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Vol. X, No. 1 ~ EINet News Briefs ~ Jan 05, 2007


*****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)
- Viet Nam (Ca Mau): Family test negative for avian influenza
- Viet Nam: Anti-avian influenza campaigns; illegal trade continues
- Japan: Norovirus outbreak update
- Indonesia (Jakarta): Undiagnosed deaths characterized by fever
- China (Shanxi): Undiagnosed respiratory illness in middle school
- Hong Kong: Cases of undiagnosed respiratory disease
- Russia (Voronezh): Outbreak of hemorrhagic fever with renal syndrome
- Australia (Northern Territory): Fatal case of Melioidosis
- USA: Feds detail progress on pandemic preparedness
- USA: NIH starts clinical trial of H5N1 DNA vaccine
- USA (Rhode Island): Outbreak of Mycoplasma pneumoniae in children
- USA (Massachusetts): Suspected pertussis in hospital employees
- Canada: Report on the investigation of the eighth case of BSE in Canada
- Canada (British Columbia)/Denmark: Case of Cryptococcus gattii in tourist
- Canada: E coli vaccine for cattle gets preliminary approval

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

2. Articles
- Molecular Anatomy of Influenza Virus Detailed
- Report may spur quest for more versatile flu vaccines
- Epidemiology. Influenza escapes immunity along neutral networks.
- Epochal Evolution Shapes the Phylodynamics of Interpandemic Influenza A (H3N2) in Humans
- Human Influenza A (H5N1): A Brief Review and Recommendations for Travelers
- Accuracy and Interpretation of Rapid Influenza Tests in Children
- Protective measures and human antibody response during an avian influenza H7N3 outbreak in poultry in British Columbia, Canada
- The Waiting Time for Inter-Economy Spread of Pandemic Influenza
- Market Wide Exercise 2006 Report
- Modelling scenarios of diffusion and control of pandemic influenza, Italy
- Production of cattle lacking prion protein
- Sporadic Campylobacter Infection in Infants: A Population-Based Surveillance Case-Control Study
- Environmental stress and antibiotic resistance in food-related pathogens
- Severe Acute Respiratory Syndrome in Children
- Surveillance for Waterborne Disease and Outbreaks Associated with Recreational Water--United States, 2003-2004
- Surveillance for Waterborne Disease and Outbreaks Associated with Drinking Water and Water not Intended for Drinking--United States, 2003-2004
- Latent Tuberculosis Infection Among Sailors and Civilians Aboard U.S.S. Ronald Reagan--United States, January-July 2006

3. Notifications
- Recommended Immunization Schedules for Persons Aged 0–18 Years--United States, 2007
- Tenth Annual Conference on Vaccine Research
- Cambridge Healthtech Institute's 11th Annual "Transmissible Spongiform Encephalopathies"
- 2007 International Conference on Biocontainment Facilities BSL-2, BSL-3, BSL-3Ag, ABSL-3, BSL-4
- Ninth International Symposium on Protection against Chemical and Biological Warfare Agents

4. APEC EINet activities
- 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 / 18 (10)
Indonesia / 55 (45)
Iraq / 3 (2)
Thailand / 3 (3)
Turkey / 12 (4)
Total / 114 (79)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 261 (157).
(WHO 12/27/06 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 12/27/06)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 1/3/07): http://gamapserver.who.int/mapLibrary/

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Asia
Viet Nam (Ca Mau): Family test negative for avian influenza
Health officials declared 2 Jan 2007 that the 4 Vietnamese family members tested negative for bird flu. They were admitted to the hospital because they were suspected to have bird flu after eating sick chickens. The affected family members from Ca Mau province were a 36-year-old mother and her 3 children between 3 and 13 years old. They were instead reportedly suffering from pneumonia.
(Promed 12/31/06, 1/2/07, 1/3/07)

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Viet Nam: Anti-avian influenza campaigns; illegal trade continues
Vietnam has banned transport of poultry and set up road checkpoints in parts of Mekong Delta in hopes of controlling bird flu among flocks. Bird flu outbreaks have hit Ca Mau, Bac Lieu and Hau Giang provinces, killing and prompting the culling of tens of thousands of poultry. Viet Nam launched a national campaign 30 Dec 2006. The month-long campaign aims to raise public awareness of bird flu, disinfect poultry farms, markets and slaughter houses, and vaccinate poultry flocks. Provincial and city administrations are required to closely monitor the transport and trading of poultry and poultry products and seize and destroy poultry and poultry products of unclear origin. The Animal Health Department said it has planned to import an additional 25 million doses of H5N1 vaccines and 4.5 million doses of H5N9 vaccines from China for domestic waterfowl. The agriculture ministry has recently decided to inoculate white-winged ducks (ngan) with H5N1 vaccines. Currently, only ducks and chickens receive the vaccines against avian flu.

However, recently authorities reported that an alarming 4 tons of illegal Chinese fowl arrived in Viet Nam since Dec 2006 in a northern province bordering China. Lang Son provincial authorities also said they confiscated nearly 2 tons of fowl transported from China on 3 occasions 2 Jan 2007 alone. In Quang Ninh province, local authorities confiscated 1.2 tons. 1kg of chicken is sold for only 5-6 Chinese yuan [USD 0.65] in China, while the price is 5 times higher in Viet Nam. On average, it is estimated that several tons of Chinese chicken are smuggled into Lang Son daily.
(Promed 12/29/06, 12/30/06, 12/31/06, 1/3/07)

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Japan: Norovirus outbreak update
Japan has been hit by an outbreak of a common stomach virus, prompting the prime minister to call for steps to deal with infections that have reached a record high this winter. Over 65 600 people throughout the country are thought to have been infected by norovirus between 27 Nov and 3 Dec 2006, the highest since data was first collected in 1981. 4 people living at nursing homes died due to norovirus infection; all but 2 of Japan's 47 prefectures have issued warnings of a potential epidemic. At least 69 primary, middle and high schools in 17 prefectures have temporarily suspended school or classes since Nov 2006 due to norovirus infections. Shares in companies that make products to protect against norovirus have shot up on the Tokyo stock exchange, with hand wash and gargle maker Meiji Seika Kaisha Ltd jumping 11.5 per cent in the past week. Clinical reagents maker Eiken Chemical Co shares have risen 14.8 per cent in a week.

The disease caused by norovirus is generally known as food poisoning that [may] occur after eating bivalve shellfish. However, many cases in recent years resulted from people failing to wash their hands sufficiently after touching patients' vomit or other excretions containing a large amount of the virus, or failing to thoroughly clean rooms where patients were treated. This season's epidemic comes mostly from human-to-human infections and can best be explained by a possible outbreak of a new virus strain by, for example, mutation, said Shigeo Matsuno, a senior researcher at the National Institute of Infectious Diseases.

Experts at the Health, Labor and Welfare Ministry have offered advice on preventive measures and how to clean up vomit from sufferers of the virus. The most effective preventative measure is to wash hands carefully. Antiseptic solution, ethanol and soap available in ordinary stores cannot kill noroviruses, but it is thought that washing hands well is a good way to stop the virus from becoming attached to the fingers. The ministry also said shellfish including oysters should be thoroughly cooked to destroy the virus.
(Promed 12/23/06)

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Indonesia (Jakarta): Undiagnosed deaths characterized by fever
Indonesian officials are investigating the deaths of 22 people in Jakarta over a 2-month period from an unidentified illness characterized by high fever. Samples from the patients--all of whom died days after being admitted to St. Carolus hospital--have been sent to the U.S.Naval Medical Research Unit 2 in Jakarta, but the cause of death remains a mystery. Samples were also sent to the US CDC. Tests there were also reportedly inconclusive. Most of the victims were over 40 and from middle-class residential areas near St. Carolus in central Jakarta. The hospital started reporting the deaths Oct 2006 and the last death was reported 27 Nov 2006. Surveillance teams have visited the homes of the patients but found no additional cases, and investigators also concluded that they did not get their infections from fellow patients at the hospital.
(Promed 12/28/06)

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China (Shanxi): Undiagnosed respiratory illness in middle school
Reportedly, 60 students and teachers developed fever 28 Dec 2006 in a middle school in Shanxi's Wenxi County. The final diagnosis has yet to be made. For now, hospitals are providing symptomatic treatment to febrile patients. By 29 Dec 2006, the number of febrile students at Chengguan Middle School had increased by 14, bringing the total to 74. Of these, 12 have been treated and released from hospital. 57 remain hospitalized, and 5 are undergoing medical observation at home. Classes were suspended for more than 1600 students in 20 classes from 28 Dec 2006, and they went home for observation. The municipal and county level Centers for Disease Control have taken swab and blood samples from some patients and sent them for lab analysis--possibility of food poisoning has been ruled out. Preliminary diagnosis is upper respiratory tract infection caused by mycoplasma or chlamydia.
(Promed 1/1/07)

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Hong Kong: Cases of undiagnosed respiratory disease
The Centre for Health Protection is investigating the death of 2 local pig farmers who succumbed to a pneumonic illness in the past 6 months. Laboratory tests have not identified a specific bacteria or virus. A 44-year-old Sheung Shui man came down with fever and cough 7 Dec 2006. He was admitted to hospital 11 Dec 2006 and died of a pneumonia-like illness 13 Dec 2006. He visited Dongguan about 20 days before the onset of symptoms, but an association between this travel and his illness cannot be established yet. Another case involved a 62-year-old Tsuen Wan man who developed a similar illness and was admitted to Yan Chai Hospital late May 2006. He died 4 Jun 2006.

5 family members of the 44-year-old patient and a worker at his farm have no symptoms. Family members of the 62-year-old patient will be tested. The Centre has been liaising with Mainland health authorities, and the Agriculture, Fisheries & Conservation Department has reminded local farmers to report any pig disease outbreak and abnormal pig death. So far there has been no unusual increase in the mortality rate of pigs in local farms. There have also been no unusual pig diseases found. Also, a 61-year-old male Sheung Shui Slaughterhouse worker hospitalised 30 Dec 2006 for pneumonia has been discharged. Preliminary tests found pneumococcus and parainfluenza virus, common respiratory pathogens that can cause pneumonia. Additionally, a meat delivery vehicle supervisor from the slaughterhouse has been admitted to hospital. The 69-year-old man went to Zhuhai and Panyu and Guangzhou Dec 2006, and came down with cough. He is now in stable condition. His family contacts are asymptomatic. A retrospective review from May to Dec 2006 is being conducted to identify pig farmers who had been hospitalised with pneumonia.
(Promed 12/29/06, 1/4/07)

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Russia (Voronezh): Outbreak of hemorrhagic fever with renal syndrome
The Voronezh region [Oblast] in central Russia is once again seeing an epidemic of hemorrhagic fever, this time affecting the kidneys [i.e. haemorrhagic fever with renal syndrome or HFRS)]. 50 people in the region have contracted the illness, as of 27 Dec 2006. The disease has been recorded in all the region's 5 areas as well as in the City of Voronezh. A large increase in the population of rodents, 10 times more than previous years, preceded this latest outbreak. The increase in rodents is connected to unseasonably warm weather in the region this winter leading to an abundant food supply. HFRS is endemic in Russia and is not rare in the Voronezh region. The Voronezh Oblast is predominantly rural with abundant tracts of forest which provide favorable habitats for the principal rodent reservoir host -- the red vole (Clethrionomys glareolus) -- responsible for transmission of HFRS to the human population. For a detailed description of HFRS see: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/hfrs.htm.
(Promed 12/29/06)

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Australia (Northern Territory): Fatal case of Melioidosis
There could be a fresh outbreak of a potentially deadly disease in Top End (Northern Territory), the Health Department said 28 Dec 2006. 1 man has died from melioidosis in 2006 and there have been 27 further cases. Centre for Disease Control director Vicki Krause warned there could be more victims following recent rains. The bacterium lives deeper in the soil during the dry season but is brought to the surface after heavy rainfalls. "Small cuts and sores on the hands and feet provide a route of infection, but are largely avoidable if simple protective measures are followed," Dr Krause said. Waterproof gloves and shoes or boots are recommended during prolonged contact with soil. "The bacteria can become airborne, so people with risk factors are advised to stay indoors during periods of heavy wind and rain in the Top End," Dr Krause said.

Melioidosis can be fatal and requires "prompt and aggressive'' antibiotic treatment. The disease can cause skin ulcers or sores that fail to heal, abscesses, unexplained fevers, weight loss, fatigue, cough, shortness of breath, abdominal pain, urinary symptoms and, occasionally, neurological problems. People most at risk of developing melioidosis have an underlying condition that impairs the immune system. Infection due to Burkholderia pseudomallei (melioidosis) is endemic in focal areas of Southeast Asia and northern Australia. B. pseudomallei is deemed to be a category B biowarfare agent.
(Promed 1/2/07)

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Americas
USA: Feds detail progress on pandemic preparedness
In a recent update on pandemic influenza preparedness planning, the US government reported meeting more than 90% of a list of objectives it set for itself about 6 months ago. The report charts progress on a wide range of preparedness measures, from shoring up laboratory capabilities to planning for distribution of critical medical supplies and preparing checklists for various sectors of the economy. In May 2006, federal officials released the National Strategy for Pandemic Influenza: Implementation Plan, describing how the government will cope with an influenza pandemic. The status report, released Dec 18, 2006, covers 104 tasks that were to be completed within 6 months of release of the implementation plan. The tasks fall into 6 categories: international efforts, transportation and borders, protecting human health, protecting animal health, law enforcement and public safety, and institutions. Of the 104 tasks addressed, 96 have been completed, and 8 are in progress, the report says.

The federal government has informed 2 million US citizens living abroad about the latest developments in avian and pandemic flu, mainly through the US government's pandemic flu site. Officials have developed a policy for contributing to international medication stockpiles and deploying antiviral medications. The US Agency for International Development (AID) and the US Department of Agriculture (USDA) developed a model compensation program for farmers affected by animal influenza outbreaks, which will be launched early 2007 with the World Bank, UN Food and Agriculture Organization (FAO), and the Indonesian government. The US has provided $400,000 to WHO to host workshops on proper transport of influenza samples to reference laboratories. The US State Department, along with the Department of Commerce and CDC, drafted a pandemic preparedness checklist for US companies that have overseas operations.

HHS and the departments of Homeland security (DHS), Transportation, and Labor (DOL) developed a pandemic planning checklist for the travel industry and workforce protection guidelines for airline crew members and others who may come in contact with people and cargo from pandemic-affected areas. HHS, USDA, and other departments reviewed the current protocol and added several groups to the notification chain. Recommendations for air, land, and maritime entries and exits, including response plans and screening, were developed. Federal security forces have been briefed about protecting shipments of critical supplies and facilities and are developing contingency plans to carry out the security responsibilities.

HHS, with the Department of Defense (DOD), the Veterans Administration, and medical specialty societies, developed a guide to help community planners address mass-casualty care with scarce resources (see Web site of the Agency for Healthcare Research and Quality). HHS and others trained a range of influential community spokespeople who will be available to speak on the pandemic crisis. Risk communication strategies are also planned for local public health, community, and tribal leaders. HHS in Jun 2006 issued a request for proposals to retrofit their facilities to produce pandemic vaccines in an emergency.

HHS and other government agencies have developed a plan to distribute critical materials. The plan was tested Oct 2006 and will undergo further trials through Mar 2007. Complete viral genome sequences can now be obtained from a clinical sample in 3 days, and HHS can publish sequence data on a human H5N1 isolate within 1 week. HHS can now distribute standardized influenza reagents for use in tests and research within 3 business days of a request. HHS, along with partners, has supplied all members of the US Laboratory Response Network with reagents and protocols to conduct tests using real-time reverse-transcriptase polymerase chain reaction (RT-PCR). HHS has developed a real-time epidemic analysis and modeling system for public health use and emergency preparedness. The National Disaster Medical System has developed a strategy for deploying medical assets held by DHS and HHS. The "Pandemic Influenza Playbook" describes what public health and medical capabilities the federal government has available to support state responses to pandemic influenza.

Federal agencies, with the assistance of states, launched a wild-bird testing program for H5N1 avian flu Aug 2006 along with an electronic reporting system, and are working on a response strategy. The departments completed a study of a key animal influenza research facility’s deficiencies. Because of the risk of an avian flu outbreak in birds, several government agencies have prepared 3 messages that can be used to deliver clear, coordinated information to the public. Food safety messages that can be customized and distributed if an avian influenza outbreak occurs have also been developed.

The Department of Justice, along with HHS, DHS, DOL, sponsored a forum May 2006 for criminal justice officials on best practices to meet the challenges they may face in a pandemic outbreak (see Web site of the Bureau of Justice Assistance). DHS and other agencies will host an emergency response forum Feb 2007 for selected federal, state, local, and tribal officials. The group will review interim guidance and adopt a national pandemic flu planning model. Checklists for law enforcement personnel and emergency responders have been developed. The documents include planning checklists for correctional facilities.

Officials have developed preparedness exercises with private-sector partners, and templates of the exercises are available for use by other interested groups. Business continuity guidance was developed and published on the government's pandemic flu Web site. Interim guidance on environmental management and cleaning practices, including the handling of potentially contaminated waste materials, has been developed.

8 of the tasks were not completed, and work on each is continuing. They include measures to:
• Draft a report analyzing the pros and cons of invoking the Defense Production Act to procure medical countermeasures during a pandemic
• Improve the speed of mortality surveillance through the 122 Cities Mortality Reporting System
• Establish a protocol for state governments on how to request federal military assistance under the Insurrection Act
• Adopt and test a planning and preparation model for emergency response systems
• Publish interim guidance on environmental management of pandemic flu viruses
• Publish final pandemic planning guidelines for critical infrastructure owners and operators
• Help critical infrastructure entities conduct collaborative exercises to test essential functions and identify critical planning, response, and mitigation needs.
(CIDRAP 12/29/06 http://www.cidrap.umn.edu/ )

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USA: NIH starts clinical trial of H5N1 DNA vaccine
Federal officials have announced the launch of the first clinical trial of an H5N1 avian influenza vaccine made from a piece of the virus's DNA rather than from the whole virus, an approach that may facilitate faster vaccine production. The trial began Dec 21 at the National Institutes of Health (NIH) Clinical Center. The vaccine was designed at the National Institute of Allergy and Infectious Diseases (NIAID). Conventional flu vaccines use viruses that are grown in eggs and administered in weakened or killed form. DNA vaccines, in contrast, contain only parts of the virus's genetic material. "Once inside the body, the DNA instructs human cells to make proteins that act as a vaccine against the virus," the agency said.

The experimental vaccine uses a modified version of the hemagglutinin gene from a recent strain of the H5N1 virus. The vaccine uses DNA from a 2005 strain of H5N1 from Indonesia. The trial will involve 45 volunteers between the ages of 18 and 60. 30 volunteers will receive 3 vaccine injections over 2 months and will be followed for a year, while 15 will receive placebo injections. Researchers will measure the volunteers' immune response to the vaccine, compare its potency with that of more traditional vaccines, and assess its safety. Nabel said the new technique has the potential to speed up flu vaccine production, but he stressed that investigators first must show that the vaccine is immunogenic and safe. If the vaccine performs well and if the H5N1 virus evolves into a pandemic strain within the next couple of years, the vaccine could possibly be of some use in combating it, Nabel said. He said DNA vaccines generate some level of cellular immune response, whereas traditional flu vaccines generate only a humoral immune response. When responding to an emerging pandemic virus, for which no precisely matched vaccine would be immediately available, the cellular immunity conferred by a DNA vaccine might be of some help, he said. Nabel and his colleagues have previously shown the efficacy of DNA flu vaccines in lab animals, including animals exposed to H5N1 viruses and the H1N1 virus that caused the 1918 pandemic.
(CIDRAP 1/4/07 http://www.cidrap.umn.edu/ )

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USA (Rhode Island): Outbreak of Mycoplasma pneumoniae in children
Health officials are investigating a rare outbreak of encephalitis that killed a second grader. The cases of encephalitis, which is usually caused by a virus and causes the brain to become inflamed and swell, are unusual because they appear to be caused by a common bacterium, Mycoplasma pneumoniae, a cause of what is commonly known as "walking pneumonia." It's rare for someone to be hospitalized with mycoplasma, and it's even more rare to see such a severe complication as encephalitis. The victim, from Warwick, died of encephalitis 21 Dec 2006. A classmate of the student became ill with meningitis that progressed to a mild form of encephalitis. The classmate and a middle school student who had encephalitis and pneumonia were recovering. Officials also are investigating higher-than-normal absentee rates among students in 2 Coventry schools who were reported to have had symptoms of a mild pneumonia.

Warwick officials turned Greenwood Elementary School into a makeshift clinic, swabbing throats and drawing blood from all but 3 of the 275 students, their families, teachers and staff members. Antibiotics were given to everyone who showed up. The school was closed after 5 students tested positive for walking pneumonia. Mayor Scott Avedisian said officials were keeping it closed for an extra week so the students would be apart for 2 weeks, well into the incubation time of 1 to 3 weeks. State officials said it was the first time a school had been closed for such an outbreak, and federal officials said they rarely intervened in cases of walking pneumonia. More than 1400 rounds of antibiotics were dispensed and 9 informational sessions were held for concerned parents. Outbreaks of respiratory disease with pneumonia caused by M. pneumoniae occur especially in closed groups of susceptible individuals such as a military recruit camp or a school. Antimicrobial prophylaxis with a macrolide or a tetracycline has been used with apparent success.
(Promed 1/4/07)

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USA (Massachusetts): Suspected pertussis in hospital employees
It seemed straightforward at first: A 19-month-old boy being treated at Children's Hospital Boston had classic symptoms of whooping cough, and a laboratory test confirmed he had the disease. Then, from late Sep to early Nov 2006, 3 dozen hospital employees in wards where the child had been treated also developed coughs and other symptoms suggesting that they too had the disease. And, just as for the toddler, initial testing confirmed they carried the bacterium. But now, more than 3 months after the child fell ill, investigators are no longer certain that the respiratory illnesses that struck workers and another patient at Children's Hospital were caused by whooping cough (pertussis). Additional testing, using approaches different from the first, could find little evidence of the germ.

Pertussis is laboratory-confirmed by 2 ways: 1) Culturing: Material from the patient is placed in a dish with a growth medium that will allow the bacterium to reproduce if it's present 2) Polymerase chain reaction, or PCR, involves looking for the genetic fingerprint of the disease. PCR is easier and faster than culturing. There were hundreds of PCR tests performed, and 38 -- 2 patients and 36 healthcare workers -- came back positive for pertussis. State lab workers also cultured the samples. They also tested blood samples from the hospital workers. The results were almost uniformly negative for pertussis. Samples were sent to CDC and researchers there performed a 2-tier PCR. The results were inconclusive--it turned out that one part of the PCR suggested the presence of the pertussis bacterium, while the other part didn't. The state lab, which initially performed just one phase of the PCR test, decided to conduct the 2nd phase and, like the federal lab, came back negative on that second phase. There are competing theories, ranging from a cold virus to a bacterial relative of pertussis to the virus that causes the condition commonly known as walking pneumonia.
(Promed 12/28/06)

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Canada: Report on the investigation of the eighth case of BSE in Canada
“Background: On August 9, 2006, a commercial beef cow on a farm in northern Alberta died following a short history of neurological disease. The following day a private practitioner sampled the cow under Canada’s National BSE Surveillance Program. Brain samples from this animal were sent to the Alberta Agriculture, Food and Rural Development (AAFRD) Laboratory, where they were screened for BSE using a Bio-Rad rapid test. The preliminary test results received on August 16, 2006 did not rule out BSE. In accordance with the prescribed testing protocol the test was repeated on August 17 and produced a second reaction. Brain samples were then sent to the National Centre for Foreign Animal Disease in Winnipeg where rapid screening tests were performed, validating the work of the AAFRD, and BSE was confirmed by the Scrapie Associated Fibril immunoblot and MAB monoclonal antibody 6H4 procedure on August 23, 2006. This method had been chosen because of poor tissue quality (autolysis and freezing artefact) which prevented a definitive identification of target areas for immunohistochemistry. The carcass was secured from the farm, transferred to the AAFRD laboratory and incinerated. No part of the carcass entered the human food supply or animal feed chain.

The CFIA immediately initiated an epidemiological investigation based on the most recent World Organization for Animal Health (OIE) recommended BSE guidelines. Specifically, the CFIA investigated:
• The birth cohort (all cattle born in the same herd as, and within 12 months of the birth of the BSE-positive animal);
• the feed cohort (all cattle which, during their first year of life, were reared with the BSE positive animal during its first year of life, and which investigation showed consumed the same potentially contaminated feed during the period); and
• feed to which the animal may have been exposed early in its life. . .”

For full report: http://www.inspection.gc.ca/english/anima/heasan/disemala/bseesb/ab2006/8investe.shtml
(Promed 12/27/06)

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Canada (British Columbia)/Denmark: Case of Cryptococcus gattii in tourist
An unprecedented outbreak of Cryptococcus gattii, genotype amplified fragment length polymorphism (AFLP) 6/VGII on Vancouver Island, British Columbia (BC), Canada, is affecting both human and animal hosts with normal immunity. Endemic acquisition of C. gattii has been occurring in the province of BC since 1999. There has been no recent increase or cluster of cases. There have been over 160 human cases reported to date among BC residents, for an annual provincial incidence of 6 cases/million population, with 6 fatalities. The incidence of C. gattii infection on Vancouver Island is 36/million. C. gattii has been found in most tree species, in soil, water and air on Vancouver Island. Since 2003, human and animal cases without exposure to Vancouver Island but with the same or similar genotype as that found on the Island have been found on the BC mainland and in Northwestern US states.

A 51-year-old, HIV-negative, apparently immunocompetent man from Denmark, with known psoriatic gout and under treatment with a nonsteroidial antiinflammatory drug, was admitted to a hospital in Denmark with chest pain. 6 weeks before his admission, he returned to Denmark from a trip to Canada, during which he visited Victoria and surrounding areas. He had visited gardens and studied the local natural vegetation. During his stay in Canada, the patient had no symptoms. Extensive molecular research showed that the isolate from his sample belonged to the highly virulent AFLP genotype 6A (VGIIa) of Cryptococcus gattii, which is the major genotype involved in the Vancouver Island C. gattii outbreak. All 7 sequenced genes had a complete match with the sequence types specific for isolates involved in the Vancouver Island outbreak.

It was concluded that the pathogen was acquired during the patient's visit to Vancouver Island and imported to Denmark. The observed incubation time of 6 weeks is shorter than that was previously reported for infections related to the Vancouver Island outbreak. These observations, in combination with the absence of any known predisposing factor in this patient, suggest that this specific AFLP6 genotype of C. gattii is highly virulent. This case suggests a potential risk of tourists acquiring cryptococcosis while visiting Vancouver Island. Before the BC outbreak, C. gattii had been found only in tropical and subtropical areas and generally causes disease in individuals who are not immunoincompetent. Why the outbreak began is not clearly established but has been postulated to be related to global warming. However, it has been suggested that the Vancouver strain has a mutation, dramatically increasing the mating efficacy of the haploid yeast.
(Promed 12/28/06, 1/3/07)

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Canada: E coli vaccine for cattle gets preliminary approval
The Canadian Food Inspection Agency (CFIA) recently gave preliminary approval for field use of the world's first vaccine to reduce Escherichia coli O157:H7 in cattle and thereby help keep it out of food. Bioniche Life Sciences reported Dec 22, 2006 that it received CFIA approval to distribute its E coli vaccine to Canadian veterinarians. Several outbreaks of E coli O157:H7 have been linked to leafy greens recently, including 2 high-profile events in 2006—one that involved fresh spinach and another traced to lettuce served at Taco Bell restaurants in the eastern US. In the spinach outbreak, authorities expressed concern about the proximity of cattle pastures to growing areas. The O157:H7 E coli strain doesn't sicken cattle, but in humans it causes diarrhea, often bloody, and abdominal cramps, but typically no fever. The illness can also cause hemolytic uremic syndrome, a potentially fatal form of kidney failure, in 2% to 7% of patients.

The vaccine was developed jointly by the University of British Columbia, the Vaccine and Infectious Diseases Organization of the University of Saskatchewan, and the Alberta Research Council. In clinical trials conducted by the University of Nebraska–Lincoln, cattle that received 2 doses of the vaccine had 75% lower prevalence of E coli O157:H7, according to Bioniche. A 3-dose regimen was associated with a 98.3% reduction in prevalence. The price for a course of the vaccine hasn't been determined yet, but is expected to be less than $10 per head of cattle. Bioniche is preparing to seek regulatory approval from the US Department of Agriculture, but it's difficult to predict when the product might be licensed in the US.
(CIDRAP 1/2/07 http://www.cidrap.umn.edu/ )

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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). Also, http://www.irinnews.org/Birdflu.asp provides latest information on avian influenza in order to help the humanitarian community better understand and respond to the possibility of a pandemic.
- 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.
- 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. Link to OPLAN
- 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
Chinese Taipei
Based on the sentinel surveillance system in Taiwan, during the 51st epidemiological week (Dec 17 to 23, 2006), the percentage of outpatient visits to sentinel physicians for influenza-like illness (ILI) increased by 18.3% compared with last week and is 51.8% higher than the same period in 2005. During weeks 48 to 51, the respective ILI consultation rates (per 100 outpatient visits) were 3.61, 3.87, 4.17 and 4.53. In week 51, all 6 regions reported an increasing trend from the previous week. The dominant respiratory virus identified for week 48 to 51 was B type influenza virus. The other main respiratory viruses were Adenovirus and HSV (Herpes simplex virus). To date, 30 clusters have been reported this influenza season. Based on reporting dates, 7 additional severe influenza cases were reported in week 51. Based on onset dates, 28 severe cases have been reported cumulatively in the 2006-2007 epidemic season. Among these, 4 were confirmed, 14 were excluded, and 10 were pending. So far this year, 1 death has been reported.
(Taiwan IHR Focal Point 1/3/07)

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Cholera, diarrhea & dysentery
Malaysia (Johor)
Authorities are on high alert for dengue and cholera outbreaks in Segamat, one of the districts worst hit by floods in Johor. Reportedly, over the last 5 days, 3 cholera cases had been detected. Reportedly the cholera victims contracted the disease after consuming untreated water.
(Promed 12/29/06)

USA (Wyoming)
The number of Fremont County residents diagnosed with shigellosis has increased to 78. The current outbreak has particularly affected children. At least 16 children have been hospitalized in recent months. Shigellosis is very easy to spread to others, and people with diarrhea have been advised to stay home until the diarrhea has completely stopped so that they do not transmit the infection.
(Promed 12/29/06)

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Dengue
Malaysia
As of 9 Dec 2006, there were 34 386 cases of dengue reported nationwide. Of these, there were 13 deaths. Reportedly, in Kuala Lumpur and Putrajaya alone, there were 6644 cases. The Communication for Behavioral Impact (COMBI) program had been introduced at 3 zones: Setapak, Klang Lama and Kuala Lumpur city center. The number of dengue cases in Selangor has gone above 11 000 so far in 2006. State Health Committee chairman Datuk Dr Lim Thuang Seng said, "Last year [2005], there were 12 700 cases, and our efforts to keep the numbers low did not work. . .We have done everything possible. . .but the people failed to take precautionary measures. . .”
(Promed 1/3/07)

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West Nile Virus
USA (Mississippi)
The Mississippi Department of Health has reported 2 new human cases of West Nile virus infection. That brings the state's total West Nile virus human case total for 2006 to 183, with 13 resulting in death. Health officials also reported 1 case of Jamestown Canyon virus in Walthall County. It is a mosquito borne virus that generally causes a mild illness and rarely meningitis or encephalitis. About 80 percent of people who are infected with the West Nile virus will have no symptoms. The remaining 20 percent may experience a range of flu-like symptoms. In a small number of people, infection can result in encephalitis or meningitis.
(Promed 12/28/06)

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2. Articles
Molecular Anatomy of Influenza Virus Detailed
Scientists at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and colleagues at the University of Virginia in Charlottesville have succeeded in imaging, in unprecedented detail, the virus that causes influenza. A team of researchers led by NIAMS’ Alasdair Steven, working with a version of the seasonal H3N2 strain of influenza A virus, has been able to distinguish 5 different kinds of influenza virus particles in the same isolate and map the distribution of molecules in each of them. This breakthrough has the potential to identify particular features of highly virulent strains, and to provide insight into how antibodies inactivate the virus, and how viruses recognize susceptible cells and enter them in the act of infection. One of the difficulties that has hampered structural studies of influenza virus is that no two virus particles are the same. In this fundamental respect, it differs from other viruses. The research team used electron tomography (ET) to make its discovery.
(Pandemicflu.gov 12/29/06 http://www.nih.gov/news/pr/dec2006/niams-29.htm )

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Report may spur quest for more versatile flu vaccines
La Jolla Institute for Allergy and Immunology (LIAI) scientists report that their analysis of the literature has yielded data on more than 600 molecular components of influenza A viruses that trigger immune responses, findings they hope will spur the search for vaccines offering protection against multiple flu strains. They scanned more than 2,000 articles in a hunt for data on influenza A molecular structures that interact with either of 2 major components of the immune system: T cells and antibody-producing B cells. They found information on 602 such structures (epitopes) from 13 different influenza A subtypes. These included 1 epitope that is shared by several human flu subtypes and the H5N1 avian flu virus. Epitopes that different strains have in common could be used to make a vaccine that could be used for years.

The authors used the Immune Epitope Database (IEDB) to search the literature for influenza A epitopes. IEDB collects all known antibody and T cell epitope information in one place and is available to scientists around the world (http://www.immuneepitope.org/home.do ). They found 2,063 articles related to influenza A epitopes, of which 429 were deemed worthy of examination. This led to the cataloging of 412 T cell epitopes and 190 antibody epitopes from 13 viral subtypes and 58 different strains. Only 2 H5N1 avian flu epitopes were found, both from a 2004 Vietnam strain of the virus. Antibody epitopes were identified from only 5 of the 10 viral proteins, whereas T cell epitopes from all 10 proteins were identified. Only 1 antibody epitope—versus 160 T cell epitopes—was identified by studying human samples. The authors found that a higher percentage of T cell epitopes than of antibody epitopes were shared by multiple viral strains. About 11% of T cell epitopes were 100% identical in human and avian strains, while 30% of them were 90% identical, and 50% were 80% identical. In contrast, only 2.7% of antibody epitopes were 100% identical, and less than 11% were found to be 80% identical.

The researchers found only 9 antibody and 9 T cell epitopes that were associated with protective immune responses. Most of the protective T cell epitopes are found in both human and avian flu strains, while most of the antibody epitopes are not, they report. "However, 1 protective Ab epitope from the M2 protein shows appreciable conservation among the selected human influenza strains and H5N1 . .Because M2 is a relatively conserved protein, identification of protective Ab epitopes derived from this protein, as has been pointed out, holds promise for the future development of a universal influenza epitope-based vaccine." The authors recommend more studies on antibody epitopes and efforts to identify more avian flu virus epitopes. The NIAID hailed the study, but cautioned that the identification of conserved epitopes doesn’t necessarily mean that broadly protective vaccines are possible. "What is less clear from the analysis is how cross-reactive an immune response would be to most of these conserved epitopes," NIAID said.
Abstract: http://www.pnas.org/cgi/content/abstract/104/1/246
(CIDRAP 1/3/07 http://www.cidrap.umn.edu/ )

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Epidemiology. Influenza escapes immunity along neutral networks.
van Nimwegen E. Science. 2006 Dec 22;314(5807):1884-6.
Given that influenza virus continues to escape immunity, why is it that only one strain dominates each year? The answer may lie in neutral networks and mapping viral genotypes to antigenic phenotypes. http://www.sciencemag.org/cgi/content/summary/314/5807/1884

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Epochal Evolution Shapes the Phylodynamics of Interpandemic Influenza A (H3N2) in Humans
Katia Koelle et al. Science. 2006 Dec 22;314(5807):1898-903.
http://www.sciencemag.org/cgi/content/abstract/314/5807/1898
Abstract: “Human influenza A (subtype H3N2) is characterized genetically by the limited standing diversity of its hemagglutinin and antigenically by clusters that emerge and replace each other within 2 to 8 years. By introducing an epidemiological model that allows for differences between the genetic and antigenic properties of the virus's hemagglutinin, we show that these patterns can arise from cluster-specific immunity alone. Central to the formulation is a genotype-to-phenotype mapping, based on neutral networks, with antigenic phenotypes, not genotypes, determining the degree of strain cross-immunity. The model parsimoniously explains well-known, as well as previously unremarked, features of interpandemic influenza dynamics and evolution. It captures the observed boom-and-bust pattern of viral evolution, with periods of antigenic stasis during which genetic diversity grows, and with episodic contraction of this diversity during cluster transitions.”

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Human Influenza A (H5N1): A Brief Review and Recommendations for Travelers
Timothy R. Hurtado. Wilderness and Environmental Medicine: Vol. 17, No. 4, pp. 276–281.
http://www.wemjournal.org/wmsonline/?request=get-abstract&issn=1080-6032&volume=017&issue=04&page=0276
Abstract: “Although avian influenza A (H5N1) is common in birds worldwide, it has only recently led to disease in humans. Humans who are infected with the disease (referred to as human influenza A [H5N1]) have a greater than 50% mortality rate. Currently there has not been documented sustained human-to-human transmission; however, should the virus mutate and make this possible, the world could experience an influenza pandemic. Probable risk factors for infection include slaughtering, defeathering, and butchering fowl; close contact with wild birds or caged poultry; ingestion of undercooked poultry products; direct contact with surfaces contaminated with poultry feces; and close contact with infected humans. Possible risk factors include swimming in or ingesting water contaminated with bird feces or dead birds and the use of unprocessed poultry feces as fertilizer. Clinically, early human influenza A (H5N1) resembles typical influenza illnesses, with fever and a preponderance of lower respiratory tract symptoms. Often, patients develop rapidly progressive respiratory failure and require ventilatory support. Treatment is primarily supportive care with the addition of antiviral medications. Currently, travelers to countries with both human and avian influenza A (H5N1) have a low risk of developing the disease. There are no current recommended travel restrictions. Travelers are advised to avoid contact with all birds, especially poultry; avoid surfaces contaminated with poultry feces; and avoid undercooked poultry products. The use of prophylactic antiviral medications is not recommended.”

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Accuracy and Interpretation of Rapid Influenza Tests in Children
Carlos G. Grijalva et al. Pediatrics. Vol. 119 No. 1 January 2007, pp. e6-e11 (doi:10.1542/peds.2006-1694)
http://pediatrics.aappublications.org/cgi/content/full/119/1/e6
Abstract: “BACKGROUND. Influenza rapid antigen detection (rapid tests) can provide timely identification of infection and aid in clinical decision-making. Although the interpretation of test results depends on test characteristics and influenza prevalence, this information is limited in routine clinical practice. OBJECTIVE. We sought to assess the times at which rapid tests are most predictive of influenza infection. METHODS. The New Vaccine Surveillance Network enrolled children aged <5 years who were hospitalized with respiratory symptoms or fever from October 2000 through September 2004. Nasal and throat swabs were obtained, and influenza virus was detected by culture and reverse-transcription polymerase chain reaction. Provider-ordered rapid influenza tests were compared with the criterion standard (culture and reverse-transcription polymerase chain reaction) to determine their sensitivity and specificity. The New Vaccine Surveillance Network also enrolled children in outpatient settings during the 2002–2003 and 2003–2004 influenza seasons and determined the weekly influenza prevalence among symptomatic children. Trends in weekly predictive values of the rapid tests were estimated over the influenza seasons. RESULTS. Rapid influenza tests had an overall sensitivity of 63% and specificity of 97%. In 2002–2003, the prevalence of influenza in symptomatic outpatient children peaked at 21% and stayed above 10% for ~4 weeks. In contrast, in 2003–2004, influenza prevalence peaked at 60% and remained above 20% for ~6 weeks. The positive predictive value of the rapid tests approached 80% when influenza prevalence was ≥15% but decreased to <70% when influenza prevalence was <10%. CONCLUSIONS. Influenza prevalence varies between and within seasons. On the basis of our estimates, rapid tests are of limited use when prevalence is <10%. The appropriate interpretation of rapid influenza tests requires local influenza surveillance and timely communication of this information to the practitioners.”

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Protective measures and human antibody response during an avian influenza H7N3 outbreak in poultry in British Columbia, Canada
Danuta M. Skowronski et al. CMAJ. 2007 Jan 2;176(1):47-53.
http://www.cmaj.ca/cgi/content/full/176/1/47
Abstract: “Background: In 2004 an outbreak of avian influenza of the H7N3 subtype occurred among poultry in British Columbia, Canada. We report compliance with recommended protective measures and associated human infections during this outbreak. Methods: We sought voluntary participation by anyone (cullers, farmers and their families) involved in efforts to control the poultry outbreak. Recruitment was by advertisements at the worker deployment site, in local media and through newsletters sent directly to farmers. Sera were tested for antibody to H7N3 by microneutralization assay. A subset of 16 sera (including convalescent sera from 2 unprotected workers with conjunctivitis from whom virus had been isolated) was further tested by Western blot and routine and modified hemagglutination inhibition assays. Results: A total of 167 people (20% to 25% of all workers) participated between May 7 and July 26, 2004. Of these, 19 had experienced influenza-like illness and 21 had experienced red or watery eyes. There was no significant association between illness reports and exposure to infected birds. Among 65 people who entered barns with infected birds, 55 (85%) had received influenza vaccine, 48 (74%) had received oseltamivir, and 55 (85%), 54 (83%) and 36 (55%) reported always wearing gloves, mask or goggles, respectively. Antibody to the H7 subtype was not detected in any sera. Interpretation: During the BC outbreak, compliance with recommended protective measures, especially goggles, was incomplete. Multiple back-up precautions, including oseltamivir prophylaxis, may prevent human infections and should be readily accessible and consistently used by those involved in the control of future outbreaks of avian influenza in poultry. Localized human avian influenza infections may not result in serologic response despite confirmed viral detection and culture.”

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The Waiting Time for Inter-Economy Spread of Pandemic Influenza
Peter Caley, Niels G. Becker, and David J. Philp. PLoS ONE 2(1): e143. doi:10.1371/journal.pone.0000143.
Abstract: “Background: The time delay between the start of an influenza pandemic and its subsequent initiation in other countries is highly relevant to preparedness planning. We quantify the distribution of this random time in terms of the separate components of this delay, and assess how the delay may be extended by non-pharmaceutical interventions. Methods and Findings: The model constructed for this time delay accounts for: (i) epidemic growth in the source region, (ii) the delay until an infected individual from the source region seeks to travel to an at-risk country, (iii) the chance that infected travelers are detected by screening at exit and entry borders, (iv) the possibility of in-flight transmission, (v) the chance that an infected arrival might not initiate an epidemic, and (vi) the delay until infection in the at-risk country gathers momentum. Efforts that reduce the disease reproduction number in the source region below two and severe travel restrictions are most effective for delaying a local epidemic, and under favourable circumstances, could add several months to the delay. On the other hand, the model predicts that border screening for symptomatic infection, wearing a protective mask during travel, promoting early presentation of cases arising among arriving passengers and moderate reduction in travel volumes increase the delay only by a matter of days or weeks. Elevated in-flight transmission reduces the delay only minimally. Conclusions: The delay until an epidemic of pandemic strain influenza is imported into an at-risk country is largely determined by the course of the epidemic in the source region and the number of travelers attempting to enter the at-risk country, and is little affected by non-pharmaceutical interventions targeting these travelers. Short of preventing international travel altogether, eradicating a nascent pandemic in the source region appears to be the only reliable method of preventing country-to-country spread of a pandemic strain of influenza.”

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Market Wide Exercise 2006 Report
UK Financial Sector executive summary of pandemic influenza exercise, released Jan 4, 2007.
http://www.fsc.gov.uk/upload/public/Files/36/Market%20Wide%20Exercise%202006%20Exec%20Summary.pdf.
“A flu pandemic is currently considered by government to be one of the leading risks to the UK. Thus, for this year’s exercise, rather than simulate a sudden impact event (which had already been rehearsed several times), we decided to model the first wave of an influenza pandemic. The exercise ran for six weeks, from 13 October to 24 November simulating 22 weeks of a pandemic. Seventy organisations from across the financial sector took part including some that extended the exercise to include their overseas offices; in total around 3500 people were involved. To gauge the success of the exercise we asked all participants to complete a detailed feedback questionnaire. Sixty-three of the seventy participants did so which gives us a high level of confidence in the reliability of the responses. The key objectives of the exercise were: firstly, to improve the sector’s preparedness by providing each of the participants with an opportunity to review, test and update their plans for managing a pandemic threat; and, secondly, to assess whether there were any sector-wide issues which might need to be addressed collectively in order to improve the capability of the financial sector to cope with a pandemic. The feedback from participants has told us unequivocally that these objectives were overwhelmingly met. . .”

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Modelling scenarios of diffusion and control of pandemic influenza, Italy
Epico working group (iannelli@science.unitn.it). Euro Surveill 2007;12(1):E070104.2.
http://www.eurosurveillance.org/ew/2007/070104.asp#2 (references removed).
“The updated Italian national plan for preparedness and response to an influenza pandemic was published in February 2006, in response to recommendations and checklists on national influenza pandemic preparedness plans issued by the World Health Organization. The Italian plan includes the following preventive measures:
• vaccination, prioritising the following categories: 1) personnel of health services and other essential services, 2) high risk groups including >=65 years old individuals and all-age individuals with underlying chronic diseases, 3) healthy children and adolescents from 2 to 18 years, 4) healthy adults;
• antiviral prophylaxis;
• social distancing measures.

To evaluate the impact of these preventive measures on the national population, a mathematical model was developed by a working group that included researchers from the Universities of Trento, Pisa and Rome, and the National Institute of Health (Istituto Superiore di sanità, ISS). The results were published in an ISS report in December 2006 and are summarised here. . .”

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Production of cattle lacking prion protein
Jürgen A Richt et al. Nat Biotechnol. 2006 Dec 31; [Epub ahead of print] http://www.nature.com/nbt/journal/vaop/ncurrent/abs/nbt1271.html
Abstract: “Prion diseases are caused by propagation of misfolded forms of the normal cellular prion protein PrPC, such as PrPBSE in bovine spongiform encephalopathy (BSE) in cattle and PrPCJD in Creutzfeldt-Jakob disease (CJD) in humans1. Disruption of PrPC expression in mice, a species that does not naturally contract prion diseases, results in no apparent developmental abnormalities2, 3, 4, 5. However, the impact of ablating PrPC function in natural host species of prion diseases is unknown. Here we report the generation and characterization of PrPC-deficient cattle produced by a sequential gene-targeting system6. At over 20 months of age, the cattle are clinically, physiologically, histopathologically, immunologically and reproductively normal. Brain tissue homogenates are resistant to prion propagation in vitro as assessed by protein misfolding cyclic amplification7. PrPC-deficient cattle may be a useful model for prion research and could provide industrial bovine products free of prion proteins.”

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Sporadic Campylobacter Infection in Infants: A Population-Based Surveillance Case-Control Study
Fullerton, Kathleen E. et al. Ped Infect Dis J. January 2007, 26:1.
Abstract: “Background: Campylobacter is an important cause of foodborne illness in infants (younger than 1 year of age), but little is known about the sources of infection in this age group. Methods: Eight sites in the Foodborne Diseases Active Surveillance Network (FoodNet) participated in a 24-month population-based case-control study conducted in 2002-2004. Cases were infants with laboratory-confirmed Campylobacter infection ascertained through active laboratory surveillance, and controls were infants in the community. Results: We enrolled 123 cases and 928 controls. Infants 0-6 months of age with Campylobacter infection were less likely to be breast-fed than controls [odds ratio (OR); 0.2; 95% confidence interval (CI), 0.1-0.6]. Risk factors for infants 0-6 months of age included drinking well water (OR 4.4; CI, 1.4-14) and riding in a shopping cart next to meat or poultry (OR 4.0; CI, 1.2-13.0). Risk factors for infants 7-11 months of age included visiting or living on a farm (OR 6.2; CI, 2.2-17), having a pet with diarrhea in the home (OR 7.6; CI, 2.1-28) and eating fruits and vegetables prepared in the home (OR 2.5, CI 1.2-4.9). Campylobacter infection was associated with travel outside the United States at all ages (OR 19.3; CI, 4.5-82.1). Conclusions: Several unique protective and risk factors were identified among infants, and these risk factors vary by age, suggesting that prevention measures be targeted accordingly. Breast-feeding was protective for the youngest infants and should continue to be encouraged.”

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Environmental stress and antibiotic resistance in food-related pathogens
M. Ann S. McMahon et al. Appl Environ Microbiol. 2007 Jan;73(1):211-7. Epub 2006 Dec 1. http://aem.asm.org/cgi/content/abstract/73/1/211
Abstract: “This study investigated the possibility that sublethal food preservation stresses (high or low temperature and osmotic and pH stress) can lead to changes in the nature and scale of antibiotic resistance (ABR) expressed by three food-related pathogens (Escherichia coli, Salmonella enterica serovar Typhimurium, and Staphylococcus aureus). The study found that some sublethal stresses significantly altered antibiotic resistance. Incubation at sublethal high temperature (45°C) decreased ABR. Incubation under increased salt (>4.5%) or reduced pH (<5.0) conditions increased ABR. Some of the pathogens continued to express higher levels of ABR after removal of stress, suggesting that in some cases the applied sublethal stress had induced stable increases in ABR. These results indicate that increased use of bacteriostatic (sublethal), rather than bactericidal (lethal), food preservation systems may be contributing to the development and dissemination of ABR among important food-borne pathogens.”

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Severe Acute Respiratory Syndrome in Children
Stockman, Lauren J. et al. Pediatric Infectious Disease Journal. 26(1):68-74, January 2007.
Abstract: “Background: Severe acute respiratory syndrome (SARS) is a febrile, respiratory tract illness caused by infection with the newly identified SARS-associated coronavirus. A notable feature of the 2003 global SARS outbreak was the relative paucity of cases reported among children. We reviewed the epidemiologic and clinical features of SARS in children and discuss implications of these findings for diagnosis, treatment and prevention of SARS. Methods: We performed a literature search to identify reports of pediatric (younger than 18 years of age) patients meeting the World Health Organization case definitions for SARS and abstracted relevant clinical and epidemiologic information. Results: We identified 6 case series reporting 135 pediatric SARS patients (80 laboratory-confirmed, 27 probable and 28 suspect) from Canada, Hong Kong, Taiwan and Singapore. Among laboratory-confirmed and probable SARS cases, the most common symptoms included fever (98%), cough (60%) and nausea or vomiting (41%); 97% had radiographic abnormalities. The clinical presentation of SARS in patients older than 12 years of age was similar to that in adults. However, patients 12 years of age or younger had milder disease and were less likely than older children to be admitted to an intensive care unit, receive supplemental oxygen or be treated with methylprednisolone. No deaths were reported among children or adolescents with SARS, and at 6 months after illness only mild residual changes were reported in exercise tolerance and pulmonary function. There is only 1 published report of transmission of SARS virus from a pediatric patient. Conclusions: Children and adolescents are susceptible to SARS-associated coronavirus infection, although the clinical course and outcome are more favorable in children younger than 12 years of age compared with adolescents and adults. Transmission of SARS from pediatric patients appears to be uncommon but is possible.”

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Surveillance for Waterborne Disease and Outbreaks Associated with Recreational Water--United States, 2003-2004
This report summarizes data from the Waterborne Disease and Outbreak Surveillance System, which tracks the occurrences and causes of waterborne disease and outbreaks (WBDOs) associated with recreational water. During 2003--2004, a total of 62 WBDOs associated with recreational water were reported by 26 states and Guam. Illness occurred in 2,698 persons, resulting in 58 hospitalizations and one death. The median outbreak size was 14 persons (range: 1--617 persons).
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5512a1.htm
(MMWR December 22, 2006 / 55(SS12);1-24)

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Surveillance for Waterborne Disease and Outbreaks Associated with Drinking Water and Water not Intended for Drinking--United States, 2003-2004
This report summarizes data from the Waterborne Disease and Outbreak Surveillance System, which tracks the occurrences and causes of waterborne disease and outbreaks (WBDOs) associated with drinking water. During 2003--2004, a total of 36 WBDOs were reported by 19 states; 30 were associated with drinking water, three were associated with water not intended for drinking, and three were associated with water of unknown intent. The 30 drinking water-associated WBDOs caused illness approximately 2,760 persons and were linked to 4 deaths.
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5512a4.htm
(MMWR December 22, 2006 / 55(SS12);31-58)

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Latent Tuberculosis Infection Among Sailors and Civilians Aboard U.S.S. Ronald Reagan--United States, January-July 2006
(references removed)
“Crews aboard ships live and work in crowded, enclosed spaces. Historically, large tuberculosis (TB) outbreaks and extensive transmission of Mycobacterium tuberculosis have occurred on U.S. Navy ships. On July 13, 2006, smear- and culture-positive, cavitary, pulmonary TB was diagnosed in a sailor aboard the aircraft carrier U.S.S. Ronald Reagan; the patient, aged 32 years, had a negative human immunodeficiency virus test. The M. tuberculosis strain cultured was susceptible to all first-line TB medications. The sailor was born in the Philippines, had latent tuberculosis infection (LTBI) diagnosed in 1995 shortly after enlisting in the U.S. Navy, and completed the 6-month daily isoniazid course that was standard treatment at that time. . .This report describes the contact investigation conducted by the U.S. Navy and CDC and demonstrates the importance of timely diagnosis of TB, identification and treatment of new LTBI, and cooperation among local, state, and federal agencies during large contact investigations. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5551a3.htm
(MMWR January 5, 2007 / 55(51);1381-1382)

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3. Notifications
Recommended Immunization Schedules for Persons Aged 0–18 Years--United States, 2007
The Advisory Committee on Immunization Practices periodically reviews the recommended immunization schedule for persons aged 0-18 years to ensure that the schedule is current with changes in vaccine formulations and reflects revised recommendations for the use of licensed vaccines. Changes to the previous childhood and adolescent immunization schedule, published Jan 2006:
• The new rotavirus vaccine (Rota) is recommended in a 3-dose schedule at ages 2, 4, and 6 months. The first dose should be administered at ages 6 weeks through 12 weeks with subsequent doses administered at 4--10 week intervals. Rotavirus vaccination should not be initiated for infants aged >12 weeks and should not be administered after age 32 weeks.
• The influenza vaccine is now recommended for all children aged 6--59 months.
• Varicella vaccine recommendations are updated. The first dose should be administered at age 12--15 months, and a newly recommended second dose should be administered at age 4--6 years.
• The new human papillomavirus vaccine (HPV) is recommended in a 3-dose schedule with the second and third doses administered 2 and 6 months after the first dose. Routine vaccination with HPV is recommended for females aged 11--12 years; the vaccination series can be started in females as young as age 9 years; and a catch-up vaccination is recommended for females aged 13--26 years who have not been vaccinated previously or who have not completed the full vaccine series.
• The main change to the format of the schedule is the division of the recommendation into two schedules: one schedule for persons aged 0--6 years and another for persons aged 7--18 years. Special populations are represented with purple bars; the 11--12 years assessment is emphasized with the bold, capitalized fonts in the title of that column. Rota, HPV, and varicella vaccines are incorporated in the catch-up immunization schedule.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5551a7.htm
(MMWR January 5, 2007 / 55(51);Q1-Q4)

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Tenth Annual Conference on Vaccine Research
CDC and others will sponsor the Tenth Annual Conference on Vaccine Research: Basic Science, Product Development, and Clinical and Field Studies, Apr 30--May 2, 2007. Symposia include immune memory, maternal immunization to protect newborns, vaccination of persons who are immunocompromised, host factors, influenza, animal model hosts, and vaccine-development constructs and topics. 2 poster and 6 oral sessions will feature presentations selected through peer review of submitted abstracts. Deadline for online submission of abstracts: Feb 2, 2007. For more information: http://www.nfid.org/conferences/vaccine07 and by e-mail (vaccine@nfid.org), fax (301-907-0878), telephone (301-656-0003, ext. 19), and mail (National Foundation for Infectious Diseases, 4733 Bethesda Avenue, Suite 750, Bethesda, MD 20814).
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5551a4.htm
(MMWR January 5, 2007 / 55(51);1382)

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Cambridge Healthtech Institute's 11th Annual "Transmissible Spongiform Encephalopathies"
Baltimore, Maryland, USA; 12-13 Feb 2007.
Transmissible Spongiform Encephalopathies continue to cause serious concern among researchers whose work utilizes materials from animals and/or humans which may be contaminated with the causative agent. The appearance of BSE in herds of cattle born after the introduction of the ruminant feed ban and the potential impact of BSE and CWD on human health in the U.S has raised new concerns and questions, as has the continued occurrence of Chronic Wasting Disease (CWD) in North American deer herds. This conference will present the newest data on TSE's in the context of its application to the pharmaceutical, biological, environmental and device industries.

Agenda: emerging concerns; new research directions; infectivity and transmission; detection and removal; conformational transition and infectivity. For more information: http://www.healthtech.com/2007/TSE or call Cambridge Healthtech Institute at 781-972-5400 or toll-free in the U.S. 888-999-6288. Advanced Registration Deadline is 12 Jan 2007:
https://commerce22.datapipe.com/chidb/2007/tse/reg.asp.
(Promed 1/4/07)

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2007 International Conference on Biocontainment Facilities BSL-2, BSL-3, BSL-3Ag, ABSL-3, BSL-4
12-13 Mar 2007; San Diego, California, USA.
In cooperation with the American Biological Safety Association (ABSA). Speaker List: http://www.TradelineInc.com/Bio2007Speakers. Agenda (http://www.TradelieInc.com/BioSessions ): Operational- and risk-based facility plans; Multi-pathogen/Multi-protocol programs; Integrated BSL-lab/animal facilities; Bioaerosol high-containment facilities; Containment for vaccine development and bio-manufacturing; Better commissioning, certification, and validation processes; Construction cost & contracting strategies; Operations and maintenance programs; and more. For more information: http://www.Tradelineinc.com/Bio2007Program. Email BIO2007@tradelineinc.com. Tel: 925-254-1744 x19.
(Promed 1/3/07)

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Ninth International Symposium on Protection against Chemical and Biological Warfare Agents
Goteborg, Sweden; 22-25 May 2007. Join the world's leading symposium on protection against chemical and biological warfare agents. For more information: http://www.cbwsymp.foi.se/.
(Promed 1/3/07)

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4. APEC EINet activities
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