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Vol. IX, No. 21 ~ EINet News Briefs ~ Oct 27, 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 seeks urgent push for pandemic flu vaccines
- Global: Novartis claims success in trial of cell-based flu vaccine
- Global: WHO and partners unveil new approach to neglected tropical diseases
- Indonesia (Sulawesi Island): 9 suspected cases of avian influenza infection
- Vietnam: Success against avian flu may offer blueprint for others
- Hong Kong: Gastroenteritis associated with consumption of raw oysters
- Russia (Tyva): Increasing incidence of tick-borne encephalitis
- Russia (Bashkortostan): 5 deaths from hemorrhagic fever with renal syndrome
- USA (Michigan): Low pathogenic avian influenza in wild avians
- USA (Ohio): No avian influenza virus found in wild avians
- USA (California): Manure implicated in E coli outbreak
- USA (multistate): E. Coli O157 strain in spinach outbreak particularly virulent
- Canada: Seventh case of botulism associated with carrot juice
- USA: Pentagon to resume mandatory anthrax shots for some
- USA (Indiana): Human case of rabies from bat exposure
- Avian/Pandemic influenza updates
- Cholera, Diarrhea, and Dysentery
- West Nile Virus
- Study: Wood ducks could be sentinel for H5N1
- Study shows flu shots safe for 6- to 23-month-olds
- Subjective and objective risk as predictors of influenza vaccination during the vaccine shortage of 2004–2005
- Risk Factors for Human Infection with Avian Influenza A H5N1, Vietnam, 2004
- In case of pandemic flu majority of Americans willing to make major changes in their lives
- New Study Has Important Implications for Influenza Surveillance, Vaccine Formulation
- Anatidae migration in the Western Palearctic and spread of highly pathogenic avian influenza H5N1 virus
- STD-prevention counseling practices and human papillomavirus opinions among clinicians with adolescent patients--United States, 2004
- Update: Guillain-Barré syndrome among recipients of Menactra meningococcal conjugate vaccine--United States, June 2005-September 2006
- Vaccination Coverage among Children Entering School--United States, 2005-06 School Year
- Varicella Surveillance Practices--United States, 2004
- Brief Report: Update: Mumps Activity --- United States, January 1--October 7, 2006
- Global pandemic influenza action plan to increase vaccine supply
- IMED 2007 abstract submission
- APHA Get Ready Campaign (for emerging infectious diseases)
- HEALTHmap: Current global state of infectious diseases
- Self-Study Course: Principles of Epidemiology in Public Health Practice, Third Edition
4. To Receive EINet Newsbriefs
- APEC EINet email list
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 256 (151).
Avian influenza age & sex distribution data from WHO/WPRO (as of 10/16/06): http://www.wpro.who.int/sites/csr/data/data_Graphs.htm.
Global: WHO seeks urgent push for pandemic flu vaccines
WHO lays out 3 main steps for closing the vaccine supply gap: 1) Increase use of seasonal flu vaccine to stimulate industry to produce more (while protecting more people from seasonal flu); 2) Increase vaccine production capacity by improving yields and building new plants; 3) Increase research to develop better vaccines that provide more protection with fewer doses and produce vaccines faster and more efficiently. The most direct way to improve production capacity is to increase the production yield and immunogenicity of H5N-based vaccines, WHO says. Several candidate vaccines containing adjuvants will be tested over the next 2 years, but funding will be needed. WHO also calls for more research on live attenuated flu vaccines, saying they may be more effective than inactivated vaccines, cost less to produce, and have higher yields. The agency also advocates further assessment of killed, whole-virus vaccines and of administering vaccines intradermally rather than intramuscularly.
WHO estimates the cost of all the strategies for boosting vaccine yields and production capacity from $2 billion to $9 billion. WHO says the ideal vaccine is one that is safe and effective in all target groups with a single dose, is easily produced on a large scale, is thermostable, provides protection for at least a year, and protects against "antigenically drifted" flu strains. WHO recommends a number of approaches for developing better vaccines: Evaluate new adjuvants; Assess the molecular basis for the immunogenicity of hemagglutinin, one of the two surface proteins on flu viruses; Develop new-generation vaccines, such as ones that target viral proteins other than hemagglutinin; Determine the potential benefits of giving a pre-pandemic vaccine to prime the immune system to respond to later vaccination with a pandemic vaccine. WHO also advocates standardizing protocols for evaluating new vaccine candidates and defining immune responses in lab animals that correlate with protection in humans.
Global: Novartis claims success in trial of cell-based flu vaccine
Global: WHO and partners unveil new approach to neglected tropical diseases
"Preventive chemotherapy does not necessarily stop infection taking place but it can help to reduce transmission. The benefit of preventive chemotherapy is that it immediately improves health and prevents irreversible disease in adults," says Dr Lorenzo Savioli, Director of the WHO Department for the Control of Neglected Tropical Diseases. “In the same way as we protect people against a number of vaccine-preventable diseases throughout their lives, the regular and coordinated use of a few drugs can protect people against worm-induced disease. . ." The new approach provides a critical first step in combining treatment regimens for diseases which, although different in themselves, require common resources and delivery strategies for control or elimination. The second key component of the strategy brings together for the first time dozens of agencies, NGOs, pharmaceutical companies and others into a coordinated assault on neglected diseases. These organizations are integrating their expertise and resources to deliver the manual’s protocols for wide-scale drug use.
More than 1 billion people are afflicted by these diseases. Their impact can be measured in the impaired growth and development of children, complications during pregnancies, underweight babies, significant and sometimes disabling disfigurements, blindness, social stigma, and reduced economic productivity and household incomes. These effects can now be dramatically reduced by scaling up interventions using highly effective drugs of proven quality and excellent safety record -- the majority donated free by companies or costing less than US$ 0.40 per person per year, including the cost of the drugs and their delivery.
Indonesia (Sulawesi Island): 9 suspected cases of avian influenza infection
Tests for bird flu are being run on 9 people from a province of Indonesia's eastern island of Sulawesi, where one of the patients, a 1-year-old boy, probably died of the virus this week. The child from the South Sulawesi district of Maros died 17 Oct 2006, hours after he was admitted to the Wahidin Sudirohusodo Hospital in Makassar with flu-like symptoms. Samples from the boy are being tested for H5N1.
Tests for the H5N1 virus are being run on 8 others being treated in the Wahidin Sudirohusodo Hospital. They are all from South Sulawesi province, where the disease is known to have infected poultry. It wasn't immediately known whether the patients are related. The virus is reported to have killed a person every 4 days worldwide this year, more than double the 2005 rate, creating more chances for it to become more contagious to people. At least 256 people in 10 countries have caught H5N1 since late 2003, WHO said 16 Oct 2006. Almost all human H5N1 cases have been linked to close contact with sick or dead birds. While the virus doesn't spread easily between people, some human-to-human transmission may have occurred.
Reportedly, in an effort to stop avian flu outbreaks, Indonesian officials said they plan to bar people in major cities from keeping free-roaming poultry. The health minister said the ban could be modeled on similar laws in Thailand and Hong Kong. No date was set for imposing it.
Vietnam: Success against avian flu may offer blueprint for others
After responding to its 2004 outbreaks mainly by culling infected flocks, Vietnam in 2005 became the first country to institute mandatory nationwide poultry vaccination. In addition—and almost simultaneously—the national government banned poultry rearing and live-market sales in urban areas; restricted commercial raising of ducks and quail, which can harbor the virus asymptomatically; imposed strict controls on poultry transport within Vietnam and agreed to examine illegal cross-border trade; and launched an aggressive public education campaign. The country also compensated farmers for birds that had to be killed—initially at 10% of the birds' market value, and now at 75%.
"Who knows what impact any of these interventions had? This is a natural experiment" that lacks controls that could measure impact, said Dr. David Dennis, the Hanoi-based Vietnam influenza coordinator for the US CDC. "How much [of the reduction in cases] is due to the natural history of this organism in birds? We don’t know." Outside the country, experts presume the engine of flu control to be the pervasive influence of Vietnamese-style socialism, which extends from the national government through provinces, districts, and communes to individual "neighborhood committees." But within Vietnam, workers in avian-flu control say the country's success depends as much on the population's support as it does on political coercion. "What makes the system work is not that it is top-down, but that it achieves consensus at every level," said Don Douglas, chief of party for Mekong Region avian flu efforts at Abt Associates, a US consulting firm that was awarded a 3-year contract for avian flu assistance in north Vietnam. "Imagine the stigma associated with being the farm that lets everyone down and causes all its neighbors' chickens to be culled."
Hong Kong: Gastroenteritis associated with consumption of raw oysters
Hong Kong is subject to frequent food scares as unlicensed goods smuggled from China -- where quality control checks are lax -- find their way into public markets and restaurants. Gastroenteritis associated with consumption of raw oysters is common throughout the world. Previously oysters imported into Hong Kong from both the Republic of Ireland and from Singapore have been associated with outbreaks of gastroenteritis. This global trade in oysters represents an unusual route for transmission of enteric viruses and may be responsible for the frequent recurrence of epidemics of shellfish-associated gastroenteritis.
Russia (Tyva): Increasing incidence of tick-borne encephalitis
The number of territories [of the Republic] reporting cases of tick-borne encephalitis during the past 10 years has increased 2-fold. Since the beginning of 2006, some 1019 people in the Republic of Tyva have experienced tick-bites (compared with 889 in 2005) and sought medical treatment. The principal causes of high tick-borne encephalitis morbidity are reductions in tick control activities, the limited extent of preventative vaccination and lack of availability of [immunoglobulin preparations] for emergency treatment. Only 4647 individuals were vaccinated in 2006 compared with 11 567 in 2003. Only 22.5 percent of people who suffered tick-bite were vaccinated and only 30.1 percent received specific antibody treatment. The funding allocated by the Ministry of Health of the Republic of Tyva did not fully cover the purchase of immunological preparations.
The high level of morbidity in Tyva (18.2 per 100 000 inhabitants) is the result of increases in tick activity, changes in climatic and other factors, and deficiencies in tick control activities and heath care. These problems are not confined to the Republic of Tyva, and tick-borne encephalitis, a vaccine-preventable disease, remains a problem throughout much of central Russia.
Russia (Bashkortostan): 5 deaths from hemorrhagic fever with renal syndrome
Bashkortostan is one of 3 foci of HFRS virus, the other 2 being the Primorsk region of Russia, and South Korea. An abundance of deciduous (lime) trees and suitable weather conditions favor the spread of the red field-vole in these regions. The average cost of treatment of a patient is 12-20 000 rubles [USD 447-745]. Rodent control measures around and in houses remains the sole means of combating the red field vole, the vector of HFRS. About 4 700 000 rubles [USD 175 000] have been allocated from the budget of the Republic for this purpose in 2006. However, payment of much of the funding has been delayed.
During Oct 2006, the number of patients suffering from HFRS in Bashkortostan had increased by more than 300. The peak of HFRS morbidity usually occurs during September/October, and a further increase in the number of HFRS patients must be expected. In 2005, a total of 2300 people contracted HFRS in the Republic. Diagnosis of HFRS has been a problem in the past. Now, a rapid diagnostic technique developed by the Tarasevich Institute of Standardization and Control has passed clinical tests and is available for use.
USA (Michigan): Low pathogenic avian influenza in wild avians
The U.S. Department of Agriculture (USDA) and Department of the Interior (DOI) announced a detection of H5 and N1 avian influenza subtypes in a wild Green-winged teal sample from Tuscola County, Mich., that was killed by hunters. Initial test results indicated the presence of low pathogenic avian influenza (LPAI) virus. On 15 Oct 2006, 51 bird samples were collected through a partnership between USDA and the Michigan Department of Natural Resources. Of the 51 samples collected from a number of wild bird species, 5 were sent to USDA's National Veterinary Services Laboratories (NVSL) for confirmatory testing. One sample tested positive for both H5 and N1 subtypes. This does not mean these birds are infected with an H5N1 strain. It is possible that there could be 2 separate avian influenza viruses, one containing H5 and the other containing N1. Confirmatory testing underway at NVSL will clarify whether one or more strains of the virus are present, the specific subtype, as well as confirm the pathogenicity.
Low pathogenic avian influenza commonly occurs in wild birds. It typically causes only minor sickness or no noticeable signs in birds. There is no known health risk to hunters or hunting dogs from contact with low-pathogenic forms of avian influenza virus. Nevertheless, hunters are always encouraged to use common-sense sanitation practices, such as hand washing and thorough cooking, when handling or preparing wildlife of any kind. DOI has issued guidelines for safe handling and preparation of wild game.
USA (Ohio): No avian influenza virus found in wild avians
To date, USDA and DOI have announced 12 presumptive positive and/or confirmatory test results in 6 states (MI, MD, PA, MT, IL and OH). As the expanded surveillance of wild birds for highly pathogenic avian influenza increases in the coming months, USDA and DOI expect additional detections of the "North American strain" of low pathogenic H5N1 avian influenza. Because these LPAI H5N1 detections are common and pose no threat to human health , USDA and DOI are transitioning to a new method of notifying the public. In an effort to maintain transparency, USDA and DOI will post all future suspected LPAI H5N1 detections on the Internet. DOI will maintain a list of all such routine detections as part of the National Highly Pathogenic Avian Influenza Early Detection Data System (HEDDS). The low path H5N1 detection list can be accessed at http://wildlifedisease.nbii.gov/ai/LPAITable.pdf . A link also will be at http://www.usda.gov/birdflu . In the event of a presumptive H5N1 test result involving a large number of sick or dead birds, or other circumstances that suggest the possibility of a highly pathogenic virus, USDA and DOI will issue a news release or conduct a briefing to notify the media and the public.
USA (California): Manure implicated in E coli outbreak
Kevin Reilly, deputy director of prevention services for the California Department of Health Services, said the results don't prove that the manure was responsible for the outbreak. The manure samples that tested positive for the outbreak strain were located between a half mile and a mile from a spinach field. However, federal and state investigators still don't know how the feces contaminated the spinach. Media reports said this is the first time investigators have been able to link an outbreak strain of E coli to a farm where contaminated spinach or lettuce was grown. The positive finding is significant but is just one aspect of the investigation, FDA said. "While the focus of this outbreak has narrowed to these four fields, the history of E coli O157:H7 outbreaks linked to leafy greens indicates an ongoing problem," FDA said. The outbreak has sickened 199 people and killed 3, and has spanned 26 states and 1 Canadian province. Since 1995, 20 E coli outbreaks have been traced to leafy greens.
The pasture where the contaminated manure was found is part of a ranch that leases fields to spinach growers. Fences on the property had been penetrated by wild pigs, and investigators are assessing whether the pigs might have spread the bacteria from the cattle pasture to the spinach field. Reilly said the farm where matching manure was found did not fully follow voluntary guidelines that growers use to prevent contamination of leafy greens. He said concerns include the proximity of the cattle to spinach fields and the failure of fences to keep wildlife out. Reportedly the closeness of cattle to leafy greens farms is not uncommon in Salinas Valley. Not all 4 of the suspected farms have both livestock and produce operations.
2 new cases of illness from the E. coli bacterium linked to spinach have been reported in Illinois. The 2 newest cases involve a woman from downstate Illinois and a child from the northeast part of the state.
USA (multistate): E. Coli O157 strain in spinach outbreak particularly virulent
Disease detectives first booked No. 0124 into the CDC's genetic fingerprint computer in Dec 1998, when it turned up in 3 cases in Massachusetts. It popped up again in 2000, causing a single illness in Kansas. There were 5 states affected in 2001 and 37 states in 2005. Before a single case of spinach-related illness was logged in 2006, there were already 34 cases in 17 states -- all of them caused by the same strain. The 0124 subtype accounts for less than 1 percent of the strains reported each year, but it has been increasingly prevalent, said Dr. Peter Gerner-Smidt, who tracks the subtypes of E. coli at the CDC as chief of a the surveillance program PulseNet.
Each year, laboratories in state health departments throughout the country log several thousand cases of E. coli infection, and submit the genetic fingerprints of each case to PulseNet. There are 73 000 cases of E. coli O157:H7 food poisoning each year, but seldom do they appear in clusters large enough to trigger closer scrutiny. Typically, E. coli O157:H7 causes severe cramping and bloody diarrhea, and about 10 percent of children who get it develop a life-threatening kidney damage called hemolytic uremic syndrome. Of the 199 confirmed cases in the spinach outbreak, however, 39 percent of children afflicted developed the kidney condition, as have about 10 percent of adults.
One possible explanation for 0124's unusual punch lies in its molecular makeup. All E. coli O157:H7 strains are dangerous because they are armed with toxins similar to those found in the intestinal disease shigellosis.
Most strains carry 2 kinds, known as Shiga Toxin Types 1 and 2. But the spinach outbreak strain appears to carry only Type 2. Early research on E. coli suggests that Type 2 toxins are more potent than Type 1, and that strains that carry Type 2 alone are more dangerous than those that carry only Type 1 or both. The unusual severity of illness found in the spinach outbreak is consistent with those laboratory findings. In 8 of 9 years prior to this summer's outbreak of a particularly virulent strain of E. coli O157:H7 among consumers of fresh spinach, CDC had detected the same microbe in 109 patients scattered through 31 states.
Canada: Seventh case of botulism associated with carrot juice
The cases in the USA were reported to be associated with a nonrefrigerated product, and the previous 2 cases from Ontario, Canada were alleged to be linked to juice that was properly refrigerated (at least in the home). The USA's FDA and CDC launched an investigation of Bolthouse Farms after the juice was voluntarily recalled by the company. Several bottles of the company's carrot juice were tested for the toxin, and all bottles came back with negative results. The 2 Toronto patients, who remain seriously ill in hospital, live together, and both ingested the toxic carrot juice before falling ill. Toronto Public Health sent a sample of the carrot juice that was left in the refrigerator to a lab in Ottawa, where it tested positive for botulism.
USA: Pentagon to resume mandatory anthrax shots for some
Soldiers concerned about the vaccine's side effects sued to stop the program several years ago, arguing that the Food and Drug Administration (FDA) had never specifically approved the vaccine for preventing inhalational anthrax. In Dec 2003 a federal judge ordered the program stopped. FDA quickly responded with an affirmation that the vaccine was safe and effective for all forms of anthrax disease, and the judge then lifted his injunction. But in Oct 2004 he stopped the program again, ruling that FDA had not followed proper procedures in issuing the new approval. In Jan 2005, FDA granted a Pentagon request for emergency authority to restart the vaccination program, but said the shots had to be voluntary. DoD has been giving the shots on a voluntary basis since Apr 2005. In Dec 2005, the FDA completed a final investigation of the vaccine and reaffirmed its earlier finding that it was safe and effective. Under the voluntary policy, about 50% of the affected service members have accepted anthrax vaccination, Winkenwerder reported. He commented, "This rate of vaccination not only put the service members at risk, but also jeopardized unit effectiveness and degraded medical readiness."
Critics of the program have said the vaccine—Anthrax Vaccine Adsorbed—can cause problems like infertility and autoimmune disorders, such as multiple sclerosis and lupus. Reportedly some soldiers died after being vaccinated, but the Pentagon said that no causal link to the vaccine was established. "The vaccine has been thoroughly reviewed by several independent outside groups" and the FDA, Winkenwerder said. "In all the studies we have performed, looking very, very thoroughly at the vaccine, there is no increase in mortality, there is no increase in morbidity, there is no increase in hospitalizations." The mandatory vaccination program should restart in 30 to 60 days.
USA (Indiana): Human case of rabies from bat exposure
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 “EMPRES WATCH: Evolution of Highly Pathogenic Avian Influenza type H5N1 in Europe: review of disease ecology, trends and prospects of spread in autumn-winter 2006” (11pgs, pdf).
- OIE: http://www.oie.int/eng/en_index.htm. Basic information about the upcoming conference (20-22 Mar 2007), “Vaccination, a tool for the control of avian influenza” is available.
- US CDC: http://www.cdc.gov/flu/avian/index.htm
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. You can now select a US map that will take you to a page with links to state pandemic planning information, state pandemic Web site information, and local state contacts.
- Health Canada: information on pandemic influenza: http://www.influenza.gc.ca/index_e.html. Information on avian influenza: http://www.hc-sc.gc.ca/dc-ma/avia/index_e.html.
- CIDRAP: http://www.cidrap.umn.edu/. Frequently updated news and journal 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. New updates: DOI expand wild bird monitoring for avian influenza.
- 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. Includes wild bird test results from US, Philippines, and Australia.
(WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; AVMA; USGS)
Cholera, Diarrhea, and Dysentery
Indonesia (West Java)
West Nile Virus
* Neurological syndrome + Non-Neurological syndrome + Asymptomatic Infections
* Cases with neurologic manifestations (such as WN encephalitis, meningitis* and myelitis)
Study: Wood ducks could be sentinel for H5N1
Researchers from the University of Georgia report that wood ducks and laughing gulls are highly susceptible to H5N1 avian influenza, which suggests those 2 species could be sensitive indicators of the virus's presence in wild birds. In a lab, the researchers exposed 6 species of wild birds—5 duck species and laughing gulls—to the lethal Asian H5N1 virus. All the birds became infected, but only the wood ducks and laughing gulls became ill or died, according to their report in the November issue of Emerging Infectious Diseases (http://www.cdc.gov/ncidod/EID/vol12no11/06-0652.htm ). The findings come amid this year's greatly expanded federal and state program to look for H5N1 avian flu in wild birds in the US. The Asian strain of H5N1 has not yet been found in North America. "If you're looking for highly pathogenic H5N1 in wild birds, it would really pay to investigate any wood duck deaths because they seem to be highly susceptible," David Stallknecht, a study coauthor, commented. Besides wood ducks, the ducks used in the study were mallards, Northern pintails, blue-winged teal, and redheads. Those species are the most likely to bring H5N1 to North America, given their behavior and habitat use, lead author Dr. Justin Brown said. The researchers found that the birds studied had more virus in their mouth and throat secretions than in feces. In contrast, said Stallknecht, birds infected with low-pathogenic avian flu viruses shed more virus in their feces.
(CIDRAP 10/25/06 http://www.cidrap.umn.edu/ )
Study shows flu shots safe for 6- to 23-month-olds
One diagnosis, gastritis/duodenitis, was more likely to occur within 14 days of vaccination, but after reviewing patient charts to exclude other possible causes of the condition, the researchers determined that the association was not significant. Yet they said they could not rule out a reaction to the vaccine and cautioned that the possible relationship bears watching as vaccination rates for young children increase. 13 diagnoses were less likely to occur after vaccination, including acute upper respiratory tract infection, asthma, bronchiolitis, and otitis media.
The Vaccine Adverse Event Reporting System (VAERS) has reported that the most frequently reported adverse effects in children who receive the TIV are fever, rash, injection site reactions, and a small number of seizures, most of which were febrile. The researchers found that most (22 of 24) seizures that occurred within 2 weeks of vaccination were febrile. Children often receive the influenza and measles-mumps-rubella (MMR) vaccines at the same time, and the MMR vaccine is known to increase the risk of febrile seizures. The authors observed that seizures were not seen in children who didn't receive an MMR shot the same day as their flu shot, which suggested that the seizures were related to MMR vaccination. They also found that only 2 of the children had Guillain-Barré syndrome (GBS), and neither was diagnosed with the condition during any of the study intervals. They found no evidence of conjunctivitis or eye symptoms following vaccination in the study group.
Recent CDC recommendations urge healthcare workers to promptly report to VAERS all clinically significant adverse events after influenza vaccination. The authors concluded that the study provides reassurance to parents and physicians regarding the safety of flu vaccination for this age-group. In 2004 the CDC formally recommended flu shots for 6- to 23-month-old children. Recent survey results indicated that 33.4% of those children received at least one dose of flu vaccine for the 2004-05 season, compared with 17.5% the previous season, according to CDC.
Hambidge SJ et al. Safety of trivalent inactivated influenza vaccine in children 6 to 23 months old. JAMA 2006;296(16):1990-7.
Subjective and objective risk as predictors of influenza vaccination during the vaccine shortage of 2004–2005
Risk Factors for Human Infection with Avian Influenza A H5N1, Vietnam, 2004
In case of pandemic flu majority of Americans willing to make major changes in their lives
More than 75% of Americans say they would cooperate if public health officials recommended that for 1 month they curtail various activities of their daily lives. 94% say they would stay at home away from other people for 7-10 days if they had pandemic flu. 85% say they and all members of their household would stay at home for that period if another member of their household was sick. 90% say that if public health officials recommended that they and the other members of their household stay in their town or city, they were likely to stay. The area where anticipated cooperation is lowest involved the workplace. While 57% of employed adults say they would stay home from work if public officials said they should, even if their employers told them to come to work, about 35% say they would go to work.
85% say they would be able to take care of sick household members at home for 7-10 days, if public health officials recommended it. However, 76% say they would be worried that if they stayed at home with a household member who was sick from pandemic flu, they themselves would get sick from the disease. 73% say they would have someone to take care of them at home if they became sick with pandemic flu and had to remain at home for 7-10 days.
If schools and daycare were closed for 1 month, 93% of adults who have major responsibility for children under age 5 in daycare or age 5 to 17 and have at least 1 employed adult in the household think they would be able to arrange care so that at least 1 employed adult in the household could go to work. 86% would be able to do so if schools were closed for 3 months. However, 60% say that at least 1 employed person would have to stay home if schools were closed for a month. Only 25% of employed people who have major responsibility for children under age 5 in daycare or age 5-17 in their household say that if schools and daycare closed for 1 month, they would be able to work from home and take care of the children.
95% of adults with major responsibility for children age 5 to 17 report that they would be willing to give school lessons at home if schools were closed for 3 months. 85% of these adults also think that if schools were closed for 3 months and public health officials recommended it, they would be able to keep their children from taking public transportation, going to public events, and gathering outside home while schools were closed. 64% of these adults would need only a little or no help at all in order to deal with the problems of having to stay home and keep children at home for a long period of time.
25% of employed people believe they would have serious financial problems if they missed 7-10 days of work. 57% think they would have serious financial problems if they had to miss work for 1 month, and 76% think they would have such problems if they were away from work for 3 months. 29% say that if they had to stay away from the workplace for 1 month, they would be able to work from home for that long. 19% are aware of any plan at their workplace to respond to a serious outbreak of pandemic flu. 22% of employed adults are very or somewhat worried that their employer would make them go to work even if they were sick. 50% believe that their workplace would stay open if public health officials recommended that some businesses in their community should shut down.
The survey was conducted with a representative national sample of 1,697 adults age 18 and over, including an oversample of adults who had children under age 18 in their households. Altogether 821 such adults with children were interviewed. In the overall results, this group was weighted to its actual proportion (38%) of the total adult population. The margin of error for the total sample is plus or minus 2.4 percentage points.
Possible sources of non-sampling error include non-response bias, as well as question wording and ordering effects. Non-response in telephone surveys produces some known biases in survey-derived estimates because participation tends to vary for different subgroups of the population. To compensate for these known biases, sample data are weighted to the most recent Census data available from the Current Population Survey for gender, age, race, region, and education. Other techniques, including random-digit dialing, replicate subsamples, callbacks staggered over times of day and days of the week, and systematic respondent selection within households, are used to ensure that the sample is representative.
New Study Has Important Implications for Influenza Surveillance, Vaccine Formulation
In an effort to better understand how seasonal influenza evolves into new strains, the researchers analyzed the genomic sequences of a large and representative collection of the two most common flu strains (called H3N2 and H1N1) from the 1995-2005 flu seasons in New York state and New Zealand. The sequence data was obtained from the Influenza Genome Sequencing Project, which recently generated over 1,000 fully sequenced influenza genomes from clinical isolates. The analysis revealed a picture of flu evolution that was surprisingly different from the prevailing conception of how the virus changes. Evolution of influenza A virus is commonly viewed as a typical Darwinian process. In this mode of evolution, the virus’ main surface protein, hemagglutinin (HA), is thought to continually change to evade human immune response, resulting in new dominant strains that eliminate all competitors in a series of rapid successions. Unexpectedly, however, the study found that the periods of intense Darwinian selection accounted for only a relatively small portion of H3N2 flu evolution during the 10-year period examined.
The study found that much of the time the H3N2 virus seemed to be “in stasis”; that is, the HA gene showed no significant excess of mutations in the antigenic regions (those recognized by the immune system). During these stasis periods, none of the co-circulating strains is significantly more fit than others, apparently because multiple mutations are required to substantially improve the virus’ ability to evade the immune system. As a result, an increased variety of strains accumulates. Ultimately, however, one of the variants will come within one mutation of achieving higher fitness and becoming dominant. Once the crucial last mutation does occur, virus evolution shifts from stasis to a brief interval of rapid Darwinian evolution, where the new dominant virus rapidly sweeps through the human population and eliminates most other variants. Because the periods of stasis allow the proliferation of many small groups of related viruses, any of which could become the next dominant virus strain, the authors suggest that sequencing much larger numbers of representative isolates could be helpful in augmenting current surveillance methods.
Anatidae migration in the Western Palearctic and spread of highly pathogenic avian influenza H5N1 virus
STD-prevention counseling practices and human papillomavirus opinions among clinicians with adolescent patients--United States, 2004
Update: Guillain-Barré syndrome among recipients of Menactra meningococcal conjugate vaccine--United States, June 2005-September 2006
Vaccination Coverage among Children Entering School--United States, 2005-06 School Year
Varicella Surveillance Practices--United States, 2004
Brief Report: Update: Mumps Activity --- United States, January 1--October 7, 2006
Global pandemic influenza action plan to increase vaccine supply
New WHO guidelines were released Oct 23, 2006. Contents include: Introduction; Overall objectives; The present situation and current challenges; Major approaches to increase supplies of pandemic influenza vaccine; Conclusion; References.
(CIDRAP http://www.cidrap.umn.edu/ )
IMED 2007 abstract submission
APHA Get Ready Campaign (for emerging infectious diseases)
HEALTHmap: Current global state of infectious diseases
Self-Study Course: Principles of Epidemiology in Public Health Practice, Third Edition
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