkey / 12 (4)
Total / 88 (58)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 232 (134).
(WHO 7/26/06 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2006_07_26/en/index.html )

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Global: Agencies launch warning system for animal diseases
Three international health agencies announced yesterday the launch of a joint early warning system to allow a quicker response to animal diseases that can spread to humans (zoonoses). The system is designed to coordinate the tracking, verification, and alert mechanisms of the United Nations Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), and the World Health Organization (WHO), according to a press release yesterday from the three groups. Known as the Global Early Warning and Response System (GLEWS), the effort is a first in the fight against animal-to-human disease transmission, the agencies said.

The groups said weaknesses in disease detection and response have contributed to the international spread of diseases of animal origin, such as bovine spongiform encephalopathy, severe acute respiratory syndrome (SARS), and avian influenza.

GLEWS is a Web-based electronic platform that allows each organization to share its tracking and verification information, analyze the information, and decide if an early warning message is warranted, according to the release. The alert messages will describe the implications of transmission of an animal disease at the national, regional, and international levels, along with the possible public health impact. If the situation requires a joint assessment or intervention, the three organizations will coordinate their responses.
(Promed 7/26/06, CIDRAP 7/25/06 http://www.cidrap.umn.edu/ )

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Global: WHO advisory committee urges quick action on emerging infectious diseases response
Infectious disease specialists meeting at World Health Organization’s Western Pacific Regional Office here yesterday recommended specific steps to ensure a faster and more comprehensive response to emerging infectious diseases, including avian influenza. Their recommendations emerged during a three-day meeting of WHO's nine-person Technical Advisory Group on emerging diseases.

"Our starting point was the Asia Pacific Strategy for Emerging Diseases," said Dr Takeshi Kasai, WHO Regional Adviser in Communicable Disease Surveillance and Response, referring to a joint approach the Organization's Western Pacific and South-East Asia Regional Offices developed to strengthen the response to emerging infectious diseases. This week we focused on a work plan that will allow us to help countries in the Region build the capacity they need to detect and quickly respond to emerging diseases, including avian and pandemic influenza," Dr Kasai said.
(WHO 7/21/06 http://www.wpro.who.int/)

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Europe/Near East
Russia: Increasing Number of Cases of Crimean-Congo hemorrhagic fever in the Southern Federal District
This year [2006], the number of people who have fallen ill with Crimean-Congo hemorrhagic fever (CCHF) has risen in the Rostov Region, according to Vladimir Ryzhkov, the head of the Department of Epidemiological Surveillance in Rostov-on-Don. Ryzhkov stated that this year, 47 cases, including 5 fatalities, have been recorded so far, whereas during the corresponding period last year [2005], only 16 cases were reported.

Vladimir Ryzhkov stated that in the Southern Federal District, cases of CCHF had already been reported in Dagestan, Kalmykia, and Stavropol, and in the Volgograd, Astrakhan and Rostov Regions. Now cases of CCHF are being reported in the 12 southeastern districts of the Rostov Region: Zavetinskiy, Salskiy, Tselinskiy, Proletarskiy, Orlovskiyl, Peschanokopskiy, Tsymlyanskiy, Zimovnikovskiy, Remontnenskiy, Dubovskiy, Martynovsliy and the city of Volgodonsk.

Vladimir Ryzhkov stated that the increasing number of CCHF cases is associated with an increase in the density of ticks in the environment. This year [2006], 2492 persons (including 469 children under 14 years of age) have sought medical attention in hospitals and out-patient departments for tick bites, 1000 more than during the orresponding period last year [2005]. Ryzhkov added that a sum of 2 750 000 roubles [USD 102 000] has been allocated from the city [Rostov-on-Don] budget for tick eradication measures.
(Promed 7/19/06)

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Bulgaria: Suspected avian influenza in domestic fowl
Bulgarian authorities reported Thursday [20 Jul 2006] the 1st case of bird flu in domestic fowl on the territory of the country -- in the village of Slanchogled (sunflower), near Kurdzhali. Veterinarians have undertaken checks of local fowl after birds were found to die in bulk. Initial tests have detected avian flu virus, the Agriculture Ministry announced at a special press conference. It has not yet been confirmed whether the deadly H5N1 strain is present.

All fowl and turkeys from 3 farms were killed, massive disinfection is under way, and stricter control on passing trucks and vehicles is in place, the officials said; 2 people who were in contact with the infected birds are under constant medical surveillance, Agriculture Minister Nihat Kabil said. He added that all farmers whose fowl were culled will be compensated.
(Promed 7/21/06)

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Asia
Thailand: 1st case of human avian influenza in 7 months
Bird flu killed a teenage boy in northern Thailand yesterday [25 Jul 2006], the 1st reported case in 7 months in the world's 4th-biggest poultry exporter. The 17-year-old tested positive for the H5N1 avian flu strain, Prime Minister Thaksin Shinawatra told reporters in Bangkok today [26 Jul 2006]. Fowl in the boy's northern province of Phetchabun province, about 350 km (218 miles) north of the capital, were infected with the lethal virus, Thaksin said. "He had been in contact with fighting cocks, which were not declared for fear they would be culled by authorities," Thaksin said. Thailand's fighting roosters are prized for gambling bouts and fetch as much as 500 000 baht (USD 13 156).

Thailand's latest case has [now] been confirmed by the World Health Organization. The youth died after being admitted to a Phichit hospital on 20 Jul 2006, said Thawat Suntrajarn, director general of the health ministry's disease control department, in a telephone interview today [26 Jul 2006]. He tested positive for both dengue hemorrhagic fever and H5N1 avian flu, Thawat said.

Field investigations have not found any indications of respiratory illness in close contacts of the young man. This is the 1st human case of H5N1 infection reported from Thailand in 2006.

Meanwhile, the Department of Medical Sciences yesterday [25 Jul 2006] announced that 5 suspected human bird flu cases from Phichit, Uttaradit, Phitsanulok, and Phetchabun, had tested negative for H5N1. Department chief Paijit Warachit said the 5 patients, including a 12-year-old girl from Phichit, were only infected with the human influenza virus.

A final verdict from an international reference laboratory is awaited on this case and that of 2 other outstanding cases associated with consumption of a (wild?) dove.

Livestock officers in the province were stepping up disinfection of sites where irregular poultry deaths were reported. Hundreds of such deaths have recently been reported in the province.
(Promed 7/23/06, 7/24/06, 7/26/06, 7/27/06, ; CIDRAP 7/26/06 http://www.cidrap.umn.edu/)

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Japan: More than 41 000 Cases of Pharyngoconjunctival Fever Nationwide
"Swimming pool fever," a fever that primarily hits toddlers sharing swimming pools, is sweeping across Japan, according to the National Institute of Infectious Diseases. The institute said it has received reports of around 41 500 patients between January and late June [2006] from around 3000 designated pediatric clinics. Patients have been reported in all 47 prefectures, it said. The institute warned in May 2006 that this summer could see the biggest outbreak of the fever in a decade. The latest figures represent a rise of more than 1.7 times the level in 2004, when a 10-year high was marked. Based on estimates, the actual number of patients, including those not covered by the designated clinics, could be around 10 times greater, the institute said. Since the start of the year [2006], the average number of patients with pharyngoconjunctival fever, commonly called "pool fever" in Japan, per clinic has exceeded the corresponding number in 2004 in almost every week, the Institute said. In the latest reporting week of 26 Jun to 2 Jul 2006, an average of 1.28 persons were reported with the fever per clinic, outpacing the 0.87 in the corresponding period of 2004. More than 70 percent of the patients were 5 years old or under, and 90 percent were age 9 or under. An Institute official advised people to take such precautions as washing hands, gargling and not sharing towels. Major symptoms of the fever include temperatures of around 39 C, headaches, fatigue and sore eyes and throat. It typically clears up in 3-5 days, but in some cases may cause severe complications such as respiratory problems.
(Promed 7/16/06)

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China (Xinjiang): Avian influenza in poultry
China has announced it had killed nearly 400 000 chickens in the far northwest of the country to control a fresh outbreak of bird flu. The outbreak was discovered on 14 Jul 2006 in Aksu city, Xinjiang region, when 3045 chickens were found dead, the agriculture ministry said in a brief statement on its website on Friday [21 Jul 2006]. Since then 356 976 chickens have been killed as part of emergency measures to contain the outbreak, according to the statement. "The epidemic is effectively under control," it said.

There was no mention of any concerns for people living in the area.The outbreak is the 37th reported among poultry in China since October 2005. Of the 19 people confirmed to have contracted the H5N1 virus in China, 12 have died.
(Promed 7/21/06)

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Malaysia: New HFMD cases in Sarawak
The Sarawak Health Department yesterday [16 Jul 2006] detected 44 new cases of hand, foot and mouth disease (HFMD), including 10 children hospitalized throughout the state. Deputy Chief Minister Tan Sri Dr George Chan said 3 of the children were admitted to the Miri Hospital, 2 in Bintulu and one in the Sarawak General Hospital here. "However, none of them are critically ill," Dr. Chan, who is also the State Disaster and Relief Management Committee Chairman, said in his daily HFMD updates. He said 16 new cases were reported in Miri, Sibu (11), Bintulu (8), Kuching (4), Saramarah (2) and the rest from other divisions. With the latest figures, HFMD infections have affected 12 035 children and claimed 11 lives, including 3 confirmed to be enterovirus 71 (EV71) positive, since the outbreak in Sibu.

On 12 Jul 2006, 2 Miri kindergartens, Prasekolah SK Senadin and Tadika T&W, were the first to be ordered shut. Sedidik Muara Tebas was ordered closed on 19 Jul while the Methodist kindergarten in Marudi and SK Gayu in Padawan here were closed 20 Jul 2006. Another kindergarten was closed on 24 July 2006 to stem the spread of hand, foot and mouth disease (HFMD). On Sun 23 Jul 2006, a seriously ill 7-month-old baby boy was transferred from Bintulu hospital to the better-equipped Sibu hospital for treatment. 40 cases were reported on 24 July 2006, bringing the total in the last 2 days to 104.

A total of 18 of the victims -- 9 on Sunday and another 9 yesterday -- were admitted to hospital. The number of admissions had also risen sharply since the so-called "2nd Wave" of the outbreak began in May 2006.
(Promed 7/17/06 and 7/25/06)

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Thailand: Avian flu disease returns after 8 months, H5N1 virus outbreak confirmed in Phichit
The 8-month bird flu-free hiatus in Thailand ended yesterday as the Agriculture and Cooperatives Ministry confirmed a fresh outbreak of the H5N1 virus in the northern province of Phichit. The confirmation came shortly after poultry farmers and an outgoing senator accused the ministry of covering up the re-emergence of the deadly disease after massive deaths of poultry in many provinces from early this month. The ministry had repeatedly denied bird flu had recurred but eventually verified the outbreak yesterday.

The Livestock Development Department's lab detected the avian flu virus in a fighting cock carcass from Bang Mun Nak district. This was where almost 300 fowls had been culled after the mysterious deaths of around 30 fighting cocks and free-range chickens 2 weeks ago, caretaker Agriculture Minister Sudarat Keyuraphan told a press conference.

The department had now employed extreme measures to contain the outbreak, including imposing a total ban on fowl movements in the province and sealing borders to prevent smuggling of poultry from neighbouring countries. The department had reported the re-emergence of the disease to the World Organisation for Animal Health and major importers of Thai cooked chicken. The area within a 10-km radius of the infected farm had been put under a 21-day surveillance.
(Promed 7/23/06 and 7/24/06, CIDRAP 7/24/06 http://www.cidrap.umn.edu/ )

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Laos: Suspected avian influenza
Bird flu has been found in about 2500 chickens who died on a farm near the Laotian capital of Vientiane last week, but the type of flu has not been determined yet, a Laotian official said Thursday [27 Jul 2006].

Lao Foreign Ministry spokesman Yong Chanthalansy confirmed a report on the website of the Vientiane Times newspaper that the Lao government's National Infectious Disease Prevention and Control Committee on 18 Jul 2006 had confirmed that the chickens died of bird flu.

The results of laboratory tests to determine whether it was the virulent H5N1 virus were expected in a week or 2, he told The Associated Press by phone.
(Promed 7/27/06)

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Americas
USA (California): Trypanosomiasis, organ transplant
This report describes 2 cases of acute Chagas disease in heart transplant recipients reported by 2 Los Angeles County hospitals in February 2006. In the United States, one previous report documented _T. cruzi_ transmission through solid organ transplantation, in which 3 organ recipients were infected.
(Promed 7/27/06)

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USA (2 New Mexico, 1 Colorado): Human bubonic plague
A girl from Bernalillo County has contracted bubonic plague, the 4th case of plague in New Mexico in 2006. She is being treated at the University of New Mexico Hospital. The Albuquerque Environmental Health Department says it will conduct an investigation at the girl's home to assess any possible risk for other people to contract the illness.[Of the 4 cases reported from New Mexico so far in 2006, 2 were in Bernalillo County and 1 in Santa Fe County; ProMED does not have information on the 4th.

A Torrance County, New Mexico woman was in critical condition Fri 21 Jul 2006 with the state's 5th human plague case of 2006. The bubonic plague case was confirmed by the state Health Department, which said it was the 1st case from the central New Mexico county in 2006.

A La Plata County, Colorado man has tested positive for plague, the 1st confirmed case of human plague since the summer of 2005, when 2 cases were reported in the county, the San Juan Basin Health Department said Tue, 18 Jul 2006. The man has been treated at a hospital and has been released and is recovering, said Lynn Westberg, director of San Juan Basin Health.

During the past 30 years, there have been 49 reported cases of plague in humans in Colorado. Human c s in the USA occurs mostly in rural areas, with an average of 10 to 15 cases each year nationwide. In Southwest Colorado, 7 animals -- including squirrels, household cats, and prairie dogs -- have tested positive for plague this summer, according to a news release from the health department. "This year particularly, there seems to be a lot of plague, and it is widespread throughout the county and region," Westberg said.
(Promed 7/17/06, 7/20/06, and 7/24/06)

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USA (Minnesota): Salmonellosis, frozen chicken
State food safety officials issued a warning Thu 20 Jul 2006 about some frozen stuffed chicken entrees that contain uncooked chicken.

Investigators from the state health and agriculture departments said 29 people in Minnesota have become ill after eating frozen chicken entrees that weren't cooked long enough to kill salmonella bacteria. They recommended against microwaving single-serving chicken products -- even when it's listed as an option on labels. They said the products should be baked in the oven to an internal temperature of 165 degrees.

The entrees include chicken cordon [bleu], chicken kiev, and chicken with broccoli and cheese. They are usually pre-browned, but contain raw chicken. Most of the cases were traced to products manufactured by Aspen Foods in Chicago and Serenade Foods of Milford, Indiana, and sold under a variety of brand names, including store brand names, state officials said. The USA Department of Agriculture issued a limited recall in Mar 2006 after the salmonella outbreak was identified. However, epidemiologists have found that new cases of illness continue to occur.

Investigators determined that 26 illness cases from August 2005 through June 2006 were caused by the same strain of _Salmonella enterica_ serotype Enteritidis, according to the release. The same strain was found in product that people still had in their freezers, said Dr. Kirk Smith, supervisor of the Foodborne Disease Unit in the Minnesota Department of Health (MDH).

The other 3 illness cases were _S. enterica_ serotype Typhimurium infections, with a DNA fingerprint that matched that of product in patients' homes, Smith said. These cases prompted the USDA to issue a consumer advisory on 3 Jul 2006 (see link below). The products were produced by Aspen Foods and sold under a store brand name. In this advisory, the USDA said at least 34 recent salmonellosis cases across the nation have been linked to undercooked chicken entrees, in addition to the Minnesota cases.
(Promed 7/22/06 and 7/24/06, CIDRAP 7/21/06 http://www.cidrap.umn.edu)

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USA (Virginia): Chlamydia pneumonia, seniors community
The nursing home and assisted-living facility at Brandermill Woods Retirement Community have been quarantined because of a suspected respiratory chlamydia outbreak affecting 72 seniors and staff members. The health care center, with 57 residents, went into an infection control mode 11 Jul 2006 when 2 people began developing headaches, nausea, sore throats, malaise, cough, hoarseness and fever. The Chesterfield County Health Department was called to monitor the matter, she said.

The bacteria spread last weekend to the assisted-living unit, which also launched infection-control measures to protect its 52 residents and staff members. Traffic between the 2 units has been halted. Doctors are treating the outbreak with an antibacterial drug. Patients in the nursing unit have improved significantly. The infection is not generally considered life-threatening unless it is not treated, Mira Pallotta, executive director of the Chesterfield County retirement development, said.
(Promed 7/21/06)

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USA (Colorado): Hantavirus pulmonary syndrome
A 58-year-old man staying at a campground for military personnel [near Colorado Springs, in central Colorado] contracted hantavirus and died this week, Air Force Academy and state health officials said Friday [21 Jul 2006].

The man died Wednesday [19 Jul 2006] of the disease that is passed to humans when they inhale particles of dried urine or feces from infected rodents, officials said. He and his wife had been staying at the Peregrine Pines FamCamp, located in a wooded area between the academy's Falcon Stadium and Interstate 25, for several months.

Dr. Chris Benjamin, deputy hospital commander at the academy, said he believes the man contracted the virus after cleaning a confined space underneath his RV or trailer. Academy officials inspected the campground and others for evidence of rodent droppings and have no plans to close the campground.
(Promed 7/25/06)

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USA: USDA to cut back BSE testing program
The US government's expanded testing program for bovine spongiform encephalopathy (BSE) will be cut back soon, having shown that the nation has "no significant BSE problem," Agriculture Secretary Mike Johanns said today. About 759,000 cattle, or more than 1,000 cattle per day, have been tested since the US Department of Agriculture (USDA) expanded BSE surveillance in June 2004, Johanns said at a news conference. Two cases were found during that time, in addition to the first US case discovered in 2003. Starting as early as late August, testing will be reduced to about 40,000 cattle a year, or about 110 a week, Johanns announced. The reduced testing program—similar to what was done before the expansion—will cost about $8 million a year, versus about $52 million a year currently, he said.

To the suggestion that the current level of testing should continue indefinitely, Johanns said, "There simply is no scientific justification for doing so. . . . The reality is this: there is no significant BSE problem in the United States. And after all this surveillance I am able to say there never was. We've proved that with our enhanced surveillance." Johanns said that testing 40,000 cattle a year is 10 times as many as recommended in the science-based guidelines of the World Organization for Animal Health (OIE). The USDA will continue to test cattle from high-risk populations and from a variety of places around the country, he said.
(CIDRAP 7/17/06 http://www.cidrap.umn.edu/)

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USA: HHS adds Relenza to state stockpile program
The US Department of Health and Human Services (HHS) yesterday announced a contract with GlaxoSmithKline (GSK) that will allow states to add the influenza drug zanamivir (Relenza) to their federally subsidized antiviral stockpiles.

The contract, worth $16,833,000, paves the way for 50 states and 9 other jurisdictions to purchase up to 15.5 million Relenza treatment courses from GSK at a federally negotiated price, with a 25% federal subsidy. HHS has already offered the same subsidy for states to purchase up to 31 million courses of the antiviral oseltamivir (Tamiflu) as part of preparations for a potential influenza pandemic. HHS's goal is to enlist the states' efforts in building antiviral medication stockpiles so that treatment courses will be available for 25% of the US population. The federal government will purchase 44 million treatment courses for the national stockpile and hopes the states will assist by adding 31 million treatment courses to their individual stockpiles.

Many experts consider stockpiling NIs an important strategy for limiting the impact of an influenza pandemic. The H5N1 avian influenza virus has been shown to be susceptible in vitro to both drugs, but most governments that are stockpiling antivirals to prepare for a pandemic have ordered Tamiflu.
(CIDRAP 7/21/06 http://www.cidrap.umn.edu/)

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USA: Roche criticized for marketing Tamiflu to businesses
Pharmaceutical maker Roche has drawn sharp criticism for promoting the sale of its antiviral drug oseltamivir (Tamiflu) to businesses while governments stockpiling the drug for defense against a possible flu pandemic wait to receive their own supplies, according to a report in the San Francisco Chronicle. In releasing a pandemic planning guide for US businesses last week, the Swiss-based company said that "close to 60" companies had ordered Tamiflu in quantities ranging up to hundreds of thousands of treatment courses. The firm said its planning "Toolkit" provides guidance on how to buy and distribute the drug. Though government policies discourage personal stockpiling, the guide suggests that businesses can give Tamiflu to employees for storage at home. In a story published Jul 23, the Chronicle quoted several medical and policy experts who criticized Roche's action, asserting that government orders for Tamiflu should come first.

James Love, director of the Consumer Project on Technology, said he believes that Roche is giving corporations priority over governments because the corporations pay much more for the drug. Businesses pay $61 per treatment course, a pack of 10 pills, while wealthy countries pay $19 and poor countries pay slightly less, according to the Chronicle. The federal government has a stated goal of stockpiling enough antiviral drugs to treat 81 million people, or about 25% of the population, by 2008. But that includes a projected 31 million courses in state stockpiles, with the states paying 75% of the cost. Roche officials maintained that the criticism of the marketing program is unjustified, because the company has succeeded in boosting production sufficiently to assure that there will be enough Tamiflu for all customers, the story said.

The firm has made deals with 15 subcontractors to handle various parts of the production process. This will boost production capacity to 400 million treatment courses by the end of this year, the report said. Roche spokesman Terry Hurley in Nutley, N.J., told the newspaper the company currently has orders for "about half of that." Roche officials also defended their marketing effort as merely a way to help businesses protect their workers and to ensure that businesses can survive and help countries weather the pandemic, according to the Chronicle.

Holly Babin, a spokeswoman for the US Department of Health and Human Services, told the newspaper that federal policy does not specifically address whether corporations should buy their own Tamiflu supplies. But she said HHS still recommends against personal stockpiling of the drug.
(CIDRAP 7/25/06 http://www.cidrap.umn.edu/)

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USA: GlaxoSmithKline says its H5N1 vaccine works at low dose
An H5N1 avian influenza vaccine made by GlaxoSmithKline (GSK) triggered a good immune response in human volunteers at a much lower dose than other H5N1 vaccines reported so far, which means that hundreds of millions of doses could be produced by next year, the company announced today. In a clinical trial, 80% of volunteers who received two vaccine doses containing 3.8 mcg of antigen with an adjuvant (a chemical that stimulates the immune system) had a strong immune response, the British-based company said in a news release. A typical dose of seasonal flu vaccine is 15 mcg. By comparison, an H5N1 vaccine developed by Sanofi Pasteur induced a good immune response in 67% of volunteers who received two 30-mcg doses with an adjuvant, according to findings reported in May. The US government is stockpiling the Sanofi vaccine.

Garnier called the GSK vaccine a breakthrough because, with the effectiveness of the low dose, a given amount of antigen will go much further than it would otherwise. "There is still a lot more work to be done with this programme, but this validation of our approach provides us with the confidence to continue developing the vaccine, including assessment of its ability to offer cross-protection to variants of the H5N1 strain," Garnier stated in the release. "All being well, we expect to make regulatory filings for the vaccine in the coming months."
(CIDRAP 7/26/06 http://www.cidrap.umn.edu/)

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USA: Reopening of the Japanese market to US beef
Statement by Agriculture Secretary Mike Johanns: I am pleased that Japan announced today it would resume imports of U.S. beef from cattle 20 months of age and younger. This has been a long process as we've confirmed that our system is in full compliance with Japan's import requirements and provided Japan with clear, scientific data confirming that American beef is extremely safe. It is gratifying to know that these efforts paid-off, as did the patience demonstrated by Congress.

"It is unfortunate that the trade resumption launched last December was cut short in January of this year. Nations need reasonable methods of addressing the inadvertent shipment of products that don't meet an importing country's specifications, without disrupting an entire trading relationship. The U.S. has such methods of addressing noncompliant shipments from Japan, as well as our other trading partners, and I am hopeful that going forward Japan will take a similar approach.

"As we look forward, we must also continue to strive to move beef trade with Japan and throughout the world toward science-based international guidelines. Science provides us with clear data upon which to build trading standards. All of us must be mindful of these guidelines and work toward complying with them. "In 2003, the United States exported $1.4 billion worth of beef and beef products to Japan. I look forward to the day when we resume that level of trade. To that end, I have asked the Japanese Government to meet with us this fall to discuss the next steps toward strengthening our beef trading relationship and graduating to standards based in science."
(USDA 7/27/06 http://www.usda.gov/wps/portal/!ut/p/_s.7_0_A/7_0_1OB?contentidonly=true&contentid=2006/07/0265.xml)

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USA (Oregon, Washington, New York) /Canada (British Columbia): Vibrio parahaemolyticus, oysters
At least 14 cases of Vibrio parahaemolyticus infection have been identified in Oregon during the past few days. Most report eating raw oysters at restaurants in Portland or Medford. One ate oysters that were privately harvested in Washington State. In the past week, more than 15 cases have also been reported among residents of Washington and British Columbia. All are linked to raw oyster consumption, according to Paul Cieslak, M.D., communicable disease manager in the Oregon Department of Human Services Public Health Division. Public health officials are currently working to identify the harvest sites for the oysters involved in this most recent outbreak, Cieslak said.

Washington State health officials have closed additional oyster-growing areas to commercial harvesting for raw consumption, after the number of shellfish lovers sickened by local oysters rose to 63. The culprit is the naturally occurring bacterium Vibrio parahaemolyticus, said Nancy Napolilli, director of the epartment of Health's Office of Food Safety and Shellfish. The recent heat wave and extremely low tides have combined to create an ideal environment for bacteria to multiply.

The state closed some oyster-growing areas last week -- including the Totten and Eld inlets near Olympia and a portion of Hood Canal. On Tue 25 Jul 2006, the state closed a much larger area of Hood Canal from Sunset Beach to Point Whitney, with the exception of Annas Bay. The restrictions will remain in place until the state gets 2 consecutive samples from affected areas at least 4 days apart with no trace of the bacteria.

There have also been reports that people in New York City became ill after eating raw clams -- an uncommon practice on the West Coast -- and officials are tracking the source to determine if the suspect shellfish also came from Washington waters.
(Promed 7/16/06, 7/21/06, 7/27/06; CIDRAP 7/27/06 http://www.cidrap.umn.edu/ )

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Canada (Saskatchewan, Manitoba): Saskatchewan man develops anthrax in quarantine area, several animals dead
A man in Melfort, Saskatchewan has developed skin anthrax in the midst of the largest outbreak of the disease among livestock in the province's history. The man is being treated with antibiotics and is expected to recover fully, according to a news release issued Friday [14 Jul 2006] by the provincial government. Cutaneous or skin anthrax is the most common and least serious form of the disease. Federal officials who are investigating the suspicious deaths of 149 livestock -- mostly cattle -- in Saskatchewan have quarantined 36 farms as of Friday [14 Jul 2006] because of the anthrax outbreak. Most of the farms under quarantine are in the Melfort area, northeast of Saskatoon, and around Wynyard, north of Regina.

Dr. Wayne Lees, Manitoba's chief veterinary officer, confirmed anthrax has been detected in 4 herds in southeastern Manitoba. The outbreak has resulted in the death of 24 cattle and one horse. "Diagnostic samples provided to the Veterinary Diagnostic Laboratory between 13 & 17 Jul 2006 from 4 locations in the regional municipalities of Stuartburn and Franklin were positive for anthrax," said Lees. "This is not a surprising issue considering anthrax outbreaks do occur from time to time and recently there have been several cases confirmed in Saskatchewan and Minnesota."

The C-F-I-A [Canadian Food Inspection Agency] confirmed another positive cattle death from anthrax [26 Jul 2006]. Swift Current Veterinarian Doctor Doug Mann says if producers should have a suspicious animal death on their farm, they should notify their veterinarian immediately. Dr. Mann says the farm where the animal was found has been quarantined as a precaution. Producers within a 6-km radius from the originating farm will be notified and encouraged to vaccinate their herds as a precaution.
(Promed 7/16/06, 7/20/06, 7/23/06 and 7/26/06; CIDRAP 7/17/06 http://www.cidrap.umn.edu/)

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Canada: Avian cholera
Scientists are trying to find answers to why hundreds of common eider ducks have died near Coral Harbour this summer. In the last 2months, researchers counted 1500 dead birds in one breeding colony on Southampton Island, in the north-central Arctic, about 715 kilometres southwest of Iqaluit. The colony is the largest known in Nunavut, with more than 4000 nesting birds. "To have over 1000 females die in a single summer over a matter of weeks is quite an outbreak," said Grant Gilchrist, a scientist with the Canadian Wildlife Service in Ottawa.

Gilchrist says the disease started spreading about 2 years ago, but they are not sure of its origin or how widespread it is. During 2005, about 300 dead birds were found in the breeding areas around Hudson Strait and northern Hudson Bay.

Gilchrist says they hope to get a better picture of what's going on by the end of the summer. He says avian cholera is not passed on to humans and should not be mistaken for avian flu, but they're also recommending people don't eat the birds if they suspect they are diseased. He says they will be doing a final count of the dead birds once those that are unaffected migrate south.
(Promed 7/25/06)

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Africa
South Africa: Highly pathogenic avian influenza in South Africa in ostriches (H5N2)
Information received on 6 Jul 2006 from Dr. Botlhe Modisane, Senior Manager of Animal Health, National Department of Agriculture, Pretoria: End of previous report period: 3 Jul 2006.End of this report period: 6 Jul 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N2. Date of start of the event: 19 Jun 2006. Details of new outbreak: A new seropositive farm has been identified in the Western Cape on a farm in Sandfontein, Riversdale on 19 Jun 2006. Only one additional seropositive farm (with 2 seropositive epidemiological groups) situated immediately adjacent to the index farm was detected in the 10-km-radius zone. This finding indicates that all these 3 epidemiological units (index farm and 2 epidemiological units on the adjacent farm) have been exposed to the same risk factors, probably related to clustering of wild birds at the nearby river confluence rather than being indicative of aerial spread. Other details/comments: Sequencing of the outbreak virus at the Onderstepoort Reference Laboratory for avian influenza indicated the presence of an H5N2 virus not identical to the H5N2 ostrich isolate of 2004 from the Eastern Cape, eradicated successfully at that time. Thus, the virus described in the OIE immediate notification report dated 3 Jul 2006 is a new strain of H5N2 that is not identical to that found in 2004. This implies that it is a completely new infection and that no chronic carrier situation exists in ostriches for this virus in South Africa.
(Promed 7/18/06, 7/19/06)

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Sudan: Update on avian influenza in poultry
New outbreaks: There were 3 outbreaks in Khartoum state, 2 of which occurred in Khartoum North; the 1st involved 1000 susceptible birds resulting in 200 cases and deaths and the 2nd involved 2000 susceptible birds with 970 cases and deaths. The 3rd outbreak included a farm with 2 units of 20 400 and 2883 susceptible birds. In the 1st unit 1500 cases and deaths occurred, in the 2nd unit 1200 cases and deaths occurred. All remaining poultry were destroyed.
Description of affected population: poultry in both closed and backyard systems. Results: - RT-PCR, virus isolation, sequence analysis 1-13 Jun 2006 were positive for H5N1; amino acid sequence at cleavage site reveals a HPAI profile.

Other details/comments: the disease has not spread and remains confined to Khartoum, Gezira and River Nile States. A velogenic strain of Newcastle disease virus has been isolated in one sample from Soba (Khartoum) which has been found negative for HPAI.
(Promed 7/21/06)

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1. Updates
Influenza
Influenza
2005-2006 US Influenza season summary
During the 2005-06 season, influenza A (H3N2) viruses predominated overall, but late in the season influenza B viruses were more frequently isolated than influenza A viruses. Influenza A (H1N1) viruses circulated at low levels throughout the season. Nationally, activity was low from October through early January, increased during February, and peaked in early March. Peak activity was less intense, but activity remained elevated for a longer period of time this season compared to the previous three seasons. The longer period of elevated activity may be due in part to regional differences in the timing of peak activity and intensity of influenza B activity later in the season.

No human infections with avian influenza A(H5N1) have been identified in the U.S. However, during the 2005-06 season, outbreaks of avian influenza A (H5N1) among poultry and isolated human cases were reported from countries in Africa, Europe, and Asia. Due to the expanding epizootic of H5N1, the Centers for Disease Control and Prevention (CDC) continues to recommend enhanced surveillance for human infection with avian influenza among travelers returning to the United States from H5N1- affected countries.
(7/21/06 CDC http://www.cdc.gov/flu/weekly/weeklyarchives2005-2006/05-06summary.htm) 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. Read about the G8 leaders recognizing the fundamental role of OIE and animal health services in the fight against infectious diseases
- 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) Dengue Indonesia Jambi's health office reported Saturday an outbreak of the most severe form of dengue fever, dengue hemorrhagic fever in the municipality. Of the 77 people infected, 4 have died, said the head of the office's communicable diseases division, M. Syafei. The deceased victims were all under the age of 20.According to the health office, of the 353 people who got dengue hemorrhagic fever in 2005, 11 died. In 2004, 275 people contracted the insect-borne viral infection and 4 died. (Promed 7/19/06) Philippines The City Health Office (CHO) has registered an increase in the number of dengue cases for the first half of 2006. A report of the CHO said that from just over 100 from January to July 2005, dengue cases in 2006 rose to 247 with one death. It also revealed that up from 32 affected barangays [neighborhoods] in 2005, 77 were affected this year. The report was based on weekly admissions in city hospitals, which showed that the number of admissions in 2006 is higher than in 2005. Among the barangays [neighborhoods] affected by dengue were those in Camp 8, Camp 7, Upper Quezon Hill,Fairview, Dagsian, & Engineer's Hill. The CSO, through its Epidemiological Services Unit (ESU), is closely monitoring barangays Camp 7, Camp 8, Dagsian, and Santa. Escholastica following reports that dengue fever has spread in those areas. With this trend, the CSO recommended a citywide clean-up as soon as the rains subside, larval survey in high risk areas, a massive information campaign, and thermal fogging in the barangays of City Camp, Engineer's Hill & Fairview. (Promed 7/19/06) West Nile virus update 2006 USA As of 11 Jul 2006 (cumulative for 2006) avian, animal or mosquito WNV infections have been reported to CDC ArboNET from the following states: Arizona, Arkansas, California, Florida, Idaho, Illinois, Indiana, Iowa, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. Of the 15 cases, 9 (60%) were reported as West Nile meningitis or encephalitis (neuroinvasive disease), 6 (40%) were reported as West Nile fever (milder disease), and 0 (0%) were clinically unspecified at this time.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 7/23/06)

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Dengue
Indonesia
Jambi's health office reported Saturday an outbreak of the most severe form of dengue fever, dengue hemorrhagic fever in the municipality. Of the 77 people infected, 4 have died, said the head of the office's communicable diseases division, M. Syafei. The deceased victims were all under the age of 20.According to the health office, of the 353 people who got dengue hemorrhagic fever in 2005, 11 died. In 2004, 275 people contracted the insect-borne viral infection and 4 died.
(Promed 7/19/06)

Philippines
The City Health Office (CHO) has registered an increase in the number of dengue cases for the first half of 2006. A report of the CHO said that from just over 100 from January to July 2005, dengue cases in 2006 rose to 247 with one death. It also revealed that up from 32 affected barangays [neighborhoods] in 2005, 77 were affected this year. The report was based on weekly admissions in city hospitals, which showed that the number of admissions in 2006 is higher than in 2005. Among the barangays [neighborhoods] affected by dengue were those in Camp 8, Camp 7, Upper Quezon Hill,Fairview, Dagsian, & Engineer's Hill.

The CSO, through its Epidemiological Services Unit (ESU), is closely monitoring barangays Camp 7, Camp 8, Dagsian, and Santa. Escholastica following reports that dengue fever has spread in those areas. With this trend, the CSO recommended a citywide clean-up as soon as the rains subside, larval survey in high risk areas, a massive information campaign, and thermal fogging in the barangays of City Camp, Engineer's Hill & Fairview.
(Promed 7/19/06)

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West Nile virus
USA West Nile virus update 2006
As of 11 Jul 2006 (cumulative for 2006) avian, animal or mosquito WNV infections have been reported to CDC ArboNET from the following states: Arizona, Arkansas, California, Florida, Idaho, Illinois, Indiana, Iowa, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. Of the 15 cases, 9 (60%) were reported as West Nile meningitis or encephalitis (neuroinvasive disease), 6 (40%) were reported as West Nile fever (milder disease), and 0 (0%) were clinically unspecified at this time.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 7/23/06)

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2. Articles
Bordetella Pertussis infections in vaccinated and unvaccinated adolescents and adults, as assessed in a national prospective randomized Acellular Pertussis Vaccine Trial (APERT).
BACKGROUND: Acellular pertussis (aP) booster immunizations have been recommended for adolescents and older persons to enhance long-term protection and to possibly reduce community transmission of infections. METHODS: This was a multicenter, randomized, double-blind vaccine trial in which one-half of the subjects received aP vaccine and one-half received hepatitis A vaccine (control subjects). All subjects were observed for almost 2 years for cough illnesses, and all underwent microbiologic and serologic studies for detection of pertussis infection. Immunoglobulin G (IgG) and immunoglobulin A (IgA) antibodies to pertussis toxin, filamentous hemagglutinin, pertactin, and fimbriae 2/3 were measured by enzyme-linked immunosorbent assay in serum samples obtained 1 and 12 months after immunization. Infection rates were determined with a variety of serologic criteria for control and vaccinated subjects. The incidence of prolonged cough illness was ascertained for subjects with and subjects without serologic evidence of infection. RESULTS: Infection rates among control subjects are particularly representative of those in nonimmunized adults. Among control subjects, 0.4%-2.7% had increases in pertussis antibody of various types and degrees over 1 year, and 20%-46% had prolonged cough illnesses during this interval. Pertussis toxin antibody had the greatest specificity for detecting increases in antibody levels. Asymptomatic infections were approximately 5 times more common than clinical illnesses that met a strict clinical and microbiologic case definition. Relative to control subjects, aP-immunized subjects may have fewer increases in the antibody level (i.e., infections), especially for antibodies to fimbriae 2/3 (an antigen not in the vaccine). CONCLUSIONS: Pertussis infections in older persons are largely asymptomatic. aP boosters confer protection for adolescents and adults against symptomatic pertussis and likely confer protection against mild and asymptomatic infections, and use of boosters may reduce transmission to others, especially infants.
Reference: Ward JI et al. Clin Infect Dis 2006;43:151-157.

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Control of Avian Influenza in Poultry
Avian influenza, listed by the World Organization for Animal Health (OIE), has become a disease of great importance for animal and human health. Several aspects of the disease lack scientific information, which has hampered the management of some recent crises. Millions of animals have died, and concern is growing over the loss of human lives and management of the pandemic potential. On the basis of data generated in recent outbreaks and in light of new OIE regulations and maintenance of animal welfare, we review the available control methods for avian influenza infections in poultry, from stamping out to prevention through emergency and prophylactic vaccination.
http://www.cdc.gov/ncidod/EID/vol12no09/06-0430.htm
(Emerging Infectious Diseases September 2006:12(9) [e-print].)

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Mental Status after West Nile Virus Infection
Mental status after acute West Nile virus infection has not been examined objectively. We compared Telephone Interview for Cognitive Status scores of 116 patients with West Nile fever or West Nile neuroinvasive disease. Mental status was poorer and cognitive complaints more frequent with West Nile neuroinvasive disease (p = 0.005).
http://www.cdc.gov/ncidod/EID/vol12no08/06-0097.htm
(Emerging Infectious Diseases August 2006:12(8) [e-print].)

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Prevention and Control of Influenza
Summary: This report updates the 2005 recommendations by the Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine and antiviral agents (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2005;54[No. RR-8]:1--44). The 2006 recommendations include new and updated information. 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. For the A/Wisconsin/67/2005 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/Hiroshima/52/2005 virus; for the B/Malaysia/2506/2004-like antigen, manufacturers may use the antigenically equivalent B/Ohio/1/2005 virus.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5510a1.htm
(MMWR Recommendations and Reports July 28, 2006 / Vol. 55 / No. RR–10)

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Duck hunters may face risk of avian flu infections
Summary: We report serologic evidence of avian influenza infection in 1 duck hunter and 2 wildlife professionals with extensive histories of wild waterfowl and game bird exposure. Two laboratory methods showed evidence of past infection with influenza A/H11N9, a less common virus strain in wild ducks, in these 3 persons.
http://www.cdc.gov/ncidod/EID/vol12no08/06-0492.htm
(Emerging Infectious Diseases August 2006:12(8) [e-print].)

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3. Notifications
Second International Congress on Infectious and Tropical Diseases
The 2nd International Congress on Infectious and Tropical Diseases, organized by the Ministry of Health in collaboration with The Sultan Qaboos University and the Executive board of the GCC [Gulf Cooperation Council], will be held in Muscat-Oman during the period 4-7 Dec 2006. For more information and to register, see the congress website at http://www.squ.edu.om/med/icitd-oman/
(Promed 7/19/06)

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Fifth Annual Systems Integration in Biodefense: Building a Blueprint for Policy and Preparedness
Cambridge Health Institute's Fifth Annual Systems Integration in Biodefense: Building a Blueprint for Policy and Preparedness will be August 21-22, 2006 at the Ritz Carton in Washington, DC. For more information visit http://www.healthtech.com/2006/btr/index.asp
(Promed 7/22/06)

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International Meeting on Emerging Diseases and Surveillance (IMED 2007)
The International Meeting on Emerging Diseases and Surveillance (IMED 2007) will take place in Vienna, Austria February 23-25, 2007. Please visit the IMED 2007 website http://imed.isid.org for more details and to take advantage of discounted early registration. Abstracts are invited and online abstract submission is available now.
(Promed 7/26/07)

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4. To Receive EINet Newsbriefs
JOIN THE E-LIST AND RECEIVE NEWSBREIFS REGULARLY
The APEC EINet email list was established to enhance collaboration among health, commerce, and policy professionals concerned with emerging infections in APEC member economies. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe, go to: http://depts.washington.edu/einet/?a=subscribe or contact apecein@u.washington.edu. Further information about APEC EINet is available at http://depts.washington.edu/einet/.

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 apecein@u.washington.edu