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Vol. X, No. 4 ~ EINet News Briefs ~ Feb 16, 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)
- Turkey (Batman): Excerpts from OIE report on avian influenza H5N1 infection
- Turkey (Diyarbakir): Preliminary tests detect avian influenza in village
- UK (England)/Hungary: High genetic similarity of avian influenza H5N1 viruses
- Indonesia: Report of 2 new avian influenza H5N1 deaths; Poultry with avian influenza culled
- Pakistan: Third avian influenza H5N1 case detected in poultry
- South Korea (Kyonggi): New outbreak of avian influenza H5N1 in poultry
- Russia (Krasnodarskiy Kray): Excerpts on the OIE report on avian influenza H5N1
- Japan (Miyazaki): Excerpts from the OIE report on avian influenza H5N1
- Hong Kong: Bird confirmed with avian influenza H5N1 infection; 2 more suspected
- China: First rabies case of 2007 reported in Beijing
- Philippines: 4 human rabies cases so far in 2007
- Australia (Victoria): Knackery workers treated for anthrax
- Australia (South Australia): E. coli O157 outbreak with unknown source
- New Zealand (Auckland)/Samoa: Typhoid outbreak apparently linked to travel
- Russia: Cases of meningococcal disease increasing
- Canada: Wild bird survey finds no highly pathogenic strains of avian influenza
- Canada (Alberta): Case of BSE in bull confirmed
- Peru (Ancash): Confirmation of 2 human cases of anthrax
- Peru (Lambayeque Region): Foodborne illness among soldiers
- USA (Maryland): Investigation of 2 infants with botulism
- USA (California): Botulism associated with fermented soybean curd
- USA (Montana): Fatal human case of hantavirus
- USA: Neurocysticercosis plagues states along Mexico border
- USA: Salmonellosis (serotype Tennessee) outbreak caused by peanut butter
- Egypt: Report of third avian influenza H5N1 case in 2007

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

2. Articles
- Live Attenuated versus Inactivated Influenza Vaccine in Infants and Young Children
- Outbreaks of highly pathogenic avian influenza (A/H5N1) in commercial poultry in Hungary and the UK – public health implications?
- Two outbreaks of H5N1 avian influenza in farm geese, Hungary, January 2007
- Can Immunity Induced by the Human Influenza Virus N1 Neuraminidase Provide Some Protection from Avian Influenza H5N1 Viruses?
- Cross-Reactive Neuraminidase Antibodies Afford Partial Protection against H5N1 in Mice and Are Present in Unexposed Humans
- Behavioral Risks for West Nile Virus Disease, Northern Colorado, 2003
- Worldwide Emergence of Extensively Drug-resistant Tuberculosis
- Survey says public health workers lag in preparedness
- Lab culture of human norovirus called an important first
- Flu pandemic could choke Internet, requiring usage restrictions

3. Notifications
- Recommended composition of influenza vaccines for 2007-2008 northern hemisphere influenza season
- Epidemiology in Action Course
- 13th International Congress on Infectious Diseases
- Information on RotaTeq and Intussusception

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 / 3 (3)
Indonesia / 6 (5)
Nigeria/ 1(1)
Total / 10 (9)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 272 (166).
(WHO 2/16/07 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 2/6/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 2/14/07): http://gamapserver.who.int/mapLibrary/

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Europe/Near East
Turkey (Batman): Excerpts from OIE report on avian influenza H5N1 infection
Highly pathogenic avian influenza, Turkey: Information received 9 Feb 2007. Start date: 5 Feb 2007. Date of previous occurrence: 31 Mar 2006. Manifestation of disease: Clinical disease. Causal agent: Highly pathogenic avian influenza virus, Serotype: Not typed. Nature of diagnosis: Clinical, Laboratory (basic). Outbreak 1: Bogazkoy, Bogazkoy, Gercus, Batman. Date of start of outbreak: 5 Feb 2007. Species: Birds. Susceptible: 993; Cases: 200; Deaths: 80; Destroyed: 793; Slaughtered: 0. Affected population: 742 backyard chickens, 37 backyard turkeys, 5 geese, 7 ducks and 2 pigeons. Apparent morbidity rate: 20.14 percent; Apparent mortality rate: 8.06 percent; Apparent case fatality rate: 40.00 percent; Proportion susceptible removed: 87.92 percent; Removed from the susceptible population either through death, destruction, or slaughter. Source of infection: Contact with wild Species. Diagnostic test results: positive by Haemagglutination (HA) test and Haemagglutination inhibition test (HIT) and rapid tests.
(Promed 2/11/07)

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Turkey (Diyarbakir): Preliminary tests detect avian influenza in village
Preliminary tests have detected bird flu among poultry in another village in southeastern Turkey, after the presence of the H5N1 virus was confirmed last week in the region. Tests on 3 dead chickens taken from the village of Akcayir in the province of Diyarbakir "have come out positive. Detailed laboratory analyses are underway," said an agriculture ministry statement. It was not yet clear what strain of bird flu had affected poultry in the region. The village and 5 nearby hamlets were placed under quarantine, and the culling of animals had commenced. The H5N1 virus, which claimed 4 lives in Turkey a year ago, resurfaced last week in the village of Bogazkoy in the neighboring province of Batman.
(Promed 2/12/07)

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UK (England)/Hungary: High genetic similarity of avian influenza H5N1 viruses
The Veterinary Laboratory Agency (VLA) analysis has revealed a very high similarity (99.96%) between the H5N1 viruses found in Suffolk and the Hungarian outbreaks at the whole genome level. "Although other European viruses have shown close relationships to these viruses, these levels of identity are much closer than with other Asian lineage H5 viruses for which data are available, including those isolated from wild birds in Europe in 2005/06," VLA chief avian virologist Ian Brown said. "The comparison between the UK and Hungarian viruses reveals a high level of genetic match which cannot be said of other European virus strains." Dame Deirdre Hutton (chair of the Food Standards Agency) commented: "The investigation so far has not found anything that raises the risk to public health. It is still a possibility that infected poultry has entered the food chain but the risk to public health remains low." Since the outbreak at a Bernard Matthews turkey farm in Suffolk 3 Feb 2007, officials have been closely scrutinising the movement of poultry products to and from the plant and 2 facilities used by the company in Hungary.

Traces of the H5N1 strain of bird flu were discovered at a goose farm in the eastern Csongrad region of Hungary late Jan 2007. Since then, Bernard Matthews has imported and exported meat from a SaGa plant it owns in Sarvar, 160 miles from the outbreak, and an abbatoir at Kecskemet, just miles from the Hungarian exclusion zone. The coincidence, and similarity between the genetic make-up of the 2 occurrences of the virus, led the Government's chief scientific adviser, Sir David King, to declare that infection from Hungary was "the most likely scenario". Britain's deputy chief vet, Fred Landeg, said the working hypothesis was that the virus had been transmitted from poultry to poultry rather than through wild birds or other animals. Bernard Matthews has voluntarily agreed to suspend poultry movement between its English and Hungarian operations until the investigation is complete.

But Hungary has disputed the claims, saying that cases across the world only vary very slightly, and issued a denial of any link between the outbreaks. Hungary's chief vet, Miklos Suth, reported that no evidence had been found of how the virus could have spread from meat products in Hungary to Suffolk. He said that the SaGa plant, owned by Bernard Matthews, had no contact with the infected region in the south east of the country, while none of the sources for Gall Foods, the abattoir closer to the exclusion zone, had tested positive for the virus. Instead, Budapest remains angry that shipments of raw meat continued to be exported from the Bernard Matthews plant to Hungary even after the site was identified as infected, raising the risk that H5N1 was transported back to Central Europe. Mr Suth pointed out that 365 tonnes of turkey products were moved from the SaGa site in Sarvar to England between Nov 2006 and Feb 2007, while 622 tonnes moved the other way. Meanwhile, turkey slaughtering began once again the Bernard Matthews plant in Suffolk. The Meat Hygiene Service re-licensed the site's slaughter houses after they had been disinfected.
(Promed 2/13/07; CIDRAP 2/9/07 http://www.cidrap.umn.edu/ )

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Asia
Indonesia: Report of 2 new avian influenza H5N1 deaths; Poultry with avian influenza culled
Indonesia’s health ministry announced 2 new H5N1 avian influenza deaths from West Java. A woman, 22, died at Slamet Hospital in Garut, and a 9-year-old boy died in the same hospital. If their infections are confirmed by WHO, they will be listed as Indonesia’s 84th and 85th cases and the 64th and 65th deaths. The woman apparently had contact with dead chickens before she died, hospital spokesman Yogi Suprayogi said. He said hundreds of chickens had died in the woman’s village, Karangpawitan recently, and 4 other people from the woman’s village had become ill. Mass culling of birds and backyard poultry was set to begin Feb 1 throughout Jakarta and surrounding areas, but the city has been hit by massive flooding in recent days. Indonesia's government has come under fire recently for stopping the sharing of samples of the highly pathogenic HN51 strain of the virus. Jakarta argues that the prevailing system allows drug firms to use these samples to make vaccines developing countries often cannot afford.

Some 50 poultry were culled in Bangkalan, Madura Island, East Java, following a finding of avian influenza virus infection in the area recently. Bangkalan District Head Fuad Amin Imron has called for efforts to control bird flu virus by culling poultry within a radius of 100 m from the location where the bird flu infection was detected earlier. There is no human infected with bird flu virus in Bangkalan so far, but the district has intensified surveillance by spraying disinfectant in poultry breeding areas and launching a public awareness campaign. The local administration has provided compensation worth USD 4.42 for each animal being culled. Reportedly the Indonesian government would allocate USD 61 million for an anti-bird flu drive in 2008, an increase from the USD 55 million it budgeted this year.
(Promed 2/11/07, 2/15/07; CIDRAP 2/12/07 http://www.cidrap.umn.edu/ )

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Pakistan: Third avian influenza H5N1 case detected in poultry
The National Reference Laboratory (NRL) has confirmed bird flu virus in domestic turkeys and peacocks in Islamabad as authorities have beefed up monitoring and surveillance activities to save commercial farms from avian flu. "This is the third confirmed H5N1 case [since 6 Feb 2007] in a domestic flock. Fortunately, commercial farms are still safe," Dr Mohammad Afzal, head of the NRL said 10 Feb 2007. The virus in Islamabad was confirmed 6 Feb 2007. Rawalpindi and Mansehra are the other places where the virus has been found in domestic poultry. In 2006, hundreds of thousands of flu-hit birds were culled in commercial farms, causing a loss of USD 164.5 million to the Pakistani poultry industry. A project for national level monitoring and surveillance of bird flu being proposed will include legislation that will remove hurdles in the way of forming a national level integrated strategy to control the avian flu. At present, there is overlap in roles of various departments at provincial and district levels which has hampered efforts to monitor the situation properly, said Dr Rafiqul Hassan Usmani of Minfal [Ministry of Food, Agriculture and Livestock]. Also, the World Bank and the Asian Development Bank have asked the government to come up with a national level project to monitor the spread of avian flu not only in animals but also in humans.
(Promed 2/11/07)

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South Korea (Kyonggi): New outbreak of avian influenza H5N1 in poultry
South Korea reported another avian flu outbreak in poultry, bringing the total since Nov 2006 to 6 outbreaks. The outbreak occurred at a chicken farm in Iljuk Village, Ansong city in Kyonggi province, about 50 miles southeast of Seoul, and officials have confirmed that it is the H5N1 strain. In response to the outbreak, officials ordered the culling of 240,000 birds, including 133,000 chickens. They also declared a 10-km quarantine zone, from which movement of birds and eggs will be prohibited. Though the new outbreak is about 30 to 40 miles from 2 of the recent outbreaks, authorities think it unlikely that the virus spread from one of the latter sites. Instead, they suspect it was spread by migratory birds. South Korea was hit hard by bird flu between Dec 2003 and Mar 2004, prompting the cull of 5.3 million poultry.
(CIDRAP 2/11/07, 2/12/07 http://www.cidrap.umn.edu/ )

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Russia (Krasnodarskiy Kray): Excerpts on the OIE report on avian influenza H5N1
Highly pathogenic avian influenza, Russia: Information received 9 Feb 2007. Start date: 12 Jan 2007. Date of confirmation of event: 26 Jan 2007. Date of previous occurrence: Aug 2006. Manifestation of disease: Clinical disease. Causal agent: Highly pathogenic avian influenza virus Serotype: H5N1. Nature of diagnosis: Suspicion, Clinical, Laboratory (basic and advanced). Outbreak 1: Upornaya, Labinsk, Krasnodarskiy Kray. Date of start of outbreak: 16 Jan 2007. Susceptible: 49; Cases: 8; Deaths: 8; Destroyed: 41; Slaughtered: 0. Affected population: native chickens and traditionally raised ducks, geese, and turkey cocks. Outbreak 2: Labinsk, Labinsk, Krasnodarskiy Kray. Date of start of outbreak: 12 Jan 2007. Species: Birds. Susceptible: 57; Cases: 18; Deaths: 18; Destroyed: 39; Slaughtered: 0. Affected population: native chickens and traditionally raised ducks, geese, and turkey cocks. Outbreak 3: Borodinskaya, Primorsko-Akhtarsky, Krasnodarskiy Kray. Date of start of outbreak: 17 Jan 2007. Species: Birds; Susceptible: 41; Cases: 3; Deaths: 3; Destroyed: 38; Slaughtered: 0. Affected population: native chickens and traditionally raised ducks, geese, and turkey cocks. Apparent morbidity rate 19.73 percent. Apparent mortality rate 19.73 percent. Apparent case fatality rate 100.00 percent. Proportion susceptible removed 100.00 percent. Removed from the susceptible population either through death, destruction, or slaughter. Source of infection: Contact with wild Species. Diagnostic test results: Positive by Polymerase chain reaction (PCR) and virus isolation.
(Promed 2/11/07)

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Japan (Miyazaki): Excerpts from the OIE report on avian influenza H5N1
Highly pathogenic avian influenza, Japan: Information received 8 Feb 2007. Date of confirmation of event: 13 Jan 2007. Date of previous occurrence: 5 Mar 2004. Manifestation of disease: Clinical disease. Causal agent: Highly pathogenic avian influenza virus, serotype: H5N1. Nature of diagnosis: Clinical, Laboratory (advanced). New Outbreaks: Shintomi-town, Miyazaki. Date of start of outbreak: 30 Jan 2007. Species: Birds; Susceptible: 93 000; Cases: 300; Deaths: 300; Destroyed: 92 700; Slaughtered: 0. Apparent morbidity rate 0.32 percent; Apparent mortality rate 0.32 percent; Apparent case fatality rate 100.00 percent; Proportion susceptible removed 100.00%. Source of infection: Unknown or inconclusive. Diagnostic test results: Positive by Haemagglutination inhibition test (HIT), Intravenous pathogenicity index (IVPI) test, neuraminidase inhibition assay and Pathogen isolation by egg inoculation.
(Promed 2/11/07)

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Hong Kong: Bird confirmed with avian influenza H5N1 infection; 2 more suspected
Preliminary testing of 2 silver-eared mesias found dead in Mong Kok has indicated a suspected case of H5 avian flu, the Agriculture, Fisheries & Conservation Department says. The carcasses were collected by department staff at 101 - 109 Boundary Street 7 Feb 2007. Stalls in the Bird Garden in Mong Kok were inspected 10 Feb 2007, and no problems were found. The department will keep close surveillance of pet bird stalls in the garden. As for a suspected case involving a dead blue magpie found in Sham Shui Po 6 Feb 2007 (at ground floor of North Kowloon Magistracy, Tai Po Road), the bird was confirmed to have H5N1.
(Promed 2/9/07, 2/12/07)

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China: First rabies case of 2007 reported in Beijing
Beijing announced 2 Feb 2007 that a farmer from the Dashing District had died of rabies. Early Jan 2007, the farmer found a stray German shepherd puppy and brought it home to keep. While catching the dog, the man was bitten on his fingers. The patient did not seek vaccination against rabies immediately. About 4 weeks after the bite, the patient felt discomfort at the site of the dog-bite lesion. A day after he went to the Yiou-an clinic in Beijing for help, he was diagnosed as a suspected rabies case. The patient exhibited typical symptoms of rabies, such as hydrophobia or fear of water, unusual sensitivity to wind, profuse salivation, difficulty swallowing, insomnia etc. The patient died 2 Feb 2007. This case has been confirmed as the first rabies case of this year in the capital. Beijing has experienced increasing numbers of people suffering from dog bite in recent years. In 2006 alone, the entire city had treated approximately 140 000 patients for dog related injuries with prophylactic rabies vaccine.
(Promed 2/4/07)

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Philippines: 4 human rabies cases so far in 2007
The rise of human rabies brought about by rabid stray dogs in Jan and Feb 2007 is alarming. 4 human rabies incidents occurred Jan 2007 and another one Feb 2007. "Victims should immediately wash their bites with water and soap, which is commonly available even in far-flung barangays [village settlements], instead of using "tandok". . .," Provincial Health Officer Grace Trabado said. Provincial Veterinary Officer Dr. Silveno Teodosio encouraged the immediate destruction of stray dogs in a humane manner. Teodosio wanted an all-out-war against the "tandok" system by passing a provincial dog control ordinance and making the "tandok" practice illegal. The indigenous healing practice for the treatment of dog and snake bites is called "tandok". It is popular in the southern parts of the Philippines, but is not endorsed by the Philippine Department of Health. They are no substitute for protection against canine rabies by compulsory vaccination of dogs and post-exposure vaccination of victims of dog-bite.
(Promed 2/9/07)

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Australia (Victoria): Knackery workers treated for anthrax
The co-workers of a Victorian knackery worker (renderer) infected with anthrax while handling affected cattle carcasses have been given antibiotics as a precautionary measure. Several workers at the Stanhope facility who were considered at risk had been provided with medications. The infected worker is expected to leave hospital in a few days. The 34-year-old was diagnosed with a skin infection during the week of 28 Jan 2007, the first such case in the state for 10 years, but has responded well to antibiotic treatment at hospital. Anthrax appeared on the index farm 19 Jan 2007 and the Victorian Department of Primary Industries (DPI) responded by tracing movements of livestock and products from the property, by destroying the affected carcasses and implementing vaccination on the affected farm and neighbouring properties. Routine control measures have been implemented including quarantine, incineration of carcasses, and vaccination of cattle. Livestock and product movements from all the affected farms have been traced.

The Department of Primary Industries has confirmed 5 more cases of anthrax cattle deaths in the Goulburn Valley in northeast Victoria this week, bringing the total anthrax death toll to 34. The cattle losses are on farms already affected by the disease during the past 3-and-a-half weeks. So far, 8 properties in Stanhope and 1 at Tatura have had stock losses to anthrax. The farm at Tatura has been quarantined and neighbouring property owners have been alerted. A mass-vaccination program against anthrax including 32 000 cattle is continuing. Mass-use of antibiotics has not been employed, as these are milking dairy herds, and that would require all milk on those farms to be discarded for a considerable period at massive cost.
(Promed 2/6/07, 2/7/07, 2/14/07)

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Australia (South Australia): E. coli O157 outbreak with unknown source
State director of Public Health Kevin Buckett said 13 Feb 2007, that no link had been established between the E. coli O157 infection patients who range in age from 2 to 81 years and live across Adelaide. Each patient had been in good health and [eaten] a wide variety of food. "Here in SA, we get around 30 to 40 cases of all strains of E. coli each year," he said. The outbreak in South Australia involves E. coli O157. They have had 11 confirmed cases with identical Shiga-toxin gene profiles. There have been no confirmed cases of hemolytic uremic syndrome definitely linked to this outbreak. Epidemiological investigation is continuing. At this stage no definite source can be identified.
(Promed 2/13/07, 2/14/07, 2/15/07)

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New Zealand (Auckland)/Samoa: Typhoid outbreak apparently linked to travel
It now appears that food outlets in the South Auckland suburb of Clendon are not the source of a typhoid outbreak in the area. Earlier in Jan 2007, officials investigated 4 retailers for links to several cases of the disease, but tests on 26 workers came up negative. Dr. Greg Simmons of the Auckland Regional Public Health Service says that based on what he has seen, it is unlikely the infection is water or food-borne and is likely to be transmitted person-to-person. A typhoid epidemic seems to be sweeping the Pacific and there may be links with the recent outbreaks in New Zealand. Samoan authorities are asking athletes heading to the South Pacific Games to be vaccinated for the disease. Since Nov 2006, there have been 17 cases of typhoid in Auckland, most of them linked to overseas travel. Dr. Simmons says authorities in Samoa and New Zealand are working together to curb any further cases and are warning travelers to take caution. Typhoid is becoming a problem in Fiji too, with a danger that the number of typhoid cases there could increase because of the recent floods.
(Promed 2/9/07, 2/15/07)

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Russia: Cases of meningococcal disease increasing
A seasonal rise of incidence of meningococcal infection has been observed in the Primorskiy area. Since the beginning of 2007, 12 cases have been reported. 8 cases have been registered in the Vladivostok area; the Spassk-Dalniy, Partizansk, Kavalerovsk, and Dalnegorsk regions have 1 case each. Of the 12 cases, 4 have been reported as mild and 1 woman died in Vladivostok. In Tyumen, 2 Armenian women, aged 25 and 49, died in the Tyumen regional Infectious Diseases hospital. Both patients had meningococcemia. Michael Orlov, the head of the medical center, said only 7 Tyumen residents with meningococcal disease were admitted during Jan 2007, of which 5 survived. Orlov said that epidemiological data on meningococcal disease is far below the annual average morbidity and that an outbreak cannot be declared.
(Promed 2/13/07)

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Americas
Canada: Wild bird survey finds no highly pathogenic strains of avian influenza
Canada found no highly pathogenic strains of avian flu in its second annual wild bird survey, the Canadian Food Inspection Agency (CFIA) announced. More than 12,000 birds were tested. Samples were collected from live and dead migratory and resident birds. Additional sampling was done in Iceland, a mingling point for birds from North America and Europe. Like the 2005 survey, the 2006 investigation found various H5 and H7 avian flu viruses, which can affect domestic poultry. "Finding avian influenza viruses in wild birds is not unexpected. Influenza viruses commonly circulate in wild birds with little or no impact on the health of the birds or other species," the CFIA said. In Aug 2006, the US Department of Agriculture and Department of the Interior expanded a wild bird surveillance program beyond Alaska to the lower 48 states, Hawaii, and other Pacific islands. So far birds in 6 instances have tested positive for the low-pathogenic North American H5N1 avian flu virus, a mild strain that has been found several times before. The US Highly Pathogenic Avian Influenza Early Detection Data System (HEDDS) has tested 74,140 samples. The 2006 sampling season runs from Apr 2006 through Mar 2007. A summary of the survey results can be viewed at the CCWHC website: http://wildlife1.usask.ca/. For additional information about AI prevention and preparedness, visit the Canadian Food Inspection Agency website, at: http://www.inspection.gc.ca/english/anima/heasan/disemala/avflu/avflue.shtml
(CIDRAP 2/9/07 http://www.cidrap.umn.edu/ ; Promed 2/9/07)

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Canada (Alberta): Case of BSE in bull confirmed
The Canadian Food Inspection Agency (CFIA) has confirmed the diagnosis of bovine spongiform encephalopathy (BSE) in a mature bull from Alberta. The animal's carcass is under CFIA control, and no part of it entered the human food or animal feed systems. Preliminary information indicates that the age of the animal falls well within the age range of previous cases detected in Canada under the national BSE surveillance program. This signifies that the animal was exposed to a very small amount of infective material, most likely during its first year of life. An investigation directed by international guidelines is underway to examine what the animal was fed early in its life and to identify its herd mates at the time. Under Canada's enhanced feed ban, which comes into effect 12 Jul 2007, BSE should be eliminated from the national cattle herd within approximately 10 years. The CFIA expects the periodic detection of a limited number of cases to continue as the level of BSE continues to decline.

The finding of a mature animal should not impact Canada's BSE country categorization submission to the World Organisation for Animal Health (OIE). The surveillance program targets the highest risk cattle populations and has tested roughly 150 000 animals since 2003. The surveillance results reflect an extremely low incidence of BSE in Canada. Though this is the ninth case of mad cow in the country since May 2003, authorities have confirmed that none of the animal has entered the food chain yet. All the animals are believed to have contracted the disease from contaminated feed. Older cattle and their beef products are still banned from the U.S., although there are chances of the trade being resumed between the 2 countries. The infection caused an estimated loss of USD 7 billion to the Canadian cattle industry.
(Promed 2/8/07)

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Peru (Ancash): Confirmation of 2 human cases of anthrax
Peru's National Agricultural Health Service confirmed 9 Feb 2007 that 2 people were affected with skin anthrax in Huarmey, a town in the Ancash province, 300 km northeast of Lima. The patients, 1 adult and 1 child, were infected by live goats suffering anthrax, rejecting reports that they had eaten contaminated mutton. However, virtually all human cutaneous cases follow from exposure to sick animals after they have been slaughtered and butchered. It occurs through the bacteremic animal blood getting into cuts in the skin of the human handlers. Reportedly, they had received medical care, while officials have begun to look for sick goats in order to slaughter them, and planned to vaccinate healthy goats in the area.
(Promed 2/11/07)

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Peru (Lambayeque Region): Foodborne illness among soldiers
According to the regional health director, Victor Echeandia, a total of 83 Peruvian army soldiers in Lambayeque are suffering from food poisoning. "We have taken food samples in the barracks to find out if they carry salmonellae or other bacteria". He said that 3 hours after they had lunch 12 Feb 2007, soldiers started to complain of severe abdominal pain, high fever, and diarrhea. (It is possible that the exposure was prior to lunch.) 11 patients were immediately taken to a hospital and received intravenous fluids to prevent dehydration. 2 soldiers remain under observation while the others continue receiving ambulatory treatment.
(Promed 2/13/07)

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USA (Maryland): Investigation of 2 infants with botulism
Maryland officials have confirmed the presence of the same type of botulinum bacteria in 2 infants living on the same street at Fort Meade, each of whom was recently diagnosed as having botulism, the Army said 1 Feb 2007. The first case was diagnosed Oct 2006, the other Dec 2006. The children, each of whom was under 6 months of age at the time, live in a residential area on the Anne Arundel County Army post. Both children have been treated and are reportedly recovering. The Clostridium botulinum bacteria found in stool samples from both infants can be found naturally in some soil as well as in contaminated food. Finding the same type in both infants is an indication that the cases could be related. In Jan 2007, Fort Meade authorities used hay to cover soil and keep down dust at a work site about a quarter of a mile from the childrens' homes. The investigation is also looking into whether the 2 children could have eaten the same food or otherwise been similarly exposed to a source. Soil at the site is being tested. The lot will be sodded and no longer used as a work site. No lots near residential areas will be used in the future for construction activities.
(Promed 2/2/07)

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USA (California): Botulism associated with fermented soybean curd
In Dec 2006, the Orange County Health Care Agency (OCHCA) and the California Department of Health Services (CDHS) were notified of 2 potential cases of foodborne botulism in an older Asian couple. This report summarizes the subsequent investigation, which identified home-prepared fermented tofu (soybean curd) as the source. The public should be aware of the risk for botulism when preparing fermented tofu at home. Botulism is a toxin-induced paralytic illness characterized by cranial nerve palsies and descending flaccid paralysis. Treatment is based on supportive care and administration of botulinum antitoxin; recovery can take from weeks to months. Foodborne botulism results from eating foods containing botulinum toxin.

On 4 Dec 2006, the 67-year-old woman visited her physician because of double vision, ptosis, dizziness, difficulty swallowing, slurred speech, drooling, and right arm weakness. The woman's husband, aged 75 years, reported 3 days of worsening double vision, dizziness, and difficulty swallowing. Both patients were admitted to an intensive care unit. Botulinum antitoxin was administered, and both were hospitalized for more than 1 week with no further symptom progression. Both patients have some blurred vision but otherwise have recovered. CDHS Microbial Diseases Laboratory found both C. botulinum type A and botulinum toxin type A in the fermented tofu samples, which had a pH of 6.8.

C. botulinum spores exist widely in the environment, but proper food-preparation practices inhibit spore germination and toxin production. Environmental conditions that facilitate spore germination and growth include a pH greater than 4.6, anaerobic conditions, low salt or sugar content, and temperatures greater than 4 C. This is the first American report of botulism caused by eating home-prepared fermented tofu. Historically, most foodborne botulism cases in the USA result from consumption of improperly prepared home-canned foods. Fermented tofu is popular in Asia, and homemade fermented bean products are the most common foods causing botulism in China.
***See the CDC MMWR report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5605a2.htm
(Promed 2/8/07)

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USA (Montana): Fatal human case of hantavirus
A Gallatin County woman has died of hantavirus, the Gallatin City-County Health Department said 24 Jan 2007. The department is investigating how and where the 43-year-old woman contracted hantavirus pulmonary syndrome. She reportedly died about a week and a half ago. People get hantavirus by inhaling airborne particles from dried droppings, saliva or urine of infected deer mice. Symptoms may include fever, vomiting, muscle and body aches and fatigue. A person's lungs eventually begin filling with fluid, causing shortness of breath. Across the state, 27 people have been diagnosed with hantavirus, and 7 have died since the disease was first recognized in 1993. The woman's illness is the second case in Gallatin County but the first resulting in death. A nonfatal case was reported in 2001.
(Promed 2/5/07)

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USA: Neurocysticercosis plagues states along Mexico border
Federal researchers say neurocysticercosis, a brain infection caused by a pork tapeworm, is a growing public health problem in the US, especially in states bordering Mexico. It is the most common parasitic disease of the central nervous system, according to CDC and California public health officials, who reported that international travel and immigration are bringing the disorder to areas where it is not endemic. "Neurocysticercosis is the primary cause of epilepsy in endemic areas. . ." Victor C. Tsang, chief of the immunochemistry laboratory in the Parasitic Disease Division of CDC said. Neurocysticercosis refers specifically to nervous-system disorders caused by cysticercosis, an infection which can also harm eyes and muscles. "Recent data indicate cysticercosis is an important cause of death in California," Tsang et al. wrote in a report. A separate report in Feb 2007 issue of Emerging Infectious Diseases found that nearly 60 percent of the 221 U.S. deaths from cysticercosis between 1990 and 2002 involved California residents. Most patients [187, or 85 percent] were foreign-born, and 137 [62 percent] had emigrated from Mexico.

Neurocysticercosis occurs when the larvae of a pork tapeworm (Taenia solium) enter and infect the brain and spinal cord and form cysts. A person infected with the intestinal tapeworm stage of the infection will shed tapeworm eggs. Tapeworm eggs that are accidentally swallowed by other people can cause infection. These eggs are spread through food, water or surfaces contaminated with feces. So if you have people cooking for you or handling your food who are tapeworm carriers and don't have good personal hygiene, you will be exposed to the eggs of the tapeworm and become infected by swallowing food they touch. The incubation period for neurocysticercosis can be years. Carriers tend to be people from developing countries with poor hygiene, where pigs are allowed to roam freely and eat human feces. Tsang said the condition is rife in Latin America and in China and Africa. Infection with neurocysticercosis often causes headaches and seizures, but it can also result in mental confusion, balance difficulties and brain swelling that can kill.
(Promed 2/12/07)

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USA: Salmonellosis (serotype Tennessee) outbreak caused by peanut butter
The Food and Drug Administration (FDA) is warning consumers not to eat certain jars of Peter Pan peanut butter or Great Value peanut butter due to risk of contamination with Salmonella Tennessee. The affected jars of Peter Pan and Great Value peanut butter have a product code that begins with the number "2111." Both brands are manufactured in a single facility by ConAgra. Great Value peanut butter made by other manufacturers is not affected. If consumers have any of this Peter Pan or Great Value brand peanut butter in their home that has been purchased since May 2006, they should discard it. Symptoms of foodborne illness caused by Salmonella include fever, diarrhea and abdominal cramps. In persons with poor underlying health or weakened immune systems, Salmonella can cause life-threatening infections.

FDA's warning is based on a study which links 288 cases of foodborne illness in 39 states to consumption of varying types of Peter Pan peanut butter. The outbreak appears to be ongoing and the first consumer may have become ill Aug 2006. ConAgra is recalling all Peter Pan and Great Value peanut butter beginning with product code 2111 that already was distributed. The company also is destroying all affected products in their possession. The company will cease production until the exact cause of contamination can be identified and eliminated. FDA has sent investigators to ConAgra's processing plant where the products are made to review records, collect product samples and conduct tests for Salmonella Tennessee. How salmonella got into peanut butter is still under investigation. CDC believes the salmonella outbreak to be the nation's first stemming from peanut butter. The most cases were reported in New York, Pennsylvania, Virginia, Tennessee and Missouri. About 20 percent of all the ill patients were hospitalized, and there were no deaths. About 85 percent of the infected people said they ate peanut butter.
(FDA 2/14/07 http://www.fda.gov/bbs/topics/NEWS/2007/NEW01563.html ; Promed 2/15/07)

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Africa
Egypt: Report of third avian influenza H5N1 case in 2007
Egypt announced that a 37-year-old woman has tested positive for H5N1 avian influenza, marking the country’s third case of 2007. The woman is from Fayyum governorate, about 60 miles south of Cairo. She was hospitalized after experiencing a high fever and bronchitis and was transferred to a government hospital in Cairo, where she was treated with osteltamivir. She was Egypt’s 21st case, and 13th fatality. She is from the same area as Egypt’s last WHO-confirmed case, in a 19-year-old woman who died Feb 2. Reportedly, the woman kept birds in her home and had been exposed to infected poultry. There was no indication that she was infected with a moderately oseltamivir-resistant strain that has infected some of Egypt’s recent H5N1 patients. In Jan 2007, WHO said the resistant H5N1 strain, which first surfaced in Vietnam in 2005, had been detected in a man and his niece from the Nile delta province of Gharbiyah. Both died Dec 2006. The Egyptian government said Jan 2007 that poultry production had recovered to 1.8 million birds a day, just short of the 2 million produced before the outbreak.
(CIDRAP 2/14/07 http://www.cidrap.umn.edu/ ; Promed 2/14/07; WHO 2/16/07)

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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. Read some recent reports from Côte d’Ivoire and Pakistan.
- 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. New updates posted.
- 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
Based on the sentinel surveillance system in Taiwan, during the fifth epidemiological week (Jan 28 to Feb 3, 2007), the percentage of outpatient visits to sentinel physicians for influenza-like illness (ILI) has decreased by 10.1% compared with last week and is 28.9% higher than the same period in 2006. During week 2 to 5, 2007), the respective ILI consultation rates (per 100 outpatient visits) were 5.80, 5.47, 5.55 and 4.99. Comparing to last week, the consultation rate increased in Central and East regions while the remaining 4 regions reported a decreased trend. The dominant respiratory virus identified by National Influenza Center and CDC Collaborating Labs for week 2 to 5, 2007 was influenza B virus, followed by A (H3) virus. The other main respiratory viruses were Adenovirus and HSV (Herpes simplex virus). To date, 43 clusters have been reported this influenza season. Based on reporting dates, 15 additional severe influenza cases were reported in week 5. Based on onset dates, 109 severe cases have been reported cumulatively in the 2006-2007 epidemic season. Among these, 23 were confirmed, 69 were excluded, and 17 are still pending. So far this season (weeks 26, 2006 to week 5, 2007), 4 deaths have been reported.
(Promed 2/13/07)

USA
This report summarizes U.S. influenza activity since the beginning of the 2006--07 influenza season (Oct 1, 2006) and updates the previous summary. Low levels of influenza activity were reported from Oct through early Dec. Activity increased from mid-Dec through the end of the year, declined slightly in early Jan, and then increased again in mid-Jan. During Oct 1, 2006--Feb 3, 2007, WHO and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories in the US reported testing 83,332 specimens for influenza viruses, and 6,244 (7.5%) tested positive. Of these, 5,161 (82.7%) were influenza A viruses, and 1,083 (17.3%) were influenza B viruses. A total of 1,696 (32.9%) of the 5,161 influenza A viruses have been subtyped: 1,507 (88.9%) were influenza A (H1) viruses, and 189 (11.1%) were influenza A (H3) viruses. Of the 189 influenza A (H3) viruses reported to CDC this season, 117 (61.9%) were from the Mountain and Pacific regions.

During the current influenza surveillance season, weekly percentages of patient visits for ILI reported by approximately 1,300 U.S. sentinel providers in 50 states, Chicago, the District of Columbia, New York City, and the U.S. Virgin Islands have ranged from 1.0 to 3.2%. The national percentage of outpatient visits for ILI during 7 weeks was above the national baseline of 2.1%. For the week ending Feb 3, 2007, 8 of the 9 influenza surveillance regions reported ILI at or above their region-specific baselines. Pneumonia and influenza (P&I) was listed as an underlying or contributing cause of death for 7.4% of all deaths reported through the 122 Cities Mortality Reporting System for the week ending Feb 3, 2007. From Oct 1, 2006, through Jan 20, 2007, the preliminary laboratory-confirmed influenza-associated hospitalization rate reported by the Emerging Infections Program sites for children aged 0--17 years was 0.13 per 10,000. From Nov 5, 2006, through Jan 20, 2007, the preliminary laboratory-confirmed influenza associated hospitalization rate for children aged 0--4 years in the New Vaccine Surveillance Network was 0.63 per 10,000 children. For the 2006--07 influenza season, 9 influenza-related pediatric deaths have been reported.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5606a3.htm
(MMWR February 16, 2007 / 56(06);118-121)

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Cholera, diarrhea & dysentery
Philippines (Bohol)
Shigella flexneri, the bacteria that has killed at least 4 and infected over 400 residents of Loon town over the past 2 weeks, has reached epidemic proportions. According to Department of Health (DOH) Region 7, such widespread shigellosis may be occurring for the first time in the country. Of Loon's 67 barangays, 47 are now affected with the bacterial outbreak, according to DOH. As of 31 Jan 2007, there were 82 confined at the Cong. Natalio Castillo Hospital with 19 new admittances. Officials have reviewed cases of diarrhea in Loon over the past months to investigate how the spread of the disease started. Long periods of rainfall could trigger high [numbers of] cases of bacillary dysentery, and officials are trying to look into water sources, as there were reports that high levels of coliform have already been detected in water samples in the town's waterworks sources as early as Dec 2006.
(Promed 2/2/07)

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Dengue
Philippines (National Capital Region)
As of 31 Jan 2007, at least 27 persons with dengue fever, who were admitted Jan 2007 alone, remained confined at the Rizal Medical Center in Pasig City. No casualties have been reported among the patients coming from the cities of Taguig, Pasig and Makati, and the towns of Taytay and Cainta in Rizal province. Health Secretary Francisco Duque III said he has ordered the health department to prepare for a 12-month coverage against the disease, spread by mosquitoes that breed in stagnant water.
(Promed 2/7/07)

Philippines (Negros Oriental)
The Department of Health in Dumaguete City reported a decrease in the number of dengue cases recorded in Negros Oriental in 2006. Data collected shows that dengue cases in the province dipped to 978 in 2006 from 1203 cases recorded in 2005. The disease, however, left a more deadly trail in 2006 with 8 deaths recorded compared to 6 victims who died in 2005. Reportedly, the areas most affected by the disease are mostly urban areas such as the cities of Tanjay, Bais, and Dumaguete. The DOH continues to conduct intervention measures such as regular health information drive, environmental sanitation, and container management in all areas and Rural Health Units in the province. Officials of San Pedro, Laguna, have earlier declared a dengue outbreak in their municipality following the death of a person and the hospitalization of some 20 persons. The Laguna Health Office is currently conducting fogging operations. A dengue outbreak has also been declared in Bayugan, Agusan del Sur, where 3 persons died and 18 persons were hospitalized.
(Promed 2/7/07)

Philippines (country wide)
Dengue cases have reached alarming highs Jan 2007 and the Government will exhaust all means to combat the disease and contain the outbreak. In San Lazaro Hospital alone, 189 dengue cases have so far been listed. Other areas with dengue cases are Marikina, Rizal, Pasig, Laguna, Agusan del Sur, Cagayan de Oro, Osamis, and Bukidnon. Jun to Aug are considered the most problematic, with persistent rains during these months. The Department of Health Secretary Francisco Duque enjoins the public to maintain a clean environment to avoid this disease. He asks the public to help with the cleanup campaigns to destroy mosquito-breeding sites.
(Promed 2/7/07)

Indonesia
A total of 4862 dengue fever cases with 75 of them dying have been recorded in Jan 2007. The cases occurred in 14 of the country's 33 provinces with the special region of Jakarta registering the highest figure, Dr. Erna Tresnaningsih, the head of the health ministry's directorate of animal-borne disease control, said. Jakarta has the highest number of dengue fever patients, followed by West Java, Central Java, and Lampung on Sumatera Island, she said, and added that in Dec 2006, a total of 5400 dengue fever cases were reported in 28 provinces leading to 77 deaths. ". . . If the environment is free of pools of water which can be used by the mosquito to breed and the people maintain environmental health, the disease is surely more controllable," Tresnaningsih said. In West Java, 42 people have died of dengue fever since early Jan 2007. The province recorded 1889 confirmed cases of dengue fever between 1 and 29 Jan 2007.
(Promed 2/7/07)

Indonesia (Central Java)
The dengue fever epidemic in Central Java killed 43 people in Jan 2007, head of the provincial health office Endang Agustinar said. The overall number of dengue fever cases in Jan 2007 reached 1358. "Several areas recorded a sharp rise in infection, such as Blora regency, where 10 out of 141 patients died. In Pati regency, 7 out of 153 patients died," said Endang. In Semarang, 1 person died of the 155 cases recorded. The city saw 364 cases in the same month in 2006, of which 27 people, mostly children, died. Dozens of patients are still being treated in hospitals. The Semarang Health Office has fumigated a number of villages, while it has also distributed notices to students to monitor mosquito larvae.
(Promed 2/12/07)

Malaysia
The Health Ministry has called on the public to report on their neighbors who harbor mosquitoes, as 16 people have died due to dengue in 2007. Health Ministry parliamentary secretary Datuk Lee Kah Choon said public tip offs on potential mosquito breeding grounds were crucial to help minimize risk of dengue outbreaks in neighborhoods, adding that 13 dengue-related deaths were recorded in Selangor. Kuala Lumpur, Negeri Sembilan and Johor had each recorded 1 dengue-related death. Lee said a total of 6458 suspected dengue cases were recorded nationwide during the first 5 weeks of 2007, adding that about 50 per cent of the cases were in Selangor and Kuala Lumpur. "We carry out fogging within 24 hours after dengue cases are traced in an area. We also distribute abates in affected areas to kill the mosquitoes larvae," he said. Lee also called on school bus drivers to spray the school buses with mosquito repellents before fetching children during dawn and dusk.
(Promed 2/12/07)

Singapore
About 3100 dengue cases were reported in Singapore in 2006, dropping significantly from the previous year's number of 14,200. The number of homes found to be breeding mosquitoes dropped to 18 in every 10,000 homes in 2006, compared to 53 in 2005. This drop was thanks to the dengue prevention campaign launched by the government. The National Environment Agency (NEA) carried out 1.5 million inspections on homes to find mosquito-breeding places in 2006, up 60 percent from 2005. Furthermore, during the run-up to the Lunar New Year (17 Feb 2007), environment officers have worked with plant nurseries to check for mosquito breeding in their premises. The agency has distributed thousands of posters to residents and companies urging them to do their part to minimize mosquito breeding. Homes or commercial areas which are found to be breeding mosquitoes will be fined USD 130 each. 60 dengue cases a week were reported for the first month of 2007, the same weekly average as last year.
(Promed 2/12/07)

Peru (La Libertad, Lambayeque)
A second person has died of dengue since the outbreak of the disease in the north of Peru, the Health Ministry said 8 Feb 2007. A man died in the Trujillo Regional Hospital, in the province of La Libertad, 550 km north of Peru's capital, Lima, after suffering high fever, hemorrhage and pain. Another 133 cases of dengue fever have been detected by the Regional Health Directorate (DRS) in the El Porvenir district [of La Libertad] province, where the victim has been living. The first victim, a 79-year-old man, who died the week of 28 Jan 2007, was also a resident of La Libertad. The ministry said it started anti-mosquito spraying. The DRS has identified 4525 homes, which are at risk from the mosquito that spreads dengue, and has declared a state of health emergency in the region. Another 16 cases were found in 2007 in the neighboring province of Lambayeque. The Ministry said there have been no cases of hemorrhagic dengue in Lambayeque.
(Promed 2/13/07)

Chile (Easter Island)
Health authorities confirmed that 3 dengue cases have been detected on Easter Island [Isla de Pascua], and have put into action measures to eradicate the outbreak. The Undersecretary of Health, Lidia Amarales, said 10 Feb 2007 that the affected individuals are 2 men ages 33 and 46 years, and a woman of 27 years, all of who are undergoing treatment on the island. The cases were confirmed as having been infected with dengue 1 [virus]. Dengue [fever] was first detected on Easter Island in 2000, but the most serious outbreak was in 2002, when 600 cases were reported on this small island. Amarales called on the local residents and tourists to undertake measures to avoid proliferation of the mosquito. She explained that trash and other recipients in which water could serve as breeding sites should be eliminated. A team will be sent to the island to deal with this emergency. The team will fumigate the entire island starting 12 Feb 2007. Also, aircraft going between the island and the Chilean mainland will be fumigated to avoid [mosquito] transport of the [virus] to Chile. It would be more difficult to avoid transport of infected individuals incubating dengue virus infection.
(Promed 2/13/07)

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2. Articles
Live Attenuated versus Inactivated Influenza Vaccine in Infants and Young Children
Robert B. Belshe et al. NEJM. Volume 356:685-696. February 15, 2007. Number 7. http://content.nejm.org/cgi/content/short/356/7/685
Abstract: “Background Universal vaccination of children 6 to 59 months of age with trivalent inactivated influenza vaccine has recently been recommended by U.S. advisory bodies. To evaluate alternative vaccine approaches, we compared the safety and efficacy of intranasally administered live attenuated influenza vaccine with those of inactivated vaccine in infants and young children. Methods Children 6 to 59 months of age, without a recent episode of wheezing illness or severe asthma, were randomly assigned in a 1:1 ratio to receive either cold-adapted trivalent live attenuated influenza vaccine (a refrigeration-stable formulation of live attenuated intranasally administered influenza vaccine) or trivalent inactivated vaccine in a double-blind manner. Influenza-like illness was monitored with cultures throughout the 2004–2005 influenza season. Results Safety data were available for 8352 children, and 7852 children completed the study according to the protocol. There were 54.9% fewer cases of cultured-confirmed influenza in the group that received live attenuated vaccine than in the group that received inactivated vaccine (153 vs. 338 cases, P<0.001). The superior efficacy of live attenuated vaccine, as compared with inactivated vaccine, was observed for both antigenically well-matched and drifted viruses. Among previously unvaccinated children, wheezing within 42 days after the administration of dose 1 was more common with live attenuated vaccine than with inactivated vaccine, primarily among children 6 to 11 months of age; in this age group, 12 more episodes of wheezing were noted within 42 days after receipt of dose 1 among recipients of live attenuated vaccine (3.8%) than among recipients of inactivated vaccine (2.1%, P=0.076). Rates of hospitalization for any cause during the 180 days after vaccination were higher among the recipients of live attenuated vaccine who were 6 to 11 months of age (6.1%) than among the recipients of inactivated vaccine in this age group (2.6%, P=0.002). Conclusions Among young children, live attenuated vaccine had significantly better efficacy than inactivated vaccine. An evaluation of the risks and benefits indicates that live attenuated vaccine should be a highly effective, safe vaccine for children 12 to 59 months of age who do not have a history of asthma or wheezing.”

Editorial on this article: “Inactivated and Live Attenuated Influenza Vaccines in Young Children — How Do They Compare?” Nancy J. Cox and Carolyn Buxton Bridges: http://content.nejm.org/cgi/content/short/356/7/729.

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Outbreaks of highly pathogenic avian influenza (A/H5N1) in commercial poultry in Hungary and the UK – public health implications?
Influenza Team. Euro Surveill 2007;12(2):E070215.3. (references removed).
“The recently reported outbreaks of highly pathogenic avian influenza (HPAI) due to influenza type A/H5N1 in Hungary and then the United Kingdom (UK) have caused considerable disquiet and interest in the agriculture industry and the media. The outbreaks in January on geese farms in the village of Lapistó (Csongrád county in southern Hungary) and then in Derekegyháza, nine kilometres from the first outbreak, were not much of a surprise as there had been outbreaks in 2006 in Hungary linked to wild birds. The more recent outbreak on a large turkey farm in the UK (in Suffolk, southeast England) is the first to have occurred in the country, and so attracted more attention. It was initially suggested that wild birds were the source in the UK. If true, this would have been evidence for the possibility that, rather than being confined to wild birds in specific areas, the virus might once again have become widely disseminated in wild bird populations across the European Union (EU). This would have meant an increased health threat to poultry in the EU, particularly for small backyard flocks because of the difficulties of maintaining separation of wild birds and poultry. Due to the close contact between birds and backyard flock owners, the owners may also have been at a limited risk of infection. However, the birds on the affected UK farm were housed in an enclosed biosecure unit with limited possibilities for contact with wild birds. Additionally, the EU's extensive wild bird surveillance has not detected any positive H5N1 infected wild birds for several months (a very different situation from the early months of 2006). If the virus is present in wild bird populations within the EU, there is no evidence that it was widely disseminated. The H5N1 specimens from affected birds in the Hungary and the UK were sent to the EU Community Reference Laboratory for testing and genetic sequencing where the genomes of the viruses from Hungary and the UK were found to be 99.96% similar. The possible link between the two outbreaks is now the subject of intense investigation by EU, Hungarian and UK veterinary authorities to determine whether and how transfer could have taken place in either direction. . .”
http://www.eurosurveillance.org/ew/2007/070215.asp#3

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Two outbreaks of H5N1 avian influenza in farm geese, Hungary, January 2007
Editorial team. Euro Surveill 2007;12(2):E070215.2.
“On 21 January 2007, an increase in deaths among geese at a farm near Lapistó village (Csongrád county in southern Hungary) was reported to the Hungarian veterinary authorities. The breeding flock consisted of 3355 birds. Two birds died on 19 January, eight on 20 January, and 18 on 21 January. During an investigation at the farm on 21 January, more than 30 birds with neurological symptoms were discovered. On 22 January, 29 more deaths in this flock were registered in the morning and further 33 during the day. . . On 25 January, veterinary authorities were notified of another possible outbreak of avian influenza at a goose farm in Derekegyháza, 9 km from the site of the first outbreak. The flock consisted of 6000 four week-old and 3 386 eight week-old geese. On 23 January, 6 geese died, the following day the number of deaths was 24, on 25 January – 21, on 26 January - 289. By 27 January altogether 2 596 geese died in the outbreak, the remaining 6790 geese were culled. In addition, in order to control the outbreak, further 367 birds which were found in 4 households within 1-kilometre distance from the outbreak were also culled. . .”
For the full article: http://www.eurosurveillance.org/ew/2007/070215.asp#2

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Can Immunity Induced by the Human Influenza Virus N1 Neuraminidase Provide Some Protection from Avian Influenza H5N1 Viruses?
Laura Gillim-Ross and Kanta Subbarao. PLoS Med 4(2): e91 doi:10.1371/journal.pmed.0040091.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040091#cor1 (references removed)
“The influenza virus major surface glycoproteins hemagglutinin (HA) and neuraminidase (NA) are the principal targets of the protective immune response. Licensed seasonal influenza virus vaccines are designed to elicit a protective immune response to the HA and NA proteins. However, only the concentration of HA protein is standardized in the currently approved inactivated seasonal influenza virus vaccines; the concentration of the NA protein is not. Hemagglutinin induces strain-specific neutralizing antibodies that prevent infection by antigenically related influenza viruses. Unlike HA-specific antibodies, NA-specific antibodies do not prevent influenza virus infection, and NA immunity is referred to as infection permissive. However, humoral immunity induced by NA can markedly reduce virus replication and release, shortening the severity and duration of illness, a reasonable goal in the event of an influenza pandemic. In mice, the induction of a relatively modest NA-specific humoral response is sufficient to inhibit virus replication after challenge with homologous influenza virus. NA-specific immunity in mice provides significant cross-protection against replication of antigenically distinct viruses of the same subtype (drift variants) but not against different subtypes. The degree of relatedness between the NA used for immunization and that of the challenge virus correlates well with the degree of cross-protection conferred by an NA-specific response. . .”

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Cross-Reactive Neuraminidase Antibodies Afford Partial Protection against H5N1 in Mice and Are Present in Unexposed Humans
Matthew R. Sandbulte et al. PLoS Med 4(2): e59 doi:10.1371/journal.pmed.0040059.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040059
Abstract: “Background A pandemic H5N1 influenza outbreak would be facilitated by an absence of immunity to the avian-derived virus in the human population. Although this condition is likely in regard to hemagglutinin-mediated immunity, the neuraminidase (NA) of H5N1 viruses (avN1) and of endemic human H1N1 viruses (huN1) are classified in the same serotype. We hypothesized that an immune response to huN1 could mediate cross-protection against H5N1 influenza virus infection. Methods and Findings Mice were immunized against the NA of a contemporary human H1N1 strain by DNA vaccination. They were challenged with recombinant A/Puerto Rico/8/34 (PR8) viruses bearing huN1 (PR8-huN1) or avN1 (PR8-avN1) or with H5N1 virus A/Vietnam/1203/04. Additional naïve mice were injected with sera from vaccinated mice prior to H5N1 challenge. Also, serum specimens from humans were analyzed for reactivity with avN1. Immunization elicited a serum IgG response to huN1 and robust protection against the homologous challenge virus. Immunized mice were partially protected from lethal challenge with H5N1 virus or recombinant PR8-avN1. Sera transferred from immunized mice to naïve animals conferred similar protection against H5N1 mortality. Analysis of human sera showed that antibodies able to inhibit the sialidase activity of avN1 exist in some individuals. Conclusions These data reveal that humoral immunity elicited by huN1 can partially protect against H5N1 infection in a mammalian host. Our results suggest that a portion of the human population could have some degree of resistance to H5N1 influenza, with the possibility that this could be induced or enhanced through immunization with seasonal influenza vaccines.”

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Behavioral Risks for West Nile Virus Disease, Northern Colorado, 2003
Indira B. Gujral et al. EID. Volume 13, Number 3–March 2007.
http://www.cdc.gov/eid/content/13/3/419.htm
Abstract: “In 2003, residents in 2 adjacent cities in northern Colorado (Loveland and Fort Collins) had severe outbreaks of human West Nile virus (WNV) disease. Unexpectedly, age-adjusted neuroinvasive disease rates were higher in Loveland (38.6 vs. 15.9 per 100,000), which had a more extensive mosquito control program and fewer mosquitoes. A survey was conducted to assess differences in personal protection and risk practices by each city's residents. During May and June 2004, a random-digit dial telephone survey was conducted among adults to assess personal protection behavioral practices used to prevent WNV infection during the 2003 outbreak. After we adjusted for identified risk factors, Loveland residents were 39% more likely to report seldom or never using N,N-diethyl-m-toluamide (DEET), and ≈30% were more likely to report being outdoors during prime mosquito-biting hours than Fort Collins residents. Personal protective practices may directly influence rates of WNV infection and remain important even when comprehensive community mosquito control measures are implemented.”

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Worldwide Emergence of Extensively Drug-resistant Tuberculosis
N. Sarita Shah et al. EID. Volume 13, Number 3–March 2007
Abstract: “Mycobacterium tuberculosis strains that are resistant to an increasing number of second-line drugs used to treat multidrug-resistant tuberculosis (MDR TB) are becoming a threat to public health worldwide. We surveyed the Network of Supranational Reference Laboratories for M. tuberculosis isolates that were resistant to second-line anti-TB drugs during 2000–2004. We defined extensively drug-resistant TB (XDR TB) as MDR TB with further resistance to >3 of the 6 classes of second-line drugs. Of 23 eligible laboratories, 14 (61%) contributed data on 17,690 isolates, which reflected drug susceptibility results from 48 countries. Of 3,520 (19.9%) MDR TB isolates, 347 (9.9%) met criteria for XDR TB. Further investigation of population-based trends and expanded efforts to prevent drug resistance and effectively treat patients with MDR TB are crucial for protection of public health and control of TB.”

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Survey says public health workers lag in preparedness
Public health workers are urging Americans to stock up and plan for the next emergency, but when it comes to their own lives, the cupboards are often bare, according to a recent survey by the American Public Health Association (APHA). APHA conducted an informal survey of its members and published the results in the Dec-Jan issue of its newsletter, The Nation’s Health. Of 4,100 public health workers who responded, 60% said they didn’t have evacuation plans for their households, 52% said they didn’t have emergency communication strategies for their families, and 81% didn’t know the evacuation plan for their community. Though most said they had adequate emergency supplies such as matches, candles, and flashlights at home, few kept such supplies or food at work, and 60% said they weren’t aware of an evacuation plan at their workplace. The American Red Cross recommends that Americans keep at least a 3-day supply of food and water for emergency use, but almost half of the respondents said they didn’t have drinking water set aside, and 35% said they lacked nonperishable food supplies. Georges Benjamin, executive director of the APHA, said the survey results point up a need for better education and outreach for the public health workforce.
(CIDRAP 2/13/07 http://www.cidrap.umn.edu/ )

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Lab culture of human norovirus called an important first
A team of researchers has achieved what has been until now an elusive goal: a tissue-culture model that allows natural growth in the lab of norovirus. Though it causes up to 23 million cases of illness each year, according to CDC, little is known about how the virus attaches to and replicates within cells. The new work by Timothy Straub of the Pacific Northwest National Laboratory and collaborators from Tulane University, the University of Arizona, and Arizona State University should change that: They produced a 3-dimensional culture of multiple cell types that mimics the epithelium of the human small intestine, and induced norovirus samples isolated from patients to grow and replicate in it. Norovirus has been a difficult organism to study because, like other viruses but unlike bacteria, it will not reproduce in a simple growth medium. Instead, it requires a tissue culture resembling cells in the organisms it infects. That lack of a lab model for studying the virus has kept testing protocols, effective sanitizing and control measures, and even newer diagnostic tests out of reach. Straub and collaborators grew human intestinal epithelial cells on collagen-coated microbeads that were tumbled in a rotating reactor vessel. They used the resulting tissues for 5 passages of 2 genotypes of norovirus that were originally isolated from patients during outbreaks on a cruise ship and in a nursing home, and proved the presence of norovirus by multiple assays following each passage.

Straub TM, zu Bentrup KH, Coghlan PO, et al. In vitro cell culture infectivity assay for human noroviruses. Emerg Infect Dis 2007 Mar; 13(3) (early online publication)
http://www.cdc.gov/eid/content/13/3/06-0549.htm?s_cid=eid06_0549_x
(CIDRAP 2/13/07 http://www.cidrap.umn.edu/ )

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Flu pandemic could choke Internet, requiring usage restrictions
Many companies and government agencies are counting on legions of teleworkers to keep their operations running in the event of an influenza pandemic. But those plans may fall apart as millions of people turn to the Internet for news and even entertainment, potentially producing a bandwidth-choking surge in online traffic. Such a surge would almost certainly prompt calls to restrict or prioritize traffic, such as blocking video transmissions wherever possible, according to business continuity planners who gathered at SunGard Availability Systems to consider the impact of a pandemic on the Internet.

Businesses as well as home users likely would be asked to voluntarily restrict high-bandwidth traffic, the planners said. And if asking didn't work, they warned, government action to restrict traffic might follow. To try to limit a pandemic's spread, many people will seek to work from home. Consequently, "the demand for communication will soar," said Renate Noone, vice president of professional services at SunGard's Availability Services unit. Businesses and government agencies are in the best position to deal with any online traffic surges, via the use of redundant communications systems and techniques such as diverse routing. But that may not help teleworkers or customers and business partners who are trying to access systems remotely. For their most critical workers, employers can sign contracts with telecommunications services providers for business-class services, such as dedicated lines. Companies may balk at paying for such services to prepare for a problem that may never occur, but waiting could be a risky strategy.

From a geopolitical perspective, a major influenza outbreak could be perceived by enemies as leaving the U.S. in "a weakened state," said George Johnson, founder and chief technology officer of The ESP Group LLC, an application services provider that focuses on development of secure systems. That could result in heightened risks of cyber attacks, Johnson warned. Another message coming out of the forum was that there will be a strong need for cooperation among businesses if a pandemic does occur. "By working together, we can make a lot of things happen, and we shouldn't have to rely on the government to make it happen," said Peter Briody, a systems specialist and business continuity coordinator at Cytec Industries Inc.
(www.computerworld.com 2/12/07)

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3. Notifications
Recommended composition of influenza vaccines for 2007-2008 northern hemisphere influenza season
It is recommended that vaccines to be used in the 2007-2008 season (northern hemisphere winter) contain the following: an A/Solomon Islands/3/2006 (H1N1)-like virus; an A/Wisconsin/67/2005 (H3N2)-like virus (Candidate vaccine viruses include: A/Wisconsin/67/2005 (H3N2) and A/Hiroshima/52/2005); a B/Malaysia/2506/2004-like virus. For more information: http://www.who.int/csr/disease/influenza/20078anorthreport.pdf.
(Promed 2/15/07)

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Epidemiology in Action Course
CDC's Office of Workforce and Career Development and Rollins School of Public Health at Emory University will cosponsor the course Epidemiology in Action, Apr 23-May 4, 2007, at Emory University. The course is designed for state and local public health professionals. The course emphasizes practical application of epidemiology to public health problems and consists of lectures, workshops, classroom exercises (including actual epidemiologic problems), and roundtable discussions. Topics include descriptive epidemiology and biostatistics, analytic epidemiology, epidemic investigations, public health surveillance, surveys and sampling, Epi Info (Windows version) training, and discussions of selected prevalent diseases. Tuition is charged. For more information: Emory University, Hubert Department of Global Health (Attn: Pia), 1518 Clifton Rd. NE, Rm. 746, Atlanta, GA 30322; or by telephone, 404-727-3485; fax, 404-727-4590; website, http://www.sph.emory.edu/epicourses; or email, pvaleri@sph.emory.edu.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5605a4.htm
(MMWR February 9, 2007 / 56(05);98)

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13th International Congress on Infectious Diseases
From Richard Wenzel, President, International Society for Infectious Diseases (ISID)
Kuala Lumpur, Malaysia, 19-22 Jun 2008

The program will include plenary talks by world-renowned experts in the science of infectious diseases and important topics critically presented by international luminaries in our field. There will be great opportunities to spend time with leaders in the field, exchange ideas, and develop collaborations with scientists from distinguished Medical Centers around the globe. All who are committed to the prevention and control of infections in developing countries will find this a compelling meeting. For further information, contact info@isid.org or visit the Congress website: http://www.isid.org/13th_icid/.
(Promed 2/5/07)

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Information on RotaTeq and Intussusception
FDA issued a Public Health Notification to inform health care providers and consumers about 28 post-marketing reports of intussusception following administration of Rotavirus, Live, Oral, Pentavalent vaccine (RotaTeq). Intussusception is a serious and potentially life-threatening condition that occurs when the intestine gets blocked or twisted. Because vaccine adverse events are not always reported to FDA, there may be additional cases of intussusception following vaccination of which we are unaware. This information is important to assess whether RotaTeq may be associated with an increased risk of intussusception and, if so, to what degree. Healthcare professionals and others are encouraged to report any cases of intussusception or other serious events that may be associated with the use of RotaTeq to the Vaccine Adverse Event Reporting System (VAERS). Parents should contact their child's doctor immediately if the child has stomach pain, vomiting, diarrhea, blood in their stool or change in their bowel movements, as these may be signs of intussusception. For more information: http://www.fda.gov/cber/safety/phnrota021307.htm.
(FDA MEDWATCH 2/13/07)

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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