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Vol. X, No. 6 ~ EINet News Briefs ~ Mar 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)
- Afghanistan: More new cases of avian influenza H5N1 infection in poultry
- Kuwait (Wafra): New case of avian influenza H5N1 in chicken
- China (Tibet): Poultry reportedly infected with avian influenza H5
- Indonesia (East Java): Additional human case of avian influenza H5N1 infection reported
- Indonesia: Asks for legal pact on sharing avian influenza H5N1 samples
- Laos (Vientiane): Second fatal human case of avian influenza H5N1 infection
- South Korea (Cheonan): Report of poultry cull to control avian influenza H5N1
- Vietnam (Hanoi): Additional outbreak of avian influenza H5N1 in poultry
- Australia (Queensland): Salmonella outbreak associated with eggs
- China (Guangdong): 16 poisoned by eating toxin-containing seafish, 1 dead
- China (Yunnan): Staphylococcal foodborne outbreak at wedding
- China (Hunan): Rabies kills 61 people in single province in 2 months
- China: Measles and rubella cases increasing
- China (Xinjiang): Rare case of visceral leishmaniasis
- Indonesia (Bekasi): Chikungunya diagnosed in 98 persons
- New Zealand (Auckland): Typhoid outbreak blamed on imported food from Samoa
- Papua New Guinea: Update on undiagnosed deaths in pigs
- Russia (Krasnoyarsk): Salmonellosis outbreak at governor’s ball
- Russia (Nizhny Novgorod): Measles outbreak registered
- Russia (Tver Oblast): Report of rotavirus outbreak
- Russia (Yekaterinburg and Sverdlovsk): Report of rotavirus outbreaks
- Russia (Chelyabinsk): South Urals prepare for tick encephalitis season
- Russia (Central Federal Region): Cases of hemorrhagic fever with renal syndrome
- USA: FDA unveils pandemic preparedness plan
- USA: USDA vows to boost avian flu prevention efforts
- Canada (Ontario): Outbreak of methicillin-sensitive Staphylococcus aureus
- Canada (Ontario, Quebec): Increased incidence in cases of Clostridium difficile infection
- Canada: Update on Canada’s latest case of BSE
- Canada (Alberta): Fatal case of bat-bite rabies
- Peru: Rabies death due to bites from vampire bats
- USA: USDA plans risk-based meat inspection system
- USA: FDA issues safety guidance for fresh-cut produce
- USA: Update on Salmonella outbreak associated with peanut butter
- USA (Arizona): Ongoing outbreak of salmonellosis, serotype Oranienburg
- USA (Pennsylvania): Salmonella associated with raw milk
- USA (Texas/Maryland): Norovirus outbreak tied to raw oyster consumption
- USA: Norovirus outbreak in New Jersey university; San Diego cruise
- USA: New norovirus strain responsible for wave of gastrointestinal infections
- Egypt (Aswan): Report of new human case of avian influenza H5N1 infection

1. Updates
- Avian/Pandemic influenza updates
- Seasonal Influenza
- Dengue

2. Articles
- Review finds little evidence of airborne spread of flu
- Racial/Ethnic Disparities in Diagnoses of HIV/AIDS--33 States, 2001--2005
- Invasive Methicillin-resistant Staphylococcus aureus infections among dialysis patients--United States, 2005
- Surveillance for Acute Viral Hepatitis --- United States, 2005
- Postmarketing monitoring of intussusception after RotaTeq vaccination--United States, February 1, 2006--February 15, 2007
- Increases in Gonorrhea--Eight Western States, 2000—2005
- Autochthonous Transmission of Trypanosoma cruzi, Louisiana
- Avian Influenza Viruses in Water Birds, Africa
- Why did outbreaks of Severe Acute Respiratory Syndrome occur in some hospital wards but not in others?
- Australia (Northern Territory): 3 fatal cases of flesh-eating bacteria, 2000-2003

3. Notifications
- World Water Day--March 22, 2007
- Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
- Automated test for West Nile screening of donors approved

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 / 6 (3)
Indonesia / 6 (5)
Laos / 2 (2)
Nigeria / 1 (1)
Total / 16 (11)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 279 (169).
(WHO 3/8/07 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 3/12/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 3/16/07): http://gamapserver.who.int/mapLibrary/

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Europe/Near East
Afghanistan: More new cases of avian influenza H5N1 infection in poultry
Over the past week, 13 new cases of bird flu have been detected in Afghanistan, bringing the number of confirmed cases in the country to 17 for 2007. Reportedly, 9 dead birds were diagnosed with the H5N1 strain in eastern Nangarhar and Kunar provinces. According to FAO, which has set up a bird flu diagnostic laboratory in Kabul, 4 other cases were identified in backyard poultry in Kabul. Prior to this, 4 cases of the H5N1 strain of the virus were reported 24 Feb 2007 in Nangarhar and Kunar provinces. The Afghan government has banned the importation of poultry products from Pakistan and other countries where avian influenza has been confirmed. There has been no human case to date. Authorities have launched a massive poultry vaccination campaign in the capital and in the 2 provinces where the disease has been confirmed. Dr Azizullah Usmani, director of Afghanistan's Department of Animal Health and Production, said 11 Mar 2007 that vaccination and culling in many poultry farms were complete and that a similar process in backyard poultry had already started. However, the government has run out of funds. "We had US $64 000 in the government's avian influenza account, almost all of which has already been spent", said Usmani, adding that the government had applied to the World Bank for US $1 million in assistance. The World Bank and the Avian & Human Influenza Trust Fund have jointly pledged US $13 million to assist Afghanistan in its fight against avian influenza over the coming 3 years.
(Promed 3/12/07, 3/14/07)

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Kuwait (Wafra): New case of avian influenza H5N1 in chicken
Reportedly Kuwait has detected a new case of the H5N1 strain of bird flu, raising the total number of the cases to 53 in the Gulf state since late Feb 2007. Dr. Rashed Owaish, spokesman for the Kuwaiti Health Ministry, said the virus was found 8 Mar 2007 in a chicken in the Wafra area, 120 km south of Kuwait City. The spokesman confirmed most of the cases were detected in backyard poultry, noting that no human cases have been discovered since the outbreak started late Feb 2007. Experts from the International Animal Health Organization (OIE) has held talks with the Kuwaiti Health Ministry on ways to prevent the spread.
(Promed 3/12/07)

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Asia
China (Tibet): Poultry reportedly infected with avian influenza H5
Poultry from a market in Lhasa, the capital of Tibet, were found infected with the bird flu virus, China's ministry of agriculture reported 6 Mar 2007. Reportedly, the birds died 1 Mar 2007, and tests for the H5 virus performed by the National Avian Influenza Reference Laboratory were positive. Officials are taking measures to control the virus and prevent further infection. The measures include closure of market, a cull of poultry in the market, disinfecting the area, inspections of poultry markets, and monitoring of wild birds. Earlier in Mar 2007, 3 wild birds and 2 poultry birds tested positive for the H5 virus out of 325 poultry and 20 wild birds tested in Fujian province, where a woman contracted the disease Feb 2007.
(Promed 3/12/07)

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Indonesia (East Java): Additional human case of avian influenza H5N1 infection reported
Indonesia reported 12 Mar 2007 that 85 bird flu cases have been recorded in the country after confirmation of infection of a 20-year-old woman by the avian influenza virus H5N1. The woman from East Java was in critical condition in a hospital. Reportedly, the woman had cleaned an area where a neighbor had dumped dead chickens. WHO has not yet recognized the young woman's case or 4 previous cases reported by Indonesian officials since Jan 29, when the agency confirmed a fatal H5N1 infection in a 6-year-old girl from Central Java province. Those 4 cases involved a 15-year-old girl and a 30-year-old man, reported Feb 6, plus a 22-year-old woman and a 9-year-old boy, reported Feb 12. Both of the latter patients died of the illness. The Indonesian health authorities have reportedly imposed a firm policy separating fowls from humans and surveillance on the viruses; authorities also forbid raising fowls in residential areas.
(Promed 3/12/07; CIDRAP 3/12/07)

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Indonesia: Asks for legal pact on sharing avian influenza H5N1 samples
Indonesia vowed not to share H5N1 avian influenza virus samples with WHO until it has a "legally binding" guarantee that the samples won't be used to develop vaccines that the country can't afford. The statement signaled the continuation of a standoff that has lasted several weeks. Indonesia has not supplied any H5N1 samples to WHO since the end of 2006. Steps toward resolution of the problem have been reported, but no final agreement has been reached. Researchers need current H5N1 samples to trace changes in the virus, map its spread, and develop vaccines. Minister Siti Failah Supari complained that WHO regulations give countries no control over how their viral samples are used. She said, "Poorer countries shouldn't become a commercial target." After a Feb 16 meeting, WHO said they had agreed in principle that Indonesia would resume sharing samples while WHO would work to ensure that developing countries have access to vaccines based on their samples. On Feb 28, WHO Director-General Margaret Chan promised Indonesia that its specimens would be used "for public health risk assessment purposes only". She also promised that, pending a formal agreement, WHO would obtain Indonesia's permission before sending any samples to a vaccine producer. But Supari said that was not enough. "We need one that is legally binding." Supari said Asia-Pacific health ministers will meet Mar 27-28 to propose changes in the WHO's virus-sharing system.
(CIDRAP 3/14/07)

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Laos (Vientiane): Second fatal human case of avian influenza H5N1 infection
The Ministry of Health in Lao People's Democratic Republic has reported a second human case of infection with the H5N1 avian influenza virus. The case was fatal. Initial testing was conducted in Laos. Samples were sent to a WHO collaborating laboratory in Tokyo for verification and analysis. Tokyo has now confirmed H5N1 infection. The 42-year-old female was from Pong Hong district in Vientiane province. She developed fever 26 Feb 2007 and was hospitalized in Vientiane Provincial hospital 28 Feb and then transferred to Sethathirat hospital 1 Mar. She died 4 Mar. Tests have found a duck positive for H5 in the woman's household. Close family and hospital contacts are being monitored and to date, none has shown signs of infection. WHO continues to work closely with the Lao government.
(WHO 3/16/07 http://www.who.int/csr/don/2007_03_16/en/index.html )

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South Korea (Cheonan): Report of poultry cull to control avian influenza H5N1
South Korea reported killing more than 35,000 ducks on farms to control an H5N1 outbreak reported last week. The disease reportedly erupted on a breeding farm in Cheonan, 56 miles south of Seoul. Reportedly, culling was done on that farm and 4 neighboring farms.
(CIDRAP 3/12/07)

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Vietnam (Hanoi): Additional outbreak of avian influenza H5N1 in poultry
Vietnam moved to contain a bird flu outbreak 9 Mar 2007 in Hanoi as the H5N1 virus spread to a fifth location within 3 weeks, in the southern Mekong Delta. Workers in Hanoi sprayed disinfectant at several poultry farms on the northern outskirts of the city where 2000 chickens died of the virus or were destroyed earlier this week. Officials manned 24-hour checkpoints in suburban Dong Anh district to quarantine the site of the outbreak, where another 2000 birds have since been vaccinated. "No poultry and poultry products are allowed to be transported in or out of the area," local veterinarian Do Van Thanh said. "Local residents must wear masks if they come out of their houses." The virus has also been reported in the northern provinces of Ha Tay and Hai Duong and in the southern Vinh Long province in recent weeks, following a spate of outbreaks in the south in Dec 2006 and Jan 2007.
(Promed 3/9/07)

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Australia (Queensland): Salmonella outbreak associated with eggs
An outbreak of salmonella has prompted a recall of eggs from the Queensland company, Game Farm Enterprises. Queensland Health negotiated the recall after cracked and dirty eggs were supplied to retail outlets and produce shops around Queensland. It was believed the eggs were linked to a spate of Salmonella poisonings in the past few months. The human cases are of Salmonella typhimurium [phage type] 197.
(Promed 3/3/07, 3/8/07)

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China (Guangdong): 16 poisoned by eating toxin-containing seafish, 1 dead
Recently, a number of villagers in Xilian Township of Xuwen County in Zhenjiang Municipality suffered food poisoning after eating a seafish, Yongeichthys criniger. 16 people developed symptoms and 1 died. On 12 Mar 2007, Zhenjiang Municipal Health Bureau reported that between 7 and 9 Mar 2007, 16 people had developed symptoms of poisoning after eating seafish; 2 children were included. Victims felt dizzy and nautious and their extremities and mouth were numb. A 56 year old male died en route to hospital. 3 people recovered and were discharged from hospital 11 Mar 2007. The toxin that Yongeichthys criniger contains is Tetrodotoxin. Local health agencies have strengthened health supervision, launched public education, and recommended prohibitions on the catching, purchasing, selling and consuming goby fish. This is reportedly the first report of food poisoning following consumption of this species in Guangdong Province.

Tetrodotoxin has been isolated from widely differing animal species. The first symptom of intoxication is a numbness of the lips and tongue, appearing between 20 minutes to 3 hours after consumption. The next symptom is increasing paresthesia in the face and extremities, which may be followed by sensations of lightness. Headache, epigastric pain, nausea, diarrhea, and/or vomiting may occur. Some reeling or difficulty in walking may occur. The second stage of the intoxication is increasing paralysis. There is increasing respiratory distress. Speech is affected, and the victim usually exhibits dyspnea, cyanosis, and hypotension. Paralysis increases and convulsions, mental impairment, and cardiac arrhythmia may occur.
(Promed 3/11/07, 3/13/07)

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China (Yunnan): Staphylococcal foodborne outbreak at wedding
Experts in Yunnan Province have linked a bacterium with the massive food poisoning at a wedding banquet. No deaths have been reported. The 371 villagers in Linxiang District of Lincang City in Yunnan province fell ill after a banquet 1 Mar 2007, with symptoms of vomiting and diarrhea. Some of the banquet dishes were contaminated with Staphylococcus aureus, a bacterium that may produce an enterotoxin, which will lead to acute gastroenteritis, said Zheng Wenkang, director with the Yunnan Provincial Center for Disease Control and Prevention. "A duck dish was contaminated by the bacteria due to unqualified storage, cooking process, and transport," Zheng said. The 371 patients were guests and family members of a villager who was hosting the banquet to celebrate his daughter's marriage. As of 5 Mar 2007, 11 victims are still in hospital for further examination, but their symptoms aren't as severe. Staphylococcal food poisoning generally abates within 24 hours. Staphylococci can be killed by pasteurization or heating. A toxin dose of less than 1.0 microgram in contaminated food will produce symptoms of staphylococcal intoxication. Foods that require considerable handling during preparation, and that are kept at slightly elevated temperatures after preparation, are frequently involved in staphylococcal food poisoning.
(Promed 3/4/07, 3/5/07)

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China (Hunan): Rabies kills 61 people in single province in 2 months
61 people in central China's Hunan Province have died from rabies in the first 2 months of 2007, leading the vice governor to call for a cull of dogs in the province. Gan Lin, vice-governor of Hunan, said the government has to kill unvaccinated dogs to keep the disease away from people. Rabies killed 443 people in Hunan in 2006. Rabies was, last year, the country's most deadly infectious disease. The increasing number of pet dogs and low vaccination rates are blamed for the rabies epidemic in Hunan, said Gan. Experts from the Provincial Center of Disease Prevention warn that rabid dogs and other animals including bats can spread the disease to humans through a bite or scratch that breaks the skin. The disease can remain latent for months or years. The disease is always fatal once symptoms appear. People who are bitten can be effectively treated by vaccination prior to the onset of symptoms. Like dogs, people can also be vaccinated against the disease. Rabies remains a significant public health problem in many countries of Asia, such as China.
(Promed 3/5/07)

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China: Measles and rubella cases increasing
The Ministry of Health reported 12 Mar 2007 that China detected 9501 cases of measles and 2341 cases of German measles Feb 2007. There were sharp rises of 68 and 134 percent respectively in the number of cases, compared to the same period in 2006. Measles infection cases have been rising fast since the beginning of 2007 and some regions have witnessed an outbreak of the disease, the Ministry said. The Western Pacific Regional Office (WPRO) of WHO has taken measles elimination as a goal for the region. Adoption of Chinese children has also been associated with measles outbreaks in the US and in Europe.

In China, there were 9501 cases of measles reported nationally Feb 2007 representing an increase of 12.5 percent (8447 cases) from that reported in Jan 2007 and an increase of 68.4 percent (5641 cases) from that seen during the same period in Feb 2006. Since the beginning of 2007 there has been a nationwide rapid growth of a measles epidemic gaining momentum from Jan to Feb. There were 2341 cases of rubella reported in the country Feb 2007 compared with 2101 cases reported Jan 2007, representing an increase of 11.4 percent. During the same period in 2006, 1001 cases of rubella were reported, representing an increase of 133.9 percent from the same period in 2005. There was a national rubella epidemic 7 Jan-17 Feb 2007.
(Promed 3/13/07)

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China (Xinjiang): Rare case of visceral leishmaniasis
Tuha Oilfield Hospital has diagnosed a case of black fever [visceral leishmaniasis], extremely rare in the Hami region of Xinjiang for more than 40 years. After isolation and treatment, the young Uygur patient's condition is stable and he has been discharged from hospital. Visceral leishmaniasis or Kala Azar was highly prevalent in China but has been effectively controlled since 1958. Only sporadic cases occur in northwestern China. Genetic typing of recent cases from Xinjiang province has found that Kala Azar from eastern China is similar to that from India. A review of leishmaniasis in China concluded that apart from sporadic cases in Xinjiang and western Inner Mongolia, leishmaniasis had been brought under control in China.
(Promed 3/10/07)

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Indonesia (Bekasi): Chikungunya diagnosed in 98 persons
The disabling mosquito-borne disease, chikungunya, has been diagnosed in 98 people from Bekasi, the capital city of the regency. Titin Restuwatuti from the Aren Jaya community health center said 5 Mar 2007 most of the cases were detected during routine health checks. "The disease is spreading rapidly. Shortly after the flood (early last month [Feb 2007]), it was confined to areas that had been inundated, but now we're also diagnosing chikungunya in people from other areas," she said. To curb the spread, the center has fumigated homes in areas where cases have been reported.
(Promed 3/8/07)

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New Zealand (Auckland): Typhoid outbreak blamed on imported food from Samoa
An outbreak of typhoid in Porirua is being blamed on imported food from Samoa. 3 people have contracted the infectious and potentially fatal disease since the beginning of 2007. Of these, 2 were from the same family and all 3 had eaten the same batch of food; 2 of the patients were treated in hospital but both have now been discharged. The most likely source of the illness is a delicacy made from taro leaves and coconut cream that was brought back from Samoa by a returning traveler, and that the 3 patients ate. Health experts in New Zealand say the problem is a lack of education. There is a need to make Pacific Islanders aware of hygiene and how to prepare the food. Officials say with 20 cases of typhoid reported in Samoa each month it is important that travelers not bring back perishable foods.
(Promed 3/5/07)

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Papua New Guinea: Update on undiagnosed deaths in pigs
(Information from Dr. Ilagi Puana cvovet@online.net.pg ) The mystery pig deaths have been investigated, and anthrax was diagnosed based on history and clinical symptoms. Anthrax in pigs is endemic in some parts of the highlands provinces and also present in West Irian Province of Indonesia. The anthrax in New Guinea Island (PNG/Irian Jaya) is only adaptable to pigs and not other species, including humans; it is very fatal in pigs but does not affect other species. Epidemics of anthrax in village pigs do occur from time to time in the highlands, and the disease was previously diagnosed in southern highlands province and has spread widely. Movement of live pigs is a common occurrence in the highlands, and this is most likely the source of spread of anthrax to Bosavi. Anthrax in pigs in PNG has only been reported and diagnosed in village and wild pigs, in this case. It has never been reported or diagnosed in commercial piggeries in PNG.

Deaths of humans are not related to anthrax but probably due to clostridial enterotoxaemia (referred to as "pig bel" in PNG) and is associated in PNG with consuming large quantities of pork, especially during feasts, or in this case, people [may have been] consuming sick pigs or dead pigs. [In Feb 2007, it was reported that 3 women in Mt. Bosavi and Walagu, in the Southern Highlands province of Papua New Guinea died after eating contaminated pork.] Both diseases are preventable by penicillin-based antibiotics. However, control in wild pigs with vaccination and antibiotics is impractical in the predominately wild and semi wild pig populations in Bosavi. People have been advised to confine their pigs. Officials have sent antibiotics.
(Promed 3/5/07)

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Russia (Krasnoyarsk): Salmonellosis outbreak at governor’s ball
A mass outbreak of food poisoning at a governor's ball in the Siberian city of Krasnoyarsk was reportedly caused by a disregard of sanitary norms. The ball, hosted by Krasnoyarsk Governor, Alexander Khloponin, 1 Mar 2007, brought together more than 1400 people, 232 of whom were suffering from symptoms of food poisoning as of 6 Mar 2007. So far, 212 guests have been hospitalized with symptoms of salmonellosis.
(Promed 3/6/07)

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Russia (Nizhny Novgorod): Measles outbreak registered
An outbreak of measles is taking place in Vyksa, located in Nizhny Novgorod region. A total of 18 cases have been recorded in the town since mid-Feb 2007, with 13 having been confirmed by laboratory diagnosis. To stem the spread of the disease, over 5300 residents received measles vaccinations on 6 Mar 2007.
(Promed 3/8/07)

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Russia (Tver Oblast): Report of rotavirus outbreak
Symptoms of high fever, headache, malaise, nausea, and vomiting affected residents of Tver and marked the beginning of a rotavirus outbreak. Reportedly the number of house calls to people suffering from symptoms had increased 60-70 fold in the past few days. According to Liliya Shevchenko, deputy chief of the hospital, city hospitals will not be closed for quarantine, since the outbreak is not extensive. She advised the population to drink more fluids (such as weak tea or boiled water) and avoid acidic fruits. She recommended families to seek medical assistance to verify a diagnosis and not to resort to antibiotics.
(Promed 3/4/07)

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Russia (Yekaterinburg and Sverdlovsk): Report of rotavirus outbreaks
The management of the municipality-owned company in Yekaterinburg has rejected statements by epidemiologists that the main cause of epidemics in the mid-Ural region is contaminated tap water. The outbreaks of rotavirus infection in the Sverdlovsk region was first registered early 2007. Since then, there has been a 3-fold increased incidence of infection. In Verchnaya Salda, a settlement in the Sverdlovsk region, the incidence of rotavirus infection increased 6-fold. A survey of hospitalized patients revealed that 60 per cent of diarrheal cases could be attributed to rotavirus infection, and rotavirus was isolated from the local water reservoir. In the other settlement, several children have been infected by rotavirus, and the local manager of the Water Supply Company was charged with failure to comply with regulations.

The deputy technical director of the same company in Yekaterinburg said that a similar situation was not possible in the capital of the Ural region [Yekaterinburg], as the water quality is monitored daily. He also stated that the source of infection could be bottled water of questionable quality. Despite public concern, the chief public health physician of the Sverdlovsk region, Andrey Yurovskikh, declared the current situation does not exceed the normal pattern. The current rates are the same as in 2006 and lower by 10-15 per cent if compared with 2003-2004. Many parents complained of the absence of vaccine, but it is costly. Specialists advised the public to boil water where it is destined for a baby under 1 year old, for food, bath and wash.
(Promed 3/4/07)

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Russia (Chelyabinsk): South Urals prepare for tick encephalitis season
Anatoly Semenov, the chief health officer of the Chelyabinsk region (Oblast) has signed a document implementing urgent measures for prophylaxis of tick-borne encephalitis. Almost 18 000 inhabitants of the South Urals experienced tick bites in 2006. A total of 126 cases of tick-borne encephalitis, including 3 fatalities, as well as 260 cases of Lyme disease were recorded in 2006 in the South Urals. Overall, the level of morbidity from tick-borne infections in the South Urals was 1.5-fold greater than elsewhere in Russia. Almost 28 per cent of those affected received their tick-bites in residential areas of cities and villages. This development is thought to be the consequence of low uptake by the population of the vaccine. In 2006, only 6 percent of inhabitants of the South Urals were vaccinated. Semenov recommended that the heads of municipalities should provide vaccination against tick-borne encephalitis for people working in woodland areas and supply them with protective clothing and repellents. Children and teenagers who have not been vaccinated should not be permitted to participate in outdoor activities. In total, 3510 cases (morbidity 2.44 per 100 000 inhabitants) of tick-borne encephalitis were registered in Russia in 2006.
(Promed 3/14/07)

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Russia (Central Federal Region): Cases of hemorrhagic fever with renal syndrome
As of 9 Mar 2007, 585 cases of hemorrhagic fever with renal syndrome (HFRS) have been registered in 4 districts of the Central Federal Region. These comprise 243 cases in the Lipetsk region, 197 cases in the Voronej region, 75 in the Tambov region and 70 cases in the Ryazan region. There have been no new cases registered in the Voronej region since 15 Feb 2007 or in the Lipetsk region since 23 Feb 2007. In the Tambov region, as of 9 Mar 2007, 63 patients are still in hospital. The majority of patients were of working age; 32 percent were unemployed, 23 percent were pensioners, 23 percent were workers, 7 percent were students and school children, and 3 percent pre-school children. In Ryazan, all 70 cases were hospitalized. 1 patient died. In 3 percent, the disease was severe; in 74 percent, moderate; and in 16 percent, mild. 64 percent of cases were men. The distribution of patients by profession and social status is as follows: workers (31 percent), pensioners (21 percent), unemployed (20 percent), servants (9 percent), students (3 percent), foresters and hunters (4 percent), physically disabled persons (6 percent), other (6 percent).
(Promed 3/11/07)

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Americas
USA: FDA unveils pandemic preparedness plan
The US Food and Drug Administration (FDA) issued a pandemic influenza preparedness plan (http://www.fda.gov/oc/op/pandemic/default.htm ) that defines the agency's current role in federal pandemic planning, such as expediting the review of new vaccines and antivirals, and spells out work it will do in areas such as food safety and targeting counterfeit drugs. The plan addresses 6 major areas: vaccines, antiviral medications, medical devices, food and feed safety, emergency preparedness and response, and enforcement. Though FDA has already accomplished several pandemic-related tasks, such as approving a pediatric indication for the antiviral oseltamivir, other tasks are ongoing. The plan details steps needed to improve the surge capacity for producing products that will be crucial during a pandemic, such as antivirals, diagnostic tests, personal protective equipment, and other medical equipment.

Also, FDA said it is identifying a list of regulated foods and animal feeds that are at increased risk for contamination from a pandemic virus strain. The agency said it would gauge the risk of food contamination from infected waterfowl and the possibility of contamination of ready-to-eat foods by infectious respiratory droplets from humans. FDA is also investigating which food-processing practices can kill influenza viruses. The agency will conduct research on the effectiveness of processing methods, and also monitor the literature on the survivability of viruses in various foods and conditions. Though FDA has already prohibited the use of human antiviral drugs in poultry and is currently educating groups about the rule, it said the next step is to provide a test for antiviral drug residues in products that contain poultry. The agency reported it is already pursuing actions against fraudulent or counterfeit pandemic-related products.
(CIDRAP 3/14/07)

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USA: USDA vows to boost avian flu prevention efforts
The US Department of Agriculture (USDA) said it would step up its antismuggling efforts and monitoring of live bird markets this year to protect the country from H5N1 avian influenza. The agency plans to more than double the number of special operations to seize banned poultry products and will expand the monitoring of live bird markets from 12 states to 29 or 30. They also announced a renewal of last year's hunt for the H5N1 virus in wild birds throughout the US. The virus was not found in any of the more than 100,000 wild bird samples tested last year.

Agriculture Secretary Mike Johanns said USDA conducted 31 operations at ports and in restaurants and markets last year, that led to the seizure of 400,000 pounds banned poultry products from countries affected by H5N1 avian flu. This year, plans call for running 70 operations. In monitoring live bird markets, USDA has focused until now on 12 northeastern states, where 132,000 birds were tested last year. This year officials hope to increase the program to a total of 29 or 30 states.

This year's wild-bird testing program will be launched Apr 2007 by USDA along with Department of the Interior (DOI), state agencies, and academic researchers. Surveillance will again be conducted in all 4 major flyways, and in Hawaii and the South Pacific. Last year, 6 samples of the more than 100,000 tested were positive for the low-pathogenic North American strain of H5N1, but the Asian H5N1 strain was not found. US agencies also aim to increase collaboration with Canadian and Mexican authorities. Officials also announced completion of a 7-year study of avian flu in waterfowl in Alaska. Scientists took 8,254 samples and concluded that the risk of introduction of the H5N1 virus in Alaska is "relatively low". Investigators found only low-pathogenic viruses of North American origin. The suspected reason the virus hasn't been found in Alaska is that the distance may be too long for a sick bird to get that far.

The USDA is prepared to test birds quickly if avian flu is suspected in a poultry flock. All 45 labs in the National Animal Health Laboratory Network are trained to use a recently developed test that can return a result in 3 hours, as compared with up to 2 weeks for previous tests. USDA compensates owners for birds destroyed for disease-control reasons. USDA also announced the signing of a agreement on coordinating technical assistance with the UN Food and Agriculture Organization (FAO). USDA is hosting a workshop to prepare more than 50 volunteer specialists from 15 countries for rapid international deployment to combat H5N1 avian flu. USDA is also helping to coordinate a workshop aimed to develop an international communications plan for dealing with animal-to-animal spread of H5N1 avian flu.
(CIDRAP 3/15/07)

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Canada (Ontario): Outbreak of methicillin-sensitive Staphylococcus aureus
A serious bacterial infection has shut down Toronto's largest neonatal intensive care unit (NICU), and it could last weeks, putting severe strain on a system that is already at maximum capacity. Women's College Hospital, where the region's most vulnerable premature babies are cared for, this week stopped accepting high-risk pregnancy transfers, as well as premature babies born at other hospitals, after an outbreak of methicillin-sensitive Staphylococcus aureus (MSSA) could not be contained. "[The closing] means that mothers will have to be transferred to other cities, out of province, even out of country to Buffalo," Mary Vearncombe, director of infection control at Women's College and at Sunnybrook Health Sciences Centre, said 8 Mar 2007. The closing of 41 beds at Women's College is significant because the province has only about 200 "Level 3" beds, which are for premature babies who need the most monitoring and care. Dr. Vearncombe said the outbreak was partly caused by extremely crowded conditions. NICU staff at Women's College noticed the first case of infection early Jan 2007. It spread, and ultimately n emergency closing was the only option. The 41 babies remain at the hospital, but hospital staff have cleared the NICU rooms to clean them out. Premature babies are extremely vulnerable to infections. Many infants here have developed abscesses, pneumonia, eye infections, and blood infections. No deaths have been reported.
(Promed 3/9/07)

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Canada (Ontario, Quebec): Increased incidence in cases of Clostridium difficile infection
Officials at Barrie's Royal Victoria Hospital are investigating whether any recent patient deaths can be linked to a virulent strain of Clostridium difficile infection. Since Jan 2007, 43 people at the facility have been diagnosed with the bacterium. The hospital says the bug is aggressive, and the large spike in cases has led them to believe it may be the dangerous "Quebec" strain that killed 2000 people in that province since 2003. Meanwhile, 3 new cases of C. difficile infection have been identified at Mississauga's Trillium Health Network, bringing their total number of cases to 17. Precautions are being taken: keeping patients in private rooms, having anyone entering the room wear gloves and gowns as well as having people wash their hands as they enter or leave the room. Similar efforts are reportedly in place at Scarborough Hospital's General Division where it was reported 28 Feb 2007 that a small group of patients have been diagnosed with C. difficile. 5 new cases had also been reported at Honore-Mercier Hospital near Montreal as of 28 Feb 2007. Reportedly, none of the patients at Honore-Mercier are currently being treated in the intensive care unit and 1 has been released. Of the 4 people at Trillium who tested positive for the bacterium after death, 1 was carrying the “Quebec" strain. C. difficile control in the health care setting involves not only aggressive infection control measures but also prudent control of the overuse of antimicrobial agents.
(Promed 3/6/07)

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Canada: Update on Canada’s latest case of BSE
The Canadian Food Inspection Agency's (CFIA) investigation of Canada's latest case of bovine spongiform encephalopathy (BSE) is nearing completion. CFIA investigators have confirmed the animal was born in 2000. Information collected through the investigation also indicates the animal was born and raised on the farm where it was found. CFIA has directed all necessary resources toward the tracing of cattle that may have been exposed to the same feed as the affected animal during the early part of their lives. The investigation also includes a thorough examination of the formulation, production, transportation, and storage of a number of feed sources used on the birth farm at the time. More than 150 000 cattle have been tested since BSE was first detected in 2003. Under Canada's enhanced feed ban, which comes into effect Jul 2007, BSE should be eliminated from the national cattle herd within approximately 10 years. CFIA expects the periodic detection of a limited number of cases to continue as the level of BSE continues to decline.
(Promed 3/8/07)

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Canada (Alberta): Fatal case of bat-bite rabies
A 73 year old man from Northern Alberta is in intensive care in a ketamine coma with a diagnosis of rabies 1 Mar 2007. He was bitten by a bat in his home Aug 2006 and developed severe left shoulder pain (the site of the bite) Jan 2007. Subsequently, he complained of weakness, "difficulty swallowing" (possible hydrophobia), rigidity (opisthotonic posturing), and was admitted to a local hospital with a diagnosis of pneumonia (possibly due to secretion retention, and phobic inspiratory spasms). Rabies was suspected 3 days later. The patient did not seek medical attention after the bat bite. He and his family were unaware of the risk. This is the third rabies case in Canada since 2000, highlighting the importance of bats in the relatively rare North American rabies cases and the need for continued public health vigilance so exposed persons and health care providers are aware of the potential for disease and need for rabies prophylaxis.
(Promed 3/4/07)

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Peru: Rabies death due to bites from vampire bats
According to Jorge Gomez Benavides, the official responsible for zoonoses in the general directorate of epidemiology of the Ministry of Health [MINSA], more than 20 persons have died from rabies transmitted by the bite of hematophagous bats in Puno and Madre de Dios. Gomez Benavides indicated that between Jul 2006 and 15 Feb 2007, health networks of Mazuko (Madre de Dios), San Gaban (Puno), and Huepetuhe (Madre de Dios) reported 27, 370, and 130 cases of vampire bat bites respectively, for a total of 527 people. Of the total of individuals affected, there have been 23 reported cases of rabies transmitted by bat bites since Dec 2006. It is assumed that the 23 people who died from this disease did so because they failed to go to health facilities for treatment after having been attacked by the bats.

Gomez Benavides indicated that bat bites frequently occur during the night and that these hematophagous bats prefer to feed on the heads when their victims are children, and on the toes in the case of adults. He remarked that in the case of a bite, the desired action is to wash the wound with soap and water and to go immediately to the closest health center to receive anti-rabies treatment, provided at no cost. MINSA will continue the vaccination campaign. The main risk factor for bat bites is the construction of unprotected housing, characteristic of gold mining camps, or in population centers. The housing in these camps consists only of plastic and wood or leaf thatched roofs, practically without walls.
(Promed 3/6/07)

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USA: USDA plans risk-based meat inspection system
Federal officials recently proposed a timetable to begin implementing a new meat and poultry inspection system designed to reduce foodborne illnesses by focusing more attention on high-risk facilities and those with poor safety records. Richard Raymond, USDA undersecretary for food safety, proposed to implement the new risk-based inspection system Apr 2007 at 30 locations, and possibly to expand it to 150 locations by the end of 2007. The proposed system is seen as the biggest change in the USDA's food inspection program since 1996, when the Hazard Analysis and Critical Point Systems (HACCP) rule made food processors responsible for systematically assessing, preventing, and controlling food safety hazards. Assessing each facility's food safety record and the relative risk of what is produced will allow the USDA's Food Safety and Inspection Service (FSIS) to better allocate its inspection resources to the processors that need them most. A processor's food safety performance will be based on information federal inspectors regularly collect at the plants. Raymond asserted that risk-based inspection "will not reduce the number of inspectors nor will it save any money." He said FSIS is rolling out the new inspection program gradually so that it can be evaluated and revised as needed before it is expanded nationwide.

Industry and consumer groups have expressed concerns about the new approach. J. Patrick Boyle, American Meat Institute’s president and chief executive officer, said USDA should slow the process down, seek additional input, and make participation voluntary. The Consumer Federation of America (CFA) criticized the plan saying that although risk-based system for meat inspection is a worthy goal, USDA has neither "meaningful scientific data" to rank product risk nor an unbiased system for determining facility risk.
(CIDRAP 3/7/07)

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USA: FDA issues safety guidance for fresh-cut produce
The US Food and Drug Administration (FDA) released final guidance on voluntary food safety procedures for processors that handle fresh-cut fruits and vegetables, including ready-to-eat spinach and other leafy greens. The document urges processors to institute risk-based food safety programs based on the Hazard Analysis and Critical Control Point (HACCP) model. HACCP plans detail procedures for identifying points in food processing where contamination can occur and taking preventive steps. Though FDA has already issued "good manufacturing practice" regulations for the food industry, the new guidance document represents the first recommendations specifically for the fresh-cut produce industry. Nega Beru, director of FDA's Center for Food Safety and Applied Nutrition (CFSAN's) Office of Food Safety, said fresh-cut fruits and vegetables are the fastest-growing facet of the produce industry and that from 1996 to 2006, 25% of foodborne illness outbreaks were linked to the sector. He said the high degree of handling involved in fresh-cut produce places the products at high risk. The document addresses 5 main areas: worker health and hygiene, training, buildings and equipment, sanitation operations, and production and processing controls. It also provides recommendations on recordkeeping, recalls, and product tracebacks.
(CIDRAP 3/12/07)

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USA: Update on Salmonella outbreak associated with peanut butter
As of 7 Mar 2007, 425 persons infected with the outbreak strain of Salmonella Tennessee have been reported to CDC from 44 states. Among 351 patients for whom clinical information is available, 71 (20 percent) were hospitalized. No deaths have been attributed to this infection. Onset dates, which are known for 301 patients, ranged from 1 Aug 2006 to 16 Feb 2007, and 67 percent of these illnesses began after 1 Dec 2006. No additional cases have been outbreak-associated with a date of onset after 16 Feb 2007. FDA is now informing consumers that ConAgra has extended their recall of all Peter Pan peanut butter and all Great Value peanut butter beginning with product code "2111", including peanut butter toppings, back to Oct 2004. Consumers who have purchased any of the products since Oct 2004 should discard them. FDA's advice to consumers continues to be not to eat any Peter Pan peanut butter or any Great Value peanut butter beginning with the "2111" product code. Both products are made at the same ConAgra plant, where investigators recently tested samples and found the same Salmonella enterica strain linked to the outbreak. S enterica typically causes fever and nonbloody diarrhea that resolves in a week. The company voluntarily recalled its products Feb 14, and recently expanded the recall to include 3 peanut butter dessert topping brands that were made from bulk Peter Pan peanut butter supplied by the ConAgra plant.
(Promed 3/9/07, 3/10/07; CIDRAP 3/9/07)

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USA (Arizona): Ongoing outbreak of salmonellosis, serotype Oranienburg
CDC is continuing to offer assistance with an investigation into the area's salmonella outbreak. State health officials are now reporting 56 confirmed cases of salmonellosis in the greater Sierra Vista area since 1 Sep 2006. The local outbreak involves Salmonella enterica serotype Oranienburg. A CDC team arrived in mid-Jan 2007 to assist local officials in the investigation. After interviewing people who were affected by the infection, along with those who came in contact with those people, officials were still looking for answers. A random phone survey is the next stage in the search, something that will continue through the first week of Mar 2007. The study involves an interview of several questions including eating habits.
(Promed 3/5/07)

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USA (Pennsylvania): Salmonella associated with raw milk
State health secretary Dr Calvin B Johnson advised 2 Mar 2007 consumers who purchased raw milk from Stump Acres Dairy of York County to immediately discard the raw milk due to the risk of contamination with salmonella. There have been 2 confirmed cases and 1 probable case of Salmonella [enterica serotype] Typhimurium infection among York County residents who drank raw milk from Stump Acres Dairy in Feb 2007. Additional cases of illness are suspected. The Department of Agriculture has suspended sales of raw milk at the dairy. The Department obtained 3 positive milk cultures from the dairy. A milk sample obtained from consumers also tested positive. The customers of the dairy are known to be from Pennsylvania, Maryland, and Virginia. No cases of salmonella infection have been identified at this time in the other states. Pathogens that infect humans are shed in the feces of cows and can contaminate milk during the milking process. Pasteurization decreases the number of pathogenic organisms, prevents transmission of pathogens, and has been determined to improve the safety of milk.
(Promed 3/3/07)

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USA (Texas/Maryland): Norovirus outbreak tied to raw oyster consumption
Following 25 cases of norovirus infection in people who ate raw oysters from San Antonio Bay in Texas, the US Food and Drug Administration (FDA) has warned against eating raw oysters taken from the bay after Feb 1. The patients ate raw oysters at a Maryland event Feb 9 to 11. Patients tested by the Maryland Department of Health and Mental Hygiene were found to have the virus. The implicated oyster beds were closed Feb 24 and remain closed. 2 seafood distributors—Bayview Seafood, Seadrift, Tex., and Rose Bay Oyster Co., Swanquarter, N.C.—issued recalls late Feb as a result of the outbreak. Rose Bay mislabeled oysters from San Antonio Bay, indicating they were from Galveston Bay instead. Osyters with tags that read "Gal 1, 2/2/07" are subject to recall. Symptoms include nausea, vomiting, diarrhea, and stomach cramps; other possible symptoms are low-grade fever, chills, headache, muscle aches, and fatigue. Most people show symptoms within 48 hours of exposure to the virus. The illness typically lasts 1 to 2 days. Norovirus contamination in oysters is not unusual. FDA said people with weakened immune systems and those who have liver, stomach, or blood disorders; cancer, diabetes, or kidney disease; or a history of chronic alcohol abuse should never eat raw oysters. Thorough cooking destroys noroviruses.
(CIDRAP 3/5/07 ; Promed 3/4/07)

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USA: Norovirus outbreak in New Jersey university; San Diego cruise
A norovirus outbreak has sickened nearly 270 students and staff in Fairleigh Dickinson University's Florham Park in recent days. School officials are telling students with new cases to simply go home early. The cafeteria, student center, freshman dormitory bathrooms, and classrooms are being disinfected 3 times a day. The 24-hour virus hit campus last week, with students falling sick 1 and 2 Mar 2007. At least 20 students suffering from diarrhea, dehydration, and nausea were sick enough that they required treatment at hospital. Approximately 2000 students attend the university.

Norovirus has also spoiled the vacation of passengers on a cruise ship that ended its 10-day voyage in San Diego. At least 167 of the ship's 1200 passengers and more than a dozen crew members contracted the stomach bug. It was the second straight trip and the fourth since May 2006 that the ship has had to report an outbreak to CDC. On the ship’s last voyage, 110 passengers became sick. In summer 2006, the ship's passengers had stomach problems resulting from norovirus infection on 2 different cruises.
(Promed 3/5/07, 3/6/07, 3/9/07)

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USA: New norovirus strain responsible for wave of gastrointestinal infections
Scientists have discovered that a new strain of norovirus is responsible for the wave of gastrointestinal infections that have overwhelmed hospitals, nursing homes, and college dormitories this winter. Genetic fingerprinting shows that the virus infecting patients is distinct and aggressive. When CDC tested stool specimens from Oct through Dec 2006, 60 percent of those patients were positive for the new form of norovirus. Investigators first detected evidence in Jan 2006 that a novel type of norovirus might be circulating, when passengers aboard the Minerva II cruise ship fell ill. Genetic testing distinguished the new strain (GII.4 Minerva) from previous versions. The Northeast and California have been particularly hard-hit. In Massachusetts, patients and staff have fallen ill at the VA Boston Healthcare System, McLean Hospital, and, most recently, Hebrew Rehabilitation Center, where 225 residents and 119 staff members became sick over the last 2 weeks. In the past, norovirus infections routinely passed after a day and fever was rare. This year, some patients were sick for 3 or 4 days and developed fevers. Noroviruses are highly infectious and the major cause of acute gastroenteritis with pandemic spread of the virus being reported from 1995 onwards. Currently, there are at least 7 norovirus genogroups (GI, GII, GIII, GIV, GV, GVI and GVII).
(Promed 3/10/07)

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Africa
Egypt (Aswan): Report of new human case of avian influenza H5N1 infection
Egyptian authorities reported a case of H5N1 avian influenza in a 10-year-old girl, marking the country's seventh case this year and 25th overall. The girl was reportedly admitted to a hospital in Aswan, Mar 13, with fever and muscle pains. An Egyptian health ministry laboratory confirmed the girl's infection. The girl's condition improved after she was treated with oseltamivir. Her family was being kept under observation. Hassan al-Bushra, a regional communicable disease official with WHO, said the case occurred in an urban area. Meanwhile, the 4-year-old boy who was identified Mar 11 as Egypt's 24th H5N1 case-patient has recovered and was to be discharged from hospital. The boy was from Ad Daqahliyah Governorate; he developed symptoms 7 Mar 2007 and was admitted to hospital 8 Mar 2007. The boy was exposed to sick birds. Contacts of the boy remain healthy and are being closely monitored. Reportedly, avian flu had been found on 9 farms in Egypt where the poultry had been vaccinated. Reportedly, almost 10,000 of 41,684 birds raised on the farms had died since the beginning of this year.
(Promed 3/12/07, 3/15/07; CIDRAP 3/15/07)

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1. Updates
Avian/Pandemic influenza updates
- UN: http://influenza.un.org/. UN response to avian influenza and the pandemic threat. Also, http://www.irinnews.org/Birdflu.asp provides information on avian influenza in order to help the humanitarian community.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html.
- OIE: http://www.oie.int/eng/en_index.htm. Link to upcoming avian influenza conferences.
- US CDC: http://www.cdc.gov/flu/avian/index.htm. Bird embargo updates.
- 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)

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Seasonal Influenza
Chinese Taipei
Based on the notifiable disease surveillance system in Taiwan, during Feb 25 to Mar 3, 2007, 4 persons under investigation for possible H5N1infections were reported in Taiwan, of which all were laboratory confirmed as influenza A (H3) positive. These cases were inbound travelers, 3 from Thailand and the other from Hong Kong. As of Mar 3, there had been 17 persons under investigation for possible A (H5N1) infections nation-wide this year, of those, 9 had been confirmed as influenza, including 8 influenza A (H3) positive and 1 influenza A (H1) positive, and the remaining 8 tested negative for influenza. So far in 2007, no death under investigation from possible H5N1 infection has been reported in Taiwan. In 2006, 14 cases were laboratory confirmed, with 12 influenza A (H1), 1 influenza A (H3), and 1 influenza B.
(Taiwan IHR Focal Point 3/16/07)

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Dengue
Philippines
The Department of Health (DOH) has already declared a year-round campaign against dengue fever, but cases continue to climb. A DOH report showed that since 1 Jan to 26 Feb 2007, a total of 1579 dengue cases with 7 deaths were recorded. However, the DOH report showed that the dengue reported during the period is lower than that of the same period in 2006, which was 3348 cases with 51 deaths. The DOH launched an all-out and year-round campaign against dengue that is aggressively being undertaken. Health Secretary Francisco Duque III reminded the public that the only means to fight dengue is to destroy the breeding sites of the dengue-causing mosquitoes, and seek medical help when early signs such as fever and rashes set in. (Promed 3/11/07)

Malaysia
Dengue cases in the country dropped by 20.9 percent over a 1-week period. The Health Ministry's Diseases Control Director Datuk Dr Hasan Abdul Rahman said the drop was the result of concerted efforts by the government and various parties. He said that during 18-24 Feb 2007, 783 suspected dengue cases were reported, compared with 990 cases the preceding week. "In the same period, there were 2 dengue-related deaths, 1 each in Selangor and the Federal Territory, bringing to 25 the total number of deaths due to dengue this year [2007]," he said. Dr Hasan said that of the 783 cases, 729 cases were suspected to be dengue fever, while 54 cases were dengue hemorrhagic fever cases. (Promed 3/11/07)

Indonesia
A total of 2767 Central Java residents contracted dengue fever between early this year and 16 Feb 2007, with the numbers of fatal victims reaching 73 people. In Jan 2007, the number of dengue patients in Central Java was 1461, and in Feb 2007, the figure increased by 1306, the head of the Central Java provincial health office, Endang Agustinar, said 19 Feb 2007. The dengue outbreaks occurred in 7 districts (Blora, Pati, Jepara, Pekalongan, Semarang, Pemalang, and Batang). "The incidence of dengue fever . . .usually increases sharply during the rainy season when there is a lot of stagnant water. . ." he said.
(Promed 3/11/07)

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2. Articles
Review finds little evidence of airborne spread of flu
A rigorous review of research into influenza transmission concludes that the virus is primarily transmitted at close quarters, a finding that downplays the likelihood of airborne transmission. Gabrielle Brankston et al. of Toronto's University Health Network described their evaluation of 32 experimental and observational studies. They come to 2 conclusions. 1) much of what is believed to be known about flu transmission is based on poorly structured studies or faulty interpretations of results. 2) the preponderance of the robust evidence supports flu being acquired only within a short distance of an infected person—making it much more likely that the virus is transmitted by large respiratory droplets that fall out of the air within several feet, rather than by fine aerosols that can travel long distances and hang in the air.

Overall, the evidence suggests that airborne transmission, "as traditionally defined, is unlikely to be of significance in most clinical settings." "Our final conclusion was that we cannot say flu is transmitted over long distances, and the only way flu can transmit over long distances would be through the airborne route," Dr. Michael Gardam, the study's senior author, said. The issue is vital for pandemic planning because assessment of transmission risk drives decisions about prevention—whether to offer health care workers surgical masks, which catch droplets, or respirators, which block airborne particles and may intercept flu viruses. N-95 respirators are hard to wear correctly and respirator manufacturers have conceded that global demand in a pandemic would outstrip their production capacity. In Canada, the Ontario Nurses Association threatened work stoppages if its members do not receive N-95 respirators during a pandemic. And in the US, CDC expanded its guidance on respirator use last Oct, and says using a respirator is "prudent" for any healthcare worker in contact with a known or potentially infected patient.

Brankston G, et al. Transmission of influenza A in human beings. Lancet Infect Dis 2007 Apr 1. (early online publication Feb 19)
(CIDRAP 3/13/07)

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Racial/Ethnic Disparities in Diagnoses of HIV/AIDS--33 States, 2001--2005
“During 2001--2004, blacks accounted for 51% of newly diagnosed human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infections in the United States. This report updates HIV/AIDS diagnoses during 2001--2005 among black adults and adolescents and other racial/ethnic populations reported to CDC through June 2006 by 33 states that had used confidential, name-based reporting of HIV and AIDS cases since at least 2001. Of the estimated 184,991 adult and adolescent HIV infections diagnosed during 2001--2005, more (51%) occurred among blacks than among all other racial/ethnic populations combined. Most (62%) new HIV/AIDS diagnoses were among persons aged 25--44 years; in this age group, blacks accounted for 48% of new HIV/AIDS diagnoses. New interventions and mobilization of the broader community are needed to reduce the disproportionate impact of HIV/AIDS on blacks in the United States. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5609a1.htm
(MMWR March 9, 2007 / 56(09);189-193)

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Invasive Methicillin-resistant Staphylococcus aureus infections among dialysis patients--United States, 2005
“Staphylococcus aureus is a leading cause of bloodstream and other invasive infections in the United States. S. aureus has become increasingly resistant to first-line antimicrobial agents in health-care settings. Dialysis patients are especially vulnerable to infections, frequently those caused by antimicrobial-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA). To assess the incidence of invasive MRSA infection among dialysis patients in the United States during 2005, surveillance data were analyzed from the Active Bacterial Core surveillance (ABCs) system. This report summarizes the results of that analysis, which estimated that, in 2005, the incidence of invasive MRSA infection among dialysis patients was 45.2 cases per 1,000 population. Persons receiving dialysis are at high risk for infection with invasive MRSA compared with the general population. . .The findings in this report underscore the need for continued surveillance and infection-control strategies aimed at reducing infection rates and preventing additional antimicrobial resistance among persons receiving dialysis. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5609a3.htm
(MMWR March 9, 2007 / 56(09);197-199)

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Surveillance for Acute Viral Hepatitis --- United States, 2005
Abstract: “Problem/Condition: “In the United States, acute viral hepatitis most frequently is caused by infection with hepatitis A virus (HAV), hepatitis B virus (HBV), or hepatitis C virus (HCV). These unrelated viruses are transmitted through different routes and have different epidemiologic profiles. Safe and effective vaccines have been available for hepatitis B since 1981 and, for hepatitis A, since 1995. Reporting Period: Cases in 2005, the most recent for which data are available, are compared with those from previous years. . .Results: Since 1995, the incidence of reported acute hepatitis A has declined by 88%, to the lowest rate ever recorded. . .Declines were greater among children and in states where routine vaccination of children was recommended beginning in 1999, compared with the remaining states. The proportion of cases among adults has increased. Since 1990, reported acute hepatitis B incidence has declined by 79%, to the lowest rate ever recorded. . .Declines occurred among all age groups but were greatest among children aged <15 years. Since the late 1980s, acute hepatitis C incidence also has declined. In 2005, as in previous years, the majority of these cases occurred among adults, and injection-drug use was the most common risk factor. Interpretation: The greater declines in hepatitis A rates among the states and age groups included in the 1999 recommendations for routine childhood hepatitis A vaccination suggest that this strategy reduced rates. Universal hepatitis B vaccination of children has resulted in substantially lower rates among younger age groups. Higher rates of hepatitis B continue among adults. . .which emphasize the need to vaccinate adults at risk for HBV infection. The decline in hepatitis C incidence is primarily attributed to a decrease in incidence among injection-drug users (IDUs). . .Public Health Actions: The recent expansion of recommendations for routine hepatitis A vaccination to include all children in the United States aged 12--23 months is expected to further reduce hepatitis A rates. Ongoing hepatitis B vaccination programs will ultimately eliminate domestic HBV transmission, and increased vaccination of adults who have risk factors will accelerate progress toward elimination. Prevention of hepatitis C relies on identifying and counseling uninfected persons at risk for hepatitis C (e.g., IDUs) regarding ways to protect themselves from infection.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5603a1.htm
(MMWR March 16, 2007 / 56(SS03);1-24)

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Postmarketing monitoring of intussusception after RotaTeq vaccination--United States, February 1, 2006--February 15, 2007
(references removed)
“Rotavirus is the leading cause of severe gastroenteritis in children aged <5 years worldwide. In February 2006, a new rotavirus vaccine, RotaTeq. . .was licensed in the United States, and the Advisory Committee on Immunization Practices (ACIP) recommended it for routine vaccination of U.S. infants with 3 doses, administered orally at ages 2, 4, and 6 months. Because a previous rotavirus vaccine, Rotashield. . .was withdrawn from the U.S. market in 1999 after postmarketing surveillance identified an association with intussusception. . .the safety of RotaTeq was evaluated in a prelicensure clinical trial involving 71,725 infants who received either vaccine or placebo. In this controlled trial, no statistically significant elevated risk for intussusception was observed within a 42-day period after RotaTeq vaccination. However, postmarketing monitoring for intussusception after RotaTeq vaccination is necessary because of possible differences in the characteristics of infants who received the vaccine in routine use compared with the infants in the clinical trials. Also, the large numbers of infants being vaccinated provides an opportunity to detect intussusception occurring at a low rate after vaccination. This report presents data from the first year of postmarketing monitoring for intussusception after RotaTeq vaccination in the United States, with particular focus on all intussusception reports received by the Vaccine Adverse Event Reporting System (VAERS) during February 1, 2006--February 15, 2007. As of February 15, 2007, postmarketing surveillance did not suggest association of RotaTeq vaccination with intussusception. CDC reaffirms vaccine policy recommendations to routinely vaccinate U.S. infants with RotaTeq at ages 2, 4, and 6 months. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5610a3.htm
(MMWR March 16, 2007 / 56(10);218-222)

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Increases in Gonorrhea--Eight Western States, 2000—2005
(references removed)
“Neisseria gonorrhoeae infection is the second most commonly reported notifiable disease in the United States. Gonorrhea increases the risk for pelvic inflammatory disease, infertility, ectopic pregnancy, and acquisition and transmission of human immunodeficiency virus (HIV). Nationally, reported gonorrhea incidence rates have been either declining or stable since 1996, although, in 2005, the national rate (115.6 cases per 100,000 population) increased for the first time since 1999. In recent decades, western states have had lower gonorrhea rates than other U.S. regions; however, from 2000 to 2005, rates in the West increased 42%, from 57.2 cases to 81.5 cases per 100,000 population. During that period, rates in the three other U.S. regions decreased (South: -22%, Northeast: -16%, and Midwest: -5%). This report describes the epidemiology of gonorrhea in eight western states that reported large increases in gonorrhea incidence rates from 2000 to 2005. The results indicated that both sexes and all specified age and racial/ethnic groups experienced increases in gonorrhea rates. Causes for these increases remain unclear; however, data suggest they likely resulted from a combination of increases in the number of tests performed, trends in the types of test performed, and actual increases in disease occurrence. . .Public health agencies should remain vigilant for early signs of increases in gonorrhea incidence in their areas. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5610a4.htm
(MMWR March 16, 2007 / 56(10);222-225)

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Autochthonous Transmission of Trypanosoma cruzi, Louisiana
Patricia L. Dorn et al. EID. Volume 13, Number 4–April 2007.
http://www.cdc.gov/EID/content/13/4/605.htm
Abstract : “Autochthonous transmission of the Chagas disease parasite, Trypanosoma cruzi, was detected in a patient in rural New Orleans, Louisiana. The patient had positive test results from 2 serologic tests and hemoculture. Fifty-six percent of 18 Triatoma sanguisuga collected from the house of the patient were positive for T. cruzi by PCR.”

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Avian Influenza Viruses in Water Birds, Africa
Nicolas Gaidet et al. EID. Volume 13, Number 4–April 2007. http://www.cdc.gov/eid/content/13/4/626.htm
Abstract: “We report the first large-scale surveillance of avian influenza viruses in water birds conducted in Africa. This study shows evidence of avian influenza viruses in wild birds, both Eurasian and Afro-tropical species, in several major wetlands of Africa.”

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Why did outbreaks of Severe Acute Respiratory Syndrome occur in some hospital wards but not in others?
Ignatius T. Yu et al. Clinical Infectious Diseases 2007;44:1017-1025. http://www.journals.uchicago.edu/CID/journal/issues/v44n8/41615/brief/41615.abstract.html
Abstract: “Background. Most documented "superspreading events" of severe acute respiratory syndrome (SARS) occurred in hospitals, but the underlying causes remain unclear. We systematically analyzed the risk factors for nosocomial outbreaks of SARS among hospital wards in Guangzhou and Hong Kong, China. Methods. A case-control study was conducted. Case wards were hospital wards in which superspreading events of SARS occurred, and control wards were wards in which patients with SARS were admitted, but no subsequent nosocomial outbreaks occurred. Information on environmental and administrative factors was obtained through visits to the wards and interviews with ward managers or nursing officers. Relevant information about host factors was abstracted from the medical records. Logistic regression analyses were used to identify the major risk factors for superspreading events. Results. Eighty-six wards in 21 hospitals in Guangzhou and 38 wards in 5 hospitals in Hong Kong were included in the study. Six risk factors were significant in the final multiple-logistic regression model: minimum distance between beds of 1 m (odds ratio [OR], 6.94; 95% confidence interval [CI], 1.68–28.75), availability of washing or changing facilities for staff (OR, 0.12; 95% CI, 0.02–0.97), whether resuscitation was ever performed in the ward (OR, 3.81; 95% CI, 1.04–13.87), whether staff members worked while experiencing symptoms (OR, 10.55; 95% CI, 2.28–48.87), whether any host patients (index patient or the first patient with SARS admitted to a ward) required oxygen therapy (OR, 4.30; 95% CI, 1.00–18.43), and whether any host patients required bi-level positive airway pressure ventilation (OR, 11.82; 95% CI, 1.97–70.80). Conclusions. Our results revealed that factors that were associated with the ward environment and administration were important in nosocomial outbreaks of SARS. The lessons learned from this study remain very important and highly relevant to the daily operation of hospital wards if we are to prevent nosocomial outbreaks of other respiratory infections in the future.”

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Australia (Northern Territory): 3 fatal cases of flesh-eating bacteria, 2000-2003
An article describes how 3 people died from necrotizing fasciitis after swimming in rivers in the Borroloola region. The report details 4 cases that were detected in recent years. In each case, the patient's legs were ravaged by a bacterium after coming into contact with rivers. In May 2001, a 63 year old man died 18 days after his legs were exposed to the waters of the Weirian River while fishing. In July 2000, a 55 year old man also died 2 years after suffering a similar infection. A 19 year old woman died in the same area within 24 hours of contracting the disease after swimming in one of the rivers. In 2003, a 38 year old man with no medical history had his lower left leg amputated after suffering a similar infection.

The disease, necrotizing fasciitis, often called the "flesh eating disease", can be caused by marine bacteria, which get in through cuts in the skin and into the deep tissues and blood. It is usually caused by Streptococcus pyogenes (group A beta-hemolytic streptococcus) or by a mixture of aerobic and anaerobic bacteria. It may be caused by other organisms including the halophilic vibrios, especially V. vulnificus. V. vulnificus wound infections can begin as redness and swelling at the site of the wound and rapidly progress in patients at high risk to cause systemic illness, including necrotizing fasciitis and sepsis. Whether acquired through wound infection or ingestion of oysters contaminated with the bacterium, V. vulnificus typically causes a severe and life-threatening illness characterized by fever and chills, decreased blood pressure, and blood-tinged blistering skin lesions. Survivors often have to have limbs amputated. People with chronic liver disease or immunocompromising conditions are particularly at risk.

Ralph A, Currie BJ. Vibrio vulnificus and V. parahaemolyticus necrotising fasciitis in fishermen visiting an estuarine tropical northern Australian location. J Infect 2007; 54(3): e111-4. Epub 2006 Aug 7.
(Promed 3/2/07)

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3. Notifications
World Water Day--March 22, 2007
Mar 22 is World Water Day. The theme for World Water Day 2007 is Coping with Water Scarcity. About 1.1 billion persons lack access to an improved water source, and 2.4 billion persons lack access to adequate sanitation. As a result of infectious diseases related to unsafe water and inadequate sanitation, an estimated 3 million people in developing regions of the world die each year, primarily children. One of the UN's millennium development goals is, by 2015, to decrease by half the proportion of persons without sustainable access to safe drinking water and basic sanitation. Diarrhea accounts for approximately 4 billion episodes of illness and 1.8 million deaths every year. Developing regions are disproportionately affected by illnesses and deaths from waterborne pathogens. WHO estimates that 94% of diarrheal disease episodes are preventable through environmental modifications, including interventions to increase the availability of clean water and to improve sanitation and hygiene. In the US, new challenges have developed, including the emergence of chlorine-resistant pathogens, chemical contamination of water sources, aging infrastructure, increased recreational water contamination, exposure to water from cooling towers and other nontraditional water sources, and increasing water reuse.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5610a7.htm
(MMWR March 16, 2007 / 56(10);228-229)

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Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Summary: “These recommendations represent the first statement by the Advisory Committee on Immunization Practices (ACIP) on the use of a quadrivalent human papillomavirus (HPV) vaccine licensed by the U.S. Food and Drug Administration on June 8, 2006. This report summarizes the epidemiology of HPV and associated diseases, describes the licensed HPV vaccine, and provides recommendations for its use for vaccination among females aged 9--26 years in the United States. Genital HPV is the most common sexually transmitted infection in the United States; an estimated 6.2 million persons are newly infected every year. Although the majority of infections cause no clinical symptoms and are self-limited, persistent infection with oncogenic types can cause cervical cancer in women. HPV infection also is the cause of genital warts and is associated with other anogenital cancers. Cervical cancer rates have decreased in the United States because of widespread use of Papanicolaou testing, which can detect precancerous lesions of the cervix before they develop into cancer; nevertheless, during 2007, an estimated 11,100 new cases will be diagnosed and approximately 3,700 women will die from cervical cancer. In certain countries where cervical cancer screening is not routine, cervical cancer is a common cancer in women. . .The vaccine is administered by intramuscular injection, and the recommended schedule is a 3-dose series with the second and third doses administered 2 and 6 months after the first dose. The recommended age for vaccination of females is 11--12 years. Vaccine can be administered as young as age 9 years. Catch-up vaccination is recommended for females aged 13--26 years who have not been previously vaccinated. Vaccination is not a substitute for routine cervical cancer screening, and vaccinated females should have cervical cancer screening as recommended.” http://www.cdc.gov/mmwr/preview/mmwrhtml/rr56e312a1.htm
(MMWR March 12, 2007 / 56(Early Release);1-24)

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Automated test for West Nile screening of donors approved
The first fully automated test to screen donors of blood, tissue, and organs for West Nile virus (WNV) was recently approved by the US Food and Drug Administration (FDA). The Procleix TIGRIS system, developed by Gen-Probe, Inc., and marketed by Chiron Corp., was approved by FDA Mar 2, 2007. The advantages of a fully automated system are that it can reduce the potential for human error, speed up donor screening, and enhance the safety of blood and tissue products. The automated system allows blood centers to process 1,000 individual blood samples in about 14 hours. People usually catch WNV from the bite of a mosquito that has picked up the pathogen from an infected bird or animal. Most people experience no symptoms or only mild illness, but the virus can cause serious infections of the brain and nervous system. For the 2006 season, 4,256 cases of West Nile virus have so far been reported to CDC; 1,449 cases involved West Nile encephalitis or meningitis, and 165 were fatal. Development of a WNV blood test began in 2002 when researchers discovered that the virus could be transmitted in blood, and nationwide screening for the virus began in 2003. Testing detected about 1,400 potentially infectious blood donations from 2003 to 2005.
(CIDRAP 3/9/07)

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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