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Vol. X, No. 2 ~ EINet News Briefs ~ Jan 19, 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)
- Global: Global goal to reduce measles deaths in children surpassed
- Indonesia: Update on avian influenza H5N1 infections in humans
- Indonesia: Report of infection of H5N1 virus in feral cats
- Viet Nam: Seventh province hit by avian influenza H5N1 virus
- Japan: Avian Influenza H5N1 infection in poultry confirmed
- Thailand (Suphan Buri): Pigeons and other wild birds died of avian influenza
- Hong Kong: Excerpts from OIE report on highly pathogenic avian influenza in birds
- Scandinavia/Thailand (Phuket): Legionellosis outbreak at hotel
- China (Jiangsu): Report of 2 cases of epidemic hemorrhagic fever
- China (Shanxi): Undiagnosed respiratory illness in school pupils
- China (Guangzhou): Highest number of measles cases in the past 20 years
- Russia (Dagestan): Botulism associated with canned food
- Russia (Penza): Norovirus infections recorded
- Russia: Rotavirus outbreaks
- USA: HHS funds work on dose-sparing H5N1 vaccines
- USA: California produce firm to fund E coli research
- USA: FDA finds Taco John's E coli strain on California farms
- USA (Multi-state): Outbreaks caused by norovirus
- Canada (Montreal): Norovirus outbreak in hospitals
- USA (Maryland): 2 cases of infant botulism
- USA (Arizona): Valley fever cases soar to a record high
- USA (Rhode Island): 3 confirmed cases of Mycoplasma pneumoniae encephalitis
- Canada: Community acquired MRSA in humans associated with horse contact
- USA/Canada: US wants to end BSE-linked ban on older Canadian cattle
- Nigeria (Sokoto, Katsina): Report of new avian influenza H5N1 outbreaks in poultry
- Egypt: Tamiflu-resistant H5N1 strain surfaces; new human case of avian influenza H5N1 infection

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

2. Articles
- Study sheds light on lethality of 1918 flu virus
- Antiviral effects on influenza viral transmission and pathogenicity: observations from household-based trials
- Subclinical Infection with Avian Influenza A H5N1 Virus in Cats
- Amantadine-Resistant Influenza A (H3N2) Virus in Japan, 2005-2006
- Ontario SARS report cites health system failings
- The US Capitol bioterrorism anthrax exposures: clinical epidemiological and immunological characteristics
- First isolation of Clostridium difficile 027 in Japan
- Reduction in infectivity of endogenous transmissible spongiform encephalopathies present in blood by adsorption to selective affinity resins
- Listeria monocytogenes Infection from Foods Prepared in a Commercial Establishment: A Case-Control Study of Potential Sources of Sporadic Illness in the United States
- Reduction in the incidence of invasive listeriosis in foodborne diseases active surveillance network sites, 1996–2003
- Indigenous Case of Disseminated Histoplasmosis, Taiwan

3. Notifications
- UNICEF Avian and Pandemic Influenza Communication Resources
- Satellite Broadcast: Epidemiology and Prevention of Vaccine-Preventable Diseases 2007
- Introduction to mathematical models of global and emerging infections
- NSF BioSurveillance Workshop Final Call for Papers
- The Asia Pacific Leadership Program
- Workshop: Converging Technologies to Combat Emerging Infectious Diseases

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 / 13 (8)
Djibouti / 1 (0)
Egypt / 18 (10)
Indonesia / 56 (46)
Iraq / 3 (2)
Thailand / 3 (3)
Turkey / 12 (4)
Total / 116 (80)

2007
Indonesia / 4 (3)
Total / 4 (3)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 267 (161).
(WHO 1/15/07 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 1/15/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 1/12/07): http://gamapserver.who.int/mapLibrary/

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Global: Global goal to reduce measles deaths in children surpassed
Measles deaths have fallen by 60% worldwide since 1999--a major public health success. This exceeds the UN goal to halve measles deaths between 1999 and 2005 and is largely due to an unprecedented decline in measles deaths in the African region. According to new data from WHO, global measles deaths fell from an estimated 873 000 deaths in 1999 to 345 000 in 2005. A strategy to reduce measles mortality, consisting of 4 components, has been key to ensuring the massive global decrease in measles deaths. The strategy calls for: the provision of one dose of measles vaccine for all infants via routine health services; a second opportunity for measles immunization for all children, generally through mass vaccination campaigns; effective surveillance for measles; and enhanced care, including the provision of supplemental vitamin A.

Accelerated measles control activities are contributing to the development of health infrastructure to support routine immunization and other health services through promotion of safe injection practices, increased ‘cold chain’ capacity for vaccines storage, and the development of a global public health laboratory network. In addition, measles vaccination campaigns are contributing to the reduction of child deaths from other causes. They have become a channel for the delivery of other life-saving interventions, such as bednets to protect against malaria, de-worming medicine and vitamin A supplements. The challenge now is to reach a new global goal: the reduction of global measles deaths by 90% by 2010, compared to 2000 levels. “The success of the Measles Initiative has added to the confidence of national governments and donor partners to undertake public-private partnerships to make a significant impact on disease prevention,” said Kathy Bushkin Calvin, Executive Vice President and Chief Operating Officer of the UN Foundation.
(WHO 1/19/07 http://www.who.int/mediacentre/news/releases/2007/pr02/en/index.html )

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Asia
Indonesia: Update on avian influenza H5N1 infections in humans
Indonesia has confirmed that H5N1 avian influenza infected the 18-year-old son of a woman who died of the infection last week, but the woman's husband escaped the virus. The report, coming amid a spate of Indonesian cases and suspected cases, indicates the latest family case cluster resembles most previous ones in that cases have been limited to blood relatives, suggesting that some people have a genetic susceptibility to the virus. WHO said the 18-year-old man had a confirmed case and was hospitalized in critical condition. His mother, a 37-year-old from Tangerang City, Banten Province, died of the disease Jan 11, 2007. The teenager's father, husband of the deceased woman, who also has been ill, has tested negative for the virus. However, it was not clear whether the 3 all lived together (reportedly the father is from Serpong in west Java). 3 sets of tests on the 46-year-old father were negative. The man was recovering and would soon be discharged from the hospital. Indonesia has had 10 H5N1 case clusters, all involving blood relatives. But there was no suggestion that the son caught the illness from his mother. WHO said investigation has indicated that both family members had similar environmental exposures to the virus.

Besides the 18-year-old's case, WHO reported a confirmed case in a 22-year-old woman from South Jakarta. Indonesian officials said the woman had become ill Jan 6 and died Jan 12. Reportedly there were bird deaths near her home in the days prior to symptom onset. In addition, WHO said Indonesia had reported the death of another 22-year-old woman, whose H5N1 infection had been announced Jan 12. The patient, from Tangerang City, Banten Province, died the same day her case was reported. 5 human cases have been WHO-confirmed in Indonesia so far this month, after about 6 weeks with no cases. Those affected have included a 14-year-old boy who died Jan 10, in addition to the 18-year-old, his mother, and the two 22-year-old women.

The government had recommended provincial governments in West Java, Banten and Jakarta ban backyard fowl in housing areas to reduce the risk of bird flu spreading to humans. Owners of backyard fowl would receive compensation of 12 500 rupiah (US$1.40) per bird once the ban was in place. Hospitals in Jakarta have also been dealing with a number of suspected H5N1 cases, prompting worries. Perahabatan Hospital, one of two Jakarta facilities designated for avian flu patients, said it was overwhelmed by suspected cases.
(CIDRAP 1/16/07 http://www.cidrap.umn.edu/ ; Promed 1/16/07)

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Indonesia: Report of infection of H5N1 virus in feral cats
A scientist is reporting a survey suggesting that 1 in 5 stray cats is carrying the H5N1 virus. C.A. Nidom, a molecular biologist at the University of Airlangga, said he tested 500 feral cats on Java island and in Lampung province of Sumatra island from Sep to Dec 2006 and found that 100 carried the virus. "I'm worried that the virus will be more easily transmitted to humans because the body temperature of mammals like cats is similar to that of humans," he said. In Oct 2006, researchers from the Indonesian Environment Information Center in Yogyakarta announced that stray cats had caught the H5N1 virus from infected poultry at live markets. Other documented instances of cats infected with the H5N1 virus include house cats in Germany, Thailand, and Austria, and a leopard and tigers at a zoo. However, the role of cats in transmitting the H5N1 virus is not known.
(CIDRAP 1/16/07 http://www.cidrap.umn.edu/ )

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Viet Nam: Seventh province hit by avian influenza H5N1 virus
The number of Mekong Delta provinces reporting poultry outbreaks recently grew to 7, Jan 14, 2007. The government reported that the lethal H5N1 strain killed 130 ducks in Soc Trang province and 800 ducks in Tra Vinh province. Tra Vinh is adjacent to Vinh Long province, where bird flu struck a chicken farm a week ago. Market inspectors have restricted the movement and sale of poultry. The country has been battling dozens of outbreaks in the Mekong Delta since early Dec 2007, but no human cases have been reported since Nov 2005. The risk of infections could also rise before the Tet Lunar New Year festival in mid-Feb 2007, where the slaughter and eating of poultry is a traditional part of the new year's feast.
(CIDRAP 1/16/07 http://www.cidrap.umn.edu/ ; Promed 1/13/07, 1/14/07)

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Japan: Avian Influenza H5N1 infection in poultry confirmed
Japan's farm ministry confirmed the country's first H5N1 avian flu outbreak in chickens in nearly 3 years. 3,800 birds on a farm in Miyazaki died of the disease. Authorities are culling the remaining 8,200 birds. No human cases or additional poultry outbreaks have been reported. Authorities would inspect 11 chicken farms within a 6-mile radius of the affected poultry farm and take blood samples from the birds. The government has set up a task force and ordered 20 poultry farms within a 10-km radius of the affected operator to halt shipments of eggs and chickens. Officials are also to conduct a national survey to look into the possibility that a bird flu virus might have been brought by migratory birds from other parts of Asia. Miyazaki, about 900 km southwest of Tokyo, is the nation's largest poultry producing region.

Excerpts from OIE report:
Information received 13 Jan 2007. Start date: 10 Jan 2007. Date of previous occurrence: 5 Mar 2004 Manifestation of disease: clinical disease. Causal agent: highly pathogenic avian influenza virus, serotype H5. Outbreak: Kiyotake town, Miyazaki. Epidemiological unit: farm. Species: birds. Susceptible 12 000; Cases 3800; Deaths 3800; Destroyed 8200; Slaughtered 0. Apparent morbidity rate 32 per cent; Apparent mortality rate 32 per cent; Apparent case fatality rate 100 per cent; Proportion susceptible removed 100 per cent. Source of infection: unknown or inconclusive. Haemagglutination inhibition test (HIT) and pathogen isolation by egg inoculation on birds, with positive results.
(CIDRAP 1/16/07 http://www.cidrap.umn.edu/ ; Promed 1/13/07, 1/14/07, 1/18/07)

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Thailand (Suphan Buri): Pigeons and other wild birds died of avian influenza
Laboratory tests have confirmed that 4 pigeons died after becoming infected with the H5N1 bird flu virus strain. The 4 birds were part of a group of wild birds that suddenly died 1 month ago in the Suphan Buri province. "We have asked all related officials to closely monitor the death of poultry and birds. Any people that have flu-like symptoms with a history of contacting poultry will be quarantined," said the director general of disease control, Thawat Suntrajarn. Wild ducks have reportedly died of bird flu infection in the north of the country. Thailand is the fourth largest exporter of poultry in the world. Millions of people depend on poultry for their livelihood and sustenance.

Excerpts from OIE report:
Information received 15 Jan 2007. Start date: 9 Jan 2007. Date of previous occurrence: 16 Jul 2006. Manifestation of disease: clinical disease. Causal agent: highly pathogenic avian influenza virus, serotype: H5N1. Outbreak 1 (ID 130) Village No. 5, PlaiChumPol, Muang, Phitsanulok. Epidemiological unit: farm. Species: birds. Susceptible 2100; Cases 130; Deaths 100; Destroyed 1970; Slaughtered 0. Affected birds were layer Khaki Campbell ducks about 5 months old. They were free ranged for feeding in nearby rice field during the day and housed by night. There is also an important activity of wild birds that feed together with the domestic flocks. Apparent morbidity rate 6 per cent; Apparent mortality rate 5 per cent; Apparent case fatality rate 77 per cent; Proportion susceptible removed 99 per cent. Source of infection: under investigation.

Thailand is conducting from 3 Jan to 3 Feb 2007 its first intensive surveillance this year. It corresponds to the current avian influenza case definition upon active clinical surveillance campaign. Conducted haemagglutination (HA) test, haemagglutination inhibition (HAI) test, and virus isolation on birds, all with positive results; and reverse transcription-polymerase chain reaction with positive results.
(Promed 1/17/07, 1/18/07)

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Hong Kong: Excerpts from OIE report on highly pathogenic avian influenza in birds
Information received 17 Jan 2007. Start date: 29 Dec 2006; date of confirmation of event: 15 Jan 2007. Date of previous occurrence: Feb 2006. Manifestation of disease: clinical disease. Causal agent: highly pathogenic avian influenza virus, serotype: H5N1.

Outbreak: Leighton road, Causeway Bay, Hong Kong. Species: wild species; Susceptible 6; Cases 6; Deaths 6; Destroyed 0; Slaughtered 0. Affected population: scaly-breasted munia (Lonchura punctulata). Source of infection: unknown or inconclusive. Lonchura punctulata is distributed in southern China, Taipei China and Hainan, Northern Thailand, Laos, Cambodia, and Vietnam. This bird is a common resident in Hong Kong. An intensive surveillance system is in place on all poultry farms and other locations in Hong Kong. All chicken farms are routinely vaccinated with inactivated H5N2 vaccine and each batch of chickens has 60 unvaccinated individually identified sentinels, which are monitored over the production life of the batch. University of Hong Kong (local laboratory) undertook gene sequencing with positive results. Tay Lung Veterinary Laboratory, AFCD, Hong Kong (national laboratory) performed haemagglutination inhibition test (HIT) and real-time reverse transcriptase/polymerase chain reaction (RRT-PCR) with positive results.

Also, a dead bird in Hong Kong's Shek Kip Mei area was found to have an H5 subtype of the avian flu virus, the city's second reported infection in 2 weeks. More tests are being conducted on the bird, a crested goshawk found 9 Jan 2007 behind a health center. Shek Kip Mei is about 3 miles north of the Tsim Sha Tsui tourist district.
(Promed 1/14/07; 1/18/07)

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Scandinavia/Thailand (Phuket): Legionellosis outbreak at hotel
2 Finns, a Norwegian, and 2 Swedish tourists have fallen ill with pneumonia caused by Legionella bacteria, after having stayed at the Phuket Grand Tropicana Hotel in Patong Beach, Phuket. The National Public Health Institute has recommended the Finnish travel operator Aurinkomatkat should transfer all its clients from the hotel as soon as possible. The hotel must not be used until the water and air-conditioning systems have been cleaned and appropriate certifications on the completion of the measures have been received. The National Public Health Institute is urging all persons who have been resident in the hotel since 20 Nov 2006 and have fallen ill with fever of more than 38 C, either during the trip or within 14 days after leaving the hotel, to go to the doctor as soon as possible. However, if symptoms have already disappeared, there is no need to seek medical care. Legionnaires' disease (or legionellosis) is a bacterial infection which presents usually as pneumonia, treatable with antibiotics. Incubation time is normally 2-10 days. Symptoms include fever, chills, headache and muscle pain followed by a dry cough and breathing difficulties. Pneumonia caused by legionellosis can be fatal for the elderly with heart and lung conditions.
(Promed 1/13/07)

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China (Jiangsu): Report of 2 cases of epidemic hemorrhagic fever
2 cases of epidemic hemorrhagic fever have been reported in Jiangsu province. No. 2 Hospital recently admitted them for treatment. Experts say that each winter and spring this type of disease breaks out easily, spread by [rodents] carrying the virus. A 42-year-old male patient from Guanyun developed fever of unknown cause and was diagnosed with upper respiratory tract infection. Treatment was ineffective and his condition became more critical. The results of dialysis were also poor. The other patient, a 43-year-old female farmer from Nanjing, inexplicably developed fever and was also incorrectly diagnosed with upper respiratory tract infection. Her high fever and anuria became more serious, and she was diagnosed with epidemic hemorrhagic fever. Wenhu Yao, Director of Nanjing No. 2 Hospital's Infectious Disease Department, explained that the source of epidemic hemorrhagic fever infection is rodents carrying hantavirus. Yao says patients develop high fever and also manifest headache, orbital pain, lower back pain or disabling pain. Yao warns if not treated with antibiotics in time, it can have fatal consequences.

For the most part, rodents and arthropods are the main reservoirs for viruses causing viral hemorrhagic fevers. The viruses carried in rodent reservoirs are transmitted when humans have contact with urine, fecal matter, saliva, or other body excretions from infected rodents. Viruses causing epidemic hemorrhagic fevers in the Far East are likely to be members of the genus Hantavirus. They are associated with severe disease in humans (often presenting with renal involvement), whereas they have little effect on their rodent hosts.
(Promed 1/13/07)

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China (Shanxi): Undiagnosed respiratory illness in school pupils
Between 26 Dec and 31 Dec 2006, 86 students were hospitalized for fever and cough in Wenxi County's Chengguan Middle School. After treatment, sick students and teachers were all discharged from hospital 2 Jan 2007. The exact cause of their illness awaits evaluation. There were no serious cases. Blood samples from Chengguan students have been sent to appropriate national labs. To prevent recurrence of disease, Chengguan Middle School conducted thorough cleaning of each classroom and dormitories in the school to ensure that students can return to class as normal after New Year. The short duration of the outbreak and the absence of severe outcomes suggest a mild seasonal respiratory virus infection.
(Promed 1/9/07)

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China (Guangzhou): Highest number of measles cases in the past 20 years
South China's city of Guangzhou reported 3650 cases of measles in the first 11 months of 2006, the highest number for the same period over the past 20 years. The figure was 88 percent higher than that for the same period in 2005. 69 percent of the measles patients were under 7 years of age; the occurrence peak was between Apr and Aug 2006. The city will carry out free vaccinations against measles for children aged between 8 months and 14 years to control this outbreak. An acute, contagious viral disease, measles usually occurs in childhood. The disease can be life-threatening if patients are not treated in time. In 2005, China recorded about 130 000 measles cases nationwide. The incidence rate had decreased by 95 percent since the 1990s thanks to planned immunizations that started in 1978, with the lowest figure in 1995 of about 5 per 100 000. However, since 1995, the incidence of measles has been rising across the country. 2005 saw the highest incidence rate of 10 per 100 000 in a decade.
(Promed 1/11/07)

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Russia (Dagestan): Botulism associated with canned food
6 people from a single family in the Hasavjurtovskiy district of Dagestan were admitted to hospital 13 Jan 2007, with botulism, after ingestion of canned food products. At present, the family members are in the central regional hospital in Khasavyurt. Several days earlier, 2 people from the Endirej settlement also were brought into the regional hospital with the same diagnosis. Often in Russia, botulism is reported with home canned vegetables and dried or smoked fish. Toxin types A, B, and E are usually found in Russia. Such poisoning can also take place with canned meat, cured pork, ham, and salty bacon.
(Promed 1/15/07)

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Russia (Penza): Norovirus infections recorded
A seasonal rise of acute intestinal infections has been reported in Penza. In addition to viral gastroenteritis caused by enteroviruses and rotaviruses, infections caused by noroviruses have been recorded. Noroviruses were detected for the first time in Penza in 2006. During a single week in Dec 2006 about 160 cases of acute intestinal diseases in adults and up to 70 cases in children were caused by various viral gastrointestinal agents. 20 cases were diagnosed as norovirus infections. Noroviruses are extremely contagious, but sources of infection can include fecal contamination of water supplies as happened at a school in Penza. Viral gastroenteritis can be particularly severe in children and the elderly.
(Promed 1/16/07)

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Russia: Rotavirus outbreaks
An outbreak of rotavirus infection has been reported among small children in Khabarovsk. Since 1 Jan 2007, over 170 children under the age of 5 have been admitted to hospitals. This is a number twice as great as usual at this time of year. Physicians believe that the virus was spread by contaminated apples and mandarins. A message has been delivered to children's institutions instructing them to avoid donation of fruits when planning New Year celebrations. The majority of the patients requiring hospital care were under the age of 5. An outbreak of rotavirus infection has also been recorded in Zelenogorsk. In the past week, more than 40 people have been affected. Local epidemiologists consider the outbreak to be foodborne and state that it mainly affects children under 2 years of age and the elderly.
(Promed 1/17/07)

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Americas
USA: HHS funds work on dose-sparing H5N1 vaccines
In an effort to stretch the nation's supply of vaccines for a potential influenza pandemic, Department of Health and Human Services announced contracts totaling $132.5 million to help 3 companies develop dose-sparing substances, or adjuvants, to be used with H5N1 flu vaccines. HHS awarded a 5-year, $63.3 million contract to GlaxoSmithKline (GSK) and a 5-year, $54.8 million contract to Novartis. In addition, Iomai Corp. received a $14.4 million, 15-month contract, which could lead to an additional $114 million award.

The Novartis contract will help the company bring its MF59 adjuvant, used in seasonal flu vaccines for elderly people in Europe, to the US. Iomai will use the funds to develop an adjuvant skin patch to be used with flu vaccines, while GSK said that the money would be used for an "innovative adjuvant technology." The aim of the contracts, HHS said, is to put each company in a position to produce, within 6 months after the emergence of a flu pandemic, either 150 million doses of an adjuvant-based pandemic vaccine or enough adjuvant for 150 million doses of such a vaccine.

Novartis said their contract will be used to test the safety and effectiveness of the MF59 adjuvant in a pandemic flu vaccine and to support work on an MF59 production facility. The vaccine will be grown in cell culture. Novartis said MF59 may reduce the amount of antigen needed in H5N1 vaccines and may help such vaccines provide cross-protection against "drifted" strains. The Novartis vaccine Fluad, which contains MF59, is licensed in Europe for preventing seasonal flu in the elderly. It said studies have shown that the vaccine induced stronger antibody responses than were seen with an unadjuvanted vaccine.

GSK will use the HHS contract to conduct "research and development leading towards licensure of antigen-sparing prepandemic and pandemic vaccines with adjuvant" to protect more people. The company's H5N1 vaccine is egg-based. In Jul 2006 GSK reported that in a clinical trial, an H5N1 vaccine coupled with the company's adjuvant triggered a good immune response with only 3.8 micrograms (mcg) of antigen, as compared with 15 mcg of antigen in a typical dose of seasonal flu vaccine (for one flu strain).

The $14.4 million award to Iomai is intended to support completion of phase 1 clinical trials of a candidate vaccine with adjuvant. A patch is applied to the skin over the site of vaccination: "Once the patch is applied, the adjuvant passes into the skin, targeting cells called Langerhans cells. Those specialized skin cells carry the adjuvant to the lymph nodes, where it works to boost an individual's immune response to the vaccine."
(CIDRAP 1/17/07 http://www.cidrap.umn.edu/ )

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USA: California produce firm to fund E coli research
Fresh Express, a California company that produces bagged salads and other produce products, announced it would provide up to $2 million for research on how to keep Escherichia coli O157:H7 out of fresh produce. A scientific advisory panel assembled by the company has chosen 5 research priorities and will evaluate research proposals and disseminate findings. The announcement comes in the wake of a string of high-profile E coli outbreaks in recent months that were clearly or possibly linked to fresh produce. Fresh Express said none of its products have ever been shown to have caused an illness outbreak, but the company decided to fund the research and share the results in the hope of benefiting both the produce industry and consumers. The scientific advisory panel has been meeting since May 2006 to pick the most important research gaps concerning the "source, mode of action and life cycle" of E coli O157:H7 in fresh produce.

The chosen research priorities are as follows:
• Determine the potential for E coli to be internalized into lettuce or spinach
• Identify new strategies and technologies to reduce the potential for E coli to contaminate leafy green produce
• Conduct field studies to identify sources, vehicles, and factors that affect the extent of E coli contamination of leafy green produce
• Determine the ability of E coli to multiply in the presence of normal background flora following the harvest of produce such as lettuce and spinach
• Determine the ability of E coli to survive composting processes
(CIDRAP 1/19/07 http://www.cidrap.umn.edu/ )

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USA: FDA finds Taco John's E coli strain on California farms
Food and Drug Administration has tentatively linked the recent Escherichia coli O157:H7 outbreak associated with Taco John's restaurants in Iowa and Minnesota to dairy farms near lettuce fields in California. The outbreak strain of E coli has been genetically matched with E coli in 2 environmental samples gathered on dairy farms near a lettuce-growing area in California's Central Valley. The samples were from standing water on the dairy farms, but FDA has not reached any conclusions about the source of the E coli in the samples. The outbreak affected 81 people in Nov and Dec 2006. 26 people were hospitalized, and 2 suffered hemolytic uremic syndrome. Earlier investigation pointed to iceberg lettuce as the likely source of contamination. There is no sign that any lettuce now on the market is causing illnesses. FDA is continuing its investigation to determine if and how E coli from the dairy farms contaminated lettuce.

Taco John's spokesman Brian Dixon said the company had suspended purchases from the company that had supplied produce to the 3 restaurants involved in the outbreak. Dixon said the company is talking with its suppliers about more testing of irrigation water and possibly holding produce shipments for microbiologic testing. Taco John's outbreak was not related to a nearly simultaneous E coli outbreak linked to Taco Bell restaurants on the East Coast. Investigation pointed to lettuce as the likeliest cause of the Taco Bell outbreak, but the E coli strains in the 2 outbreaks were different.
(CIDRAP 1/12/07 http://www.cidrap.umn.edu/ )

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USA (Multi-state): Outbreaks caused by norovirus
In recent weeks health officials have seen 2-3 times as many norovirus cases as usual. Hundreds of patients have sought help in emergency rooms since mid-Dec 2006. Norovirus can be spread through contaminated food or water, causing large outbreaks. About half of food-borne diseases are thought to be caused by noroviruses, CDC says. But this winter, it is spreading mainly person to person, and experts believe the majority of cases are unreported. It can linger for days on surfaces, and both vomit and stool are highly infectious. It can be present in the stool up to 3 weeks after the patient recovers.

Why it's so widespread this winter is not known. San Quentin State Prison in California closed 3 Jan 2007 to new prisoners and visitors after nearly 500 inmates and guards fell ill with gastroenteritis. In Corpus Christi, Texas, dozens of cases at a time were reported during the holidays, and hundreds more likely went unreported. Hospitals saw about 3 times as many cases as usual. In Asheville, North Carolina, 30 to 40 people have been sick enough to seek emergency room treatment for norovirus symptoms in the past 2-3 weeks. 20 nursing homes in Contra Costa County, California have reported outbreaks, twice as many as in a normal year. The Wisconsin State Division of Public Health put out an alert to local and tribal health departments last month. Outbreaks in schools led a few to close before the holidays. In Montana 6 nursing homes have confirmed positive cases. About 50 University of Missouri football players, coaches, staff and family members were flattened days before Christmas while in El Paso for a footbowl game. More than 3700 patients with gastroenteritis have visited Boston's emergency rooms during the past 6 weeks.

Dr Marc-Alain Widdowson, a norovirus specialist at CDC, said the current outbreak of illness appears to be the worst since 2002-2003. Widdowson speculated that the virus currently circulating may be a different strain, one that is more easily transmitted or one that spawns more severe symptoms. There are 30 to 40 major norovirus strains; new variations are often responsible for spikes in the number of cases. CDC doesn't yet have information on strains circulating now.
(Promed 1/5/07, 1/12/07, 1/18/07)

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Canada (Montreal): Norovirus outbreak in hospitals
An epidemic of viral gastroenteritis has spread to at least 29 health-care institutions across Montreal. "It's certainly one of the worst years in the past 8-10," said Mark Miller, chief of infection prevention and control at the Jewish General Hospital. Similar outbreaks have been reported in the US, Europe and Japan. Experts suspect that a new, more contagious strain of the norovirus has emerged. A total of 12 patients and 8 staff at the Jewish General have developed viral gastroenteritis. The hospital has taken extraordinary precautions to contain the outbreak. Less than 3 weeks ago, 6 Montreal hospitals were hit with outbreaks of gastroenteritis. By yesterday, that number had jumped to 13. 16 nursing homes are grappling with gastro outbreaks, up from 10 in Dec 2006. At the Centre hospitalier de LaSalle, a dozen patients have come down with gastroenteritis, forcing the hospital to quarantine the second floor. Miller explained that the hospital outbreaks probably originated in the community. People visiting hospitals have unwittingly passed it on to patients.
(Promed 1/9/07)

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USA (Maryland): 2 cases of infant botulism
2 cases of infant botulism have been reported in residents at the Fort Meade Army post since Oct 2006. Fort Meade spokesman Travis Edwards says 1 infant, who was diagnosed 6 Oct 2006, has recovered. The second, who was diagnosed late Dec 2006, remains hospitalized at Walter Reed Army Medical Center. Both infants were under the age of 6 months when they were diagnosed. Some 6000 people live on the installation. Officials placed hay on a dirt lot at the base to reduce the spread of dust, and a fact sheet about infant botulism has been distributed. Infant botulism results from the ingestion of spores of the Clostridium botulinum bacterium found naturally in soils and in some contaminated food products. It is the most common form of botulism in the US.
(Promed 1/12/07)

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USA (Arizona): Valley fever cases soar to a record high
Valley fever is at epidemic levels in Arizona, afflicting 56 percent more people in 2006 than in 2005. A record 5493 Arizonans were diagnosed with the disease, but as in years past, officials say thousands of other cases went unreported. A study in May 2006 showed that 1 in every 3 Arizonans diagnosed with pneumonia actually had valley fever [coccidiomycosis]. Health officials are unsure what caused the increase but point to weather changes. The wet winter of 2005, followed by many dry months in 2006, may have been responsible. Valley fever is an infection in the lungs caused by a fungus, Coccidioides immitis, found in soils primarily in southwestern states. The fungus flourishes in rain, and then is stirred into the air in dry conditions. About 60 percent of people who inhale the spore and contract the disease have mild symptoms. The patients may suffer fatigue, extreme pain in joints and difficulty in breathing. The exhaustion can linger for months. Very seldom, it can lead to other complications that may require life-long therapy. One of the problems is that valley fever is often misdiagnosed. Some doctors believe their patients have pneumonia. Antibiotics don't work on valley fever. The most common treatment is anti-fungal medication. There are more cases in Arizona than anywhere else in the country, and about half of the cases in the US come out of Maricopa County. 28 Arizonans died of valley fever in 2005.
(Promed 1/14/07, 1/16/07)

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USA (Rhode Island): 3 confirmed cases of Mycoplasma pneumoniae encephalitis
Health investigators concluded that a third child, a West Warwick middle schooler, suffered from encephalitis probably brought on by a common infection that usually causes pneumonia. The bacterium that seems to have caused the infection, Mycoplasma pneumoniae, rarely causes encephalitis, and encephalitis itself is rare, so the cluster of 3 cases -- which included a death -- has prompted an intensive investigation by CDC. The surviving children have recovered. A possibility under consideration is that a new, more virulent strain of the bacteria may have developed.
(Promed 1/5/07)

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Canada: Community acquired MRSA in humans associated with horse contact
Horse and pet owners are at more risk of contracting an infection spreading across the country than the rest of the population. Scott Weese, associate professor at Ontario Veterinary College, University of Guelph, started looking at community associated methicillin-resistant Staphylococcus aureus (CA-MRSA) after a cluster of cases was found in horses in Ontario. A human strain of the bacteria was found in the horses, meaning the infection initially was passed from people to horses. "But now it moves between horses and people. People working with horses have a higher prevalence of carrying this bug," he said. Surveys have found that about 14 percent of equine veterinarians are carrying the bacteria and more than 10 percent of people working with horses are carrying the bug. Almost all have the unusual strain found in horses.

Much of the time the bacteria will be carried in the nose and will not cause problems for either horses or humans. "But if the horses are carrying it, they are at greater risk of infection, and there is a risk of transmitting it to people. . ." he said. MRSA has also been found in domestic pets, such as dogs, cats and rabbits, but, unlike horses, the strain of bacteria mirrors whatever is found in people. Pets can act as a reservoir of infection, and doctors treating people with MRSA should also be looking at the pets, particularly if people in a household are becoming re-infected, he said.

Victoria appears to be the epicenter of the countrywide epidemic. Victoria already has seen 800 cases of CA-MRSA, and its cousin, hospital-acquired MRSA, since Apr 2006. While HA-MRSA is resistant to many antimicrobials, CA-MRSA responds to several types of common treatment. Typically, it is seen in high-risk groups like the homeless and drug users, but increasingly it is being seen in the military and sports teams. Routine infection control, prudent use of antibiotics and hand washing are the best protection, Weese said.
(Promed 1/8/07)

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USA/Canada: US wants to end BSE-linked ban on older Canadian cattle
The US Department of Agriculture (USDA) proposed to reopen the US border to older Canadian cattle and beef for the first time since bovine spongiform encephalopathy cropped up in Canada in 2003. USDA reopened the border to live Canadian cattle under age 30 months in 2005, but the ban remained on older cattle and beef. USDA said a formal risk assessment indicates that if BSE prevalence in Canada declines or stays the same over the next 20 years, the risk that BSE would enter and spread within the US is negligible. Agriculture Secretary Mike Johanns said, "We previously recognized Canada's comprehensive set of safeguards and we have now completed a risk assessment confirming that additional animals and products can be safely traded. . ." The rule would allow importation of live cattle born on or after Mar 1, 1999, effectively permitting cattle much older than 30 months. Meat from cattle of all ages would also be permitted. In USDA's estimation, the Mar 1999 date marks the start of effective enforcement of Canada's ban on putting cattle protein into cattle feed, a practice that is believed to spread the BSE agent, if present. Canada and US both imposed similar feed bans Aug 1997. The Mar 1999 date was picked to allow 6 months for implementation of the ban, plus another year for potentially contaminated feed to have passed through the system. USDA is also proposing to allow importation of Canadian cattle blood and blood products and part of the small intestine of cattle. USDA said it followed World Organization for Animal Health (OIE) guidelines in assessing the possible risks of lifting the ban on older Canadian cattle and meat. Officials estimated the prevalence of BSE in Canada to be 6.8 cases per 10 million adult cattle. USDA examined the risk in relation to all the BSE safeguards in place in Canada and the US, including the ban on putting higher-risk cattle parts into the food supply. The assessment recognized that 3 of the 8 BSE-infected cattle found in Canada so far were born after Mar 1999.
(CIDRAP 1/5/07 http://www.cidrap.umn.edu/ )

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Africa
Nigeria (Sokoto, Katsina): Report of new avian influenza H5N1 outbreaks in poultry
Nigeria confirmed 12 Jan 2006 a new outbreak of H5N1 bird flu in the Sokoto state. Officials culled more than 20,000 chickens on a farm in Sokoto, which had no previous outbreaks. Reportedly the birds in Sokoto have been culled. Authorities are also investigating at least 2 suspected cases of avian influenza in nearby Katsina. Reportedly, 5,000 infected chickens and pigeons on 3 farms were culled. Since 2006, Nigeria has culled more than 450 000 infected chickens.
(Promed 1/13/07; CIDRAP 1/12/07 http://www.cidrap.umn.edu/ )

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Egypt: Tamiflu-resistant H5N1 strain surfaces; new human case of avian influenza H5N1 infection
2 patients who recently died of H5N1 avian influenza in Egypt had a strain of the virus that was moderately resistant to oseltamivir (Tamiflu). News of the drug-resistant strain came as Egypt's health ministry announced a new human H5N1 case--a 27-year-old woman from Beni Suef, about 62 miles south of Cairo. Also, reportedly, a 20 year old woman is being treated for suspected avian flu at a hospital in Fayoum, southwest of Cairo. Oseltamivir is recommended by WHO as the first-line drug for H5N1 patients. The patients who had resistant infections were a 16-year-old girl and her 26-year-old uncle, who lived in the same house in Gharbiyah province, 50 miles northwest of Cairo. They got sick Dec 2006; the man was hospitalized 17 Dec 2007, followed by his niece 2 days later. Both received 2 tablets of oseltamivir Dec 21. The girl died Dec 25 and her uncle died Dec 28. They were part of a possible family cluster; H5N1 avian influenza was also confirmed in a 30-year-old woman in the household, said to be the man's sister, who died. WHO said the patients reportedly had contact with sick ducks.

Genetic sequencing suggested that the virus had "moderately reduced susceptibility" to osteltamivir. The same type of mutation was previously identified in a Vietnamese case in 2005. But in contrast to the Egyptian cases, the virus in the Vietnamese case appeared to be highly resistant to oseltamivir. The case involved a girl who was started on oseltamivir the day she was hospitalized, receiving the recommended dose of 75 mg twice a day for 5 days. Fred Hayden, a WHO avian flu and antiviral expert, said the drug-resistant strains in the Egyptian patients likely developed after they were treated with oseltamivir. The Vietnamese strains were definitely resistant to oseltamivir, but the Egyptian ones were only shown to be less susceptible to the drug. There is no evidence that oseltamivir-resistant strains are spreading in Egypt or elsewhere. WHO is not changing its antiviral treatment recommendations, because the clinical level of resistance of the mutations is not yet well established. Implications of the findings are limited because the mutation is not associated with any known changes in transmissibility of the virus between humans, WHO said. The oseltamivir-resistant strain in Egypt was susceptible to zanamir (Relenza), and to amantadine, which is not normally used as a first-line treatment because many avian flu strains are resistant to it.
(CIDRAP 1/18/07 http://www.cidrap.umn.edu/ ; Promed 1/15/07, 1/18/07)

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1. Updates
Avian/Pandemic influenza updates
- UN: http://influenza.un.org/. UN response to avian influenza and the pandemic threat. Also, http://www.irinnews.org/Birdflu.asp provides information on avian influenza in order to help the humanitarian community.
- 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/.
- 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
During the first epidemiological week (Dec 31, 2006 to Jan 6, 2007), the percentage of outpatient visits to sentinel physicians for influenza-like illness (ILI) has decreased by 1.4% compared with last week and is 52.1% higher than the same period in 2006. From week 50, 2006 to week 1, 2007, the respective ILI consultation rates (per 100 outpatient visits) were 4.53, 5.35, 5.63 and 5.55. Comparing to last week, the consultation rates decreased in Taipei, South and Kao-Ping regions, while the remaining 3 regions reported an increasing trend. The dominant respiratory virus identified for week 50, 2006 to week 1, 2007 was influenza B virus. To date, 37 clusters have been reported this influenza season. Based on reporting dates, 9 additional severe influenza cases were reported in week 1. Based on onset dates, 49 severe cases have been reported cumulatively in the 2006-2007 epidemic season. Among these, 10 were confirmed, 19 were excluded, and 20 are still pending. Between weeks 26, 2006 to week 1, 2007, 1 death has been reported.
(Taiwan IHR Focal Point 1/17/07)

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Cholera, diarrhea & dysentery
Philippines (Northern Samar)
Department of Health (DOH) confirmed reports on the outbreak of diarrhea and amoebiasis diseases in the flood-stricken municipalities of Northern Samar. Reportedly the DOH disaster team was in Northern Samar 2 Jan 2007 in order to conduct Rapid Assessment of the area, health status of the families, health needs and the magnitude of damage to health infrastructure and other lifeline. The Epidemiology and Surveillance Team of the DOH reported the occurrence of amoebiasis and diarrhea cases. About 27 cases were reported in Catarman, 38 in Mondragon, 80 cases in San Roque and 5 in Lapinig. The team reported 163 cases.
(Promed 1/12/07)

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Dengue
Malaysia
5 Malaysian states have registered a leap in the number of dengue fever cases in the first week of the year, with authorities fearing that the mosquito-borne disease could further spread due to the rainy season. The northeastern state of Kelantan registered the highest jump, from 18 cases in the last week of Dec 2006 to 32 cases in the first week of Jan 2007. The central Selangor state recorded the highest number of cases at 562, compared to 471 the previous week. The other 3 states that recorded an increase were the central state of Pahang, from 35 to 47, the state of Negeri Sembilan, from 20 to 26, and the eastern Sabah state, from 9 to 12. The first week of the year recorded a total of 1155 suspected dengue cases. Officials have been deployed in the affected states to help with dengue control operations. Officials have been also sent to the southern Johor state, which was hit by massive floods to prevent an outbreak of the disease.

Also, 2 deadlier forms of dengue virus have resurfaced in Malaysia. The resurgence is why doctors are seeing patients with the more severe form of dengue fever, said University Malaya Medical Centre's Prof Dr Sazaly Abu Bakar. "This year, we have been seeing predominantly the Den-2 and Den-3 viruses (in samples sent for testing)," he said. Den-2 and Den-3 are 2 of the 4 viruses that cause dengue and dengue haemorrhagic fever. These 2 viruses have a particularly bad effect on those who have survived dengue fever caused by Den-1. Immunity from one virus does not confer immunity from the other 3. While Den-1 is endemic to Malaysia, the incidence of Den-2 and Den-3 occurs in cycles. Den-2 last struck in 1998/99 and Den-3 in 2003. Den-4 has lost the predominance it had in the '60s and '70s. (Promed 1/11/07)

Hong Kong/Malaysia
The Centre for Health Protection has confirmed the first imported Dengue fever case of 2007, involving a 31-year-old Tuen Mun woman. She travelled to Malaysia 24-31 Dec 2006 and came down with fever, headache, a rash, and muscle and joint pain 2 Jan 2007. She was admitted to Tuen Mun Hospital 6 Jan 2007 and is now in stable condition. Her travel companions have no symptoms.
(Promed 1/11/07)

Indonesia
Cibinong Hospital has been forced to move most of its dengue fever patients to its function hall. The hospital had run out of room to accommodate the dengue patients, who number 58 in total, including 18 children. Most of the patients are from Cibinong and Cileungsi, Gunung Putri and Citeureup districts. Also, multiple cases of dengue fever have been reported in Yogyakarta, where 1 person has died so far. Areas affected by the 27 May 2006 earthquake were prone to the outbreak of disease. Many earthquake survivors have been forced to live in makeshift shelters and tents, leaving them exposed to mosquitoes. Data at the Bantul Health Office showed that following the earthquake the number of people suffering from dengue fever jumped by 290, up to 498. 6 of these died as a result of the disease. Bantul Health Office launched an initiative Dec 29 2006 to eradicate mosquitoes. The Yogyakarta mayoralty has donated 1 ton of anti-larva abate powder to residents to help prevent future dengue outbreaks.
(Promed 1/11/07)

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2. Articles
Study sheds light on lethality of 1918 flu virus
A virus recovered from victims of the 1918 influenza pandemic kills by replicating so rapidly that it revs the immune system into overdrive. The finding, from a small study done in cynomolgus macaque monkeys, appears to confirm historical accounts of the 1918 pandemic that describe victims drowning from within as their lungs filled with blood and fluid. And it may offer a starting place for interventions against future pandemics, because avian influenza H5N1, the viral strain currently considered the most substantial pandemic threat, causes a similar intense immune reaction in human victims.

The study, led by Yoshihiro Kawaoka of the University of Wisconsin–Madison, used a virus that was reassembled in 2005 out of fragments recovered from the tissues of 1918 victims. The researchers compared clinical course, pathology, and genomic analyses for 7 monkeys experimentally infected with high doses of the 1918 virus and 3 monkeys infected with a modern virus from the same H1N1 family as the 1918 strain. Monkeys from both groups were euthanized on the third and sixth days after infection. The scientists had planned to let the experiment run for 21 days, but the 1918-infected monkeys were so gravely ill that they had to be euthanized at day 8. The lungs of the 1918-infected group, but not the modern-virus group, were filled with blood and watery fluid and had widespread tissue destruction. The 1918 virus kept replicating throughout the monkeys' respiratory systems until they were put to death—unlike the modern virus, which the last monkey from the modern-virus group largely cleared from its system. The macaques that received the conventional virus spiked an immune response after 3 days, but that response faded by day 6 as healing began. The 1918-infected group, on the other hand, experienced an initially muted immune response that grew progressively stronger and never abated. That over-revved reaction was recorded last fall in mice experimentally infected with the same recovered 1918 virus.

But it also has suggested a possible defense strategy if a pandemic begins--something dearly sought by public health planners. On the basis of their findings, the authors recommend additional research into drugs that damp down the immune-system response triggered by the 1918 virus. One possible defense strategy hinges on statins, a class of drugs used against cardiovascular disease that target the same inflammatory response observed in the flu studies. Several studies have found that patients who are taking statins experience less sepsis and bacteremia. And a forthcoming article in the journal Critical Care Medicine follows a group of 11,400 patients with atherosclerotic disease, half of whom were taking statins, and finds that statin use cut the risk of death from infections—mostly pneumonia—by two thirds.

Kobasa D, Jones S, Shinya K, et al. (Letter) Nature 2007 Jan 18;445. http://www.nature.com/nature/journal/v445/n7125/abs/nature05495.html.
(CIDRAP 1/17/07 http://www.cidrap.umn.edu/ ; Promed 1/18/07)

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Antiviral effects on influenza viral transmission and pathogenicity: observations from household-based trials
Halloran ME et al. Am J Epidemiol. 2007 Jan 15;165(2):212-21. Epub 2006 Nov 6. http://aje.oxfordjournals.org/cgi/content/abstract/165/2/212
Abstract: “Four household-based, randomized clinical trials, two each of zanamivir and oseltamivir, were designed primarily to estimate the effect of postexposure prophylaxis on preventing influenza illness in household contacts. However, the effect of influenza antivirals on infectiousness as well as on the ability of the virus to cause disease-the pathogenicity-have important public health consequences. The authors show how such studies can provide estimates of pathogenicity, antiviral efficacy for pathogenicity, and the antiviral effect on infectiousness. Analysis of the four studies confirmed the high prophylactic efficacy against illness of both zanamivir (75%, 95% confidence interval (CI): 54, 86) and oseltamivir (81%, 95% CI: 35, 94). The effect on reducing infectiousness was 19% (95% CI: -160, 75) for zanamivir and 80% (95% CI: 43, 93) for oseltamivir. Pathogenicity in controls ranged from 44% (95% CI: 33, 55) to 66% (95% CI: 48, 72). Efficacy in reducing pathogenicity for zanamivir was 52% (95% CI: 19, 72) and 56% (95% CI: 14, 77) in the two studies; for oseltamivir, it was 56% (95% CI: 10, 73) and 79% (95% CI: 45, 92). Studies of influenza antivirals in transmission units would be improved if randomization schemes were used that allow estimation of the antiviral effect on infectiousness from individual studies.”

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Subclinical Infection with Avian Influenza A H5N1 Virus in Cats
Michael Leschnik et al. EID. Volume 13, Number 2–February 2007. http://www.cdc.gov/eid/content/13/2/242.htm
Abstract: “Avian influenza A virus subtype H5N1 was transmitted to domestic cats by close contact with infected birds. Virus-specific nucleic acids were detected in pharyngeal swabs from 3 of 40 randomly sampled cats from a group of 194 animals (day 8 after contact with an infected swan). All cats were transferred to a quarantine station and monitored for clinical signs, virus shedding, and antibody production until day 50. Despite unfamiliar handling, social distress, and the presence of other viral and nonviral pathogens that caused illness and poor health and compromised the immune systems, clinical signs of influenza did not develop in any of the cats. There was no evidence of horizontal transmission to other cats because antibodies against H5N1 virus developed in only 2 cats.”

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Amantadine-Resistant Influenza A (H3N2) Virus in Japan, 2005-2006
Saito R, Li D, Suzuki H. N Engl J Med. 2007 Jan 18;356(3):312-3. http://content.nejm.org/cgi/content/short/356/3/312 (references removed)
To the Editor: “Strains of influenza A (H3N2) virus with a specific mutation (Ser31Asn) have recently shown a dramatic increase in resistance to amantadine in communities in Asia and North America. This resistance in 70 to 90% of strains has occurred despite the absence of sustained selective drug pressure. We conducted a multicenter study to assess the prevalence of such resistance during the 2005–2006 influenza season in Japan. The study included molecular analysis of the hemagglutinin gene of resistant and sensitive influenza A (H3N2) viruses. We examined a total of 415 isolates of influenza A virus, sampled . . .”

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Ontario SARS report cites health system failings
Inadequate worker-safety protocols probably contributed to the severity of the 2003 SARS epidemic in Ontario. Justice Archie Campbell authored the 1204-page report, released Jan 9, 2007, on behalf of the SARS Commission. During Ontario's SARS epidemic, Feb - Jun 2003, the disease struck 375 people and killed 44. One of the most glaring breakdowns in worker protections involved controversy about the use of N95 respirators. Few hospitals complied with a law requiring them to properly train and fit-test employees who used the respirators. The commission also found that some Ontario hospital officials argued against N95 respirator use on the grounds that healthcare workers could safely wear the less expensive surgical masks. The commission identified several other shortcomings in Ontario's response to the crisis, including a lack of infection control expertise, poor communication between public health agencies and hospitals, nonfunctional health and safety committees, blurred authority and accountability, inadequate surveillance, minimization of the role of the Ministry of Labor, and failure to heed the advice of front-line healthcare workers. The commission contrasted the response of Ontario with the response in British Columbia, where a patient was also hospitalized at about the same time for SARS, but no major outbreak occurred. "A combination of worker safety and infection control culture at Vancouver General, with better systemic preparedness, ensured that BC was spared the devastation that befell Ontario," Campbell pointed out. Full SARS Commission report: http://www.sarscommission.ca/report/index.html
(CIDRAP 1/12/07 http://www.cidrap.umn.edu/ )

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The US Capitol bioterrorism anthrax exposures: clinical epidemiological and immunological characteristics
Doolan DL et al. J Infect Dis 2007 Jan 15;195(2):174-84.
Abstract: “Background. Bioterrorism-related anthrax exuposures occurred at the US Capitol in 2001. Exposed individuals received antibiotics and anthrax vaccine adsorbed immunization. Methods. A prospective longitudinal study of 124 subjects--stratified on the basis of spore exposure, nasopharyngeal culture results, and immunization status from inside and outside an epidemiologically defined exposure zone--was performed to describe clinical outcome and immune responses after Bacillus anthracis exposure. Antibody and cell-mediated immune (CMI) responses to protective antigen (PA) and lethal factor were assayed by enzyme-linked immunosorbent assay and fluorescence-activated cell sorting. Results. Antibody and CMI dose-exposure responses, albeit generally of low magnitude, were seen for unimmunized subjects from inside, within the perimeter, and outside the exposure zone and in nonexposed control subjects. Anti-PA antibody and CMI responses were detected in 94% and 86% of immunized subjects. No associations were seen between symptoms and exposure levels or immune responses. Conclusions. Anthrax spores primed cellular and possibly antibody immune responses in a dose-dependent manner and may have enhanced vaccine boost and recall responses. Immune responses were detected inside the perimeter and outside the exposure zone, which implies more-extensive spore exposure than was predicted. Despite postexposure prophylaxis with antibiotics, inhalation of B. anthracis spores resulted in stimulation of the immune system and possibly subclinical infection, and the greater the exposure, the more complete the immune response. The significance of low-level exposure should not be underestimated.”
(CIDRAP 1/10/07 http://www.cidrap.umn.edu/ )

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First isolation of Clostridium difficile 027 in Japan
H Kato et al. Eurosurveillance weekly releases 2007. Volume 12 / Issue 1. http://www.eurosurveillance.org/ew/2007/070111.asp#2
“We report the first isolation of a variant strain of Clostridium difficile from a patient with pseudomembranous colitis in Japan. The strain was chararacterized as North American pulsed field gel electrophoresis type 1 (NAP1), PCR ribotype 027, toxinotype III. This strain has been reported previously as the cause of outbreaks in Canada, USA, the Netherlands, the UK, France, and Belgium. . .”

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Reduction in infectivity of endogenous transmissible spongiform encephalopathies present in blood by adsorption to selective affinity resins
Gregori L et al. Lancet. 2006 Dec 23;368(9554):2226-30.
Abstract: “BACKGROUND: Transmissible spongiform encephalopathies (TSE) can be contracted through blood transfusion. Selective adsorption of the causative agent from donated blood might be one of the best ways of managing this risk. In our study, affinity resin L13, which reduces brain-derived infectivity spiked into human red blood cell concentrate by around 4 log(10)ID(50), and its equivalent, L13A, produced on a manufacturing scale, were assessed for their ability to remove TSE infectivity endogenously present in blood. METHODS: 500 mL of scrapie-infected hamster whole blood was leucoreduced at full scale before passage through the affinity resins. Infectivity of whole blood, leucoreduced whole blood (challenge), and the recovered blood from each flow-through was measured by limiting dilution titration. FINDINGS: Leucoreduction removed 72% of input infectivity. 15 of 99 animals were infected by the challenge, whereas none of the 96 or 100 animals inoculated with the final flow-throughs from either resin developed the disease after 540 days. The limit of detection of the bioassay was 0.2 infectious doses per mL. The overall reduction of the challenge infectivity was more than 1.22 log10ID. The results showed removal of endogenous TSE infectivity from leucoreduced whole blood by affinity ligands. The same resins adsorb normal and abnormal prion protein from human infections with variant, sporadic, and familial Creutzfeldt-Jakob disease, in the presence of blood components. INTERPRETATION: TSE affinity ligands, when incorporated into appropriate devices, can be used to mitigate the risks from TSE-infected blood, blood products, and other materials exposed to TSE infectivity.”

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Listeria monocytogenes Infection from Foods Prepared in a Commercial Establishment: A Case-Control Study of Potential Sources of Sporadic Illness in the United States
http://www.journals.uchicago.edu/CID/journal/issues/v44n4/40007/brief/40007.abstract.html - fn1
Jay K. Varma et al. Clinical Infectious Diseases. 2007;44:000.
Abstract: “Background. Listeria monocytogenes has been estimated to cause >2500 illnesses and 500 deaths annually in the United States. Efforts to reduce foodborne listeriosis have focused on foods frequently implicated in outbreaks. Potential sources for L. monocytogenes infection not associated with outbreaks remain poorly understood. Methods. The Foodborne Diseases Active Surveillance Network conducts surveillance for culture-confirmed listeriosis at clinical laboratories in 9 states. After excluding outbreak-associated cases, we attempted to enroll eligible case patients with L. monocytogenes infection in a case-control study from 2000 through 2003. Control subjects were recruited through health care providers and were matched to case patients by state, age, and immunosuppression status. Data were collected about exposures occurring in the 4 weeks before specimen collection from the case patients. Results. Of the 249 case patients with L. monocytogenes infection, only 12 (5%) had cases that were associated with outbreaks; 6 other patients were ineligible for other reasons. Of 231 eligible case patients, 169 (73%) were enrolled in the study. We classified 28 case patients as having pregnancy-associated cases. We enrolled 376 control subjects. In multivariable analysis, L. monocytogenes infection was associated with eating melons at a commercial establishment (odds ratio, 2.6; 95% confidence interval, 1.4–5.0) and eating hummus prepared in a commercial establishment (odds ratio, 5.7; 95% confidence interval, 1.7–19.1). Conclusions. Most cases of L. monocytogenes infection were not associated with outbreaks. Reducing the burden of foodborne listeriosis may require interventions directed at retail environments and at foods, such as melons and hummus, that are not commonly recognized as high risk. Because of the severity of listeriosis, pregnant women and other persons at risk may wish to avoid eating these newly implicated foods.”

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Reduction in the incidence of invasive listeriosis in foodborne diseases active surveillance network sites, 1996–2003
Andrew C. Voetsch et al. Clinical Infectious Diseases. 2007;44:000.
Abstract: “Background. Listeriosis is a leading cause of death among patients with foodborne diseases in the United States. Monitoring disease incidence is an important element of listeriosis surveillance and control. Method. We conducted population-based surveillance for Listeria monocytogenes isolates obtained from normally sterile sites at all clinical diagnostic laboratories in the Foodborne Diseases Active Surveillance Network from 1996 through 2003. Results. The incidence of laboratory-confirmed invasive listeriosis decreased by 24% from 1996 through 2003; pregnancy-associated disease decreased by 37%, compared with a decrease of 23% for patients 50 years old. The highest incidence was reported among Hispanic persons from 1997 through 2001. Differences in incidence by age group and ethnicity may be explained by dietary preferences. Conclusion. The marked decrease in the incidence of listeriosis may be related to the decrease in the prevalence of L. monocytogenes contamination of ready-to-eat foods since 1996. The crude incidence in 2003 of 3.1 cases per 1 million population approaches the government's Healthy People objective of 2.5 cases per 1 million population by 2005. Further decreases in listeriosis incidence will require continued efforts of industry and government to reduce contamination of food and continued efforts to educate consumers and clinicians.”

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Indigenous Case of Disseminated Histoplasmosis, Taiwan
Chung-Hsu Lai et al. EID. Volume 13, Number 1–January 2007. http://www.cdc.gov/ncidod/EID/13/1/127.htm
Abstract: “We report the first indigenous case of disseminated histoplasmosis in Taiwan diagnosed by histopathology of bone marrow, microbiologic morphology, and PCR assay of the isolated fungus. This case suggests that histoplasmosis should be 1 of the differential diagnoses of opportunistic infections in immunocompromised patients in Taiwan.”

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3. Notifications
UNICEF Avian and Pandemic Influenza Communication Resources
Online centre for avian and pandemic influenza related communication resources. The Resource Centre aims to provide users with strategic communication products, information and tools developed around the globe to prevent, contain and respond to outbreaks of highly pathogenic avian influenza virus. The search function allows users to search the site by type of resource, audience, country or language.
http://www.unicef.org/influenzaresources/

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Satellite Broadcast: Epidemiology and Prevention of Vaccine-Preventable Diseases 2007
CDC and the Public Health Training Network will present the satellite broadcast/webcast series, Epidemiology and Prevention of Vaccine-Preventable Diseases. This series is scheduled from 12 pm - 4 pm, Jan 25 and Feb 1, 8, and 15, 2007. Session 1 includes an overview of general immunization concepts and principles and vaccine safety, storage and handling, and administration. Session 2 topics include pertussis, pneumococcal disease (childhood), polio, rotavirus, and Haemophilus influenzae type b. Session 3 topics include measles, rubella, varicella, zoster, and meningococcal disease. Session 4 topics include hepatitis B, hepatitis A, influenza, human papillomavirus, and pneumococcal disease (adult). Additional information regarding the series is available at http://www2.cdc.gov/phtn/epv07/default.asp. Information for site administrators regarding establishing and registering a viewing location: http://www.cdc.gov/phtnonline.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5601a5.htm
(MMWR January 12, 2007 / 56(01);10)

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Introduction to mathematical models of global and emerging infections
Short Course for Public Health Professionals; 3-14 Sep 2007 at Imperial College London.
Our understanding of infectious-disease epidemiology and control has been greatly increased through mathematical modelling. Insights from this increasingly-important and exciting field are now informing policymaking at the highest levels, for pandemic influenza, SARS, HIV/AIDS, etc. It is taught by active researchers in the world-leading Department of Infectious Disease Epidemiology. Participants need only a basic mathematical ability (high school level is more than sufficient): most course participants do not use math regularly, and calculation is done using Excel and the user-friendly modelling package, Berkeley Madonna; hence manipulation of equations is not required. We offer an optional 'maths refresher' day 2 Sep 2007 for free. This programme will be of interest worldwide to public health professionals, policy makers, commissioning agencies, immunologists,medical, veterinary, biological and pharmaceutical scientists. For more information: http://www.imperial.ac.uk/cpd/epidemiology/

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NSF BioSurveillance Workshop Final Call for Papers
May 22, 2007, New Brunswick, New Jersey, USA
Paper submission deadline: Jan 30, 2007; Notification of acceptance: Feb 20, 2007.
The 2007 NSF BioSurveillance Workshop (BioSurveillance 2007) will build on the success of the first NSF BioSurveillance Workshop, hosted by the University of Arizona's NSF BioPortal Center Mar 2006, and will bring together infectious disease informatics (IDI) researchers and practitioners to discuss selected topics directly relevant to data sharing and analysis for real-time animal and public health surveillance. The Workshop objectives are: (a) review and examine various real-time data sharing approaches for animal and public health surveillance from both technological and policy perspectives; (b) identify key technical challenges facing syndromic surveillance for both animal and human diseases, and discuss and compare related systems approaches and algorithms; and (c) provide a forum to bring together IDI researchers and practitioners to identify future research opportunities. In addition to systems and technology research submissions, we strongly encourage case studies of successful local, state, and national biosurveillance system implementations. For more information: http://ai.arizona.edu/BIO2007.

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The Asia Pacific Leadership Program
Entering its sixth year, the Asia Pacific Leadership Program (APLP) is the center of excellence for leadership education in the Asia Pacific region. The APLP is a graduate certificate program combining the development of regional expertise with the enhancement of individual leadership capacity. Based at the East-West Center in Honolulu, Hawaii, the program is creating a network of dynamic leaders from around the world who are familiar with the critical issues and cultures of the Asia Pacific region and trained to work collaboratively. The program involves intensive coursework and field studies. All participants receive an APLP Entry Fellowship valued at approximately $10,000. APLP seeks outstanding individuals with high leadership potential from across the Asia Pacific region, North America and beyond. APLP Fellows come together from all walks of life, including areas as diverse as government, business, NGOs, health sciences, media, monastic orders, and academe. Participants will gain a broad regional perspective, become knowledgeable about the critical challenges facing the Asia-Pacific region, and be trained to exercise collaborative leadership and promote cooperation. For more information visit: http://www.eastwestcenter.org/aplp. The application deadline is Feb 15, 2007.
(East-West Center Association)

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Workshop: Converging Technologies to Combat Emerging Infectious Diseases
Through the APEC Center for Technology Foresight (APEC CTF), under the Industrial Science and Technology Working Group (ISTWG) of APEC and National Electronics and Computer Technology Center (NECTEC), you are invited to attend a workshop on "Converging Technologies to Combat Emerging Infectious Diseases", 5-7 Feb 2007 at Khaolak Merlin resort, Phang-nga, Thailand. The main purpose of the workshop is to enhance the region's capacity in using converging technologies to contribute to the prevention and management of emerging infectious diseases. Experts are invited to discuss on converging technologies to prevent and manage emerging infectious diseases by using scenario planning. For more information visit: http://www.apecforesight.org/apec_wide/EID/eid_main.cfm
(APEC Center for Technology Foresight)

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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