Login   

Vol. X, No. 5 ~ EINet News Briefs ~ Mar 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)
- Afghanistan (Nangarhar, Kunar): Confirmation of new avian influenza H5N1 outbreaks
- Europe: Preparedness against pandemic influenza
- Kuwait: Report of avian influenza H5N1 outbreaks in birds
- Kuwait: Excerpts from OIE report on avian influenza H5N1 in poultry
- China (Fujian): New human case of avian influenza H5N1 infection
- Hong Kong: More wild birds found infected with avian influenza H5N1
- Indonesia (Bandung): Suspected human case of avian influenza H5N1 infection
- Indonesia: WHO still seeking virus-sharing pact
- Laos: Human case of avian influenza H5N1 infection
- Myanmar: Excerpts from OIE report on avian influenza H5N1 infection in poultry
- Pakistan (Islamabad): Peacocks suspected of spreading avian influenza at zoo
- Russia: Avian influenza detected in birds in Moscow and Kaluzhskaya
- Viet Nam (Hai Duong): Avian influenza H5N1 kills poultry
- Australia (Victoria, New South Wales): Illness from listeria forces recall
- Australia (Victoria): Human case of botulism from pre-packaged nachos
- Indonesia (Ruteng): Fatal human cases of rabies
- North Korea: Measles Epidemic causes at least 4 deaths
- Russia (Yamal-Nenets): Increase in incident cases of Opistorchiasis
- USA: FDA panel supports new H5N1 vaccine approval
- USA: IOM studying protective garb for health workers against pandemic influenza
- Canada: Food poisoning due to staphylococcal toxin
- Peru (Cuzco): 3 deaths from yellow fever
- USA: Salmonella outbreak update: FDA finds Salmonella in ConAgra plant
- USA (New York): Streptococcus suis infection confirmed in human
- Egypt (Dakahlea): New human case of avian influenza H5N1 infection

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

2. Articles
- Unprepared for a Pandemic
- The 1918 influenza pandemic: insights for the 21st century
- Questions raised about study on masks as aerosol barrier
- Vaccine effectiveness against medically attended, laboratory-confirmed influenza among children aged 6 to 59 months, 2003–2004
- Influenza Vaccine Coverage and Missed Opportunities Among Inner-city Children Aged 6 to 23 Months: 2000-2005
- Influenza Virus Type A Serosurvey in Cats
- Chikungunya Outbreaks--The Globalization of Vectorborne Diseases
- Blood Donor Screening for Chagas Disease--United States, 2006--2007
- Measles among adults associated with adoption of children in China--California, Missouri, and Washington, July-August 2006
- Escherichia coli O157:H7 infection associated with drinking raw milk--Washington and Oregon, November-December 2005
- Bloodstream infections among patients treated with intravenous epoprostenol or intravenous treprostinil for pulmonary arterial hypertension--seven sites, United States, 2003--2006

3. Notifications
- Supply of Vaccines Containing Varicella-Zoster Virus

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
China / 1 (0)
Egypt / 5 (3)
Indonesia / 6 (5)
Laos / 1 (0)
Nigeria / 1(1)
Total / 14 (9)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 277 (167).
(WHO 3/1/07 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 2/27/07)

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

^top


Europe/Near East
Afghanistan (Nangarhar, Kunar): Confirmation of new avian influenza H5N1 outbreaks
Afghanistan confirmed that poultry deaths at 2 farms in the eastern part of the country were caused by H5N1 avian influenza. The outbreak occurred among 202 birds and killed 73 backyard poultry, including turkeys, the country reported to the World Organization for Animal Health (OIE). The affected farms were in Nangahar and Kunar provinces, about 100 miles from Kabul. The OIE report said the outbreak began Feb 12, 2007. The Afghan authorities have carried out screening and culling in their response to the outbreaks. Reportedly, Afghanistan has also banned poultry imports from Pakistan because of its outbreaks of H5N1. Afghanistan's last confirmed outbreak occurred Apr 2006; the country has reported no human H5N1 cases.
(CIDRAP 2/23/07 http://www.cidrap.umn.edu/ ; Promed 2/23/07 www.promedmail.org )

^top

Europe: Preparedness against pandemic influenza
Member states plus Iceland and Norway are 2 to 3 years away from being prepared for an influenza pandemic, according to a 39-page report released yesterday by the European Centre for Disease Prevention and Control (ECDC). ECDC Director Zsuzsanna Jakab said that health authorities in the EU have put major efforts into pandemic preparations since 2005. The member countries' pandemic preparation accomplishments include producing and beginning to implement national preparedness plans and investing in influenza research. Some countries are building stockpiles of antiviral medications, and most have systems in place to detect and investigate initial cases of pandemic flu. In addition, the EU and WHO have collaborated on pandemic preparedness workshops and on standardizing methods of assessing preparedness. Also, the EU conducted a pandemic simulation exercise involving all members Nov 2005. The ECDC identified 5 key challenges for the years ahead. They include integrating planning within countries, making national plans operational at the local level, coordinating plans between countries, improving prevention of seasonal flu, and expanding flu research from basic science into areas such as seasonal flu prevention and vaccine development.
Read the ECDC report: http://www.ecdc.eu.int/pdf/Pandemic_preparedness.pdf
(CIDRAP 2/23/07 http://www.cidrap.umn.edu/ )

^top

Kuwait: Report of avian influenza H5N1 outbreaks in birds
Health ministry spokesman Ahmed al-Shatti announced that 20 falcons, chickens, and turkeys at the Kuwait Zoo, on farms, and at a clinic for falcons were infected. The H5N1 outbreaks are the first reported in Kuwait since Nov 2005, when the disease was found in a flamingo and a falcon. The country has reported no human H5N1 cases. The health ministry closed the Kuwait Zoo and bird markets and banned all bird imports and exports. Officials culled poultry on the involved farms and gave antiviral medication to people who had been in contact with infected birds. Blood samples from all people suspected of having had contact with the infected birds were taken. Kuwait is a member of the 6-nation Persian Gulf Cooperation Council which has recently adopted measures to prevent the spread of avian flu, including the ban of birds, poultry and their products mainly from countries in Asia and Europe.
(CIDRAP 2/26/07 www.cidrap.umn.edu )

^top

Kuwait: Excerpts from OIE report on avian influenza H5N1 in poultry
Information received 26 Feb 2007: Date of confirmation of event: 18 Feb 2007. Manifestation of disease: clinical disease. Causal agent: highly pathogenic avian influenza virus, Serotype H5N1. Nature of diagnosis: suspicion, laboratory (basic), laboratory (advanced), necropsy.

Outbreaks:
Kuwait Zoo, Al Omaria, Al Omaria (Al Farwaniyah). Date of start of outbreak: 17 Jan 2007. Affected population: Different types of birds are kept in the zoo; however, only falcons were affected by the disease. In response to the outbreak, other susceptible birds in the zoo were vaccinated.

Wafra, Wafra, Al Wafra (Al Ahmadi). Date of start of outbreak: 13 Feb 2007

Nwasib, Al Nwasib, Al Nwasib (Al Ahmadi). Date of start of outbreak: 22 Feb 2007. Affected population: a backyard farm with different types of birds. Chickens and turkeys were affected by the disease.

Wafra, Al Wafra, Al Wafra (Al Ahmadi). Date of start of outbreak: 20 Feb 2007. Affected population: a backyard farm that includes different types of birds. Antibody was detected in 2 guinea fowls.

Um Alhiman, Um Alhiman, Um Alhiman (Al Ahmadi). Date of start of outbreak: 17 Feb 2007. Affected population: backyard chickens.

Wafra, Al Wafra, Al Wafra, (Al Ahmadi). Date of start of outbreak: 22 Feb 2007. Affected population: A backyard farm with a variety of birds. Tissue sample from a dead turkey tested positive for H5N1.

Summary of outbreaks: Total outbreaks: 6; Susceptible: 3651; Cases: 47; Deaths: 43; Destroyed: 2613; Slaughtered: 0. Apparent morbidity rate: 1.29 per cent; Apparent mortality rate: 1.18 per cent; Apparent case fatality rate: 91.49 per cent; Proportion susceptible removed: 72.75 per cent. Source of infection: unknown or inconclusive. The first case occurred in falcons and then reports of mortality in poultry followed. The first mortality report of chickens was received from 2 individuals. The individuals purchased the birds from markets 2 days before their death. Consequently, surveillance was intensified across the country. Diagnostic test results: rapid tests and real-time polymerase chain reaction (PCR) positive.
(Promed 2/28/07 www.promedmail.org )

^top


Asia
China (Fujian): New human case of avian influenza H5N1 infection
As of 1 Mar 2007, The Ministry of Health in China has reported 1 case of human infection with the H5N1 avian influenza virus. The case is a 44 year old woman from Jian'ou county, Fujian province. She became ill with fever and pneumonia 18 Feb 2007 and was hospitalized 22 Feb 2007, where she remains in critical condition. The case was laboratory confirmed by the Fujian provincial laboratory 26 Feb 2007 and by the national laboratory the next day. Information provided to WHO indicates that she is a farmer who kept birds in her backyard and was possibly exposed to sick birds. An investigation is underway to determine whether this exposure was the source of her infection. Close contacts have been placed under medical observation. The woman's case is China's first in 7 weeks. Of the 23 cases confirmed to date in China, 14 have been fatal.
(Promed 3/1/07 www.promedmail.org ; CIDRAP 2/28/07 www.cidrap.umn.edu)

^top

Hong Kong: More wild birds found infected with avian influenza H5N1
The Hong Kong Agriculture, Fisheries, and Conservation Department [AFCD] said 26 Feb 2007 that 2 birds had been confirmed to be H5N1 virus positive. The chestnut munia [Lonchura atricapilla] was collected 18 Feb 2007 at Prince Edward Road Westin Kowloon City. The carcass of the scaly-breasted munia [Lonchura punctulata] was found 19 Feb 2007 in Happy Valley. The department reminded people to observe good personal hygiene. According to an update of 26 Feb 2007, 12 wild birds of 10 species have been found H5N1 positive since the beginning of 2007, namely 2 scaly-breasted munias, 2 house crows, and 1 each of the following: crested goshawk, Japanese white-eye, white-rumped munia, peregrine falcon, blue magpie, silver-eared mesia, common kestrel, and a chestnut munia. In 2006, 17 wild birds, belonging to 11 species, were reportedly found infected, all of them during the winter months, between 10 Jan and 22 Mar 2006.
(Promed 2/27/07 www.promedmail.org )

^top

Indonesia (Bandung): Suspected human case of avian influenza H5N1 infection
A 26-year-old suspected bird flu patient from Ciruluk village, in Subang, died 21 Feb 2007 at the Hasan Sadikin Hospital in Bandung, 2 days after many of his chickens began dying. The victim was a policeman who died after being treated at the hospital. A relative said the victim's symptoms began 19 Feb 2007 when he returned from duty with breathing difficulties. Ciruluk's village chief, Norwon, said more than 9000 chickens and ducks had died in the past 2 weeks. Some of them had been examined and were found to be reportedly infected with the H5N1 virus. "Around 4000 free-range chickens owned by 2 residents have even died in the past week," Norwon said. The head of the Bird Flu Prevention Team at Hasan Sadikin Hospital, Hadi Jusuf, said the victim was likely infected via direct contact with his infected chickens. To confirm this, his blood and fluid samples were sent to the Health Ministry's lab in Jakarta 22 Feb 2007.
(Promed 2/24/07 www.promedmail.org )

^top

Indonesia: WHO still seeking virus-sharing pact
WHO stated that a disagreement with Indonesia about sharing H5N1 virus samples has not yet been fully resolved. WHO spokesman Dick Thompson denied Indonesia's claims that the 2 parties had reached a final agreement paving the way for Indonesia to resume sharing H5N1 samples with WHO. In early Feb 2007, Indonesia announced it would stop sharing H5N1 samples with WHO because the government believes it is unfair for foreign countries to use the samples to develop vaccines that poor nations can't afford. The country also signed a memorandum of understanding with US vaccine producer Baxter International that laid the groundwork for future collaborations or supply agreements. Unrestricted sharing of avian flu virus samples is vital to the research community for developing pandemic vaccines and monitoring the virus's evolution and global spread. Indonesian Health Minister Siti Fadilah Supari met Feb 16, 2007 with David Heymann, WHO's acting director-general for communicable diseases, to discuss virus sharing. Afterward, the 2 parties announced that Indonesia would resume sharing its H5N1 samples while WHO would work to ensure that developing countries would have access to pandemic vaccines based on viruses they supply.
(CIDRAP 3/1/07 www.cidrap.umn.edu )

^top

Laos: Human case of avian influenza H5N1 infection
The Ministry of Health in Lao People's Democratic Republic has reported the first human case of infection with the H5N1 avian influenza virus. The 15 year old female was from Vientiane, where she developed influenza-like symptoms 10 Feb 2007 and was hospitalized with fever and respiratory symptoms 15 Feb 2007. She sought medical care in neighbouring Thailand 17 Feb 2007 and is currently in Nongkhai public hospital where she remains in stable condition. Samples taken by Lao epidemiologists and Thai clinicians were tested by the National Institute of Health in Thailand and were positive for H5N1 infection. The Lao Government is also providing samples to a WHO-collaborating centre for examination. On 24 and 25 Feb 2007, a team from the Thai and Lao ministries of health and WHO officials investigated the situation in the girl's village and those districts where poultry deaths had occurred earlier. Close contacts of the girl have been identified and are being monitored daily. The adults were provided prophylaxis with oseltamivir and, to date [27 Feb 2007], all of these people remain healthy. The country has reported sporadic bird outbreaks since 2004; in Jul 2006, bird flu broke out again in Xaythany district in Vientiane, where authorities slaughtered around 20 000 poultry.
(Promed 2/25/07, 2/28/07 www.promedmail.org ; CIDRAP 2/28/07 www.cidrap.umn.edu )

^top

Myanmar: Excerpts from OIE report on avian influenza H5N1 infection in poultry
Information received 28 Feb 2007, fromMinistry of Livestock and Fisheries, Rangoon, Myanmar. Start date: 26 Feb 2007. Date of previous occurrence: 27 April 2006. Manifestation of disease: clinical disease. Causal agent: highly pathogenic avian influenza virus, serotype H5N1. Nature of diagnosis: suspicion, clinical, laboratory (advanced), necropsy. Outbreak Location: 9 ward, Mayangone, Yangon (West), (Rangoon). Outbreak status: continuing (or date resolved not submitted). Susceptible: 1360. Cases: 68. Deaths: 68. Destroyed: 1292. Affected population: layer chickens, ducks and pullets. Apparent morbidity rate 5.00 per cent. Apparent mortality rate 5.00 per cent. Apparent case fatality rate 100 per cent. Proportion susceptible removed 100 per cent. Source of infection: low biosecurity. Diagnostic test results: polymerase chain reaction (PCR) and rapid tests positive.
(Promed 3/1/07 www.promedmail.org )

^top

Pakistan (Islamabad): Peacocks suspected of spreading avian influenza at zoo
A fresh outbreak of bird flu has struck at the zoo in Pakistan's capital Islamabad, where a gift batch of infected peacocks is blamed for decimating bird displays. The Marghazar Zoo has been temporarily closed after test results confirmed the deaths of ducks and geese from the H5N1 virus. "We took emergency action by culling 5 peacocks and vaccinated the rest of the flocks. The entire premises has also been fumigated," zoo director Raja Javed said as his 84 staff members underwent daily medical checks. 2 dozen of around 200 birds died after the zoo received a gift of 7 peacocks 12 Feb 2007. The virus hit only ordinary species of ducks, geese and peacocks kept in 1 section of the zoo. Other birds like eagles, owls and birds of song tested negative for H5N1. Red ribbons mark the infected area, and staff are wearing surgical masks and protective suits as they go about their daily tasks. However, some staff have complained about not receiving sufficient supplies during the containment of the outbreak. Water and oil-based vaccine against the virus was being administered to the remaining birds. A single vial costing around USD 60 is enough to inoculate more than 100 birds, said Javed. Pakistani officials warned keepers to avoid contact with the animals. While media have reported earlier cases of bird flu, public knowledge about the virus is still generally low in the country.
(Promed 2/25/07 www.promedmail.org )

^top

Russia: Avian influenza detected in birds in Moscow and Kaluzhskaya
H5N1 avian influenza has been detected in birds in more Moscow districts, bringing the total to 8. The report quoted Nikolai Vlasov, head of Russia's agricultural oversight agency. Vlasov said increased awareness about bird flu had produced a rush of calls from people reporting bird deaths. Russia's Emergency Situations Ministry said Feb 21 that at least 333 domestic birds had died since Feb 9 and that 1,833 more had been culled at 8 locations outside Moscow.

The H5N1 virus had also spread to Kaluzhskaya province, about 50 miles southwest of Moscow, according to an OIE report. The province is the third affected this year. The outbreak, which began Feb 5, 2007, killed a flock of 17 backyard poultry. Several poultry outbreaks were recently reported around the Moscow region, and in late Jan 2007 the virus was detected in poultry in the Krasnodar region in southwestern Russia.
(CIDRAP 2/23/07, 2/26/07 www.cidrap.umn.edu )

^top

Viet Nam (Hai Duong): Avian influenza H5N1 kills poultry
Bird flu has surfaced in the northern province of Hai Duong, killing about 60 chickens in Thanh Mien district 16 Feb 2007, said a health official 25 Feb 2007. According to the provincial animal health department, they immediately culled the whole flock of 10 500 birds. The infected site was quarantined and sterilized, and the disease has not spread any further. Bird flu, or the H5N1 virus, which reappeared in Vietnam's Mekong Delta Dec 2006, has been contained in the region for over a month. Vietnam has recorded the second highest number of H5N1-related human deaths after Indonesia since the virus first hit in 2003. But no human case has occurred in Vietnam since Nov 2005.
(Promed 2/27/07 www.promedmail.org )

^top

Australia (Victoria, New South Wales): Illness from listeria forces recall
A listeria contamination scare has forced a Victorian foodmaker to recall its smoked trout mousse products after a Melbourne man became ill. The 89-year-old fell ill after eating the Yumi brand of smoked trout mousse. Tests proved positive for listeria. The health scare has prompted 200 gm. packs of Yumi-branded smoked trout mousse or dip with use-by dates of 10-16 Mar 2007, to be recalled from supermarkets across Victoria and New South Wales. The 89-year-old man fully recovered after treatment with antibiotics.
(Promed 2/23/07 www.promedmail.org )

^top

Australia (Victoria): Human case of botulism from pre-packaged nachos
Authorities have warned against eating a brand of pre-packaged nachos, after a Melbourne man was struck down with the potentially deadly food poisoning, botulism. The 26-year-old has been in intensive care for more than 2 weeks after being diagnosed with the rare but dangerous condition, which usually leaves survivors with long-lasting symptoms. Victoria's chief health officer Dr. Robert Hall warned people to avoid eating the Nachos To Go brand. The Nachos to Go products marked "best before April 19" should be discarded or returned to the place of purchase for a refund. Dr. Hall said evidence so far suggested the cheese component of the product may have been responsible for the condition. The leftovers of the packet were used to confirm the presence of botulism. Dr. Hall said the victim became ill 19 Jan 2007, but his condition was not confirmed until 31 Jan 2007 because it was difficult to diagnose. The department was not aware of any other cases related to the same batch. South Australian food producer Mexican Express has agreed to recall a batch of their product. Questions remained about the source of the botulism.
(Promed 2/18/07 www.promedmail.org )

^top

Indonesia (Ruteng): Fatal human cases of rabies
Eligilius Tantu, a patient who was bitten by a rabid dog, died in the regional public hospital (RSUD) Ruteng. The Topok resident from the Ponggeok Village of the Satar Mese Subdistrict died after being treated for 6 days in this hospital. The director of RSUD Ruteng, Dr Dupe Nababan, said the victim was already in critical condition. The patient had suffered several symptoms, such as suffocating, pain in the throat, hydrophobia, fear of light, fear of wind, anxiety, and drooling. The victim had been bitten by the rabid dog on his left arm Nov 2006. The victim had already [undergone] VAR (anti rabies vaccination) 4 times. However, on the last week before death, the victim's condition worsened and he was sent to the principal hospital in Ruteng. A 3 year old girl has also been admitted to the principal hospital as a rabies victim. She was already in a very critical condition. On 13 Jan 2007, she had been bitten on her lower lip by a dog.

Dr Nababan said that right after a dog bite, the wound should be washed clean with water and soap. The next important thing to do is to seek medical attention and get anti rabies vaccination (VAR) injections. He also suggested that stray and local dogs should be eliminated. The local Government has shot many dogs, but the effort wasn't maximal, because the rabies prevention movement only took place in Manggarai region. 9 people from Manggarai died of rabies in 2005. WHO has recently published a comprehensive update on pre- and post-exposure adminstration of anti-rabies vaccine: http://www.who.int/wer.
(Promed 2/27/07 www.promedmail.org )

^top

North Korea: Measles Epidemic causes at least 4 deaths
Since Nov 2006, some 3000 people in 30 counties throughout the Democratic Peoples Republic of Korea (DPRK) have been diagnosed with measles virus infection. To date, there have been 4 reported deaths, when on 4 Jan 2007, 2 children and 2 adults died from the illness and its complications. Local health facilities throughout the country are continuing to provide treatment to 1013 patients. Confirmation of measles came from the country's Ministry of Public Health (MOPH) 15 Feb 2007, and information was shared with the International Federation, the DPRK Red Cross Society, WHO and the UN Children's Fund (UNICEF) 16 Feb 2007. A mass vaccination campaign is currently underway.

Indications of the disease were first reported in Ryanggang province's Pujon ri, Kimhyongjik county Nov 2006. As the disease could not be contained within these areas, it has subsequently spread throughout the country. On 26 Jan 2007, WHO supplied the MOPH with testing kits for further investigations into the possibility of an epidemic. 77 out of 84 samples confirmed the presence of immunoglobulin M (IgM) antibodies against measles virus. The process of confirming measles cases faced constraints, as the disease was thought to have been eradicated from the country in 1992, and there was an absence of recent cases. The country's health care workers were not familiar with this disease due to its 15 year absence, complicated by the cases' atypical symptoms and different virus genotype [H1].

The continued presence of measles is accompanied by a risk of increasing cases and the further spread of the illness. Children below the age of 7 are already vaccinated against measles through routine immunization. Following recommendations from UNICEF, it was suggested that immunization be aimed at for all people up to the ages of 39 years (including all infants and toddlers). An initial rough estimate has placed the cost of 5 million doses with disposable syringes at USD 1.5 million.
(Promed 2/21/07 www.promedmail.org )

^top

Russia (Yamal-Nenets): Increase in incident cases of Opistorchiasis
18 cases of opistorchiasis were registered in Noyabrsk between 1 and 10 Feb 2007. The chief physician of sanitary and epidemiological surveillance in Yamal island has commented that controls in the food markets, especially for imported fish, should be strengthened. The chief physician has noted that this is a high number of cases. The authorities stress that people should be careful eating raw fish and follow recommendations on fish selection and fish cooking. The Southeast Asian liver fluke Opistorchis is widespread in Russia.
(Promed 2/22/07 www.promedmail.org )

^top


Americas
USA: FDA panel supports new H5N1 vaccine approval
A US Food and Drug Administration (FDA) panel recommended that the agency approve the nation's first H5N1 influenza vaccine. The panel of health advisors, convened to weigh the risks and benefits of the "prepandemic" vaccine made by Sanofi Pasteur, called the vaccine safe and effective. The vaccine is based on an H5N1 virus isolated from a Vietnamese patient in 2004. Sanofi and Chiron Corp. have both been producing clade 1 H5N1 vaccines for the national stockpile under US Department of Health and Human Services (HHS) contracts worth more than $200 million. At least 3 million courses of the vaccine are already in the national stockpile. The government's most recent pandemic planning update, released Nov 2006, said up to 5 million more courses could be added in 2007 if vaccine seed stock supply and production yield are adequate. The stockpile goal is 20 million courses.

Sanofi revealed that two 90-microgram (mcg) doses, administered 28 days apart, generated a protective immune response in 45% of patients. That level is less than the 54% rate reported almost a year ago in the New England Journal of Medicine. The higher rate was based on interim findings. The researchers used a neutralizing antibody titer of 1:40, a fourfold or more increase in antibody titer, to define adequate immune response. The 2-dose course used in the study is 12 times the standard (15-mcg) dose used in the seasonal flu vaccine and lags behind its 75% to 90% protection rate. However, the vaccine is still better than nothing in the event of a pandemic, Norman Baylor, director of the FDA's vaccine office, said.

Sanofi said there were almost no serious side effects, even at the highest dosages. The company said no clinically significant adverse reactions were identified after a 2-dose, 7-month controlled follow-up study in adults aged 18 to 64. When HHS issued its most recent pandemic preparedness update, it acknowledged that a prepandemic vaccine would provide only partial protection against new viral strains. HHS has said that it is moving forward with the development of a clade 2 H5N1 vaccine based on viruses that circulated in birds in China and Indonesia in 2003-04 and spread to the Middle East, Europe, and Africa in 2005 and 2006. Also, HHS has supported the development of cell-based vaccine production methods that would streamline and modernize vaccine production and is exploring new adjuvants that would stretch the vaccine supply.
(CIDRAP 2/27/07 www.cidrap.umn.edu )

^top

USA: IOM studying protective garb for health workers against pandemic influenza
A special committee of the Institute of Medicine (IOM) is studying questions about the role of equipment such as masks, gowns, and gloves in protecting healthcare workers during an influenza pandemic and is expected to release a report Sep 2007. The 12-member committee met to hear from medical experts, manufacturers, government agencies, and others with a stake in the use of personal protective equipment (PPE). The panel "is looking for ideas to understand and improve the effectiveness of PPE" in a flu pandemic and also examining behavioral factors that affect health workers' use of such equipment, said Debra Berg, director of the Bioterrorism Hospital Preparedness Program at the New York City Department of Health and Mental Hygiene. The committee is looking at factors that affect workers' willingness to wear PPE, how well they can breathe and communicate through masks and respirators, and how long they can wear them at a time, among other issues.

The group also examined "what was needed to further develop face masks and respirators in terms of materials and equipment and wearability for healthcare workers to maintain their own safety during pandemic flu," she added. Another topic was the usefulness and wearability of reusable masks (elastomeric masks). The aim of the meeting was to gather information, not try to build consensus on particular issues. The meeting's formal agenda included discussions on the risks to health workers, designing and engineering PPE, individual and institutional issues in the use of PPE, and certification and regulation of PPE.
(CIDRAP 3/1/07 www.cidrap.umn.edu )

^top

Canada: Food poisoning due to staphylococcal toxin
The Canadian Food Inspection Agency (CFIA) is warning Canadians about a frozen creme brulee [a dessert consisting of a rich custard base topped with a layer of hard caramel] that is suspected to have poisoned nearly 190 people. The Cranberry Creme Brulee slabs, manufactured by Selection du Pattisier, is suspected to contain staphylococcal toxin. The manufacturer says the product was distributed in Quebec, but may have also found its way across the country. Selection du Pattisier is recalling the product, and the CFIA is urging people who may have purchased it not to eat the frozen dessert. The CFIA says food contaminated with Staphylococcus aureus bacteria may not look or smell spoiled, and that the toxin is difficult to destroy at normal cooking temperatures. According to the US FDA, staphylococcal food poisoning is a disease with an incubation period of 4-8 hours, that generally causes an illness with vomiting and little fever. Foods that are frequently incriminated in staphylococcal food poisoning include meat and meat products; poultry and egg products; salads such as egg, tuna, chicken, potato, and macaroni; bakery products such as cream-filled pastries, cream pies, and chocolate eclairs; sandwich fillings; and milk and dairy products.
(Promed 2/22/07 www.promedmail.org )

^top

Peru (Cuzco): 3 deaths from yellow fever
The regional director of Health, Alberto Caro Palavisini, reports that recently 3 deaths have taken place from yellow fever in the province of La Convencion, department of Cuzco. 1 of these deaths was registered in the sector of Matoriato. The authorities decided to elaborate a contingency plan that includes a mass vaccination campaign against yellow fever, for all people coming to the valleys of La Convencion. Cuzco (3400 m) and Machu Picchu (2300m), are both too high in elevation for Aedes capable of transmitting yellow fever. US CDC guidelines state explicitly: "Travelers who are limiting travel to the cities of Cuzco and Machu Picchu do not need vaccination". The 3 cases of yellow fever which have been reported in a long-infected place, La Convencion, in the low-jungle in a remote northern area of Cuzco department (not Cuzco city) would not impact the thinking behind these recommendations.
(Promed 2/16/07, 2/17/07 www.promedmail.org )

^top

USA: Salmonella outbreak update: FDA finds Salmonella in ConAgra plant
Investigators have found Salmonella enterica in samples collected at a Sylvester, Ga., ConAgra plant that made the Peter Pan and Great Value peanut butter linked to an illness outbreak involving 370 people in 42 states, the US Food and Drug Administration (FDA) announced. No deaths have been reported, but the peanut butter subject to the current recall was sold in more than 60 other countries on 3 other continents as well as islands in the Caribbean and the Pacific. The ConAgra plant has been closed since 16 Feb 2007. Finding Salmonella at the food processing plant suggests that the contamination occurred before the product reached consumers, FDA said. Also, CDC said the outbreak strain, S enterica serovar Tennessee, had been identified in 9 opened peanut butter jars. The Salmonella found in the plant and in the open jars matched the outbreak strain recovered from consumers who became ill.

FDA also discovered that ConAgra sent bulk Peter Pan peanut butter to a plant in Humboldt, Tenn., that used the product to make 3 peanut butter toppings. They are part of the original Peter Pan recall and are no longer being sold, but FDA said consumers might still have the products in their homes. They include: Sonic Brand Ready-To-Use Peanut Butter Topping in 6-lb, 10.5-oz cans. Sonic outlets used the product in peanut butter shakes and sundaes; Carvel Peanut Butter Topping in 6-lb, 10-oz cans. The topping was an ingredient in several Carvel ice cream products, including Chocolate Peanut Butter, Peanut Butter Treasure, Peanut Butter and Jelly, Reese's Peanut Butter Cup Sundae Dasher, and custom products such as peanut butter flavored ice cream in ice cream cakes; J. Hungerford Smith Peanut Butter Dessert Topping in 6-lb, 10-oz cans. The topping is used in retail outlets and restaurants throughout the US.

FDA also said ConAgra has extended its recall of all Peter Pan brands and Great Value peanut butter with the number 2111 in the product code on the lid to products made since Dec 2005. The earlier recall only involved products made since May 2006. The Salmonella outbreak began Aug 2006 and is ongoing, according to CDC and FDA, which announced the outbreak and voluntary product recall Feb 14, 2007. S enterica typically causes fever and nonbloody diarrhea that resolves in a week. Salmonella outbreaks involving peanut butter are rare. Documented episodes include a 1996 Australian outbreak that sickened 15 people and a 1994-95 outbreak in Israel and Wales that was traced to contaminated peanut-butter–coated snacks and affected about 2,200 people, mostly children.

CDC guidance regarding the outbreak, updated weekly: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/salmonellosis_2007/outbreak_notice.htm
(CIDRAP 2/28/07, 3/1/07 www.cidrap.umn.edu ; Promed 3/1/07 www.promedmail.org ; FDA 3/1/07 http://www.fda.gov/bbs/topics/NEWS/2007/NEW01574.html )

^top

USA (New York): Streptococcus suis infection confirmed in human
US scientists have confirmed a case of pig meningitis in a human. The patient is a previously healthy 59-year-old farmer from upstate New York who was hospitalized with meningitis. The hospital's preliminary tests revealed the presence of Streptococcus suis, a bacterium prevalent in pigs, which can lead to meningitis. Farmers can contract the disease from handling pigs and their feces. Butchers are also at risk. Washing hands and cooking pork thoroughly can minimize the risk. Ruth Zadoks, research associate and veterinarian at Cornell University's College of Veterinary Medicine, provided the insights and a DNA-level analysis of S. suis strains found in both the farmer and the pigs from his farm. With the farmer's bacterial cultures and the pig samples, Zadoks confirmed that the patient was indeed infected with S. suis.

S. suis has occasionally affected humans in Europe over the last 20 years. However, people have regularly contracted the disease in Southeast Asia, especially China, where a 2005 outbreak resulted in 204 human cases with 38 deaths, and some 600 pigs killed. In 2005, South America also documented its first case from Argentina. The 2005 Chinese outbreak was atypical because most previous cases had been sporadic, not in an outbreak, and cases of streptococcal toxic shock syndrome (STSS) occurred. The outbreak was summarized in Yu et al: http://www.cdc.gov/ncidod/eid/vol12no06/05-1194.htm.
(Promed 2/23/07 www.promedmail.org )

^top


Africa
Egypt (Dakahlea): New human case of avian influenza H5N1 infection
The Egyptian Ministry of Health and Population has announced a new human case of avian influenza A(H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3). The 4 year old girl was from Dakahlea Governorate. She developed symptoms (fever) 25 Feb 2007, was admitted to hospital 26 Feb and her condition remains stable. The girl was exposed to sick birds at her home 1 week prior to the onset of symptoms. Contacts of the girl remain healthy and are being closely monitored. She is the country’s fifth case this year. Of the 23 cases confirmed to date in Egypt, 13 have been fatal. Also, Egyptian officials denied a report that a 31-year-old woman from Beheira had tested positive for avian flu.
(Promed 3/1/07 www.promedmail.org ; CIDRAP 2/28/07 www.cidrap.umn.edu )

^top


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 latest reports from Africa and the Near East.
- 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/.
- 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)

^top

Seasonal Influenza
Seasonal influenza activity in APEC economies
Overall influenza activity in the northern hemisphere increased during weeks 1–7 but remained moderate in general. Influenza A(H3N2) viruses predominated in some Asian countries/areas. Influenza A (H1N1) viruses circulated in the US. Influenza B viruses circulated at low levels.

Canada. Overall influenza activity continued to increase, but the influenza-like illness (ILI) consultation rate remained below the expected range for this time of year. Widespread influenza A activity was reported in some parts of Canada.
Hong Kong. Influenza activity continued to increase during weeks 1–7, with influenza A(H3N2) viruses predominating.
Japan. Localized influenza A(H3N2) activity was reported from weeks 3 to 5.
Republic of Korea. Regional influenza A(H3N2) activity was reported in weeks 1–4.
Russia. Influenza activity continued to increase and was reported as regional in weeks 5–6. Influenza A(H1N1) and B viruses co-circulated.
USA. Influenza activity continued to increase and was reported as widespread during weeks 5–6, when the overall ILI consultation rate was above the national baseline but the percentage of deaths due to pneumonia and influenza remained below the baseline level. During week 6, 82% of the influenza viruses detected were influenza A and 18% influenza B. Of the A viruses subtyped, 86% were influenza A(H1) and 14% A(H3) viruses.
(WHO http://www.who.int/csr/disease/influenza/update/en/ 2/28/07)

Chinese Taipei
During the sixth epidemiological week (Feb 4 to 10, 2007), the percentage of outpatient visits to sentinel physicians for influenza-like illness (ILI) has decreased by 8.8% compared with last week but is 21.5% higher than the same period in 2006. During week 3 to 6, the respective ILI consultation rates (per 100 outpatient visits) were 5.47, 5.55, 5.02 and 4.58. Comparing to last week, all 6 regions reported a decrease in trend. The dominant respiratory virus identified by National Influenza Center and CDC Collaborating Labs for week 3 to 6 was influenza B virus, but the number of A (H3) virus isolates had been on the rise. 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, 9 additional severe influenza cases were reported in week 6. Based on onset dates, 118 severe cases have been reported cumulatively in the 2006-2007 epidemic season. Among these, 25 were confirmed, 82 were excluded, and 11 are still pending. So far this season (weeks 26, 2006 to week 6, 2007), 5 deaths have been reported.
(Taiwan IHR Focal Point 3/1/07)

^top

Cholera, diarrhea & dysentery
Philippines (Camarines Sur)
The Department of Health (DOH) is monitoring the health and sanitation conditions in a municipality in Camarines Sur province in the Bicol Region after more than 100 people suffered from diarrhea recently. Dr. Eric Tayag, head of the DOH National Epidemiology Center (NEC) said they are looking at dysentery as the cause of 102 diarrhea cases in Ocampo town in Camarines Sur. Tayag said they have already taken stool samples from the victims. 22 barangays in Ocampo are under watch after the number of diarrhea cases there had been rising since 1 Jan 2007. Initial investigation showed that residents in the affected area get their water supply from shallow wells which may be contaminated.
(Promed 2/17/07 http://promedmail.org )

^top

Dengue
Indonesia (Nationwide)
The total number of deaths from seasonal dengue fever in Indonesia since Jan 2007 has reached 330 out of 23 000 infected people, the Health Ministry said 20 Feb 2007. Head of the Sub Directorate of Arbovirosis in the ministry Rita Kriastuti said that the death figure from the disease has risen sharply. The Health Ministry had declared 8 of the country's 33 provinces, including all provinces on densely populated Java Island, as high-risk for dengue fever because of the skyrocketing number of cases. The health ministry has taken several measures to decrease the rate of fatalities from the mosquito-borne disease, which spreads during the rainy season, according to the ministry. Aedes aegypti mosquitoes lay their eggs in fresh, still water. The mosquitoes can breed in discarded tires, flower pots, oil drums and water storage containers [in and] near human dwellings. It is difficult to know if the recent flooding in Indonesia has washed away existing Aedes aegypti breeding sites or created new ones.
(Promed 2/19/07, 2/25/07 www.promedmail.org )

Indonesia (West Java)
In Indramayu, West Java, the spread of dengue fever has intensified in areas along the north coast, especially in Indramayu and Cirebon. The Indramayu administration has placed the area on high alert, while the Cirebon administration planned to increase the number of facilities and medical equipment to treat the dengue patients. Reports gathered 21 Feb 2007 indicated the number of dengue fever patients in Indramayu in Feb 2007 had reached 138, twice as many compared to the corresponding month in 2006. The number of dengue fever patients in Cirebon reached 120, causing hospitals to suffer bed and ward shortages. Dengue fever is a severe, flu-like illness that affects infants, young children, and adults but is seldom fatal. Infants and young children may have a non-specific febrile illness with rash (although some infants and very young children may develop shock syndrome, with sudden loss of circulating fluid volume, and die). Older children and adults may have either a mild febrile syndrome or the classical incapacitating disease, with abrupt onset and high fever, severe headache, pain behind the eyes, muscle and joint pains, and rash. Dengue hemorrhagic fever 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. With appropriate intensive supportive therapy, mortality may be reduced to less than one percent.
(Promed 2/25/07 www.promedmail.org )

^top


2. Articles
Unprepared for a Pandemic
Michael T. Osterholm. Foreign Affairs. March/April 2007.
http://www.foreignaffairs.org/20070301faessay86204/michael-t-osterholm/unprepared-for-a-pandemic.html
Summary: “The need to prepare for an influenza pandemic has not yet sunk in, partly because disaster has not yet struck. But that good news could turn into very bad news if it leads to slacking off on necessary preparations today: although no one can predict when or how, a pandemic will occur for sure, and it will have implications far beyond its toll on human health.”

^top

The 1918 influenza pandemic: insights for the 21st century
Morens DM, Fauci AS. J Infect Dis. 2007 Apr 1;195(7):1018-28. Epub 2007 Feb 23.
Abstract: “The 1918-1919 H1N1 influenza pandemic was among the most deadly events in recorded human history, killing an estimated 50-100 million persons. Because recent H5N1 avian epizootics have been associated with sporadic human fatalities, concern has been raised that a new pandemic, as fatal as the pandemic of 1918, or more so, could be developing. Understanding the events and experiences of 1918 is thus of great importance. However, despite the genetic sequencing of the entire genome of the 1918 virus, many questions about the 1918 pandemic remain. In this review we address several of these questions, concerning pandemic-virus origin, unusual epidemiologic features, and the causes and demographic patterns of fatality. That none of these questions can yet be fully answered points to the need for continued pandemic vigilance, basic and applied research, and pandemic preparedness planning that emphasizes prevention, containment, and treatment with antiviral medications and hospital-based intensive care.”

^top

Questions raised about study on masks as aerosol barrier
A recent study has raised expectations that simple surgical masks might offer a reasonable substitute for N-95 respirators for healthcare workers seeking protection from airborne viruses. In the study, Y. Li and associates, from Hong Kong Polytechnic University, measured how much of a potassium chloride spray penetrated masks and respirators worn by people walking on a treadmill. They found that the surgical masks filtered out at least 95% of the material, while the N-95 respirators filtered out 97%. This suggested that "surgical masks and N-95 respirators can provide effective protection in a relatively low viral loading environment," says the report, published in the Dec 2006 issue of the American Journal of Industrial Medicine. Such a finding, if true, could be a benefit during an influenza pandemic, since masks are less costly than respirators and likely to be in better supply. However, experts at 3M Co., which makes both surgical masks and N-95 filtering facepiece respirators, said the study has serious limitations. The researchers did not assess the size of the particles used or employ an accepted method for counting the particles sprayed onto the mask and the particles that penetrated it, among other problems, they said.

Surgical masks are designed mainly to protect other people from respiratory droplets or particles expelled by those wearing the masks, whereas N-95 respirators are designed to reduce the wearer's exposure to potentially harmful particles in the surrounding air. In view of the uncertainty about airborne transmission of flu, HHS issued new guidelines saying that N-95 respirator use is "prudent" for medical workers caring for pandemic flu patients. The Hong Kong researchers used 10 volunteers to test the filtration effectiveness of an N-95 respirator made by 3M and a surgical mask made by Winner Medical Group. In a series of tests, each volunteer wore a mask or a respirator while a solution containing potassium chloride and a fluorescent stain (Fluorescein) was sprayed at them from an atomizer 1 m away. The tests were conducted with the volunteers at rest and walking on a treadmill at 3 different speeds.

Specialists at 3M said, "Overall, what was done by Li et al is not considered filtration efficiency testing and should not be used to evaluate filtration efficiency or compare media. They also did not use accepted methods for evaluating the fit to the face which is a very important component in reducing exposure to airborne particles," said Robert Weber, lab manager for technical service and regulatory affairs in 3M's Occupational Health and Environmental Safety division. A key problem with the study is that the researchers didn't determine the size of particles that were generated by the atomizer they used, said Craig Colton, a 3M senior technical service specialist. Colton said the study also should have included a control group of volunteers wearing the masks and doing the same exercises but not being sprayed with the test solution. Questions also were raised by Raymond Tellier, a University of Toronto microbiologist who has written about the risk of airborne transmission of flu viruses. Tellier said the US National Institute of Occupational Safety and Health (NIOSH) test method for respiratory protection calls for using sodium chloride particles in a particular size range and an airflow rate of 85 liters per minute, because the difference between respirators and surgical masks diminishes at lower airflow rates. It's not clear whether Li and colleagues used that prescribed flow rate, he said.
(CIDRAP 2/28/07 www.cidrap.umn.edu/ )

^top

Vaccine effectiveness against medically attended, laboratory-confirmed influenza among children aged 6 to 59 months, 2003–2004
Carrie M. Shuler et al. PEDIATRICS Vol. 119 No. 3 March 2007, pp. E587-E595 (doi:10.1542/peds.2006-1878).
http://pediatrics.aappublications.org/cgi/content/abstract/119/3/E587
Abstract: “OBJECTIVES. Influenza is a leading cause of illness among children. Studies rarely have measured influenza vaccine effectiveness among young children, particularly when antigenic match between vaccine and circulating viruses is suboptimal. We assessed vaccine effectiveness against medically attended, laboratory-confirmed influenza for children who were aged 6 to 59 months during the 2003–2004 influenza season. METHODS. In a case-control study that was conducted in a single pediatric practice, case patients who were aged 6 to 59 months and had laboratory-confirmed influenza were age matched 1:2 to eligible control subjects. Vaccination status was ascertained as of the date of the case patient’s symptom onset. Conditional logistic regression was used to calculate vaccine effectiveness, adjusting for underlying medical conditions and health care usage. RESULTS. We identified 290 influenza case patients who were seen for medical care from November 1, 2003, to January 31, 2004. Vaccine effectiveness among fully vaccinated children, compared with unvaccinated children, was 49%. Partially vaccinated children who were aged 6 to 23 months had no significant reduction in influenza (vaccine effectiveness: –70%), but partially vaccinated children who were aged 24 to 59 months had a significant (65%) reduction in influenza, compared with unvaccinated children. CONCLUSIONS. Full vaccination provided measurable protection against laboratory-confirmed influenza among children who were aged 6 to 59 months during a season with suboptimal vaccine match. No vaccine effectiveness was identified with partial vaccination among children who were aged 6 to 23 months, affirming that children need to be fully vaccinated to obtain protective effects. These results strengthen the evidence of the vaccine’s ability to reduce substantially the burden of disease in this age group.”

^top

Influenza Vaccine Coverage and Missed Opportunities Among Inner-city Children Aged 6 to 23 Months: 2000-2005
Jennifer R. Verani et al. PEDIATRICS Vol. 119 No. 3 March 2007, pp. E580-E586 (doi:10.1542/peds.2006-1580). http://pediatrics.aappublications.org/cgi/content/abstract/119/3/E580
Abstract: “OBJECTIVE. In 2002, the Advisory Committee on Immunization Practices recommended universal influenza vaccination of 6- to 23-month-olds. Little is known about coverage and missed opportunities for influenza vaccination at inner-city practices. The objective of this study was to assess the 2000–2001 to 2004–2005 coverage and the prevalence of missed opportunities for influenza vaccination among inner-city children. METHODS. We conducted a retrospective review for the 2000–2001 to 2004–2005 influenza seasons at a practice network in New York City. The study population included 5 annual cohorts of 6- to 29-month olds as of March 31 of each year with 1 visit to the network in the previous 12 months (n = 7063). Immunization data were obtained from the network registry and the New York Citywide Immunization Registry. Coverage levels were estimated for 1 dose (partial) and 2 doses (full). Missed opportunities were assessed for visits within each influenza season. RESULTS. Coverage rose steadily throughout the 5 years (full: 1.6% to 23.7%; partial: 1.5% to 18.1%). The relationship between year and coverage was linear. Missed opportunities occurred in 82% of visits and were more common for first (89%) than for repeat doses (38%). Missed opportunities per child per season decreased from 2.9 to 2.0 during the study period. CONCLUSIONS. Influenza vaccine coverage among 6- to 23-month-olds at inner-city practices increased steadily from 2000–2001 through 2004–2005, and the prevalence of missed opportunities per child decreased. However, coverage remained suboptimal, with most of children not vaccinated or undervaccinated. Missed opportunities were major contributors to low coverage.”

^top

Influenza Virus Type A Serosurvey in Cats
Saverio Paltrinieri et al. EID. Volume 13, Number 4–April 2007. http://www.cdc.gov/eid/content/13/4/06-0736.htm (references removed)
To the Editor: “Recent reports of cats positive for H5N1 type A influenza virus raised the hypothesis that cats might have an epidemiologic role in this disease. Experimental findings seem to support this hypothesis. Experimentally infected cats might act as aberrant hosts (as do humans and other mammals), with symptoms and lesions developing and the virus subsequently spreading to other cats. The experimental conditions under which this occurs, however, can rarely be observed for domestic or wild cats. No spontaneous cases of transmission from cat to cat or cat to mammal have been reported, and scientifically validated reports about spontaneous disease in cats are rare. Reports about cats with circulating influenza virus antibodies are even more rare and occur in unusual epidemiologic situations. The true susceptibility of cats to type A influenza viruses in field conditions thus remains to be elucidated. . .”

^top

Chikungunya Outbreaks--The Globalization of Vectorborne Diseases
Charrel RN, de Lamballerie X, Raoult D. N Engl J Med. 2007 Feb 22;356(8):769-71. http://content.nejm.org/cgi/content/full/356/8/769 (references removed)
“In 2006, an outbreak of chikungunya fever — an arthralgic disease caused by a mosquito-borne alphavirus — swept over a number of islands in the Indian Ocean (the Comoros, Mauritius, the Seychelles, Madagascar, Mayotte, and Reunion). In Reunion, which has a population of 770,000, there were 265,000 clinical cases (an incidence of 34%), and the disease was implicated in 237 deaths (about 1 per 1000 clinical cases); a recent report by Reunion health authorities indicated that the seroprevalence was 35%, with very few asymptomatic cases. The epidemic had started with outbreaks in Kenya in 2004 and the Comoros early in 2005. More recently, it jumped to India, where there have been an estimated 1.3 million cases to date. When all is said and done, the global toll of chikungunya in 2006 could be close to 2 million, and the disease may well continue to spread this year. . .”

^top

Blood Donor Screening for Chagas Disease--United States, 2006--2007
(References removed)
“Chagas disease, a zoonotic disease caused by the bloodborne parasite Trypanosoma cruzi, affects an estimated 11 million persons throughout much of Latin America. In endemic areas, T. cruzi is transmitted primarily by triatomine insects (i.e., kissing bugs); infection also can occur via blood transfusion, congenital transmission, organ transplantation, laboratory incident, and ingestion of triatomine-contaminated food or drink. To evaluate an investigational assay for detecting T. cruzi infection in blood donations, the American Red Cross conducted a clinical trial during August 2006--January 2007, screening 148,969 blood samples at three blood-collection centers in the United States. In January 2007, after the new assay was licensed by the Food and Drug Administration (FDA), other centers began screening donors for T. cruzi. This report describes the results of the American Red Cross study, which identified 32 donations (approximately one in 4,655) as confirmed positive for T. cruzi antibodies. As blood-donation screening for Chagas disease becomes more widespread, public health officials and health-care providers should anticipate increased numbers of questions regarding the diagnosis, evaluation, and management of Chagas disease. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5607a2.htm
(MMWR February 23, 2007 / 56(07);141-143)

^top

Measles among adults associated with adoption of children in China--California, Missouri, and Washington, July-August 2006
(References removed)
“On August 15, 2006, the Missouri Department of Health and Senior Services (MoDHSS) was notified of a measles case in a Missouri resident who had recently traveled to China. The patient had traveled with a group of 11 families seeking to adopt children from 3 orphanages in Guangdong Province. Members of the group. . .traveled separately but stayed at the same hotel in Guangdong Province during July 13--27. This report describes the multistate investigation that followed, which identified 2 additional measles cases. None of the 3 patients recalled contact during travel with anyone who appeared ill. All 3 patients recovered fully, and no secondary cases were identified among family members, other travelers, patients, or medical staff who might have been exposed. Because of delays in diagnoses (the earliest case was identified 2 weeks after rash onset), no control measures. . .were indicated. Communicable diseases that are no longer endemic in the United States continue to occur among travelers, often resulting in delayed recognition and delayed notification of public health authorities. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5607a3.htm
(MMWR February 23, 2007 / 56(07);144-146)

^top

Escherichia coli O157:H7 infection associated with drinking raw milk--Washington and Oregon, November-December 2005
(References removed)
“During the week of December 5, 2005, public health officials in Clark County, Washington, were notified of four county residents with laboratory-confirmed Escherichia coli O157:H7 infection. All four residents reported having consumed raw (i.e., unpasteurized) milk obtained from a farm in neighboring Cowlitz County, Washington. The farm participated in a cow-share program, in which persons purchase interests in, or shares of, dairy cows in return for a portion of the milk produced. . .Washington farms that provide raw milk to consumers must be licensed, meet state milk-production and processing standards, and pass health and sanitation inspections by the state department of agriculture. The Cowlitz County farm was not licensed. This report summarizes the investigation of E. coli O157:H7 cases associated with the farm and reinforces previous warnings about the health hazards of consuming raw milk. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5608a3.htm
(MMWR March 2, 2007 / 56(08);165-167)

^top

Bloodstream infections among patients treated with intravenous epoprostenol or intravenous treprostinil for pulmonary arterial hypertension--seven sites, United States, 2003--2006
“Pulmonary arterial hypertension (PAH) is a life-threatening disorder characterized by elevated pulmonary artery pressure and pulmonary vascular resistance. Continuous infusion of a prostanoid. . .is indicated in the treatment of patients with severe PAH. Two prostanoids are approved for intravenous (IV) use in the United States: epoprostenol (epoprostenol sodium [brand name Flolan]. . .) and treprostinil (treprostinil sodium [brand name Remodulin]. . .). . .In September 2006, CDC received a report from a PAH specialist of a suspected increase in the number of gram-negative bloodstream infections (BSIs) among PAH patients treated with IV treprostinil. CDC conducted a retrospective investigation with the assistance of several state health departments and the cooperation of seven PAH treatment centers to determine the relative rates of BSI in a sample of patients treated with IV treprostinil and IV epoprostenol during 2003--2006. This report describes the results of that investigation, which indicated that. . .pooled mean rates of BSI (primarily gram-negative BSI) were significantly higher for patients on treprostinil than for those on epoprostenol. The results do not suggest intrinsic contamination of IV treprostinil as a cause of the infections; the difference in rates might have been caused by differences in preparation and storage of the two agents, differences in catheter care practices, or differences in the anti-inflammatory activity of the agents. . .Further investigation is needed to determine the causes of the different infection rates at centers where this was observed and to determine whether such a difference exists in other PAH treatment centers. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5608a5.htm
(MMWR March 2, 2007 / 56(08);170-172)

^top


3. Notifications
Supply of Vaccines Containing Varicella-Zoster Virus
CDC received notice from Merck that it has lower amounts of varicella-zoster virus (VZV) than expected from recently manufactured bulk vaccine. Bulk vaccine production is an intermediate step in the manufacture of VZV-containing vaccines. Merck is the only U.S. supplier of VZV-containing vaccine, including varicella vaccine (Varivax); combined measles, mumps, rubella, and varicella (MMR-V) vaccine (ProQuad); and zoster vaccine (Zostavax). This lower virus yield does not affect the quality of any of Merck's VZV-containing vaccines currently on the market, any lots of vaccine manufactured and ready for release to the market, or any VZV-containing vaccines presently being manufactured. Current supply assessments in the US indicate that this interruption in bulk vaccine supply will not affect the supply of either varicella vaccine or zoster vaccine. The U.S. varicella vaccine supply is expected to be adequate to fully implement the recommended immunization schedule for varicella vaccine for all age groups. For zoster vaccine, the supply is expected to be adequate to vaccinate adults aged >60 years. The MMR-V vaccine supply is adequate to continue ordering this combination vaccine; however, the manufacturer expects supplies of MMR-V vaccine to be depleted late 2007. When this occurs, supplies of separate MMR and varicella vaccines are expected to be adequate to fulfill the need for these 2 products.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5607a4.htm
(MMWR February 23, 2007 / 56(07);146-147)

^top


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/.

^top

 apecein@u.washington.edu