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Vol. IX, No. 16 ~ EINet News Briefs ~ Aug 11, 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: FAO/OIE initiative to share virus samples and gene sequences
- Global: APEC's response to the threat of pandemic influenza
- Russia: Crimean-Congo hemorrhagic fever
- Germany: Bird flu identified in a swan in Dresden zoo
- Avian influenza in Siberia, Russia
- Indonesia: 2 more fatal human cases of H5N1 avian influenza
- Indonesia: Cluster of suspected avian flu cases test negative
- Indonesia: Bird flu virus spreads to Papua
- Indonesia: Bird flu data to be shared with foreign scientists
- Indonesia: Parents plan to sue for children with avian flu
- Thailand: Fatal human cases of avian influenza
- Thailand: 3 Suspected Bird Flu Patients Admitted To Hospital
- Thailand: Massive chicken cull as experts await human avian flu test results
- Taiwan: Vaccine associated case of poliomyelitis
- China: Confirmation that 1st human case of H5N1 occurred in 2003
- China: Rabies outbreak
- Viet Nam: Wild storks killed to prevent bird flu spread
- Australia (New South Wales): Lymphogranuloma venereum
- USA: Professional groups call on White House to elevate role of pandemic flu vaccines
- USA: Wild bird H5N1 monitoring expands beyond Alaska
- USA: Researchers develop new way to assess pandemic potential of influenza viruses
- USA: HHS adds new anthrax drug to national stockpile
- USA: Huge cattle feed recall due to mammalian protein
- USA (Colorado): Third Human case of plague
- USA (Rhode Island): Vibrio vulnificus
- USA (Washington state): Consumers advised to avoid raw oysters from the Pacific Northwest
- USA (California): Fatal case of hantavirus pulmonary syndrome
- USA (Massachusetts): Pneumonic Tularemia
- Canada: Case of hantavirus pulmonary syndrome imported from Bolivia

1. Updates
- Avian/Pandemic influenza updates
- Dengue
- West Nile Virus

2. Articles
- Avian influenza among waterfowl hunters and wildlife professionals
- WHO WER, Volume 81, Number 32—August 11, 2006
- WHO WER, Volume 81, Number 31—August 4, 2006
- WHO WER, Volume 81, Number 30—July 28, 2006

3. Notifications
- APEC Pandemic Response Exercise - Lessons Learnt Workshop
- 10th International Dengue Course & Symposium
- Roche Publishes Pandemic Planning Toolkit
- CDC' releases updated Sexually Transmitted Diseases Treatment Guidelines, 2006
- CDC releases recommendations on use of varicella vaccines


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

2003
China / 1 (1)
Viet Nam / 3 (3)
Total / 4 (4)

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 / 39 (33)
Iraq / 2 (2)
Thailand / 2 (2)
Turkey / 12 (4)
Total / 91 (61)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 236 (138).
(WHO 8/09/06 http://www.who.int/csr/disease/avian_influenza/en/index.html )

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Global: FAO/OIE initiative to share virus samples and gene sequences
OFFLU, the OIE/FAO joint network of expertise on avian influenza, will systematically make avian influenza virus sequences accessible to the entire scientific community. With this gesture OFFLU reiterates its call to the world's scientists, international organizations and countries for a global sharing of virus strains and sequences.

Since its launch in April 2005, OFFLU has been mainly working on promoting the key objectives “to exchange scientific data and biological materials (including virus strains) within the network, and to share such information with the wider scientific community”. Under this new impetus, strains will be sent to the U.S. National Institutes of Health for sequencing and deposited in full transparency on the free-access database, GenBank.

On 14 March 2006, the Scientific Committee of OFFLU, made up of the world's leading veterinarian experts on avian influenza, revised its terms of reference to put new emphasis on the need for further collection, characterization and exchange of avian influenza viruses, and for the expansion of the genomic database for animal influenza viruses.

Sharing virus strains, samples and sequences is a critical part of the global work on the surveillance and control of the highly pathogenic H5N1 virus, and supports the preparation of human vaccines. Avian influenza brings long-term implications for human health, and therefore OFFLU works closely with the World Health Organization Working Group on Influenza Research at the human-animal interface.

Virus strains can be considered as intellectual property and sharing them can be seen as potentially hampering research progress and scientific publication. However, OFFLU went forward on 16 February 2006 when Dr Ilaria Capua of the Italian Istituto Zooprofilattico Sperimentale delle Venezie in Italy, and Chair of the Scientific Committee of OFFLU, released sequence data of the H5N1 virus found in Nigeria and Italy on GenBank. In the meantime, she urged 50 colleagues around the world to share their isolated H5N1 virus strains.

Scientists of the FAO/OIE network repeated their conviction in a letter published by the review Science a few weeks later. “We will make available for genome nucleotide sequencing of H5N1 contemporary isolates from several countries and relevant historical strains,” said Ilaria Capua and fellow Drs Ian Brown, Michael Johnson, Dennis Senne and David Swayne.

The stance taken by G8 leaders in Russia on global sharing of virus samples further strengthens this daring initiative.

In its statement on the fight against infectious diseases, the Group of Eight declared being “determined to achieve tangible progress in improved international cooperation on the surveillance and monitoring of infectious diseases, including better coordination between the animal and human health communities, building laboratory capacities, and full transparency by all nations in sharing, on a timely basis, virus samples in accordance with national and international regulations and conventions, and other relevant information about the outbreaks of diseases.”
(FAO 8/1/06 http://www.fao.org )

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Global: APEC's response to the threat of pandemic influenza
A hypothetical outbreak of a new strain of influenza put APEC's 21 economies to the test in a successful pandemic response exercise completed in Australia on 7-8 June.

For the purposes of the 'APEC Pandemic Response Exercise 2006', the new 'Malacca Straits Flu' was suspected in some fishermen, whose boat subsequently capsized and who were rescued by a passing passenger cruise ship. This led to a hypothetical 'outbreak' of pandemic proportions within the APEC region.

The exercise was part of a concerted program which has seen APEC emerge as a major driver behind regional efforts to prepare for and respond to the threat of avian and pandemic influenza across the Asia-Pacific region. This was the first time that all 21 APEC economies had cooperated in such a complex and major emergency preparedness exercise.

The exercise outcomes will provide direction for future work to help build the region's preparedness and response capability. APEC's efforts in preparing for the event of a pandemic influenza are designed to enhance the work of international and regional organizations such as the World Health Organization.

APEC's ongoing work on avian influenza focuses on providing technical assistance and helping member economies already affected by an avian influenza outbreak. Additionally, it has undertaken to establish a regional register of experts who have specialist skills in human and animal health disaster response.

A 'Lessons Learned' workshop hosted by Singapore will be the next phase of APEC's preparations to deal with a potential pandemic. A final report and recommendations for future arrangements will then be submitted to APEC Ministers and Leaders in November 2006.
(APEC July, 2006 http://www.apec.org/ )

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Europe/Near East
Russia: Crimean-Congo hemorrhagic fever
Thus far in 2006, a severe deterioration in the epidemiological situation for Crimean-Congo hemorrhagic fever (CCHF) has been observed in the Southern Federal District of Russia. As of 8 Aug 2006, the Federal Service for Surveillance of Consumer Rights and Human Well-being reported that 192 cases of CCHF had been recorded in the Southern Federal district. This figure exceeds that for the corresponding period of [2005] by 43 percent. The greatest deterioration has occurred in the Republic of Kalmykia (65 cases of CCHF recorded) and in the Rostov region (53 cases of CCHF). CCHF has been diagnosed in 40 patients in the Stavropol region, in 15 patients in the Astrakhan area, in 16 patients in the Volgograd area, and in 3 patients in the Republic of Dagestan.

So far in 2006, 5 patients have died as a consequence of CCHF virus infection, compared with 4 fatalities in the corresponding period of 2005. Two fatal cases were recorded in the Republic of Kalmykia, and one each in the Stavropol, Rostov and Astrakhan regions. The majority of CCHF cases are contracted during the maintenance of animals on private farms. Frequently ticks are removed by hand with no protection of the skin of the farm-worker. Delay in seeking medical attention often results in development of more severe forms of CCHF.

In the case of 4 patients in the Republic of Kalmykia, 2 in the Stavropol region, 2 in the Astrakhan region and one in the Rostov region, medial attention was not sought for 4 or more days after the 1st symptoms of CCHF infection.
(Promed 8/10/06)

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Germany: Bird flu identified in a swan in Dresden zoo
A swan found dead in Dresden zoo in eastern Germany was infected with the deadly H5N1 bird flu virus, the 1st such case in the country in nearly 3 months, local authorities said Thursday [3 Aug 2006]. The Saxon state health ministry said that all birds at the zoo had been confined as a precaution following confirmation of the virus in the swan and that a ban had been put on dogs and cats being allowed to stray in a 10 km (6 mile) radius.

Last February [2005], Germany suffered an outbreak of H5N1, which can be fatal to humans, among wild birds, and in April 2006, the virus was detected among domestic fowl. It also spread to mammals, infecting 3 cats and a stone marten -- a member of the weasel family -- on the Baltic Sea island of Ruegen. But the last case reported in a migratory bird before the latest infection was on 12 May 2006 in Bavaria, in the south of the country. Last month [July 2006], the German parliament extended to next February 2007 a lock-up order in force for domestic poultry in areas with a high risk of bird flu.
(Promed 8/6/06)

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Avian influenza in Siberia, Russia
During 2006, in Siberian Federal District, avian influenza was reported in private backyards in Altaj, Tomsk, Omsk and Novosibirsk regions. In Tomsk region, 2 outbreaks were registered, one of them in domestic pigeons. On 31 Jul 2006, one outbreak of avian influenza was still active in Tomsk region. No new outbreaks of the disease have been reported since 5 Jul 2006. In Tyva Republic, wild birds were found dead due to avian influenza.
(Promed 8/5/06)

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Asia
Indonesia: 2 more fatal human cases of H5N1 avian influenza
Two Indonesian teenagers have died of the bird flu virus, bringing the country's number of human fatalities to 44. This gives Indonesia the highest human toll from H5N1 avian influenza.

As of 8 Aug 2006, The Ministry of Health in Indonesia confirmed the country's 55th case of human infection with the H5N1 avian influenza virus. The case occurred a 16-year-old male from West Java Province. He developed symptoms on 26 Jul, was hospitalized on 4 Aug, and died on 7 Aug 2006. Prior to symptom onset, the case had contact with sick and dying chickens in his household. A joint investigation by health and agricultural officials detected the H5 virus subtype in chickens from the household. Family members and close contacts have been placed under surveillance. This represents the 43rd fatal case of human H5N1 avian influenza in Indonesia.

The 56th Indonesia case of human infection with the H5N1 avian influenza virus was identified in a 17-year-old female from Jakarta Province. She developed symptoms on 28 July, was hospitalized on 4 August, and died on 8 August. An investigation into her source of infection found that pet pigeons were kept inside her home and that several neighbouring households maintained flocks of backyard poultry. Animal health authorities have collected samples from birds in the neighbourhood and these will be tested as part of the continuing investigation. This represents the 44th fatal case of human H5N1 avian influenza in Indonesia.
(Promed 8/9/06, 8/8/06; CIDRAP 8/9/06 http://www.cidrap.umn.edu )

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Indonesia: Cluster of suspected avian flu cases test negative
Preliminary tests have cleared 6 Indonesians from North Sumatra province of suspected bird flu, the health minister said on Thursday [3 Aug 2006].

"Investigations by the Ministry of Health lab and NAMRU-2, [released] on 2 and 3 Aug 2006 established that all specimens collected from the suspected cases in Kabanjahe district came up negative," health minister Siti Fadilah Supari told a news conference, referring to the United States Naval Medical Research Unit based in Jakarta [NAMRU-2]. She said the investigation showed the patients to be suffering from common seasonal flu that normally affects humans.

The suspected bird flu cases were in a village about 5 km (3 miles) from one where as many as 7 members of an extended family died from bird flu in May 2006, triggering fears the H5N1 bird flu virus had mutated into a form that could spread easily between people. The minister said the government was still investigating and would carry out further tests, with final results expected within 5-7 days. She did not mention a 7th possible case some officials had referred to previously.

The National Commission on Avian Flu Control and Preparedness has also set up a post in Kabanjahe district to provide services for the community there, including compensating farmers whose poultry were culled, the minister said. For future diagnosis of bird flu, Supari said Indonesia would not send human samples to the World Health Organisation-authorised laboratory in Hong Kong for confirmation, but would still send samples to the US Centers for Disease Control and Prevention in Atlanta.
(Promed 8/4/06; CIDRAP 8/2/06 http://www.cidrap.umn.edu )

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Indonesia: Bird flu virus spreads to Papua
The bird flu virus has now reached easternmost Papua after attacking poultry populations in Java and Sumatra in the western section of the country. About 174 chickens are believed to have died of the H5N1 virus in Mimika regency as of 11 Jul 2006, while 414 others were culled due to suspected infection.

Based on a lab analysis from the Bogor Veterinary Research Center conducted on 19 Jul 2006, 3 of 37 birds tested were positive for H5N1, an official said Monday [7 Aug 2006]. "Test results showed that 3 of the chickens contain the H5N1 virus; one of them was from SP3 Timika Jaya and 2 were from the traditional market," head of the Papua Husbandry Office AR Pintadewa told The Jakarta Post in Jayapura.

According to Pintadewa, officers from the Mimika Husbandry Office received a report from a farmer in Sempan village, Timika, on 11 Jul 2006 that his chickens were sick. They found 40 birds with H5N1 symptoms at the farm. Inspections of the traditional market also found many chickens with symptoms of the disease.

To prevent the spread of the virus to other areas, Pintadewa said the Mimika regent issued a circular banning transportation of chickens out of the regency.
(Promed 8/9/06)

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Indonesia: Bird flu data to be shared with foreign scientists
Bowing to international pressure, Indonesia has said that foreign scientists can have full access to the country's data on bird flu, the infectious disease that has claimed 43 lives here.

The move is expected to help international scientists understand how the H5N1 bird flu virus works. Researchers are especially interested in the limited human-to-human transmission of the virus that happened in May 2006 in North Sumatra in the world's largest cluster of infections. Scientists fear bird flu could become more easily transmissible among humans, sparking a deadly global pandemic.

"I've learned that scientists across the world have complained that they could not access the data and made statements as if we had hidden it," health minister Siti Fadilah Supari told a press conference here on Thursday [3 Aug 2006].

"For the sake of basic human interests, the Indonesian government declares that genomic data on bird flu viruses can be accessed by anyone."

In its 13 Jul 2006 edition, the respected journal Nature reported scientists were complaining that they were hindered from studying the virus because the Indonesian government had declined to release the data from bird flu samples.

In a recent interview with The Jakarta Post, the minister admitted the government had kept the data to itself and its partners while conducting its own research.

Siti said the decision to open up access to the information came after a suggestion from the medical committee of the Indonesian Academy of Sciences, a government-sanctioned forum of experts. Professor Sangkot Marzuki of the academy said the committee made the suggestion because emerging diseases like bird flu should be addressed promptly, involving as many stakeholders as possible.

He said the academy had considered the potential benefits that the government could reap by developing vaccines and drugs based on its data, and from royalties from intellectual rights. Health experts have been debating for decades whether genomic data from new viruses and other microscopic materials should be owned by the organizations that sponsor the research, or placed in the public domain so that the world can have access to it.

Siti said opening up global access could be the key to unlocking such important information as the origin of the virus, how it causes disease, how it is mutating, the sources of infection, and how to prevent or cure the virus.

"But in future cooperation on bird flu with other countries, the delivery of specimens should be regulated under 'Material Transfer Agreement' documents as is commonly practiced in scientific cooperation," she added.
(Promed 8/5/06)

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Indonesia: Parents plan to sue for children with avian flu
The parents of 3 young children from North Sumatra's Karo regency who were earlier reported as exhibiting classic bird flu symptoms plan to sue the provincial administration and the central government for saying their children most likely had bird flu.

The plan was disclosed on Friday [4 Aug 2006] when the parents along with the director of the Legal Aid Institute for Health met Karo Regency Legislative Council members. Institute director Iskandar Sitorus said the lawsuit, which is being prepared and is expected to be completed in 3 weeks, would target health minister Siti Fadilah Supari and president Susilo Bambang Yudhoyono. The lawsuit will be filed at Central Jakarta District Court. He said they were also considering suing the World Health Organization (WHO), the provincial administration, and doctors who treated his clients' children.

The 3 children, 2 sisters and the son of a neighbor from Sumbul village in Kabanjahe, were referred to Adam Malik Hospital in Medan on Tuesday after being treated at Kabanjahe Hospital in Karo. Karo is the site of a cluster of 8 bird flu fatalities in one family who died in May, the world's largest single cluster.

But on Thursday, the health minister said that preliminary tests on their blood samples were negative. However, she warned that the results were tentative because they were tested when they were showing symptoms of bird flu, including fever and respiratory difficulties. A 2nd test was being carried out to confirm the results. "The health minister should be responsible for her statement that the 3 are suspected of having bird flu and then that they tested negative. These statements have made the families of the victims outcasts," he [Iskandar Sitorus] told The Jakarta Post after the meeting.

Iskandar said it seemed like the central government was not serious in dealing with bird flu, especially in Karo, as seen by the way it named people who it suspected had bird flu. "If the government keeps doing this, it will cause chaos. It simply corrected the statement. This is related to people's lives so the government should be more careful," he said. The families, he said, have demanded that the government make a public apology and compensate them. But he could not provide details of the compensation demanded. The father of the 2 girls said since the government announced that his children were possible bird flu patients, his family had been shunned by neighbors.
(Promed 8/5/06)

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Thailand: Fatal human cases of avian influenza
Thailand reported that avian influenza virus had killed a man in a central province, the 2nd such human death in less than 2 weeks, a senior official at the Health Ministry said today [Sat 5 Aug 2006]. A 27 year old man in Uthai Thani province who died on 3 Aug 2006 has tested positive for the H5N1 virus. He was the country's 16th human bird flu death.

Thailand, the world's 4th-biggest poultry exporter, has widened its search for avian flu patients and improved surveillance for the virus in poultry after the government on 26 Jul 2006 confirmed the death of a 17 year old man from bird flu who died July 24, its 1st human fatality in 7 months.

New cases create chances for H5N1 to mutate into a pandemic form and world health authorities are tracking the disease for signs that it may become more contagious. "The man had a history of contacting dead poultry". "His initial test in the province had an inconclusive result and further tests in Bangkok just came out today, confirming the H5N1 infection."

The Health Ministry is concerned that an outbreak of seasonal influenza during this rainy season will increase the risk of dual infections with the H5N1 virus. Dual infections may help the H5N1 virus to mutate into a pandemic form.
(Promed 8/6/06; CIDRAP 7/31/06 http://www.cidrap.umn.edu )

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Thailand: 3 Suspected Bird Flu Patients Admitted To Hospital
Three persons were admitted to hospital in Bangkok, capital of Thailand, on Tue 8 Aug 2006 on suspicion of contracting bird flu virus, an official of the Bangkok Metropolitan Administration told the Xinhua News Agency. Laboratory blood tests will take at least 3 days to confirm whether the patients were infected with avian influenza virus, the official said.

On Mon 7 Aug 2006, a man who lives in downtown Bangkok was put in quarantine at a hospital in Bangkok after suffering a few days of flu-like symptoms.

The initial test of a 61 year old woman in central Thailand who fell ill with bird-flu-like symptoms showed positive for avian influenza, Thai officials and local media reported Thursday [3 Aug 2006]. The patient in Lop Buri Province's Sa Bot district fell ill with bird-flu-like symptoms soon after her backyard chickens all suddenly dropped dead. She had initially tested positive for avian influenza and was being treated in an isolation ward pending confirmation from laboratory tests. The victim was admitted on Tuesday [1 Aug 2006].

Meanwhile, Thailand's caretaker Prime Minister Thaksin Shinawatra has [announced] at a meeting on Tue 8 Aug 2006 [an allocation of] 20 million baht (about USD 500 000) to fight bird flu, which reemerged in the kingdom late July [2006], when a 17-year-old boy died from the deadly H5N1 avian influenza virus, the 1st fatality of the disease this year and the 16th death since the epidemic broke out in early 2004. The 2nd victim was a 27-year-old man who died on 3 Aug 2006. Both of the 2 fatalities occurred in lower northern Thailand.
(Promed 8/9/06; CIDRAP 8/3/06 http://www.cidrap.umn.edu )

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Thailand: Massive chicken cull as experts await human avian flu test results
A Thai province is culling 300,000 chickens after a laboratory test confirmed an avian influenza outbreak, and the country's health ministry is monitoring 80 patients who are suspected of having avian flu.

The Bangkok Post reported today that the cull in the Nakhon Phanom province is being carried out on 70 farms by 1,500 health officials. The culling was prompted by the deaths of several chickens. The province's governor, Nikhom Kerdkhanmak, told the Post that samples of chicken carcasses were sent to the Centre for Veterinary Research and Development in Kohn Kahn, and results showed that the chickens were infected with bird flu; the strain was not specified in the story. Last least week, 40,000 chickens were culled in the province as a precautionary measure.

Health officials are disinfecting households and vehicles, the Post said, and poultry movement has been banned along the Thailand-Laos border. Last week, Laos reported its first major outbreak of H5N1 avian influenza in more than 2 years, and the poultry farm where the disease surfaced borders part of Thailand.

Meanwhile, the Post reported that 19 Thai provinces have patients on the suspected avian influenza watch list. All are in northern and central Thailand. The Phichit province, where a 17-year-old boy died of H5N1 avian flu last week, has the most patients on the list (18). Provinces with several patients on the list include Sukhothai (14), Phitsanulok (9), Suphan Buri (9), and Nan (7). Nakhon Phanom, the site of the major chicken cull, has two patients on the list.

The province of Buri Ram has banned cockfighting matches in August after mysterious poultry deaths were reported, the Post reported.

In other avian flu news, representatives from 11 Asian countries gathered in New Delhi recently at a conference sponsored by the World Health Organization, according to a report from Reuters. The health officials agreed to join forces to fight the spread of avian flu. They plan to share details about their outbreak investigations and pledged to collaborate on the development and production of drugs, vaccines, and diagnostic tests. They also said they would pool their research efforts.

The report noted that Thai officials said they would push for early use of osteltamivir (Tamiflu) in suspected H5N1 avian flu cases, rather than wait for lab results.

An official from the United Nations Food and Agriculture Organization (FAO) told the group that the Asia-Pacific region has lost an estimated $10 million because of avian flu outbreaks, The Financial Express, an Indian newspaper, reported today. FAO regional representative He Changchui said more than 200 million birds have been culled over two and a half years.
(Promed 8/5/06; CIDRAP 7/31/06 http://www.cidrap.umn.edu )

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Taiwan: Vaccine associated case of poliomyelitis
In October 2005, a 3-month-old male infant presented with a weakness of the right upper limb. One day later, he developed bilateral lower limb paralysis with diminished reflexes. Poliovirus identical to Sabin 2 strain was isolated from 3 sets of stool specimens. A lumbar puncture was performed and the cerebrospinal fluid analysis was normal. The case was then reported to the AFP reporting system and diagnosed as GB [Guillain-Barre] syndrome. The stool samples taken from the close contacts were all negative for enteroviruses. In May 2006, paralysis of the bilateral lower limbs (more severe on left side) and monoplegia of an upper right limb were still found present in the infant.

Tracing the infant's history, a perianal abscess was found at 15 days of age, which subsided after oral antibiotic therapy. He received oral poliomyelitis vaccine (OPV) at 2 months of age. The infant was admitted to hospital due to fever and bleeding from an anal fistula 21 days after the immunization. He received a fistulectomy the next day, but paralysis appeared 2 days after the operation. The parents suspected the severe symptoms could be related to OPV, so they applied for the national VICP in 2006 asking for compensation. After review by the committee, the presence of vaccine-associated paralytic poliomyelitis (VAPP) was suspected in the patient.

The last polio case in Taiwan occurred in 1983, and polio has been eradicated since 2000 in the West-Pacific region. However, since there are outbreaks in neighboring countries and global polio eradication is not yet achieved, the Taiwan ACIP still recommends OPV. During polio epidemics in the 1970s, intramuscular injection and surgery were forbidden as they probably activated the virus. Although such cases are rare and there are still 14 percent of VAPP cases without immunodisorders, the issue of whether to include surgery as an OPV precaution will be discussed in the next ACIP meeting.
(Promed 8/8/06)

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China: Confirmation that 1st human case of H5N1 occurred in 2003
As of 8 Aug 2006, The Ministry of Health in China has today retrospectively confirmed a human case of H5N1 infection dating back to November 2003. The case occurred in a 24-year-old member of the military service based in Beijing. The man developed symptoms on 25 Nov 2003 and was hospitalized with pneumonia in Beijing. His condition deteriorated rapidly and he died of severe respiratory disease on 3 Dec 2003. Confirmation of this case marks the earliest known instance of human H5N1 infection in mainland China, and is now the 1st confirmed case in the present outbreak. Previously, the 1st confirmed cases were thought to have occurred in Viet Nam in December 2003.

The case was initially reported by several Chinese researchers, affiliated with the military services, in a June 2006 letter to the New England Journal of Medicine. According to that communication, doctors initially suspected the man might have been infected with the SARS virus. Although WHO declared the SARS outbreak over in July 2003, suspicions were high that the virus might return during the cooler months.

Specimens tested for SARS infection prior to the man's death were negative, but the cause of death remained undetermined. As stated in the published letter, stored specimens from the man subsequently tested positive for H5N1 infection. Successful isolation of the virus from these specimens was also reported.

As the man's illness was initially thought to be SARS, no history of possible poultry exposure was taken. The source of his H5N1 infection remains uncertain, particularly as no poultry outbreaks of H5N1 avian influenza have been reported in Beijing.

The Ministry of Health informed WHO that it had been unaware of these tests and their results prior to publication of the research letter. In line with WHO recommendations, confirmatory testing in a laboratory affiliated with the Ministry of Health was arranged. Following an official request, WHO sent laboratory experts to consult with national experts performing the tests. That joint undertaking, conducted in late July, confirmed the man's infection with the H5N1 virus. These findings were further reviewed by a panel of experts, which concluded that the man's H5N1 infection was now laboratory-confirmed.

Prior to this announcement, the 1st official laboratory-confirmed H5N1 case on the Chinese mainland occurred in Hunan Province in October 2005 and was reported to WHO in mid-November 2005.

The case has been added to the WHO cumulative table of confirmed cases. Retrospective confirmation of the case brings the cumulative total in China to 20. Of these cases, 13 have been fatal.

The Ministry of Health has informed WHO of its intention to strengthen communication mechanisms, and to ensure that more of the country’s research institutes are integrated into the reporting system. WHO will be providing support and guidance in these activities, as officially requested.
(Promed 8/8/06)

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China: Rabies outbreak
A Chinese city has ordered the destruction of all dogs within a 3 mile radius of a rabies outbreak -- the 2nd major cull in less than a week. Officials in Jining, the provincial capital of Shandong province, refused to reveal how many of the city's 500,000 dogs would be killed in the latest cull, which was ordered after the deaths of 16 local people this year.

Animal rights groups have condemned the extermination campaigns, which they say are cruel, disproportionate, and evidence of the failure of the country's vaccination and monitoring campaigns.

The outrage was sparked this week, when it emerged that police and public health officials in Mouding -- a county in Yunnan province -- clubbed, electrocuted, and buried alive 50,000 dogs to control the disease. Regardless of vaccinations, no animal was spared apart from police and army dogs.

An official from Jining's centre for disease control and surveillance said: "I cannot reveal any information because this is an epidemic situation and I need authorization to talk." But the state media said all dogs within a 3 mile radius of every rabies case would be slaughtered. A total of 16 villages inside the municipality have been affected by the disease.

Mad dog disease, as rabies is called in China, [has killed] 2651 people in 2004. The number of cases has risen steadily in recent years because of a rise in pet ownership and a low (3%) vaccination rate.

The World Health Organisation [WHO] says the recent countermeasures have been excessive. "Rabies is a big problem for China and it is one that is probably under-reported," said Roy Wadia of the UN agency's Beijing office. "But we don't encourage this sort of dramatic culling. There would be no need for it if adequate vaccination and surveillance measures were in place."

Animal rights groups have complained that the slaughter is indiscriminate. "This inhumane act has damaged China's international reputation," said He Yong, of the International Federation for Animal Welfare. "Simply killing dogs is no answer to rabies."

In the absence of a strong health system and effective monitoring and reporting of diseases, China has frequently had to resort to mass culls. The SARS outbreak in 2003 prompted the destruction of countless civet cats. The bird flu epidemic has led to the slaughter of millions of ducks and chickens.
(Promed 8/5/06)

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Viet Nam: Wild storks killed to prevent bird flu spread
Viet Nam's animal health workers have killed 53 wild storks at a theme park in Ho Chi Minh City, after random tests showed 2 of the birds carried an avian influenza virus strain, officials said on Saturday [5 Aug 2006]. An official at the park said the findings of the H5 component, part of the H5N1 poultry virus, led to the slaughter of the birds even though they all appeared healthy. H5N1 influenza type-A virus that has killed 42 people in Viet Nam since late 2003, but there have been no human infections detected in the South East Asian country this year [2006]. Vietnamese officials say a failure to control waterfowl, which can be silent carriers of bird flu, made the country vulnerable to new outbreaks and that wild birds believed to carry H5N1 would soon migrate from the north, raising the risk of infection.
(Promed 8/6/06)

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Australia (New South Wales): Lymphogranuloma venereum
Sydney doctors have confirmed 4 cases of lymphogranuloma venereum (LGV), a sexually transmissible infection caused by certain strains of chlamydia, NSW Health announced today, 1 Aug 2006. The infection, whose symptoms can include the discharge of blood from the anus, constipation, and fever, was reported among gay men in the Netherlands in 2003 and has since been seen in other European countries and North America.

NSW Health and ACON (AIDS Council of New South Wales) warned the infection, most commonly transmitted through unprotected anal intercourse between men, was often asymptomatic. "Typically people develop a small, painless sore where the bacterium enters the body, usually inside the rectum, 1 to 2 months after infection," NSW Health communicable disease director Dr Jeremy McAnulty said. "But sometimes these signs can go unnoticed so it's important to be aware of symptoms and seek antibiotic treatment as soon as possible."

ACON president Adrian Lovney said using condoms and water-based lubricant during sex and latex gloves during fisting would reduce the likelihood of infection. "A new glove or condom should be used with every new partner to prevent the spread of infection being passed from one to another," Lovney said.
(Promed 8/1/06)

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Americas
USA: Professional groups call on White House to elevate role of pandemic flu vaccines
Two national groups of infectious disease experts urged the White House to make the development of vaccines the most important element in the nation's pandemic influenza plan. In a press release today, the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) detailed the letter they sent to Frances Townsend, Assistant to the President for Homeland Security and Counterterrorism, on Aug 4 responding to the White House's National Strategy for Pandemic Influenza, released in May.

The government's 228-page pandemic plan explains the steps that federal agencies will take in the event of a pandemic. It spells out 300 government responses to a pandemic and outlines what pandemic planning measures are expected from other groups.

The pandemic plan states that vaccines are the best way to contain a pandemic and that the government is attempting to stockpile enough existing, or prepandemic, H5N1 vaccine to immunize 20 million people and create a vaccine-manufacturing surge capacity to make enough pandemic vaccine for all Americans within 6 months of a pandemic's start. The government's current supply is only a few million doses.

However, the IDSA and SHEA say a more comprehensive, international approach is needed for vaccine development, and the United States should lead international efforts to develop the new vaccines. "We must do the legwork now so that we can produce and deploy these vaccines were we need them when a pandemic hits," said Martin J. Blaser, MD, president of the IDSA.

New vaccine science and delivery approaches are urgently needed, and vaccine makers must be involved in the process, the two groups said. "There is a need for rapid, transparent, and extensive exchange of scientific information among experts, and a novel systematic approach is needed to speed vaccine development," the groups wrote in their comments to the White House. Strong working relationships with other countries—particularly those in Southeast Asia—will be the keys to detecting novel viruses early enough to develop effective vaccines.

In addressing other parts of the federal pandemic plan, the societies lauded the White House for clearly designating the Department of Health and Human Services as the lead medical responder and the Department of Homeland Security as the operation and resource coordinator.
(CIDRAP 8/8/06 http://www.cidrap.umn.edu )

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USA: Wild bird H5N1 monitoring expands beyond Alaska
US agriculture and interior secretaries announced yesterday that their departments are expanding wild bird monitoring for H5N1 avian influenza beyond Alaska in partnerships with the lower 48 states, Hawaii, and other Pacific islands.

"Because we cannot control wild birds, our best protection is an early warning system, and this move to test thousands more wild birds throughout the country will help us to quickly identify, respond to, and control the virus if it arrives in the United States," said US Department of Agriculture (USDA) secretary Mike Johanns in a USDA–Department of Interior (DOI) press release yesterday.

Scientists are not certain what role migratory birds play in transmitting the H5N1 virus.

DOI secretary Dirk Kempthorne said joint federal and state testing programs will be important this fall when birds now nesting in Alaska and Canada begin migrating south through the continental United States.

President Bush allocated $29 million in his 2006 fiscal year avian influenza supplemental package to cover the cost of implementing the wild bird monitoring component of the National Strategy for Pandemic Influenza. Of the $17 million the UDSA received, $4 million has gone to states to expand wild bird monitoring. The remainder funds USDA sampling efforts, purchase of sampling kits, and analysis of bird and environmental samples.

Of the $12 million that went to the DOI, about $2.4 million has gone to state agencies and other agencies for collecting wild bird samples. The rest of the DOI's allocation will fund DOI's sampling and analysis activities and a data management system for state-federal wild bird sampling efforts.
(CIDRAP 8/10/06 http://www.cidrap.umn.edu )

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USA: Researchers develop new way to assess pandemic potential of influenza viruses
Study provides first assessment of the risk of an H5N1 pandemic strain emerging from the combining of avian and human influenza viruses.

Researchers at the Centers for Disease Control and Prevention (CDC) have developed a new research method that may help identify the types of genetic changes necessary for the avian influenza virus (H5N1) to be more easily transmitted among people.

After developing the research method, CDC scientists used it to investigate the ability of a lab-engineered combination of the avian influenza virus and a more common human virus to spread in lab animals. Efficient and sustained human-to-human transmission is the remaining property that H5N1 avian influenza viruses do not yet have that is needed to cause a pandemic.

In this series of experiments, published in the July 31 issue of the journal Proceedings of the National Academy of Sciences, genes from a human H3N2 influenza virus were added to genes from an H5N1 avian influenza virus to create new hybrid viruses. The new viruses were tested in ferrets because their susceptibility to flu viruses is similar to that of humans. The animals were then placed in close proximity, to see if infected ferrets passed the new virus to uninfected animals and whether they transmitted it more easily than the original H5N1 virus.

In this model, human H3N2 viruses transmitted efficiently between the ferrets, but avian H5N1 viruses did not. When the hybrid viruses were tested it was found that these viruses also did not pass easily between ferrets.

“This important science has established a new research method to help us learn more—in advance—about the genetic changes that enable new influenza viruses to spread efficiently and in a continuous manner among people,” said CDC Director Dr. Julie Gerberding. “H5N1 viruses continue to spread among birds worldwide and their genetic properties are constantly changing. There is an urgent need to better understand how these viruses could acquire the ability to spread efficiently between people. This research increases our knowledge, and may enable us to more quickly identify H5N1 viruses and other influenza viruses that have the potential to cause a pandemic.”
(CDC 8/01/06 http://www.pandemicflu.gov )

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USA: HHS adds new anthrax drug to national stockpile
The US government announced Jul 28 that it will add 10,000 courses of anthrax immune globulin (AIG) to the strategic national stockpile. In a press release Jul 28, the Department of Health and Human Services (HHS) said it awarded a $143,833,719 contract to Cangene, based in Winnipeg, Man. Deliveries of AIG, used to prevent or treat inhalational anthrax cause by Bacillus anthracis, to the stockpile are expected to begin in 2007. Full payment to Cangene hinges on the product being approved by the US Food and Drug Administration (FDA); however, the contract permits delivery of the product before FDA approval in an emergency.

The HHS had previously awarded Cangene and another company, Human Genome Sciences, Inc., of Rockville, Md., contracts to test two experimental anthrax drugs.

"Our first line of defense against anthrax is antibiotics," said HHS assistant secretary for public health emergency preparedness Craig Vanderwagen, MD. "While additional studies are underway to determine its efficacy and ultimate role in treatment, AIG may have the potential to provide physicians with a source of human antibodies against the anthrax toxin that could improve the management of patients with the life-threatening toxemia associated with severe anthrax."

Toxins produced by the anthrax bacteria are believed to be a major cause of mortality in infected patients. The HHS says AIG is a potentially promising addition to the options physicians have to prevent and treat anthrax infections.

B anthracis is classified as a category A bioweapon. Anthrax spores sent through the US mail in the fall of 2001 caused 22 cases of anthrax,11 cutaneous and 11 inhalational. Five patients with the latter form died. The source of the anthrax has never been identified.
(CIDRAP 7/31/06 http://www.cidrap.umn.edu )

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USA: Huge cattle feed recall due to mammalian protein
The Food and Drug Administration announced 2 recalls, one for 27 million pounds of feed produced in Michigan and the other an unknown amount of feed produced in Kentucky. Both were suspected of being adulterated with ruminant or mammalian protein, including ruminant meat and bone meal in the 2nd recall.

Vita Plus Corp., Gagetown, Michigan, has recalled 27 694 240 pounds of dairy feed produced between February of 2005 and 16 Jun 2006, because it is believed it was contaminated with mammalian protein. The feed was distributed in Michigan and the recall is complete.

Burkmann Feeds LLC, Glasgow, Kentucky, has recalled an unknown amount of custom feed because it contains an ingredient called Pro-Lak, which may contain ruminant-derived meat and bone meal. The Burkmann feed was distributed in Kentucky.
(Promed 8/9/06)

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USA (Colorado): Third Human case of plague
The 3rd human case of plague in the last 5 weeks has been reported in La Plata County, according to the San Juan Basin Health Department. The male patient was released from the hospital after several days and is recovering at home, said Lynn Westberg, the executive director of the Health Department. While it is the 3rd case of the plague in the county in 2006, there have been 5 human cases in the last 12 months.

"I am quite concerned by the situation in La Plata County right now," said Joe Fowler, regional epidemiologist for the Health Department. "The entire state of Colorado has never had more than 4 cases in a single year, but in 2006, if our residents do not take precautions to protect themselves, La Plata County could single-handedly surpass that number."

In New Mexico in 2006, 2 of the 6 people who have contracted the disease died. Historically, in Colorado, about 1 in 5 cases results in death, the health department said in a news release.

"The plague is so widespread," Fowler said, "that the health department hesitates to say what regions these individual cases are popping up in because people don't think it is in their area. But it's all over Southwest Colorado." Westberg said that no other human cases have been reported in the state, but animals have tested positive in both Archuleta and Montezuma counties as well.

At least 8 animals in Southwest Colorado, including squirrels, household cats and prairie dogs, have tested positive for plague this summer, according to the news release. Cats become infected from flea bites or by direct contact with infected rodents. Plague-infected cats generally will have a history of roaming freely in rural or semi-rural areas, and their owners often report that they are known hunters.

The plague season generally begins in mid-August and continues for about 2 months, Westberg said. If it gets really hot, it will knock it out, she said. "Everyone in Southwest Colorado should be on high alert," Fowler said.
(Promed 8/8/06)

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USA (Rhode Island): Vibrio vulnificus
The Health Department has advised beachgoers not to expose open wounds to saltwater or eat raw or undercooked shellfish. A rare type of bacteria normally found on Gulf Coast beaches has shown up in Rhode Island waters in Narragansett Bay. The bacteria, which can cause infections and nausea and diarrhea in most people, can be life threatening to those with underlying illnesses such as liver disease, AIDS, cancer, diabetes, and blood disorders.

The Vibrio vulnificus bacterium has never been in Rhode Island waters before, according to David R Gifford, director of the state Department of Health. His department yesterday suggested that Rhode Islanders avoid exposing open wounds to saltwater and avoid eating raw or undercooked shellfish. (The shellfish advice is always in effect, Gifford said, because of the potential dangers of eating raw shellfish.)

Of particular concern to the state are the warmer waters of the upper Bay, from Greenwich Bay north to Providence, and inlets, shallow areas and coastal ponds such as Ninigret Pond and the Great Salt Ponds.

Gifford said the bacteria need warm salt water to survive, but he would not rule out the possibility of their presence in cooler parts of the Bay or in the ocean. Nationally, there are about 100 cases of this infection a year, 1/3 of which are fatal, Gifford said.

In the last 5 years, Gifford said, there have been only 2 reported cases of infection by the bacterium in Rhode Island. Both were in people who ate shellfish in other states, Maryland and Connecticut, and then became ill after they returned to Rhode Island.

The latest case is different. Gifford said a man in his 50s or 60s was collecting shellfish near Warwick's Conimicut Point in Jul 2006. A wound on his leg became infected, leading to a serious hospitalization. The man is now recovering, Gifford said. He refused to release more information, saying he did not want to jeopardize the man's privacy.

The state does not routinely test the water for this organism, since it is normally found in warmer waters, Gifford said. But after learning of this man's case, the waters and shellfish around Coniicut Point were tested. On Thu night, 3 Aug 2006, the results came back showing low levels of the bacteria. Gifford said the levels were high enough to issue the advisory notice.

The department is now testing shellfish and water in the upper Bay and other warm saltwater areas, including the inlets and coastal ponds. Results could take a few weeks because of the complexity of detecting the bacteria, Gifford said. The department was not sure how the bacterium got to Rhode Island waters, but Gifford speculated that either the Gulf Stream carried it up here or a ship in the Gulf carried it up here in water in its ballast tank.
(Promed 8/5/06)

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USA (Washington state): Consumers advised to avoid raw oysters from the Pacific Northwest
The FDA is advising consumers to avoid eating raw oysters harvested in the Pacific Northwest [of the USA] as a result of reports that some of the oysters recently harvested from that region were contaminated with Vibrio parahaemolyticus (Vp), a bacterium that can cause gastrointestinal illness.

Nineteen new cases of food poisoning from eating raw oysters have spurred Washington officials to widen a ban on oyster harvesting. At least 188 people in several states and British Columbia -- including 16 Oregonians -- have reported illnesses in recent weeks from eating tainted Northwest oysters. Hundreds more probably have been sickened in what appears to be the 2nd-biggest outbreak of its kind recorded in the USA.

Late on Thu 3 Aug 2006, Washington broadened the ban on recreational and commercial oyster gathering to include all of Hood Canal and Oakland Bay and Skookum Inlet in the South Puget Sound near Olympia. The closures also spread to 2 northern Washington sites: Mystery Bay, near Port Townsend, and Samish Bay, south of Bellingham. Parts of Hood Canal as well as Totten Inlet and Eld Inlet near Olympia were closed the past 2 weeks.

Washington has reports of 91 people infected with the bacterium Vibrio parahaemolyticus from eating undercooked or raw oysters. That is up from 72 cases reported at the start of the week. The number of Oregon cases is unchanged. Health workers have logged at least 75 cases in New York and 6 in British Columbia. A few residents of other states, including Utah and Arizona, have reported getting sick after eating raw oysters in Oregon, said William E Keene, an epidemiologist with Oregon's Acute and Communicable Disease Prevention Program. None of the cases has been definitely traced to oysters from Oregon waters.

Most of Washington's recent reports involve people sickened weeks ago. But a few cases are new, Washington State Department of Health spokesman Tim Church said. Tracing the origin of oysters eaten and testing different oyster beds led to the expanded closures. Washington officials regularly test closed areas and will reopen the harvest once bacterial levels drop to a safe zone, Church said. A combination of warm weather and low midday tides has raised bacteria levels in the water.

Since the condition usually is not severe, many people don't see a doctor or get diagnosed with vibrio infections, Keene said. So "there are undoubtedly hundreds and hundreds of cases happening now," he said, only some of which get reported.
(Promed 8/1/06, 8/5/06)

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USA (California): Fatal case of hantavirus pulmonary syndrome
A summer camping trip in the Sierra Nevada mountains turned tragic for one California family after a man died from a rare virus. The man died 2 weeks ago from hantavirus, becoming the 1st Californian in 3 years to die of the rodentborne virus. Health officials believe the 52 year old was infected near Bridgeport, about 50 miles north of the Mammoth Lakes resort area. He died on 14 Jul 2006, after being transported to a hospital in Reno, Nevada.
(Promed 8/1/06)

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USA (Massachusetts): Pneumonic Tularemia
State public health officials are warning people on Martha's Vineyard about the dangers of a potentially fatal disease known as "rabbit fever," after 6 new cases were identified.

Cases of the disease tularemia, or rabbit fever, have occurred on Martha's Vineyard every year since an initial outbreak in 2000 sickened 15 people and resulted in a fatality, according to the Department of Public Health (DPH). More than 2 dozen confirmed cases have been reported on the island in the last 5 years.

Tularemia is caused by a bacterium found in animals, especially rabbits. It can be contracted through the bite of an infected dog tick, when an open sore or cut comes into contact with the bacteria or by inhaling the spores. Symptoms include a lesion on the skin, swollen lymph nodes and flu-like problems. Tularemia is not spread from person to person. A few people have gotten sick after bites from their infected pet cats.

Those affected on Martha's Vineyard range in age from 33 to 67 and became ill between 13 May and 5 Jul 2006, the DPH said. All 6, 4 of whom are employed as landscapers, have been treated and are recovering, officials said. All of the cases reported in 2006 had the respiratory form of the disease -- pneumonic tularemia -- according to the DPH's announcement late this week. "While landscapers should definitely take precautions, anyone working outside near lawn mowing or brush cutting activities should also be careful," Dr Bela Matyas, DPH medical director for epidemiology, said in a statement.
(Promed 7/31/06)

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Canada: Case of hantavirus pulmonary syndrome imported from Bolivia
On 19 Jun 2006, a 15 year old female resident of British Columbia, Canada was admitted to hospital presenting with respiratory failure. She died the same day. Hantavirus pulmonary syndrome (HPS) was suspected. Three weeks prior to onset of symptoms, she returned from Bolivia, where she took part in activities on farms where rodent droppings were observed. She had no known contact or exposure to rodents or rodent droppings after her return to Canada.

Samples were sent to the National Microbiology Laboratory (Winnipeg, Canada) for testing. Sera was found by ELISA (enzyme linked immunosorbent assay) to be reactive against Sin Nombre antigen, and both lung tissue and blood were PCR (polymerase chain reaction) positive for hantavirus. Given the recent travel history to Bolivia, PCR assays were used that targeted Andes and Laguna Negra hantaviruses. Sequence of these original PCR products identified the virus as an Andes-like strain, and further sequence data (open reading frames of the S and M segments) placed the virus in the Andes Nort clade of hantaviruses, but with an as-of-yet unreported/unique sequence most closely related to Oran virus and Lechiguanas virus.

Unlike the North American Sin Nombre hantavirus, in which person-to-person transmission has not been documented, there have been limited reports of person-to-person transmission of Andes hantavirus in Argentina (Wells, et al. Emerging Infectious Diseases 1997; Martinez, et al. Emerging Infectious Diseases 2005). Because of this concern, about 40 household and health care contacts were put under surveillance for the development of fever and/or other symptoms. After 6 weeks of surveillance, none of the contacts have developed symptoms compatible with HPS. Two contacts with non-specific symptoms were tested and found to be IgM, IgG, and PCR negative. Surveillance of contacts will continue until 8 weeks post last exposure to the case.

Since 1994, 9 cases of hantavirus infection (5 fatal) have been reported in British Columbia, including this one and one other locally acquired Sin Nombre case in 2006. All cases except the one described above have been locally-acquired Sin Nombre infections. Enzootic foci of Sin Nombre virus in Peromyscus maniculatus (deer mice) have been found in several locations in British Columbia (unpublished data, BC Centre for Disease Control and National Microbiology Laboratory).
(Promed 8/3/06)

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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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Dengue
Taiwan The dengue outbreak in Kaohsiung continues to worsen. Since the 1st autochthonous dengue case was reported on 6 Jul 2006 in the Qienzeng district of this city, there have been 28 reported cases. Among these, 25 cases are from Qienzeng district and 3 from Qianjin district. The municipal bureau of diseases prevention and control points out that among the 18 demographic units tested in the 2 prevalent districts, the Aedes-positive ovitrap indices ranged from 75 per cent in Qienzeng and 50 per cent in Qienjin. This means that the area is still in a vulnerable situation for dengue infections.

The health bureau reminds clinicians, especially those in infested districts, to look out for any suspected cases of dengue fever, either of local source or imported through overseas traveling. Should these happen, the clinicians must inform the health authorities.

Hong Kong The Centre for Health Protection (CHP) of the Department of Health confirmed an imported case of dengue fever [from Cambodia] today [19 Jul 2006] and urged people to guard against the disease.

Warning issued on dengue vector: The surveillance program on the prevalence of Aedes albopictus has found that 17 out of 20 areas surveyed tested positive for the area ovitrap index in July 2006.

Thailand Two girls have died of dengue fever, and another 638 people are sick, as the mosquito-borne disease spreads rapidly in Surin province, the local public health office said Tuesday [25 Jul 2006]. The districts of Sanom, Sangkha, Lamduan Jom Phra and the subdistrict of Sri Narong have reported the highest number of dengue cases ever recorded in the province, said health office chief, Dr. Khimhan Yongrattanakij. The 2 girls, aged 9 and 15, died after succumbing to high fever caused by the disease. A teenage boy in northern Thailand who died 25 Jul 2006 was also diagnosed with hemorrhagic fever
(Promed 7/30/06)

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West Nile Virus
Canada
Human cases were reported for week 31 (30 Jul - 5 Aug 2006)from the following provinces: Quebec 1 Manitoba 5

USA Human Cases have been reported from:
State Neuroinvasive / Fever / Unspecified / Total / Fatalities
Arizona 2 / 2 / 1 / 5 / 0
California 7 / 11 / 2 / 20 / 0
Colorado 3 / 8 / 0 / 11 / 0
Idaho 6 / 38 / 1 / 45 / 2
Indiana 1 / 0 / 0 / 1 / 0
Iowa 1 / 3 / 0 / 4 / 0
Kansas 0 / 1 / 0 / 1 / 0
Michigan 1 / 0 / 0 / 1 / 1
Minnesota 6 / 3 / 0 / 9 / 1
Mississippi 11 / 5 / 0 / 16 / 2
Missouri 1 / 0 / 1 / 2 / 0
Nebraska 4 / 4 / 0 / 8 / 0
Nevada 6 / 10 / 1 / 17 / 0
New York 1 / 0 / 0 / 1 / 0
North Dakota 0 / 5 / 0 / 5 / 0
Oklahoma 3 / 0 / 0 / 3 / 0
Pennsylvania 3 / 0 / 0 / 3 / 0
South Dakota 8 / 10 / 0 / 18 / 0
Texas 17 / 0 / 0 / 17 / 0
Utah 3 / 2 / 0 / 5 / 0
-------------------------------------
Totals 84 / 102 / 6 / 192 / 6

As of August 8, 2006 avian, animal or mosquito WNV infections have been reported to CDC ArboNET from the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

Human cases have been reported in Arizona, California, Colorado, Idaho, Indiana, Iowa, Kansas, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New York, North Dakota, Oklahoma, Pennsylvania, South Dakota, Texas, and Utah.
(Promed 8/3/06)

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2. Articles
Avian influenza among waterfowl hunters and wildlife professionals
Researchers who studied Iowa duck hunters and wildlife workers have reported the first laboratory evidence of transmission of an avian influenza virus from wild birds to humans, though not the deadly H5N1 strain. Two laboratory methods showed evidence of past infection with influenza A/H11N9, a less common virus strain in wild ducks, in 3 persons.
http://www.cdc.gov/ncidod/EID/vol12no08/06-0492.htm
(Emerging Infectious Diseases August 2006 / 12(8): 1284-6; CIDRAP 7/28/06
http://www.cidrap.umn.edu )

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WHO WER, Volume 81, Number 32—August 11, 2006
WHO Weekly Epidemiological Record, volume 81, number 32 (page 309–316) is now available at: http://www.who.int/wer/2006/wer8132/en/index.html. This issue discusses the global leprosy situation.

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WHO WER, Volume 81, Number 31—August 4, 2006
WHO Weekly Epidemiological Record, volume 81, number 31 (page 293–296) is now available at: http://www.who.int/wer/2006/wer8131/en/index.html. This issue discusses the sharp increase in cholera reported in 2005.

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WHO WER, Volume 81, Number 30—July 28, 2006
WHO Weekly Epidemiological Record, volume 81, number 30 (page 293–296) is now available at: http://www.who.int/wer/2006/wer8130/en/index.html. This issue discusses onchocerciasis (river blindness) in the Americas.

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3. Notifications
APEC Pandemic Response Exercise - Lessons Learnt Workshop
Aug 14-15, 2005, Singapore
(http://www.apec.org )

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10th International Dengue Course & Symposium
6-17 August 2007, Havana, Cuba
The Pedro Kouri Tropical Medicine Institute (IPK) is pleased to announce its 10th International Dengue Course, 6-17 Aug 2007, and its Symposium "25 Years of Experience Struggling against Dengue", from 9-11 Aug 2007, which will be held at IPK's facilities, Havana, Cuba.

Both the Course and the Symposium will received all those professionals working or researching on dengue and hemorrhagic dengue (physicians, virologists, immunologists, sociologists, epidemiologists, entomologists, health managers, among others interested in this field).
(Promed 7/28/06)

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Roche Publishes Pandemic Planning Toolkit
Roche has developed a guide to help organizations prepare for a possible influenza pandemic.
http://www.pandemictoolkit.com/

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CDC' releases updated Sexually Transmitted Diseases Treatment Guidelines, 2006
Available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm

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CDC releases recommendations on use of varicella vaccines
http://www.cdc.gov/nip/ACIP/default.htm

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 apecein@u.washington.edu