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Vol. IX, No. 19 ~ EINet News Briefs ~ Sep 29, 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: WHO flu pandemic task force begins work
- Russia (Lipetsk): Botulism from canned food, fish
- Russia (Novosibirsk): Tick-borne encephalitis
- Russia (Bashkortostan): Hemorrhagic fever with renal syndrome
- Russia: 6 people in Rostov Region contract West Nile fever
- China (Qinghai samples): Sharing of avian influenza H5N1 samples from wild birds
- Indonesia: 52nd human death from avian influenza H5N1 infection
- Indonesia: 2 additional cases of human infection with avian influenza H5N1
- Thailand: 25th case of human infection with avian influenza
- Japan (Kyoto): Hepatitis B from hemodialysis unit
- Philippines (Bukidnon): Emergence of Heterophyiasis
- USA: FDA Issues Guidance to Industry for Development of Cell-Based Viral Vaccines
- USA (Pennsylvania): Low pathogenic avian influenza H5N1 in mallards
- USA: USDA to help farms cover costs of avian flu
- Peru (Oxapampa): Chagas disease recognized in non-endemic zone
- Peru (Lima Province): Outbreak of bartonellosis
- USA (multistate): Update on E. coli O157 outbreak from bagged spinach
- USA: Outbreak of Botulinum toxin Type A associated with bottled carrot juice
- USA (California): E. coli O157 from unpasteurized milk
- USA (Colorado): Fourth case of plague diagnosed in La Plata County
- USA (Florida): Giardiasis from spraying fountain
- Egypt: New case of avian influenza H5N1 in birds detected in rural area
- Egypt: Excerpts from the OIE report on avian influenza H5N1 in animals
- Seasonal Influenza
- Avian/Pandemic influenza updates
- Cholera, Diarrhea, and Dysentery
- West Nile Virus
- CDC EID Journal, Volume 12, Number 10—Oct 2006
- Food Markets with Live Birds as Source of Avian Influenza
- Review of Aerosol Transmission of Influenza A Virus
- Safety and immunogenicity of nonadjuvanted and MF59-adjuvanted influenza A/H9N2 vaccine preparations
- Mouse study reveals new clues about virulence of 1918 influenza virus
- Ongoing Multistate Outbreak of Escherichia coli serotype O157:H7 Infections Associated with Consumption of Fresh Spinach--United States, September 2006
- Diarrheagenic Escherichia coli
- Chikungunya Fever Diagnosed Among International Travelers--United States, 2005--2006
- Importance of Culture Confirmation of Shiga Toxin-producing Escherichia coli Infection as Illustrated by Outbreaks of Gastroenteritis--New York and North Carolina, 2005
- Inadvertent misadministration of meningococcal conjugate vaccine--United States, June-August 2005
- Public Health Response to Varicella Outbreaks--United States, 2003--2004
- National, state, and urban area vaccination coverage among children aged 19--35 months--United States, 2005
- The CDC Experience Application Deadline--Dec 4, 2006
- Epidemiology in Action Course--Oct 23-Nov 3, 2006
- Preventive Medicine Residency Application Deadline--Oct 11, 2006
- Malaria 2007 and Pathogenic Helminths 2007--First Call for Participants & Contributions
- First APUA World Congress: Strengthening Society's Infectious Disease Defenses
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Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Viet Nam / 3 (3)
Total / 3 (3)
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 17 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 95 (41)
Azerbaijan / 8 (5)
Cambodia / 2 (2)
China / 12 (8)
Djibouti / 1 (0)
Egypt / 14 (6)
Indonesia / 49 (40)
Iraq / 3 (2)
Thailand / 3 (3)
Turkey / 12 (4)
Total / 104 (70)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 251 (148).
(WHO 9/28/06 http://www.who.int/csr/disease/avianinfluenza/en/ )
Avian influenza age & sex distribution data from WHO/WPRO:
Global: WHO flu pandemic task force begins work
An international group of experts that will advise WHO on avian and pandemic influenza issues met for the first time in Geneva, Switzerland. Task force members will advise the WHO on the critical questions of when to raise the pandemic alert level, when to declare a pandemic, and how to handle the international response. The panel is called the Ad Hoc Influenza Pandemic Task Force. The task force is a temporary body that will advise the agency until the new International Health Regulations take effect Jun 2007. The new rules require member countries to have or develop specific capabilities to identify and respond to public health emergencies of international concern and to take routine preventive measures at ports, airports, and border stations. The recent revision took into account lessons learned during the SARS outbreak and the ongoing H5N1 avian influenza experience.
The task force covered setting roles and responsibilities, deciding how meetings will be run, and discussing how to hold emergency sessions via tele- or video conferencing. They also agreed to serve as an advisory group to WHO's Global Influenza Programme. Of the 21 task force members, 16 were present at the first meeting. Absent were members from China, Indonesia, and Thailand. The experts who are on the task force include Dr. Robert Webster, St. Jude's Research Hospital in Memphis, Tenn.; Albert Osterhaus, a veterinary virologist from Erasmus University in Rotterdam; Dr. Nancy Cox, director of the influenza division at the US CDC; Theresa Tan, director of the Public Health Agency of Canada's respiratory infections division; Dr. Maria Zambon from Britain's public health agency; Masato Tashiro, director of Japan's National Institute of Infectious Diseases; and Dmitri Lvov, a virologist from Russia.
Russia (Lipetsk): Botulism from canned food, fish
According to the sanitary surveillance center of the Lipetsk region, 7 people have suffered from botulism in Lipetsk. One of them, a 51-year-old man, had died. The cause of the disease is usually domestically canned food. One of the 7 affected individuals ate canned mushrooms; another one consumed canned stewed meat, which proved fatal. The other 5 people with botulism consumed domestically prepared fish. Botulinum toxin can be destroyed during heating. If canned food is boiled for 10-15 minutes the botulinum toxin is destroyed. It is recommended not to use iron caps when mushrooms are canned. Mushrooms should be carefully washed to rid them of various debris, since the dirt and other organic debris may contain spores of botulism.
Depending on the geography, the most common cause is either fish (canned, dried or salted, stockfish) or domestically cooked mushrooms. Canned meat and fruit are in second place as causal factors of botulism.
Russia (Novosibirsk): Tick-borne encephalitis
During 1 to 7 Sep 2006, 318 visits have been registered in the health care facilities of the Novosibirsk Region in connection with tick-bites, including 65 visits by children. According to the Territorial Agency for Epidemiological Surveillance in the Novosibirsk Region, this number is higher than for the same period of 2005, when only 123 cases of tick-bite were recorded. 5 patients, all of whom are residents of the city of Novosibirsk were admitted to hospital during this period. A total of 499 patients, including 29 children, have been admitted to hospital during the tick season in 2006. Tick-borne encephalitis has been confirmed in 87 cases, 2 of whom were children. Of the 71 ticks submitted for lab examination, 4 were virus-positive. A total of 3993 ticks from the city and the region have been submitted for lab examination and 565 were found to be positive for tick encephalitis virus. Since the beginning of the summer, 18 913 patients sought medical advice for tick-bites in the city and Region. 3 fatal cases have been registered due to tick borne encephalitis.
Russia (Bashkortostan): Hemorrhagic fever with renal syndrome
Since the beginning of 2006, 1600 people have fallen ill with haemorrhagic fever with renal syndrome (HFRS) in the Republic of Bashkortostan. Morbidity has increased more than 2-fold in comparison with 2005; 3 HFRS patients have died. "Distribution of viral HFRS proceeds cyclically," stated Nasima Kuchinova, Deputy Head of Territorial Management of Rospotrebnadzor in Bashkortostan. "Peak incidence [occurs every] 5-6 years. During the last 3-4 years we have observed low HFRS morbidity in the Republic, but last year it began to increase rapidly. Now we are on the verge of a new peak in virus prevalence. This has been brought about by the high density of virus-carrying field mice".
The territory of the Republic of Bashkortostan (Bashkiria) is one of the largest natural endemic foci of distribution of HFRS virus in the world. The last peak of morbidity occurred in 1997 when 9500 people fell ill and there were 34 fatalities. Since Jun 2006 the number of cases in the Republic appears to have more than quadrupled, confirming the prediction that 2006 is likely to be a peak year in the incidence of HFRS. HFRS is caused caused by a hantavirus. Hantaviruses cause non-pathogenic infections of their rodent hosts. Human infection is incidental to viral survival and is almost always a dead end in the infection chain.
Russia: 6 people in Rostov Region contract West Nile fever
6 people contracted West Nile fever infection in the Rostov Region (Oblast) in 2006. All the cases have been recorded between the end of Aug and mid Sep 2006. The affected patients stated that they spent their spare time in the country-side near water. Laboratory studies indicated that infection had been contract through the bite of blood-sucking insects. Mortality from West Nile fever may be 4 to 11 percent. West Nile fever was recorded first some 6 years ago in the Volgograd and Astrakhan Regions. Infection has now reached the Rostov Region by migrant birds, rodents and mosquitoes.
China (Qinghai samples): Sharing of avian influenza H5N1 samples from wild birds
China has shared long-sought samples of the H5N1 bird flu virus, in what many scientists view as a breakthrough in cooperation, WHO said 28 Sep 2006. The samples, taken from thousands of wild birds which died in Qinghai Lake Apr 2005, have been sent to the CDC, a WHO Collaborating Center, for further analysis. Michael Perdue said the animal samples, the first from China in 2-1/2 years, should help scientists understand the origin of a sub-type of the H5N1 virus which later circulated in Turkey and Africa but is genetically different from the one hitting other parts of Asia, including Indonesia, Thailand and Viet Nam.
The lake, a major stop-off point for migratory birds in the remote northwestern Qinghai province, has become a focus for scientists studying mutations of the virus. The Agriculture Ministry previously had placed "certain restrictions" on sharing the virus samples, but this had been resolved through negotiations, Perdue said. Chinese scientists have published some analyses of the samples, but the CDC is expected to carry out more sophisticated testing with antibodies which will reveal variations of immune responses. "It gives us an animal index case for birds to have the samples from Qinghai Lake, which is the first time that particular type was detected in China," Perdue said. "It will go into the global collection we are making of the virus to see how it changes over time," he added. China has shared samples from human cases.
Indonesia: 52nd human death from avian influenza H5N1 infection
An Indonesian man who had been suffering from bird flu for days died, a hospital official said, taking Indonesia's death toll from the disease to 52. "He died because of breathing problems which he had suffered since he was admitted to the hospital," said Hadi Yusuf, who heads the bird flu ward at Hasan Sadikin hospital in Bandung. His 25-year-old brother died a few days earlier 24 Sep 2006, with symptoms of the same disease. His death came about before blood samples could be taken for testing and he has been included on the list of suspect cases. Both men had direct contact with dead chickens when feeding carcasses to their dogs. Local agricultural authorities also found evidence of H5 infection in household birds. Senior Health Ministry official, Nyoman Kandun, said the 2 victims' 15-year-old sister, who was also hospitalized with high fever and respiratory problems, tested negative for H5N1 virus (negative for the H5 virus subtype and positive for the H1 subtype, indicating an infection with normal seasonal influenza). Kandun said for now, with only 1 confirmed case, human-to-human transmission could not be considered as a possibility.
(Promed 9/27/06, 9/28/06)
Indonesia: 2 additional cases of human infection with avian influenza H5N1
As of 25 Sep 2006, the Ministry of Health in Indonesia has confirmed 2 additional cases of human infection with the H5N1 avian influenza virus. Both cases were fatal. The first case occurred in an 11-year-old boy from East Java Province. He developed symptoms of fever and cough 16 Sep 2006, was hospitalized 18 Sep 2006, and died the same day. Poultry in the child's household began dying in the month prior to symptom onset, and poultry deaths continued thereafter in his neighborhood. The second case occurred in a 9-year-old boy from South Jakarta. He developed symptoms of fever and a runny nose 13 Sep 2006, was hospitalized 20 Sep, and died 22 Sep. His history showed recent contact with sick chickens, which he kept as pets.
Thailand: 25th case of human infection with avian influenza
The Ministry of Public Health in Thailand has confirmed the country's 25th case of human infection with the H5N1 avian influenza virus. The case, which was fatal, was the third detected this year and the third fatality. The case occurred in a 59-year-old farmer from Nong Bua Lam Phu Province in the north-eastern part of the country. He developed fever 14 Jul, was hospitalized 21 Jul, and died 10 Aug. Reportedly the man bred and raised fighting cocks. Possible H5N1 infection was suspected when relatives reported the sudden death, in the days prior to symptom onset, of several fighting cocks raised by the farmer. Local veterinary authorities noted a number of poultry outbreaks in the area.
Repeated tests on samples taken from his upper respiratory tract were negative by PCR for all influenza A viruses, including H5N1. He was treated with the antiviral drug, oseltamivir. Virus was eventually isolated from lung samples taken at autopsy. Officials said he was the first to die of complications rather than H5N1 itself. The case was the first that took almost a month from the day the patient fell ill to his eventual death, compared to past cases in which victims died within a few days of falling sick. The Department of Livestock Development, meanwhile, insisted Nong Bua Lumphu was not on the list of bird-flu districts and past testing on poultry had found no signs of H5N1 there. There would be no culling of poultry in the province for now. Cock fighting is hugely popular in Thailand, and owners have resisted previous culls by hiding their expensive birds. Thailand has stockpiled 1.5 million capsules of the anti-viral drug oseltamivir, which the kingdom began producing this year.
(WHO 9/27/06, Promed 9/26/06)
Japan (Kyoto): Hepatitis B from hemodialysis unit
8 patients receiving dialysis treatment at Rakuwakai Otowa Hospital in Kyoto contracted hepatitis B in Aug 2006, causing 5 of them to be hospitalized, hospital officials said 20 Sep 2006. The hospitalized patients are in stable condition and recovering. The hospital and the Kyoto Municipal Government are treating the cases as in-hospital infections. According to the hospital, a male dialysis patient who was scheduled to have an operation was given a blood test in late Aug and found infected with the virus. 4 other men and 3 women were found infected during regular checkups that were conducted around the same time on about 300 dialysis patients there. All 8 are in their 50s to 70s. The hospital alerted the city 11 Sep 2006 and disinfected its equipment after concluding the 8 were likely infected around the same time. Evaluations of their liver functions had been normal until the end of July, it said.
Hepatitis B virus infection is a hazard associated with any medical procedure involving transfusion of blood. With advances in medical care, the risk of infection should be declining due to increasing rigor of donor selection and improvements in the screening of blood products. In addition, the wider use of hepatitis B vaccine in the populations of countries with comprehensive medical care should also be contributing to a decline in risk. However, this potentially decreasing risk may be obscured by the increasing use of hemodialysis and similar procedures to treat chronic renal diseases in aging populations.
Philippines (Bukidnon): Emergence of Heterophyiasis
The Department of Health office in Bukidnon reported the emergence of heterophyiasis, an emerging disease in the province. Heterophyiasis, according to Dr. Vincent C. Raguro, is an infection of the small intestines caused by intestinal flukes acquired by eating raw or "insufficiently" cooked fish. He said the disease is endemic in 59 barangays from 10 municipalities and 2 cities in the province. As of Aug 2006, the DOH identified 592 individuals who turned out to be positive of the disease out of the 2739 examined in the endemic areas. Investigators are constrained by lack of funds for fuel and other operating expenses to conduct tests all over the province. They have so far monitored only 2 cases out of the 3 fatalities this year.
Ingestion of insufficiently cooked or raw fish is the only way to acquire heterophyiasis, according to the DOH. Adult worms and eggs of the intestinal flukes thrive in the intestines and will also spread to other organs like the brain, spinal cord, and the heart. The DOH said those infected suffer from upper abdominal discomfort or pain, gurgling abdomen, colicky abdominal pain, and diarrhea. Tissue reactions may lead to cardiac arrest for those with heart problems and also cause intra-cerebral hemorrhage in the brain. The statement said if it reaches the spinal cord, the disease may result in loss of motor and sensory functions.
Sotelo said definitive tests could only be done in the laboratory to check parasite eggs using stool analysis. He identified fish from both pond and brackish water or estuarine waters as susceptible to become hosts to the fluke. He said those who tested positive could be given medication to cure schistosomiasis. The DOH advised proper or thorough cooking of fish as preventive measure. They have also called for control measures, calling local health authorities to educate the population regarding proper eating habits. They also called for the banning of fish pond seeding using human and animal waste. The DOH also warned of feeding fish scraps and of giving water used to clean fish to animals like dogs, cats, poultry and hogs.
USA: FDA Issues Guidance to Industry for Development of Cell-Based Viral Vaccines
The U.S. Food and Drug Administration (FDA) issued new guidance to aid manufacturers in developing safe and effective cell-based viral vaccines. FDA's goal is to facilitate the development and availability of safe and effective vaccines, including those to address emerging and pandemic threats. Acting Commissioner Andrew von Eschenbach, Food and Drugs, said, "This guidance promises to help modernize the development of life-saving vaccines for influenza and other diseases and facilitate the development of more plentiful, reliable supplies." The updated guidance conveys information for determining the suitability of a cell culture for manufacturing, as well as testing and validating the safety and purity of the cells used in the development and production of viral vaccines. It also provides information on testing at different stages of production and quality-control test methods for cell substrate and adventitious agent issues.
Cell cultures are used to produce licensed vaccines that help protect against diseases such as measles, mumps and polio. The guidance outlines the best practices using current and emerging science. Cell-based vaccine manufacturing holds the promise of a reliable and flexible alternate method of producing influenza vaccines, which are currently produced in chicken eggs by a technique developed more than 50 years ago. With increasing demand for seasonal influenza vaccine and with the potential threat of a pandemic, as well as other emerging infectious diseases, more flexible approaches that allow surge capacity in an emergency are critical. With cell-based manufacturing, cells can be frozen and stored and thawed as needed to produce more vaccine. A copy of the guidance, "Guidance for Industry: Characterization and Qualification of Cell Substrates and Other Biological Starting Materials Used in the Production of Viral Vaccines for the Prevention and Treatment of Infectious Diseases," is available at: www.fda.gov/cber/gdlns/vaccsubstrates.pdf.
USA (Pennsylvania): Low pathogenic avian influenza H5N1 in mallards
The U.S. Departments of Agriculture and Interior announced final test results, which confirm that low pathogenic H5N1 avian influenza virus was found in samples collected Aug 2006 from wild mallard ducks in Pennsylvania. This subtype has been detected several times in wild birds in North America and poses no risk to human health. The USDA National Veterinary Services Laboratories (NVSL) confirmed the presence of the "North American strain" of low pathogenic H5N1 avian influenza through virus isolation in one of the 15 samples collected from the wild mallards in Crawford County, Pennsylvania. Initial screening results indicated that an H5N1 avian influenza subtype was present in the collected samples, but further testing was necessary to confirm pathogenicity. Genetic testing ruled out the possibility that the samples carried the specific highly pathogenic strain of H5N1 avian influenza that is circulating overseas. Low pathogenic strains of avian influenza commonly occur in wild birds and typically cause only minor sickness or no noticeable signs of disease in birds. Highly pathogenic strains of avian influenza spread rapidly and are often fatal to chickens and turkeys.
USA: USDA to help farms cover costs of avian flu
The US Department of Agriculture (USDA) said it would, under certain conditions, reimburse commercial poultry farms for the cost of stopping low-pathogenic H5 and H7 avian influenza outbreaks. Under a new rule, the USDA promised to provide "100 percent indemnity for specified costs" involved in eradicating H5 and H7 viruses at commercial poultry operations that participate in the National Poultry Improvement Program (NPIP), a voluntary federal, state, and industry program to prevent the spread of poultry diseases.
Until now, the states usually handled reimbursement for the costs of fighting avian flu, and the provisions varied. The change also helps ensure US compliance with international animal health guidelines that require countries to report all H5 and H7 virus detections. The program expansion will encourage testing and provide incentives to report outbreaks. The new rule takes effect Sep 26, 2006.
To be eligible for full indemnification, commercial poultry facilities and states must meet certain requirements. The main requirements are that:
• States must have a surveillance program for all poultry.
• States must have APHIS-approved plans spelling out response and containment efforts in case of an H5 or H7 outbreak.
• Industry must maintain active surveillance that includes testing of birds and eggs.
Peru (Oxapampa): Chagas disease recognized in non-endemic zone
During the first week of Aug 2006, in San Bartolome Mother-and-Child Hospital in Lima, a case of Chagas' disease was diagnosed in a 6-year-old girl from Pozuzo District, Oxapampa Province, Pasco Department in Peru, the very first case from an area not previously recognized as endemic for Chagas' disease. The case was confirmed in the Chagas and Leishmaniasis Laboratory in Peruvian National Institutes of Health. It is a case of acute Chagas' disease. Before being diagnosed, the girl was examined by different physicians, both in her home town as well as in Lima, and nobody ever thought of Chagas' disease, since the Peruvian Central Jungle had been considered a non-endemic zone for this disease.
During a visit to the Pozuzo region, Panstrongylus geniculatus was found, a vector that apparently does not colonize households, but it enters the houses at night, attracted by light bulbs, and it bites people while they sleep. In the house of the patient, P. geniculatus specimens were found at night, but all of them tested negative for members of the Trypanosoma family. In the serological study performed on all family members and neighbours (14 persons), no other person seropositive to Chagas' disease was found. In a survey performed in other 44 adult persons in Pozuzo District, it was determined that this vector has been detected for approximately 30 years, and it is identified as "chirimacha", a popular term used in Southern Peru for Triatoma infestans. This vector is the one with the widest distribution in the Americas.
Peru (Lima Province): Outbreak of bartonellosis
Initial report: Bartonellosis outbreak, Collo Locality, Arahuay Distric, Canta Province, DISA Lima North, 2006. On 12 Sep 2006, the Epidemiology Unit of the Lima North DISA reported 10 cases of bartenellosis coming from the Collo locality in the Arahuay District in the Canta Province. No cases of bartonellosis had been reported from this zone in the past. The first case, in a 7 year-old girl, resident of Arahuay District, with date of onset of symptoms 10 Apr 2006, had the appearance of a verruga [wart] on her right arm, was treated with doxacillin for 7 days without good result. Treatment of 10 persons, 70 percent of which were children less than 10 years of age was done. The majority of the cases had presented between epidemiologic weeks 19 to 26, and was distributed geographically in different localities and caserios from each other. Specimens were obtained from 10 patients, of which 10 were negative for bartonella, 3 were positive for rickettsias and are presently being studied for leptospirosis.
Activities conducted by the DIRESA [District health unit]: Notification and Investigation of cases; Household visits to cases and active search for additional cases; Coordination with Health Facilty staff and Zonal authorities, the Cayetano Heredia Hospital for laboratory results and referrals.
Luis Suarez, chairman of the Directorate for Epidemiology at Peru's Ministry of Health, explained that bartonellosis is an endemic disease and that since 1998, individual infections have increased in some parts of Peru. The last time the Health Ministry declared an epidemic was in 2004, after more than 7000 cases were treated. Suarez emphasized that so far in 2006, 4200 cases have been registered. He said a vaccine against infection does not exist, but effective individual treatment can avoid fatal consequences. He also said that the transmitting insect does not bite before sundown, and the typical symptoms do not appear until weeks after the incubation period, which can be up to 2 months.
Bartonellosis is identified by symptoms and the patient's history, such as recent travel in areas where bartonellosis occurs. Isolation of B. bacilliformis from the bloodstream or lesions can confirm the diagnosis. Antimicrobial agents are the mainstay of bartonellosis treatment. The bacteria are susceptible to several antibiotics, including chloramphenicol, penicillins, and aminoglycosides. Blood transfusions may be necessary to treat the anemia caused by bartonellosis. Antibiotics have dramatically decreased the fatality associated with bartonellosis. Prior to the development of antibiotics, the fever was fatal in 40 percent of cases. With antibiotic treatment, that rate has dropped to 8 percent. Fatalities can result from complications associated with severe anemia and secondary infections.
(Promed 9/23/06, 9/27/06)
USA (multistate): Update on E. coli O157 outbreak from bagged spinach
To date, 183 cases of illness due to E. coli O157:H7 infection have been reported to the CDC, including 29 cases of Hemolytic Uremic Syndrome (HUS), 95 hospitalizations and 1 death. States Affected; Canadian case identified: the 26 affected states are: Arizona (7), California (1), Colorado (1), Connecticut (3) Idaho
(4), Illinois (1), Indiana (9), Kentucky (8), Maine (3), Maryland (3), Michigan (4), Minnesota (2), Nebraska (9), Nevada (1), New Mexico (5), New York (11), Ohio (24), Oregon (6), Pennsylvania (8), Tennessee (1), Utah (18), Virginia (2), Washington (3), West Virginia (1), Wisconsin (47), and Wyoming (1). In addition, Canada (Ontario) has confirmed that one case of E. coli O157:H7 has been positively matched to the outbreak strain in a person who ate bagged spinach.
On 13 Sep 2006, CDC officials were alerted by epidemiologists in Wisconsin and Oregon that fresh spinach was the suspected source of small clusters of Escherichia coli serotype O157:H7 infections in those states. On the same day, New Mexico epidemiologists contacted Wisconsin and Oregon epidemiologists about a cluster of E. coli O157:H7 infections in New Mexico associated with fresh spinach consumption. Wisconsin public health officials had 1st reported a cluster of E. coli O157:H7 infections to CDC 8 Sep 2006.
On 12 Sep 2006, CDC PulseNet had confirmed that the E. coli O157:H7 strains from infected patients in Wisconsin had matching pulsed-field gel electrophoresis (PFGE) patterns and identified the same pattern in patient isolates from other states. This report describes the joint investigation and outbreak-control measures undertaken by state public health officials, CDC, and the FDA. This investigation and additional case finding are ongoing.
As of 26 Sep 2006, a total of 183 persons infected with the outbreak strain of E. coli O157:H7 had been reported to CDC from 26 states. Among the ill persons, 95 (52 percent) were hospitalized, 29 (16 percent) had hemolytic uremic syndrome (HUS), and one person died. The deaths of 2 other patients possibly related to this outbreak are under investigation. 85 percent of patients reported illness onset from 19 Aug to 5 Sep 2006. Fresh spinach was identified as the source of the outbreak. 123 of 130 patients (95 percent) reported consuming uncooked fresh spinach during the 10 days before illness onset. In addition, E. coli O157:H7 with a PFGE pattern matching the outbreak strain has been isolated from 3 open packages of fresh spinach consumed by patients (1 from New Mexico, 1 from Utah, and 1 from Pennsylvania).
On 14 Sep 2006, FDA advised consumers to not eat bagged fresh spinach. On 15 Sep 2006, a California company that bags spinach under several brand names announced a voluntary recall of all fresh spinach-containing products. On 16 Sep 2006, FDA expanded its warning and advised consumers to not eat fresh spinach or fresh spinach-containing products. On 21 Sep 2006, FDA informed consumers that only spinach grown in 3 California counties (Monterey, San Benito, and Santa Clara) was implicated in the outbreak. California produces 74 percent of the nation's fresh spinach crop.
A confirmed case is defined as a culture-confirmed E. coli O157:H7 infection in a person residing in the USA, with illness onset from 1 Aug 2006 to the present (or, if date of onset is unknown, E. coli O157:H7 isolated from 15 Aug 2006 to the present) and a PFGE pattern identified by the XbaI restriction enzyme that matches the pattern of the outbreak strain. 1 Aug 2006 was selected as the earliest illness onset date in the case definition to ensure that the earliest cases in the outbreak were identified and investigated. However, the 1st 6 confirmed cases (with illness onsets during 2-15 Aug 2006) were in persons who did not report fresh spinach consumption during the week before illness onset. The first date that illness onset was reported by a person who recently consumed fresh spinach was 19 Aug 2006.
Infections with this outbreak strain of E. coli O157:H7 (one of 3520 unique E. coli O157:H7 strains reported to CDC PulseNet since 1996) have been reported sporadically to CDC PulseNet since 2003 (an average of 21 cases per year during 2003-2005). This finding suggests the occasional presence of this strain in the environment and food supply; however, it has not been associated with a recognized outbreak in the past.
The time from illness onset to confirmation that a case of E. coli O157:H7 is part of an outbreak is typically 2-3 weeks, including the time required for an infected person to seek medical care and for health-care providers and public health officials to obtain a culture, transfer the bacterial culture to a public health laboratory, perform PFGE testing, and submit the PFGE pattern into the national database at CDC. In this outbreak, the average time from illness onset to PFGE pattern submission to the national database at
CDC has been 15 days: http://www.cdc.gov/foodborne/ecolispinach/reportingtimeline.htm.
Parallel laboratory and epidemiologic investigations were crucial in identifying the source of this outbreak. Timely PFGE testing by state public health laboratories, PFGE pattern submission by states to CDC PulseNet, and analysis of PFGE patterns in the CDC PulseNet national database resulted in rapid detection of the outbreak. Concurrent collection of case exposure information by epidemiologists in affected states and sharing of exposure information among states and CDC led to rapid identification of the suspected food source and public health action. Continued rapid diagnosis, culture, PFGE analysis, and reporting to CDC of E. coli O157:H7 infections are needed to aid this investigation and to detect and investigate E. coli O157:H7 outbreaks in the future.
The most current information is available online at http://www.cdc.gov/foodborne/ecolispinach; this website contains information updated daily on the number of cases and affected states in addition to general information regarding E. coli O157:H7, resources for clinicians and activities by CDC and other agencies.
The FDA website, at http://www.fda.gov/oc/opacom/hottopics/spinach.html, contains advice for consumers on the current outbreak and food-safety guidelines. CDC's public inquiry line (telephone, 1-800-CDC-INFO) also can provide information on the current outbreak to both the public and health-care workers. Information about the current E. coli O157:H7 outbreak is also available by RSS (Really Simple Syndication); a subscription to the E. coli O157:H7 outbreak RSS information can be obtained at http://www.bt.cdc.gov/rss.
(Promed 9/27/06, 9/26/06, 9/21/06)
USA: Outbreak of Botulinum toxin Type A associated with bottled carrot juice
A commercial beverage has been confirmed as the cause of a cluster of 3 botulism cases in Georgia. The 3 patients had onset of symptoms Sep 8, after consuming a common meal that included commercially produced carrot juice Sep 7. 2 bottles of juice were consumed. All 3 patients drank from bottle #1; whether all 3 patients drank from bottle #2 is unknown. Botulinum toxin type A was identified in the serum and stool of all 3 patients by mouse bioassay. Subsequently, botulinum toxin type A was identified from carrot juice remaining in bottle #1 by mouse bioassay. Bottle #2 had been rinsed with water, and the test for toxin was negative. The label on the implicated bottle reads "Bolthouse Farms, Bakersfield, California, 100% carrot juice." The use by date is 09-18-06.
It is unknown whether the contaminated juice was subjected to time or temperature abuse that might have facilitated the growth of Clostridium botulinum spores, which can survive pasteurization. CDC has not been notified of any cases of suspected botulism since this cluster was reported Sep 8. CDC has dispatched a notice of this outbreak to public health officials in all 50 states through the Foodborne Disease Listserve, reminding them about the contact numbers for CDC's Botulism Clinical Consultation and Antitoxin Release Service. The Georgia Department of Health issued an Epi-X alert, alerts to Georgia clinicians and local health officials, and a press release about this outbreak and the implicated food. For more information on botulism: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/botulism_g.htm
(CDC Advisory; Promed 9/16/06)
USA (California): E. coli O157 from unpasteurized milk
Tainted milk has infected people with E. coli O157:H7 bacteria, prompting a recall of some milk products, officials said 22 Sep 2006. Those infected got sick after drinking unpasteurized milk produced by Organic Pastures, a FCalifornia dairy. An 8-year-old girl, a boy, 7, and a 10-year-old girl got sick after drinking the contaminated milk. The state has ordered all Organic Pastures whole and skim raw milk to be pulled immediately from stores and consumers were encouraged to throw away any of the milk in their refrigerators. The recall order also affects raw cream and raw colostrum made by the dairy. Organic Pastures has been prohibited from producing raw milk for the retail market until further notice. The E. coli outbreak was limited to raw, or unpasteurized milk.
Escherichia coli O157:H7 is just one of a number of infections that can be transmitted to humans from unpasteurized milk or dairy products. These include Salmonella sp and Campylobacter sp, both of which may be multi-drug resistant, as well as staphylococcal food poisoning, Q fever, listeriosis, brucellosis, and bovine tuberculosis. In addition, Brainerd diarrhea, a chronic diarrheal process of unknown etiology, is also associated with raw milk ingestion. Shigellosis can also be spread by unpasteurized dairy products.
People who consume unpasteurized milk and milk products might believe that these products taste better, provide greater nutrition than pasteurized products, and/or decrease the risk for various medical conditions, but the benefits of consuming unpasteurized milk and milk products have never been validated scientifically. Obtaining a license to sell raw milk may legitimize this cottage industry but does not remove the risk of infection. "Certified" unpasteurized milk from a "licensed" dairy remains inherently unsafe.
USA (Colorado): Fourth case of plague diagnosed in La Plata County
A 49-year-old woman has been diagnosed with plague, the fourth case in La Plata County in 2006, health officials announced 25 Sep 2006. The 4 cases--all caused by fleas brought in by family pets, health officials suspect -- equal an annual record for the entire state. Nationally, 10 to 15 cases of plague occur in humans every year. New Mexico has already seen 7 this year. So far in 2006, 13 rodents and cats in southwest Colorado have tested positive for plague. Cats become infected from flea bites or by direct contact with infected rodents. Plague-infected cats generally have a history of roaming freely in rural areas. In 2005, 2 of the 3 cases in the state were found in La Plata County. Health officials recommend taking steps against fleas to reduce the chances of contracting the disease. Yersinia pestis infection in humans continue to be reported in the southern USA with more cases recognized this year.
USA (Florida): Giardiasis from spraying fountain
About a dozen children have fallen ill and tested positive for Giardia, a waterborne intestinal parasite that causes diarrhea and painful bloating. The kids all at the spraying-jet fountain at the park on Tanya King Boulevard, Orange County. Orange County Health Department inspectors checked the fountain 2 weeks ago. It has been closed since then, after inspectors found it had no chlorine, was filthy with algae and was not draining properly. It also had the wrong kind of chlorine pump. Bill Toth, who heads the epidemiology division at the county Health Department, said further investigation is needed to establish a definitive link between the water and the cases of giardiasis. He said testing the water for the parasite is not practical. "But those children that have Giardia have been linked to the fountain," he said. This is the third time in 10 months that the fountain has been shut down because of maintenance problems. Toth recommended that parents whose kids have played at the fountain and had any of the symptoms ask their doctors to take a stool sample. Giardia can be fought only with appropriate medication, he said.
Egypt: New case of avian influenza H5N1 in birds detected in rural area
Another case of avian flu in birds has been confirmed in Egypt. Ministry of Health officials and WHO staff said 27 Sep 2006 that a case of H5N1 in birds was detected in a house near Aswan, in Upper Egypt. WHO spokesman Hassan el-Bushra said that the infected animals, raised in the backyard of a house in the town of Edfu, have now been culled. Ministry of Health officials have "instigated the WHO-approved control measures, and no human infection has been reported," he said. Animals within a 1-km radius of the site of infection have been culled and removed for sterile burial.
This year, Egypt suffered the worst outbreak of avian flu outside Asia. The disease was largely brought under control, although fears remained of a new outbreak. It led to the culling of at least 20 million birds nationwide from that time to May 2006. 14 human cases of bird flu have been found in Egypt since mid-Mar 2006, al-Bushra said. Of these, 6 have died. Specialists say that the overwhelming majority of human cases in Egypt have been women who were infected by domestically-kept birds. Although health authorities sought to assure the public through various awareness campaigns that the consumption of cooked chicken was risk-free throughout the crisis, the collapse in demand and the mass culling combined brought the poultry industry to a standstill.
Egypt: Excerpts from the OIE report on avian influenza H5N1 in animals
Information received 20 Sep 2006 from Dr Ahmed Tawfik Mohamed, Chairman of the General Organization for Veterinary Services, Ministry of Agriculture: Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 17 Feb 2006. New outbreaks: Between 29 Aug and 6 Sep 2006, 8 backyard poultry flocks in Cairo (3 flocks), Damietta (2 flocks), Giza (2 flocks) and Sohag were found to be infected. Vaccination with an inactivated vaccine has been carried out on 5 400 000 backyard birds. Affected population: backyard poultry. Laboratories where diagnostic tests were performed: Central Laboratory for Veterinary Inspection of poultry production. Results: RT-PCR between 29 Aug - 10 Sep 2006 was positive for H5N1. Source of new outbreaks: unknown or inconclusive. Thus, while the number of infections is small, they cover 4 governorates (administrative divisions) over a wide geographic area. The efforts to control have included an extensive backyard vaccination program in 23 governorates.
During weeks 31- 33, with the exception of New Zealand, where regional influenza A(H3N2) activity continued, overall influenza activity in both northern and southern hemispheres was low.
Australia. Localized influenza activity continued to be reported. Influenza A and B viruses co-circulated.
New Zealand. Influenza A activity remained similar to previous weeks and was reported as regional.
Low influenza activity was reported in Hong Kong (H1, H3 and B), Japan (H1). Sweden reported an A(H3N2) case imported from China during week 33. Mexico reported no influenza activity.
(WHO http://www.who.int/csr/disease/influenza/update/en/ 8/30/06)
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 Issue 4 of the newsletter that presents the latest figures for donor contributions to FAO’s avian influenza programme.
- OIE: http://www.oie.int/eng/en_index.htm.
- US CDC: http://www.cdc.gov/flu/avian/index.htm. Antivirals section has been updated.
- The US government’s website for pandemic/avian flu: http://www.pandemicflu.gov/. Read the latest statements from US government officials.
- 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)
Cholera, Diarrhea, and Dysentery
Shigellosis ([infection with] Shigella sonnei) was reported among children in Chuvashia. According to the ministry of emergency situations in Russia, children affected were confined in a Republican Children's Sanatorium in the village of Shomikovo in the district of Morgushev. The poisoning happened due to cottage cheese that did not go through proper thermal processing. Currently 61 children are hospitalized due to shigellosis. Also, shigellosis has been reported in children in a sanatorium for children with rheumatism. In the city of Cheboksari, 74 children aged 7 to 15 years old were hospitalized in different hospitals. The Ministry of Health has organized a special committee that will conduct epidemiological investigations.
Based on the notifiable disease surveillance system in Taiwan, during the 38th epidemiological week (Sep 17 to 23), 82 dengue fever (DF) cases were reported in Taiwan, of which 36 were laboratory confirmed, including 1 dengue hemorrhagic fever (DHF) case. As of Sep 23, there had been 965 reported cases of DF nation-wide this year, of those, 312 had been confirmed, including 5 DHF cases. So far in 2006, no DF deaths have been reported. The cumulative number of dengue confirmed cases has increased by 157.8 percent compared with the same period last year (2005, 121 cases). Among this year’s cases, 73 were classified as imported cases and 239 were domestic cases. The origins of the imported cases were as follows: 26 from Vietnam; 13 from Indonesia; 12 from the Philippines; 9 from Thailand; 4 from Cambodia; 3 from Malaysia; 2 from Myanmar; 1 from El Salvador; 1 from India; 1 from Bangladesh; and 1 from Madagascar. Of the domestic cases, the main serotype of circulating DF virus is DEN-3, and only 4 cases are DEN-2. The case distribution was mainly in southern Taiwan, including Kaohsiung City, Kaohsiung County, Tainan City, Tainan County, and Pingtung County.
(Taiwan IHR Focal Point 9/28/06)
The Philippine Department of Health (DOH) reported 1447 new dengue cases and 21 related deaths a week after it sounded the alarm on the disease's rise. Doctor Eric Tayag, head of the DOH's National Epidemiology Center, said that latest agency data showed 14 915 dengue cases this year. Of this number, 188 succumbed to the disease. Reportedly, at least 16 people were afflicted with dengue in Rizal province during the last 24 hours alone. 3 towns in Rizal province were earlier placed under states of calamity because of the increase in dengue cases. Most of the recent dengue patients were from Taguig City, Cainta and Taytay towns in Rizal, Makati City and Mandaluyong City in Metro Manila.
A new study revealed that the reported dengue incidence in the Philippines constitutes only a fraction of the actual cases. The study, entitled the "Burden of Disease and Economic Impact of Dengue," conducted by the University of the Philippines' College of Public Health, showed that 81 percent of dengue cases in the country are unreported. The study reviewed monitoring results of the National Epidemic Sentinel Surveillance System (NESSS) from 248 sentinel hospitals and the data from the Field Health Surveillance Information System (FHIS), both by the Department of Health's National Epidemiological Center (NEC), likewise data from the serologic confirmatory tests done by the St. Luke's Hospital on blood specimens from 4367 suspected dengue cases and various documents pertinent to the dengue prevention and control program of LGUs and at the national level.
It cited NEC's FHSIS and NESSS 2004 report which revealed some inconsistencies. The FHSIS reported a total of 19 067 cases, while the NESSS reported 22 828 hospitalized cases. "Logically, the number of cases should be more than the hospitalized cases," the study pointed out. The study also cited that many cases are clinically diagnosed without the benefit of confirmatory tests. The same study disclosed that even the serological test that is commonly used has relatively low sensitivity (77 percent) and specificity (76 percent) and takes an average of 4 days before the results are available.
NEC Director Dr. Eric Tayag, however, maintained that this is not the reason why dengue cases are lower this year. He added that dengue shows a wide spectrum of ailments, some of which are asymptomatic, so many cases go unnoticed or undiagnosed. He said that the UP study is a review from consultations in hospitals, wherein they found out that, for example, only 19 in 100 dengue cases were reported. Proponents of the study have called on the government to enhance the country's health information system.
Quantifying mild or inapparent dengue cases is a daunting challenge. Infections not resulting in visits to health providers usually go undetected and, hence, unreported. The kinds of prospective studies required to accrue this information, such as the study of school children in Thailand reported at last year's  meeting of the American Society of Tropical Medicine and Hygiene, require monitoring of large numbers of people and are labor-intensive and expensive. However, studies like that one are necessary to determine incidence of infection and ratios of clinical to inapparent infections, and to associate severity of disease with the infecting virus strain and serotype and with prior immune status of the individual infected.
West Nile Virus
Human cases were reported for week 37 (as of 16 Sep 2006) from the following provinces:
Province / Neurological / Non-Neurological / Unclassified; Unspecified / Total* / Asymptomatic**
Alberta / 1 / 23 / 0 / 24 / 0
Ontario / 10 / 7 / 6 / 23 / 0
Manitoba / 11 / 19 / 18 / 48 / 1
Saskatchewan / 2 / 5 / 0 / 7 / 0
TOTALS / 24 / 54 / 24 / 102 / 1
* Neurological syndrome + Non-Neurological syndrome + Asymptomatic Infections
** Most identified through blood donor testing.
Human Cases have been reported from:
State / Neuroinvasion* / *West Nile* fever** / Other*** / Total **** / Fatalities
Alabama / 4 / 0 / 1 / 5 / 0
Arizona / 10 / 10 / 5 / 25 / 0
Arkansas / 13 / 4 / 0 / 17 / 0
California / 54 / 150 / 11 / 215 / 3
Colorado / 40 / 159 / 0 / 199 / 1
Connecticut / 6 / 2 / 0 / 8 / 1
District of Columbia / 0 / 1 / 0 / 1 / 0
Florida / 3 / 0 / 0 / 3 / 0
Georgia / 2 / 2 / 1 / 5 / 1
Idaho / 94 / 542 / 6 / 642 / 10
Illinois / 92 / 47 / 22 / 161 / 9
Indiana / 11 / 5 / 12 / 28 / 0
Iowa / 13 / 11 / 0 / 24 / 0
Kansas / 14 / 10 / 0 / 24 / 3
Kentucky / 4 / 1 / 0 / 5 / 1
Louisiana / 57 / 46 / 0 / 103 / 0
Maryland / 1 / 0 / 1 / 2 / 0
Michigan / 17 / 2 / 10 / 29 / 3
Minnesota / 26 / 34 / 0 / 60 / 3
Mississippi / 65 / 65 / 0 / 130 / 6
Missouri / 35 / 8 / 1 / 44 / 2
Montana / 10 / 19 / 1 / 30 / 0
Nebraska / 30 / 82 / 0 / 112 / 1
Nevada / 33 / 71 / 10 / 114 / 1
New Jersey / 2 / 1 / 1 / 4 / 0
New Mexico / 1 / 2 / 0 / 3 / 0
New York / 7 / 3 / 1 / 11 / 1
North Dakota / 18 / 108 / 0 / 126 / 1
Ohio / 19 / 4 / 0 / 23 / 1
Oklahoma / 19 / 9 / 1 / 26 / 5
Oregon / 2 / 19 / 1 / 22 / 0
Pennsylvania / 7 / 1 / 0 / 8 / 2
South Dakota / 34 / 67 / 0 / 101 / 2
Tennessee / 7 / 1 / 0 / 8 / 1
Texas / 148 / 63 / 0 / 211 / 22
Utah / 40 / 74 / 0 / 114 / 4
Virginia / 0 / 0 / 2 / 2 / 0
Washington / 0 / 1 / 0 / 1 / 0
West Virginia / 1 / 0 / 0 / 1 / 0
Wisconsin / 8 / 7 / 0 / 15 / 0
Wyoming / 11 / 22 / 22 / 55 / 2
TOTALS / 958 / 1653 / 109 / 2720 / 87
* Cases with neurologic manifestations (such as WN encephalitis, meningitis and myelitis)
** Cases with no evidence of neuroinvasion.
*** Cases for which insufficient clinical information was provided.
**** Total number of human cases of WNV illness reported to ArboNET
A Pierce County woman in her forties was confirmed as the state's second case of a person infected with West Nile virus. Blood tests at the state Public Health Laboratories were positive, so samples were sent to CDC. The woman is the wife of the man who was listed as the state's first case Sep 13. The couple did not travel out of the state during the time they were likely bitten by an infected mosquito. The disease is not spread person to person so they are not a threat to public health. The Department of Health is monitoring for the presence of West Nile virus by tracking mosquito samples, horses, and dead birds. So far in 2006, there have been 5 horse infections acquired in our state and 1 dead bird has tested positive - all in Yakima County.
(Washington State Dept. of Health 9/26/06)
CDC EID Journal, Volume 12, Number 10—Oct 2006
CDC Emerging Infectious Diseases Journal, Volume 12, Number 10—Oct 2006 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm.
Food Markets with Live Birds as Source of Avian Influenza
Ming Wang et al. EID Journal. Volume 12, Number 11–November 2006.
Abstract: “A patient may have been infected with highly pathogenic avian influenza virus H5N1 in Guangzhou, People's Republic of China, at a food market that had live birds. Virus genes were detected in 1 of 79 wire cages for birds at the market. One of 110 persons in the poultry business at markets had neutralizing antibody against H5N1.”
(CIDRAP http://www.cidrap.umn.edu/ )
Review of Aerosol Transmission of Influenza A Virus
Raymond Tellier. EID Journal. Volume 12, Number 11–November 2006.
Abstract: “In theory, influenza viruses can be transmitted through aerosols, large droplets, or direct contact with secretions (or fomites). These 3 modes are not mutually exclusive. Published findings that support the occurrence of aerosol transmission were reviewed to assess the importance of this mode of transmission. Compelling evidence in the literature indicates that aerosol transmission of influenza is an important mode of transmission, which has obvious implications for pandemic influenza planning, and in particular for recommendations about the use of N95 respirators as part of personal protective equipment.”
(CIDRAP http://www.cidrap.umn.edu/ )
Safety and immunogenicity of nonadjuvanted and MF59-adjuvanted influenza A/H9N2 vaccine preparations
Robert L. Atmar et al. Clinical Infectious Diseases. 2006;43:000
Abstract: “Background. Influenza A/H9N2 viruses can infect humans and are considered to be a pandemic threat. Effective vaccines are needed for these and other avian influenza viruses. Methods. We performed a phase I, randomized, double-blind trial to evaluate the safety and immunogenicity of a 2-dose schedule (administered on days 0 and 28) of 4 dose levels (3.75, 7.5, 15, and 30 ìg of hemagglutinin) of inactivated influenza A/chicken/Hong Kong/G9/97 (H9N2) vaccine with and without MF59 adjuvant. Vaccine safety was assessed with a diary and selected blood tests. Immunogenicity was measured using serum hemagglutination inhibition (HAI) and microneutralization (MNt) antibody assays. Results. Ninety-six healthy adults (age, 18–34 years) were enrolled in the study. Arm discomfort was more common in groups that received adjuvant, but adverse effects of the vaccination were generally mild. Geometric mean serum HAI and MNt antibody titers to the influenza A/chicken/Hong Kong/G9/97 (H9N2) virus strain for all vaccine groups were similar on day 0 but were significantly higher (P < .001) on both days 28 and 56 for the MF59-adjuvanted vaccine groups than for groups given nonadjuvanted vaccine. Other measures of immunogenicity were also higher in the adjuvanted vaccine groups. HAI and MNt geometric mean titers measured after the administration of a single dose of MF59-adjuvanted vaccine were similar to those measured after 2 doses of nonadjuvanted vaccine. Conclusions. The combination of MF59 adjuvant with a subunit vaccine was associated with improved immune responses to an influenza A/H9N2 virus. The adjuvanted vaccine was immunogenic even after a single dose, raising the possibility that a 1-dose vaccination strategy may be attainable with the use of adjuvanted vaccine.”
(CIDRAP http://www.cidrap.umn.edu/ )
Mouse study reveals new clues about virulence of 1918 influenza virus
The first comprehensive analysis of an animal's immune response to the 1918 influenza virus provides new insights into the killer flu, report scientists in an article in "Nature." They found that the 1918 virus triggers a hyperactive immune response that may contribute to the lethality of the virus. Furthermore, their results suggest that it is the combination of all 8 of the 1918 flu virus genes interacting synergistically that accounts for the exceptional virulence of this virus. Michael G. Katze, Ph.D., of the University of Washington, a grantee of the National Institute of Allergy and Infectious Diseases (NIAID), led the research team with University of Washington's John Kash, Ph.D. The work with the fully reconstructed 1918 virus was conducted by coauthor Terrence Tumpey, Ph.D., in a biosafety level 3-enhanced laboratory at CDC.
Modern analyses of 1918 flu victim autopsy samples show extreme and extensive damage to lung tissues. This observation gave rise to the hypothesis that the 1918 flu virus infection provoked an uncontrolled inflammatory response leading to rapid lung failure and death. To test this idea, Dr. Tumpey infected mice intranasally with 1 of 4 types of flu virus: human seasonal flu virus from a strain that circulated in Texas in 1991; lab-made viruses containing either 2 or 5 of 8 viral genes from the 1918 virus; or a reconstructed virus containing all 8 1918 flu virus genes. Lung tissue from 3 infected mice in each group was removed on days 1, 3 and 5 post-infection and processed to destroy any virus. RNA was then extracted from these lung samples. Drs. Katze and Kash and colleagues examined the mouse RNA using microarrays to determine which genes were activated when exposed to each of the 4 viruses. This analysis showed that the immune response to the reconstructed 1918 virus containing all 8 flu genes was much greater than to any of the other viruses with all 8 genes, says Dr. Katze. In particular, genes involved in promoting inflammation were strongly and immediately activated following infection by the reconstructed 1918 virus.
A complete understanding of the host's response to the 1918 flu virus, adds Dr. Katze, requires use of a fully reconstructed virus. A fuller picture of the host immune response to the 1918 flu virus could also be valuable to scientists working to develop therapies against such viruses as the H5N1 avian influenza. Besides targeting the flu virus itself, Dr. Katze explains, researchers might develop new or improved agents aimed at moderating or halting the human immune system's overactive response to these viruses.
(U.S. Department of Health and Human Services 9/27/06)
Ongoing Multistate Outbreak of Escherichia coli serotype O157:H7 Infections Associated with Consumption of Fresh Spinach--United States, September 2006
“On September 13, 2006, CDC officials were alerted by epidemiologists in Wisconsin and Oregon that fresh spinach was the suspected source of small clusters of Escherichia coli serotype O157:H7 infections in those states. On the same day, New Mexico epidemiologists contacted Wisconsin and Oregon epidemiologists about a cluster of E. coli O157:H7 infections in New Mexico associated with fresh spinach consumption. Wisconsin public health officials had first reported a cluster of E. coli O157:H7 infections to CDC on September 8. On September 12, CDC PulseNet had confirmed that the E. coli O157:H7 strains from infected patients in Wisconsin had matching pulsed-field gel electrophoresis (PFGE) patterns and identified the same pattern in patient isolates from other states. This report describes the joint investigation and outbreak-control measures undertaken by state public health officials, CDC, and the Food and Drug Administration (FDA). This investigation and additional case finding are ongoing. . .”
(MMWR September 26, 2006 / 55(Dispatch);1-2)
Diarrheagenic Escherichia coli
This comprehensive CIDRAP-authored overview includes sections on: Agent, Pathogenesis, Epidemiology, Clinical Features, Differential Diagnosis, Laboratory Diagnosis, Antimicrobial Susceptibility, Treatment, Vaccines, Travel Implications, Infection Control Recommendations, Public Health Measures, Information for Businesses, Information for Consumers, Information for Food Service Establishments, References.
(CIDRAP http://www.cidrap.umn.edu/ updated Sep 26)
Chikungunya Fever Diagnosed Among International Travelers--United States, 2005--2006
“Chikungunya virus (CHIKV) is an alphavirus indigenous to tropical Africa and Asia, where it is transmitted to humans by the bite of infected mosquitoes, usually of the genus Aedes. Chikungunya (CHIK) fever, the disease caused by CHIKV, was first recognized in epidemic form in East Africa during 1952--1953. . .Large outbreaks of CHIK fever have been reported recently on several islands in the Indian Ocean and in India. In 2006, CHIK fever cases also have been reported in travelers returning from known outbreak areas to Europe, Canada, the Caribbean (Martinique), and South America (French Guyana). During 2005--2006, 12 cases of CHIK fever were diagnosed serologically and virologically at CDC in travelers who arrived in the United States from areas known to be epidemic or endemic for CHIK fever. This report describes four of these cases and provides guidance to health-care providers. Clinicians should be alert for additional cases among travelers, and public health officials should be alert to evidence of local transmission of chikungunya virus (CHIKV), introduced through infection of local mosquitoes by a person with viremia. . .”
(MMWR September 29, 2006 / 55(38);1040-1042)
Importance of Culture Confirmation of Shiga Toxin-producing Escherichia coli Infection as Illustrated by Outbreaks of Gastroenteritis--New York and North Carolina, 2005
“Escherichia coli O157:H7 and other strains of E. coli that produce Shiga toxin are collectively known as Shiga toxin-producing E. coli (STEC). The current outbreak of STEC O157 infections associated with eating fresh spinach illustrates the importance of obtaining isolates to identify the source of the infections. Laboratory methods that do not require bacterial culture of stool specimens to identify STEC are being used increasingly by clinical diagnostic laboratories, sometimes without subsequent confirmation of a strain by isolating it in culture. This report describes findings from outbreaks of gastroenteritis in 2005 in New York and North Carolina in which clinical diagnostic laboratories initially used only non-culture methods to detect Shiga toxin (Stx). The findings highlight the importance of confirmation of Stx-positive stool specimens by bacterial culture for timely and reliable identification of STEC infections, including E. coli O157 and non-O157 STEC, to enable implementation of appropriate public health actions. An important part of that identification is determining the serotype of all STEC isolates and the subtype of STEC O157 strains so that outbreaks can be detected and traced back to sources. . .”
(MMWR September 29, 2006 / 55(38);1042-1045)
Inadvertent misadministration of meningococcal conjugate vaccine--United States, June-August 2005
“During June--August 2005, CDC and the Food and Drug Administration (FDA) were notified of seven clusters of inadvertent subcutaneous (SC) misadministration of the new meningococcal conjugate vaccine (MCV4, Menactra) (Sanofi Pasteur, Inc., Swiftwater, Pennsylvania), which is licensed for intramuscular (IM) administration only. A total of 101 persons in seven states were reported to have received MCV4 by the SC route. Of these, 100 were contacted by their health-care providers and advised of the administration error. CDC conducted an investigation to determine whether SC administration of MCV4 resulted in a protective immunologic response. This report describes the results of that investigation, which indicated that, despite the misadministration, persons vaccinated by the SC route were sufficiently protected and that revaccination was not necessary. . .”
(MMWR September 22, 2006 / 55(37);1016-1017)
Public Health Response to Varicella Outbreaks--United States, 2003--2004
“Since introduction of varicella vaccine in 1995, incidence of varicella has decreased as vaccination coverage has increased. Nevertheless, varicella outbreaks continue to occur, even among populations with high vaccination coverage. Although varicella typically is mild, the outbreaks can last for several months and be challenging and costly for health departments to control. In 2005, CDC conducted a national survey to determine the distribution and extent of reported varicella outbreaks during 2003--2004 and the public health response. This report summarizes the results of that survey, which indicated that varicella outbreaks are still common and that health jurisdictions are responding to these outbreaks, although they have varying definitions and guidelines for varicella-outbreak management. . .”
(MMWR September 15, 2006 / 55(36);993-995)
National, state, and urban area vaccination coverage among children aged 19--35 months--United States, 2005
“The National Immunization Survey (NIS) provides vaccination coverage estimates among children aged 19--35 months for each of the 50 states and selected urban areas.Findings from the 2005 NIS include nationwide increases in coverage with >3 and >4 doses of pneumococcal conjugate vaccine (PCV) and continued high levels of coverage for the other recommended vaccines and vaccine series. In addition, no racial/ethnic disparities in coverage estimates were observed in the 4:3:1:3:3:1 vaccine series, the recommended series for children aged 19--35 months that includes DTP/DT/DTaP; poliovirus vaccine; measles, mumps, and rubella vaccine (MMR); Haemophilus influenzae type b vaccine; hepatitis B vaccine; and varicella vaccine. An important accomplishment indicated by the 2005 NIS data is the achievement of >50% coverage for the full series of PCV (>4 doses) and >80% coverage for >3 doses within 5 years after being added to the U.S.-recommended childhood immunization schedule in 2000. This occurred despite shortages of this vaccine during 2001--2004, which might have affected accessibility to PCV. . .”
(MMWR September 15, 2006 / 55(36);988-993)
The CDC Experience Application Deadline--Dec 4, 2006
The CDC Experience is a 1-year fellowship in applied epidemiology that is tailored for rising third- and fourth-year medical students and aims to develop a pool of physicians with a population health perspective. 8 fellows spend 10--12 months at CDC in Atlanta, where they conduct epidemiologic analyses in areas of public health that interest them. The fellowship environment provides multiple opportunities to enhance skills in research and analytic thinking, written and oral scientific presentations, and the practices of preventive medicine and public health. Applicants do not need experience in public health to apply for this program. Fellows will acquire practical tools useful for approaching population-based health problems. Graduates of The CDC Experience have an appreciation of the role of epidemiology and are able to apply their knowledge and skills to enhance their clinical acumen and help improve the quality of the US health-care system. For more information: http://www.cdcfoundation.org/thecdcexperience. Applications for The CDC Experience fellowship class of 2006--07 must be postmarked by Dec 4, 2006. For questions contact Catherine Piper: firstname.lastname@example.org.
(MMWR September 29, 2006 / 55(38);1047)
Epidemiology in Action Course--Oct 23-Nov 3, 2006
The Rollins School of Public Health's Hubert Department of Global Health and CDC's Office of Workforce and Career Development will cosponsor a course, Epidemiology in Action, Oct 23--Nov 3, 2006, at Emory University in Atlanta, USA. The course is designed for state and local public health workers. The course emphasizes the practical application of epidemiology to public health problems and will consist of lectures, workshops, classroom exercises, and roundtable discussions. Topics include descriptive epidemiology and biostatistics, analytic epidemiology, epidemic investigations, public health surveillance, surveys and sampling, Epi Info training, and discussions of selected prevalent diseases. Additional information and applications are available from Emory University, Hubert Department of Global Health (attention: Pia), 1518 Clifton Road NE, Room 746, Atlanta, GA 30322; by telephone, 404-727-3485; fax, 404-727-4590; online at http://www.sph.emory.edu/epicourses; or by e-mail, email@example.com.
(MMWR September 15, 2006 / 55(36);997)
Preventive Medicine Residency Application Deadline--Oct 11, 2006
The Preventive Medicine Residency (PMR) is accepting applications from physicians with public health and applied epidemiologic practice experience who seek to become preventive medicine/population health specialists and public health leaders. The PMR prepares physicians for leadership roles in public health at federal, state, and local levels through instruction and supervised practical experiences focused on translating epidemiology to public health practice, management, and policy and program development. Residents spend the practicum year at CDC or in a state or local health department. PMR alumni occupy many leadership positions at CDC, at state and local health departments, and in academia and private-sector agencies. Applications are being accepted for the class that begins in mid-June 2007. Application materials must be postmarked by Oct 11, 2006. For more information: http://www.cdc.gov/epo/dapht/pmr/pmr.htm or by telephone, 404-498-6140.
(MMWR September 15, 2006 / 55(36);997)
Malaria 2007 and Pathogenic Helminths 2007--First Call for Participants & Contributions
Dakar, Senegal; 21 Apr 2007 and 1 May 2007, respectively
MALARIA 2007: <http://www.mangosee.com/malaria2007>
PATHOGENIC HELMINTHS: <http://www.mangosee.com/helminths2007>
For further information, contact:
Anthony F. England, Ph.D.
Mangosteen Meetings & Fora
3544 DZ Utrecht, The Netherlands
Tel: +31 30 21 45 715; firstname.lastname@example.org
First APUA World Congress: Strengthening Society's Infectious Disease Defenses
11-12 Dec 2006; Boston, Massachusetts, USA
6 Topic Tracks: Regulation and Legislation; Economic Burden; Biosecurity Applications; Drug Development; Public/Private Partnerships; Enabling Technologies.
Registration: Student/Postdoc $159; Government/Academic $399; Commercial $599
Exhibit spaces and sponsorship packages available.
Contact: Christopher.Spivey@tufts.edu; Phone: +1 - 617.636.0966; http://www.tufts.edu/med/apua/.
4. To Receive EINet Newsbriefs
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The APEC EINet email list was established to enhance collaboration among health, commerce, and policy professionals concerned with emerging infections in APEC member economies. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe, go to: http://depts.washington.edu/einet/?a=subscribe or contact email@example.com. Further information about APEC EINet is available at http://depts.washington.edu/einet/.