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Vol. IX, No. 17 ~ EINet News Briefs ~ Aug 25, 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: Proposal to share avian influenza data
- Global: Experts worry that antivirals may mask avian influenza
- Global: Caucasus, Balkans at high risk for deadly H5N1 virus: Disease continues to spread in Africa, Asia and the Near East
- Netherlands: Dutch order poultry indoors to prevent bird flu
- Russia: Human anthrax in West Siberia
- Russia: 5 persons ill with botulism after eating canned mushrooms
- Indonesia: 46th bird flu death confirmed
- China: Antibiotic contamination blamed for 6 deaths and dozens of illnesses
- China: Undiagnosed febrile illness among infants in Qingdao, Shandong Province
- China: Highly pathogenic avian influenza in China: Follow-up Report No. 19
- China: Human bocavirus infection confirmed
- China: Snails cause meningitis in Beijing
- Cambodia: 2 new outbreaks of the deadly bird flu virus in ducks
- Indonesia: 61st suspected case of avian influenza
- Indonesia: 60th confirmed case of bird flu
- Malaysia: Hand, Foot & Mouth Disease Cases in Sarawak Reach 13 800
- Thailand: New strain of avian influenza poses no added human hazard
- Thailand/Laos: Recent wave of bird flu in poultry in result of both old and new strains of H5N1
- Thailand: Increased failure rate in diagnostic testing for human avian influenza
- Viet Nam: 2 suspected cases of avian influenza test negative
- Viet Nam: Avian influenza may break out from 8 million geese
- Viet Nam: Ban on transporting poultry, cattle
- USA: CDC and APHL make influenza virus sequence data publicly accessible
- Trinidad & Tobago: Low strain bird flu found
- USA (California): Paragonimiasis from eating raw imported freshwater crab
- USA (California): 12 cases of Vibrio parahaemolyticus after consumption of raw oysters
- USA (California): Tick-borne relapsing fever
- USA (Washington): Red tide shuts down shellfish beds
- Egypt:Avian influenza Follow-up report No. 3

1. Updates
- Influenza
- West Nile Virus

2. Articles
- Pandemic influenza preparedness in the Asia–Pacific region
- Long-Term Clinical and Neuropsychological Outcomes of West Nile Virus Infection
- Imported Melioidosis --- South Florida, 2005

3. Notifications
- CDC releases recommendations on prevention of rotavirus gastroenteritis among infants and children
- 8th International Feline Retrovirus Research Symposium
- Biological Crisis Management in Human and Veterinary Medicines 2006.


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 / 12 (8)
Djibouti / 1 (0)
Egypt / 14 (6)
Indonesia / 43 (35)
Iraq / 2 (2)
Thailand / 2 (2)
Turkey / 12 (4)
Total / 96 (64)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 241 (141).
(WHO 8/23/06 http://www.who.int/csr/disease/avian_influenza/country/en/index.html )

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Global: Proposal to share avian influenza data
Agreement has been reached in principle to release avian influenza data. Researchers studying avian influenza say they have agreed to share data that were previously being kept behind closed doors -- a move they hope will speed insights into the virus that threatens to spark a human pandemic. Some countries and organizations have come under fire for hoarding genetic information about the virus. The data have been kept under wraps partly because of concerns that other groups might use them and publish scientific findings without giving due credit to researchers involved.

Now many leading avian influenza scientists have tentatively agreed to share data as part of an effort called the Global Initiative on Sharing Avian Influenza Data (GISAID). In essence, the participants have agreed to place genetic sequences into secure sections (which have not yet been set up) of existing online databases, as soon as possible after producing and analysing them. The group proposes using the International Nucleotide Sequence Database Collaboration, a network of 3 major public databases, for the collection.

The data will at first only be accessible to scientists who have signed the agreement, but will become open to the public after 6 months at the most. Scientists who sign up make a promise to share their sequences. They must also agree to collaborate with, and appropriately credit, all other researchers in publications and intellectual-property agreements.

By storing all the sequences in a designated place and allowing more open access, the hope is that researchers will be able to carry out comparisons quickly of one new strain against many others from both animals and humans. This type of analysis can reveal whether a virus is acquiring mutations as it spreads between bird flocks, or -- should the virus start spreading between people -- whether it is becoming resistant to drugs.
(Promed 8/24/06)

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Global: Experts worry that antivirals may mask avian influenza
Avian flu experts in two of the countries with the most human H5N1 avian influenza cases to date—Vietnam and Thailand—are warning that the antiviral drug oseltamivir may mask the infection and complicate laboratory detection.

Menno de Jong, a virologist at an Oxford University clinical research unit in Ho Chi Minh City, Vietnam, told Bloomberg News this week that avian influenza may go undetected in patients who take the drug days before testing. An incorrect diagnosis is problematic because it may hamper early detection of disease spread.

Some countries are responding to local human H5N1 avian influenza outbreaks by distributing oseltamivir to local citizens. For example, the Jakarta Post reported this week that Indonesia's health ministry had distributed the drug to 2,100 villagers in Garut, a district in West Java, Indonesia, where three recent cases have been documented (one not yet in the World Health Organization's [WHO's] official count) and authorities are investigating the possibility of human-to-human transmission.

Antiviral drugs such as oseltamivir are designed to reduce the duration of viral replication and should be taken within 48 hours of symptom onset, according to WHO recommendations. However, De Jong's team, which observed 18 cases in Vietnam, found that analysis of nasal and throat swabs taken from patients 48 to 72 hours after beginning oseltamivir treatment was unable to detect the virus.

Meanwhile, a public health official in Thailand expressed the same concerns about possible false-negative testing results for the H5N1 avian influenza virus in patients who take oseltamivir. In an article that appeared in The Nation, a Thai daily newspaper, Paijit Warachit, director-general of the Department of Medical Sciences, said that initial laboratory tests did not detect the H5N1 avian influenza virus in the country's two most recent cases.
(CIDRAP 8/24/06 http://www.cidrap.umn.edu)

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Global: Caucasus, Balkans at high risk for deadly H5N1 virus: Disease continues to spread in Africa, Asia and the Near East
The deadly H5N1 avian influenza virus, or bird flu, continues to threaten people, animals and economies in a growing number of countries, according to FAO, despite numerous successful efforts in several countries to contain the spread of the virus.

Though the disease has now been confirmed in some 55 countries in Africa, Asia and Europe, up from 45 in April this year, the rate of infection among poultry has slowed in most countries, according to FAO surveillance reports, thanks to programmes and projects to improve surveillance efforts, strengthen veterinary services and in some cases through the implementation of vaccination campaigns.

The deadly virus continues to spread in Asia, particularly in Indonesia where 45 people were confirmed to have died from bird flu. There have also been new outbreaks in Thailand recently and HPAI has been confirmed at a commercial poultry farm in Laos.

HPAI is also problematic in some African countries including Côte d’Ivoire and Nigeria, where FAO’s Emergency Prevention System reports outbreaks in poultry farms near Abeokuta, the capital of Nigeria’s southwestern state of Ogun.

“In Europe, we believe the southern Balkan area and Caucasus are a high-risk region for H5N1,” said Juan Lubroth, head of FAO’s Emergency Prevention System for Transboundary Animal Diseases. “The region is not only a prime resting ground for migratory bird species, but poultry production is mostly characterized by rural and household husbandry with little in terms of biosecurity and strong regulatory inspection. In Romania it is still too early to say if the situation has stabilized.”
(FAO 8/21/06 www.fao.org)

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Europe/Near East
Netherlands: Dutch order poultry indoors to prevent bird flu
The Dutch Agriculture Ministry ordered farmers on Tuesday [22 Aug 2006] to keep their poultry indoors from 1 Sep 2006 to protect flocks from the threat of avian flu from migrating birds.

"During the forthcoming migration period, there is a risk that migratory birds can spread bird flu," the ministry said in a statement. "For this reason, all holders of chickens, geese and other birds should keep them indoors." [The official press release says, "chickens, geese and other poultry, including waterbirds." - Mod.AS]

Alternatively, farmers can construct an enclosure that would make contact with wild birds impossible, it said.

The Netherlands, Europe's 2nd biggest poultry producer after France, reported 2 suspected cases of the highly pathogenic H5N1 bird flu in owls at a Rotterdam zoo earlier this month [August 2006] but later said initial tests ruled out the disease. Final test results are due later this week.
(Promed 8/23/06)

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Russia: Human anthrax in West Siberia
A man in West Siberia has been diagnosed with anthrax, a spokesman for the local emergency situations West Siberia department said Tuesday [15 Aug 2006]. He said the man had been hospitalized on 10 Aug 2006 in the Altai Territory. "The situation with the 40-year-old suffering from anthrax ... is under the control of the Emergency Situations Ministry," the spokesman said. The ministry representative added that the patient felt well and that his condition was not life threatening. He said the man may have been infected while slaughtering a cow.

Local authorities have imposed quarantine restrictions in the village where the man lived, and no other anthrax cases have been reported, the spokesman said.
(Promed 8/16/06)

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Russia: 5 persons ill with botulism after eating canned mushrooms
After eating canned mushrooms of domestic preparation, 5 inhabitants of the Tambov region have fallen ill with botulism. These are the 1st cases of botulism in 2006. Among those affected are 2 local inhabitants and their relatives who were visiting from Moscow and Voronezh.

The implicated mushrooms, _Lepista nuda_, were collected and preserved in 2005. The [day after consuming the mushrooms], those affected became ill with weakness, vomiting, and diarrhea. The patients did not seek medical attention on the 1st day and [instead treated themselves]. When the visitors from Moscow returned home, [they sought] medical aid. Doctors in Tambov have taken measures to identify other victims after physicians from Moscow sent them information about cases of botulism.

Now 6 more inhabitants of the village of Kulichevka are [under observation by] infectious disease physicians, including 3 children under 14 years old; 4 more victims are undergoing treatment in clinics in Moscow, Voronezh, and Tambov.
(Promed 8/19/06)

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Asia
Indonesia: 46th bird flu death confirmed
A 35-year-old woman was Indonesia's 46th bird flu death, health authorities said today [20 Aug 2006] as they stepped up an urgent probe into whether she may belong to a [suspected] cluster of cases.

The woman came from Cikelet, a group of villages in West Java's Garut district, where 2 other people -- one of whom remains alive -- have been confirmed as being infected with H5N1. At least 16 others are being tested.

Three other people from Cikelet have also died recently while exhibiting possible bird flu symptoms but were not tested for the virus, heightening concern that limited human-to-human transmission may have occurred in the area. Health Minister Siti Fadilah Supari told ElShinta radio that one of the 3 people who died of possible bird flu was the child of the latest victim, the 35-year-old female patient.

The minister said samples from a further 16 people in the area had been taken for testing. Of 3 suspected bird flu cases earlier hospitalized in the provincial capital of Bandung, 2 have [tested negative], but test results for the 3rd were not yet available, she said.
(Promed 8/19/06, 8/20/06)

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China: Antibiotic contamination blamed for 6 deaths and dozens of illnesses
Investigators say that the makers of a Chinese antibiotic blamed for 6 deaths and dozens of illnesses failed to properly sterilize the drug, which allowed dangerous amounts of bacteria to grow in it, state media said Tuesday. The government ordered a recall of batches of the drug last month after a 6-year-old girl died. At least 5 more deaths were later blamed on the clindamycin phosphate glucose manufactured by Anhui Huayuan Worldbest Biology Pharmacy Co. China's national drug regulator said the deaths were caused by "improper manufacturing" and has promised to punish people responsible for the mistakes, the official Xinhua News Agency said.

"The drug should go through a 30-minute disinfection process at 221 degrees," Xinhua quoted Wang Zhexiong, an official with the state Food and Drug Administration (FDA), as saying. "But the company lowered the temperature to between 212 degrees to 219 degrees and shortened the time to only 1 to 4 minutes," Wang said.

A team sent to investigate the manufacturer in Anhui province found "excessive bacteria" in the sample they took, Xinhua said. Wang said further analysis was needed to find out what kind of bacteria the sample contained.

The FDA has promised to punish the manufacturer for its production faults and hold related producers and managers accountable, but the agency did not give details, Xinhua said.

The company had produced 3.7 million bottles of the injection since June 2006, with most of that sold in 26 provinces across China, it said. So far, more than 1.2 million bottles have been recalled and more than 403 000 bottles have been located and sealed up, Zhang Jixiang, another FDA official was cited as saying. He could not account for the remaining stock.
(Promed 8/18/06)

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China: Undiagnosed febrile illness among infants in Qingdao, Shandong Province
Three Hospitals have treated nearly 200 patients a day with high fever. According to Children's Hospital, Haici Hospital and No. 8 People's Hospital, a strange virus [i.e. illness] has afflicted infants under 2 years of age over the past week. These 3 hospitals alone treated about 200 patients a day. The most typical symptom in these children is a continuous fever of about 39 C. About 3 hours after antipyretic infusion, body temperature commonly rises again. Many parents take their children to the hospital 3 or 4 times a day. But most of these children have not had other ailments. Recovery typically takes place after a week of treatment. According to expert analysis, this [outbreak] may have something to do with the recent heat wave in Qingdao.

According to the Children's Hospital, recurrent high fever is unusual. "For children to come down with this type of virus [virus involvement cannot not be assumed from this description - Mod.CP] is a bit unusual! Only 3 hours after intravenous drip, body temperature can rise again," said Municipal Children's Hospital ER Director Xu Jing. "We ran blood tests on every child, and the results were basically normal. And there are no complications. Over the past week, our clinical staff has been worn out treating children. In a single day, we might treat more than 80 infants with fever caused by unknown illness. Among these, the youngest is 40 days old and the oldest 2 years old," said Xu Jing.

Experts at the municipal Center for Disease Control believe that admission to hospitals of large numbers of infants with sustained high fevers is likely due to the abnormal weather in Qingdao, created by continuous high heat and humidity. Parents are advised to be cautious about food hygiene with toddlers and prevent the effects of the weather from causing the pathogen [pathogens?] to reproduce and accelerate transmission.
(Promed 8/20/06)

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China: Highly pathogenic avian influenza in China: Follow-up Report No. 19
New outbreak:
First administrative division (province): Hunan
Lower administrative division: Changsha
Type of epidemiological unit: village
Name of the location: Hanhui
Date of start of the outbreak: 4 Aug 2006
Species: avians
Number of animals in the outbreak: susceptible/ cases/ deaths/ destroyed/ slaughtered
.../ 1805/ 1805/ 217 000/ 0
(Promed 8/19/06)

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China: Human bocavirus infection confirmed
Chinese scientists have diagnosed a child suffering from respiratory illness as being infected with human bocavirus, which was identified only last year [2005], an official newspaper reported on Monday [21 Aug 2006]. The child, from Chenzhou in the central Chinese province of Hunan, had been admitted to hospital with a severe respiratory infection, the Guangming Daily said. DNA tests then confirmed the child had contracted the virus, the newspaper said. It did not give other details about the case.

Last August 2005, Swedish researchers said they had identified a previously unknown virus that may cause many cases of serious respiratory infections in children. They named the virus human bocavirus and suggested researchers start a systematic search for all the viruses that cause respiratory infections.
(Promed 8/21/06)

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China: Snails cause meningitis in Beijing
At least 50 people have been diagnosed as suffering from a parasite-caused meningitis after eating raw or half-raw snails at Beijing restaurants.

It is the first time the so-called Guangzhou angiostrongylus meningitis has been found in Beijing, according to the Beijing Municipal Health Bureau's website. It has warned people not to eat raw seafood, which may carry parasites that threaten health.

The 1st case, involving a 34-year-old man, was found by the Beijing Friendship Hospital in June [2006]. The patient suffered from unbearable headaches and nausea after eating a dish called cold snail meat in [a local] restaurant. The snail meat was from Amazonian snails Fushouluo in Chinese a popular dish in Sichuan-style restaurants in Beijing.

Doctors took samples from the restaurant and found the parasite in 2 of the snails. By last Thursday [17 Aug 2006], 23 people had been found to suffer from the meningitis in the capital's hospitals, said the bureau. They had all eaten cold or spicy snail meat, from Amazonian snails, at branches of the same restaurant.

According to the bureau, 5 of the 23 were in a serious condition, 3 had left hospital, and 2 were seemingly self-cured. No deaths have been reported.
(Promed 8/21/06)

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Cambodia: 2 new outbreaks of the deadly bird flu virus in ducks
Cambodia has detected 2 new outbreaks of the deadly bird flu virus in ducks, just days after the disease resurfaced for the 1st time in more than 4 months.

"We have discovered 2 more outbreaks of bird flu, but it has not infected the people yet," Kao Phal, the director of animal health at the agriculture ministry, told AFP on Friday [18 Aug 2006]. Both the new outbreaks of the H5N1 virus were in Kampong Cham province, just northeast of the capital Phnom Penh, he said.

One outbreak originated with ducks from the region where bird flu was detected on 12 Aug 2006, after a farmer smuggled 2000 ducks out of the area where authorities were slaughtering birds to prevent the disease from spreading, he said. Those ducks were taken to Tbong Khmum district, 125 kilometers (80 miles) northeast of the capital, where most of them had died by Friday [18 Aug 2006], Kao Phal said. Health authorities slaughtered the remaining ducks, and one official was fired for failing to prevent the movement of the birds, he added.

A separate outbreak was detected in nearby Batheay district, where ducks began falling ill on 12 Aug 2006. Kao Phal said 600 birds in that district have died or been killed.
(Promed 8/19/06)

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Indonesia: 61st suspected case of avian influenza
Another suspected human case of bird flu was reported on Wed [23 Aug 2006] in Simalungun regency near Medan, North Sumatra, despite the government's assurances it is doing its utmost to bring the [H5N1] virus [outbreak] under control.

A 35-year-old woman was admitted to Adam Malik Hospital after showing symptoms of bird flu. Simalungun is close to Karo regency where 8 people in one family died after contracting H5N1 last May in the world's largest cluster of cases. If [samples taken from her prove] positive, the woman may have contracted [infection] from chickens in her neighborhood which had died suddenly and tested positive for the disease.

There are still 4 people suspected of having bird flu in Cikelet, but they have not been hospitalized because their condition is improving. However, another person suspected of having bird flu was admitted to Hasan Sadikin Hospital in Bandung.
(Promed 8/24/06)

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Indonesia: 60th confirmed case of bird flu
A 6-year-old Indonesian girl tested positive for bird flu on Tuesday [22 Aug 2006], a government official said, as the World Health Organisation ruled out human transmission in a village with a series of confirmed and suspected bird flu cases.

The girl from Bekasi, an eastern suburb of Jakarta, is the 60th case of avian influenza in Indonesia, 46 of which have been fatal. "The girl is still alive and receiving treatment in hospital. She is getting better," I Nyoman Kandun, Director General of Communicable Disease Control, told reporters.

Indonesia has seen a steady rise in human bird flu deaths this year and the virus is endemic in poultry in nearly all of the provinces of the sprawling archipelago. Fears of a possible new cluster arose after a 35-year-old woman from the West Javan village of Cikelet who died was confirmed to have been infected by bird flu [virus]. Her 9-year-old daughter died a week before after showing signs of bird flu, although no samples were taken for testing. They are among 18 people in the area being investigated for suspected bird flu.

"Though some of these undiagnosed deaths occurred in family members of confirmed cases, the investigation has found no evidence of human-to-human transmission and no evidence that the virus is spreading more easily from birds to humans," the WHO said in a statement.
(Promed 8/22/06, 8/23/06; CIDRAP 8/23/06 http://www.cidrap.umn.edu)

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Malaysia: Hand, Foot & Mouth Disease Cases in Sarawak Reach 13 800
Sarawak state in eastern Malaysia has detected 23 new cases of Hand, Foot and Mouth Disease (HFMD) in the past 24 hours, an official said on Sun 20 Aug 2006. Among the new cases reported up to 10 a.m. local time (0200 GMT) on Sunday, 10 children have been hospitalized, said State Deputy Chief Minister George Chan. Six of the children were admitted to the Miri hospital, 2 to the hospital in Bintulu and the rest in Sibu and Limbang, said Chan, who is also Chairman of the State Disaster Relief Management Committee.

The latest figure brought the total number of children infected since the disease broke out early this year [2006] to 13 800, Chan said at a news conference in Kuching, capital of the state. Throughout the state, Sibu registered the highest number with 3025 cases, followed by Miri (2872), Kuching (2125), Bintulu (1761) and Sarikei (946). So far, the disease has claimed 13 lives, including 7 who have tested positive for Enterovirus 71 (EV71).
(Promed 8/21/06)

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Thailand: New strain of avian influenza poses no added human hazard
Recent outbreaks of H5N1 bird flu in Thailand were caused by 2 strains of the virus, but neither of them showed any significant mutation that would enable them to jump easily to people or spread with ease among humans.,p> Yong Poovorawan, a professor at Chulalongkorn University's Medical Faculty in Thailand, analysed 2 H5N1 samples taken from infected chickens in Thailand's central Pichit province and one taken from northeastern Nakhon Phanom province last month. The 2 samples from Pichit closely resembled a H5N1 strain that had circulated in Thailand in 2004 and 2005, his laboratory found. But the one from Nakhon Phanom was a new strain that had never been seen in Thailand and was most closely related to a strain that had been circulating since 2005 in southern China.

Genetic analyses showed all three samples had undergone slight mutations -- which are typical of influenza A viruses that have circulated for some time -- but the changes did not make them any more dangerous to people, Poovorawan said. "There was no change in their receptor binding sites and there was no change in their resistance to (anti-viral) Tamiflu," he said, referring to 2 key traits of H5N1. Scientists look at these traits when determining if there may be changes in H5N1 that would enable it to jump more easily to people and spread easily among them.
(Promed 8/18/06)

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Thailand/Laos: Recent wave of bird flu in poultry in result of both old and new strains of H5N1
Laboratory results show that a recent wave of bird flu in poultry in Thailand and Laos was the result of both old and new strains of the H5N1 virus, the United Nations Food and Agriculture Organization (FAO) said today, calling for vigorous implementation of control measures to prevent further spread of the disease.

The FAO says last month's outbreak in Thailand's Pichit province was caused by the same strain that has been circulating in the area since 2003, meaning the virus has become endemic to the region.

Outbreaks in Thailand's Nakhon Phanom province and Vientiane in Laos, on the other hand, were caused by strains that did not exist there previously but that did resemble ones found in southern China, the FAO said.

"Timely reporting and sharing information continue to be crucial," said He Changchui, FAO's Regional Representative for Asia and the Pacific, pointing out that while some countries can beat back occasional bird flu reoccurrence, poorer countries still need funding to strengthen veterinary services and build up transboundary animal disease containment programmes.
(Promed 8/19/06, 8/17/06 FAO www.fao.org)

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Thailand: Increased failure rate in diagnostic testing for human avian influenza
Health officials say changes caused by the drug oseltamivir might be the reason why tests on 2 recent cases were negative initially. The H5N1 avian influenza virus has become more complex, probably as a result of the antiviral drug oseltamivir, and that has caused complications in detecting it in the laboratory, the Public Health Ministry said yesterday [Thu 17 Aug 2006].

Dr Paijit Warachit, director-general of the Department of Medical Sciences, said there had been laboratory failures in detecting the [H5N1] virus during the first tests of the 2 most recent cases of bird flu in 2006. "It's been more difficult to test [the virus] this year," he said. Both cases were confirmed as H5N1 in a ubsequent test.

"It may be because the progress of the disease [in humans] has become more complicated," Paijit said. One factor could be the effect of oseltamivir, or tamiflu, which is believed to be the only effective defence against bird flu in humans. The drug, Paijit said, was only able to prevent the virus from replicating and did not destroy it. That meant little of the virus was excreted into that part of the respiratory tract where specimens are taken for testing. "[Medical staff] took swabs in that area, yet as it turned out there was not enough of the virus to enable them to detect it," he said. "The virus was deeper in the respiratory passage."

Since 2004 when bird flu emerged in Thailand, the ministry has tested more than 4000 people for the virus and the failure rate due to [incorrect specimen collection] had been only 3 per cent, he said. But that figure had risen to 20 per cent in 2006, Paijit said. "We need to continue our studies to see whether the virus will become more and more difficult [to detect] in the future," he said.

In response to findings by Chulalongkorn University scientists that a new form [i.e. strain] of the virus had been detected in Nakhon Phanom, Paijit said this strain had yet to infect humans. The virus was found in poultry and it would probably be more virulent than the old one, he said.
(Promed 8/19/06)

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Viet Nam: 2 suspected cases of avian influenza test negative
A patient from the Mekong delta province of Hau Giang, who was hospitalized on 3 Aug 2006 and died on 6 Aug 2006 at the Ho Chi Minh City Tropical Hospital, was not infected with H5N1 avian influenza virus, the Public Heath Ministry officially reported on Fri 18 Aug 2006. This has been the 2nd suspected H5N1 infection case in Kien Giang and Hau Giang southern provinces since early this month [August 2006], but both cases have tested negative to the H5N1 virus.

No new human cases of H5N1 have been reported in Viet Nam for 10 months now.
(Promed 8/20/06)

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Viet Nam: Avian influenza may break out from 8 million geese
H5N1 has been found in unvaccinated ducks and geese in southern provinces. Meanwhile, the Veterinary Department is unable to produce a vaccine for geese, which signals a high risk for a recurrence of the bird flu epidemic in Viet Nam.

In southern Ben Tre province, 50 ducks and geese tested positive for H5N1. The local veterinary agency has sent 600 blood samples of 300 ducks and geese to the HCM City Veterinary Centre for testing.

Mai Van Hiep, head of the provincial Veterinary Agency, said that the local government should not ban farmers from rearing ducks and geese. Ben Tre currently has around 700 000 ducks and geese. Its ducks have received the 1st vaccination only. The province is preparing for the 2nd injection.

In Tien Giang province, analyses of blood samples of 11 geese that were not vaccinated shows that up to 2/3rds of the samples were positive for type A/H5N1 virus.
(Promed 8/23/06)

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Viet Nam: Ban on transporting poultry, cattle
Viet Nam has banned transport of fowl, cattle and related products in public transport vehicles, like buses and coaches, in a move to prevent potential disease outbreaks, local media reported Monday [21 Aug 2006]. Under a recent instruction of the Transport Ministry, the country, besides ensuring the enforcement of the ban nationwide, will intensify control movements of poultry, cattle and related products in border areas, said Viet Nam Agriculture newspaper.

The Vietnamese government on 8 Aug 2006 instructed state agencies and localities nationwide to beef up management and inspection of transport, slaughtering, trade and import of fowl and related products, including placing a temporary ban on import of live poultry and related products from countries hit by bird flu, combating poultry smuggling more fiercely, enforcing the existing ban on raising fowl in inner areas of major cities, and continuing bird flu vaccination.
(Promed 8/23/06)

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Americas
USA: CDC and APHL make influenza virus sequence data publicly accessible
Scientists at the Centers for Disease Control and Prevention (CDC) have released genetic blueprints for over 650 genes of influenza viruses into a database accessible to researchers worldwide. The action marks the beginning of a collaboration between the CDC and the Association of Public Health Laboratories (APHL) that will allow for greater access to data on a variety of influenza virus samples obtained from patients in the United States, including avian influenza H5N1 if it should arrive here.

Through the new collaboration, CDC expects to provide genetic information for several hundred influenza viruses per year as a way to encourage more research on influenza. The sequence data will be available in nearly real time through GenBank, the public-access library for virus sequences managed by the National Institutes of Health, and through an influenza database housed at Los Alamos National Laboratories (LANL). The information added will include viruses from the annual flu season in the United States, any animal influenza viruses that infect humans and any novel strains that may emerge such as avian influenza H5N1. The new agreement will only apply to viruses isolated in the United States.

Previously, the influenza sequences were available to a small number of influenza researchers who work together with WHO to recommend which influenza viruses should be included in influenza vaccines around the world. The sequence data will now be available through GenBank to anyone with Internet access.
(Promed 8/22/06, CIDRAP 8/23/06 http://www.cidrap.umn.edu, CDC 8/22/06 www.cdc.gov)

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Trinidad & Tobago: Low strain bird flu found
The agriculture Ministry yesterday [18 Aug 2006] announced that a "low pathogenic strain" of avian influenza (AI) has been detected at a farm in Central Trinidad. The Ministry said it should not be confused with the H5N1 strain of AI that is responsible for deaths in Asia and Western Europe.

The Ministry said the low pathogenic strain of AI (LPAI) "does not pose a significant threat to human beings." "It does have some agricultural significance, as it may cause deaths in poultry, although the impact on the country's poultry industry is expected to be negligible," the release stated.

Samples have been sent to the United Kingdom for verification, and the Ministry said measures are being implemented to contain the spread of the disease. The Ministry is taking a "positive" view of the identification of LPAI, saying it provided proof that measures implemented to detect bird flu were effective. No information was available regarding culling of birds at the farm, which was not identified.
(Promed 8/20/06)

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USA (California): Paragonimiasis from eating raw imported freshwater crab
Two cases of this parasitic infection have been identified in persons who consumed live, imported, freshwater crabs in a restaurant in Orange County, Santa Ana, CA, USA.

"The Orange County Health Care Agency has received reports of 2 cases of lung fluke infection caused by the parasite Paragonimus. These infections are usually related to eating raw or undercooked freshwater crab that is infected with the parasite," said Dr. Hildy Meyers, Medical Director of Public Health Epidemiology and Assessment.

Lung fluke infection can be a serious illness in humans, but it is not transmitted from person-to-person. Symptoms of lung fluke infection can include cough, difficulty breathing, diarrhea, abdominal pain, fever and hives. The parasite, Paragonimus, can migrate from the lungs to other organs, and infection can last for years. Medication is available to treat the infection. "We encourage anyone who has developed any of these symptoms after eating raw or undercooked freshwater crab, even if the symptoms are mild, to contact their physician as soon as possible and provide information about when and where raw crab or crayfish may have been consumed. In many people, onset of symptoms may not occur until 6-10 weeks after ingestion of raw, undercooked, salted or pickled crab. It is also very important that freshwater crab and crayfish are properly cooked and not undercooked before they are eaten," Dr. Meyers stated.
(Promed 8/20/06)

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USA (California): 12 cases of Vibrio parahaemolyticus after consumption of raw oysters
The San Diego County Health and Human Services Agency has received reports of people possibly sickened by eating raw oysters, and it is urging precautions. 12 people have been infected with Vibrio parahaemolyticus, a bacterium common to oysters. The cases were reported from 1 Jun 2006 through Thu 17 Aug 2006. Nine people said they had eaten raw oysters in Mexico or the USA shortly before becoming ill.

[These are cases diagnosed in southern California. The original source of the shellfish eaten in these cases is not stated (while exposure may have occurred in Mexico, the source of the shellfish was not mentioned). - Mods.LL/MPP]
(Promed 8/21/06)

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USA (California): Tick-borne relapsing fever
A rare tick-borne disease is making its rounds at Lake Tahoe at an unprecedented pace, according to health officials. Tick-borne relapsing fever is non-lethal in most cases, but can result in serious complications if left untreated.

People contract the disease from soft ticks, which live in the nests of small animals like mice and chipmunks. Rustic, rodent-infested cabins are often a source of the disease.

"The Tahoe Basin is becoming a hotbed for this disease," said El Dorado County Health Officer Jason Eberhart-Phillips. Five cases were reported here in 2005, and health officials have identified 3 cases so far this summer [2006].

There are only about 25 cases of tick-borne relapsing fever in the USA each year, according to the CDC, primarily in high-altitude, coniferous Western forests.
(Promed 8/21/06)

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USA (Washington): Red tide shuts down shellfish beds
The worst red tide in perhaps a decade has shut down shellfish beds all along Puget Sound and prompted serious public health worries, state officials said Wednesday. But industry officials worried that more bad news could further damage businesses already reeling from a separate bacterial outbreak.

The eastern Kitsap Peninsula also has been affected, along with areas near Port Gamble, Port Ludlow and along the Strait of Juan de Fuca, said Frank Cox, a Health Department marine biotoxin coordinator.

Scientists were particularly worried by very high levels of the toxic organisms called Alexandrium sp., which produce powerful neurotoxins that cause paralytic shellfish poisoning in humans.

The large bloom of toxic algae also was worrisome for the state's shellfish farmers, who battled a recall of raw oysters [in July 2006] after a separate outbreak of vibriosis, a bacterial illness.
(Promed 8/24/06)

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Africa
Egypt:Avian influenza Follow-up report No. 3
To date, the results of active and passive surveillance for highly pathogenic avian influenza indicate that there have been no positive cases in domestic or wild birds since 30 Jun 2006.

The results of laboratory tests for highly pathogenic avian influenza in zoo birds in all the governorates indicate that there have been no positive cases of highly pathogenic avian influenza since 24 Apr 2006.
(Promed 8/19/06)

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1. Updates
Influenza
Seasonal influenza activity in the APEC Economies
(WHO 8/17/06 http://www.who.int/csr/disease/influenza/update/en/ )
Seasonal influenza activity, weeks 27-30, 2006
During weeks 27–30, with the exception of New Zealand, where high levels of influenza activity were reported, overall influenza activity in both northern and southern hemispheres was low.
Australia. Localized influenza A activity was reported during weeks 27–30.
Chile. Localized influenza A(H3N2) and A(H1N1) activity continued to be reported during weeks 27–29.
Hong Kong Special Administrative Region of China. Influenza A(H1N1) virus has been circulating since the first week of 2006 together with B virus. Since week 11 A(H1N1) virus has predominated. Activity started to increase during week 23 and remained at a high level until week 30.
New Zealand. An increase in A(H3N2) activity was observed during week 23. Since week 25, activity was reported as regional until week 30, when widespread A(H3N2) activity was reported.
Thailand. Localized influenza A(H1N1) activity has been reported since week 26.
During weeks 27–30, low influenza activity was reported in Canada (A and B), Japan (H3 and B), and Mexico (A). Philippines reported no influenza activity.

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. Read the EMPRES WATCH - Asia: Updated situation of Highly Pathogenic Avian Influenza (H5N1) in Asia
- OIE: http://www.oie.int/eng/en_index.htm. Read this week’s updated animal health news
-US CDC: http://www.cdc.gov/flu/avian/index.htm US 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/disease_information/avian_influenza/index.jsp Very frequent news updates.
(WHO; FAO, OIE; CDC; CIDRAP; PAHO; AVMA; USGS)

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West Nile Virus
Canada
Human cases were reported for week 32 (as of 12 Aug 2006) from the following provinces:
Quebec 1
Manitoba 16

Of the 7 provinces testing dead wild birds for West Nile virus, those having positives include: Alberta, Manitoba, Ontario, and Saskatchewan

USA
Human Cases have been reported from:
State / Neuroinvasion* / *West Nile* fever** / Other*** / Total **** / Fatalities
Arizona / 2 / 2 / 1 / 5 / 0
Arkansas / 4 / 0 / 0 / 4 / 0
California / 14 / 44 / 4 / 62 / 1
Colorado / 5 / 18 / 0 / 23 / 0
Connecticut / 0 / 1 / 0 / 1/ 0
Georgia / 0 / 0 / 1 / 1 / 0
Idaho / 13 / 102 / 1 / 116 / 2
Illinois / 5 / 1 / 0 / 6/ /0
Indiana / 1 / 0 / 0 / 1 / 0
Iowa / 3 / 4 / 0 / 7 / 0
Kansas / 0 / 1 / 0 / 1 / 0
Louisiana / 11 / 6 / 0 / 17 / 0
Michigan / 1 / 0 / 1 / 2 / 0
Minnesota / 14 / 13 / 0 / 27 / 2
Mississippi / 24 / 7 / 0 / 31 / 2
Missouri / 5 / 1 / 1 / 7 / 0
Nebraska / 4 / 4 / 0 / 8 / 0
Nevada / 21 / 30 / 4 / 55 / 0
New York / 1 / 0 / 0 / 1 / 0
North Dakota / 1 / 23 / 0 / 24 / 1
Oklahoma / 4 / 0 / 0 / 4 / 1
Oregon / 1 / /6 / 0 / 7 / 0
Pennsylvania / 4 / 1 / 0 / 5 / 1
South Dakota / 16 / 30 / 0 / 46 / 1
Texas / 59 / 9 / 0 / 68 / 6
Utah / 16 / 11 / 0 / 27 / 2
Wisconsin / 0 / 1 / 0 / 1 / 0
Wyoming / 1 / 3 / 0 / 4 / 0
(Promed 8/24/06)

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2. Articles
Pandemic influenza preparedness in the Asia–Pacific region
Coker R, et al. Lancet. Available online 22 August 2006.
Summary: Concerns are mounting that the threat of another influenza pandemic will become a reality and that the epicentre of the outbreak could be the Asia–Pacific region. We assessed the documents that some Asia–Pacific countries have published as part of preparedness planning for an outbreak of influenza in people. Regional approaches were polarised. Thailand, China, and Vietnam had set out a strategic vision to strengthen future capacity in preparedness planning. By contrast, Hong Kong, Australia, and New Zealand took a strategic approach aimed mainly at harnessing available resources or preparing for the deployment of resources such as stockpiled antiviral agents and vaccines. The plans of Hong Kong, Australia, and New Zealand compared favourably with the best European plans. The plans of resource-poor countries addressed some issues that were largely neglected by most European plans. Other countries (including those that do not yet have plans) could benefit from analysis of the strengths and weaknesses of the plans drawn up by countries in the region and in Europe.
(CIDRAP 8/24/06 http://www.cidrap.umn.edu/index.html )

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Long-Term Clinical and Neuropsychological Outcomes of West Nile Virus Infection
Carson PJ, et al.
Clinical Infectious Diseases 15 Sep 2006;43:723-730
Abstract:
Background. Since its introduction in 1999, West Nile virus has rapidly become the most common arboviral infection in North America. Little is known about the long-term clinical sequelae of West Nile virus infection.
Methods. A total of 49 patients with laboratory-confirmed West Nile virus infection were identified through state-based surveillance. Stratification for disease severity was based on hospitalization during the infection episode. Assessment occurred a mean of 13 months after diagnosis. Medical records were reviewed, and a complete neurologic examination was performed. Standardized surveys for quality of life, functional ability, fatigue, and depression were performed for all subjects. An extensive battery of neuropsychological tests was performed to assess cognitive function.
Results. Self-reported fatigue, memory problems, extremity weakness, word-finding difficulty, and headache were common complaints. Standardized survey data confirmed an overall sense of poor physical health, fatigue, depression, and moderate-to-severe disability in 24 (49%), 24 (49%), 12 (24%), and 4 (8%) patients, respectively. New tremor was seen or reported for 10 (20%) of the patients. Neuropsychological testing showed abnormalities of motor skills, attention, and executive functions. Univariate analysis of multiple risk factors did not identify any predictors of adverse outcomes.
Conclusions. Multiple somatic complaints, tremor, and abnormalities in motor skills and executive functions are common long-term problems among patients who have had West Nile virus infection. Patients with milder illness are just as likely as patients with more-severe illness to experience adverse outcomes.
(CIDRAP http://www.cidrap.umn.edu/index.html)

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Imported Melioidosis --- South Florida, 2005
In 2005, two cases of melioidosis (one in August, one in October) were reported to the Florida Department of Health, the first cases since reporting the disease became mandatory in Florida in 2003. In one case, Burkholderia pseudomallei was not recognized as the bacterium that causes the disease melioidosis, which led to a delay in reporting the case to the local health department. In both cases, delayed recognition and unsafe laboratory practices resulted in laboratory workers being exposed to B. pseudomallei. This report summarizes the clinical and laboratory aspects of the cases and the epidemiologic study conducted by the Florida Department of Health. The findings emphasize the need for improved laboratory recognition and reporting of B. pseudomallei, safe laboratory handling of B. pseudomallei, and close adherence to antibiotic regimens for treating and preventing recurrence of melioidosis.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5532a1.htm
(MMWR August 18, 2006 / Vol. 55 / No.32, Promed 8/20/06)

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3. Notifications
CDC releases recommendations on prevention of rotavirus gastroenteritis among infants and children
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5512a1.htm
(MMWR Recommendations and Reports August 11, 2006 / Vol. 55 / No. RR–12)

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8th International Feline Retrovirus Research Symposium
Please join us for the 8th International Feline Retrovirus Research Symposium in Washington, DC on 8-11 Oct 2006. The conference promises to be an innovative and exciting look at retroviral research, and this year will also include speakers on cat genomics and advances in the cat as a model in other infectious diseases: our program will begin with a presentation on the cat as a vector/model for influenza research by Albert D. M. E. Osterhaus.

Please visit the conference website at http://ifrrs8.ncifcrf.gov for additional information.
(Promed 8/21/06)

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Biological Crisis Management in Human and Veterinary Medicines 2006.
As the first meeting of a new series on Biological Crisis Management in Human and Veterinary Medicines, BCM 2006 will bring together experts and representatives from industry and regulatory bodies to discuss important public health problems related to emerging infectious diseases.

The goal of BCM 2006 is to help assure the rapid availability of safe and effective biologicals for use in emergency situations by identifying safety, efficacy, standardisation, liability and regulatory issues related to their production and use and to propose solutions.

The meeting aims to provide recommendations for the scientific community, manufacturers and health authorities concerning the production, evaluation, standardisation and regulation of biologicals for use in emergency situations.

For comprehensive information about the meeting (registration, accommodation, fees, programme, etc.), please visit the BCM2006 website: http://www.bcm2006.org
(Promed 8/22/06)

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 apecein@u.washington.edu