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Vol. X, No. 7 ~ EINet News Briefs ~ Mar 30, 2007


*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- Global: International network to study high-dose Tamiflu
- Global: WHO, Indonesia reach accord on virus sharing
- Afghanistan: Avian influenza H5N1 cases surge in new areas
- Bangladesh: More chickens culled as avian influenza spreads
- China (Anhui): New human case of bird flu confirmed
- Hong Kong: Child's H9N2 flu case probably from birds
- Indonesia: Additional suspected avian influenza H5N1 cases and deaths
- Myanmar (Yangon): Confirmation of avian influenza outbreak in 5 townships
- Thailand: Experts see double threat from avian influenza strains
- Australia (New South Wales, Tasmania): Salmonellosis outbreaks
- Australia (South Australia): Surge in cases of cryptosporidiosis
- Australia (Northern Territory): Melioidosis attacks healthy man
- North Korea: Measles outbreak sickens 3600 people
- Russia: Rotavirus outbreak in Khabarovsk
- Canada (Ontario): Unpasteurized milk/cheese associated with yersiniosis and listeriosis
- USA: Update on salmonella outbreak associated with peanut butter
- USA (California): FDA releases final report on spinach E coli outbreak
- USA (Illinois): Salmonella cases associated with Mexican-style cheese
- USA (California): 3 cases of Meningococcal meningitis in school
- USA (Utah): Campylobacteria outbreak associated with unpasteurized milk
- USA: Son of vaccinated soldier has severe vaccinia infection
- Egypt: Additional new human cases of avian influenza H5N1 infections

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

2. Articles
- Recent expansion of highly pathogenic avian influenza H5N1: a critical review
- Vibrio parahaemolyticus O3:K6 Epidemic Diarrhea, Chile, 2005
- Trends in Tuberculosis Incidence--United States, 2006
- Extensively Drug-Resistant Tuberculosis--United States, 1993—2006
- Three Outbreaks of Salmonellosis Associated with Baby Poultry from Three Hatcheries--United States, 2006
- Update: Chikungunya Fever Diagnosed Among International Travelers--United States, 2006

3. Notifications
- Avian influenza prediction market
- Introduction to Public Health Surveillance Course
- National Public Health Week--April 2--8, 2007
- World TB Day--March 24, 2007
- FDA Clears Rapid Test for Meningitis
- Obituary: Professor Aileen Plant


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 / 2 (1)
Egypt / 11 (3)
Indonesia / 6 (5)
Laos / 2 (2)
Nigeria / 1 (1)
Total / 22 (12)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 285 (170).
(WHO 3/29/07 http://www.who.int/csr/disease/avianinfluenza/en/ )

Avian influenza age, sex distribution data: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm.
(WHO/WPRO 3/20/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 3/29/07): http://gamapserver.who.int/mapLibrary/

Timeline of major H5N1 avian influenza events: events listed by animals and humans: http://www.who.int/csr/disease/avian_influenza/Timeline_2007_03_20.pdf
(WHO 3/20/07)

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Global: International network to study high-dose Tamiflu
A network of clinical researchers is about to begin testing whether doubling the standard dosage of oseltamivir (Tamiflu) will help patients overcome either the H5N1 avian influenza or severe seasonal flu. Researchers in Indonesia, Thailand, Vietnam, and the US hope to enroll up to 400 patients over the next 2 years and treat them with either the standard regimen or twice that amount for up to 10 days. The trial will be run by the Southeast Asia Influenza Clinical Research Network (SEA ICRN). Experts have been suggesting for some time that higher doses of the antiviral drug might give victims of H5N1 infection a better chance of surviving. The results of the trial could affect not only recommendations for use of the drug, but also government decisions about how much of it to stockpile for use in a flu pandemic.

Patients will be randomly assigned to receive either the standard dosage of oseltamivir—75 mg twice a day—or 150 mg twice a day. Patients won't know which regimen they are on. Elizabeth Higgs, deputy of the Collaborative Clinical Research Branch of the National Institute of Allergy and Infectious Diseases (NIAID), said patients will be treated for 5 days and then assessed. "Then we'll continue [the treatment] if the patient isn't clinically better. . .The hypothesis is the higher dose for a longer period of time will work better." The hope is that a higher dose of oseltamivir will be more effective in countering the high viral load in H5N1 patients. In animal studies, higher doses of oseltamivir have reportedly yielded higher cure rates for H5N1. The trial also aims to uncover differences between human and avian influenza in their clinical manifestations, the relationship between viral blood concentration and viral dynamics, and pathogenesis. The protocol calls for enrolling up to 100 patients with avian flu and up to 300 with severe seasonal flu. The aim is to enroll all laboratory-identified avian flu patients who seek treatment within 1 week of illness onset. The participating hospitals include 5 in Vietnam, 2 in Indonesia, 4 in Thailand, and 1 in the US. 5 labs in Indonesia, Thailand, and Vietnam will also be involved. Higgs described the network as a remarkable example of international cooperation. "This [network] is the only group of its type that has this type of cooperation among countries," Higgs said. ". . .It's significant that all of these countries want to cooperate at a scientific level and everybody has the same information."
(CIDRAP 3/29/07 www.cidrap.umn.edu )

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Global: WHO, Indonesia reach accord on virus sharing
Indonesia's health minister Siti Fadilah Supari announced her country would resume sharing its H5N1 avian influenza virus samples with WHO. Supari had been demanding that WHO change its 50-year-old virus sharing system, in which it collects regular flu samples from all over the world and makes them available to vaccine makers and others. WHO promised that it would not share virus samples with commercial vaccine makers without permission from the source country. Indonesia announced Feb 2007 that it had suspended sharing H5N1 samples with WHO and would provide no more without a guarantee that the samples would not be used by private companies to make vaccines priced out of Indonesia's reach. "We have struck a balance between the need to continue the sharing of influenza viruses for risk assessment and for vaccine development, and the need to help ensure that developing countries benefit from sharing without compromising global public health security," Dr. David Heymann of WHO said. Supari reportedly said, "We have now agreed with WHO and other member states of WHO on a timetable to make the changes necessary to accomplish our objective of achieving equitable and affordable access to vaccines for developing countries around the world."

Heymann said standard procedures for sharing seed viruses with pharmaceutical companies will be outlined in revised "terms of reference" for WHO collaborating laboratories. The terms of reference will spell out exactly what the labs can do with the viruses they receive. He said the document "will, we believe, permit WHO to receive shared viruses for risk assessment, to develop noncommercial diagnostic tests and to characterize the viruses in addition to preparing seed strains for vaccine. Those seed strains will then be shared with pharmaceutical companies to develop vaccine, and that mechanism will be outlined in the Terms of Reference of the WHO Collaborating Centres." The Jakarta meeting, organized by WHO and hosted by Indonesia, was attended by officials from about 20 countries that have had human or animal H5N1 outbreaks, senior scientists, and directors of WHO collaborating centers, along with representatives of the Asian Development Bank and nonprofit groups.

WHO said that projects to establish flu-vaccine manufacturing capacities in up to 6 developing countries—4 in Asia and 2 in Latin America—were "in the final stage of approval." Japan and the US have provided $18 million toward the effort. Heymann said solutions for improving H5N1 vaccine access in developing countries will require both short- and long-term measures, which could include: National stockpiles; Virtual stockpiles—certain amounts of pandemic vaccine that producers would set aside for the WHO to buy for developing countries; Fill-and-finish operations that allow developing countries to package bulk vaccine from manufacturers; Technology-transfer agreements like those used for the conjugate meningitis vaccine, which would allow developing countries to add to the world's flu vaccine supply.
(CIDRAP 3/26/07, 3/27/07 www.cidrap.umn.edu ; Promed 3/28/07)

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Europe/Near East
Afghanistan: Avian influenza H5N1 cases surge in new areas
New cases of a strain of bird flu have been confirmed in Kabul and in the southern province of Kandahar. A dead bird found in the Turkish embassy in Kabul 20 Mar 2007 was infected with H5N1 virus, officials confirmed 28 Mar 2007. A quarantine that had been imposed on the embassy compound was lifted after the health ministry completed a bird-culling operation there. "The blood test of an embassy driver who was injured by a bird has shown no sign of avian influenza," the ministry said. On 23 Mar 2007, 2 more cases of bird flu [in poultry] were confirmed in Kabul. Over the past week, bird flu was also detected in the Damaan and Shah Wali Kot districts of Kandahar province. Officials in Kabul say that insecurity is impeding their efforts to curb the spread of the virus in Shah Wali Kot. In an effort to mitigate the outbreak of avian influenza in Afghanistan, WHO on 25 Mar 2007 called on Afghans to stop buying and selling live birds. In addition, WHO has requested Afghan bird-lovers to refrain from touching their birds. But given the important socio-economic role of birds in the life of many Afghans, both recommendations are difficult for civilians. More than 20 cases of bird flu [in poultry] have been confirmed in the country since Feb 2007. The Afghan government has prohibited the importation of live birds and poultry products from Pakistan, where cases of avian influenza in poultry have also been confirmed.
(Promed 3/28/07)

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Asia
Bangladesh: More chickens culled as avian influenza spreads
Over 6000 chickens were culled 26 Mar 2007, around 4000 at 3 poultry farms in Jamalpur and 2110 chickens at a farm in Narayanganj, following confirmations of bird flu at those farms. Meanwhile, 400 chickens died at a farm in Gazipur due to "unknown reasons". Gazipur district livestock officials surveyed 47 poultry farms in Gazipur. They checked 64 634 layer chickens and broiler chickens but did not find any new cases of avian influenza infection. Earlier, around 40 000 chickens were culled at poultry farms in Gazipur and Savar, Dhaka after bird flu was detected there. Local officials culled chickens that were infected with bird flu at Kuranipara. Also, the government issued instructions to kill all chickens at the Sonakanda Poultry Farm--recently, more than 5000 chickens died at the farm within a short period of time.
(Promed 3/27/07)

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China (Anhui): New human case of bird flu confirmed
A teenage boy has died after falling ill with the bird flu virus, China reported 29 Mar 2007, confirming the country's third case of human infection from the virus so far in 2007. The 16-year-old student from Bengbu in eastern China's Anhui province died 27 Mar 2007. The boy was admitted to hospital 18 Mar 2007 after falling ill with a fever and signs of pneumonia. Tests by China's Centre for Disease Control and Prevention confirmed he had H5N1. Initial investigations failed to reveal that the boy had any "history of exposure to fowl that died because of illness". Animal health experts have also failed to find signs of the virus among birds in the area. His close contacts have so far shown no symptoms of the disease. China has now reported a total of 24 human cases of H5N1, including 15 deaths, since 2003.
(Promed 3/29/07; CIDRAP 3/28/07 www.cidrap.umn.edu )

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Hong Kong: Child's H9N2 flu case probably from birds
Hong Kong officials concluded that a baby girl who was recently infected with H9N2 avian influenza—a strain believed to have pandemic potential—probably contracted it from birds. A 9-month-old girl who was hospitalized with respiratory symptoms twice in recent weeks tested positive for an H9N2 infection Mar 20, 2007. The girl had only a mild illness but was treated in isolation at Princess Margaret Hospital, the Hong Kong Department of Health reported Mar 22. At the time of her second hospitalization she had respiratory syncytial virus. Dr. Thomas Tsang, controller of the Hong Kong Centre for Health Protection, said tests had ruled out the possibility of human-to-human transmission in the girl's case. Tsang said genetic analysis of the H9N2 virus showed that it was entirely of avian origin, suggesting that the child contracted it directly from a bird. She may have caught the virus at a bird market that she visited with her family, Tsang said.

He also said tests on respiratory specimens from a healthcare worker and 3 children who were in the same hospital cubicle with the baby in early Mar tested negative for H9 viruses, and her family had no symptoms. Meanwhile, leading virologist Robert Webster warned that H9N2 is an "insidious" virus that needs close monitoring because it could trigger an outbreak in humans. He said H9N2 can spread among pigs and infects chickens without making them sick. On the "hit list" of viruses, he added, "H5N1 is at [the] top, and H9N2 is right behind. Then come H7N7 and H2N2." At least 3 cases of H9N2 illness, all of them mild, have occurred in Hong Kong children in recent years. 2 girls were infected in 1999 and a 5-year-old boy had the virus in 2003. Robert L. Atmar, a Baylor College of Medicine professor, said human H9N2 illnesses may be less rare than the record suggests. Seroprevalence studies in China in the 1990s found H9 antibodies in 2% to 3% of the population, which suggests that some cases are missed, he said.
(Promed 3/28/07)

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Indonesia: Additional suspected avian influenza H5N1 cases and deaths
Initial tests indicated H5N1 infection in a 22-year-old female university student who died Mar 24 and a teenage boy who died Mar 25. Further test results were awaited. The 15-year-old boy was from Indramayu in West Java, while the 22-year-old woman was from Palembang in southeast Sumatra. In addition, a 39-year-old bird flu patient at Dr. Soetomo Hospital died 28 Mar 2007 after having been treated for several days. Reportedly, the woman, a resident of Jetis village in Mojokerto district, East Java died of H5N1 virus-induced liver and kidney failure. She was the second bird flu patient who died at Dr. Soetomo Hospital, after the death of another patient, also from Mojokerto, a week earlier.

Also, Indonesian officials said initial tests indicated H5N1 infection in a 14-year-old boy who died in West Sumatra province Mar 24 and a 28-year-old woman from central Jakarta who died 28 Mar 2007. Haris Subiantoro of Indonesia's health ministry said chickens in the boy's neighborhood died suspiciously 2 weeks before the boy got sick. Subiantoro said it was not clear if the woman had any contact with infected birds. Officials are waiting for the results of second tests to confirm the cases. By the WHO count, Indonesia has had 81 H5N1 cases with 63 deaths. But since Jan 29, Indonesia has reported at least 9 cases (besides those reported here) that have not yet been recognized by WHO; 7 of those were fatal. The 9 cases include 3 reported Mar 27 in which further test results were awaited.
(CIDRAP 3/27/07, 3/28/07, 3/29/07 www.cidrap.umn.edu ; Promed 3/27/07, 3/29/07)

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Myanmar (Yangon): Confirmation of avian influenza outbreak in 5 townships
The Myanmar livestock authorities have confirmed that 5 townships in Yangon have been hit by an H5N1 outbreak, according to the Livestock Breeding and Veterinary Department (LBVD) 27 Mar 2007. The 5 townships are Mayangon, Hlaingtharya, North Okkalapa, Mingaladon and Hmawby. Poultry, quail and pheasants of the affected farms together with those from possibly affected farms and from farms that are contiguous to the affected farms were culled and necessary preventive measures are being taken. The authorities have warned breeders and those engaged in poultry marketing to use new farm equipment instead of old and to ensure that crows do not enter poultry farms. Suspected avian influenza was first detected 27 Feb 2007 in a small poultry farm in Yangon's township of Mayangon. In the outbreak, 1863 fowl died of the virus, with 37 883 culled. Meanwhile, 2 townships, Mayangon and Hlaingtharya, have been further confirmed to be involved in the bird flu outbreak by the UN Food and the Agriculture Organization (FAO). FAO agreed 10 Mar 2007 to provide technical assistance to strengthen emergency preparedness for avian influenza. The assistance also includes equipment worth USD 600 000 donated by USAID to be used in preventive measures against the disease.
(Promed 3/28/07)

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Thailand: Experts see double threat from avian influenza strains
Experts voiced concern 23 Mar 2007 over the possibility that the 2 different genotypes, called "sub-clades", of the H5N1 bird-flu virus found in Thailand could merge into an unknown and "unpredictable" mutated form. Chulalongkorn University has found that a virus sample from Nakhon Phanom province in the Northeast was of a strain newly observed in Thailand and more closely related to H5N1 strains that have been circulating since 2005 in southeast China. In contrast, H5N1 samples from Phichit province in the lower North region were similar to the cluster of samples isolated during 2004 and 2005 outbreaks in Thailand and Viet Nam, said Professor Yong Poovorawan, author of the Chulalongkorn University study. The viruses isolated from Phichit belonged to genotype Z, whereas the virus isolated from Nakhon Phanom belonged to genotype V.

The latest bird-flu outbreak, in the Northeast province of Mukdahan, has raised concerns that the genotype V virus from the Northeast could spread to meet with the genotype Z virus endemic in the lower North and Central region, said Rakthai Ngampak, head of the Department of Livestock Development's Bird Flu Control Centre. Yong and Rakthai agreed that the consequences of a new strain of H5N1 emerging from the mixing of the 2 genotypes might or might not be serious. Rakthai said various measures were needed for blocking the spread of the Northeast strain to other regions. Bird-flu screening measures carried out during past outbreaks did manage to intercept certain infected poultry, he added. "Since we cannot control the migratory birds, what could be done is keep the poultry away [from them] in closed farms," he said. The problem is a lot of poultry is raised outdoors, Rakthai said. As a result active laboratory surveillance is very important to provide warning signs of the 2 genotypes getting mixed, said Yong.
(Promed 3/24/07)

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Australia (New South Wales, Tasmania): Salmonellosis outbreaks
Almost 100 people have now been affected by an outbreak of gastroenteritis linked to a bread shop in Sydney's west. Sydney South West Area Health Service (SSWAHS) is investigating the outbreak involving 98 people. Of the affected people, 18 have been hospitalized. All of the cases interviewed so far had eaten either pork rolls or chicken rolls from the French Golden hot bread shop in Homebush West. So far, 13 have been confirmed as having salmonellosis. The Public Health Unit is warning anyone who may have eaten these food products from the bread shop between 23 Mar and 27 Mar 2007 to watch out for the symptoms of salmonellosis. Common symptoms usually last 4 to 7 days, and include nausea, vomiting, diarrhea, fever, and abdominal pain. The bread shop has been prohibited from producing or selling the implicated foods.

Tasmania's Health Department is testing food samples to try to find the cause of a salmonella outbreak in the state's northwest. A Somerset bakery has been closed after it was linked to the outbreak. At least 14 people have been struck down with salmonella poisoning in 2 weeks; 2 of them went to hospital. The director of public health, Roscoe Taylor, says several of the patients had eaten food from VJ's Bakery. "The particular food business has voluntarily closed while we try and sort out what the underlying causes were within the premises there," he said. Dr Taylor says the bakery’s link to the outbreak has not been confirmed. Other shops and suppliers are also being investigated. All the victims of the outbreak are recovering well.
(Promed 3/28/07)

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Australia (South Australia): Surge in cases of cryptosporidiosis
A surge in cases of gastroenteritis in South Australia has prompted a warning from health authorities for people to take greater care with personal hygiene. The outbreak of cryptosporidium infections may also be linked to the drought, with concerns that more children are bathing together to save water and the water in wading pools is being changed less frequently. Health department spokeswoman Ann Koehler said there have been 228 cases of gastroenteritis so far in 2007, compared to 52 cases in the same period last year. Dr Koehler said cryptosporidiosis was being spread within families. "The most important way is through good personal hygiene, make sure anyone with diarrhoea does not prepare food for others, and ensure those who are infected stay out of shared baths and swimming pools," she said. The department's water quality adviser David Cunliffe said the organism was commonly spread by contact with people already infected or from contaminated water or livestock. "Swimming pools are a particular concern because they can be a source of outbreaks if used by people with cryptosporidiosis," Dr Cunliffe said. "The organism is shed for an extended time after symptoms have ceased and it is difficult to kill by chlorination."
(Promed 3/21/07)

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Australia (Northern Territory): Melioidosis attacks healthy man
A survivor of melioidosis who spent 10 days in an induced coma in Royal Darwin Hospital during his treatment, says he was not an obvious candidate for catching the disease. Melioidosis is caused by a bacterium in the soil, which can be exposed during heavy rain and has killed 2 people in the Northern Territory this wet season. The patient says he did not have any pre-existing illnesses and doctors suspect he contracted it while mowing his lawn in bare feet or by breathing it in during heavy rain. "Couldn't hardly walk and I just kept coughing and there was a point when I was coughing blood," he said. Infection due to Burkholderia pseudomallei (melioidosis) is endemic in focal areas of Southeast Asia and northern Australia. B. pseudomallei is primarily an infection of humans with underlying diseases such as diabetes mellitus, alcoholism, malnutrition, cirrhosis, and immunosuppresion, but can also affect healthy individuals, as in this report. Infection due to B. pseudomallei can be subclinical, but rapidly progressive disseminated disease involving the skin, liver, or spleen can occur. Pneumonia may be the presenting form.
(Promed 3/19/07, 3/20/07)

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North Korea: Measles outbreak sickens 3600 people
Since Nov 2006, 3597 people in 35 of the country's 205 counties (all 10 provinces of Democratic People's Republic of Korea [DPRK]) were diagnosed with measles, which led to the deaths of 2 children and 2 adults. A further 1482 people have been hospitalized as a result of the outbreak. Local health facilities provided treatment to patients with these symptoms. The DPRK Ministry of Public Health (MoPH) confirmed the measles outbreak 16 Feb 2007. A joint plan of action resulted in a 2-phased nationwide measles vaccination campaign for Mar to Apr 2007. The first phase took place 14-16 Mar and was carried out by the MoPH and UNICEF. 6 million children between 6 months - 15 years old were immunized. The second phase is scheduled for mid-Apr 2007, and the national society and the Federation is providing vitamin A and ampicillin injections.

The reemergence of measles in the country is linked to the high risk of disease outbreaks, especially among children and other vulnerable groups still recovering from prolonged malnutrition during the winter months. UNICEF is leading the immunization response in coordination with the MoPH. All people between 6 months to 45 years of age will be immunized and administered with vitamin A. The DPRK Red Cross and the Federation have in place a system for the supply of drugs and medical materials to 2000 health institutions in DPRK. This will complement the MoPH during this nationwide campaign. All primary- and secondary-level health facilities are being supplied with ampicillin injections to treat secondary bacterial infections and other complications as a result of measles. Measles is a highly contagious viral disease spread by airborne droplets circulated by coughing and sneezing. It is a leading cause of death among young children, despite the availability of a safe and effective vaccine.
(Promed 3/25/07)

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Russia: Rotavirus outbreak in Khabarovsk
More than 50 children with classical symptoms of gastrointestinal illness caused by rotavirus infection have sought medical attention in hospitals and out-patient departments in Khabarovsk during 11-17 Mar 2007. Reportedly, in recent years, rotavirus infection had replaced bacterial dysentery as the prime cause of gastroenteritis during the cold seasons in the Khabarovsk region. Infants up to the age of 3 are especially susceptible to rotavirus infection and may exhibit high temperature, vomiting and diarrhea. For prevention of rotavirus disease, physicians emphasize the need to observe basic rules of hygiene and in an affected household to allocate separate utensils and materials to a sick child. An increase in rotavirus morbidity is observed usually during winter and early spring. Rotavirus infection is transmitted by infected products and water. In the city of Khabarovsk and throughout the Khabarovsk and Nanaian Amur districts, an increase in morbidity has been observed from the end of Dec 2006, mainly in children under 3 years old.
(Promed 3/18/07)

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Americas
Canada (Ontario): Unpasteurized milk/cheese associated with yersiniosis and listeriosis
2 recent cases of infection in children in Grey Bruce have been linked to raw milk products, health officials said 18 Mar 2007. A 2-year-old was taken to hospital with yersiniosis, a gastrointestinal infection, after drinking raw milk on her family farm. Another infant was confirmed to have listeriosis, an infection that causes flu-like symptoms, which seems to have come from raw milk cheese consumed by the baby's mother; infant seems to be recovering. Women with newborns should not consume raw milk or non-pasteurized dairy products in order to avoid infecting their babies. The association of listeriosis with unpasteurized cheese is well known. The infection has also been reported to cause infection from pasteurized milk. It is important to note that pasteurized milk is not sterile and can possibly contain these and/or other pathogens, and that post-pasteurization contamination can occur. Consumers should follow the guidelines about storage at 4C or less and use prior to expiration date.
(Promed 3/19/07)

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USA: Update on salmonella outbreak associated with peanut butter
U.S. Food and Drug Administration (FDA) investigators finally have some details on the location of the Salmonella enterica serotype Tennessee outbreak that shut down the ConAgra Foods plant 5 weeks ago. On 22 Mar 2007, ConAgra Foods blamed a USD 48 million loss this quarter on its recall of Peter Pan and Great Value Peanut Butter and there still is no timetable of when production will start again. Investigators found 2 environmental positives; one of them was in relation to the roaster and the other was on some cleaning equipment. Because it was found twice in the environment, FDA investigators assume it is in other places and recommend a complete cleanup. ConAgra is working with microbiologists on a plan to resume operations, but doesn't have an exact date. The company says employees continue the clean up effort. FDA inspectors will return once the cleanup is complete to make sure there are no future problems. CDC has stopped updating the number of reported cases after reporting 425 people in 44 states were sickened by the peanut butter. 20 percent of those illnesses were serious enough to require hospitalization.
(Promed 3/26/07)

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USA (California): FDA releases final report on spinach E coli outbreak
The US Food and Drug Administration (FDA) and California officials released a final report on last fall's nationwide Escherichia coli O157:H7 outbreak linked to fresh spinach, tracing the pathogen to a specific farm. The outbreak sickened 205 people and caused 3 deaths. During the investigation, federal and California officials found the outbreak strain in 13 bags of Dole brand baby spinach and traced the contaminated products to an Aug 15 production run at a Natural Selection Foods facility in San Juan Bautista, Calif. Testing at the facility found no samples that matched the outbreak strain. Investigators traced the product code to 4 fields in Monterey and San Benito counties. Though E coli O157:H7 was found in environmental samples on all of the farms, samples that matched the outbreak strain were limited to 1 farm: the Paicines Ranch in San Benito County. There, officials found the outbreak strain in river water, cattle feces, and wild-pig feces. A grass-fed cattle operation was located on the ranch, less than a mile from the spinach field. Investigators found evidence of wild pigs in and around the cattle, growing, and irrigation well areas. Changes in groundwater levels during the 2006 growing season could have contributed to contamination problems on the field. Also, the spinach grower was marketing products for conventional sale, but the field was being changed into an organic growing area.

Kevin Reilly, deputy director for prevention services at the California Department of Health Services (CDHS), said the investigation was a success. "This is the first time we've found a clear link between an individual with a contaminated product and taken that link down to the farm level," he said. "In real time, we saw evidence of some of the risk factors coming to fruition." The multifaceted problems identified point to an urgent need for more research on the microbial ecology of E coli, said David Acheson, chief medical officer for the FDA's Center for Food Safety and Applied Nutrition. "We need to find out how the bugs get onto the produce in the first place and how we can prevent that from happening in the future," he said. http://www.cidrap.umn.edu/cidrap/content/fs/food-disease/news/mar2307ecoli.html

To read the full report, released Mar 21, 2007: http://www.dhs.ca.gov/ps/fdb/local/PDF/2006%20Spinach%20Report%20Final%20redacted.PDF
(CIDRAP 3/23/07 www.cidrap.umn.edu )

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USA (Illinois): Salmonella cases associated with Mexican-style cheese
Additional laboratory tests confirmed that the salmonella strain found in an unregulated Mexican-style cheese sold at a local Hispanic grocery store exhibits the same patterns as the bacteria found in a recent outbreak of the disease in Kane County. This would likely indicate the same source. 2 additional cases of the food-borne illness have been reported since 22 Mar 2007, when the health department warned people not to eat the cheese, usually labeled as "queso fresco" and "queso cotija". The new cases bring to 34 the number of people infected with the Newport serotype of salmonella in Kane County since Jan 2006. Most are Hispanic. Typically, there are only about 8 such cases reported here in a 14-month period, officials said. Officials believe the cheese is sold at stores across Kane county, and investigators are looking into about 40 grocery stores throughout the County. Officials still do not know where the cheese originated. Officials believe there may be more than 300 people affected who have yet to be confirmed as having salmonella.
(Promed 3/24/07, 3/29/07)

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USA (California): 3 cases of Meningococcal meningitis in school
Fresno County officials said 21 Mar 2007, that 3 El Capitan Middle School students have been hospitalized with meningococcal meningitis, a rare and contagious bacterial disease. Health officials said they will provide preventive antibiotics to students, teachers, and staff at the school 22 Mar 2007. Students also will be offered a meningococcal vaccine. Of the 3 students, 1 has developed meningococcemia, a potentially life-threatening infection of the bloodstream. Close contacts of the infected students received antibiotics to prevent them from becoming infected. Fresno County has an average of 8 cases of meningococcal meningitis in a year. Since the early 1990s, outbreaks of meningococcal disease have occurred with increasing frequency in the USA. Because the rate of secondary disease for close contacts is highest immediately after onset of disease in the index patient, antimicrobial chemoprophylaxis should be administered as soon as possible. Rifampin, ciprofloxacin, and ceftriaxone are 90-95 percent effective in reducing nasopharyngeal carriage of N. meningitidis and are all acceptable agents for chemoprophylaxis.
(Promed 3/22/07)

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USA (Utah): Campylobacteria outbreak associated with unpasteurized milk
Utah County officials issued a warning against raw milk consumption after 7 cases of a potentially severe foodborne illness were linked to products from the same dairy. Utah's Department of Agriculture and Food issued a notice of investigation 21 Mar 2007 to Woolsey's Dairy in Payson, where the sick consumers said they purchased raw milk. State investigators are collecting milk samples at the dairy. There have been 15 confirmed cases of the illness and 7 of the cases were traced back to raw milk from Woolsey's Dairy. All of the cases have tested positive for Campylobacter, a common bacterial infection that can cause diarrhea, cramping, abdominal pain, and fever. Severe cases can result in a life-threatening infection. Most people fall ill within 1 to 10 days after exposure. 1 person has been hospitalized and several of the sick are from the same family. Epidemiologists are conducting DNA tests to determine if all 15 cases are linked.

Raw milk is a well-documented cause of enteric infections. Pathogens that infect humans, including Campylobacter, are shed in the feces of cows and can contaminate milk during the milking process. Using standard hygiene practices during milking (such as, washing hands, keeping equipment clean, and keeping the milking area separated from other areas) can reduce but not eliminate the risk for milk contamination. Pasteurization decreases the number of pathogenic organisms, prevents transmission of pathogens, and has been determined to improve the safety of raw milk.
(Promed 3/22/07)

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USA: Son of vaccinated soldier has severe vaccinia infection
A 2-year-old Indiana boy is in critical condition in a hospital with eczema vaccinatum, a rare type of vaccinia virus skin infection that he contracted through his father, a soldier who recently had a smallpox shot. The boy, who has a history of eczema, has been ill since early Mar and is being treated at the University of Chicago's Comer Children's Hospital. The boy's father received smallpox vaccine, in which vaccinia virus is the active ingredient, late Jan. He was allowed to visit his family mid-Feb, and he had close contact with his son. The boy became ill with a rash early Mar and was hospitalized in Indiana. When the rash continued to spread, he was taken to University of Chicago Medical Center (UCMC) Mar 3. His mother also has a vaccinia infection, though mild, and is hospitalized with her son. Doctors believe she contracted the disease from the boy because of their close contact.

By Mar 10 and 11, the boy had a rash over 80% of his body and was close to death. Doctors treated him with vaccinia immune globulin (VIG). He has also been treated with the antiviral cidofovir and an experimental smallpox drug called ST-246. The boy has slowly improved since Mar 11, when treatment with ST-246 began. The boy is still in critical condition and on a ventilator, with the infection involving the full thickness of the epidermis over about 20% of his body. But he has not had any new lesions in about a week. He was first treated with VIG, followed a few days later by cidofovir and a few days after that by ST-246. It was difficult to tell which of the drugs is most responsible for the patient's improvement. He is also still on pain medication and receiving wound care.

The US military revived its long-discontinued smallpox vaccination program late 2002, and by Jun 2006 about 1.1 million service members had been vaccinated. Until now, no cases of eczema vaccinatum or progressive vaccinia had been reported. Eczema is a well-known contraindication for smallpox vaccination, and safety guidelines say that vaccinees should avoid contact with anyone with a history of eczema until the vaccine lesion has fully healed. Data mostly from the 1960s suggest that eczema vaccinatum occurred in between 10 and 39 cases out of every million first-time smallpox vaccinees. But widespread smallpox immunization today could result in a higher rate, because of the large numbers of people with immunity weakened by cancer treatment, other immune-suppressing drugs, and HIV. CDC has contacted people who might have been exposed to the boy before he was hospitalized, and no additional cases have been found.
(CIDRAP 3/19/07 www.cidrap.umn.edu ; Promed 3/18/07)

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Africa
Egypt: Additional new human cases of avian influenza H5N1 infections
The health ministry reported that the 46-year-old woman who tested positive for H5N1 is from the city of Damnhour, 80 miles north of Cairo. The woman reportedly contracted the virus from domestic birds. If WHO confirms the woman's case, she will be listed as Egypt's 30th case-patient. Her case is the country's 12th reported this year. Of the 29 cases confirmed to date by WHO in Egypt, 13 have been fatal. WHO confirmed 2 other Egyptian cases that were reported earlier, involving a 6-year-old girl and a 5-year-old boy. Both were hospitalized Mar 25, 2007, had contact with infected birds, and remain in stable condition. The 6-year-old girl is from the southern province of Qena, and the 5-year-old boy is from Menia province in central Egypt. These 2 cases come 2 days after the announcement of a case in a 3-year-old girl from Aswan in southern Egypt. WHO recognized her case, saying she remained in stable condition in a hospital after receiving oseltamivir. WHO said the 3-year-old had contact with poultry, and her case was not linked with 2 other recent cases in Aswan, announced Mar 19 and 20. Those cases involved a 2-year-old boy and a 10-year-old girl. Egypt has the largest number of confirmed human bird flu cases outside Asia.
(CIDRAP 3/27/07, 3/28/07 www.cidrap.umn.edu ; Promed 3/28/07 )

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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. Read summary from the vaccination conference.
- 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)

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Seasonal Influenza
Seasonal influenza activity in APEC economies
Overall influenza activity in the northern hemisphere remained moderate in weeks 8–11. In north America, influenza activity declined in general, while in some Asian countries and areas, widespread activity continued, with influenza A(H3N2) viruses predominating. Influenza A(H1N1) viruses circulated in the US. Influenza B viruses circulated at low levels.

Canada. A decline in influenza activity was observed in weeks 10–11, with the overall influenza-like illness (ILI) consultation rate remaining within the expected range for this time of year. Widespread influenza A activity continued to be reported in some parts of the country.
Hong Kong. High level influenza A(H3N2) activity continued in weeks 8–11.
Japan. Widespread influenza activity was reported in weeks 8–11, with A(H3N2) viruses predominating.
Russia. Regional influenza activity continued in weeks 8–11. Influenza A(H1N1), A(H3N2) and B viruses co-circulated.
USA. The number of states reporting widespread influenza activity started to decline in week 9; activity was reported as regional for America as a whole in week 11. The overall ILI consultation rate was still above the national baseline, but the percentage of deaths due to pneumonia and influenza remained below baseline level. During week 11, 69% of the influenza viruses detected were influenza A and 31% influenza B. Of the A viruses subtyped, 61% were influenza A(H1) and 39% A(H3) viruses.
Others. During weeks 8–11 of 2007, low influenza activity was detected in Chile (A), Mexico (A and B), and Thailand (H3 and B).
(WHO http://www.who.int/csr/disease/influenza/update/en/ 3/29/07)

Chinese Taipei
Based on the sentinel surveillance system in Taiwan, during the 11th epidemiological week (Mar 11 to 17, 2007), the percentage of outpatient visits to sentinel physicians for influenza-like illness (ILI) has decreased by 7.8% compared with last week and is 22.2% lower than the same period in 2006. During week 8 to 11, 2007, the respective ILI consultation rates (per 100 outpatient visits) were 4.05, 3.62, 3.35 and 3.09. Comparing to last week, the consultation rate increased in South region while the remaining 5 regions reported a decreased trend. The dominant respiratory virus identified by National Influenza Center and CDC Collaborating Labs since Feb 2007 has been influenza A (H3), followed by B type. The other main respiratory viruses were Adenovirus and HSV (Herpes simplex virus). Based on reporting dates, 1 severe influenza case was reported in week 11. Based on onset dates, 132 severe cases have been reported cumulatively in the 2006-2007 epidemic season. Among these, 29 were confirmed, 98 were excluded, and 5 are still pending. So far this season (weeks 26, 2006 to week 11, 2007), 5 deaths have been reported.
(Taiwan IHR Focal Point 3/26/07)

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Dengue
Viet Nam
So far, there have been approximately 5000 cases of dengue fever in Viet Nam, mainly in southern provinces. There have been few cases found in 2007 in the north (the disease there often occurs between Jun and Nov). The Dengue Fever Control Project has actively trained health care workers and coordinators to keep close watch over the development of the disease and has called on people to take preventive measures.
(Promed 3/26/07)

Malaysia
Subang Jaya recorded the highest number of dengue cases in the first 11 weeks of 2007. As of 17 Mar 2007, the municipality recorded 1023 suspected dengue cases with 5 deaths, outstripping Shah Alam, which recorded 711 cases. Parliamentary secretary to the Health Ministry Datuk Lee Kah Choon said that for 2007, the number of suspected dengue infections stood at 12 086 cases. "This number is still high, particularly for areas in Selangor and Federal Territory, which continue to be the hotspots for dengue infections," he said 20 Mar 2007. Lee said the government remained concerned over the lack of effort shown by some residents in the Klang Valley in controlling the spread of the disease and the breeding of Aedes mosquitoes.
(Promed 3/26/07)

Philippines
Dengue cases in Bukidnon province have now reached a 5-year record high, pushing the region-wide figure despite a declining trend in other provinces in the past 3 months of 2007. As of 20 Mar 2007, 47 dengue cases have been recorded in Bukidnon, compared to only 12 in the same period in 2006. The mosquito disease has already killed 3 persons. Although the Bukidnon figure was only a fraction of the 168 dengue incidents recorded in Misamis Oriental as of Mar 2007, it marks a steady growth above the average number posted in the past 5 years, said Dr. David Mendoza, head of the Regional Epidemic Surveillance Unit (Resu). Meanwhile, dengue cases in 2007 have already reached 256 as of Mar 2007, slightly higher than the 234 cases recorded in 2006. However, cases in all other provinces except Bukidnon have gone down in the past 3 months. Mendoza reiterated the DOH's 4S strategy to prevent a dengue outbreak: "Search and destroy mosquito breeding sites, seek treatment in case of high fever, self-protection through the use of mosquito repellent and other contraptions, and say no to indiscriminate fogging."
(Promed 3/26/07)

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2. Articles
Recent expansion of highly pathogenic avian influenza H5N1: a critical review
M. GAUTHIER-CLERC, C. LEBARBENCHON, F. THOMAS. Ibis (OnlineEarly Articles). doi:10.1111/j.1474-919X.2007.00699.x
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1474-919X.2007.00699.x
Abstract: “Wild birds, particularly waterfowl, are a key element of the viral ecology of avian influenza. Highly pathogenic avian influenza (HPAI) virus, subtype H5N1, was first detected in poultry in November 1996 in southeast China, where it originated. The virus subsequently dispersed throughout most of Asia, and also to Africa and Europe. Despite compelling evidence that the virus has been dispersed widely via human activities that include farming, and marketing of poultry, migratory birds have been widely considered to be the primary source of its global dispersal. Here we present a critical examination of the arguments both for and against the role of migratory birds in the global dispersal of HPAI H5N1. We conclude that, whilst wild birds undoubtedly contribute to the local spread of the virus in the wild, human commercial activities, particularly those associated with poultry, are the major factors that have determined its global dispersal.”

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Vibrio parahaemolyticus O3:K6 Epidemic Diarrhea, Chile, 2005
Felipe C. Cabello et al. EID. http://www.cdc.gov/EID/content/13/4/655.htm (references removed)
To the Editor: “Outbreaks of diarrhea and gastroenteritis caused by Vibrio parahaemolyticus have been recently reported in many countries and regions where this pathogen was previously unknown. In mid-January 2005, the number of cases of acute diarrhea produced by V. parahaemolyticus dramatically increased in Puerto Montt. . .a major city in Region X of Chile. . .A total of 3,725 cases of acute diarrhea were detected during the summer months of January–April, 2005 throughout Region X. . .This epidemic rapidly spread to other urban areas in Region X and to the rest of Chile because Region X is the source of ≈75% of the seafood consumed in Chile. By the end of March 2005, the total number of cases in Chile was 10,783, making this the largest documented occurrence of V. parahaemolyticus diarrhea in the world. . . Spread of V. parahaemolyticus toward the boreal and austral latitudes. . .might be the result of climatic changes; a warming trend in seawater was noted in both events. Expansion of the V. parahaemolyticus O3:K6 pandemic clone may have also been facilitated by expansion of international trade because bacteria could have been transported to Chile by ballast water. . .The appearance of V. parahaemolyticus O3:K6 in Chile has thus converted the expansion of this strain into a real pandemic because this vibrio is now present in 5 continents. The persistence of V. parahaemolyticus in Region X might also have been encouraged by an expansion of finfish and shellfish aquaculture in that area. . .Emergence of V. parahaemolyticus in Region X has also coincided with expansion of harmful algal blooms in the same area. . .”

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Trends in Tuberculosis Incidence--United States, 2006
(references removed)
“In 2006, a total of 13,767 tuberculosis (TB) cases (4.6 per 100,000 population) were reported in the United States, representing a 3.2% decline from the 2005 rate. This report summarizes provisional 2006 TB incidence data from the National TB Surveillance System and describes trends since 1993. The TB rate in 2006 was the lowest recorded since national reporting began in 1953, but the rate of decline has slowed since 2000. The average annual percentage decline in the TB incidence rate decreased from 7.3% per year during 1993--2000 (95% confidence interval [CI] = 6.9%--7.8%) to 3.8% during 2000--2006 (CI = 3.1%--4.5%). Foreign-born persons and racial/ethnic minority populations continue to be affected disproportionately by TB in the United States. In 2006, the TB rate among foreign-born persons in the United States was 9.5 times that of U.S.-born persons. The TB rates among blacks, Asians, and Hispanics were 8.4, 21.2, and 7.6 times higher than rates among whites, respectively. The slowing of the decline in the overall national TB rate and the inability to effectively address persistent disparities in TB rates between U.S.-born and foreign-born persons and between whites and racial/ethnic minority populations threaten progress toward the goal of eliminating TB in the United States. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5611a2.htm
(MMWR March 23, 2007 / 56(11);245-250)

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Extensively Drug-Resistant Tuberculosis--United States, 1993—2006
(references removed)
“The worldwide emergence of extensively drug-resistant tuberculosis (XDR TB) and a provisional definition for this form of TB were first reported in November 2005. A more detailed description of these findings and preliminary data from the U.S. National TB Surveillance System (NTSS) were published in 2006. The U.S. data indicated that 74 TB cases reported during 1993--2004 met the case definition for XDR TB. Subsequent reports suggested different definitions for XDR TB. In October 2006, the World Health Organization convened an Emergency Global Task Force on XDR TB, which revised the case definition to specify resistance to at least isoniazid and rifampin among first-line anti-TB drugs, resistance to any fluoroquinolone, and resistance to at least one second-line injectable drug (amikacin, capreomycin, or kanamycin). This report updates the 2006 report on XDR TB in the United States, using the revised case definition and provisional data for 2006. NTSS data were analyzed for reported XDR-TB cases during 1993--2006; a total of 49 cases (3% of evaluable multidrug-resistant [MDR] TB cases) met the revised case definition for XDR TB. Of these, 17 (35%) were reported during 2000--2006. . .XDR TB presents a global threat and a challenge to TB-control activities in the United States. To prevent the spread of XDR TB, renewed vigilance is needed through drug-susceptibility testing, case reporting, specialized care, infection control, and expanded capacity for outbreak detection and response. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5611a3.htm
(MMWR March 23, 2007 / 56(11);250-253)

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Three Outbreaks of Salmonellosis Associated with Baby Poultry from Three Hatcheries--United States, 2006
(references removed)
“During 2006, state health departments notified CDC of three outbreaks of Salmonella species infections in persons who had been in contact with chicks and other baby poultry. . .purchased at agricultural feed stores. The feed stores received the poultry from hatcheries, and each of the three outbreaks was traced to a single hatchery. For decades, baby poultry, particularly chicks and ducklings, have been known to be a source of salmonellosis. More recently, the source of birds associated with salmonellosis outbreaks has been traced back to individual hatcheries. Many persons who purchase baby poultry remain unaware that contact with these birds puts them and others who are exposed to the birds, especially children and immunocompromised persons, at risk for salmonellosis. This report describes the three outbreaks and provides recommendations for preventing transmission of Salmonella infection from birds to humans. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5612a1.htm
(MMWR March 30, 2007 / 56(12);273-276)

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Update: Chikungunya Fever Diagnosed Among International Travelers--United States, 2006
(references removed)
“Chikungunya virus (CHIKV) is a mosquitoborne alphavirus indigenous to tropical Africa and Asia, where it causes endemic and epidemic chikungunya (CHIK) fever, an acute illness characterized by fever, arthralgias, and sometimes arthritis, commonly accompanied by conjunctivitis and rash. Although symptoms of CHIKV infection usually last days to weeks, joint symptoms and signs usually last for months and occasionally for 1 year or longer; deaths from CHIKV infection are rare. No specific antiviral treatment exists for CHIKV infection; treatment consists of supportive care. . .During 2005--2006, an epidemic of CHIK fever occurred on islands in the Indian Ocean and in India, resulting in millions of clinically suspected cases, mainly in southern India. In the United States, CHIK fever has been diagnosed in travelers from abroad. CDC previously reported 12 imported cases of CHIK fever diagnosed in the United States from 2005 through late September 2006, including 11 with illness onset in 2006. This report of 26 additional imported cases with onset in 2006 underscores the importance of recognizing such cases among travelers. Health-care providers are encouraged to suspect CHIKV infection in travelers with fever and arthralgias who have recently returned from areas with CHIKV transmission. Acute- and convalescent-phase serum specimens can be submitted to CDC for testing through state health departments. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5612a2.htm
(MMWR March 30, 2007 / 56(12);276-277)

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3. Notifications
Avian influenza prediction market
ProMED-mail and the University of Iowa Health Prediction Market Project invite you to join in an experiment to help predict H5N1 influenza related events. Many experts consider a global influenza pandemic inevitable and recent cases of avian influenza (H5N1) in birds and humans have led some to fear that H5N1's pandemic potential is increasing. However, the likelihood that an H5N1 strain of influenza will cause the next pandemic is still unknown, and some believe that another strain altogether may cause the next pandemic. The goal of our project is to predict the likelihood of H5N1 related events. These events, if they occur, may suggest that H5N1's pandemic potential is increasing. Our predictions will be based on information collected from health care experts through the use of a prediction market. The project, a collaboration between The University of Iowa (UI) and ProMED-mail, is funded by a grant from the Robert Wood Johnson Foundation. To find out how you can participate, and for additional information and the online application form, go to: http://fluprediction.uiowa.edu/.
(Promed 3/28/07)

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Introduction to Public Health Surveillance Course
CDC and Rollins School of Public Health at Emory University will cosponsor a course, Introduction to Public Health Surveillance, May 7--11, 2007, at Emory University. The course is designed for state and local public health professionals. The course will provide practicing public health professionals with the theoretical and practical tools necessary to design, implement, and evaluate an effective surveillance program. Topics include overview and history of surveillance systems; planning considerations; sources and collection of data; analysis, interpretation, and communication of data; surveillance systems technology; ethics and legalities; state and local concerns; and future considerations. For more information, by mail (Hubert Global Health Dept., 1518 Clifton Rd. NE, Rm. 746, Atlanta, GA 30322), tel (404-727-3485), fax (404-727-4590), online (http://www.sph.emory.edu/epicourses), or e-mail (pvaleri@sph.emory.edu).
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5612a5.htm
(MMWR March 30, 2007 / 56(12);282)

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National Public Health Week--April 2--8, 2007
During this year's observance, April 2--8, 2007, American Public Health Association members and partners will host events throughout the US, encouraging all persons to "Take the First Step!" toward creating preparedness plans for public health threats. In conjunction with the observance, CDC's Coordinating Office for Terrorism Preparedness and Emergency Response and Public Health Training Network will host a live satellite broadcast, "Pandemic Influenza: Progress in Planning and Exercising: Federal, State, and Local Perspectives," Apr 5, from 1 p.m. to 2:30 p.m. EST. A panel will discuss progress in pandemic influenza planning and exercising and answer viewers' questions. The broadcast also will be available as a live webcast. Additional information regarding the satellite broadcast is available at http://www2a.cdc.gov/phtn.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5612a4.htm
(MMWR March 30, 2007 / 56(12);281-282)

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World TB Day--March 24, 2007
World TB Day is observed Mar 24 each year and commemorates the date in 1882 when Dr. Robert Koch announced the discovery of Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB). Worldwide, TB remains one of the leading causes of death from infectious disease. Each year, approximately 9 million persons become ill from TB; of these, nearly 2 million die from the disease. World TB Day provides an opportunity for TB programs, nongovernmental organizations, and other partners to describe problems and solutions related to the TB pandemic and to support worldwide TB-control activities. Although the 2006 TB rate is the lowest recorded in the US since national reporting began in 1953, the average annual decline has slowed since 2000. In addition, multidrug-resistant TB remains a threat, extensively drug-resistant TB has become an emerging threat, and persons of racial/ethnic minority populations and foreign-born persons continue to account for a disproportionate number of TB cases. In many states, education and awareness programs convened by local TB coalitions will take place in commemoration of World TB Day. For more information: http://www.cdc.gov/nchstp/tb/worldtbday.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5611a1.htm
(MMWR March 23, 2007 / 56(11);245)

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FDA Clears Rapid Test for Meningitis
The U.S. Food and Drug Administration (FDA) cleared for marketing a test that uses molecular biology to quickly detect the presence of viral meningitis. The Xpert EV test, when used in combination with other tests, will help physicians distinguish between viral meningitis and the less-common, but more severe, bacterial meningitis. Meningitis is an infection of the cerebrospinal fluid surrounding a person's spinal cord and brain, causing inflammation of the tissues in these areas. Typically, diagnostic tests for meningitis can take up to a week to get results. But results from the Xpert EV test are available in 2.5 hours. Knowing whether the meningitis is viral or bacterial is imperative to early effective treatment. Patients with viral meningitis usually recover within 2 weeks without any medical intervention. Bacterial meningitis, however, can lead to brain damage, hearing loss and even death if not treated properly. For patients over 2 years of age, symptoms of meningitis include fever, severe headache, stiff neck, nausea, sleepiness, confusion, and sensitivity to bright lights or seizures. These symptoms may be absent or difficult to detect in newborns and small infants. The Xpert EV test is the first fully-automated medical diagnostic test that isolates and amplifies viral genetic material present in a patient's cerebrospinal fluid by a process called reverse transcription-polymerase chain reaction. The test identifies infection resulting from a class of viruses known as Enterovirus, which are responsible for approximately 90 percent of all viral meningitis cases.
(FDA 3/16/07 http://www.fda.gov/bbs/topics/NEWS/2007/NEW01588.html )

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Obituary: Professor Aileen Plant
Dr. Aileen Plant was a major contributor to the public health the Asia Pacific and we at EINet join in mourning her passing. A world leading authority on deadly infectious diseases, she died suddenly at the age of 52 in Indonesia, 27 Mar 2007. Below is one of the many obituaries that have been written about her:

“Today, I would like to express my most sincere condolences to the family, friends, and colleagues of Dr Aileen Plant. Dr Plant, of Australia, was a renowned medical epidemiologist, an outstanding global public health leader, and longtime friend to the public health community. She was a path-blazing, respected lecturer, teacher and writer. Many at WHO considered her a mentor. She died suddenly yesterday at the Jakarta airport, traveling home from a WHO meeting. Dr Plant made enormous contributions to the health and welfare of people in her country, and to the world. In the very early weeks of the SARS outbreaks in Viet Nam, she was instrumental in analysing the threat. She was a core part of the team which designed the influenza pandemic containment plan. Just this week in Indonesia, she helped to bring consensus on the challenging issues surrounding avian influenza virus sharing and ensuring access to influenza vaccine for developing countries. . .She brought a deep sense of duty, commitment, vast experience, ethics, courage, and professionalism to her work. Those who knew her described her as "the best," "the beating heart" and a "true servant" of public health. We and many others will miss her personally and professionally very much.”
Margaret Chan, WHO Director-General
(Promed 3/30/07)

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 apecein@u.washington.edu