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Vol. VIII, No. 4 ~ EINet News Briefs ~ Feb 18, 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:
- USA (Delmarva): Avian influenza, Industry privacy issues
- USA: Influenza found in turkey flock in Sampson County, North Carolina
- USA (NYC): Highly Virulent Strain of HIV Resistant to Three Categories of Drugs is Associated with Rapid Onset of AIDS
- Dominican Republic/USA/Canada/Europe: Malaria Update
- USA: Pseudomonas fluorescens, syringes recall
- WHO Latest SituationReports on South-East Asia Earthquake and Tsunami
- Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1)
- Cambodia: FAO avian influenza update, as of 11 Feb 2005
- Viet Nam: FAO avian influenza update, as of 15 Feb 2005
- Thailand: FAO avian influenza update, as of 15 Feb 2005
- Thailand: Brakes put on measures to curb bird flu
- China: New bird flu vaccine capable of prevention
- China: Outbreak Notice: Meningococcal Disease, Anhui Province
- Japan: First Japanese Case of Human Variant of Mad Cow Disease
- Japan: Ministry runs out of yellow fever vaccine
- Philippines: Health officials alarmed over soar of typhoid cases
- Indonesia (East Nusa Tenggara): emergency declared following 44 rabies deaths
- Russia: Epizootic of rabies in Krasnodar region
- Russia: Epizootic outbreak of rabies registered in Sverdlovsk
- Russia: Hemorrhagic Fever with Renal Syndrome, Sverdlovsk Region
- Russia: Trichinellosis (badger), Novosibirsk region, Russia.
- Australia: Cases of Acute Nephritis hospitalized
- Australia (New South Wales): Legionellosis, Alarm as more fall ill amid deadly outbreak
- New Zealand: Exotic mosquito intercepted at Auckland port

1. Updates
- Influenza
- Cholera, diarrhea & dysentery
- Dengue/DHF
- Viral gastroenteritis
- West Nile Virus

2. Articles
- Influenza vaccination among adults and children during the 2004-05 influenza season
- Japanese Encephalitis in a U.S. Traveler Returning from Thailand, 2004
- Hepatitis A Vaccination Coverage Among Children Aged 24--35 Months --- United States, 2003
- Tuberculosis Transmission in a Homeless Shelter Population --- New York, 2000--2003

3. Notifications
- FAO/OIE Second Regional Meeting on Avian Influenza Control in Animals in Asia
- The OIE's involvement in the field of food safety
- International Conference on Biosafety and Biorisks
- Caution Regarding Testing for Lyme Disease
- New Plasma-derived Product to Treat Complications of Smallpox Vaccination

4. APEC EINet activities
- Global Health conferences; APEC Health Task Force

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
USA (Delmarva): Avian influenza, Industry privacy issues
In the wake of an economically devastating avian flu outbreak in the Delmarva region (the Eastern seaboard states of Delaware, Maryland, and Virginia) in 2004, poultry producers asked lawmakers for legislation to conceal the identity of infected farms, saying they want to avoid panicked embargoes by overseas purchasers. However, secrecy would also limit the ability of non-government officials to monitor disease spread, potentially placing human populations at risk. At a meeting of the Eastern Shore delegation to the General Assembly, Bill Satterfield, executive director of Delmarva Poultry Industry Inc., asked state legislators to support HB76, authorizing civil penalties for people who violate animal health regulations, and HB104, protecting the identity of infected farms. And the industry sought to assure the legislators that they are doing all they can to ensure safety at their farms. "We're now working with county health departments and other states to protect workers against avian influenza," said Ron Darnell, Delmarva Poultry Industry Inc. president.

The strain of flu that infected Delmarva poultry in 2004, H7N2, is not very virulent. Only two poultry workers of hundreds tested showed signs of having been infected with the disease. However, in Southeast Asia, other strains of avian flu have long been known to spread to and kill humans in close contact with poultry. Dr. Richard Slemons, Ohio State University professor of veterinary medicine, noted that the poultry industry is so vertically integrated that even if Europe refuses to accept imports of American poultry for a week the cost can be millions of dollars. "Maryland and Delaware did a great job last year" containing the disease, Slemons said. "We're due for another pandemic. The only thing that's predictable is that (the viruses are) unpredictable." (Promed 2/6/05)

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USA: Influenza found in turkey flock in Sampson County, North Carolina
A turkey breeder flock in Sampson County has been confirmed to have H3N2 influenza, according to Cooperative Extension Poultry Agent James Cochran. The most likely source of the virus is a swine herd in the area, he said. The flock was late in its laying cycle when one house experienced a drop in egg production. The flock processed shortly thereafter. On 14 Jan 2005, the National Veterinary Services Laboratory confirmed that the virus isolated from the flock at Rollins laboratory was a subtype H3N2 influenza virus (a low-pathogenicity variety). This diagnosis has significance for those that export to the Russian Federation, said state veterinary officials. The export agreements made with Russia include the requirement to report all subtypes of influenza diagnosed in commercial poultry.

The isolation of H3N2 influenza from North Carolina poultry will be reported by USDA to Russia. This will change North Carolina's Avian Influenza status as it relates to Russian exports from A to B for the next 30 days. After 30 days has passed the status will change to C. It will be an additional 5 months before the status returns to A. While in status B, processing plants located in the index county and adjacent counties will not be able to export to Russia. The counties affected include Sampson, Harnett, Johnston, Wayne, Duplin, Pender, Bladen and Cumberland. All other processing plants in the state exporting to Russia will need to test 15 birds per flock for the virus at slaughter during the 30-day period if they wish to export to Russia. If the plant has no intention of exporting product produced during the 30-day period they do not need to test. While in status C, processing plants located in the noted counties can resume exports to Russia if they test 15 birds per flock at slaughter. Processing plants located outside of the index county and adjacent counties can discontinue testing for avian influenza. (Promed 2/8/05)

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USA (NYC): Highly Virulent Strain of HIV Resistant to Three Categories of Drugs is Associated with Rapid Onset of AIDS
AIDS viruses isolated from two people are being studied to determine whether either might be the source of a rare and potentially more aggressive form of HIV detected in a New York City man, an AIDS scientist said 13 Feb 2005. Many more tests need to be conducted to determine whether the strains from the three people are the same, said Dr. David Ho. He directs the Aaron Diamond AIDS Research Center in Manhattan, which is conducting some of the studies in collaboration with the New York City health department. While some findings may be available in a week, others will take longer.

Even if the strains prove to be the same that would not necessarily mean that a "supervirus" is on the loose, since there could be genetic factors in the first man that would make his infection progress faster. Lab tests in Dr. Ho's laboratory and elsewhere have shown that the strain from the man, whose case started the investigation, is resistant to 19 of the 20 licensed anti-retroviral drugs. Experts said that the strain might have led to the rapid onset of AIDS in the man or that his immune defenses might have been weakened by drug use or genetics (he was a crystal meth user).

Molecular tests of the man's HIV show that it has changes that appear to differ significantly from the typical strains circulating in New York City, and precisely what those changes mean remains to be determined, Dr. Ho said. His lab has begun testing a virus that was isolated from a man who was known to be HIV-infected before he became a sex partner of the New York City man. That partner probably had sex with the New York City man in October 2004, a few weeks before the New York City man became ill with what his doctors believe was an acute retroviral syndrome. It occurs in the earliest stages of HIV infection. The partner is "a potential source for this man's case," Dr. Ho said. "But he may not be."

The second virus is from an unidentified patient in San Diego who was apparently infected before the New York City man. It was found from the records of a commercial laboratory, ViroLogic Inc., and portions of its genetic makeup closely resemble the molecular pattern of the New York City man's virus, Dr. Ho said. Dr. Ho's team sent the partner's virus to ViroLogic for testing.

An additional man who was a sex partner of the New York City man has declined to participate in the epidemiologic investigation, Dr. Ho said. It is not known whether he is HIV-infected. The two male contacts in New York City, only one of whom is cooperating with the investigation, are among hundreds of men with whom the New York City man told health officials he has had sex in recent weeks while using crystal methamphetamine. The New York man who sparked the investigation is cooperating with city health officials but apparently does not know the names of all his partners. The health department is trying to trace as many of his sex contacts as can be ascertained. To protect his privacy, health officials have identified him only as in his mid-40's. So far, city health workers have reached about a dozen of the man's contacts. CDC officials have notified health departments elsewhere.

On 11 Feb 2005, Dr. Thomas R. Frieden, the commissioner of the New York City Department of Health and Mental Hygiene, said the man's case was the first in which a strain of HIV had been found that showed both resistance to multiple classes of drugs and apparently led to a rapid progression from infection to AIDS. Each component has been reported earlier. Dr. Frieden and other AIDS experts said they considered it prudent to investigate what they knew was only one case and to issue an alert to doctors and hospitals to seek other cases.

Dr. Frieden was joined by other AIDS experts at a news conference that he said was intended to issue a wake-up call to the public and health professionals about the seriousness of unsafe sex and the apparent increase in drug-resistant HIV strains. While the experts said that they could not rule out the possibility that they were dealing with an extraordinary confluence of two rare events, they also said they were concerned about the possibility of the man passing it to his hundreds of sexual contacts. The health department asked doctors and hospitals for their help, because the city, like most other areas of the country, has no system to monitor the occurrence of HIV drug resistance among recently infected people. So, Dr. Frieden said, the city has no easy way to determine whether such a strain was an isolated event or whether it was infecting a cluster of people. Dr. Frieden and other experts said that, logically, there had to be at least one other individual with the rare strain who gave it to the New York City man.

Dr. Frieden defended his department's decision to issue a warning 11 Feb 2005. He said that the decision to go public was not easy and was not taken lightly, but that, given the evidence he had available, he had no doubt they did the right thing. As he cautioned 11 Feb 2005, several things remain unknown. They do not know how widespread this strain is or how widespread it will become. They also do not know how this patient will fare. But they do know several troubling things beyond a doubt, he said. "There is not a question that drug resistance is on the increase," he said. In addition, he said, there is no good system in place to track patient adherence to drug treatment. That, paired with the fact that there is far too much risky sex taking place in which methamphetamine use plays a role, is enough to give anyone pause. (Promed 2/16/05)

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Dominican Republic/USA/Canada/Europe: Malaria Update
As of 4 Feb 2005, the CDC has received reports of 20 cases of malaria in travelers to resort areas of the Dominican Republic. Plasmodium falciparum malaria has been confirmed in four patients from the US, six from Canada, and 10 from European countries, all of whom had recently traveled to areas of the Dominican Republic where malaria had not previously been reported. All returned home between 3 Nov 2004 and 2 Jan 2005. CDC continues to recommend that all travelers to La Altagracia Province, including the Punta Cana resort area, should take an antimalarial drug (prophylaxis). In addition, an antimalarial drug is recommended for travelers to rural areas throughout the country. Chloroquine is the recommended drug for the Dominican Republic. Infection with P. falciparum may rapidly result in a severe, life-threatening illness if not promptly treated.

Antimalarial drugs taken correctly and consistently, along with other measures to prevent mosquito bites, have been shown to be effective in preventing malaria. CDC has rescinded recommendations for malaria prophylaxis for Duarte Province because no new cases have been reported from the area in the last two months, the epidemiologic investigation by the Ministry of Health of the Dominican Republic did not reveal any new cases, and their surveillance system did not detect any cases of malaria in the province in recent years. The Ministry of Health in the Dominican Republic has implemented malaria control measures, including intensified surveillance, prompt case management, and intensive mosquito control activities. Please see: http://www.cdc.gov/travel/regionalmalaria/caribean.htm (Promed 2/6/05)

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USA: Pseudomonas fluorescens, syringes recall
FDA is issuing a nationwide alert against the use of all lots of preloaded syringes containing either heparin or sodium chloride intravenous catheter flushes manufactured by the IV Flush, LLC and distributed by Pinnacle Medical Supply because these products have not received proper clearance from FDA and may be contaminated. Consumers and institutions who have these preloaded syringes containing heparin or sodium chloride intravenous flushes should return them to the IV Flush, LLC or the original distributor. The firm voluntarily recalled the products. FDA and the company have also been informed of Pseudomonas fluorescens infections in patients possibly caused by the heparin flushes. These cases are continuing to be investigated. The heparin and sodium chloride containing intravenous flushes were sold to distributors who redistributed to other medical distributors and hospitals. They can be identified by the syringe label: "IV Flush Dallas, TX."

P. fluorescens is an infrequent cause of infection, but has been reported to cause outbreaks of pseudobacteremia, i.e., presence in a blood culture in the absence of clinical evidence of bloodstream infection. P. fluorescens has also been reported as the cause of procedure-related infections and infections resulting from transfusion with contaminated blood components. In one city in the Northeast, six children have been discovered with P. fluorescens bacteremia that may be associated with contaminated pre-loaded syringes containing heparin. Of the six cases, five required hospitalization, two became hypotensive and one of these required intensive care. An outbreak of P. fluorescens bacteremia has also been found among patients at an oncology clinic in the Midwest. P. fluorescens can be confused with P. putida and P. aeruginosa on automated microbiologic testing. Consumers with questions may contact the company at 1-972-463-7389. Persons wanting to report anything to the FDA regarding either of these products may contact FDA's MedWatch office at 1 800-FDA-1088. (Promed 2/7/05, FDA 2/4/05)

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Asia
WHO Latest SituationReports on South-East Asia Earthquake and Tsunami
Health systems are being rapidly strengthened across all tsunami-affected countries. Nutrition needs are being assessed and met. As many survivors try to return to their homes, the fluidity of internally displaced people makes the delivery of humanitarian assistance a challenge. Environmental issues, especially sanitation improvements, remain a priority.

- In Indonesia, 247 cases of gastroenteritis due to suspected food poisoning occurred in a camp in Aceh Utara. Cases of jaundice, dengue, typhoid fever and measles have also been reported from various sites in Aceh, but no outbreaks or new cases of tetanus have been reported. In Indonesia, more than 110 000 internally displaced people (IDP) in the east coast, and 30 000 people in the west coast, have received food from WFP.
- 12 519 mental health services have been provided in Thailand.
- WHO is supporting the concept of ‘health and nutrition huts’ that will provide all healthcare facilities in the Andaman and Nicobar Islands, India.

For more information visit: http://www.who.int/hac/crises/international/asia_tsunami/en/. The latest WHO situation report, with communicable disease information, is available at: http://w3.whosea.org/EN/Section23/Section1108/Section1835/Section1862_8774.htm (WHO 2/15/05)

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Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1)
Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) since 28 January 2004 (WHO), as of 2 Feb 2005: total cases, deaths in parentheses.
Cambodia: 1 (1)
Thailand: 17 (12)
Viet Nam: 37 (29)
Total: 55 (42)
(WHO http://www.who.int/csr/disease/avian_influenza/country/cases_table_2005_02_02/en/)

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Cambodia: FAO avian influenza update, as of 11 Feb 2005
An outbreak of HPAI H5N1 was discovered at a small family chicken farm in Takmao district, Kandal province, about 12 km south of Phnom Penh City. The H5N1 virus was confirmed by the Pasteur Institute in Phnom Penh City. Two chickens tested positive. Cambodia has introduced a temporary ban on the transportation of poultry into and out of 3km-diameter quarantine zones around infected farms. The rearing of all poultry within quarantine zones is banned. Surveillance of poultry movement within a 10 km diameter around the outbreak is being carried out. H5N1 infection of a 25-year-old woman from Kampot Province was also confirmed 31 Jan 2005. There have been no HPAI outbreaks reported in the area where the woman lived, about 3 miles from the Vietnamese border. Her 14-year-old brother had died in mid-January 2005 with similar symptoms. The woman did not raise chickens at home, but relatives in her village had reported dead poultry. Cambodia and Viet Nam have agreed to set up a specialized team to fight HPAI in the border region linking the two provinces. (Promed 2/16/05)

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Viet Nam: FAO avian influenza update, as of 15 Feb 2005
From 1 Jan to 15 Feb 2005, HPAI has been confirmed in 34 provinces and cities, and nearly 1.5 million birds, including doves, have died or have been culled. On 7 Feb 2005, the Prime Minister announced a new measure to stop farmers from allowing their ducks to roam freely in canals and rice fields. Viet Nam also suspended the breeding of ducks on 3 Feb 2005. In Viet Nam, ducks traditionally roam for several kilometers, swimming in flooded rice paddies and eating leftover grains in harvested fields (especially in the Mekong Delta). As infected ducks may not show clinical signs, there is a greater risk that they will spread the virus. Ho Chi Minh City decided to cull its ducks 2 Feb 2005. Viet Nam made an appeal to the United Nations to help it fight HPAI on 3 Feb 2005. Since 30 Dec 2004, the confirmed cases in Viet Nam reported by WHO are 10, of which 9 were fatal. (Promed 2/16/05)

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Thailand: FAO avian influenza update, as of 15 Feb 2005
During 27 Jan-10 Feb 2005, HPAI outbreaks were reported in nine districts of five provinces (Nakhonpathom, Nongkai, Suphanburi, Phitsanulok and Phichit Provinces), and a total of 6911 birds have died or have been culled. As of 15 Feb 2005, six provinces were still the subject of the 21-day surveillance period imposed by the Department of Livestock Development (DLD), Ministry of Agriculture and Cooperatives. Outbreaks were also reported in Kalasin and Nakhon Sawan Provinces on 8 Feb 2005. A total of 496 wild birds died between 18 Jan and 3 Feb 2005 at the Boraphet reservoir, Thailand's largest freshwater swamp in Nakhon Sawan Province. Samples from more than 6800 wild birds of 80 species in seven provinces have been tested. More than 500 pigeons nesting around Uthai Thani provincial hall had been culled by the end of January 2005, after some tested positive for AI. Thailand plans to cull about 2.7 million young free-range ducks to prevent HPAI outbreaks, because ducks are believed to carry the virus without showing clinical signs, and the nomadic nature of free-range farmed ducks can help to spread disease. Thailand has found a high rate of infection in ducks. (Promed 2/16/05)

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Thailand: Brakes put on measures to curb bird flu
Prime Minister Thaksin Shinawatra put the brakes on anti-bird flu measures tabled for cabinet approval on 15 Feb 2005 out of concern that they could send an alarming message to the public and other countries. The measures, proposed by Deputy Prime Minister Chaturon Chaisaeng, include the slaughter of 10.7 million ducks and an emergency plan to cope with the spread of bird flu and possible human-to-human infection. A meeting of experts and business groups that would be affected would be called the fourth week of February 2005.

A Government House source said the prime minister withdrew the proposal from consideration, because he was concerned that the cabinet's stamp of approval, particularly the human-to-human infection measures, could send a wrong signal that Thailand had already had such problems. "We still have time to carefully consider the measures," Mr. Thaksin was quoted. "We can't afford to make mistakes, because misunderstandings would be difficult to correct." Mr. Thaksin was not too convinced by the information gathered by the anti-bird flu committee chaired by Mr. Chaturon. The data from other countries hit by the disease might not be applicable to the Thai situation, he said. He also wanted more scientific studies and tests into the possibility of human-to-human infection. The prime minister also expressed doubt that it was appropriate to slaughter the ducks when there was no clear proof that it was the most effective way to curb bird flu. The mass culling would have a big impact on poultry farmers, he said. (Promed 2/16/05)

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China: New bird flu vaccine capable of prevention
Chinese scientists claim to have developed a vaccine to prevent the spread of the killer bird flu. The Ministry of Agriculture (MOA) says its new vaccine can effectively "cut a key link in the transmission chain of highly pathogenic avian influenza among water fowl." Using reverse genetics, scientists at the Key Laboratory of Animal Influenza, affiliated with Harbin Veterinary Research Institute, altered the genome sequence of the virus to construct a vaccine that is believed to be safe for both poultry and mammals. The MOA suggests that if necessary, the new vaccine could be used on waterfowl in the high-risk area, which contains many water bodies, namely lakes and rivers.

Laboratory tests show the vaccine enabled ducks and geese to fight H5N1, the highly lethal strain of bird flu, three weeks after the flocks were vaccinated, the statement claimed. The new vaccine also provides at least 10 months of protection for chickens, four months longer than the existing bird flu preventive drugs. "China has developed and mass-produced shots targeting H9 and H5N2, the less dangerous subtypes of avian influenza," Xu Shixin, a division director of the Veterinary Bureau of the Ministry of Agriculture, said 6 Feb 2005. The bureau has released a certificate for the new vaccine as a registered veterinary drug. Ministry sources said the new vaccine had overcome the bottleneck in the technology of developing a remedy for preventing "highly pathogenic bird flu." Apart from the encouraging laboratory test results, field tests also indicate that upon receiving two shots of the vaccine, ducks and geese can each produce antibodies effective for 10 months and 3 months, respectively. The birds could then fight the H5N1 strain of the virus. "The vaccination thus makes it impossible for ducks and geese to become the load of H5 subgroup bird flu virus. Therefore, it can cut a key link for the highly pathogenic avian influenza to spread," said the ministry.

China developed advanced bird flu virus test technology (RT-PCR reagent kit) in April 2004. This can detect H5, H7 and H9 subgroups of the bird flu simultaneously in several hours. Vaccination is a must for water fowl and poultry farms in Chinese regions at high risk, according to a national teleconference in bird flu prevention 28 Jan 2005 in Beijing. Mass-application techniques for live vaccines are preferred by today's large poultry operations, worldwide. The goal for mass vaccination is to deliver a minimum of one dose of live vaccine to each bird.

Details on the recombinant H5N1 fowlpox vaccine have been published by Chuan-Ling Qiao et al (National Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute of the Chinese Academy of Agricultural Sciences, Harbin 150001, P.R. China) in their paper "Protection of chickens against highly lethal H5N1 and H7N1 avian influenza viruses with a recombinant fowlpox virus co-expressing H5 haemagglutinin and N1 neuraminidase genes", Avian Pathology (2003) 32, 25 - /31. (Promed 2/7/05, 2/10/05)

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China: Outbreak Notice: Meningococcal Disease, Anhui Province
According to a 31 Jan 2005 report from the Ministry of Health (MOH) of China, an outbreak of meningococcal disease is occurring in 11 cities in Anhui Province in eastern China. From 20 Dec 2004 through 30 Jan 2005, 62 cases have been reported, including six deaths. Most of the cases are reported to be caused by Neisseria meningitidis, serogroup C. Students 13-18 years of age have reportedly been predominately affected. The MOH has responded to the outbreak by issuing a notice to all local health bureaus to enhance surveillance and intensify prevention and control measures, including vaccination and preventive medication for close contacts. According to the MOH, most previous cases of meningococcal disease in China were caused by serogroup A. Since 1984 the government has provided vaccine for serogroup A to children. Currently, bivalent polysaccharide vaccine that protects against serogroups A and C is being distributed. Meningococcal disease, which can be found worldwide, is a serious, sometimes fatal disease, caused by bacteria. It can cause meningitis, as well as blood infections. The bacteria that cause meningococcal disease are spread through close, direct contact with an infected person that leads to exchange of saliva or respiratory secretions. Household contacts of patients with meningococcal disease may be at risk. Risk factors for getting meningococcal disease include [older] age, immune system problems such as HIV or AIDS, respiratory problems such as influenza, smoking or being around people while they smoke, and indoor crowding. *EINet has found the following site from Hong Kong to be also useful: http://www.info.gov.hk/dh/new/index.htm (Promed 2/15/05)

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Japan: First Japanese Case of Human Variant of Mad Cow Disease
The Ministry of Health, Labor and Welfare stated 4 Feb 2004 that it has confirmed Japan's first case of the human variant of mad cow disease (variant Creutzfeldt-Jakob disease—vCJD). The patient, who died December 2004, was in Britain for about a month around 1990, the Ministry stated. "I know that this will make many people worry, but we must take note of the fact that his stay was only one month," Tetsuyuki Kitamoto, a Tohoku University professor and Head of the Ministry panel on the disease, said. More than 160 people, most of them in Britain, have died worldwide from definitive or probable vCJD after eating meat contaminated with mad cow disease, formally known as bovine spongiform encephalopathy (BSE). Britain has been the worst hit by BSE, which is thought to be transmitted among animals via feed containing bovine brains or spinal cord. Around seven million animals had been slaughtered in Britain by the end of June 2004 to prevent the spread of the infection.

Japan has reported 14 cases of BSE and began testing all its cattle for the disease after the first case in September 2001. It also banned imports of Canadian beef in May 2003 and of U.S. beef in December 2003 after cases of BSE were found in those countries, and is in drawn-out talks on when to lift the ban. Cases of vCJD have also been reported in France, Canada, Ireland, Italy, the US and Hong Kong, Health. In all cases outside of Europe, victims are believed to have contracted the disease during stays in Britain, but a one month period would be the shortest stay reported so far, the health ministry experts said. The Japanese man, who was in his 40s when he first showed symptoms of the disease in December 2001, had no record of blood transfusions or brain surgery--other ways in which the disease could be transmitted. The Health Ministry sought to calm any fears among the Japanese public, issuing a statement saying that the disease is not transmitted among humans under regular living conditions. (Promed 2/4/05)

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Japan: Ministry runs out of yellow fever vaccine
Vaccination against yellow fever, which is required for travel to parts of Africa and South America, has been suspended at several quarantine stations due to higher-than-expected demand. According to the WHO, 41 countries in Africa and South America are designated as yellow fever areas, and all of Japan's quarantine stations recommend that travelers to these destinations be inoculated against the disease. In many cases, vaccination prior to entry into the areas is obligatory. Japan's Ministry of Health, Labor and Welfare purchases the vaccine in bulk from the US and distributes it to 18 quarantine stations and other facilities. The ministry order is based on estimates received from the quarantine stations every spring and autumn. Since fiscal 2002, when it over-ordered by several thousands of vials, the ministry has erred on the side of caution when ordering the vaccine.

The vaccine shortage became serious last month, especially in quarantine stations in large cities, such as Osaka and Tokyo. The Narita Airport Quarantine Station temporarily displayed a notice saying, "We have suspended vaccinations until arrival of vaccine shipments." The Tokyo Quarantine Station also temporarily suspended vaccinations. Although it was able to resume the service after asking stations in Hokkaido to rush vaccine from their own stocks, Tokyo has only been able to meet half the demand. The ministry managed to secure enough vaccine for 1000 people from a regular supplier and plans to distribute the vaccine to stations in large cities. However, the vaccine will be in short supply until later in February 2005 or early March, when the ministry expects to receive 7000 doses, which were ordered in autumn 2004. A ministry official said: "It's a basic requisite that we keep enough vaccine on hand. We apologize for being unable to meet requests as our forecast was out. We'll do our best to make sure this doesn't happen again by reviewing the system by which we estimate vaccine requirements." (Promed 2/6/05)

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Philippines: Health officials alarmed over soar of typhoid cases
Dumaguete City health officer Erlinda Cabrera is alarmed over the increasing number of typhoid fever cases in the town of Sibulan, province of Negros Oriental. The town and the city share a common boundary, and residents from Sibulan go to Dumaguete daily. Cabrera said it is possible that some individuals visiting Dumaguete daily might already have the bacteria in their system but are not yet symptomatic. The number of confirmed typhoid fever cases from Sibulan town, as of 2 Feb 2005, has soared to 170, from the 133 reported incidents at the end of Jan 2005. In Negros Oriental Provincial Hospital (NOPH), 24 patients with typhoid fever were admitted. However, patients admitted to the two other hospitals in Dumaguete remained unaccounted for. Dr. Clarita Cadiz, head of NOPH's Department of Medicine, said the hospital admitted some 50 typhoid fever patients at the start of the week, but most have been treated. Governor George Arnaiz cautioned the public against blaming the spread of the disease on the water supply from the Sibulan Water District (Siwad). Arnaiz told reporters that some of the patients were from outside Sibulan and, therefore, not using Siwad supply. So far, most of the typhoid fever cases were from Looc, Poblacion, San Antonio, Cangmating, Bolobboloc, Ajong, and Tubod. (Promed 2/7/05)

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Indonesia (East Nusa Tenggara): emergency declared following 44 rabies deaths
The government of Lembata regency declared an emergency 3 Feb 2005, after 44 people died in the first week of February 2005 due to rabies. The latest victim was a 7-year-old, who died 5 Feb 2005 after being bitten by a rabid dog. In order to control the outbreak, since 6 Feb 2005, the government has shot dead 212 dogs suspected of having the virus and is now hunting down more, said Maria Geong, the Head of the Animal Husbandry Office at the Lembata administration. The government will also vaccinate the remaining healthy dogs in the regency. The number of deaths in this outbreak in such a short period of time is exceptional and demands exceptional measures, firstly to make available adequate amounts of vaccine and immune globulin for post-exposure treatment of the victims of dog-bite, and, secondly, for immediate control of the feral dog population by destruction and by vaccination of domestic dogs. (Promed 2/9/05)

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Russia: Epizootic of rabies in Krasnodar region
In January 2005, two women died from rabies in the Adlersk district of the city of Sochi in the Krasnodar region. Both of them had been bitten by domestic puppies. One of the victims, age 70, did not seek medical attention. The other, age 78, received only one vaccination and refused the follow-up vaccinations. In December 2004, also in the same district of Sochi, another woman died after being bitten by a dog. Vaccination of domestic and wild animals is being carried out now. Representatives of the State Epidemiological Surveillance Center of the Krasnodar region believe that the reason for the rapid spread of infection is the uncontrolled migration of animal vectors of rabies from the Republic of Abkhazia, where the vaccination and destruction of sick animals has been neglected. The Vice-president of the Society of Hunters and Fishers of the Krasnodar Region, Michael Ivanchenko, however, believes that the reason for the outbreak of rabies is a rapid increase in the density of foxes (more than 4 animals/1000 hectares). The increase in the fox population has been caused by a warming of the climate.

In 2004, 140 cases of rabies were recorded among wild animals and pets in the Krasnodar region, and in January 2005, there have already been 38 cases, stated Murad Muradyan, the Head of the Anti-epizootic group. Across the Krasnodar region, and especially in Sochi, where the situation is most serious, control measures have been initiated. In Krasnodar city, only one case of rabies was identified in 2004, involving a domestic dog. Now in January 2005, two cases of rabies have been recorded already. Nonetheless, the population is not taking the situation seriously enough. The Municipal Veterinary Science, in 2004, vaccinated 16 000 domestic pets, whereas the owners of pets have sought vaccination only for 1200 pets, despite the fact that inoculations are free-of-charge for all animals. (Promed 2/7/05)

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Russia: Epizootic outbreak of rabies registered in Sverdlovsk
An epizootic outbreak of rabies has been registered in the Sverdlovsk region. The report by the epidemiological surveillance center indicates that during 2004, an unfavorable disease situation was observed in the rayons (regions) of Krasnoufimsk, Artinsk, Siserts, Nevyansk, Irbitsk, Kamishlovsk and Kamensk. Following the spread of rabies among badgers, raccoons, dogs and foxes, dogs, cows and horses have been exposed; consequently, 56 humans have been exposed in 2004. The situation has deteriorated even further since the beginning of 2005 in the Sverdlovsk region. During January 2005, 25 rabies cases were recorded in wildlife, three in stray dogs and two in farm animals. 12 people were bitten; the total number of exposed people was 30. The situation is associated with the active migration of wild animals, especially foxes, from the neighboring infected regions Bashkiriya, Kurgansk, and Chelyabinsk. (Promed 2/15/05)

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Russia: Hemorrhagic Fever with Renal Syndrome, Sverdlovsk Region
In total, 125 cases of hemorrhagic fever with renal syndrome (HFRS) were registered in the Sverdlovsk region in 2004. The morbidity of HFRS in 2004 was 2.63 percent among 100 000 inhabitants, 21 times higher than 2003, and eight times higher than the median level of morbidity over a period of several years. Cases of HFRS were registered in the city of Ekaterinburg and in eight districts of the region. The Krasnoufimsky district was the most severely affected, with 97 cases of HFRS diagnosed, 50 times higher than the average level of morbidity in the whole of the Sverdlovsk region. An epidemiological investigation established that about 30 percent of all persons affected had drunk unboiled water, whereas the other 70 percent were infected from the environment, where wild animals are the main source of infection. An increase in the number and activity of small mammals suggests that the Sverdlovsk region will remain a centre of HFRS. (Promed 2/10/05)

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Russia: Trichinellosis (badger), Novosibirsk region, Russia.
25 inhabitants of Kochkovsky district of Novosibirsk region are hospitalized with a diagnosis of trichinellosis and six of them are in serious condition in the Hospital for Infectious Diseases, Novosibirsk. The source of the outbreak is shish kebabs made from badger meat. Patients assure the attending physicians that shish kebab from a badger is tasty, exotic, and most important, cheap. But meat from these wild animals, as a rule, is infected by Trichinella, and because shish kebab is often not thoroughly cooked, the organisms may survive. "We have not previously seen such big outbreak of trichinellosis from badger meat," said Zinaida Figurenko, a physician in the Department of Infectious Diseases. However, trichinellosis from pork is frequent. Trichinellosis is widespread in carnivores in Russia -- in wild boar and bears -- and also in domestic pigs. (Promed 2/4/05)

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Australia: Cases of Acute Nephritis hospitalized
10 children in the Torres Strait have been hospitalized after an outbreak of a disease that can lead to severe kidney failure and death. Cases of acute nephritis are not uncommon in indigenous communities in northern Australia; the last major outbreak of the disease in north Queensland was in 1993 when 100 children were hospitalized and two died. Acute nephritis is caused when skin sores become infected with streptococcal bacteria. The Tropical Public Health Unit (TPHU) says so far 10 children from three different islands in the Torres Strait are being treated at the Thursday Island Hospital. Health staff are now examining children between the ages of two and 12, and those with skin sores are being given penicillin. Poststreptococcal glomerulonephritis (PSGN) occurs when certain strains of Group A streptococcus infect humans, usually children. Unlike poststreptococcal rheumatic fever, which is almost always related to streptococcal sore throats, PSGN is usually related to streptococal skin infections. (Promed 2/10/05)

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Australia (New South Wales): Legionellosis, Alarm as more fall ill amid deadly outbreak
A further seven cases of potentially deadly legionnaires' disease are now under investigation, after five cases were confirmed in Wollongong. The fifth person was identified as it was revealed that three air conditioning towers in Wollongong's Central Business District (CBD) were positive for legionella bacteria during the second week of February 2005. A 61-year-old Wollongong man, who started showing symptoms of the disease 4 Feb 2005, is being treated at Wollongong hospital. Four other men, aged 35, 57, 75 and 84, were infected between 30 Dec 2004 and 25 Jan 2005. Seven other patients are under investigation after visiting their GPs or hospital emergency departments with pneumonia-like symptoms.

The earlier victims had visited Wollongong CBD before getting the disease, which is contracted through breathing contaminated air from air conditioning cooling towers or bacteria in potting mix (the potting mix organism is Legionella longbeachae, not the more usual L. pneumophila). Doctor of infectious diseases and immunology at Sydney University, Ray Kearney, said health authorities were dealing with a "significant incidence well above average." He said there was a potential link between all 12 cases and the contaminated air conditioning units. South Eastern Sydney/Illawarra Health said the source of the outbreak was too difficult to pinpoint. "The only thing we can say is that, based on our advice from council, with regard to the cleaning of those towers that had tested as positive, there is no evidence of any ongoing risk," a SESIHS spokeswoman said. The Illawarra area had the world's third largest outbreak of the disease in 1987, which resulted in 13 deaths and 53 cases of legionnaires' disease. It should be noted that Legionella sp. can be commonly isolated in cooling towers of commercial air conditioner units even without human cases. In order to prove the association with human cases, human isolates have to be shown in the laboratory to be identical to environmental isolates. (Promed 2/16/05)

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New Zealand: Exotic mosquito intercepted at Auckland port
Public health staff are checking for yellow fever mosquito larvae and have set up traps at the Ports of Auckland, after they were found in a canoe being imported from Rarotonga (Cook Islands). Ministry of Agriculture and Forestry Quarantine staff found the yellow fever mosquito larvae (Aedes aegypti) on an outrigger canoe being imported for dragon boat racing during routine inspections at the Ports of Auckland. Although the canoe was inspected before leaving Rarotonga, the protective plastic covering had been badly damaged, allowing infestation as the canoe was transported through the Pacific to New Zealand. The Ministry of Health's Chief Technical Officer for Health, Sally Gilbert, says: "The canoe where the larvae were found has been treated with chlorine, as well as other insecticides, and is being fumigated. We're confident that these measures would have eradicated any other mosquitoes in the canoe, but the Auckland Regional Public Health Service has also implemented a program of enhanced surveillance. Health protection staff have checked the surrounding area and placed a number of adult and larval mosquito traps in the vicinity." Health protection staff will monitor the traps for at least three weeks to see whether there is any sign the mosquitoes may have escaped into the local environment. Ms. Gilbert said the fact that the exotic mosquitoes have been detected at the border shows systems are working efficiently, and it means it is less likely they'll spread in New Zealand. Exotic mosquitoes of public health significance have been intercepted on 32 occasions since January 1998. (Promed 2/17/05)

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1. Updates
Influenza
WHO Recommends Replacement of One of 3 Components of Influenza Vaccine A new strain of influenza virus has emerged in California. The WHO is predicting that it will be the dominant influenza virus strain next fall and winter. The new strain is called A/California. Health officials in Santa Clara County discovered it late in 2004. CDC says that the California influenza virus already represents 20 percent of influenza cases nationally this year. A WHO flu expert says the California strain has popped up in Canada, Mexico, Europe, Asia, Africa and Pacific islands. This rapid spread has led WHO to recommend that the California strain replace the A/Fujian virus, which is one of three main components in this year's influenza vaccine. US officials are expected to follow suit. Researchers are working to develop a prototype vaccine by March 2005 so manufacturers can start growing it in chicken eggs, the first step in producing next year's influenza vaccine. The composition of the influenza vaccine for the 2005/06 season (Northern Hemisphere winter) was announced by WHO 13 Feb 2004. WHO has recommended that the vaccines should contain the following:
(1) an A/New Caledonia/20/99(H1N1)-like virus
(2) an A/California/7/2004(H3N2)-like virus
(3) a B/Shanghai/361/2002-like virus.

In 2005, more than 10 000 influenza viruses from all continents were isolated and characterized by the WHO/National Influenza Centers. These laboratories, which are located in more than 80 countries, form the backbone of the global influenza surveillance program. These recommendations are used by pharmaceutical manufacturers to update the composition of the influenza vaccines they produce. This annual adjustment is necessary to match the vaccine with the changing viruses expected to be circulating during the coming influenza season. Recommendations for the composition of the vaccine to be used in the Southern Hemisphere will be made at a meeting in September 2005.

While influenza vaccine coverage has improved significantly in the last 10 years, the vaccine is not reaching everyone in the high risk categories. These categories include the elderly, those who are at increased risk because they have other respiratory or cardiovascular disease, and health care workers. However, influenza vaccine use in developing countries remains minimal to nonexistent. In 2004, WHO's Member States set a goal of 60 percent coverage for those in these high risk groups and 75 percent coverage by 2010. Since young children can develop severe disease, some countries have started including vaccination of children as part of their influenza policy. Vaccinating children may not only reduce their disease burden, but it may also reduce transmission to the elderly and others at increased risk. (Promed 2/10/05, 2/13/05)

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Cholera, diarrhea & dysentery
Russia
In the Ust-Avam settlement in the Tajmyrskiy autonomous region, a 6-month-old child has died from paratyphoid fever. In total, 18 cases of acute intestinal infections have been reported in this settlement, including 11 children under age 14. Victims were hospitalized in the Dudinka and Norilsk infectious diseases hospitals. By serologic study, the diagnosis of paratyphoid A fever has also been confirmed in the mother of the deceased child and in seven others. The epidemiological investigation established that the source of the infection in the settlement was a patient with the asymptomatic form of the disease. Epidemiologists did not exclude contamination of substandard potable water. Inhabitants of the settlement obtain their water in the river and lake without disinfection. (Promed 2/4/05)

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Dengue/DHF
Indonesia
Indonesia's capital Jakarta and 5 provinces have been placed under alert for a possible dengue epidemic, following a growing number of fatalities and infections. Health authorities said efforts were being stepped up to prevent a repeat of 2004’s dengue fever outbreak that killed 669 people and infected 59 321 others in 24 of the country's 32 provinces. Health Minister Siti Fadilah Supari was quoted as saying five other provinces, East Java, East Kalimantan, South Sulawesi, West Nusa Tenggara and East Nusa Tenggara, were also under dengue watch. Dengue has led to 102 fatalities so far in 2005 in the six provinces, with 4700 infections, she said. No outbreak has been reported in tsunami-battered Aceh, where more than 240 000 people have died or are missing, despite earlier concerns of threats posed by malaria and dengue. (Promed 2/9/05)

Malaysia/Singapore
Travelers to Asia are being warned about a possible epidemic of dengue fever, following serious outbreaks in Malaysia and Singapore. Malaysia recorded 13 deaths from the mosquito-borne disease in January 2005, three times the monthly average. The number of confirmed cases also rose alarmingly, with 1387 reported during the past four weeks. Kuala Lumpur is one of the worst-affected places, with the number of sufferers rising from 176 two weeks ago to 336 during the final week of January 2005.

Singapore is experiencing its most serious outbreak of the condition in more than 10 years. 4450 people fell ill with dengue fever during 2003, yet 1145 were diagnosed January 2005 alone. In 2004 Singapore experienced its worst outbreak of dengue fever in a decade, with the number of cases in the final three months tripling, compared with the same period in 2003. The number of dengue cases October - December 2004 rose to 3340. For all of 2004, Singapore recorded 9459 cases of dengue, almost double the number in 2003. The National Environment Agency did not provide figures on fatal dengue cases in Singapore. However, the government did say that three people had died in 2004 from the virus.

Private homes were the main breeding grounds of mosquitoes, accounting for almost 90 percent of all breedings found in January 2005. The government this month launched a crackdown in which homeowners found with mosquitoes breeding on their premises would be fined instantly. Penalties for construction sites are much stiffer and can include up to 6 months in jail for those responsible. Malaysia has also launched public awareness campaigns. WHO says the global prevalence of dengue has grown dramatically in recent decades, and the disease is now endemic in more than 100 countries. (Promed 2/9/05)

Timor-Leste
As of 15 February, WHO has received reports of 215 hospitalized cases of dengue infection and 20 deaths (case fatality ratio, 9.3%). One hundred sixty-six cases of the 215 cases had clinical features compatible with dengue haemorrhagic fever (DHF) and the remaining 49 cases were diagnosed as suspected dengue fever (DF) using WHO standard case definitions. Districts reporting DF/DHF cases are Baucau, Dili, Liquica, Maliana and Manatuto with 80% of the cases reported from Dili. An entomologist and a virologist from the National Institute of Infectious Diseases, Japan, partners in the Global Outbreak Alert and Response Network, are assisting the Ministry of Health, Timor-Leste. The virologist is supporting the Ministry in laboratory detection of dengue and helping with the collection and identification of the predominant strain in circulation. The entomologist is working with the Ministry and WHO to conduct larval and mosquito surveys to develop a strategy for vector control. WHO and the Ministry of Health have continued to provide practical training seminars on early diagnosis and clinical management of dengue patients for doctors and nurses from the National Hospital, Dili, other hospitals and clinics. (WHO 2/15/05)

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Viral gastroenteritis
USA (Indiana)
Local residents who thought that they had influenza might have been wrong. Delaware County health officials have reported that it actually could have been norovirus infection, a common intestinal illness. Delaware County Health Officer Dr. Donna Wilkins said that norovirus infection is often confused with influenza. However, symptoms of norovirus infection include vomiting and diarrhea, whereas influenza symptoms more often are fever, aches, and coughing. "People contract norovirus infection through contaminated food or water," said Wilkins. There are no medications to treat the virus, but Wilkins suggested drinking a lot of water to stay hydrated while sick. According to Wilkins, cleanliness is the key to prevention. Noroviruses are more prevalent during the winter, probably due to people having more close contact. Norovirus infection is self-limiting and usually takes two to three days to recover. (Promed 2/5/05)

Russia (Arkhangelsk)
Since 24 Jan 2005, 42 children have fallen ill with symptoms of intestinal infection in the city of Kotlas, Arkhangelsk region, of whom, 28 have been hospitalized in the City Hospital in serious or relatively serious condition. The children were predominantly between one and two years of age. All the affected children exhibited the same symptoms: vomiting, diarrhea, and high temperature. In response, the City of Kotlas Health Department implemented quarantine measures in pre-school establishments. Samples of products and swabs from utensils used by affected children are being examined. The preliminary diagnosis is acute intestinal infection. Preliminary tests have not revealed evidence of bacterial infection, and the outbreak is now considered to be a viral infection. The most likely cause of the outbreak is considered to be exposure to rotatavirus via a contaminated water supply. Hyper-chlorinaion of the city water supply is being undertaken urgently. A similar outbreak of suspected rotavirus infection, also attributed to a contaminated water supply, was reported recently in the city of Novodvinsk. (Promed 2/16/05)

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West Nile Virus
Canada
As of 31 Dec 2004, revised figures for the 2004 season have been posted on the Health Canada web-site, reducing the total number of probable and confirmed cases of West Nile virus infection in all of Canada from 29 to 25: Alberta - one travel-related case (down one); Manitoba - three cases (unchanged, but only one travel-related now), Ontario - 13 cases (unchanged, but only one travel-related now), Quebec - three cases (up two), and Saskatchewan - five cases (down five). No deaths have been recorded. As before, the provinces of Newfoundland and Labrador, Prince Edward Island, Nova Scotia, New Brunswick, British Columbia, Yukon Territory, Northwest Territories, and Nunavut have not reported confirmed cases of West Nile virus in 2004 in any host species. (Promed 2/15/05)

USA (California)
The first human case of West Nile virus in Los Angeles County for 2005 was reported 8 Feb 2005, months before the mosquito-borne illness usually appears and prompting health officials to remind people to take precautions. An elderly man is recovering after he was hospitalized with fevers and altered consciousness, said Dr. Jonathan Fielding, health officer for the county Department of Health Services. Fielding said a bird infected with the mosquito-borne virus was reported 7 Feb 2005, but it was unknown whether the bird was the source of the man's infection. The man was infected near his home. The case could be the first human case in California in 2005, but it has not been confirmed by the state Department of Health Services. In Los Angeles County, which had the most cases of any of California's 58 counties, 329 people were infected and 13 died from the virus. West Nile virus first appeared in California in 2003 and infected three people in Southern California. Health officials said the worst outbreaks usually occur in the second year in many states. In Colorado, for example, nearly 3000 people were infected and 63 people died in 2003, the second year of the outbreak. Ken Fujioka, assistant manager of the San Gabriel Valley Mosquito and Vector Control District, said the recent storms and warm evening temperatures may contribute to the spread of the virus. (Promed 2/15/05)

Cuba, Puerto Rico
Ecologist Peter Marra of the Smithsonian Environmental Research Center (SERC) found West Nile virus antibodies in resident birds species collected in Cuba and Puerto Rico during field work conducted in 2004. In Puerto Rico, Marra's team found 2 resident birds, a bananaquit and a green heron, with antibodies to the virus, and in Cuba, 2 red-legged thrushes and a little blue heron tested positive for antibodies. "It's the first year we've looked in Cuba," Marra said, "but it's only 90 miles from Miami, Florida, where birds have tested positive for at least two years." The researchers expected to find signs of the virus in Cuba, but the recent test results provide the first confirmed evidence that the virus is there. "One of the most perplexing issues in the West Nile virus story thus far has been its behavior in tropical regions," said Marra, "We just aren't seeing the same sort of bird, horse or human impacts as we did in temperate areas. This is a huge relief, since wildlife and people have already been seriously impacted from the effects of habitat destruction. Understanding why West Nile's lethal effects appear to be reduced in the tropics is something we're preparing to study." For more information, please visit: http://www.serc.si.edu/migratorybirds/migratorybirds_index.htm, http://sio.si.edu/Nestwatch/, http://www.serc.si.edu. (Promed 2/7/05, 2/8/05)

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2. Articles
Influenza vaccination among adults and children during the 2004-05 influenza season
Behavioral Risk Factor Surveillance System (BRFSS) Summary for data collected January 2-22, 2005
This report provides an update of 2004-05 influenza vaccination coverage based on results from the Behavioral Risk Factor Surveillance System (BRFSS) survey. Information from this report includes persons interviewed during January 2-22, 2005 and updates information that was reported in the December 17, 2004 MMWR (www.cdc.gov/mmwr/pdf/wk/mm5349.pdf). The January 2005 data suggest that vaccination continued to occur during the month of December and was concentrated among persons in priority groups. Although coverage among most priority groups was somewhat lower than in non-shortage years, vaccination coverage of children 6-23 months of age was 57%, a large increase compared with the previous estimate of 7.7% from the 2002 National Immunization Survey (www.cdc.gov/mmwr/pdf/wk/mm5337.pdf). Children 6-23 months of age were first recommended for annual influenza vaccination beginning in 2004. Main findings:
• Most of the available 2004-05 influenza vaccine administered through the end of December 2004 was used to vaccinate persons in priority groups.
• Vaccination coverage among children in priority groups combined was 50.7%. For children aged 6-23 months, coverage was 57.3%; for children aged 2-17 years with high-risk medical conditions, coverage was 43.8%
• Vaccination coverage among non-institutionalized adults in priority groups was 43.1% compared with 8.3% among adults not in a priority group
• Nearly 59% of persons aged 65 years and older reported influenza vaccination during September through December 31, 2004
• Twenty-eight percent of high-risk persons 18-64 years of age and 42.6% of healthcare workers reported vaccination with the 2004-05 vaccine
• Influenza vaccination uptake continued through the month of December.
• State and local health officials should continue efforts to reach people who are in vaccination priority groups, particularly as they receive influenza vaccine.
http://www.cdc.gov/flu/professionals/vaccination/brfss0405season.htm (CDC 2/10/05)

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Japanese Encephalitis in a U.S. Traveler Returning from Thailand, 2004
“Japanese encephalitis (JE) virus is a mosquito-borne flavivirus that is closely related to the West Nile and St. Louis encephalitis viruses endemic to North America. JE virus is a leading cause of viral encephalitis in Asia but is rarely reported among travelers to countries where JE is endemic. This report describes a case of an unvaccinated Washington resident who had JE after traveling to northern Thailand. The Advisory Committee on Immunization Practices (ACIP) recommends JE vaccine for travelers to JE-endemic areas of Asia during the transmission season, especially those spending >1 month in those areas and whose travel itineraries include rural settings. JE vaccine should also be considered for travelers visiting areas with epidemic transmission or those engaging in extensive outdoor activity in rural settings in areas where JE is endemic, regardless of the duration of their visit. In addition, health-care providers and organized international travel programs should ensure that travelers obtain appropriate preventive health guidance before travel.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5405a4.htm (MMWR February 11, 2005 / 54(05);123-125)

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Hepatitis A Vaccination Coverage Among Children Aged 24--35 Months --- United States, 2003
“Hepatitis A vaccine was first licensed in the United States in 1995. In 1996, the Advisory Committee on Immunization Practices (ACIP) recommended vaccination of children aged >24 months in populations with the highest incidence of hepatitis A (e.g., American Indian/Alaska Native [AI/AN], Asian/Pacific Islander, and selected Hispanic and religious communities). In 1999, these guidelines were expanded to recommend routine vaccination for children residing in 11 states* where average annual hepatitis A incidence during 1987--1997 was at least 20 per 100,000 population (twice the national average) and to consider routine vaccination for children in six states† where average annual incidence was 10--20 per 100,000 population. This report is the first national analysis of hepatitis A vaccination coverage among children. The results indicate that, in 2003, vaccination coverage levels with at least 1 dose of hepatitis A vaccine for children aged 24--35 months varied from 6.4% to 72.7% in areas where routine vaccination is recommended. In addition, hepatitis A vaccination coverage rates for children aged 24--35 months are lower than overall rates for other vaccines recommended for children. Sustaining and improving vaccination coverage among young children is needed to ensure continued declines in hepatitis A incidence in the United States. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5406a1.htm (MMWR February 18, 2005 / 54(06);141-144)

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Tuberculosis Transmission in a Homeless Shelter Population --- New York, 2000--2003
“In 2003, the incidence of tuberculosis (TB) cases in the United States declined for the eleventh consecutive year to a record low of 5.1 cases per 100,000 population. In 2003, 6.3% of reported TB cases in the United States were among homeless persons. Compared with the general population, this group has a greater risk for latent TB infection (LTBI) and progression to active disease. This report summarizes a recent outbreak of TB and highlights the challenges of preventing TB among homeless persons, particularly when multiple chains of transmission are occurring and multiple jurisdictions are involved. The findings underscore the complementary role of rapid DNA genotyping in the detection of possible TB transmission in homeless populations. To ensure early detection of unsuspected TB transmission in homeless populations, health department TB-control programs are encouraged to use CDC's universal Mycobacterium tuberculosis rapid genotyping system.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5406a4.htm (MMWR February 18, 2005 / 54(06);149-152)

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3. Notifications
FAO/OIE Second Regional Meeting on Avian Influenza Control in Animals in Asia
A joint FAO/OIE meeting in collaboration with WHO and Government of Viet Nam, is to be held in Ho Chi Minh City, 23-25 Feb, 2005, to discuss the current AI situation in the region and to;
- review recommendations of the first HPAI Emergency Regional Meeting and global activities of International Organizations in 2004;
- discuss scientific advances; Diagnosis, Surveillance, Prevention and Control; Economic and policy issues (rehabilitation & restructuring); International standards and trade and international cooperation; and Human health implications.

The meeting will be attended by Chief Veterinary Officers from the region, national expert scientists, representatives of international (FAO, OIE and WHO) and regional organizations, international experts working in close collaboration with infected countries in the region and representatives of donors. (FAO/OIE 2/11/05)

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The OIE's involvement in the field of food safety
International standards on food safety are established by the Codex Alimentarius Commission, as stated in the Agreement on the Application of Sanitary and Phytosanitary Measures (SPS Agreement) of the WTO. For its part, the OIE is responsible for standards relating to animal health and zoonoses. Since many zoonoses can be transmitted to humans through food, OIE standards also apply to animal products that could spread pathogens via international trade. It has become apparent that the new global concept of implementing sanitary controls "from the stable to the table" requires the OIE and the Codex Alimentarius Commission to work more closely together and collaborate on a permanent basis. This will ensure that the standards issued by the two Organisations cover all potential hazards throughout the food chain and those standards on topics of common interest do not prove to be contradictory.

The OIE and the Codex Alimentarius Commission are now working much closer together than in the past to try to develop the synergy needed to ensure better consumer protection through the international standards and guidelines that each Organisation adopts …Once the necessary mandate had been obtained from our Member Countries, the Working Group was officially launched in 2002 as the "Working Group on Animal Production Food Safety". Its members include the Chairman and the Secretary of the Codex Alimentarius Commission, the Chairman of the Codex Committee on Meat Hygiene, the Director of the Food Safety Department of the World Health Organization (WHO) and representatives from among the Delegates of OIE Member Countries, from several different continents.

The Working Group's first main role was to help the two Organisations to define more precisely their future policies on the development of standards aimed at protecting consumers, with regard to precautions to be taken throughout the entire "production-to-consumption" continuum. This task, involving both the Codex and the OIE, notably helped to pinpoint areas in which international standards had not yet been adopted. The Working Group then proposed that the majority of its work should be devoted to identifying measures to be taken at the production level prior to the slaughter of animals for food: e.g., how to avoid pathogens that generally have no visible effect on animals being present in food products (Listeria, salmonellae, Trichinella, etc.). The Working Group is also trying to ensure that there are no inconsistencies or gaps in standards on topics falling within the scope of both Organisations. This is for example the case with standards relating to antimicrobial resistance. It also takes into account, within the framework of existing OIE standards on food-borne zoonoses (brucellosis, tuberculosis, etc., already dealt with in the Terrestrial Animal Health Code), the elaboration of new standards aimed at strengthening consumer safety with regard to products presenting a risk with respect to these diseases.

All this work will give rise to proposals that will first be examined by the OIE Terrestrial Animal Health Standards Commission before being submitted for adoption to the General Assembly of our Member Countries. However, the scope of the Working Group is not limited to proposing new international standards. It also includes the drafting of guidelines on control procedures throughout the food chain. The Working Group is currently preparing several documents for the application of controls throughout the food chain…Furthermore the Working Group is invited to consult, whenever necessary, representatives of private sector industries. All the proceedings of the Working Group are brought to the attention of the relevant Committees of the Codex Alimentarius Commission… (OIE 2/05 http://www.oie.int/eng/edito/en_lastedito.htm)

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International Conference on Biosafety and Biorisks
Lyon, France, 2-3 Mar 2005
The Center for Biosecurity of the University of Pittsburgh Medical Center (UPMC) is organizing this event, in collaboration with the WHO Communicable Disease Surveillance and Response Office. Scientists, health leaders, and practitioners from all over the world will discuss biosafety and biosecurity challenges presented by SARS, influenza, and other major epidemic threats, as well as the efforts needed to improve international cooperation prior to and during future epidemics. The conference is being funded in large part by the Nuclear Threat Initiative, a non-profit organization that aims to strengthen global security by preventing the spread of nuclear, biological, and chemical weapons and materials. For more information, please see http://www.upmc-biosecurity.org.

If you are interested in attending, please contact: Gigi Kwik Gronvall, Ph.D., Fellow UPMC Center for Biosecurity ggronvall@upmc-biosecurity.org. Attendance is by invitation only, and there are a limited number of seats left. There is no cost for registration.

Jennifer Nuzzo, SM, Center for Biosecurity, University of Pittsburgh Medical Center, The Pier IV Building, 621 E. Pratt Street, Suite 210, Baltimore, Maryland 21202 Phone: 443.573.3315; Fax: 443.573.3305; jnuzzo@upmc-biosecurity.org (Promed 2/10/05)

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Caution Regarding Testing for Lyme Disease
CDC and the Food and Drug Administration (FDA) have become aware of commercial laboratories that conduct testing for Lyme disease by using assays whose accuracy and clinical usefulness have not been adequately established. These tests include urine antigen tests, immunofluorescent staining for cell wall--deficient forms of Borrelia burgdorferi, and lymphocyte transformation tests. In addition, some laboratories perform polymerase chain reaction tests for B. burgdorferi DNA on inappropriate specimens such as blood and urine or interpret Western blots using criteria that have not been validated and published in peer-reviewed scientific literature. These inadequately validated tests and criteria also are being used to evaluate patients in Canada and Europe…In the US, FDA has cleared 70 serologic assays to aid in the diagnosis of Lyme disease…Initial testing should use an enzyme immunoassay (EIA) or immunofluorescent assay (IFA); specimens yielding positive or equivocal results should be tested further by using a standardized Western immunoblot assay. Specimens negative by a sensitive EIA or IFA do not need further testing. Similar assays and recommendations are used in Canada. In the European Union, a minimum standard for commercial diagnostic kits is provided by Conformité Européene (CE) marking; application and interpretation guidelines appropriate for Europe have been published… http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5405a6.htm (MMWR February 11, 2005 / 54(05);125)

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New Plasma-derived Product to Treat Complications of Smallpox Vaccination
FDA has approved Vaccinia Immune Globulin Intravenous (VIGIV), the first intravenous human plasma-derived product available to treat certain rare complications of smallpox vaccination. VIGIV, licensed to DynPort Vaccine Company LLC is made from the pooled plasma of donors who received booster immunizations with the licensed smallpox vaccine, Dryvax. This plasma contains increased levels of protective antibodies against the vaccinia virus, the live virus used in the currently available smallpox vaccine. The vaccinia virus is similar to the smallpox virus, but does not cause smallpox. Because the smallpox vaccine is made with this live virus, even though it is a weakened virus, occasionally it can cause infections in susceptible vaccinated people or those in close contact with them. People with weakened immune systems or certain skin conditions are susceptible to vaccine complications. VIGIV helps treat these complications.

Historically, up to 30 percent of smallpox cases are fatal. No proven treatment exists. Thus, in people who are considered at high risk for contracting smallpox, such as those who would be called upon to respond to a bioterrorist attack using smallpox as a weapon, the benefits of the highly effective smallpox vaccine outweigh its risks. This approval of VIGIV may help minimize these risks. The most common side effects from the smallpox vaccine such as a sore arm, fever, and body rashes, are self-limiting and do not require treatment. VIGIV would only be used for rare serious vaccine complications, such as a severe infection of the skin. Those at increased risk for these complications include people with eczema or other skin conditions, and people whose immune systems are suppressed due to diseases or medications.

The approval of VIGIV was based on both the safety of the product and prior evidence that the levels of protective antibodies achieved during treatment were adequate for treating complications of vaccination. In clinical studies of VIGIV in 111 volunteers, the medicine was well tolerated. When adverse effects were noted, they were mild to moderate and included headaches, hives, and other rashes. (FDA 2/18/05 http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01341.html)

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4. APEC EINet activities
Global Health conferences; APEC Health Task Force
APEC EINet Director Dr. Ann Marie Kimball is currently involved in two globalization conferences: 1) The Third International Health Conference: Politics, Social Justice, and Global Health, 18-20 Feb 2005 and 2) Global Health and Justice Conference, 25-26 Feb 2005. Both conferences are at the University of Washington, Seattle, USA. Dr. Louis Fox will present his talk on the EINet initiative at the APEC Health Task Force meeting in Seoul, Korea, 28 Feb 2005.The EINet website development team is currently working on several ways to improve the site. The website is hoping to make the subscription process automatic and allow for a “search” option for the news briefs.

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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