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Vol. VIII, No. 2 ~ EINet News Briefs ~ Jan 21, 2005


*****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:
- Canada: New case of BSE detected
- Peru: Children at Greatest Risk in Outbreak of Vampire Bat-transmitted Rabies
- Chile: More than 200 Persons may be affected by Vibrio parahaemolyticus
- USA (Michigan): Hunter contracts bovine TB, state says
- Indonesia: Two cases of measles confirmed among tsunami survivors in Aceh
- India: Measles spreads in relief camps
- Indonesia: Tetanus on the rise in Aceh, Sumatra
- Indonesia: Cholera outbreak among refugees
- South and Southeast Asia: FAO says rumors of unsafe fish in tsunami zone unfounded
- Viet Nam: Avian influenza update from WHO
- Thailand: Man charged with dove smuggling
- Vietnam: Tough measures intensified to stop bird flu spread
- EU/East Asia: Review of the avian influenza situation in Asia
- Philippines: Meningococcal disease update
- Malaysia: Outbreak of hand foot and mouth disease in Penang
- Australia (Northern Territory): Melioidosis cases
- Russia (Kaliningrad): Outbreak of hepatitis A
- Russia (Rostov): Botulism cases reported
- New Zealand/Australia: Ross River Virus Patient Worked in Northern Territory

1. Updates
- Influenza
- Cholera, Diarrhea, and Dysentery
- Dengue/DHF
- Viral gastroenteritis

2. Articles
- CDC EID Journal, Volume 11, Number 1-January 2005
- British Medical Journal (BMJ) rapid response articles to tsunami
- Infectious disease: Vietnam's war on flu
- Final analysis of Netherlands avian influenza outbreaks...
- E coli O157:H7 infections associated with ground beef from a U.S. Military Installation, Okinawa...
- Racial Disparities in Nationally Notifiable Diseases --- United States, 2002

3. Notifications
- WHO avian influenza updates
- CDC avian influenza updates
- WHO Tsunami website
- CDC Tsunami website
- The World Organisation for Animal Health (OIE) launches its first distance learning course
- New CDC Program for Rapid Genotyping of Mycobacterium tuberculosis Isolates
- CDC: QuickStats from the National Center for Health Statistics

4. APEC EINet activities
- no title

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Canada: New case of BSE detected
The Canadian Food Inspection Agency (CFIA) announced that Canada's national surveillance program has detected bovine spongiform encephalopathy (BSE) in an Alberta beef cow just under seven years of age. No part of the animal has entered the human food or animal feed systems. Public health remains protected through the removal of specified risk material (SRM) from all animals slaughtered for human food. SRM are tissues that, in infected animals, contain the BSE agent. This measure is internationally recognized as the most effective public health measure against BSE. The CFIA is investigating what the animal may have been fed early in its life and the source of the feed. The infected animal was born March 1998, and the farm of origin has been confirmed. Based on preliminary information, feed produced prior to the introduction of the 1997 feed ban in Canada remains the most likely source of infection in this animal. The infected animal was detected through the recently enhanced national surveillance program. Additional cases may be found as testing of high-risk cattle continues. In 2004, Canada tested over 22 000 animals.

Canada's science-based BSE safeguards to protect public and animal health have been designed with the understanding that BSE is potentially present in a small and declining number of animals. This includes animals born before and shortly after the 1997 feed ban. The Government of Canada continues to believe that the ruminant to ruminant feed ban introduced in 1997 has limited the spread of BSE and remains effective. Initial testing on the animal was conducted by Alberta authorities. Results were inconclusive and samples were sent to the Canadian Science Centre for Human and Animal Health in Winnipeg. The definitive diagnosis was made using the internationally recognized "gold standard" test for BSE.

Since the surveillance program was enhanced in January 2004, Canada has tested more than 24 000 high-risk cattle. This targeted approach has detected an additional two BSE positive cattle. These findings demonstrate the shared commitment of cattle producers, industry and governments to responsibly search for any remaining cases of BSE. This current investigation is independent of the BSE investigation on the case which was confirmed 2 Jan 2005. (Promed 1/11/05)

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Peru: Children at Greatest Risk in Outbreak of Vampire Bat-transmitted Rabies
Peru will receive 22 000 doses of rabies vaccine from Ecuador and Argentina in order to limit a rabies outbreak due to vampire bites that has already killed 12 children, stated the Peruvian Ministry of Health 14 Jan 2005. The announcement was made by the Head of Environmental Health, Jorge Albinagorta, who said that, in addition to these donations, Peru will receive from UNICEF USD 8000 for purchasing sanitation materials. The outbreak is located in Condorcanqui, a remote Amazon province near Ecuador, which was declared a health emergency in December 2004. The donated money will allow the purchase of 100 nylon nets for capturing bats, 40 pairs of leather gloves for chasing bats, 10 sleeping bags, and 20 waterproof ponchos.

Vaccination will include the entire population of 16 native communities in the area, regardless of age, since all of them are at risk, according to the Peruvian authorities. It is estimated that the number of people living in the Amazonian region involved is 13 300. So far, those most affected are children under age 15. As well as carrying out vaccination, the health authorities will trap bats in order to spray them with poison, so that disease transmission will be controlled. Some of the difficulties are cultural: natives think rabies is a product of sorcery of some kind between rival tribes. Such beliefs lead some villagers to reject vaccination and perform certain rites in order to be cured or to protect themselves. Vampire bats bite villagers while they sleep. Symptoms such as fever, delirium, muscle pain and spasm, seizures and finally death may ensue. (Promed 1/18/05)

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Chile: More than 200 Persons may be affected by Vibrio parahaemolyticus
There are 201 persons presumably infected with Vibrio parahaemolyticus in the Puerto Montt area, 10th Region, because of eating contaminated seafood. Out of the total, at least eight persons have a confirmed diagnosis of V. parahaemolyticus infection, while the others are under observation, having symptoms suggestive of the disease. Sanitary authorities confirmed that most of the affected people ate raw seafood. Therefore, authorities insisted that people must eat seafood cooked at high temperatures if possible in order to avoid these problems.

The results of tests on 50 additional persons who are being cared for of are awaited, to confirm whether they were infected by the bacterium, said Dr. Alejandro Roa, from the Llanchipal Health Service. The physician ruled out the implementation of any fishing ban. "It is the responsibility of the community to take the appropriate measures, since we have been systematically reporting that any intoxication can be avoided by using cooked seafood. To ban fishing may lead to economic loss for small-scale and industrial fishing", he affirmed. Meanwhile, last weekend a prevention campaign led by the sanitary authority in the communication media was intensified. In spite of this, according to non-official data more cases presumably attributed to V. parahaemolyticus may have occurred in persons who ate or bought raw seafood in Angelmo, a tourist resort. The Head of the Fish and Seafood Traders in Angelmo, Mr. Juan Oyarzo, confirmed that more than 90 percent of restaurants in the area sell cooked seafood. A correlation exists between the probability of infection and warmer months of the year. Improper refrigeration of seafoods contaminated with this organism will allow its proliferation. (Promed 1/18/05)

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USA (Michigan): Hunter contracts bovine TB, state says
A hunter who cut his hand while gutting a deer was diagnosed with the strain of bovine tuberculosis found in some northern Michigan deer and cattle, officials said 6 Jan 2005. The man killed the deer in October 2004 and sought medical attention after spotting telltale lesions in the animal's chest cavity, said a spokesman for the Michigan Department of Community Health. He is being treated and is expected to recover. Different strains of the disease have been found in eight people from foreign countries in Michigan since 1995. Human infection from bovine tuberculosis caused by Mycobacterium bovis has been mostly eradicated in the USA by the use of pasteurization of milk and culling of herds shown positive on skin testing, starting in about 1917. It continues to be reported in the USA, primarily in immigrants, although it generally accounts for less than one per cent of all mycobacterial isolates. The bacillus has a broad host range, including cattle, pigs, goats, cats, dogs, badgers, foxes, marsupials, rabbits, sheep, horses and, deer. The disease has saddled Michigan farmers with costly testing requirements and hampered their ability to market cattle in neighboring states during the decade-long outbreak in the northern Lower Peninsula. Human cases usually are caused by breathing infected barn air or drinking unpasteurized milk from a sick cow. It's extremely rare to get the disease the way it happened in the latest case (cutaneous transmission). Janet Olszewski, state community health director, said, "People should not consume wild animals that appear or are confirmed to be sick, regardless of the circumstance." The case also shows the importance for hunters of wearing gloves while gutting deer and washing hands afterwards. The infected man was not wearing gloves. The USDA revoked Michigan's status as free of bovine TB in 2000. State officials have ordered testing of the state's nearly one million cattle, and cattle on 34 farms and 483 deer have tested positive. The federal agency in 2004 upgraded most of Michigan to "modified accredited advanced," the rating immediately below TB-free. (Promed 1/12/05)

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Asia
Indonesia: Two cases of measles confirmed among tsunami survivors in Aceh
WHO confirmed 10 Jan 2005 two unconnected cases of measles in tsunami survivors in Sumatra, and health workers quickly vaccinated more than 1000 people to stop the spread of the virus. The cases occurred in separate villages outside the regional capital of Banda Aceh, the area hit hardest by the tsunami. UNICEF already was in the midst of a campaign to vaccinate 600 000 people in devastated Sumatra against the disease when the cases occurred, and it immediately inoculated a ring of 1200 people living around the villages where each case was confirmed.

Measles circulates in Indonesia, and there have been several outbreaks during the last few years, because most children have not been vaccinated. WHO recommends immunizing more than 90 percent of children to protect the population. In Aceh province, only about 25 percent of the children were vaccinated before the earthquake, said Dr Georg Petersen, WHO's representative in Indonesia. As aid agencies flooded into the province in the wake of the tsunami, mass measles vaccination was a high priority from the beginning. Overcrowded refugee camps provide opportunities for the virus to spread out of control. Vaccinating people living in neighborhoods surrounding a case usually stops transmission very effectively. Patients are not contagious during the 12 days they are incubating the disease, which spreads through coughing and sneezing. (Promed 1/11/05)

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India: Measles spreads in relief camps
Despite mass immunisation campaigns, measles seems to be spreading in relief camps in tsunami-affected areas. At least 13 cases of measles have been reported among children in relief camps in Andamans and 15 in Tamil Nadu. Union health secretary P K Hota said the government was on high alert. He said the cases of measles and chicken pox reported so far were sporadic and spread over several relief camps. Hota said there was no major breakdown in health conditions. As there is no known treatment for chicken pox in the modern system of medicine, practitioners of homeopathic medicine had been sent to the areas. More than 100 doctors had been mobilised by the centre to supplement the resources of state governments. Hota said the government would be alert on all medical needs of the affected areas for at least another two months. Experts say cases of typhoid and jaundice may not start appearing for another month or so as they have a long incubation period. Hota said the coming few months would also be crucial for monitoring the health of expectant mothers and babies and that antenatal care would be stepped up. (Promed 1/11/05)

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Indonesia: Tetanus on the rise in Aceh, Sumatra
Doctors Without Borders (MSF) teams working in different locations in Aceh, Sumatra, are being increasingly confronted with cases of tetanus, a potentially life-threatening disease. They have already found 67 cases of the disease: 45 in Banda Aceh; 15 in Meulaboh; and six in Sigli. The numbers are rapidly increasing. There is a high mortality rate of about 25 per cent. People are becoming infected when they search for corpses or useful objects in the rubble left by the tsunami. Wounds on their arms and legs can become infected by the tetanus bacteria when they walk through the mud. Since the disease has an incubation period of 2-60 days, most cases are only starting to show up now. The fear is that many more people will develop the disease.

MSF teams started tetanus prevention work in the port of Banda Aceh. A tent has been set up in Ulee Lhue, one of the most devastated areas of town, to provide medical consultations, give dressings and to raise awareness among the locals about tetanus, its risks, and how to prevent it. During a rapid assessment done by MSF, six people who were searching in the debris were checked for tetanus. All of them had wounds on arms and/or legs and three of them had wounds that were infected. Because a vast area needs to be covered and many people are at risk, MSF has asked other organizations to also start prevention activities. Since the vaccination coverage is probably very low in Aceh, the population would need a series of three tetanus injections to be fully protected for 10 years. One vaccination will give them only partial immunity. (Promed 1/16/05)

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Indonesia: Cholera outbreak among refugees
Cholera has struck in Aceh due to the unsanitary conditions left by the tsunami, according to the Islamic relief organization Mer-C, which has teams of medics working in the worst-hit towns of Banda Aceh and Meulaboh. 20 cholera cases were being treated in a refugee camp in Nagan Raya, in the Meulaboh area, said Mer-C official Jose Rizal Jurnalis. Two of the cases were serious, with the patients severely dehydrated from constant diarrhea, Dr Jurnalis said. Aside from one 12-year-old child, the other cases were adults. Dr Jurnalis said the disease had yet to become epidemic, but poor sanitation and dirty water supplies made prevention difficult. "Vaccination is not effective," he said. "A simple way to deal with the disease is by having clean water and proper sanitation..." WHO epidemiologist Tom Grein said he had yet to document any cases of cholera, although there had been cases of severe diarrhea along the west coast, where Mer-C claimed to have found the disease. If the patients were given proper care, he said, cholera was only fatal in about 1 percent of cases, with dehydration the most serious problem. However, providing proper healthcare for the hundreds of thousands of homeless Acehnese is proving difficult. Dr Jurnalis said he was concerned the cholera would spread because people were still using contaminated water for cooking and in some cases drinking. Mer-C had tried to sterilize some of the water wells with chlorine, but an adequate supply of bottled water was essential, he said. "If cholera contaminates one refugee camp, it can wipe out that camp." (Promed 1/18/05)

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South and Southeast Asia: FAO says rumors of unsafe fish in tsunami zone unfounded
There is no evidence that fish- and seafood-borne illnesses have increased in Asian countries hit by the tsunami, according to an FAO assessment. Rumors that it is dangerous to eat fish that have been in proximity to or have fed on victims' bodies are spreading, and reports suggest that fish consumption is dropping as a result. However, FAO said, "In light of the information available, there is no evidence, epidemiological or of any other nature, of an increased risk of fish- and seafood-borne illnesses in the affected regions". This assessment was based on information gathered from FAO and WHO personnel working on the ground in the affected countries.

Fish plays a major nutrition role in all of the countries hit by the tsunami, where the average annual per capita fish consumption is among the highest in the world. According to FAO, eliminating fish from the diet could have adverse nutritional impacts, with possible health consequences, especially for weakened tsunami survivors recovering from injuries. "The best advice is to avoid eating any fish or seafood with visible signs of spoilage, and most importantly to ensure that fish is eviscerated and well cooked before consumption," FAO said. FAO did warn that the damaged wastewater and sanitation systems might leak into fishing grounds or aquaculture ponds, leading to viral, bacterial and parasitic intestinal infections. In such situations, people eating raw or lightly cooked fish would be especially vulnerable, while consumption of only healthy-looking, properly cleaned, and fully cooked fish would minimize risks.

FAO also addressed fears that one tsunami after-effect could be an increase of biotoxin concentrations in fish. "It is conceivable that events of the tsunami amplitude could potentially lead to algal bloom and accumulation of ciguatoxin in some finfish species and biotoxins in bivalve shellfish," FAO noted. "In extreme cases, red tides or massive fish deaths would signal the risk, and fishing areas would need to be closed." However, current environmental conditions in the tsunami-affected region (wet and cool rainy season) are unlikely to favour biotoxin upsurges, the agency concluded. FAO added that risks for seafood from naturally occurring chemical contaminants stirred up by the earthquake, like heavy metals, are also unlikely. (FAO, 1/14/05 http://www.fao.org/newsroom/en/news/2005/88610/index.html)

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Viet Nam: Avian influenza update from WHO
Laboratory results have confirmed avian influenza infection (H5 subtype) in two brothers in the northern part of Viet Nam. The first case, age 46, from Thai Binh Province, developed symptoms 1 Jan 2005 and died 9 Jan 2005. His brother, age 42, resident of Hanoi, developed symptoms 10 Jan 2005. He remains hospitalized in Hanoi and is recovering. He is known to have provided bedside care for his brother, who was treated at the same hospital. The investigation surrounding the new cases is considering two hypotheses. The first one includes the possibility that the 42-year-old man may have acquired his infection directly from his brother. All evidence to date suggests that isolated instances of limited, unsustained human-to-human transmission can be expected from avian influenza viruses in humans. Their occurrence does not call for any change in the present level of pandemic alert. Intensified surveillance for respiratory symptoms in close contacts of the two men has been initiated in both Tai Binh Province and Hanoi and it is reassuring that no cases of respiratory illness have so far been detected among these people. Health authorities in Viet Nam are investigating the source of infection in the two brothers.

The second hypothesis is focusing on a possible direct source of poultry-to-human transmission. Preliminary findings point to a family meal in which a dish containing raw duck blood and raw organs was served. Public health officials in Viet Nam have repeatedly advised against the consumption of dishes made with fresh duck blood or with raw or inadequately cooked poultry products. As a precautionary measure, similar culinary practices involving dishes containing raw poultry parts or organs should be avoided in all countries experiencing outbreaks of highly pathogenic H5N1 avian influenza in poultry.

To date, most human cases linked to contact with poultry are thought to have acquired their infection following exposure to dead or diseased birds around households. Evidence suggests that particularly risky exposure occurs during the slaughter, defeathering, and preparation of poultry for cooking. In general, WHO recommends that poultry should be cooked until all parts reach an internal temperature of 70oC. No cases of H5N1 infection have been linked to the consumption of thoroughly cooked poultry and egg products.

Media reports that a third 35-year-old brother has been hospitalized have not been confirmed. These latest two cases bring the total in Viet Nam since mid-December 2004 to eight. Of these, seven have died. The 18-year-old woman from Tien Giang Province, announced previously, died 19 Jan 2005. According to the WHO, as of 1/21/05, there have been 52 confirmed cases and 39 deaths. Thailand has had 17 cases and 12 deaths; Viet Nam has had 35 cases and 27 deaths. (WHO 1/21/05 http://www.who.int/csr/don/2005_01_21/en/)

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Thailand: Man charged with dove smuggling
A Thai was charged in the Sessions Court after he was caught with 120 doves, believed to have been smuggled from Thailand. State Veterinary Department director Dr Azizol Shahrun said the man, from Thailand's southern province, was arrested at a police roadblock 11 Jan 2005. "The birds, packed in boxes, tested positive to the avian flu virus. The court has given orders to destroy all the birds," he said. Alertness and the ability of the authorities to respond immediately and efficiently is a prerequisite for the control of infectious animal diseases. Spreading avian influenza from country to country by smuggling has been discussed extensively, including previous attempts to smuggle infected birds from Thailand into Malaysia. (Promed 1/13/05)

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Vietnam: Tough measures intensified to stop bird flu spread
The National Steering Committee for Bird Flu Control organised a meeting in Ho Chi Minh 14 Jan 2005 to discuss the implementation of urgent preventive measures against the bird flu epidemic in southern provinces. Bird flu is spreading widely and quickly. In December 2004, there were 39 bird flu outbreaks in 12 provinces and cities across the country. By 13 Jan 2005, the country experienced as many as 84 outbreaks in 16 cities and provinces. The Veterinary Department said that, due to low temperatures, the bird flu would be spreading and developing faster in the regions which were earlier hit by the epidemic, even in those areas having large poultry farms and slaughter houses. It is essential to raise public awareness of the danger of the bird flu and provide farmers with basic knowledge about preventive measures to help them curb the epidemic, Mr Cao Duc Phat, Minister of agriculture and rural development, said. Head of the Veterinary Department Bui Quang Anh warned that if tougher measures are not implemented in the next two weeks, the epidemic will likely spread to south-eastern provinces. He underlined the need for appropriate measures to prevent the spread of the disease to ensure safety of food supplies for the upcoming lunar New Year Festival.

Vice chairman of the HCM City People Committee Nguyen Thien Nhan asked local people not to eat poultry products without clear origin, not to buy or sell poultry without clear origin, not to breed poultry, and not to transport poultry illegally. Meanwhile, the prime minister instructed provincial and the municipal People's Committees, relevant ministries and sectors to mobilise all resources and take drastic measures to isolate and extinguish outbreaks of avian flu at the first signs. The ministries of agriculture and rural development, health, and culture and information should closely co-operate with provincial and city People's Committees to disseminate information. Inspection of transporting and slaughtering poultry must be tightened to prevent the spread of the disease. Illegal poultry imports through land and sea routes must be stopped while quarantine for imported animals at border gates must be strengthened, the PM said. (Promed 1/16/05)

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EU/East Asia: Review of the avian influenza situation in Asia
The Standing Committee on the Food Chain and Animal Health had an exchange of views on the situation and the measures applicable with regard to avian influenza (AI) in ten Asian countries. Japan and South Korea have submitted their final report on the AI situation in their territory and on the measures taken to control the disease to the OIE. These countries can now be considered AI free. The Committee therefore agreed to a Commission proposal to lift the restrictions applicable to the two countries. As the EU did not import poultry or poultry meat from those two countries, the lifting applies only to pet birds. For the eight other Asian countries--Thailand, Cambodia, Indonesia, Laos, China, Vietnam, Pakistan and Malaysia--the suspension of the imports of all poultry products and pet birds have been extended until 30 Sep 2005, as AI is either still present in these countries or they cannot be certified disease-free. (Promed 1/18/05)

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Philippines: Meningococcal disease update
From 1 Oct 2004 to 16 Jan 2005, a total of 38 cases of meningococcal disease and 18 deaths (case fatality ratio 47 percent) have been reported from Baguio City, and a total of 40 cases and 12 deaths (case fatality ratio 30 percent) have been reported from the Cordillera Region, excluding Baguio City. Out of the total of 78 cases, 11 have been laboratory confirmed for N. meningitides by the Baguio City Hospital and the Research Institute for Tropical Medicine. Since 7 Jan 2005, the number of weekly cases has decreased. Current control measures include case management of suspect cases, active surveillance and chemoprophylaxis of close contacts as well as vaccination of health workers directly involved in case management. Further field investigations to better understand the risk factors involved in the transmission of this disease are planned. WHO, with the assistance of partners in the Global Outbreak Alert and Response Network (GOARN), is supporting the Department of Health, Philippines in strengthening epidemiological surveillance, increasing laboratory capacity for detection/confirmation of meningococcal disease, and implementing additional epidemiological studies.

Dr. Eric Bertherat, a meningococcemia expert of the WHO, said Baguio's semi-temperate weather is a big factor in the upsurge of cases. Bertherat, whom the WHO sent to the country to help authorities address the health problem, said cold weather is often associated with "outbreaks" of meningococcemia. "Cold weather brings influenza and other infections of the respiratory tract,” he said. Bertherat and another WHO expert, Gerald Dziekan, have been closely working with local authorities to stamp out the bacterial infection or at least prevent an outbreak. Health Secretary Manuel Dayrit has hinted that sporadic cases of meningococcemia may arise elsewhere in the country, because its bacteria (Neisseria meningitidis) are everywhere. This time of the year, Bertherat said, meningococcal outbreaks hit the so-called "meningitis belt" in Africa. "In the meningitis belt, outbreaks can affect about 250 000 people in five months. It usually starts this time of year, when the evenings are very cold," he said.

There have been no new admissions of suspected meningococcemia cases to the Baguio General Hospital since 7 Jan 2005. Despite this, Dziekan said WHO is thoroughly investigating the blood bacterial infection. "We are taking the situation seriously, and our aim is to find out what is going on here," he said. He said WHO lacks enough data on the meningococcal infection in the Philippines, adding that they don't know whether the Baguio occurrence was normal or abnormal. (Promed 1/19/05)

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Malaysia: Outbreak of hand foot and mouth disease in Penang
37 children in Penang have come down with hand, foot and mouth disease (HFMD) since 1 Jan 2005. The causative agent has not yet been identified. Dr Ramlee Rahmat, director of the Health Ministry's Communicable Disease Control Division, noted that there were 67 enteroviruses known to cause HFMD, adding that enterovirus 71 was possibly the most dangerous virus, having killed many of the 31 children affected in a 1997 outbreak. Dr Ramlee said that, although no deaths had been reported so far this year, authorities were on alert for new cases. Since 2000, Penang had recorded many cases of HFMD. In 2000 there were 459 cases followed by 776 in 2001, 1384 in 2002, 436 in 2003, and 364 last year. He said that many children below age five in Penang could have come down with HFM because of poor personal hygiene and improper sanitation. He said the 334 sentinel centers were closely monitoring the situation. So far results showed they suffered normal symptoms of hand-foot-mouth disease. HFMD is predominantly a disease of childhood, usually associated with coxsackievirus A16 or enterovirus 71 infection. More severe disease in a minority of patients has been associated with enterovirus 71 infection in some Asian countries. Typical cases of HFMD have vesicles and ulcers in the mouth and on the tongue, and a vesicular exanthem usually located on the palms and soles. Recovery from HFMD is usually complete within one or two weeks. (Promed 1/15/05)

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Australia (Northern Territory): Melioidosis cases
Three tourists are in intensive care after contracting melioidosis, a potentially fatal disease, while on holiday in the Territory. 11 people, the three tourists and eight Territorians, have contracted the soil-based bacterial infection since heavy rain started falling on the Top End just before Christmas. Six people have been infected in the past week alone. The three tourists are in serious conditions at interstate hospitals. All eight of the Territorians required hospital admission. A Territory man, who was diagnosed with the disease 14 Jan 2005, became the NT's 400th victim in 15 years. Six men and five women have contracted the disease so far this wet season. One victim is a woman in her 20s, while the rest are agec 40-60. All 11 people fell into the major risk category. Melioidosis can be a life-threatening disease that requires prompt and aggressive antibiotic treatment. Symptoms included skin ulcers or sores that failed to heal, abscesses, unexplained fevers, weight loss, fatigue, cough, shortness of breath, abdominal pain, urinary symptoms and headaches. Small cuts and sores on the hands and feet provided a route of infection but are largely avoidable if simple protective measures are followed. People should wear waterproof gloves and shoes or boots when prolonged contact with the soil is likely. People most at risk from the disease include those with diabetes or cancer, and the elderly. Infection due to Burkholderia pseudomallei (melioidosis) is endemic in focal areas of Southeast Asia and northern Australia. It is a category B biowarfare agent. (Promed 1/16/05)

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Russia (Kaliningrad): Outbreak of hepatitis A
Since the beginning of Jan 2005, about 30 people (adults and children) have fallen ill with hepatitis A in the city of Sovetsk in the Kaliningrad region. Epidemiologists say the route of infection is contact transmission. The outbreak is a consequence of poor hygiene. Most contracted infection by consumption of unclean vegetables and fruit. Patients with a diagnosis of hepatitis A have been admitted daily to the City Infectious Diseases Hospital. Hospital wards are overflowing and some departments have been rearranged in order to accommodate patients with hepatitis A. It was reported by the same source on 7 Dec 2004 that hepatitis A morbidity in the Kaliningrad region during 2004 was 200 cases per 100 000 inhabitants <http://kaliningrad.rfn.ru/rnews.html?id=3D5837>. The level of hepatitis A infection in the Kaliningrad region is 14 times higher than the average for Russia. (Promed 1/14/05)

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Russia (Rostov): Botulism cases reported
Nine cases of botulism have been reported in the Rostov region so far in January 2005. These cases are connected to the use of smoked fish and home-canned food. Despite numerous warnings to the population about the danger of using tinned products and homemade smoked fish, there is an increase in cases. During the same period in 2004, only four persons developed botulism. (Promed 1/18/05)

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New Zealand/Australia: Ross River Virus Patient Worked in Northern Territory
Authorities have confirmed that a person in Waikato has contracted the rare Ross River virus. The virus is spread by mosquitoes, and there have been 11 cases of the illness in New Zealand since it became notifiable in 1970. However, authorities say the person did not contract the virus in New Zealand and had been working in Australia's Northern Territory for over a year before returning home. Ross River virus, isolated in Australia in 1963, is a mosquito-transmitted virus. Ross River virus is endemic in most coastal regions of Australia and since the 1980's appears to have extended its range to include most of the island communities of the South Pacific. Ross River virus has been associated with outbreaks of benign polyarthritis in humans. The animal reservoir species are various, and humans exhibit a significant viraemia such that some epidemics in Australia are maintained in a human-mosquito-human transmission cycle. The mosquito vectors vary according to the local environment. Fortunately, illness in humans, although occasionally prolonged and painful, is not fatal, and recovery is complete. (Promed 1/20/05)

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies 2005, 19 Jan 2005
Influenza activity continued to increase in some countries in Africa, Europe and North America. The overall levels of influenza activity remained medium-low in most parts of the world.

Canada
During week 1, the number of regions reporting widespread activity increased as well as the number of localized outbreaks in long-term care facilities/retirement home. Of the influenza viruses detected during week 1, 99% were influenza A virus and 1% were B viruses.

United States (October 3, 2004--January 1, 2005)
Influenza activity was low in the US during October through early December but has increased steadily since mid-December. Current surveillance indicators suggest that influenza activity for the season has not yet peaked. Laboratory-confirmed influenza infections have been reported from 45 states, and this season's influenza vaccine strains have been well matched antigenically to the influenza viruses isolated so far this season. In response to this season's influenza vaccine supply shortage, the Department of Health and Human Services has purchased 1.2 million doses of 2004--05 inactivated influenza vaccine from GlaxoSmithKline (GSK).

During October 3--January 1, WHO collaborating laboratories and National Respiratory and Enteric Virus Surveillance System laboratories in the US tested 34,497 respiratory specimens for influenza viruses; 1,369 (4.0%) were positive. The percentages of specimens testing positive for influenza ranged each week from 0.7% to 12.1% and first exceeded 10% during the week ending December 25. During October 3--January 1, influenza viruses were reported from 45 states. As of January 1, approximately one half of the viruses have been reported from the Mid-Atlantic (26.4%) and New England (23.1%) regions. Of the 1,369 influenza viruses identified since October 3, a total 1,128 (82.4%) were influenza A viruses, and 241 (17.6%) were influenza B viruses. Of the 1,128 influenza A viruses, 406 (36.0%) have been subtyped; 404 (99.5%) were influenza A (H3N2) viruses, and two (0.5%) were influenza A (H1) viruses. During the week ending January 1, 6.7% of recorded deaths in the 122 Cities Mortality Reporting System were attributed to pneumonia and influenza (P&I), which is below the epidemic threshold of 7.9% for that week. The percentage of P&I deaths exceeded the epidemic threshold for one week during October 3--January 1 but otherwise has remained below.

Other reports
During week 53, low influenza activity was detected in Hong Kong (H3), Japan (H3), Malaysia (B), Mexico (B), the Republic of Korea (H3), Russian Federation (H1, H3 and B). Chile reported no influenza activity. (CDC http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a6.htm and WHO http://www.who.int/csr/disease/influenza/update/en/)

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Cholera, Diarrhea, and Dysentery
USA (Tennessee)
Health officials are warning parents of day-care and elementary school children about a shigellosis outbreak, a bacterial illness that can cause severe diarrhea, vomiting, fever and stomach cramps. The Metro Public Health Department issued its warning after seeing a sharp increase in the number of cases of the disease in Davidson County. Usually, one or two cases are reported in Nashville monthly. In December 2004, there were 21 cases. The illness appeared to be spread throughout the county and epidemiologists hadn't been able to find a common source. Shigellosis usually resolves in five to seven days, and usually does not cause complications. Dr. Tim Jones, deputy state epidemiologist for the Tennessee Department of Health, says the number of shigellosis cases tends to rise and fall in five or six year cycles. In the past few years, the number of cases has been on the upswing. Health officials are encouraging physicians to test for the disease and the public to wash their hands regularly. (Promed 1/19/05)

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Dengue/DHF
Hong Kong
The Centre for Health Protection of Department of Health has confirmed imported cases of dengue fever. The case is a 30 year old male, resident of Yuen Long, date of onset 4 Dec 2004. He had fever, headache and eye pain, but did not require hospitalization and is now recovered. He had traveled to Bangladesh in December 2004, before the onset of symptoms. The cumulative number of dengue fever cases in 2004 was 31 imported cases and 0 local cases. Another recent case of imported dengue fever is a 32 year old female, resident of Sham Tseng, date of onset 24 Dec 2004. Symptoms included fever and generalized rash—she was admitted to Baptist Hospital in stable condition. She had traveled to Malaysia and Australia in December 2004, before onset of symptoms. This is the first dengue fever case in 2005. Latest information on dengue fever in other places can be found under "Outbreak News" on the department's Hong Kong Travellers' Health Service website: <http://www.info.gov.hk/trhealth>. Travel agents, tour guides and travelers can visit the website for the latest news and advice on preventive measures. (Promed 1/17/05)

Malaysia
Malaysia's Health Minister, Chua Soi Lek, announced a doubling in dengue cases December 2004, from an average 450 a week to about 1000, with the increase especially noticeable in the capital Kuala Lumpur. 12 people have died from dengue fever since Nov 2004. Abandoned building projects and construction sites, found to be the main dengue culprits, will be targeted in a clean-up campaign in the capital. Chua said owners of a total of 14,186 premises had been fined and 59 people brought to court in 2004, after mosquitoes were found breeding in their compounds. The ministry issued an alert for Kuala Lumpur and Selangor state 2 Jan 2005.

Health authorities have detected 70 dengue cases in Penang over the last two weeks. State Health, Welfare and Caring Society committee chairman P. K. Subbaiyah, however, said, “...there is usually a sudden surge in dengue cases every four years. This is a normal occurrence here and has nothing to do with the tsunami". Subbaiyah said the reported cases came from all over Penang. Whenever two or more cases are reported in a particular area, surveillance and preventive measures would immediately be intensified, he said. "An area with suspected dengue cases will be fogged within 24 hours and again after 7 days," he said.

In Malaysia, a total of 361 people died of dengue fever out of 130 673 cases reported since 1999, Health Ministry Disease Control Division Director Dr. Ramlee Rahmat said. He said the total did not include the latest death reported in the second week of 2005. Based on Health Ministry statistics, in 1999 there were 37 deaths out of 10 146 cases; in 2000, 45 deaths out of 7146 cases; in 2001, 50 deaths out of 16 368 cases; in 2002, 99 deaths out of 32 767 cases; in 2003, 72 deaths out of 31 043 cases; and in 2004, 58 deaths out of 33 203 cases. He said the number deaths and cases reported in Malaysia remained low compared to Thailand and Singapore. The tourism sector need not worry, as the ministry was constantly monitoring the situation, he said.

Some 53% of 11 621 confirmed cases of dengue fever and dengue hemorrhagic fever in 2004 were children and youths up to the age of 24, said the Communicable Disease Control Division. Of these 6199 children and youths, roughly 75% were those aged 10 - 24 years. There were 33 025 suspected dengue cases in 2004. Dr. Rahmat said a health ministry study found students with dengue fever were bitten on university campuses and during indoor and outdoor recreational activities. School children could have been bitten in school buses, in school, or during evening outdoor activities. "...School bus operators have been asked to use aerosol insecticide before picking up children in the morning and school managements to destroy all Aedes mosquito breeding grounds," he said. Ramlee warned that fogging to kill mosquitoes was limited in its effectiveness, as larvae would still develop into adult mosquitoes. So far, mosquitoes have not become resistant to the chemicals used for fogging, but it should be closely supervised by health officials to ensure that it is not haphazard, which could lead to resistance, he added.

The week of 2-8 Jan 2005 saw a slight drop of 2.6 percent in the number of suspected cases reported overall, to 1049 from 1077 the previous week. However, the number of cases could rise again if proper measures, such as destroying breeding grounds, were not taken, Dr. Ramlee said. Selangor remained the state with the highest number of cases, which rose for the period to 501 from 469 the previous week. Penang, Johor, Pahang and Kedah states also saw more cases, while in Kuala Lumpur and Perak, the number of cases fell substantially. A six-year-old is the first victim to die from the disease in 2005. Dr. Ramlee said WHO representative for Malaysia, Singapore and Brunei has been in touch. "I informed him Malaysia was taking the risk management approach. We want people, including tourists, to know that we are taking all measures to keep the situation under control,” he said. (Promed 1/17/05)

Singapore
Singaporean authorities recorded more than 8500 dengue cases in 2004, a 10-year high and almost double the number in 2003. Starting February 2005, the city-state plans to impose fines on homeowners found with mosquitoes breeding on their premises. Private homes, rather than construction sites, are the main breeding grounds of mosquitoes in Singapore, and first-time offenders will be fined USD 60, and double that for the next offence. Most Singaporeans live in apartment buildings, but many families keep potted plants and other receptacles in which mosquitoes can breed. Penalties for construction sites where mosquitoes are found breeding are much stiffer and can include up to six months in jail for those responsible. (Promed 1/17/05)

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Viral gastroenteritis
Canada (Alberta)
A major norovirus outbreak has infected dozens of seniors in central Alberta lodges and nursing homes. Noroviruses are a group of viruses that cause gastroenteritis. "It's a really active year for the virus and it's the same in many provinces," said Dr Martin Lavoie, medical health officer for the David Thompson Health Region. Norovirus outbreaks have been reported at 12 facilities in the health region in the last month. There are about seven outbreaks at the moment, he said. In Red Deer, visitors are advised to stay away from the Parkvale and Pines seniors lodges because of the virus. Other outbreaks have been reported in Stettler, Ponoka, Castor and Drumheller. The virus has hit people of all ages. Symptoms include vomiting, diarrhea and muscle aches that last 24 to 48 hours. The virus can spread quickly through close contact with infected people or by eating food prepared by an infected person. Large outbreaks were reported late 2002, early 2003. (Promed 1/15/05)

Canada (Ontario)
A second Northwestern Ontario hospital, Nipigon District Memorial Hospital, has declared an outbreak of norovirus infection 4 Jan 2004. Six patients and eight staff have shown symptoms of the gastrointestinal virus since the weekend, said Bruce Sutton, the hospital's executive director. The illness has not been laboratory confirmed as a norovirus infection, but it has similar symptoms, he said. The hospital is restricting visitors to its patient care areas for both acute and long term patients. Symptoms typically last 24 to 48 hours, so Sutton is confident the outbreak is coming to an end. The outbreak at Nipigon's hospital follows an outbreak of norovirus infection that was confirmed at the Dryden Regional Health Centre in early January 2005. About 12 patients and eight staff were treated for norovirus infection symptoms there.

The virus is spread through fecal-oral contact. It can also be transmitted by aerosolized droplets to people who are within 3-4 feet of a person experiencing active vomiting or diarrhea. It takes 1-2 days to exhibit the infection after being in contact with someone who has it. The best way to prevent the spread of norovirus infection is to wash your hands thoroughly with soap and water for at least 15 seconds. It is important to stay home from work when sick. (Promed 1/9/05)

Japan
A total of 4114 people, mainly in homes for the elderly, have shown symptoms of stomach flu in Japan since Dec 2004, and 15 others have died after suffering diarrhea, vomiting and other symptoms, according to a Kyodo News tally released 11 Jan 2005. Noroviruses have been detected in 591 people (14 % of total tested). The outbreak is not limited to homes for the elderly; 1735 suspected cases were reported in schools, kindergartens, and hospitals. Kyodo compiled the tally based on reports from the nation's 47 prefectural governments and other authorities about suspected group infections or food poisoning cases, following reports earlier this month that at least seven elderly people in a public care home died after developing similar symptoms in Hiroshima Prefecture. The Kyodo survey showed that suspected group infections at homes for the elderly were reported in 34 prefectures with more than 100 people infected in 13 prefectures. In Hokkaido, a total of 226 people at six homes developed symptoms, and noroviruses were found in each of the homes. In addition to seven deaths at a home in Hiroshima, two deaths were reported in Akita, while one death each was reported at homes for the elderly in five other prefectures. One death was also reported at a hospital in Yamagata Prefecture.

Japan will survey conditions at all of its 5000 nursing homes, the health ministry said. "We take the outbreak very seriously and have decided to survey all the nursing homes to see whether they are properly following health guidelines," a ministry official said. The Ministry is investigating the source of the outbreak. News reports said that norovirus infection may have spread when care workers mixed old and new diapers and neglected to wash their hands. Norovirus infection can be deadly for elderly people or others with weak immune systems. Japan has one of the world's oldest populations, with more than 23 000 people aged 100 or more. (Promed 1/15/05)

USA (Florida)
Nearly 120 passengers and crew members became sick with norovirus aboard a ship that returned to Fort Lauderdale, Florida 8 Jan 2005 after a five-day Caribbean cruise, Royal Caribbean International officials said. The outbreak of norovirus infection aboard sickened 108 passengers and eight crew members. It was traced to a man who had symptoms two days before boarding the ship 3 Jan 2005. Noroviruses affect 23 million Americans a year and were blamed for a rash of cruise ship illnesses more than a year ago that prompted the CDC to investigate several lines. (Promed 1/9/05)

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2. Articles
CDC EID Journal, Volume 11, Number 1-January 2005
The following expedited article is available at http://www.cdc.gov/ncidod/eid/index.htm: Lack of H5N1 Avian Influenza Transmission to Hospital Employees, Hanoi, 2004, N.T. Liem et al.

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British Medical Journal (BMJ) rapid response articles to tsunami
• Bridging the technology gap, Nick Wilson (8 January 2005) • Medical Emergency Alerts in Natural Disasters, Jairaj Kumar Chinthamani (10 Jan 2005) • Mainstream HIV prevention into ‘Tsunami’ response, Dr.Joe Thomas, Dr.Mridula Bandyopadhyay, The University of Melbourne, Victoria 3010 (10 Jan 2005) • Aftermath of 'Tsunami' will cause endogenous 'HIV' expression, Alexander H Russell (11 Jan 2005) • Re: Mainstream HIV prevention into ‘Tsunami’ response, Breda Gahan (12 Jan 2005) • Need for Post-Disaster HIV/AIDS Prevention, Memoona Hasnain (13 Jan 2005) • Re: Mainstream HIV prevention into ‘Tsunami’ response, Beverley F Snell (18 Jan 2005)
(BMJ http://bmj.bmjjournals.com/cgi/eletters/330/7482/59#92036)

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Infectious disease: Vietnam's war on flu
Excerpts from the Nature news feature article below: “…Vietnam has just enough scientific infrastructure from which to build a proper monitoring effort. But experts on the ground complain that the international community hasn't prioritized such efforts--leaving them frustrated by a lack of funding, and alarmed by what might happen next. Today, the crisis teams that helped with the initial diagnosis and epidemiology have long since departed…the need for surveillance of H5N1 and other flu viruses has scarcely diminished--all of the ingredients to brew a pandemic strain of influenza are still in place, and people continue to get infected…"When there's a problem, everyone flies in, creates a certain amount of havoc, flies out, and leaves nothing behind to change the situation," complains Jeremy Farrar, who heads the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City…Even if surveillance for human cases is improved, that still leaves the mammoth task of looking for the virus in poultry and other livestock…At present, some local veterinary offices lack even basics such as reliable phone and fax connections…The FAO has recognized the problem, and with the World Bank has put together a two-year Avian Influenza Emergency Recovery Project for Vietnam, which includes US$2.8 million for lab diagnostics, surveillance in the field, and other research into avian flu. But Rychener argues that much larger sums are needed, given that H5N1 is now believed to be endemic in southeast Asia…” (Nature, http://www.nature.com/cgi-taf/DynaPage.taf?file=/nature/journal/v433/n7022/full/433102a_fs.html)

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Final analysis of Netherlands avian influenza outbreaks...
Final analysis of Netherlands avian influenza outbreaks reveals much higher levels of transmission to humans than previously thought, Arnold Bosman et al. “Recent alerts demonstrate that the transmission of avian influenza to humans, which re-emerged at the beginning of 2004, is far from over in South East Asia. As efforts to control the epidemic and prevent further human cases continue, the need to assess the effectiveness of current control measures grows. An executive summary of the final report of the outbreak of avian influenza A/H7N7 in the Netherlands has recently been published in English. Between March and May 2003, an unprecedented outbreak of avian influenza occurred in humans in the Netherlands. During an extensive epizootic of influenza A virus H7N7 on commercial poultry farms, 86 cases in poultry workers and 3 cases in people with no poultry contact were initially confirmed by PCR. The predominant symptom was conjunctivitis. One veterinarian developed fatal respiratory distress syndrome after close contact with infected poultry. A questionnaire survey was carried out as a follow up to the outbreak. Approximately 400 poultry farmers and their families and almost 900 people who were involved in controlling the epidemic participated in this investigation. Blood samples were taken from 500 of these participants to determine possible infection with the avian flu virus. Additional studies were performed for 62 household contacts of 25 persons with avian flu virus infection. Routine serological tests failed to detect any antibodies, even in the group of persons with confirmed avian influenza virus conjunctivitis. A modification of the haemagglutination assay was developed, based on observations that avian influenza viruses favour binding to red blood cells from horses rather than turkeys. As at least 50% of the people exposed to infected poultry had H7 antibodies detectable with the modified assay, it was estimated that avian influenza A/H7N7 virus infection occurred in at least 1000, and perhaps as many as 2000 people…Although the disease in humans is more severe for A/H5N1, both avian influenza outbreaks illustrate that crossing the species barrier is less rare than previously recognised, that avian influenza virus adaptation occurs rapidly, and that if such jumps between species occur, human behaviour in the broad sense may accelerate dissemination.” (Eurosurveillance, http://www.eurosurveillance.org/ew/2005/050106.asp#2)

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E coli O157:H7 infections associated with ground beef from a U.S. Military Installation, Okinawa...
Escherichia coli O157:H7 Infections Associated with Ground Beef from a U.S. Military Installation --- Okinawa, Japan, February 2004 “In February 2004, the Okinawa Prefectural Chubu Health Center (OCHC) and the Okinawa Prefectural Institute of Health and Environment (OIHE), Japan, investigated three cases of Escherichia coli O157:H7 infection in a Japanese family associated with eating ground beef. Public health officials from multiple agencies in Japan and the United States collaborated on this investigation, which resulted in a voluntary recall of approximately 90,000 pounds of frozen ground beef in the United States and at U.S. military bases in the Far East. This was the first reported instance in which Japanese public health officials identified contaminated, commercially distributed ground beef that was produced in the United States. This report summarizes epidemiologic and laboratory investigations conducted by OCHC and OIHE. The results underscore the importance of using standardized molecular subtyping methods throughout the world to facilitate international public health communication and intervention.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5402a3.htm (MMWR, January 21, 2005 / 54(02);40-42)

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Racial Disparities in Nationally Notifiable Diseases --- United States, 2002
“Infectious diseases are a major cause of morbidity, mortality, and disability in the United States and often affect racial/ethnic populations disproportionately. Eliminating racial disparities is a goal of many of the national health objectives for 2010. To estimate racial disparities in the incidence of nationally notifiable infectious diseases by race/ethnicity, CDC reviewed 2002 data from the Nationally Notifiable Diseases Surveillance System (NNDSS), collected through the National Electronic Telecommunications System for Surveillance (NETSS). This report summarizes the results of that analysis, which indicated that incidence rates were at least two times greater for blacks than whites for eight of 42 nationally notifiable diseases; however, substantial gaps exist in the reporting of racial/ethnic data for the 42 diseases, which accounted for approximately 1.3 million of the cases reported by NNDSS. Public health practitioners and policy makers might use these results to address disparities in disease rates among blacks and other racial/ethnic populations, but they also should work to close gaps in data reporting to accurately measure progress toward achieving the national health objectives.” http://www.cdc.gov/flu/avian/outbreaks/asia.htm (MMWR January 14, 2005 / 54(01);9-11)

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3. Notifications
WHO avian influenza updates
Updates are available at http://www.who.int/csr/disease/avian_influenza/en/. Includes information on the latest situation updates, cumulative number of cases and deaths (by country), guidelines/recommendations/descriptions, and additional information.

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CDC avian influenza updates
Updates are available at http://www.cdc.gov/flu/avian/outbreaks/asia.htm Includes information on Recent Developments, Assessment of the Current Situation, and CDC Response to Outbreaks.

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WHO Tsunami website
The regularly updated WHO site offers situation reports, videos (Dr David Nabarro-- Special Reprentative to the Director-General: Message to Kobe and a video report from Banda Aceh, 21 Jan 2005), WHO strategies and appeals, briefings, various health information, and other resources. Please visit: http://www.who.int/hac/crises/international/asia_tsunami/en/

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CDC Tsunami website
CDC offers information on health issues related to the recent tsunamis in South Asia at: http://www.bt.cdc.gov/disasters/tsunamis/. Topics of interest include an overview of CDC's contributions to the on-going tsunami relief effort; questions and answers about travel to assist family and friends in tsunami affected areas; interim guidance for travelers to areas affected by the tsunami; food safety after a tsunami; and a list of general resources related to possible health concerns associated with the recent tsunamis in South Asia is included on this page.

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The World Organisation for Animal Health (OIE) launches its first distance learning course
The OIE in collaboration with the Michigan State University is launching its first distance learning course aimed at increasing overall knowledge and awareness of OIE activities in particular among members of the veterinary profession. The course will cover all issues relevant to the role of the veterinarian in protecting animal and public health in international trade. It will also indicate how the world community is being kept informed on issues of animal diseases and zoonoses. Members of the veterinary profession, veterinary students, as well as scientists and stakeholders in international trade, will benefit. The Internet-based course will cover OIE mandate and activities, the global animal health situation and its relationship to international trade in animals and animal products. This course will also cover the history, development and operations of the OIE. Particular emphasis will be given to its role as the organization responsible for setting international standards for terrestrial and aquatic animal health and zoonoses; for disseminating selected scientific information and up to date global animal health reports; it will also provide information on its new mandates on animal welfare, food safety and capacity building in Member Countries. The course will begin January 2005. Specific information as to how to participate may be found at http://www.vu.msu.edu/preview/anr-ifl/2002/oie.html or can be obtained by sending an e-mail to verlege3@msu.edu . (OIE 1/21/05 http://www.oie.int/eng/press/en_050121.htm)

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New CDC Program for Rapid Genotyping of Mycobacterium tuberculosis Isolates
In January 2004, the CDC Tuberculosis Genotyping Program was initiated to enable rapid genotyping of isolates from every patient in the USA with culture-positive tuberculosis (TB). The Federal Tuberculosis Task Force recommended nationwide TB genotyping in response to the Institute of Medicine report, Ending Neglect: The Elimination of Tuberculosis in the United States. Subsequently, TB control programs in 50 states and two large cities (New York and San Diego) were approved to participate in the TB Genotyping Program, which was developed in collaboration with the National TB Controllers Association (NTCA). The TB Genotyping Program contracts with laboratories which provide results within 10 working days from two PCR-based genotyping tests: mycobacterial interspersed repetitive units (MIRU) typing and spoligotyping. In combination, these two tests provide a highly discriminatory method to identify strains. An additional genotyping method is available to provide further discrimination between strains for isolates with identical PCR results. The mycobacteriology laboratory branch at CDC also participates in the TB Genotyping Program by performing genotyping testing for quality-control purposes. TB genotyping will help TB-control programs identify recent transmission of TB, detect outbreaks sooner, identify false-positive M. tuberculosis cultures, evaluate completeness of routine contact investigations, and monitor progress toward TB elimination. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5402a6.htm (MMWR January 21, 2005 / 54(02);47)

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CDC: QuickStats from the National Center for Health Statistics
A new feature will appear in CDC MMWR. QuickStats will provide updates on key indicators, important trends, and critical relations in public health, based on data from CDC's National Center for Health Statistics (NCHS). NCHS monitors the nation's health through its many data systems, collecting and analyzing information regarding a range of health topics. Each QuickStats will feature the latest available data and provide an Internet link to additional information. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a8.htm (MMWR January 14, 2005 / 54(01);18)

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4. APEC EINet activities
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APEC EINet is on heightened alert for the rise in the incidence of infectious disease in the tsunami-affected region, avian influenza in Vietnam and Thailand, and BSE (mad cow disease) in Canada. We will continue to provide you with updates to keep you informed about infectious disease news in the region. Currently we are also discussing other ways in which we can be of assistance with the tsunami disaster by communicating with our partners at Hawaii's Tripler Army Medical Center (http://www.pacom.mil/special/0412asia/) and Uplift International, based in Seattle, USA (http://www.upliftinternational.org/).

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5. To Receive EINet Newsbriefs
APEC EINet email list
The APEC EINet email list was established to enhance collaboration among academicians and public health professionals in the area of emerging infections surveillance and control. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe (or unsubscribe), contact apec-ein@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://depts.washington.edu/einet/.

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 apecein@u.washington.edu