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Vol. IX, No. 25 ~ EINet News Briefs ~ Dec 22, 2006


*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- Global: New vaccines against cervical cancer major opportunity for developing world
- Vietnam: New avian influenza H5N1 outbreaks
- South Korea: Fourth outbreak of avian influenza H5N1
- China: Reported closure of live poultry markets
- China: Rabies heads fatal infectious disease list again in November
- Japan: Largest norovirus outbreak since 1981
- Philippines (Agusan del Sur): Suspected amoebiasis outbreak in village
- Russia (Buryatiya): Botulism death from salted fish
- Russia: 11 HFRS Deaths in Republic of Bashkortostan
- USA: Congress passes public health preparedness bill
- USA: HHS seeks advice on allocating pandemic vaccine
- Canada: BSE probe reaches dead end
- USA: Lettuce suspected in Taco Bell E coli outbreak
- Canada (British Columbia): Streptoccus pneumoniae serotype 5 outbreak
- USA (Connecticut): Outbreak of swimmer’s itch
- USA (New Jersey): Herpes gladiatorum outbreak in Jersey City
- USA (California): Norovirus outbreaks in hospitals
- USA/Caribbean: Cruise ship hit by second norovirus outbreak
- USA/South Korea: Oregon outbreak prompts multistate frozen oyster recall
- USA: HHS cancels VaxGen anthrax vaccine contract
- Nigeria: Avian influenza H5N1 in poultry samples from 3 states

1. Updates
- Avian/Pandemic influenza updates
- Seasonal Influenza
- Cholera, diarrhea & dysentery
- Dengue
- West Nile Virus

2. Articles
- CDC EID Journal, Volume 13, Number 1—Jan 2007
- Study: 1918-like pandemic now would kill 62 million
- Assessing the role of basic control measures, antivirals and vaccine in curtailing pandemic influenza: scenarios for the US, UK and the Netherlands
- The Prospect of Using Alternative Medical Care Facilities in an Influenza Pandemic
- Designing a biocontainment unit to care for patients with serious communicable diseases: a consensus statement
- What Hospitals Should Do to Prepare for an Influenza Pandemic
- CDC rates hospital bioterrorism preparedness
- The effect of travel restrictions on the spread of a moderately contagious disease
- Public Health Surveillance for Smallpox--United States, 2003—2005
- Measles --- United States, 2005
- Clinical presentation and pre-mortem diagnosis of vCJD associated with blood transfusion: a case report

3. Notifications
- Pandemic influenza implementation plan
- CDC Influenza Pandemic Operation Plan (OPLAN)
- WHO’s Global Health Atlas

4. To Receive EINet Newsbriefs
- APEC EInet email list


Global
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)

2003
Viet Nam / 3 (3)
Total / 3 (3)

2004
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)

2005
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 17 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 95 (41)

2006
Azerbaijan / 8 (5)
Cambodia / 2 (2)
China / 12 (8)
Djibouti / 1 (0)
Egypt / 15 (7)
Indonesia / 55 (45)
Iraq / 3 (2)
Thailand / 3 (3)
Turkey / 12 (4)
Total / 111 (76)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 258 (154).
(WHO 11/29/06 http://www.who.int/csr/disease/avianinfluenza/en/ )

Avian influenza age & sex distribution data from WHO/WPRO: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm. (WHO/WPRO 11/29/06)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 12/22/06): http://gamapserver.who.int/mapLibrary/

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Global: New vaccines against cervical cancer major opportunity for developing world
The introduction of new vaccines against Human Papillomavirus (HPV), the virus that causes cervical cancer, could have a major impact on the health of women in the developing world. More than 250 000 women died from cervical cancer in 2005 - the vast majority in developing countries. Cervical cancer is the second most common type of cancer among women, with deaths projected to rise by almost 25 per cent over the next 10 years. In 2005 there were more than 500 000 new cases of cervical cancer, of which over 90 per cent were in developing countries. Left untreated, invasive cervical cancer is almost always fatal.

Well-organized screening and early treatment programmes have been very effective in preventing the most common kind of cervical cancer but they are costly and difficult to implement in low-resource settings. In 2006, a vaccine- that protects against infection and disease associated with the HPV was licensed, and another vaccine may be licensed soon. The recently licensed vaccine is effective in preventing infections with the HPV types (16 and 18) that cause approximately 70 percent of all cervical cancers, as well as in preventing infections with those types (6 and 11) that cause approximately 90 percent of genital warts.

The vaccines -- which are initially targeted at girls and may be expanded to boys in the future before or around the time of first sexual activity -- offer the unique opportunity to address segment of the populations that are traditionally difficult to reach: young adolescents. Thus, a multifaceted strategy should exploit the opportunity to promote sexual and reproductive health by strengthening health programmes for adolescents. /Mobilizing resources for strengthening health systems and purchasing HPV vaccines must be a priority and there must be innovative ways to finance HPV introduction. At an international level, partnerships will be needed to try to reduce the usual time-lag between formal registration and availability in developed countries, and establishing a negotiated price and adequate production capacity to supply developing countries.
(WHO 12/12/06 http://www.who.int/mediacentre/news/releases/2006/pr73/en/index.html )

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Asia
Vietnam: New avian influenza H5N1 outbreaks
3 new avian influenza H5N1 outbreaks were detected in poultry this week in Vietnam's Ca Mau and Bac Lieu provinces in the southern Mekong Delta, the sites of recent outbreaks that represented the first major reappearance of the disease in almost a year. One in Ca Mau province began Dec 6, killing 2,523 unvaccinated chickens and duck chicks. Another in Bac Lieu province began Dec 7 and killed 3,550 unvaccinated 1-month-old ducks. Vietnam's deputy prime minister, Nguyen Sinh Hung, ordered animal health workers to finish culling poultry in the affected areas by the end of tomorrow (23 Dec 2006). Nearly 8300 birds have been killed by the virus or slaughtered to hold it back, the Agriculture Ministry said Hoang Van Nam, deputy director of the Department of Animal Health, said the risk of the virus spreading in the area was high because farmers had dumped dead ducklings into canals. The farms where poultry was found dead have been ordered to cull all the live poultry and to disinfect all the areas surrounding.

Earlier news reports said the outbreaks occurred on farms where poultry had not undergone mandatory vaccination and some birds were hatched illegally. The country instituted tough avian flu prevention efforts after widespread outbreaks in 2004 and 2005 led to the culling of 66 million birds and 93 human cases. Vietnam has vaccinated 83 million chickens and 43 million ducks in the second vaccination round in 2006. Vietnamese animal health officials said temperatures were falling in the southern region incorporating the delta, which would help the spread of a virus that thrives best in cooler temperatures.
(CIDRAP 12/20/06, 12/22/06 http://www.cidrap.umn.edu/ ; Promed 12/19/06, 12/21/06)

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South Korea: Fourth outbreak of avian influenza H5N1
The Ministry of Agriculture and Forestry reported that ducks at a farm in Asan, South Chungchong province, tested positive for highly pathogenic avian flu. But it wasn't clear whether it was the virulent H5N1 virus. The agriculture ministry said it would cull about 23,000 poultry within a 3-km radius around the farm in Asan. The 3 initial cases were found in farms in the North Cholla province. The outbreaks were South Korea's first in about 3 years. Between Dec 2003 and Mar 2004, about 400 000 poultry at South Korean farms were infected by bird flu. During that outbreak, the country destroyed 5.3 million birds.

Also a 9-member crisis management team from the OIE and the UN Food and Agriculture Organization (FAO) is on a 10-day mission to South Korea to investigate the H5N1 outbreaks in poultry that occurred south of Seoul late Nov 2006. The mission is the first full-scale deployment of the FAO-OIE crisis management team since it was launched mid-Oct 2006 at FAO headquarters in Rome. The Korean government invited the team to evaluate the risk of further disease spread in South Korea. The team includes international and Korean veterinary epidemiologists, wildlife veterinarians, biologists, and poultry specialists. They will be looking for any wild bird deaths on affected farms or adjacent wetlands and collecting environmental samples. If time allows, the team will also investigate other disease angles, such as how dead birds, eggs, and manure are handled and the role that fencing, cages, vehicles, and water might have played as sources of infection.
(CIDRAP 12/20/06, 12/22/06 http://www.cidrap.umn.edu/ ; Promed 12/21/06)

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China: Reported closure of live poultry markets
Beijing's Municipal Bureau of Agriculture reportedly said the city will ban live poultry markets permanently. According to the bureau, the move is part of its effort to comply with a newly issued document by the State Council that calls for gradually moving live poultry markets away from urban areas in a renewed effort to combat bird flu. Beijing suspended live poultry trade, as well as bird marketing and pigeon shooting from Nov 2006, when several outbreaks were confirmed in its neighboring provinces. In Jun 2006, the city noticed that the trade could be resumed as long as live poultry markets or shops get certification from local veterinary inspection agencies. But according to the bureau, none of the shops have been certified yet. Scientists from Chinese Academy of Sciences said it is poultry rearing and trade causes the spread of bird flu, and restricting the number of live poultry markets is essential to control the disease.
(Promed 12/21/06)

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China: Rabies heads fatal infectious disease list again in November
Rabies killed more people in China than any other infectious disease for the sixth consecutive month in Nov 2006, the Ministry of Health said 11 Dec 2006. There were 270 deaths caused by rabies in Nov 2006 out of 743 deaths due to infectious disease on the Chinese mainland, according to the Ministry of Health. In all, 354 people were reportedly bitten by rabid animals. Rabies has topped the list of the most deadly infectious disease since Jun 2006; before that, tuberculosis was number one. In Nov 2006, tuberculosis was the second-ranked killer, followed by AIDS and hepatitis B, Ministry figures showed. No rabies cases were reported from 1993 to 2004. China ranks second after India in the number of reported cases of human rabies.

All the 550 323 registered dogs in Beijing have received anti-rabies inoculations, the Municipal Agriculture Bureau said 11 Dec 2006. Liu Yaqing, vice-director of the Bureau, said 319 anti-rabies inoculation stations had been opened in the capital to offer free inoculations for all registered dogs. Deng Xiaohong, another Bureau vice-director, said Beijing had recorded 12 [human] rabies cases by 15 Nov 2006. 11 cases involved non-Beijing residents who came to seek medical help in the city. The only case involving a Beijinger was bitten by a dog which had been brought to the city from outside. This means the vaccination of dogs has paid off, said Deng. Deng said that more than 118 000 people had received anti-rabies inoculations in Beijing after being bitten or scratched by dogs or cats by mid-Nov 2006, up 22 per cent on the previous year. Most of the people bitten were aged 17 and under, and 70 per cent of the people bitten were relatives of the dog owners. Deng said Beijing had also set up 45 anti-rabies clinics to provide 24 hour medical assistance to those bitten by dogs. Police in Beijing have implemented a "one-dog policy" -- one family is only allowed one dog -- and banned dangerous dogs or dogs taller than 35 cm. Deng attributed the sudden jump of deaths this year to the sharp increase of unvaccinated dogs nationwide and the large migration of people to Beijing.
(Promed 12/13/06)

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Japan: Largest norovirus outbreak since 1981
An epidemic of highly infectious gastroenteritis, which is due to norovirus infection, is spreading rapidly across the country, prompting the Health, Labor and Welfare Ministry to issue warnings in Tokyo and 44 prefectures. According to the National Institute of Infectious Diseases (NIID), this winter has already seen the most serious epidemic since NIID began monitoring the disease in 1981. On 15 Dec 2006, 4 elderly patients in Matsuyama died after being hospitalized earlier this month for suspected gastroenteritis. The average number of patients suffering from the disease across all districts (there are 570 districts nationwide) stood at a record 19.83 in Nov 2006. This year's epidemic has spread rapidly eastward after a warning was issued in the Kyushu region Oct 2006.

Schools and facilities for the elderly are particularly prone to outbreaks of the infection. For the physically infirm, the infection can prove fatal. Earlier this month, the Ministry instructed the metropolitan and prefectural governments to ensure adequate levels of sanitation at nursing care facilities. The infectivity of noroviruses is not destroyed by neutral detergent, and treatment with chloride bleach is advised. Norovirus is currently classified into genogroup I (GI), containing 15 genotypes, and genogroup II (GII), containing 18 genotypes. GII.4 viruses are now sweeping across Japan.

The first thing that comes to mind regarding the source of the norovirus infection is raw oysters or other raw shellfish with double shells. However, Shigeo Matsuno, a chief researcher at NIID, said, "Far more people get the virus from other infected people than from raw oysters". Norovirus multiplies prolifically only in the human intestinal tracts. Noroviruses is mostly concentrated in the waste of a person infected with it. About 10 000 to 100 million viral particles can be found per gram of feces. A tiny amount of feces can spread the virus because as few as 10 particles can cause an infection. Another problem is that infected people will continue to discharge the virus for a week, even though their symptoms disappear after a couple of days. In some cases, the virus remained in feces for more than 3 months.
(Promed 12/9/06, 12/17/06)

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Philippines (Agusan del Sur): Suspected amoebiasis outbreak in village
Authorities on 25 Nov 2006 ordered deployment of health personnel after an outbreak of suspected amoebiasis in remote tribal villages in Binicalan, San Luis town, Agusan del Sur killed 24 persons. Authorities joined efforts to contain the disease to prevent it from spreading to other villages. Reportedly at least 117 persons affected by the disease were still under medication. Authorities suspect that the outbreak was caused by contaminated water. The municipal government of San Luis declared an outbreak. The local government asked for more financial assistance as aid earlier extended to the victims was already depleted.

***It is very unusual for amoebas to cause waterborne outbreaks, and it is not known why infection with E. histolytica is suspected. A waterborne outbreak in an area with no access to clean water would much more likely be caused by bacteria like that of cholera, Salmonella or pathogenic E. coli.
(Promed 12/10/06)

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Russia (Buryatiya): Botulism death from salted fish
The first death from botulism in 2006 has been registered in Buryatiya. A 66 year old inhabitant of the Zaigraevskiy district of Buryatiya died after eating salted omul fish. Noncommercial production has been found in Ulan-Ude in the settlement of Vostichniy. 8 individuals have suffered from botulism in Buryatiya since the beginning of 2006. Over the last 5 years, more than 400 cases of botulism have been registered in Buryatiya, including 27 fatalities. All cases are connected to the use of salted or smoked omul, prepared in domestic conditions or obtained from unknown persons in places of non-authorized trade. The Omul or Arctic cisco is a salmon-like fish found only in Lake Baikal. It is a vital food fish for the Baikal region and, for the rural population, is often necessary for survival. Classically, botulism is a foodborne disease caused by the ingestion of preformed toxin, although there also exists wound botulism (in which C. botulinum spores germinate in a wound) and infant botulism (in which the spores germinate in the intestinal tract).
(Promed 12/15/06)

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Russia: 11 HFRS Deaths in Republic of Bashkortostan
11 fatal cases of hemorrhagic fever with renal syndrome (HFRS) have been recorded during 2006 in the Republic of Bashkortostan. In total, 2723 cases of HFRS have been recorded in 2006 in Bashkortostan, 40% more than last year. Half of all recorded cases of HFRS in Russia are recorded in Bashkortostan. The highest morbidities are recorded in the Blagoveshchenskiy, Myshinskiy, Tatyshlinskiy and Ufimskiy districts. The Republic of Bashkortostan is one of 3 regions in the world exhibiting high incidences of HFRS, the others being the Primorskiy region [Krai] of Russia and South Korea. The vector of the HFRS virus in these regions is the red field-vole.
(Promed 12/18/06)

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Americas
USA: Congress passes public health preparedness bill
Congress passed the bill Pandemic and All-Hazards Preparedness Act (S 3678) to establish a new biodefense research and development agency and tune up the nation's emergency preparedness programs. The legislation sets up an agency called the Biodefense Advanced Research and Development Authority (BARDA) within the Department of Health and Human Services (HHS). The bill reauthorizes the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. Besides setting up the BARDA, the legislation does the following, among other things:

• Clarifies that HHS, not the Department of Homeland Security, is the lead federal agency for health and medical response to public health emergencies
• Requires HHS to set general preparedness standards and pandemic influenza preparedness standards for states and to penalize states financially for failure to meet them
• Requires states to match federal preparedness grants at the 5% level initially and at 10% in later years
• Calls for establishing within 2 years a nationwide electronic information-sharing system to enhance detection of and response to disease outbreaks and other public health emergencies
• Requires HHS to study the possibility of providing local communities with additional medical surge capacity in an emergency
• Makes political subdivisions of states and groups of states eligible for federal assistance for public health preparedness
• Codifies and expands the Medical Reserve Corps, a community-based network of volunteers who provide assistance in public health emergencies

The BARDA aims to boost Project BioShield, which was set up to nurture the development of vaccines and other medical countermeasures against biological, chemical, radiological, and nuclear agents. Major pharmaceutical companies have shown little interest in pursuing BioShield projects. HHS Secretary Mike Leavitt said the HHS is taking steps to streamline countermeasure development by making the process more transparent and predictable. The new legislation will allow HHS to make milestone-based advance payments to companies, rather than withholding payment until the product is delivered. The new legislation authorizes spending of $1.07 billion for BARDA for fiscal years 2006 through 2008.
(CIDRAP 12/15/06 http://www.cidrap.umn.edu/ )

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USA: HHS seeks advice on allocating pandemic vaccine
The Department of Health and Human Services invited the public 14 Dec 2006 to submit comments on which groups should have priority for receiving pre-pandemic and pandemic vaccines. The deadline for commenting is Jan 18, 2007. A federal interagency task force will use the comments in developing guidance to help state and local governments, cities, tribes, territories, and the private sector decide how to allocate vaccine doses. The task force is also currently holding meetings to gather information from individual stakeholders. Pre-pandemic and pandemic vaccines are expected to be in short supply at least in the early stages of a pandemic, necessitating a plan for allocating the available doses, HHS noted. HHS is seeking responses to related questions, such as: What objectives, principles, criteria, assumptions, and rationales should be considered in allocating supplies? How can fairness, equity, efficiency, and related principles be reflected in the determinations? Who should determine when and how the vaccine is distributed and administered? For more information visit: http://www.pandemicflu.gov/vaccine/index.html#vprioritization
(CIDRAP 12/21/06 http://www.cidrap.umn.edu/ )

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Canada: BSE probe reaches dead end
Government investigators were unable to determine where Canada's latest cow infected with bovine spongiform encephalopathy (BSE) was born, making it impossible to tell how the animal was exposed to the disease or find other cows that might have been exposed. The case, first reported Aug 23, 2006, was in an Alberta beef cow estimated to be between 8 and 10 years old, the Canadian Food Inspection Agency (CFIA) said Dec 18, 2006. The cow was not born at the farm but was part of a herd assembled in 2001 and was purchased within the previous 5 years. The farm’s records didn’t conclusively document a transaction for the cow, which could have occurred before rules requiring identification of transported animals took effect.

Of 56 possible farm origins, investigators ruled out 43. Investigators couldn’t determine which of the 13 remaining farms the cow was from, so they were unable to trace its herd mates or locate potential sources of contaminated feed. CFIA said more than 90% of cows aged 8 to 10 years have already left the cattle population. The BSE agent was present in limited instances in northern Alberta from 1996 to 1998, which includes the estimated first year of the animal's life, CFIA said. The cow would have been born and exposed before Canada's 1997 ban on feeding cattle protein to cattle or during the early stages of implementation, when contaminated material could have remained on farms and at feed mills. 5 of Canada’s BSE cases have occurred in 2006, from a total of 8 since May 2003. In 3 of the 2006 cases, the cows were born after the 1997 feed ban became effective.
(CIDRAP 12/21/06 http://www.cidrap.umn.edu/ )

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USA: Lettuce suspected in Taco Bell E coli outbreak
A case-control investigation points to lettuce as the likeliest source of the Escherichia coli O157:H7 outbreak linked to Taco Bell restaurants. Taco Bell pulled green onions from all its restaurants recently after preliminary tests by an independent lab indicated contamination in a few samples. But CDC said those tests have not been confirmed. No contamination has been found in lettuce or other food items tested so far, but interviews with ill and well people who ate at the same Taco Bell restaurants, along with other information, point to lettuce. The investigation also has suggested cheddar cheese and ground beef as possible sources of E coli, but the evidence is strongest for lettuce, said Christopher Braden, a medical epidemiologist with CDC. But he cautioned that the conclusion is not final.

The case count in the outbreak has increased to 71, including 33 cases in New Jersey, 22 in New York, 13 in Pennsylvania, 2 in Delaware, and 1 in South Carolina. 53 people were hospitalized and 8 had hemolytic uremic syndrome, a potentially fatal form of kidney failure. The patients fell ill between Nov 20 and Dec 6. The peak of the outbreak occurred in the last week of Nov 2006. Baden said there have been no reports of new illnesses over the past few days. E coli isolates from at least 47 cases have been matched to the outbreak strain by PulseNet, an electronic network for sharing DNA fingerprinting data. No deaths have been linked to the outbreak. CDC and others are working to trace where the lettuce came from. Taco Bell said it changed produce suppliers for the affected region Dec 9, 2006 as a "strictly precautionary measure." The company also said all the cheese it uses is pasteurized and therefore is highly unlikely to be contaminated.

David Acheson of the Food and Drug Administration said there was no indication that the Taco Bell outbreak is connected with the E coli O157:H7 outbreak associated with Taco John's restaurants in Iowa and southern Minnesota. The Minnesota Department of Health confirmed that 5 E coli cases had the same DNA fingerprint as cases from the outbreak in Iowa. The bacteria found in the Minnesota and Iowa patients do not match those from the East Coast outbreak. The cause of the outbreak has reportedly been tied to lettuce served at Taco John’s. Minnesota has 27 cases associated with the outbreak, including 5 confirmed ones, 1 "presumptive positive," and 21 probable cases still under investigation. The Iowa outbreak has sickened at least 50 people. The Taco John's chain has 430 restaurants in 26 states.
(CIDRAP 12/8/06, 12/12/06, 12/13/06 http://www.cidrap.umn.edu/ ; Promed 12/14/06)

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Canada (British Columbia): Streptoccus pneumoniae serotype 5 outbreak
Vancouver, British Columbia (BC) is experiencing an outbreak of invasive pneumococcal disease (IPD) in an inner city neighborhood. To date in 2006, 376 cases of IPD have been reported in BC (incidence 8.7 cases/100 000 population); 137 of these are from Vancouver (incidence 22.9 cases/100 000 population). The majority of these cases are serotype 5. The Vancouver outbreak was identified by St. Paul's Hospital, which serves Vancouver's inner city. Normally, 0-5 cases of IPD are admitted per month to St. Paul's Hospital. An increase began Aug 2006; 46 cases of IPD were admitted Nov 2006 and admissions are continuing Dec 2006. Serotype data available to date indicate that 85 percent of cases from St. Paul's Hospital are serotype 5. To date, 6 BC serotype 5 IPD cases have been reported from areas outside of Vancouver. Of these, 4 had some connection with the affected Vancouver demographic; exposures for the other 2 are being assessed.

Serotype 5 Streptococcus pneumoniae was previously uncommon in BC (1 case per year in 2004 and 2005), but was responsible for recent outbreaks among similar high-risk populations in Alberta. Risk factors for cases include homelessness or living in rooming houses, use of illicit drugs, and underlying medical risk factors such HIV and hepatitis C infection. Many cases require ICU admission, and there have been at least 3 deaths. In response, Vancouver Coastal Health launched a pneumococcal immunization campaign in inner city Vancouver beginning early Nov 2006. Polysaccharide pneumococcal vaccine (23-valent, including serotype 5) is being given in rooming houses, shelters, food banks and other community locations. Other responses include: accelerated pneumo 23 polysaccharide immunization of indigent and drug-using people in regions adjacent to Vancouver; enhanced surveillance by serotype to track the distribution of disease within BC; stringent facility infection control practices. The present serotype 5 outbreak is considered not linked to strain replacement associated with conjugate pneumococcal immunization.
(Promed 12/9/06, 12/12/06)

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USA (Connecticut): Outbreak of swimmer’s itch
The state Department of Public Health is investigating the outbreak of a skin rash among about 230 New England college cross-country runners who participated in an Oct 2, 2006 meet at Harkness Memorial State Park in Waterford. Health officials think the rash is "swimmer's itch", which is caused by a water-borne parasite. They have not, however, made a definitive diagnosis, said Stephen Mansfield, director of environmental health at the Ledge Light Health District. The rash can cause oozing and scabs and can lead to secondary infections, but it is easily treatable and disappears without leaving permanent scars. The runners are thought to have contracted the rash after running through about 3 feet of standing water. About 380 runners participated in the race, and more than 60 percent contracted a rash. The usual course of treatment for mild cases is over-the-counter cortisone or Benadryl, and for more severe cases, prescription steroids. Mansfield said "swimmer's itch" can be prevented by drying off with a towel after swimming.

Swimmer's itch is found worldwide and is caused by cercariae of the avian schistosomes Trichobilharzia spp. and Gigantobilharzia spp. penetrating the skin of persons swimming or wading through infected water. Birds are the main hosts and the cercaria emerge from the intermediate molluscan hosts living in the water. Humans are the wrong host and as soon as the cercariae have penetrated the skin, they die, which causes an intense inflammation seen as a severely itching rash which lasts about one week and is always self-limiting.
(Promed 12/8/06)

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USA (New Jersey): Herpes gladiatorum outbreak in Jersey City
An unusual outbreak of the herpes 1 virus [herpes simplex virus 1, now renamed human herpesvirus 1] infection in 5 wrestlers has shut down St. Peter's Prep in Jersey City this week. Days after a 30 Nov 2006 wrestling scrimmage a wrestler had to be hospitalized after showing signs of the virus, and 4 others were later diagnosed with the disease. Human herpesvirus 1 usually produces sores around the face, head and neck, and is transmitted when skin contacts these sores. The infections are not the first instance of skin diseases breaking out among North Jersey high school wrestlers. St. Peter's Prep officials closed school, and workers disinfected areas of the school used by the wrestling team.
(Promed 12/20/06)

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USA (California): Norovirus outbreaks in hospitals
A gastrointestinal virus outbreak that has sickened dozens in a Belmont senior living center may have also struck at 3 medical facilities in San Mateo County, causing up to 45 other people to become ill, officials said 12 Dec 2006. However, doctors said they do not believe the highly contagious virus is any more common this winter than in years past, but rather is being reported more. 25 people (12 patients and 13 staff) have become sick from norovirus infection in San Mateo Medical Center's long term care wing. At a skilled nursing facility and an assisted living facility, another 21 people have fallen ill. There are 412 residents living between those 2 facilities. On 9 Dec 2006, officials quarantined Bonnie Brae Terrace, an independent living center in Belmont that houses 164 seniors. About 85 people became sick with norovirus there, including at least 3 staff. Noroviruses typically cause a 1-2-day bout of vomiting and diarrhea. However, patients in frail health can become gravely ill.

Officials have established similar procedures at all of the locations in which they believe outbreaks have occurred: isolating the patients and asking infected staff to stay home. At the Medical Center, new patients are not being admitted to the long-term care wing. Staff at the facilities are also being asked to wear gowns, gloves, and masks. The quarantine will be lifted 72 hours after the first day in which there are no new cases. Health officials have also notified emergency rooms countywide of the outbreak.
(Promed 12/15/06)

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USA/Caribbean: Cruise ship hit by second norovirus outbreak
The world's largest cruise ship was held in port 11 Dec 2006 for intensive cleaning after a second outbreak of gastrointestinal illness in 2 voyages affected 106 people. More than 380 passengers and crew members aboard Royal Caribbean's "Freedom of the Seas" were sickened by norovirus during a 26 Nov to 3 Dec 2006 Caribbean cruise. The ship was cleaned before its next cruise, but 97 passengers and 11 crew members became sick with the same illness last week. CDC recommended keeping the ship in port and will oversee repeated cleaning of "high-touch" surfaces, such as door handles. 2 additional doctors and 45 more cleaning staff will be aboard for its next voyage, now scheduled to begin 12 Dec 2006. The ship carried more than 3900 passengers on its latest cruise. Another ship, Princess Cruises' "Sun Princess," is also undergoing a thorough cleaning 10 Dec 2006 with 97 sick passengers. The ship carried about 1950 passengers.
(Promed 12/11/06)

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USA/South Korea: Oregon outbreak prompts multistate frozen oyster recall
An outbreak investigation by Oregon state and Marion County public health officials has led to a multistate recall of thousands of pounds of frozen oysters, the Oregon Department of Human Services Public Health Division said 11 Dec 2006. The recall, announced by US Food and Drug Administration, covers a large lot of frozen oysters on the half-shell imported from Korea. The investigation unfolded rapidly, starting 22 Nov 2006. Investigations indicated that people had been sickened by eating oysters, which were served raw on the half shell. Specimen testing confirmed the infection was by a norovirus. While there were no reports of serious illness or hospitalization, about 40 people were affected. The oysters were traced back to a chain of suppliers to their source in Central Fisheries Company, Korea. Other portions of the same lot were sold in Oregon, California, Colorado, Texas and Nevada, but no other illnesses have been reported. An FDA lab confirmed the presence of noroviruses in samples of frozen oysters from the same production lot, and the recall became official. Noroviruses are the most common cause of acute gastrointestinal illness in the US.
(Promed 12/13/06; CIDRAP 12/12/06 http://www.cidrap.umn.edu/ )

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USA: HHS cancels VaxGen anthrax vaccine contract
The US government canceled its $877.5 million contract with VaxGen Inc. for a new anthrax vaccine, after problems with the vaccine's stability caused the company to miss a deadline for starting a clinical trial. The contract was the first and largest award under Project BioShield. Because of concerns about the vaccine's stability, the Food and Drug Administration (FDA) refused to allow VaxGen to start a phase 2 trial Dec 18, 2006 as required by the Department of Health and Human Services (HHS), said Marc Wolfson, a spokesman for the HHS Office of Public Health Emergency Preparedness. The contract, awarded in 2004, called for VaxGen to produce 75 million doses of a new anthrax vaccine for the US civilian stockpile, or enough to immunize 25 million people. The hope was that the vaccine would improve on the anthrax vaccine used by the US military, called anthrax vaccine adsorbed (AVA), which was developed in the 1950s. Some military personnel have objected to AVA because of reported serious side effects. Wolfson said HHS is still committed to a next-generation anthrax vaccine. Meanwhile, HHS has been stockpiling the older anthrax vaccine. "Thus far we have just over 8 million doses that have been delivered to the stockpile," Wolfson said.
(CIDRAP 12/20/06 http://www.cidrap.umn.edu/ )

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Africa
Nigeria: Avian influenza H5N1 in poultry samples from 3 states
Government inspectors found H5N1 avian flu in poultry samples from 3 more states, according to a United Nations report. The states are Delta in the south, Kwara in the west, and Borno in the northeast. All Nigerian states have now had avian flu outbreaks. Within the last 2 months the disease has also resurfaced in Kano and Ogun states. In Feb 2006, Nigeria became the first African nation to report an avian flu outbreak. Public health officials fear that the disease will be difficult to contain in Africa, where many people have backyard poultry and veterinary services are weak. Recently, the World Bank put Africa at the top of the priority list for aid because countries there are economically weaker and less able to respond to avian flu threats.

John Lange heads the U.S government programs for foreign governments and international organizations to deal with avian influenza. He said, “It is very important having the federal government working closely with state governments and local government areas to fully implement their plans on avian influenza. And, as part of that strategy is the need to undertake surveillance activities, to send veterinarians and others to all the states of Nigeria to really verify the level of avian influenza outbreaks". Veterinary officials believe widespread disaffection with the compensation system put in place by the government is keeping farmers from reporting bird deaths, making tracking of the virus more difficult.
(CIDRAP 12/22/06 http://www.cidrap.umn.edu/ ; Promed 12/21/06)

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1. Updates
Avian/Pandemic influenza updates
- UN: http://influenza.un.org/. UN response to avian influenza and the pandemic threat; managed by UN System Influenza Coordination (UNSIC).
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Documents from the International Conference on Avian Influenza in Mali are available.
- OIE: http://www.oie.int/eng/en_index.htm. Link to “Vaccination: a tool for the control of avian influenza”; various updates under “Highlights”.
- US CDC: http://www.cdc.gov/flu/avian/index.htm.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. The public is also being asked to comment on vaccine prioritization.
- Health Canada: information on pandemic influenza: http://www.influenza.gc.ca/index_e.html. Check out the highlights from the Canadian Pandemic Influenza Plan for the Health Sector.
- CIDRAP: http://www.cidrap.umn.edu/. Frequently updated news and journal articles.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp. Global updates.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

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Seasonal Influenza
Seasonal influenza activity in APEC economies
During weeks 47–50, 2006, overall influenza activity worldwide remained low. Low influenza activity was reported in Canada (A and B), Chile (A and B), Hong Kong (H1, H3 and B), Japan (H1, H3 and B), Mexico (A and B), Russia (H1 and H3), South Korea (H3), and Thailand (H1, H3 and B).
(WHO http://www.who.int/csr/disease/influenza/update/en/ 12/21/06)

United States
During Oct 1--Dec 9, 2006, influenza activity remained low in the US overall but increased in southeastern states. During this period, there was testing for 27,474 specimens for influenza viruses and 884 (3.2%) were positive. Of these, 689 (77.9%) were influenza A viruses and 195 (22.1%) were influenza B viruses. A total of 171 (24.8%) of the 689 influenza A viruses were subtyped; 162 (94.7%) of these were influenza A (H1) viruses, and 9 (5.3%) were influenza A (H3) viruses. Influenza-positive tests were reported from 37 states in all 9 surveillance regions; 441 (49.9%) of the 884 positive tests were reported from Florida. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5550a5.htm
(MMWR December 22, 2006 / 55(50);1359-1362)

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Cholera, diarrhea & dysentery
Philippines (Camarines Sur)
3 cases of cholera have been lab-confirmed by the Bicol Medical Center (BMC), amid an outbreak of diarrhea that affected at least 70 persons in Barangay Hamorawon of Minalabac. Reportedly the first reported victim died at the BMC the day Supertyphoon Reming hit Camarines Sur.
(Promed 12/22/06)

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Dengue
Chinese Taipei
During the 49th epidemiological week (Dec 3 to 9, 2006), 108 dengue fever (DF) cases were reported in Taiwan, of which 55 were lab confirmed. As of Dec 9, there had been 2,255 reported cases of DF nation-wide this year, of those, 973 had been confirmed, including 17 dengue hemorrhagic fever (DHF) cases. So far in 2006, 3 DF deaths have been reported. The cumulative number of dengue confirmed cases has increased by 243.8 percent compared with the same period in 2005. Among this year’s cases, 102 were imported cases and 871 were domestic cases. The origins of imported cases: Vietnam (33); Indonesia (19); the Philippines (13); Thailand (12); Cambodia (9); Malaysia (5); Bangladesh (4); India (3); Myanmar (2); 1 each from El Salvador and Madagascar. Of the domestic cases, the main serotype (351 cases) of circulating DF virus is DEN-3, followed by 32 cases of DEN-2, and 1 case of DEN-1. The case distribution was mainly in southern Taiwan. There was 1 case each in Taipei County, Keelung City and Taoyuan County in the north, and in Taichung County in the central region.
(Promed 12/14/06)

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West Nile Virus
USA
Human Cases have been reported from:
State / Neuroinvasion* / *West Nile* fever** / Other*** / Total **** / Fatalities
Alabama / 7 / 0 / 0 / 7 / 0
Arizona / 48 / 58 / 42 / 148 / 6
Arkansas / 23 / 5 / 0 / 28 / 3
California / 79 / 182 / 11 / 272 / 6
Colorado / 63 / 269 / 0 / 332 / 7
Connecticut / 7 / 2 / 0 / 9 / 1
District of Columbia / 0 / 1 / 0 / 1 / 0
Florida / 3 / 0 / 0 / 3 / 0
Georgia / 2 / 5 / 1 / 8 / 1
Idaho / 111 / 752 / 26 / 889 / 14
Illinois / 116 / 70 / 24 / 210 / 9
Indiana / 26 / 7 / 42 / 75 / 3
Iowa / 21 / 13 / 2 / 36 / 0
Kansas / 17 / 13 / 0 / 30 / 4
Kentucky / 5 / 1 / 0 / 6 / 1
Louisiana / 89 / 83 / 0 / 172 / 8
Maryland / 7 / 1 / 2 / 10 / 0
Massachusetts / 2 / 1 / 0 / 3 / 0
Michigan / 47 / 2 / 2 / 51 / 6
Minnesota / 30 / 35 / 0 / 65 / 3
Mississippi / 87 / 93 / 0 / 180 / 13
Missouri / 47 / 12 / 1 / 60 / 3
Montana / 12 / 21 / 1 / 34 / 0
Nebraska / 43 / 212 / 0 / 255 / 1
Nevada / 34 / 75 / 14 / 123 / 1
New Jersey / 2 / 2 / 1 / 5 / 0
New Mexico / 3 / 5 / 0 / 8 / 0
New York / 16 / 7 / 0 / 23 / 4
North Dakota / 20 / 117 / 0 / 137 / 1
Ohio / 36 / 11 / 0 / 47 / 4
Oklahoma / 27 / 18 / 2 / 47 / 5
Oregon / 7 / 50 / 12 / 69 / 0
Pennsylvania / 8 / 1 / 0 / 9 / 2
South Carolina / 1 / 0 / 0 / 1 / 0
South Dakota / 38 / 75 / 0 / 113 / 3
Tennessee / 15 / 2 / 0 / 17 / 1
Texas / 214 / 105 / 0 / 319 / 28
Utah / 56 / 101 / 0 / 157 / 5
Virginia / 0 / 0 / 4 / 4 / 0
Washington / 0 / 3 / 0 / 3 / 0
West Virginia / 1 / 0 / 0 / 1 / 0
Wisconsin / 11 / 9 / 0 / 20 / 1
Wyoming / 15 / 40 / 10 / 65 / 2
TOTALS / 1396 / 2459 / 197 / 4052 / 146

* Cases with neurologic manifestations (such as WN encephalitis, meningitis, and myelitis).
** Cases with no evidence of neuroinvasion.
*** Cases for which insufficient clinical information was provided.
**** Total number of human cases of WNV illness reported by state and local health departments.
(Promed 12/14/06)

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2. Articles
CDC EID Journal, Volume 13, Number 1—Jan 2007
CDC Emerging Infectious Diseases Journal, Volume 13, Number 1—Jan 2007 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. Article of interest: “Interaction Between Humans and Poultry, Rural Cambodia” by Sowath Ly et al.

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Study: 1918-like pandemic now would kill 62 million
Scientists who analyzed mortality records from the 1918 influenza pandemic estimate that a similarly severe pandemic today would kill about 62 million people worldwide, the vast majority of them in the developing world. Christopher Murray et al. used data from areas that have reasonably complete statistics from 1915-1923. They compared influenza mortality with per capita income and latitude in 27 countries, 24 US sates, and 9 Indian provinces. The researchers used the data to estimate excess mortality for a hypothetical pandemic in 2004, the most recent year for which per capita gross domestic product data are available.

For the 1918 pandemic, the researchers found a 31-fold difference between areas that had the lowest and highest excess mortality rates. The authors concluded that per capita income explained about half of the variance in pandemic mortality in the 1918 event. They determined that a 10% increase in income was associated with a 9-10% decrease in mortality. Latitude did not significantly affect mortality rates. The study yielded estimates for a 2004 event ranging from 51 million to 81 million deaths worldwide (median 62 million). 96% of the deaths were in developing countries. Southeast Asia accounted for 30%; Sub-Saharan Africa, 29%; East Asia, 19%, and the Middle East, 10%. Latin America, Eastern Europe/Central Asia, and the remaining developed countries each accounted for 4%. "Most of the strong relation that we observed between per-head income and pandemic mortality must be mediated through factors such as nutritional status, comorbidity, community characteristics associated with poverty, and the effect of supportive care," the authors write. The authors write that a severe pandemic today might be blunted by improvements in medical care among people in high- and middle-income groups. A prudent approach would be to develop practical and affordable strategies for low-income countries, it says.

However, Michael T. Osterholm, director of CIDRAP, asserted that a pandemic that disrupted industrial production and international transportation would acutely affect developed countries, because their economies depend on just-in-time supply shipments, their healthcare systems have almost no excess capacity, and about 80% of pharmaceutical products are produced offshore. In a Lancet editorial that accompanies the Murray study, Neil Ferguson at Imperial College in London, says the study's projections on mortality may be optimistic. Experts don't know what effect an influenza pandemic would have on the 35 million people in the world who are infected with HIV, Ferguson writes.

Murray CJL et al. Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis. Lancet 2006;368:2211-8;
Ferguson N. Poverty, death, and a future influenza pandemic. (Commentary) Lancet 2006;368:2187-8
(CIDRAP 12/22/06 http://www.cidrap.umn.edu/ )

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Assessing the role of basic control measures, antivirals and vaccine in curtailing pandemic influenza: scenarios for the US, UK and the Netherlands
M. Nuño, G. Chowell, A.B. Gumel. Journal of The Royal Society Interface, 13 Dec 2006. http://dx.doi.org/10.1098/rsif.2006.0186.
Abstract: “An increasing number of avian flu cases in humans, arising primarily from direct contact with poultry, in several regions of the world have prompted the urgency to develop pandemic preparedness plans worldwide. Leading recommendations in these plans include basic public health control measures for minimizing transmission in hospitals and communities, the use of antiviral drugs and vaccination. This paper presents a mathematical model for the evaluation of the pandemic flu preparedness plans of the United States (US), the United Kingdom (UK) and the Netherlands. The model is used to assess single and combined interventions. Using data from the US, we show that hospital and community transmission control measures alone can be highly effective in reducing the impact of a potential flu pandemic. We further show that while the use of antivirals alone could lead to very significant reductions in the burden of a pandemic, the combination of transmission control measures, antivirals and vaccine gives the most ‘optimal’ result. However, implementing such an optimal strategy at the onset of a pandemic may not be realistic. Thus, it is important to consider other plausible alternatives. An optimal preparedness plan is largely dependent on the availability of resources; hence, it is country-specific. We show that countries with limited antiviral stockpiles should emphasize their use therapeutically (rather than prophylactically). However, countries with large antiviral stockpiles can achieve greater reductions in disease burden by implementing them both prophylactically and therapeutically. This study promotes alternative strategies that may be feasible and attainable for the US, UK and the Netherlands. It emphasizes the role of hospital and community transmission control measures in addition to the timely administration of antiviral treatment in reducing the burden of a flu pandemic. The latter is consistent with the preparedness plans of the UK and the Netherlands. Our results indicate that for low efficacy and coverage levels of antivirals and vaccine, the use of a vaccine leads to the greatest reduction in morbidity and mortality compared with the singular use of antivirals. However, as these efficacy and coverage levels are increased, the use of antivirals is more effective.”

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The Prospect of Using Alternative Medical Care Facilities in an Influenza Pandemic
Clarence Lam et al. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. Dec 2006, Vol. 4, No. 4 : 384 -390.
http://www.liebertonline.com/doi/abs/10.1089/bsp.2006.4.384@
Abstract: gAlternative care facilities (ACFs) have been widely proposed in state, local, and national pandemic preparedness plans as a way to address the expected shortage of available medical facilities during an influenza pandemic. These plans describe many types of ACFs, but their function and roles are unclear and need to be carefully considered because of the limited resources available and the reduced treatment options likely to be provided in a pandemic. Federal and state pandemic plans and the medical literature were reviewed, and models for ACFs being considered were defined and categorized. Applicability of these models to an influenza pandemic was analyzed, and recommendations are offered for future ACF use. ACFs may be best suited to function as primary triage sites, providing limited supportive care, offering alternative isolation locations to influenza patients, and serving as recovery clinics to assist in expediting the discharge of patients from hospitals.h

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Designing a biocontainment unit to care for patients with serious communicable diseases: a consensus statement
Philip W. Smith, et al. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. Dec 2006, Vol. 4, No. 4 : 351 -365.
http://www.liebertonline.com/doi/abs/10.1089/bsp.2006.4.351
Abstract: “In spite of great advances in medicine, serious communicable diseases are a significant threat. Hospitals must be prepared to deal with patients who are infected with pathogens introduced by a bioterrorist act (e.g., smallpox), by a global emerging infectious disease (e.g., avian influenza, viral hemorrhagic fevers), or by a laboratory accident. One approach to hazardous infectious diseases in the hospital setting is a biocontainment patient care unit (BPCU). This article represents the consensus recommendations from a conference of civilian and military professionals involved in the various aspects of BPCUs. The role of these units in overall U.S. preparedness efforts is discussed. Technical issues, including medical care issues (e.g., diagnostic services, unit access); infection control issues (e.g., disinfection, personal protective equipment); facility design, structure, and construction features; and psychosocial and ethical issues, are summarized and addressed in detail in an appendix. The consensus recommendations are presented to standardize the planning, design, construction, and operation of BPCUs as one element of the U.S. preparedness effort.”

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What Hospitals Should Do to Prepare for an Influenza Pandemic
Eric Toner, Richard Waldhorn. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. Dec 2006, Vol. 4, No. 4 : 397 - 402.
http://www.liebertonline.com/doi/abs/10.1089/bsp.2006.4.397
This article offers recommendations on what hospitals should do to prepare for an influenza pandemic and proposes specific actions and priorities for the purpose of making the discussion of hospital pandemic preparedness issues more operationally useful.

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CDC rates hospital bioterrorism preparedness
Soon after the terrorist attacks of 2001, Congress approved emergency funds to teach hospital staffs how to recognize and respond to bioterrorism attacks, and CDC released its first report on those efforts. The information in the report came from 2003 and 2004 supplements to the National Hospital Ambulatory Medical Care Surveys. The survey assessed terrorism preparedness training and identify training differences related to hospital characteristics. Of 874 hospitals included in the survey, 739 (84.6%) responded. Teaching hospitals were better trained for handling bioterrorism than other types of hospitals. Hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations were well ahead of other hospitals in training nurses, staff physicians, laboratory employees, nurse practitioners, physicians, and residents about terrorism response. However, only 9.5% of the hospitals in the survey were not accredited.

88 percent of the hospitals said their nurses had been trained in recognizing and treating patients exposed to at least 1 of 7 diseases potentially associated with bioterrorism (smallpox, anthrax, plague, botulism, tularemia, viral encephalitis, and hemorrhagic fevers) or to chemical or radiological attacks. In hospitals that had 24-hour emergency departments or outpatient clinics, 86% of clinical staff members were trained to recognize and treat smallpox, and 82% were trained to recognize and treat anthrax infections. Staff physicians were far more likely than residents to have received training (75.1% versus 39.3%). The survey showed that more than three quarters of hospitals had taught their key personnel how to implement a "Hospital Emergency Incident Command" system or similar program. But the authors voiced concern that a quarter of the nation's hospitals are unprepared for a "chaotic event."

Niska RW, Curt CW. Training for terrorism-related conditions in hospitals: United States, 2003-04. Advance data from vital and health statistics, no 380. Hyattsville, Md., National Center for Health Statistics, 2006.
http://www.cdc.gov/nchs/data/ad/ad380.pdf
(CIDRAP 12/11/06 http://www.cidrap.umn.edu/ )

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The effect of travel restrictions on the spread of a moderately contagious disease
Camitz M, Liljeros F. BMC Med. 2006 Dec 14;4(1):32 [Epub ahead of print].
Abstract: “BACKGROUND: Much research in epidemiology has been focused on evaluating conventional methods of control strategies in the event of an epidemic or pandemic. Travel restrictions is often suggested as an efficient way to reduce the spread of a contagious disease that threatens public health, but few papers study the effects in depth. In this study we investigate what effect different levels of travel restrictions may have on the speed and geographical spread of an outbreak of a disease similar to SARS. METHODS: We use a stochastic simulation model incorporating survey data of travel patterns between municipalities in Sweden collected over three years. We test scenarios of travel restrictions where travel above 50 km and 20 km is banned, taking into account compliance of different levels. RESULTS: We find that a ban on journeys longer than 50 km drastically reduces the speed and the geographical spread of outbreaks, even when compliance is less than 100%. The result is found to be robust for different rates of inter-municipality transmission intensities. CONCLUSIONS: The study supports travel restrictions as an effective way to mitigate the effect of a future outbreak.”
http://www.biomedcentral.com/1741-7015/4/32/abstract

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Public Health Surveillance for Smallpox--United States, 2003—2005
(References removed)
“. . .In 2005, CSTE conducted a cross-sectional survey in the United States and its territories to assess key components for surveillance of suspected smallpox disease, including legal reporting requirements, laboratory testing, and training and education (e.g., oral presentations and guides). This report summarizes the results of that survey, which indicated that 100% had the capacity to receive and investigate reports, 94% of states had legal requirements to report suspected smallpox disease, 70% had mandatory laboratory reporting of results indicative of smallpox disease, and 68% were providing ongoing training and education of health-care providers and public health staff.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5549a2.htm
(MMWR December 15, 2006 / 55(49);1325-1327)

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Measles --- United States, 2005
(References removed)
“Measles is a highly infectious, acute viral illness that can be complicated by severe pneumonia, diarrhea, and encephalitis and can result in death. In the prevaccine era, approximately 500,000 cases of measles occurred annually in the United States. During 2005, local and state health departments reported to CDC 66 confirmed cases of measles (incidence rate: less than one case per 1 million population), 34 of which were from a single outbreak in Indiana associated with infection in a traveler returning to the United States. This report describes the epidemiology of U.S. measles cases in 2005 and documents the absence of endemic measles and the continued risk for imported measles infections that can result in transmission within the United States. The findings underscore the need to maintain the highest possible measles vaccination coverage in the United States and to adhere to recommendations regarding measles vaccination. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5550a2.htm
(MMWR December 22, 2006 / 55(50);1348-1351)

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Clinical presentation and pre-mortem diagnosis of vCJD associated with blood transfusion: a case report
Stephen J Wroe et al. Lancet. 2006 Dec 9;368(9552):2061-7.
Abstract: “BACKGROUND: Concerns have been raised that variant Creutzfeldt-Jakob disease (vCJD) might be transmissible by blood transfusion. Two cases of prion infection in a group of known recipients of transfusion from donors who subsequently developed vCJD were identified post-mortem and reported in 2004. Another patient from this at-risk group developed neurological signs and was referred to the National Prion Clinic. METHODS: The patient was admitted for investigation and details of blood transfusion history were obtained from the National Blood Service and Health Protection Agency; after diagnosis of vCJD, the patient was enrolled into the MRC PRION-1 trial. When the patient died, brain and tonsil tissue were obtained at autopsy and assessed for the presence of disease-related PrP by immunoblotting and immunohistochemistry. FINDINGS: A clinical diagnosis of probable vCJD was made; tonsil biopsy was not done. The patient received experimental therapy with quinacrine, but deteriorated and died after a clinical course typical of vCJD. Autopsy confirmed the diagnosis and showed prion infection of the tonsils. INTERPRETATION: This case of transfusion-associated vCJD infection, identified ante-mortem, is the third instance from a group of 23 known recipients who survived at least 5 years after receiving a transfusion from donors who subsequently developed vCJD. The risk to the remaining recipients of such transfusions is probably high, and these patients should be offered specialist follow-up and investigation. Tonsil biopsy will allow early and pre-symptomatic diagnosis in other iatrogenically exposed individuals at high risk, as in those with primary infection with bovine spongiform encephalopathy prions.” http://www.thelancet.com/journals/lancet/article/PIIS0140673606698358/abstract

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3. Notifications
Pandemic influenza implementation plan
HHS document released Dec 18: http://www.hhs.gov/pandemicflu/implementationplan/. Also see: “National strategy for pandemic influenza implementation plan: summary of progress”, HHS report issued Dec 18, 2006: http://pandemicflu.gov/plan/federal/stratergyimplementationplan.html

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CDC Influenza Pandemic Operation Plan (OPLAN)
The CDC Influenza Pandemic OPLAN is an INTERNAL document that provides guidance for CDC operations. This plan is made available to outside agencies for the sole purpose of providing an understanding of the internal processes within CDC. This document in no way prescribes guidance for any entity other than CDC agencies.
(CDC 12/20/06 shttp://www.cdc.gov/flu/pandemic/cdcplan.htm )

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WHO’s Global Health Atlas
In a single electronic platform, the WHO’s Communicable Disease Global Atlas is bringing together for analysis and comparison standardized data for infectious diseases at country, regional, and global levels. The analysis of data is further supported through information on demography, socioeconomic conditions, and environmental factors. Over the next year, the system aims to provide a single point of access to data, reports and documents on the major diseases of poverty including malaria, HIV/AIDS, tuberculosis, the diseases on their way towards eradication and elimination and epidemic prone and emerging infections. The database will be updated on an ongoing basis and in addition to epidemiological information, the system aims to provide information on essential support services such as the network of communicable diseases collaborating centres, the activities of the Global Outbreak Alert and Response Network among others.
(WHO http://globalatlas.who.int/ )

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4. To Receive EINet Newsbriefs
APEC EInet email list
The APEC EINet email list was established to enhance collaboration among health, commerce, and policy professionals concerned with emerging infections in APEC member economies. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe, go to: http://depts.washington.edu/einet/?a=subscribe or contact apecein@u.washington.edu. Further information about APEC EINet is available at http://depts.washington.edu/einet/.

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 apecein@u.washington.edu