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Vol. X, No. 3 ~ EINet News Briefs ~ Feb 02, 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: WHO to speed release of vaccine viruses if pandemic risk grows
- Hungary (Csongrad): New avian influenza outbreak in poultry suspected
- Azerbaijan: Report of suspected human case of avian influenza H5N1 infection
- Indonesia (Central Java): Confirmed case of human infection of avian influenza H5N1
- Indonesia (West Java): More chickens suspected of dying from avian influenza
- Thailand (Ang Thong): Third province affected by avian influenza H5N1
- Japan: New outbreak of avian influenza in Okayama, another suspected in Miyazaki
- Russia (Krasnodar): Avian influenza reportedly resurfaces in poultry
- Russia (Volgograd, Astrakhan): Increased risk of plague
- Russia (Moscow oblast): 3 cases of typhoid fever
- New Zealand (Auckland): 4 cases of typhoid
- Philippines (Caraga): Cases of gastroenteritis and typhoid fever
- Malaysia (Perak): Chikungunya strikes 36 persons
- Japan: First case of Chikungunya, imported from Sri Lanka
- China: Blood products recall, hepatitis C virus contamination
- Indonesia (Jambi): Incidence of filariasis reported to be increasing
- USA: HHS ties pandemic mitigation advice to severity
- USA: Possible increased risk of contamination from bagged greens
- USA (California): Debate on produce safety measures
- USA/Mexico: Norovirus outbreak hits world cruise
- USA (Virginia): Norovirus outbreak affects 100 guests
- Canada (Ontario): Extensively drug-resistant tuberculosis
- USA (Texas/Kansas, North Dakota): Cases of hantavirus infection
- USA (Minnesota): Human herpesvirus 1 outbreak in wrestlers
- Peru (Condorcanqui, Madre de Dios, Puno): Vampire bat rabies kills children
- Nigeria: Report of first human case of avian influenza

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

2. Articles
- CDC EID Journal, Volume 13, Number 2—Feb 2007
- Avian influenza H5N1 infections in Indonesian cats
- Hampered Foraging and Migratory Performance in Swans Infected with Low-Pathogenic Avian Influenza A Virus
- Activities, Achievements, and Lessons Learned during the First 10 Years of the Foodborne Diseases Active Surveillance Network: 1996–2005
- Bioterrorism Training in U.S. Emergency Medicine Residencies: Has It Changed since 9/11?
- Laboratory-confirmed non-O157 Shiga toxin-producing Escherichia coli--Connecticut, 2000-2005
- West Nile Virus Transmission Through Blood Transfusion--South Dakota, 2006
- The Changing Epidemiology of Invasive Haemophilus influenzae Disease, Especially in Persons 65 Years Old
- HIV/AIDS Diagnoses Among Blacks--Florida, 1999-2004

3. Notifications
- Beginning and Intermediate/Advanced Courses in Epi Info
- 17th Meeting of International Society for Sexually Transmitted Diseases Research
- APEC Health Task Force Meeting
- National Black HIV/AIDS Awareness Day--Feb 7, 2007

4. To Receive EINet Newsbriefs
- APEC EINet email list


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

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

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

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

2006
Azerbaijan / 8 (5)
Cambodia / 2 (2)
China / 13 (8)
Djibouti / 1 (0)
Egypt / 18 (10)
Indonesia / 56 (46)
Iraq / 3 (2)
Thailand / 3 (3)
Turkey / 12 (4)
Total / 116 (80)

2007
Egypt / 1 (1)
Indonesia / 6 (5)
Total / 7 (6)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 270 (164).
(WHO 1/29/07 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 1/29/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 2/2/07): http://gamapserver.who.int/mapLibrary/

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Global: WHO to speed release of vaccine viruses if pandemic risk grows
WHO said that if the threat of an influenza pandemic increases, it will release viruses to vaccine manufacturers before completion of some safety tests, a step that could save about 2 weeks in vaccine development. WHO collaborating centers, such as US CDC, have been developing recombinant viruses based on circulating strains of H5N1 avian influenza. If WHO raises the pandemic alert level beyond the current stage of 3 (meaning a new virus is causing human cases, but there is no or very limited human-to-human transmission), those viruses will be released to vaccine manufacturers before safety tests on animals are completed. "Following an analysis of biosafety risks, WHO and OIE [World Organization for Animal Health] have agreed that if the pandemic preparedness alert phase reaches level 4 [signaling evidence of increased human-to-human transmission] or above, pandemic influenza vaccine viruses that have been developed using reverse genetics by WHO Collaborating Centres, can be made available to vaccine manufacturers prior to the completion of all subsequent in vivo safety tests, including chickens and ferrets," WHO said. Health authorities generally estimate it will take at least 6 months from the time a pandemic strain emerges until the first doses of a precisely matched vaccine can be made available. US and other countries are currently stockpiling H5N1 vaccines, but no one knows how well they will work if existing H5N1 viruses evolve into a pandemic strain. The accelerated procedure will be used only if the viruses involved are classified as an infectious substance as defined by the International Air Transport Association (IATA), WHO said. In addition, the handling of such viruses must comply with all national import, export, and biosafety regulations as well as IATA regulations. To read the original WHO document: http://www.who.int/csr/disease/avian_influenza/guidelines/earlyrelease2007/en/index.html
(CIDRAP 2/1/07 http://www.cidrap.umn.edu/ )

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Europe/Near East
Hungary (Csongrad): New avian influenza outbreak in poultry suspected
Hungary announced a suspected avian influenza outbreak at a goose farm. The ministry said authorities culled 9,400 goslings at a farm in Derekegyhaz in Csongrad County after some showed nervous system symptoms. Tests for a bacterial infection were reportedly negative. Also, the European Union confirmed that the H5N1 virus was the cause of goose deaths on another farm in Hungary, as first reported by the Hungarian agriculture ministry. The outbreak marked the first appearance of H5N1 in Europe this winter.

Also, the avian influenza outbreak strain in geese is 99.4% similar to the strain found in some European countries in 2006, the World Organization for Animal Health (OIE) reported. "This information tells us that the genetic characterization of the virus isolated in Hungary has still not mutated significantly," said OIE Director Bernard Vallat. Since the start of the H5N1 crisis in late 2003, the OIE calls for increased global monitoring and control measures of the virus at animal source. Transparent sharing and sequencing of virus samples is also key to tracking the virus and trigger appropriate global rapid response mechanisms.
(Promed 1/30/07; CIDRAP 1/29/07, 1/31/07 http://www.cidrap.umn.edu/ )

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Azerbaijan: Report of suspected human case of avian influenza H5N1 infection
Officials said a 14-year-old boy who was hospitalized with suspected avian flu died before his diagnosis could be established. Reportedly he was the brother (or a cousin) of a girl who died of H5N1 disease last year. They lived in the southern region of Salyan (one of the 2 centers of avian influenza outbreak in 2006). Reportedly, 3 initial tests indicated only that the boy had pneumonia. Samples were reportedly sent to a WHO laboratory in London for further testing. Since Apr 2006, there have been no confirmed human cases of avian influenza infection in Azerbaijan. Also, there have been rumors of a human case of H5N1 virus recorded in Gudauta, Abkhazia region, Georgia.
(Promed 1/26/07, 2/1/07; CIDRAP 1/29/07 http://www.cidrap.umn.edu/ )

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Asia
Indonesia (Central Java): Confirmed case of human infection of avian influenza H5N1
WHO confirmed 29 Jan 2007 a new case of human infection of H5N1 avian influenza. Her case was announced by the Indonesian government Jan 25, 2007. A 6-year-old female from Magelang District in Central Java Province developed symptoms 8 Jan 2007 and died in hospital 19 Jan 2007. Initial investigations into the source of her infection indicate exposure to dead poultry. Of the 81 cases confirmed to date in Indonesia, 63 have been fatal. Reportedly, Indonesia is looking into 2 suspected bird flu patients.
(Promed 1/29/07; CIDRAP 1/29/07 http://www.cidrap.umn.edu/ )

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Indonesia (West Java): More chickens suspected of dying from avian influenza
3 chickens were found dead and positively identified as [having died of] bird flu (Avian Influenza/AI) cases earier this week in Purwakarta, West Java. The chickens belonged to residents of Sinangpanong village in Bojong subdistrict and of Raharja village in Wanayasa sub district. The local animal husbandry office had already taken measures to prevent the virus from spreading such as conducting limited depopulation, intensive immunization and spraying chicken coops with disinfectant. Also, Indonesian government officials said they may declare avian flu a national disaster. Indonesia has had 6 avian flu deaths this season, which has prompted a ban on backyard poultry in Jakarta. Declaring avian flu a national disaster would pave the way for centralized measures and greater funding, Planning Minister Paskah Suzetta said.
(CIDRAP 1/31/07 http://www.cidrap.umn.edu/ ; Promed 2/1/07)

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Thailand (Ang Thong): Third province affected by avian influenza H5N1
Thailand's Department of Livestock Development confirmed 1 Feb 2007 that it has found the H5N1 virus in samples of 6 fighting cocks and native chickens from Samko district in the central province of Ang Thong, the third location in which the virus detected this year. All poultry in the flock were culled 23 Jan 2007. Officials sprayed disinfectant and checkpoints have been set up to prevent poultry movement in the area. Since the beginning of 2007, the H5N1 virus was found in Phisanulok, Nong Khai, and now, Ang Thong. Nirandorn Uangtrakulsuk, Director of the Bureau of Disease Control Veterinary Service said that some migratory birds were believed to have carried the disease to Ang Thong's chicken population since last month. The 3 outbreaks recently detected in Thailand are situated in different provinces.
(Promed 2/1/07)

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Japan: New outbreak of avian influenza in Okayama, another suspected in Miyazaki
A new outbreak of bird flu is suspected after 23 birds died at a poultry farm in the prefecture of Miyazaki, the Agriculture Ministry said 30 Jan 2007. Authorities are conducting preliminary tests on chickens at the farm, which keeps about 93 000 birds for their eggs, the ministry said. If confirmed, it would be the fourth bird flu case reported in Japan since the beginning of 2007. Japan confirmed its third outbreak of avian influenza H5N1 on 29 Jan 2007 at a farm in the western prefecture of Okayama. Dozens of chickens died in a poultry farm in the city of Takahashi, Okayama prefecture, the prefectural government said 29 Jan 2007. Earlier this month, Japan had 2 H5N1 outbreaks among poultry in Miyazaki. About 1300 birds died 22-24 Jan 2007 at a farm in the city of Hyuga. On Jan 26, 2007, authorities began slaughtering the farm’s 49,000 remaining chickens. Earlier in Jan 2007, a farm in the town of Kiyotake, 60 km away from Hyuga, saw 3500 of its birds killed by the H5N1 strain of bird flu and had all of its 12 000 birds incinerated.
(Promed 1/26/07, 1/29/07, 1/30/07; CIDRAP 1/29/07, 1/31/07 http://www.cidrap.umn.edu/ )

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Russia (Krasnodar): Avian influenza reportedly resurfaces in poultry
Russia reported its first H5N1 avian influenza outbreak of the season. The Russian government’s agricultural watch group Rosselkhoznadzor announced that poultry deaths were reported at 3 farmsteads in southern Krasnodar territory. The samples from the birds reportedly tested positive for H5N1. Krasnodar is in southwest Russia. The outbreaks occurred at 3 settlements, Labinsk, Upornaya, and Borodinskaya, and further tests on the samples will be conducted. Russia’s last confirmed outbreak was Jul 2006, according to the World Organization for Animal Health (OIE). The country experienced its first significant poultry outbreak in 2005 but has reported no human cases. Russia recorded more than 90 cases of bird flu in 2006.
(CIDRAP 1/29/07 http://www.cidrap.umn.edu/ ; Promed 1/29/07)

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Russia (Volgograd, Astrakhan): Increased risk of plague
Plague has been recorded in the Volgograd and Astrakhan regions of the Southern Federal District of Russia. Sick rodents were found in several parts of these regions. According to experts, rats and mice have been infected by plague; humans are at risk of being infected by pets [which have killed infected rodents]. Vaccination of the population at risk is being applied. It has been postulated that unusually warm winter weather has contributed to the development of the outbreak. The control activities undertaken include poisoning of rats and mice. In Russian, natural foci of plague in rodents have been recorded historically in several regions, namely the republics of Chechnya, Kabardino-Balkaria, Karachaevo-Cherkessia, Kalmykia and Dagestan, and the regions Stavropol and Astrakhan, all located in the South Federal District of Russia. Cases have also been observed in the republics of Tyva and Gorniy Altay. Since 1984, no plague cases have been recorded in humans in Russia.
(Promed 1/28/07)

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Russia (Moscow oblast): 3 cases of typhoid fever
Reportedly, during a regular follow up on a female resident from Serpuhov, it was determined that she was affected by a mild case of typhoid fever 10 Jan 2007. The same diagnosis was made in a woman and her 5-year-old son from Serpuhov. All 3 were hospitalized in the infectious diseases hospital of Serpuhov. The current condition of all 3 is satisfactory. 70 people who were in contact with them were checked, and no new cases have been identified. By 16 Jan 2007, 60 people were vaccinated out of the contact cohort.
(Promed 1/23/07)

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New Zealand (Auckland): 4 cases of typhoid
4 food outlets are being investigated as possible sources of a typhoid outbreak. The disease, which is transmitted by water and food contaminated by fecal bacteria, has hospitalized 4 Clendon residents. Authorities initially had trouble identifying a link between the victims--2 teenagers and 2 middle-aged people--who had no connection other than where they lived. 3 of the 4 had eaten at the Clendon food outlets now under investigation. Samples have been taken to eliminate premises and staff from the investigation. None of the staff at the outlets had been ill but that they would submit samples for testing. It is not believed that the fourth typhoid case is related to the other 3. All 4 victims have been released from hospital and are recovering at home. Since 1 Nov 2006, there have been 17 cases of typhoid in the Auckland region. Normally, the average is 20 cases per year.
(Promed 1/19/07, 1/23/07)

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Philippines (Caraga): Cases of gastroenteritis and typhoid fever
13 persons are being treated for diarrhea, while there are 2 cases of typhoid fever in Barangays Buenavista and Poblacion, Bayugan, Agusan del Sur. These do not include 12 cases of gastroenteritis with mild dehydration also in the same areas, attributed to the continuous rains of the past 4 weeks. The Provincial Health Office will assist barangay and municipal officials in containing the said illnesses that hit Bayugan town at the start of 2007. Bayugan is one of the most progressive and populated towns of Agusan del Sur.
(Promed 1/23/07)

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Malaysia (Perak): Chikungunya strikes 36 persons
Chikungunya, a rare mosquitoborne disease, has struck Perak again, this time in 36 people in this city since Dec 2006. The disease has been brought under control through various measures, said state health, science, technology and environment committee chairman Datuk Tan Chin Meng 9 Jan 2007. He said the Perak Health Department had taken samples of blood from 47 people, and 36 of them were confirmed to have the viral disease. The disease causes fever, severe headache, and pain in the joints. The death rate from the disease is extremely low. The disease is spread through mosquito bites and cannot be transmitted directly person to person. Tan said the virus had been brought to Malaysia by Malaysians who had visited India.
(Promed 1/21/07)

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Japan: First case of Chikungunya, imported from Sri Lanka
A woman in her 30s who returned to Japan from Sri Lanka after coming down with a fever has been confirmed as having contracted a viral fever called chikungunya, officials announced 24 Jan 2007. It is the first time in Japan that a Japanese person has been confirmed as having contracted the disease. The woman came down with a fever in Sri Lanka Nov 2006 and was diagnosed by local doctors as having either chikungunya or dengue fever. When she temporarily returned to Japan Dec 2006, she went for a medical checkup and an antibody test confirmed that the disease was indeed chikungunya. The woman has already recovered from the symptoms and returned to Sri Lanka, where she lives.
(Promed 1/24/07)

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China: Blood products recall, hepatitis C virus contamination
Almost 90 000 doses of the drug produced by Guangdong Bioyee Pharmaceutical Co, Ltd, have been recalled. In Beijing 68 558 bottles of the drug have been recalled, along with 20 000 bottles in Guangdong Province. The tainted drugs had been sold in 12 provinces and regions. The Ministry of Health issued an urgent statement 24 Jan 2007 ordering all medical institutions to register patients who have used the drug. Those who have used the intravenously administered drug must be given blood tests for hepatitis C [virus] nucleic acid and antibodies, and should be put under close observation, the MOH said. Doctor Jia Jidong of the Beijing Friendship Hospital, estimated that about 50 to 85 percent of patients who have tested positive for antibodies would end up contracting the disease. If the tests show the Hepatitis C antibodies to change from positive to negative in 2-8 weeks, the patients are not infected with the virus, he said.

Hepatitis C is a liver disease caused by hepatitis C virus, which is present in the blood of persons who have the disease. HCV is spread by contact with the blood of an infected person. Prior to 1992 the presence of hepatitis C virus in blood collected for transfusion was an unrecognized hazard. At the present time considerable effort is devoted to ensuring that blood used for transfusion is free of hepatitis C virus.
(Promed 1/25/07)

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Indonesia (Jambi): Incidence of filariasis reported to be increasing
The preventable but disfiguring disease of elephantiasis is on the rise in Jambi, with 277 people diagnosed with the illness during the past 5 years. The cases were recorded in 3 of the province's 10 regions. The 3 regencies--Muarojambi and West and East Tanjungjabung--are located in swampy areas. Clinics in the 3 regencies have been treating the illness. However, more clinics were needed to prevent the disease from spreading. Elephantiasis, which is caused by the invasion of lymphatic glands by tiny worms, leads to the gross swelling of limbs or the scrotum. Villagers in the 3 regencies have been warned to maintain sanitation standards around residential areas. They should also guard against being bitten by mosquitoes.

Filariasis caused by Wuchereria bancrofti, Brugia malayi, and Brugia timori is endemic in Indonesia, and WHO estimates that "22 of 27 provinces, which comprises of approximately 150 million people, are estimated to be endemic for LF." Filariasis is transmitted by mosquitoes. Filariasis control in Indonesia relies on: interruption of transmission (vector control) to reduce the prevalence below 1 percent; institute early treatment to prevent chronic sequelae. Mass drug administration (MDA) has been gradually scaled up in endemic districts.
(Promed 1/24/07)

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Americas
USA: HHS ties pandemic mitigation advice to severity
Federal officials unveiled recommendations for nonpharmaceutical steps to battle pandemic influenza, tying them to a new "Pandemic Severity Index" (PSI). Officials predicted that the early, coordinated use of "community mitigation measures" such as isolating patients, sending students home, and canceling public gatherings could make a significant difference in the course of an epidemic. Relatively disruptive steps such as dismissing classes, changing work schedules, and canceling meetings should be reserved for moderate and severe pandemics, says the report released by the Department of Health and Human Services (HHS). In a mild pandemic, the only community mitigation measure recommended is isolating sick people at home, along with using antiviral treatment as available. The severity level is initially based on case-fatality ratio (CFR). 2 events would prompt the CDC director to designate a pandemic category: WHO declaring a phase 6 pandemic level and the US government declaring a stage 3, 4, or 5 alert. The pandemic severity index levels are: Category 1, CFR of less than 0.1%; Category 2, CFR 0.1% to 0.5%; Category 3, CFR 0.5% to 1%; Category 4, CFR 1% to 2%; Category 5, CFR 2% or higher.

The new report is titled "Interim Pre-Pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States—Early, Targeted, Layered Use of Nonpharmaceutical Interventions". In preparing the recommendations, planners looked at the history of the last 3 pandemics, examined mathematical models, studied seasonal flu transmission, consulted experts from many fields, and conducted citizen focus groups. The report describes 4 types of measures for battling a pandemic: 1) Isolation and treatment of people who have suspected or confirmed cases of pandemic influenza in their homes or in healthcare settings, depending on illness severity and medical capacity; 2) Voluntary home quarantine of household contacts of those with suspected or confirmed pandemic influenza, along with prophylactic antiviral medication use, if available; 3) Dismissing school classes and closing daycare centers, along with other social distancing measures for young people; 4) Social distancing for adults through actions such as changing work schedules and environments and canceling large public gatherings.

For Category 4 and 5 pandemics, CDC recommends that all 4 interventions be used and that school classes be suspended for up to 12 weeks. Category 2 or 3 pandemics would warrant voluntary isolation of sick people, though other measures may be added or modified depending on the recommendations of local health authorities. The goals of community interventions are to slow the pandemic in order to buy time for producing an effective vaccine and to lower both the peak number of cases and total cases. Dr. Julie Gerberding, director of CDC, said, “One important conclusion is the earlier you initiate an intervention, the more likely it is to make a big impact”.
(CIDRAP 2/1/07 http://www.cidrap.umn.edu/ )

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USA: Possible increased risk of contamination from bagged greens
The centralized processing of fresh greens can increase the risk of more widespread contamination, just as tainted beef from one steer can find its way into hundreds of packages of ground meat, said Dr David W K Acheson, chief medical officer at the Food and Drug Administration's Center for Food Safety and Applied Nutrition. The way some greens are harvested also has raised concerns, said Michael Doyle, director of the University of Georgia's Center for Food Safety, who was recently hired by Taco Bell to review its safety guidelines. Doyle referred specifically to bagged iceberg lettuce, which has been investigated in the simultaneous but separate Taco John's and Taco Bell outbreaks of E. coli O157:H7.

Iceberg lettuce intended for packaging is vulnerable to contamination in part because it is often cut and initially processed in the field, Doyle said. The core is cut out of the head and discarded, as are the protective outer leaves. "When you've chopped that product, you've created a lot more avenues for bacteria to enter, especially if you're doing it in the fields," said Bob Martin, general manager of Rio Farms in King City. Processing plants wash leafy greens 3 times in chlorinated water before bagging them. They also employ other safety measures, said Jim Gorny, senior vice president for food safety and technology at United Fresh Produce Association, a trade group. Although washing in chlorinated water should kill E. coli O157 bacteria, it takes only a small amount to make someone sick.

Not everyone agrees that packaged greens are a problem. Christine Bruhn, director of the Center for Consumer Research at UC Davis, said she believes that buying bagged, pre-washed greens is safer than buying head or loose lettuce and washing it yourself. She said that research confirms that neither home nor restaurant cooks diligently follow all sanitary practices. Prepackaged produce was seen as a safety innovation when it was introduced in fast-food restaurants in the 1980s, Gorny said. The industry's very success could be one of the reasons behind recent outbreaks. People are eating more fresh produce, including the bagged variety, than ever before, and in doing so, they are increasing their risk of exposure to bacteria. Moreover, outbreaks are being detected earlier and traced more precisely.
(Promed 1/21/07)

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USA (California): Debate on produce safety measures
California officials are encouraging growers and producers to sign on to a plan to voluntarily bolster produce safety standards. The measures come on the heels of 3 recent widespread Escherichia coli O157:H7 outbreaks. One, linked to fresh spinach, killed 3 people and sickened about 200, and 2 were traced to prepackaged lettuce that sickened 152. In the spinach outbreak, contamination was traced to cattle manure from pastures next to Salinas Valley spinach fields. In the Taco John's outbreak, the implicated O157:H7 strain matched samples from dairy farms near lettuce fields in California's Central Valley. In Aug 2006, FDA announced its Lettuce Safety Initiative, which will involve an examination of growing practices as well as conditions in storage and packing facilities in California's Salinas Valley. Of 10 US outbreaks of E coli O157:H7 linked to lettuce and spinach since 1995, 8 have been traced to that region.

Recently the California Department of Food and Agriculture (CDFA) released a marketing agreement that food handlers and producers can join, which states that they accept products only from farmers who follow specific food safety procedures. Products certified by state-authorized inspectors and grown with good agricultural practices can carry an official seal to assure consumers. The marketing agreement will be overseen by the state of California, but it was drafted by the produce industry. California State Sen. Dean Florez, who represents an agricultural region of the San Joaquin Valley, said self-regulation has been tried and has done little improve produce safety. He said he will introduce bills Feb 1, 2007 that would require growers to separate crops from feedlots and dairies, test irrigation water for bacteria, and set standards for the size and durability of fencing to keep wild animals off the fields.
(CIDRAP 1/26/07 http://www.cidrap.umn.edu/ )

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USA/Mexico: Norovirus outbreak hits world cruise
The Queen Elizabeth 2 has become the first cruise ship in 2007 to suffer a serious outbreak of norovirus illness, with about 16 per cent of passengers sickened since the ship left England 2 Jan 2007. CDC workers will board the ship 19 Jan 2007 in Acapulco, Mexico. So far, 263 passengers and 27 crew members have shown signs of norovirus infection, a common ailment that causes vomiting and diarrhea for 48 to 72 hours. The Cunard Line ship is on a 106-night world cruise that included a stop in Fort Lauderdale last week. After a dockside meeting with Queen Mary 2, the 2 ships left Port Everglades on 10 Jan 2007 on separate itineraries. Cunard spokesman Brian O'Connor said the norovirus outbreak began before the ship reached Fort Lauderdale on its trans-Atlantic trip to New York. Cases began declining after it left New York. 4 passengers were still sick 18 Jan 2007.
(Promed 1/19/07)

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USA (Virginia): Norovirus outbreak affects 100 guests
The Hilton Washington Dulles Airport hotel closed 19 Jan 2007 for the weekend so crews could sanitize after about 120 employees and guests were sickened by the highly contagious norovirus, which officials say is particularly severe this year. The hotel said some guests began complaining of gastrointestinal distress, including nausea, vomiting, and diarrhea 16 Jan 2007.

This season is shaping up to be severe for the illness, said an expert at CDC, which helps track some of the 23 million annual cases of norovirus infection. Current estimates are that at least half of the more than 75 million annual cases of foodborne illness in the US are caused by norovirus. About 20 per cent of people who go to a doctor because of acute diarrhea are infected with it. The Virginia Department of Health has reported 52 norovirus outbreaks this winter (2006-2007). Norovirus survives prolonged periods on such surfaces, and it can become airborne under some circumstances. Some common disinfectants -- such as alcohol-based waterless hand scrubs -- won't kill it. The best prevention is frequent hand washing. If you become ill, disinfect everything you've touched. Norovirus is passed through vomitus or feces. Incubation period is usually a day or more. Three-quarters of people report vomiting and diarrhea, although only 1/3 have fever. Death from the infection is uncommon, but it can occur in the debilitated elderly.
(Promed 1/21/07)

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Canada (Ontario): Extensively drug-resistant tuberculosis
A Toronto hospital is treating several cases of extensively drug resistant tuberculosis (XDR TB), with 1 of the patients being held in isolation under court order, the doctor overseeing the treatment said 22 Jan 2007. Experts fear the dangerous strain of tuberculosis, which is susceptible to very few of the anti-tuberculosis medications normally used to treat TB, is a global health crisis. Dr. Monica Avendano, the physician in charge of the TB service at West Park Healthcare Centre, said all the patients were either infected abroad or infected by a family member who picked up the highly resistant strain elsewhere. All of them have a previous history of TB that was not well managed.

Multi-drug resistant TB and the more difficult XDR TB can arise one of 2 ways. A person with TB can fail to take all their medication, as in the case of the "not-well managed" patients to which Avendano referred. This spotty treatment allows the bacterium to survive the assault of the drugs and develop resistance to them. Or a person can be infected by contact with a person sick with XDR TB. XDR TB has been found in a number of places, including China, South Africa, and many republics of the former Soviet Union. It is believed to have spread, still at low levels, from these jurisdictions to developed countries. The Public Health Agency of Canada currently doesn't know the scope of the problem in Canada.

Where such cases arise, they are treated in isolation. "All provinces and territories will use their public health legislation if necessary to ensure treatment of XDR TB," said Dr. Edward Ellis, manager of tuberculosis prevention and control with the public health agency. Treatment with alternative drug regimes is effective, but it can take months of in-hospital care. Even then, it's not clear whether these patients -- who will be required to be seen on an ongoing basis -- are cured for life. That's because the strain hasn't been around long enough, and the treatment regime being used is too new to gauge its long-term efficacy.

The definition of XDR TB until fall 2006 was an isolate of M. tuberculosis resistant to isoniazid and rifampin and at least 3 of the 6 main classes of second-line drugs (aminoglycosides, polypeptides, fluoroquinolones, thioamides, cycloserine, and para-aminosalicyclic acid). After Oct 2006, the definition was modified to: an isolate resistant to INH and rifampin (also called rifampicin) which was also resistant to a fluoroquinolone and to 1 or more of the following 3 drugs: capreomycin, kanamycin and amikacin.
(Promed 1/24/07, 1/25/07)

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USA (Texas/Kansas, North Dakota): Cases of hantavirus infection
There has been a non-pulmonary syndrome hantavirus case of infection in a male, about 19-years-old, from the Rio Grande Valley, who had worked the potato harvest in Kansas. He got sick on his way home and was hospitalized. He thought he got exposed while unloading potatoes, which, according to him, contained numerous rats. The Kansas public health veterinarian felt that he was exposed where he lived, because at least 1 other case came from the same site. This is one of the small proportion of N. American hantavirus infections that did not have pulmonary symptoms, thus presenting more like the clinical cases seen in Europe which mainly show renal symptoms.

Also, another hantavirus infected person died late Dec 2006, said Kirby Kruger, a North Dakota state Health Department disease specialist. The person was involved in cleaning outbuildings that may have led to exposure to rodents. The case is the ninth case of hantavirus reported in North Dakota. "The carrier of this virus is a small rodent called the deer mouse [Peromyscus maniculatus]. If you have rodent infestations in the area where you live and work, you are potentially at risk." People get the hantavirus after exposure to urine, saliva or feces from infected rodents. Victims rapidly develop severe respiratory infection. Residents should try to control rodents before they start cleaning buildings, Kruger said.
(Promed 1/28/07)

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USA (Minnesota): Human herpesvirus 1 outbreak in wrestlers
High school wrestling has been suspended across the state due to a widespread outbreak of a skin infection, the Minnesota State High School League announced 30 Jan 2007. 24 cases of herpes gladiatorum, spread by direct skin-to-skin contact, have been reported by 10 teams. Symptoms have included lesions on the face, head and neck of wrestlers. The League has banned competitions and direct contact between wrestlers in practice from 30 Jan 2007 until 6 Feb 2007. The Minnesota Department of Health has been tracking the outbreak. Skin infections caused by human herpesvirus 1 are not uncommon among wrestlers and others engaged in contact sports. In the case of wrestlers the condition is known as herpes gladiatorum.
(Promed 1/30/07)

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Peru (Condorcanqui, Madre de Dios, Puno): Vampire bat rabies kills children
11 children from native communities in the Northern Peruvian Amazon Jungle died because of rabies, after they were bitten by vampire bats. Attacks by vampire bats led some villagers to leave their homes in Condorcanqui Province, near the Ecuadorian border. Peruvian authorities assured them that the outbreak is under control. Reportedly the 2 outbreaks occurred in different places, one between Sep and Nov 2006, in which 3 children died, and another one Nov 2006, in which 8 children died. All of them were less than 6 years old. The total number of persons bitten is 1101 and they already received their rabies vaccination.

Also, 11 people, 4 of them children, have died since Christmas Day in Peru's southeastern artisan mining districts after being bitten by rabid bats, officials said 30 Jan 2007. Victims in the Madre de Dios and Puno departments of Peru were bitten by what they believe were the same bats and infected with rabies. Reportedly other people who had reported bat bites in the region were vaccinated against rabies even if they weren't showing symptoms of the disease. Many of the victims were poor people who slept in open areas. People in the region had been instructed on how to avoid bat bites.

Blood is the only food consumed by vampire bats. They only live in Latin America, and these animals attack humans when they are not able to find suitable animals. Standard rabies virus vaccine provides cross-protective immunity against the rabies virus strain (or strains) carried by vampire bats.
(Promed 1/23/07, 1/31/07)

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Africa
Nigeria: Report of first human case of avian influenza
As of 31 Jan 2007, Nigeria has announced the death from suspected avian influenza infection in a 22-year-old female from Lagos. She died 16 Jan 2007. Reportedly the woman fell ill after de-feathering and disemboweling an infected chicken. The mother of the 22-year-old died 4 Jan with similar symptoms. Preliminary tests on the samples from the 22-year-old were positive for influenza A/H5. Samples have now been sent to a WHO laboratory for confirmation. No samples were taken from the mother. Contacts have been followed up and have shown no symptoms at twice the incubation period for avian influenza infection. Samples have been tested from these contacts as well as from 3 other suspected cases, including one fatal case and have all been negative in preliminary tests.

Nigeria has been hit hard by bird outbreaks, with 17 of 36 states affected so far. A Jul 2006 report in Nature said the H5N1 virus had entered Nigeria 2 different times, possibly carried by migratory birds. But the report also said international poultry trade could have been a factor. The UN had expressed concerns about the Nigerian government response to the disease, as poultry are still being moved around by local farmers despite an official quarantine and promised compensation for infected birds. WHO is working with the government of Nigeria to monitor the situation.
(Promed 1/29/07, 1/31/07, 2/1/07; CIDRAP 1/31/07 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. Also, http://www.irinnews.org/Birdflu.asp provides information on avian influenza in order to help the humanitarian community. Read some recent reports regarding Nigeria.
- 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 upcoming avian influenza conferences.
- US CDC: http://www.cdc.gov/flu/avian/index.htm.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Pandemic Flu Public Service Announcement has been released.
- Health Canada: information on pandemic influenza: http://www.influenza.gc.ca/index_e.html.
- 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 third epidemiological week (Jan 14 to 20, 2007), the percentage of outpatient visits to sentinel physicians for influenza-like illness (ILI) has decreased by 5% compared with last week and is 45.8% higher than the same period in 2006. During week 52, 2006 to week 3, 2007, the respective ILI consultation rates (per 100 outpatient visits) were 5.63, 5.53, 5.80 and 5.51. Comparing to last week, the consultation rate increased in Taipei and East regions while decreased in remaining 4 regions. The dominant respiratory virus identified for week 52, 2006 to week 3, 2007 was influenza B virus. The other main respiratory viruses were Adenovirus and Herpes simplex virus. To date, 40 clusters have been reported this influenza season. Based on reporting dates, 15 additional severe influenza cases were reported in week 3. Based on onset dates, 83 severe cases have been reported cumulatively in the 2006-2007 epidemic season. Among these, 16 were confirmed, 54 were excluded, and 13 are pending. So far this season (week 26, 2006 to week 3, 2007), 1 death has been reported.
(Taiwan IHR Focal Point 2/1/07)

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Cholera, diarrhea & dysentery
Philippines
In Cebu, food poisoning struck 60 people who were supposed to perform 14 Jan 2007 at a gala dinner for the Association of Southeast Asian Nations (ASEAN). The performers were rushed to hospitals in Cebu province, 14 Jan 2007, after suffering from severe stomachaches, diarrhea, and vomiting. The victims began to suffer the symptoms 13 Jan 2007, after eating their packed food during rehearsals.

Also, at least 170 people were stricken by an outbreak of diarrhea caused by contaminated water in the town of Aguinaldo in Ifugao province, the Department of Health reported 24 Jan 2006. Victims ranged from 4 months to 70 years old. Reportedly the outbreak started Nov 2006, after the typhoons, and continued until Dec 2006, purportedly because of contaminated water. The barangays (districts) of Awayan, Butac, Chalalo, Damag, Galonogon, Monggayang, Pojnaan, and Ubao. Pojnaan has the highest number of diarrheal cases.

A diarrhea outbreak in Loon, Bohol claimed the life of a 3-year-old girl and caused 150 residents to be admitted to the provincial and district hospitals. Officials are looking at the town's water source as a possible reason. Heavy rains from late Dec 2006 to early Jan 2007 could have caused the contamination. At least 20 barangays are being served by the water system, but the victims were from 8 barangays only. Reportedly, there was no other outbreak this big in Loon except in 1975, when a cholera outbreak affected Cabilan.
(Promed 1/19/07, 1/26/07)

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Dengue
Hong Kong/Indonesia
The Centre for Health Protection is investigating an imported dengue fever case involving a 27 year old North Point woman. The woman traveled to Indonesia from Nov 2006 to 12 Jan 2007. She came down with fever 13 Jan 2007 was admitted to hospital 16 Jan 2007, and is now in stable condition. Her family does not have any symptoms. This is the second imported dengue fever case reported in 2007.
(Promed 1/21/07)

Indonesia
At least 28 people have died and hundreds were infected in an outbreak of dengue fever on Java since New Year's Day, a local report said 25 Jan 2007. The mosquito-borne disease is at its worse during the current monsoon season, which creates pools of water that are ideal breeding places. The worst-hit region has been West Java province, where 23 people died and 848 were infected since 1 Jan 2007; 4 other people, including 2 children, have died in the Central Java city of Yogyakarta, and 1 more in eastern Indonesia. The situation in Central Java is potentially more dire in 2007 because tens of thousands of people remain in makeshift emergency shelters following the May 2006 earthquake.

In Jakarta, the number of dengue cases escalated by the dozen each day in Jan 2007, reaching 1240 with 6 fatalities as of 23 Jan 2007, 3 of whom died in Tarakan. Jakarta Health Agency deputy head Salimar Salim said the constant stream of dengue cases was the result of longer transition periods between the rainy and dry seasons in the past 4 years. She said that as a result, mosquito breeding was almost continuous. People's poor living conditions, she added, also contributed to the mounting number of cases. The head of City Council Commission for social welfare, Dani Anwar, said the rapid growth in the number of dengue cases and the resurgence of bird flu in the city exposed the low hygiene standards that many residents had.
(Promed 1/27/07)

Malaysia (Peninsular)
Dengue fever has claimed 13 lives in barely 1 month in Malaysia this year. In the third week of Jan 2007, Malaysia has reported 1423 suspected cases, of which 403 have been confirmed as dengue fever. Ramlee said Selangor and Kuala Lumpur remained the places with the biggest number of cases reported. For the third week of Jan 2007, Selangor reported 574 suspected cases while Kuala Lumpur recorded 312 cases. The health ministry has carried out several preventive and control measures throughout the country, especially in the 2 hot spots. The ministry is still distributing the pesticide free to the public and has also roped in 60 health officers from other states to help contain the cases in Selangor and Kuala Lumpur.
(Promed 1/27/07)

Philippines (Agusan del Sur)
At least 4 persons died while 12 others were hospitalized in Bayugan town, Agusan del Sur [Province] in what authorities fear to be a dengue outbreak. It was reported 19 Jan 2007 that at least 13 other persons are undergoing treatment. Bayugan is a first class town in Agusan del Sur with a population of 93 623 people in 17 222 households. Reportedly most of the victims are aged 1-4 years. Authorities have reportedly fumigated areas affected and conducted information and dissemination campaigns. Yet 3 weeks of continuous rains have afflicted schoolchildren in Barangay Poblacion with dengue fever. At least 2 had died from dengue, with 13 cases Dec 2006, while 2 others, mostly 1-year-olds, were killed Jan 2007. The number may rise if no immediate remedies are installed. Government officials have already asked for support from the provincial government to contain the diseases affecting mostly poor people in the area.
(Promed 1/27/07)

Mexico (Jalisco)
The Secretary of Health of Jalisco is calling for urgent intervention in Puerto Vallarta because actions so far have not been adequate to control the dengue outbreak, indicating that 2007 is a year of greater risk of dissemination of the disease. The first cases of dengue in 2007 have been reported. Of a total of 109 people affected, 101 were from Puerto Vallarta, and of these, 20 had dengue hemorrhagic fever (DHF). As of 2006, Puerto Vallarta has been the municipality most affected by dengue outbreaks. In 2006, 1107 cases were recorded in this tourist destination (of a total of 1851 in the entire state of Jalisco). Beginning 29 Jan 2007 a "rapid response plan" will be launched. Efforts will be redoubled and will proceed along 3 lines: fogging with insecticide to kill adult mosquitoes, use of abate to eliminate breeding, and getting citizens to clean up to avoid proliferation of new breeding sites. Implementation of this plan will cost 4 million pesos [USD 400 000] and take a month, with weekly fogging.

Dengue fever as a severe, flu-like illness that affects infants, young children, and adults but is seldom fatal. DHF is a potentially deadly complication that is characterized by high fever, hemorrhagic phenomena, and in severe cases, circulatory failure. There is no specific treatment for dengue fever.
(Promed 1/27/07)

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2. Articles
CDC EID Journal, Volume 13, Number 2—Feb 2007
CDC Emerging Infectious Diseases Journal, Volume 13, Number 2—Feb 2007 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm.

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Avian influenza H5N1 infections in Indonesian cats
In the first survey of its kind, an Indonesian scientist has found that in areas where there have been H5N1 avian influenza outbreaks of H5N1 in poultry and humans, 1 in 5 cats have been infected with the virus and survived. This suggests that as outbreaks continue, H5N1 will have more opportunities to adapt to mammals than had been supposed. Chairul Anwar Nidom of Airlangga University in Surabaya, Indonesia, said he had taken blood samples from 500 stray cats near poultry markets in 4 areas of Java, including Jakarta, and 1 area in Sumatra, all of which have recently had outbreaks of H5N1 in poultry and people. Of these cats, 20 per cent carried antibodies to H5N1. This means that they had been infected, probably through eating birds that had H5N1. Many other cats that were infected are likely to have died from the resulting illness, so more than 20 per cent of the original cat populations may have acquired H5N1. Nidom also found the virus in Indonesian pigs in 2005.

Amin Soebandrio, head of medical sciences at the Indonesian ministry for research and technology, says that the infection has also been found in dogs and cats on Bali, which has also had outbreaks of H5N1. The new findings follow reports that unusually large numbers of dead cats have been found near many outbreaks of H5N1. Albert Osterhaus and his team at the Erasmus University in Rotterdam found that cats can catch the H5N1 virus. Infected cats shed large amounts of the virus and pass it to each other. Infected cats may not directly increase the danger of people catching the virus, as humans seem to catch the current strain only with difficulty from birds. The main worry, says Osterhaus, is that as the virus replicates in cats, it will further adapt to mammals and acquire the ability to spread more efficiently to people and person to person.

Nidom's findings are the first to indicate what proportion of cats can become infected by H5N1. In Bangkok, Thailand all the cats in 1 household are known to have died of H5N1 in 2004. Tigers and leopards in Thai zoos also died, while in 2006, 2 cats near an outbreak in poultry and people in Iraq were confirmed to have died of H5N1, as were 3 German cats that ate wild birds. In Austria, cats were infected but remained healthy. Killing cats won't solve the problem, Osterhaus warns. Like shooting wild birds, it is unlikely to have much impact and could send infected animals elsewhere. It would also lead to a population explosion of disease-carrying rodents. "Cats must just be kept from eating sick chickens," Osterhaus says, though this will be a tall order in open-air markets across Asia and Africa, which are typically swarming with hungry cats.
(Promed 1/26/07)

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Hampered Foraging and Migratory Performance in Swans Infected with Low-Pathogenic Avian Influenza A Virus
Jan A. van Gils et al. PLoS ONE 2(1): e184. doi:10.1371/journal.pone.0000184. http://www.plosone.org/article/fetchArticle.action?articleURI=info:doi/10.1371/journal.pone.0000184
Abstract: “It is increasingly acknowledged that migratory birds, notably waterfowl, play a critical role in the maintenance and spread of influenza A viruses. In order to elucidate the epidemiology of influenza A viruses in their natural hosts, a better understanding of the pathological effects in these hosts is required. Here we report on the feeding and migratory performance of wild migratory Bewick's swans (Cygnus columbianus bewickii Yarrell) naturally infected with low-pathogenic avian influenza (LPAI) A viruses of subtypes H6N2 and H6N8. Using information on geolocation data collected from Global Positioning Systems fitted to neck-collars, we show that infected swans experienced delayed migration, leaving their wintering site more than a month after uninfected animals. This was correlated with infected birds travelling shorter distances and fuelling and feeding at reduced rates. The data suggest that LPAI virus infections in wild migratory birds may have higher clinical and ecological impacts than previously recognised.”

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Activities, Achievements, and Lessons Learned during the First 10 Years of the Foodborne Diseases Active Surveillance Network: 1996–2005
Elaine Scallan. Clinical Infectious Diseases, volume 44 (2007).
http://www.journals.uchicago.edu/CID/journal/issues/v44n5/41367/brief/41367.abstract.html
Abstract: “Since the establishment of the Foodborne Diseases Active Surveillance Network (FoodNet) in 1996, it has been an essential resource for the surveillance and investigation of foodborne disease in the United States. FoodNet has had a major impact on food safety because it conducts population-based, active surveillance for laboratory-confirmed infections from 9 pathogens commonly transmitted through food. Each year, FoodNet publishes the National Report Card on Food Safety, which is used by regulatory agencies, industry and consumer groups, and public health personnel to prioritize and evaluate food safety interventions and monitor progress toward national health objectives. FoodNet also determines the human-health impact of foodborne illness by conducting related epidemiological studies that contribute to the estimates of the overall burden of foodborne illness, attribute the burden of foodborne illness to specific foods and settings, and address important foodborne disease-related issues, such as antimicrobial resistance and sequelae from foodborne infections. This article summarizes the activities, achievements, and lessons learned during the first 10 years of FoodNet.”

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Bioterrorism Training in U.S. Emergency Medicine Residencies: Has It Changed since 9/11?
Philip Kevin Moye et al. Acad Emerg Med. doi: 10.1197/j.aem.2006.10.102.
http://www.aemj.org/cgi/content/abstract/j.aem.2006.10.102v1
Abstract: “OBJECTIVES: To assess the change in prevalence of bioterrorism training among emergency medicine (EM) residencies from 1998 to 2005, to characterize current training, and to identify characteristics of programs that have implemented more intensive training methods. METHODS: This was a national cross sectional survey of the 133 U.S. EM residencies participating in the 2005 National Resident Matching Program; comparison with a baseline survey from 1998 was performed. Types of training provided were assessed, and programs using experiential methods were identified. RESULTS: Of 112 programs (84.2%) responding, 98% reported formal training in bioterrorism, increased from 53% (40/76) responding in 1998. In 2005, most programs with bioterrorism training (65%) used at least three methods of instruction, mostly lectures (95%) and disaster drills (80%). Fewer programs used experiential methods such as field exercises or bioterrorism-specific rotations (35% and 13%, respectively). Compared with other programs, residency programs with more complex, experiential methods were more likely to teach bioterrorism-related topics at least twice a year (83% vs. 59%; p = 0.018), to teach at least three topics (60% vs. 40%; p = 0.02), and to report funding for bioterrorism research and education (74% vs. 45%; p = 0.007). Experiential and nonexperiential programs were similar in program type (university or nonuniversity), length of program, number of residents, geographic location, and urban or rural setting. CONCLUSIONS: Training of EM residents in bioterrorism preparedness has increased markedly since 1998. However, training is often of low intensity, relying mainly on nonexperiential instruction such as lectures. Although current recommendations are that training in bioterrorism include experiential learning experiences, the authors found the rate of these experiences to be low.”

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Laboratory-confirmed non-O157 Shiga toxin-producing Escherichia coli--Connecticut, 2000-2005
(references removed)
“Shiga toxin-producing Escherichia coli (STEC) infection causes diarrhea that is often bloody and can result in potentially life-threatening hemolytic uremic syndrome (HUS). Escherichia coli O157:H7 is the most common cause of STEC infection in the United States, producing 73,000 illnesses annually, according to the last estimate in 1999. Unlike O157, however, little is known about the incidence of non-O157 strains. Because STEC other than O157 are not commonly identified, the incidence, trends, and epidemiology of non-O157 STEC are not well understood. To assess trends in Shiga toxin enzyme immunoassay (Stx EIA) testing by local clinical laboratories, the Connecticut Department of Public Health (CTDPH) analyzed results of confirmatory testing conducted in the state laboratory during 2000-2005. The findings indicated that a total of 403 STEC infections were reported by clinical laboratories in Connecticut, including 207 identified as STEC by Stx EIA testing alone, and that the use of Stx EIA increased from 2000 to 2005. Use of Stx EIA without prompt culture confirmation can delay or prevent serotyping and subtyping of isolates and detection of both O157 and non-O157 STEC outbreaks. Public health authorities in all states should ensure that clinical laboratories forward Stx EIA-positive specimens to the state laboratory for isolation and identification of STEC, as recommended by the Association of Public Health Laboratories and CDC. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5602a2.htm
(MMWR January 19, 2007 / 56(02);29-31)

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West Nile Virus Transmission Through Blood Transfusion--South Dakota, 2006
(references removed)
“West Nile virus (WNV) transmission through blood transfusion was first reported in 2002, prompting rapid implementation of nationwide screening of blood donations for WNV by 2003. Screening strategies were developed using minipool nucleic acid-amplification testing (MP-NAT) based on 6 or 16 pooled donor samples. To improve sensitivity of WNV detection, blood-collection agencies (BCAs) later implemented enhanced screening by individual donation NAT (ID-NAT), most often used when a given trigger threshold of positive MP-NAT results is reached during the WNV transmission season. This approach has been effective, resulting in the detection and interdiction of approximately 1,400 potentially infectious blood donations during 2003--2005 and a reduction in recognized transfusion-transmission events. A total of 23 confirmed WNV transfusion-transmitted cases were reported in 2002, before screening was implemented; 6 probable or confirmed cases were detected in 2003 after MP-NAT screening was initiated, 1 was detected in 2004, and none were detected in 2005. This report describes the first WNV transfusion-transmission cases detected since the initiation of enhanced screening strategies using ID-NAT triggering. In 2006, 2 immunosuppressed patients had onset of West Nile neuroinvasive disease (WNND) after receiving blood products from a single infected donor despite a negative MP-NAT result at the time of donation. Although risk for transmission has been substantially reduced as a result of routine MP- NAT and triggered ID-NAT screening, clinicians should be reminded that transfusion-transmitted WNV infections can still occur, and that immunosuppressed patients are more likely to have onset of WNND. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5604a4.htm
(MMWR February 2, 2007 / 56(04);76-79)

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The Changing Epidemiology of Invasive Haemophilus influenzae Disease, Especially in Persons 65 Years Old
Mark S. Dworkin et al. Clinical Infectious Diseases. 2007;44:000.
http://www.journals.uchicago.edu/CID/journal/issues/v44n6/40766/brief/40766.abstract.html
Abstract: “Background. Few studies have reported the epidemiological characteristics of Haemophilus influenzae disease among adults. Methods. Public health surveillance and hospital discharge data from Illinois were examined to determine the descriptive epidemiological characteristics and trends of invasive H. influenzae disease, and mortality data from Illinois were compared with data from several other states. Results. During January 1996–December 2004, 770 cases of invasive H. influenzae disease were reported to the Illinois Department of Public Health (Springfield). The incidence of disease increased from 0.4 to 1.0 cases per 100,000 persons, including an increase of incidence in adults aged 65 years from 1.1 to 3.9 cases per 100,000 persons. Nontypeable H. influenzae disease accounted for the greatest proportion of cases (35.8%–61.5%) in all but 1 age group. The number of cases of invasive nontypeable H. influenzae disease increased by 657%, from a low of 7 cases in 1996 to a high of 53 cases in 2004; as a proportion of annual cases, nontypeable H. influenzae disease increased from 17.5% in 1996 to 70.7% in 2004. Overall, the case-fatality rate was 12.7%, with the highest rate observed in persons aged 65 years (20.6%). The case-fatality rate was similar for the hospital discharge database and for Indiana, Maryland, Oregon, and Wisconsin (range, 12.9%–18.2%). Conclusions. In Illinois, the incidence of invasive H. influenzae disease increased from 1996 to 2004, and its epidemiological characteristics changed from a disease predominantly found in children and dominated by serotype b to a disease predominantly found in adults and dominated by nontypeable strains.”

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HIV/AIDS Diagnoses Among Blacks--Florida, 1999-2004
(references removed)
“In 2004, Florida accounted for 11% of the total number of acquired immunodeficiency syndrome (AIDS) cases in the United States, ranking third behind New York and California. Florida also had the second-highest reported AIDS diagnosis rate (behind New York). During 2004, non-Hispanic blacks accounted for 14% of the Florida population but 52% of the 77,421 persons in Florida living with human immunodeficiency virus (HIV)/AIDS. This report describes trends in diagnoses of HIV/AIDS cases that occurred among blacks during 1999--2004 and were reported to the Florida Department of Health. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5604a2.htm
(MMWR February 2, 2007 / 56(04);69-73)

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3. Notifications
Beginning and Intermediate/Advanced Courses in Epi Info
Emory University's Rollins School of Public Health and CDC's Office of Workforce and Career Development will cosponsor training for Epi Info (CDC statistical software for public health practitioners) Mar 12-14, 2007, for beginning-level students, and Mar 15-17, 2007, for intermediate/advanced- level students. Courses will be held at Emory University; tuition is charged. These courses are designed for practitioners of epidemiology and computing who would like to develop software applications using Epi Info for Windows. The beginning-level course will cover MakeView, Analysis, Enter, Epi Map, and Epi Report. The intermediate/advanced level will cover importing and converting other data formats; creating relational databases; advanced check-coding and using Epi Info functions; advanced analysis including linear regression, logistic regression, Kaplan Meier, Cox proportional hazards, complex sample frequencies, tables, and means; special topics on Epi Map and Epi Report; and issues related to students' own projects. Additional information and applications are available from Emory University, Rollins School of Public Health (ATTN: Pia), 1518 Clifton Rd. N.E., Room 746, Atlanta, Georgia, 30322; fax: 404-727-4590; website: http://www.sph.emory.edu/EPICOURSES; e-mail: pvaleri@sph.emory.edu.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5602a4.htm
(MMWR January 19, 2007 / 56(02);32)

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17th Meeting of International Society for Sexually Transmitted Diseases Research
Jul 29 - Aug 1, 2007, Seattle, Washington, USA
Abstract submission: Jan 2 - Mar 9, 2007; Registration opens Jan 2, 2007. The International Society for Sexually Transmitted Diseases Research conducts biennial scientific meetings that address the entire range of the biomedical, behavioral and social sciences related to all STDs, including HIV infection. For more information visit: www.isstdr.org.

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APEC Health Task Force Meeting
Jan 19-20, 2007; Canberra, Australia.
At the HTF meeting, members discussed the current HTF projects and activities (Enhancing avian and human pandemic influenza preparedness and response; Fighting against HIV/AIDS in the APEC region; Guidelines for creating an enabling environment for employers to implement effective workplace practices for people living with HIV/AIDS; Improving health outcomes through advances in health information technology). There was also discussion on the updated HTF Workplan, the progress achieved on the APEC Action Plan on the Prevention and Response to Avian and Influenza Pandemics, and other HTF activities.
(Asia-Pacific Economic Cooperation)

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National Black HIV/AIDS Awareness Day--Feb 7, 2007
During 2001-2004, the estimated annual number of cases of HIV/AIDS among blacks decreased in the 33 states. However, the impact of HIV among blacks remained disproportionately high compared with other racial/ethnic populations. Blacks made up approximately 13% of the population in the 33 reporting states yet accounted for approximately 49% of persons who had a diagnosis of HIV/AIDS. Of the estimated 1 million persons living with HIV/AIDS in the US at the end of 2003, 47% were black. AIDS is a leading cause of death for blacks, who die sooner after AIDS diagnoses than persons in other racial/ethnic populations. Feb 7 is National Black HIV/AIDS Awareness Day. To address the racial disparity in occurrence of HIV/AIDS, CDC conducts research and programs for HIV prevention among blacks.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5604a1.htm
(MMWR February 2, 2007 / 56(04);69)

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

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 apecein@u.washington.edu