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Vol. X. NO. 8 ~ EINet News Briefs ~ Apr 13, 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)
- Bangladesh: Avian influenza detected in another Savar farm
- Cambodia: Seventh fatal human case of avian influenza H5N1 infection
- Indonesia: Confirms 74th fatal human case of avian influenza H5N1 infection
- Pakistan (Sindh, North West Frontier): New avian influenza infections in poultry
- Australia (New South Wales): Large salmonella outbreak linked to meat rolls
- Australia (Tasmania): Salmonella outbreak linked to eggs
- China: Chinese CDC to Launch Program to prevent HIV/AIDS among MSM
- New Zealand (South Island): Norovirus outbreak hits badminton tournament
- Philippines (Mindanao): Typhoid outbreak infects 47, kills 1
- Canada: Completion of probe of ninth BSE case
- Canada: Mumps Update from Capital District Health Authority, Halifax, Nova Scotia
- USA: Peanut butter maker says moisture triggered Salmonella contamination
- USA (California): 14 E. coli infections linked to restaurant
- USA (Florida): Fatal case of Salmonella associated with pet turtle
- Egypt: 14th fatal human case of avian influenza H5N1 infection

1. Updates
- Avian/Pandemic influenza updates
- Dengue

2. Articles
- Apoptosis and Pathogenesis of Avian Influenza A (H5N1) Virus in Humans
- Trends for Influenza-related Deaths during Pandemic and Epidemic Seasons, Italy, 1969–2001
- Avian Influenza (H5N1) Virus in Waterfowl and Chickens, Central China
- Safety and Immunogenicity of a Baculovirus-Expressed Hemagglutinin Influenza Vaccine: A Randomized Controlled Trial
- Avian Influenza Virus (H5N1): a Threat to Human Health
- The Courts, Public Health, and Legal Preparedness
- Preclinical Evaluation of Microneedle Technology for Intradermal Delivery of Influenza Vaccines
- Contribution of H7 haemagglutinin to amantadine resistance and infectivity of influenza virus
- Multiple antimicrobial resistance in plague: an emerging public health threat.
- Elimination of Measles --- South Korea, 2001—2006
- Severe Methicillin-Resistant Staphylococcus aureus Community-Acquired Pneumonia Associated with Influenza--Louisiana and Georgia, December 2006--January 2007
- Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food--10 States, 2006
- Respirator donning in post-hurricane New Orleans.
- Optimizing Severe Acute Respiratory Syndrome Response Strategies: Lessons Learned From Quarantine
- Responding to a Small-scale Bioterrorist Anthrax Attack

3. Notifications
- Attendees of School Planning Summit for Bird Flu Preparedness Announced
- Webcast: Is the Bird Flu Threat Still Real and Are We Prepared?
- CCOHS: Pandemic Planning
- OIE Avian influenza Web Portal
- New Promed RSS Reader
- Preventing HIV/AIDS Among Men Who Have Sex with Men: Challenges and Innovations
- Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections


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
Cambodia / 1 (1)
China / 2 (1)
Egypt / 16 (4)
Indonesia / 6 (5)
Laos / 2 (2)
Nigeria / 1 (1)
Total / 28 (14)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 291 (172).
(WHO 4/11/07 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 3/20/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 4/12/07):
http://gamapserver.who.int/mapLibrary/

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Asia
Bangladesh: Avian influenza detected in another Savar farm
The avian influenza virus was detected 7 Apr 2007 at another poultry farm in Savar. Laboratory tests confirmed infection of the virus at Laura Poultry Farm at Aukpara in Savar. A total of 2000 chickens were culled. All the chickens at the infected farm will be culled, Livestock Department Director Abdul Motaleb said 7 Apr 2007. The army and police cordoned off the infected farm. Suspicion arose that the farm was infected with avian influenza after a considerable number of chickens died there 6 Apr 2007. The Savar Livestock Office has been conducting drives in the area to investigate whether there is any fresh infection of the avian flu virus at any farm or place in the upazila. Fisheries and Livestock Adviser Dr Chowdhury Sajedul Karim said, "The [fisheries and livestock] ministry will sort out a working plan by next week to determine how to help or compensate the affected poultry farm owners”. Earlier, Sajedul visited Mukta Poultry Farm in Narayanganj sadar upazila and Chistia Poultry Farm at Shiarchar in Fatulla. The adviser gave assurances to provide modernized instrument, increase trained manpower and other laboratory facilities for testing bird flu infection. He also directed the deputy commissioner (DC) to take necessary measures to provide the tuition fees for the children of the affected poultry farm owners.Bangladesh reported 3 outbreaks of H5N1 30 Mar 2007. About 75,000 chickens on 27 farms have been destroyed since the outbreaks began.
(Promed 4/9/07; CIDRAP 4/9/07)

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Cambodia: Seventh fatal human case of avian influenza H5N1 infection
WHO confirmed that the death of a 13-year-old Cambodian girl 6 days ago was due to H5N1 infection. The girl, from Ponhea Kreak district in Kampong Chang province, experienced symptoms Apr 2, was hospitalized the next day, and died Apr 5. Samples taken from the girl have tested positive for H5N1 at the Pasteur Institute in Phnom Penh. She is Cambodia's first human case of 2007 and the country's 7th case overall. All 7 cases have been fatal. An initial investigation found that there had been sick and dead poultry in the girl's village in recent weeks and that she had consumed a sick chicken right before she developed symptoms. Reportedly, 68 ducks and nearly 300 chickens had died in the vicinity before and after the girl fell ill. Although 2 siblings of this seventh case have been under surveillance, they are recovering, and there is no evidence favoring the occurrence of a cluster of human cases that might be indicative of person-to-person transmission. A team from Cambodia's health ministry, the WHO, and the Pasteur Institute is following up with the girl's close contacts and is conducting avian flu awareness activities in the area. 18 outbreaks of Avian influenza in domestic poultry have been reported in Cambodia between its 1st outbreak of Jan 2004 in layer hens, and the most recent reported outbreak of Aug 2006 (OIE follow-up report at <http://www.oie.int/eng/info/hebdo/AIS_02.HTM#Sec5>) in free-ranging ducks in the village Balaing, province Kompong Cham, the same province where the current human case has been identified.
(Promed 4/9/07, 4/12/07; CIDRAP 4/11/07)

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Indonesia: Confirms 74th fatal human case of avian influenza H5N1 infection
The second laboratory blood test confirmed 7 Apr 2007 that a 29-year-old man, who died 5 Apr 2007, had the H5N1 bird flu virus, bringing the death toll in Indonesia to 74, an official said 7 Apr 2004. Indonesian officials reported the 29-year-old's fatal case Apr 7, saying he came from the town of Sukoharjo and died at a hospital in the Central Java city of Solo. Reportedly the man had had contact with a large number of dead chickens. The man's case raised Indonesia's total case count to 94, 1 more than Vietnam, which has long been first on the list with 93 cases. According to Indonesia, the number of Indonesian deaths are at 74, far more than Vietnam's 42. However, WHO has not recognized any cases in Indonesia since late Jan and still lists the country as having 81 cases with 63 deaths.

Also, more than 1000 ducks have been culled in Jembrana, Bali after some of the birds tested positive for the H5N1 strain of the bird flu virus. The Indonesian health authorities have imposed a firm policy separating poultry from humans and intensifying surveillance of the virus. In addition, the authorities have forbidden the raising of poultry in residential areas. Over 32 million families in Indonesia's vast archipelago have been raising chickens in backyards, according to the Indonesian Agriculture Minister, Anton Apriantono.
(CIDRAP 4/7/07, 4/9/07; Promed 4/11/07)

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Pakistan (Sindh, North West Frontier): New avian influenza infections in poultry
Pakistan reported new bird flu cases 9 Apr 2007 in commercial poultry farms in the southern province of Sindh and in North West Frontier Province. "2 to 3 days back, we found traces of H5N1 virus in small poultry farms in Sindh and NWFP," Mohammad Afzal, Commissioner for Livestock at the Ministry of Food and Agriculture, said. A total of 600 chickens were destroyed on the two farms, which are small and isolated, Afzal said. Several outbreaks have been detected in chickens in small poultry farms this year in Pakistan, and birds have been culled. Authorities temporarily shut Islamabad Zoo Feb 2007 after 4 peacocks and a goose died of the H5N1 strain. Pakistan has had no human cases of the virus. Afzal said quarantine and vaccination measures were also being used in and around the affected farms. Pakistan first detected the H5N1 strain of the virus Feb 2006 in North West Frontier Province and ordered about 40 000 birds culled.
(Promed 4/11/07; CIDRAP 4/9/07)

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Australia (New South Wales): Large salmonella outbreak linked to meat rolls
An outbreak of food poisoning linked to a bread shop in Sydney's west has now affected 247 people, health authorities say. Sydney South West Area Health Service (SSWAHS) says 60 people have been hospitalized so far and 26 of them have gastroenteritis caused by salmonellosis (serotype Typhimurium). The SSWAHS is investigating the French Golden hot bread shop at Homebush West, where all of the affected people ate either Vietnamese style pork or chicken rolls last weekend. The New South Wales Food Authority has sent inspectors to the bread shop to examine food safety practices and to sample foods for laboratory tests. The shop stopped selling the rolls 27 Mar 2007, and is prohibited from producing or selling the implicated foods. Authorities warn anyone who may have eaten the rolls from the bread shop between 23 Mar and 27 Mar 2007, to be vigilant for the symptoms of salmonella infection and seek medical care. This current outbreak in New South Wales is the largest point source outbreak of foodborne salmonellosis in this State for at least 5 years. Food safety regulators in Australia have worked with the Vietnamese community to improve the safety of these products.
(Promed 3/30/07)

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Australia (Tasmania): Salmonella outbreak linked to eggs
A growing salmonella outbreak (serotype Typhimurium phage type 135) in northwest Tasmania is likely to have been caused by eggs, health officials say. Tasmania's Director of Public Health, Dr Roscoe Taylor, said at least 16 people have reported food poisoning in the past 2 weeks. Somerset bakery VJ's closed 26 Mar 2007 after being linked to 11 of the cases. But Dr Taylor said a very limited number of small egg producers have introduced cracked and dirty eggs into the market, which have a higher risk of carrying salmonellosis. He said the eggs were mixed and sold under a variety of different brand names at retail outlets throughout the northwest. Dr Taylor said the egg producers implicated have withdrawn the eggs from sale. "Consumers across Tasmania who have purchased eggs are urged to check their quality and where there is any evidence that they are cracked, dirty, bloody, or come in re-used cartons, to either dispose of or return the eggs immediately to the point of sale," he said. He said it was impossible to identify the source and link the supplier because several small producers combined eggs from different farms. Health [authorities] are working with the Department of Primary Industry and Water to see what longer-term measures can be put in place to help consumers steer clear of eggs that are cracked or dirty.
(Promed 3/30/07)

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China: Chinese CDC to Launch Program to prevent HIV/AIDS among MSM
The Chinese Center for Disease Control and Prevention this week plans to begin soliciting opinions from men who have sex with men on a program to prevent the spread of HIV/AIDS among MSM, scheduled to be implemented May 2007. About 10% to 20% of MSM in the country currently use condoms, according to China's CDC. The program plans to use special funding, technical support and information sharing to spread awareness about HIV among the estimated 20 million MSM in China. The program aims to increase availability of condoms and lubricants to 70% of MSM and to build a national network for the sale and distribution of condoms and lubricants. In addition, the program will relax registration rules for gay advocacy groups. HIV/AIDS advocacy organizations that target MSM are encouraged to develop peer-education campaigns, information hotlines and community activities to increase awareness about HIV.

Also, Shanghai, China, recently reported a record 718 new HIV cases and for 2006, a 54% increase from 2005. The city, which recently launched a five-year plan to curb HIV/AIDS, also reported 53 new AIDS cases during 2006. The city's plan emphasizes government intervention and HIV education. In addition, the plan requires that 90% of government workers be trained on how to deal with HIV/AIDS and calls for citizens and migrants to receive information about HIV prevention and blood safety.
(Kaisernetwork.org 4/17/07)

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New Zealand (South Island): Norovirus outbreak hits badminton tournament
Badminton officials have suspended play for 24 hours at an international tournament in Christchurch (New Zealand) after a stomach bug cut a swathe through a large number of competitors. Since 7 Apr 2007, more than 80 people at the trans-Tasman under-17 tournament, players, coaches, and tournament officials, have succumbed to vomiting and diarrhea. Public health officials believe it is caused by norovirus as the most likely cause. Highly infectious norovirus causes vomiting and diarrhea. It is spread through contact with infected people, and contaminated food and eating surfaces. Generally it is present in the community in various strains and outbreaks are periodically linked to institutions where people are confined in close contact with each other. A shared dinner during the June Bevan Badminton Trophy tournament opening ceremonies 6 Apr 2007 was the "prime suspect" as the infection's source. It was likely something happened at that event where an infected person passed on the infection to many others. About 74 people had been affected in the first wave of norovirus 7-8 Apr 2007. A further 12 had become ill 9 Apr 2007. Tournament organisers had decided to halt the competition for 24 hours to allow those affected to fully recover. Public health officials had contacted counterparts in Australia where several norovirus outbreaks had been reported at sporting events, and would continue to monitor the current situation here.
(Promed 4/10/07)

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Philippines (Mindanao): Typhoid outbreak infects 47, kills 1
The typhoid fever outbreak that hit Zamboanga City has claimed the life of at least 1 victim and infected over 47 residents, city health authorities said 12 Apr 2007. Most of the patients included women and children from ages 1 to 30. Blood, stool, and water samples taken from the patients and the Zamboanga City Water District water pipes in the affected villages have already been sent for bacteriology examination. As of 12 Apr 2007, at least 4 patients admitted in the hospital tested positive for the salmonella bacterium that causes typhoid fever. The investigating team is looking into whether bacteria could have seeped into leaking water pipes or contaminated food. Residents were advised to boil water before drinking and wash their hands prior to eating.
(Promed 4/12/07)

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Americas
Canada: Completion of probe of ninth BSE case
Canada recently released a report on the investigation of its ninth case of bovine spongiform encephalopathy (BSE), or mad cow disease, the first case of 2007. The case was in a 79-month-old bull from an Alberta beef farm, according to an investigation report released Mar 26 by the Canadian Food Inspection Agency (CFIA). The bull was born in 2000, about 3 years after Canada banned the use of cattle protein in feed for cattle and other ruminants in 1997. The agency said the bull died sometime between Jan 20 and 22. A private veterinarian determined the bull met the inclusion criteria for Canada's National BSE Surveillance Program, and forwarded brain samples for testing. BSE was confirmed Feb 7. The animal's carcass was transferred to the Alberta Agriculture and Food laboratory, where it was burned. The report said none of it entered the human food supply or animal feed chain.

The bull was born on the farm, and its birth and feed cohort consisted of 593 animals. Investigators had traced 518 of the cohort so far and hoped to finish tracing the remaining 75 animals by the end of March. 57 of the animals remaining on the farm were under quarantine until officials decide when to destroy them, the report said. Their carcasses will be excluded from the food and feed chains. In a study of the feed the animal was exposed to on the farm, officials found no direct link between specific products or production practices that carried a risk of cross-contamination. However, they found that the bull was exposed to feed from facilities that have handled material banned from cattle feed. These facilities were supplied by the same rendering plant that has been identified in previous BSE probes, the report said. It also said investigators could not rule out the possibility of cross-contamination when the feed was transported.

Canadian officials said the latest BSE case is not unexpected and still reflects an extremely low level of BSE in the country. Of 150,000 cattle tested since 2003, only 9 have tested positive for BSE, the report noted. The US banned imports of Canadian cattle and beef after Canada's first BSE case in May 2003. The border was reopened to boneless beef from young cattle a few months later, but live cattle were banned until July 2005, when officials reopened the border to cattle intended for slaughter before reaching 30 months of age.
(CIDRAP 4/4/07)

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Canada: Mumps Update from Capital District Health Authority, Halifax, Nova Scotia
Overview: A total of 32 laboratory confirmed cases of mumps have been reported to Public Health Services (PHS) as of 5 Apr 2007]. Cases have been confirmed from throat swabs and urine specimens of persons meeting the clinical case definition using RT-PCR.

The first case was reported to PHS on [25 Feb 2007]. By [28 Feb 2007], 5 additional cases had been identified. Epidemiologic investigation of that initial cluster revealed that the majority of cases (4/6) occurred in local university students. These students all attended the same event at a local establishment on [11 Feb 2007], as did a known mumps case from outside of Nova Scotia. This imported case appears to have been the source of infection for those 4 students, and the index case for the wider outbreak. Subsequent cases have occurred mostly in university students. Epidemiologic links to confirmed cases have been evident in nearly all subsequent cases thus far. Preliminary analysis of the 25 cases analyzed so far reveals that the average age of the cases is 24.3 years old (median 20.8; range 6-50). 64 percent of cases (16/25) have been male. 5 cases have had no history of mumps in childhood or MMR vaccine; 15 cases report having had 1 MMR, and 2 cases have been confirmed as having had 2 doses of MMR vaccine. Vaccine status for the remaining 3 cases is unknown. 20 of the cases have occurred in university students. No unusual presentations of mumps or complications of mumps have occurred in cases presenting to this point.

Outbreak control measures have included: Aggressive contact tracing for each lab-confirmed case, including household and intimate contacts as well as casual contacts through workplace, recreational, social, and school settings; Isolation of cases for 9 days post symptom onset (as opposed to the 5 days used by some authorities); Identification of susceptible contacts via serology; this has resulted in 2 non-immune persons quarantined for 25 days to prevent possible transmission of disease to high-risk groups. Vaccine has not been used for outbreak control at this time.
(Promed 4/9/07)

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USA: Peanut butter maker says moisture triggered Salmonella contamination
ConAgra, the producer of peanut butter linked to a nationwide Salmonella outbreak in Feb 2007, announced that its own investigation found that moisture might have triggered the growth of the bacteria. Inadvertent moisture in the company's production facility could have allowed the growth of dormant Salmonella organisms that were likely present in raw peanuts or peanut dust, ConAgra stated. Reportedly, the moisture came from a roof that leaked during a rainstorm and a faulty sprinkler system that went off twice. The company cleaned the plant thoroughly and repaired the sprinkler system after the moisture problems occurred. The Salmonella outbreak began August and sickened 425 patients in 44 states. After the CDC linked Salmonella enterica serovar Tennessee isolates from sick patients to their consumption of Peter Pan products and certain jars of Great Value peanut butter, both made at the same plant, ConAgra recalled the products Feb 14. S enterica typically causes fever and nonbloody diarrhea that resolves in a week.

On Mar 1, the US Food and Drug Administration (FDA) announced that its investigators found S enterica in samples collected at the ConAgra plant, suggesting that the contamination occurred before the product reached consumers. ConAgra detailed several steps it will take to improve the safety of its food products. The company: Established a new position, vice president of global food safety; Formed a Food Safety Advisory Committee and; Approved a plan to install new machinery throughout the plant. The FDA's investigation at the plant is ongoing. ConAgra said it has contracted with a third-party manufacturer to make Peter Pan products while plant renovations are under way.
(CIDRAP 4/6/07)

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USA (California): 14 E. coli infections linked to restaurant
A new case of E. coli O157 infection linked to a Souplantation restaurant has been identified, bringing to 14 the total number of people who have tested positive for the bacterium, Orange County health officials said 9 Apr 2007. The new case, involving an adult customer who was not hospitalized, was reported 8 Apr 2007. The initial 13 patients--3 adults and 10 children--had eaten at the Souplantation in Lake Forest between 23 and 25 Mar 2007. Among them was a 12-year-old girl, who remained hospitalized in good condition. A Souplantation employee who did not report any symptoms or illness also tested positive for the E. coli. Officials were trying to determine the source of the outbreak. Meanwhile, the serve-yourself salad-buffet restaurant remained closed while its approximately 40 employees complete tests to determine whether they were infected. The Health Care Agency has suspended the restaurant's permit as a precaution. Last week, CDC stated that the strain that sickened the diners is very rare and has not been reported in California before. The food served at the restaurant is prepared in the company's central kitchen, which supplies the 9 Souplantation restaurants in Orange County, and there have been no reported cases from guests who dined at the other locations during the identified time period.
(Promed 4/3/07, 4/10/07)

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USA (Florida): Fatal case of Salmonella associated with pet turtle
The Food and Drug Administration (FDA) is urgently reminding the public that contact with baby turtles can pose a serious health risk to infants, small children, and adults with impaired immune systems, as the turtles can be natural hosts to Salmonella, a group of bacteria that can cause severe illness. Recently, a 4-week-old infant in Florida died of infection traced to Salmonella [enterica serotype] Pomona, a bacterium that was also found in a pet turtle in the home. Salmonella can be found on the outer skin and shell surfaces of the turtles, causing salmonellosis for those handling turtles without properly washing their hands after handling the animals. In the early 1970s, it was determined that pet turtles were responsible for an estimated 280 000 cases of salmonellosis each year in the USA. In 1975, FDA banned the sale of turtles with a shell less than 4 inches long. FDA has repeatedly emphasized the risks of turtle-associated salmonellosis, because of a resurgence in the sales of such turtles in the last 4 years. The public health impact of turtle-associated salmonellosis in humans is an estimated 74 000 cases in the USA per year.

Salmonellosis can be transmitted either directly from contact with the turtle or its feces or indirectly through the animal's water. Turtles carrying the organism usually do not appear to be sick. Although anyone can acquire a salmonellosis infection, the risk is highest in infants, young children, the elderly, and others with lowered natural resistance to disease. Pregnancy, cancer, chemotherapy, organ transplant, diabetes, and liver problems pose particular risks. Gastrointestinal symptoms following Salmonella exposure begin in 6 to 72 hours (usually 12 to 36 hours) and generally last for 2 to 7 days.
(Promed 4/9/07)

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Africa
Egypt: 14th fatal human case of avian influenza H5N1 infection
A 15-year-old Egyptian girl has died in hospital of the H5N1 bird flu virus, bringing the number of deaths from the disease in Egypt to 14. The patient, who was admitted to hospital in Cairo 5 Apr 2007, died of respiratory failure 10 Apr despite treatment with the antiviral Tamiflu and being placed on a respirator. Amr Kandeel, Director of Communicable Diseases at the Ministry of Health, said the treatment failed because the girl did not enter hospital until a week to 10 days after the symptoms started (she became ill 30 Mar 2007). Most of the fatalities in Egypt have been women or girls whose families were raising poultry in the backyards, and having daily contact with chicken or turkeys. But this victim's family did not. She is believed to have contracted the virus 3 weeks ago when she bought a chicken at a market.

WHO also confirmed a 2-year-old girl as Egypt's 33rd H5N1 case-patient. The girl, from Menia governorate, about 100 miles south of Cairo, fell ill Apr 3 and was hospitalized the next day. She remained in stable condition. Reportedly she had recent contact with backyard poultry. The Health Ministry said no one in the patient's family was found to have bird flu. The disease hit Egypt Feb 2006 and did extensive damage to the poultry industry and the economy as a whole. But the government still finds it hard to enforce restrictions on the movement and sale of live poultry. Out of a total of 34 humans who have caught bird flu in Egypt, 14 have died and 19 have recovered.
(Promed 4/10/07, 4/12/07; CIDRAP 4/11/07)

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1. Updates
Avian/Pandemic influenza updates
- UN: http://influenza.un.org/. UN response to avian influenza and the pandemic threat. Also, http://www.irinnews.org/Birdflu.asp provides information on avian influenza in order to help the humanitarian community. Read some recent reports regarding Nigeria.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. The website has a new look and design.
- OIE: http://www.oie.int/eng/en_index.htm. Link to upcoming avian influenza conferences; see the new OIE web portal.
- US CDC: http://www.cdc.gov/flu/avian/index.htm. New document: “Keep Bird Flu out of the US”
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Pandemic Flu Public Service Announcement has been released.
- Health Canada: information on pandemic influenza: http://www.influenza.gc.ca/index_e.html.
- CIDRAP: http://www.cidrap.umn.edu/. Frequently updated news and journal articles.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp. Global updates.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

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Dengue
Indonesia
Fatmawati Hospital in South Jakarta is struggling to keep pace with a large dengue outbreak, with 30 people [receiving] treatment for the mosquito-borne disease 2 Apr 2007 alone. As of 2 Apr 2007, the hospital was treating 152 patients, including 27 children. 36 late arrivals are sleeping on foldable beds in the hospital's corridors because the wards are full. Dozens of dengue patients had been admitted daily since last week. From Jan - Feb 2007, the hospital treated 1259 people for the disease. In Mar 2007, it saw 861 dengue patients. In Jan 2007, 8 patients died due to late treatment.
(Promed 4/8/07)

Mexico
Dengue is increasing dramatically in Mexico, and specialists predict a big increase in dengue incidence in all of Latin America. This epidemic is being driven by a combination of factors, such as climate change, migration, urbanization and deficiencies in mosquito control campaigns. Dengue incidence has increased 600 percent since 2001. The epidemic also reflects a longer rainy season as well as the abundance of disposable plastic containers, which serve as breeding places for mosquitoes. Immigrant and tourist travelers transport new dengue serotypes of the virus. Dengue hemorrhagic fever (DHF), which can be fatal, is becoming more frequent, compared with six years ago, according to the Mexican Secretary of Health.

In past weeks, the Mexican [Health] authorities sent hundreds of their employees to eradicate mosquitoes in Puerto Vallarta, Cancun and Acapulco -- the 3 principal tourist destinations -- with the objective of stopping possible outbreaks during Easter Week, when the beaches are jammed. The Canadian Embassy has issued an alert, after 5 of its citizens contracted the disease in Puerto Vallarta at the beginning of 2007. However, the problem is more serious in the poor suburbs that circle the tropical cities, where trash collection and sanitation are inferior to those of the tourist areas. The Mexican Secretary of Health says that dengue is one of the primary public health problems of the country. In Jan and Feb 2007, 1589 dengue cases were registered, an increase of 389 percent compared to the same period of 2006. In 2001, there were just 1781 confirmed [dengue] cases in the entire country.
(Promed 4/1/07)

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2. Articles
Apoptosis and Pathogenesis of Avian Influenza A (H5N1) Virus in Humans
Mongkol Uiprasertkul et al. EID. Volume 13, Number 5–May 2007.
http://www.cdc.gov/eid/content/13/5/708.htm
Abstract: “The pathogenesis of avian influenza A (H5N1) virus in humans has not been clearly elucidated. Apoptosis may also play an important role. We studied autopsy specimens from 2 patients who died of infection with this virus. Apoptosis was observed in alveolar epithelial cells, which is the major target cell type for the viral replication. Numerous apoptotic leukocytes were observed in the lung of a patient who died on day 6 of illness. Our data suggest that apoptosis may play a major role in the pathogenesis of influenza (H5N1) virus in humans by destroying alveolar epithelial cells. This pathogenesis causes pneumonia and destroys leukocytes, leading to leukopenia, which is a prominent clinical feature of influenza (H5N1) virus in humans. Whether observed apoptotic cells were a direct result of the viral replication or a consequence of an overactivation of the immune system requires further studies.”

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Trends for Influenza-related Deaths during Pandemic and Epidemic Seasons, Italy, 1969–2001
Caterina Rizzo et al. EID. Volume 13, Number 5–May 2007.
http://www.cdc.gov/eid/content/13/5/694.htm
Abstract: “Age-specific patterns of death from influenza vary, depending on whether the influenza season is epidemic or pandemic. We assessed age patterns and geographic trends in monthly influenza-related deaths in Italy from 1969 through 2001, focusing on differences between epidemic and pandemic seasons. We evaluated age-standardized excess deaths from pneumonia and influenza and from all causes, using a modified version of a cyclical Serfling model. Excess deaths were highest for elderly persons in all seasons except the influenza A (H3N2) pandemic season (1969–70), when rates were greater for younger persons, confirming a shift toward death of younger persons during pandemic seasons. When comparing northern, central, and southern Italy, we found a high level of synchrony in the amplitude of peaks of influenza-related deaths.”

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Avian Influenza (H5N1) Virus in Waterfowl and Chickens, Central China
Zhengjun Yu et al. EID. Volume 13, Number 5–May 2007.
http://www.cdc.gov/eid/content/13/5/772.htm
Abstract: “In 2004, 3 and 4 strains of avian influenza virus (subtype H5N1) were isolated from waterfowl and chickens, respectively, in central People's Republic of China. Viral replication and pathogenicity were evaluated in chickens, quails, pigeons, and mice. We analyzed the sequences of the hemagglutinin and neuraminidase genes of the isolates and found broad diversity among them.”

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Safety and Immunogenicity of a Baculovirus-Expressed Hemagglutinin Influenza Vaccine: A Randomized Controlled Trial
John J. Treanor et al. JAMA. 2007;297:1577-1582.
http://jama.ama-assn.org/cgi/content/abstract/297/14/1577
Abstract: “Context A high priority in vaccine research is the development of influenza vaccines that do not use embryonated eggs as the substrate for vaccine production. Objective To determine the dose-related safety, immunogenicity, and protective efficacy of an experimental trivalent influenza virus hemagglutinin (rHA0) vaccine produced in insect cells using recombinant baculoviruses. Design, Setting, and Participants Randomized, double-blind, placebo-controlled clinical trial at 3 US academic medical centers during the 2004-2005 influenza season among 460 healthy adults without high-risk indications for influenza vaccine. Interventions Participants were randomly assigned to receive a single injection of saline placebo (n = 154); 75 µg of an rHA0 vaccine containing 15 µg of hemagglutinin from influenza A/New Caledonia/20/99(H1N1) and influenza B/Jiangsu/10/03 virus and 45 µg of hemagglutinin from influenza A/Wyoming/3/03(H3N2) virus (n = 153); or 135 µg of rHA0 containing 45 µg of hemagglutinin each from all 3 components (n = 153). Serum samples were taken before and 30 days following immunization. Main Outcome Measures Primary safety end points were the rates and severity of solicited and unsolicited adverse events. Primary immunogenicity end points were the rates of 4-fold or greater increases in serum hemagglutinin inhibition antibody to each of the 3 vaccine strains before and 28 days after inoculation. The prespecified primary efficacy end point was culture-documented influenza illness, defined as development of influenza-like illness associated with influenza virus on a nasopharyngeal swab. Results Rates of local and systemic adverse effects were low, and the rates of systemic adverse effects were not different in either vaccine group than in the placebo group. Hemagglutinin inhibition antibody responses to the H1 component were seen in 3% of placebo, 51% of 75-µg vaccine, and 67% of 135-µg vaccine recipients, while responses to B were seen in 4% of placebo, 65% of 75-µg vaccine, and 92% of 135-µg vaccine recipients. Responses to the H3 component occurred in 11% of placebo, 81% of 75-µg vaccine, and 77% of 135-µg vaccine recipients. Influenza infections in the study population were due to influenza B and A(H3N2), and influenza A infections were A/California/7/2004–like viruses, an antigenically drifted strain. Seven cases of culture-confirmed CDC-defined influenza-like illness occurred in 153 placebo recipients (4.6%) compared with 2 cases (1.3%) in 150 recipients of 75 µg of vaccine, and 0 cases in recipients of 135 µg of vaccine. Conclusions In this study, a trivalent rHA0 vaccine was safe and immunogenic in a healthy adult population. Preliminary evidence of protection against a drifted influenza A(H3N2) virus was obtained, but the sample size was small. Inclusion of a neuraminidase component did not appear to be required for protection.”

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Avian Influenza Virus (H5N1): a Threat to Human Health
J. S. Malik Peiris, Menno D. de Jong, and Yi Guan. Clinical Microbiology
Reviews, April 2007, p. 243-267, Vol. 20, No. 2.
http://cmr.asm.org/cgi/content/abstract/20/2/243
Abstract: “Pandemic influenza virus has its origins in avian influenza viruses. The highly pathogenic avian influenza virus subtype H5N1 is already panzootic in poultry, with attendant economic consequences. It continues to cross species barriers to infect humans and other mammals, often with fatal outcomes. Therefore, H5N1 virus has rightly received attention as a potential pandemic threat. However, it is noted that the pandemics of 1957 and 1968 did not arise from highly pathogenic influenza viruses, and the next pandemic may well arise from a low-pathogenicity virus. The rationale for particular concern about an H5N1 pandemic is not its inevitability but its potential severity. An H5N1 pandemic is an event of low probability but one of high human health impact and poses a predicament for public health. Here, we review the ecology and evolution of highly pathogenic avian influenza H5N1 viruses, assess the pandemic risk, and address aspects of human H5N1 disease in relation to its epidemiology, clinical presentation, pathogenesis, diagnosis, and management.”

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The Courts, Public Health, and Legal Preparedness
Stier DD, Nicks D, Cowan GJ. American Journal of Public Health, 10.2105/AJPH.2006.101881.
http://www.ajph.org/cgi/content/abstract/AJPH.2006.101881v1
Abstract: “The judicial branch's key roles, as guardian of civil liberties and protector of the rule of law, can be acutely relevant during public health emergencies when courts may need to issue orders authorizing actions to protect public health or restraining public health actions that are determined to unduly interfere with civil rights. Legal preparedness for public health emergencies, therefore, necessitates an understanding of the court system and how courts are involved in public health issues. In this article we briefly describe the court system and then focus on what public health practitioners need to know about the judicial system in a public health emergency, including the courts' roles and the consequent need to keep courts open during emergencies.”

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Preclinical Evaluation of Microneedle Technology for Intradermal Delivery of Influenza Vaccines
Jason B. Alarcon et al. Clinical and Vaccine Immunology, April 2007, p. 375-381, Vol. 14, No. 4 http://cvi.asm.org/cgi/content/abstract/14/4/375 (References removed)
Abstract: “Recent clinical studies have suggested that, for certain strains of influenza virus, intradermal (i.d.) delivery may enable protective immune responses using a lower dose of vaccine than required by intramuscular (i.m.) injection. Here, we describe the first preclinical use of microneedle technology for i.d. administration of three different types of influenza vaccines: (i) a whole inactivated influenza virus, (ii) a trivalent split-virion human vaccine, and (iii) a plasmid DNA encoding the influenza virus hemagglutinin. In a rat model, i.d. delivery of the whole inactivated virus provided up to 100-fold dose sparing compared to i.m. injection. In addition, i.d. delivery of the trivalent human vaccine enabled at least 10-fold dose sparing for the H1N1 strain and elicited levels of response across the dose range similar to those of i.m. injection for the H3N2 and B strains. Furthermore, at least fivefold dose sparing from i.d. delivery was evident in animals treated with multiple doses of DNA plasmid vaccine, although such effects were not apparent after the first immunization. Altogether, the results demonstrate that microneedle-based i.d. delivery elicits antibody responses that are at least as strong as via i.m. injection and that, in many cases, dose sparing can be achieved by this new immunization method.”

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Contribution of H7 haemagglutinin to amantadine resistance and infectivity of influenza virus
Natalia A. Ilyushina et al. J Gen Virol 88 (2007), 1266-1274; DOI 10.1099/vir.0.82256-0.
http://vir.sgmjournals.org/cgi/content/abstract/88/4/1266
Abstract: “In the present study we determined the antiviral effect of amantadine against influenza A/Netherlands/219/03 (H7N7) virus in cell culture and in a mouse model. Amantadine at concentrations <100 µM failed to inhibit virus replication in Madin–Darby canine kidney (MDCK) cells. When orally administered to mice for 5 days, amantadine at 15 mg kg–1 day–1 did not protect animals against lethal challenge with H7N7 infection, and virus titres in mouse organs were not reduced. However, sequence analysis of the M2 protein revealed none of the mutations previously described as being associated with amantadine resistance. We used reverse genetics to generate viruses containing the haemagglutinin (HA) or M gene of A/Netherlands/219/03 virus to investigate the role of these genes in amantadine sensitivity. All recombinant viruses carrying the HA segment of A/Netherlands/219/03 (H7N7) virus were amantadine-resistant, regardless of the origin of their other genes. To study the role of fusion activity in the mechanism of drug resistance, we introduced the Gly23 Cys mutation in the H7 fusion peptide. This substitution resulted in a decrease of the pH of fusion and was also associated with reduced virus replication in both MDCK cells and mice, as compared to that of the wild-type virus. We suggest that H7 HA protein plays a role in amantadine resistance, although all HA amino acids that participate in drug resistance still remain to be characterized. Our finding reveals that sequence analysis of the transmembrane domain of M2 protein may not adequately identify all drug-resistant variants.”

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Multiple antimicrobial resistance in plague: an emerging public health threat.
Welch TJ et al. PLoS One 2007 Mar 20;2(3):e309.
Abstract: “Antimicrobial resistance in Yersinia pestis is rare, yet constitutes a significant international public health and biodefense threat. In 1995, the first multidrug resistant (MDR) isolate of Y. pestis (strain IP275) was identified, and was shown to contain a self-transmissible plasmid (pIP1202) that conferred resistance to many of the antimicrobials recommended for plague treatment and prophylaxis. Comparative analysis of the DNA sequence of Y. pestis plasmid pIP1202 revealed a near identical IncA/C plasmid backbone that is shared by MDR plasmids isolated from Salmonella enterica serotype Newport SL254 and the fish pathogen Yersinia ruckeri YR71. The high degree of sequence identity and gene synteny between the plasmid backbones suggests recent acquisition of these plasmids from a common ancestor. In addition, the Y. pestis pIP1202-like plasmid backbone was detected in numerous MDR enterobacterial pathogens isolated from retail meat samples collected between 2002 and 2005 in the United States. Plasmid-positive strains were isolated from beef, chicken, turkey and pork, and were found in samples from the following states: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York and Oregon. Our studies reveal that this common plasmid backbone is broadly disseminated among MDR zoonotic pathogens associated with agriculture. This reservoir of mobile resistance determinants has the potential to disseminate to Y. pestis and other human and zoonotic bacterial pathogens and therefore represents a significant public health concern.”

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Elimination of Measles --- South Korea, 2001—2006
(references removed)
“Before the introduction of measles-containing vaccine (MCV), measles was endemic in South Korea. MCV became available in South Korea in 1965, and measles, mumps, and rubella (MMR) vaccine was added to the country's national immunization program in 1983, with 1 dose administered at age 9--15 months. In 1997, a second dose of MCV (MCV2) was added to the schedule; recommended ages for administration of MCV1 and MCV2 were 12--15 months and 4--6 years, respectively. However, with insufficient policies and programs in place to promote 2-dose coverage, this 1997 recommendation achieved limited coverage with 2 doses of MCV. In a 2000 seroepidemiologic study among children aged 7--9 years who had been eligible for vaccination since 1997, only 39% had received MCV2. . .During 2000--2001, South Korea experienced a measles epidemic that affected tens of thousands of children. In response, in 2001, South Korea announced a 5-year National Measles Elimination Plan. This report describes the activities and summarizes the results of that plan, which enabled South Korea to announce in late 2006 that interruption of indigenous measles transmission had been achieved, making South Korea the first country in the World Health Organization's (WHO) Western Pacific Region declare measles eliminated. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5613a3.htm
(MMWR April 6, 2007 / 56(13);304-307)

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Severe Methicillin-Resistant Staphylococcus aureus Community-Acquired Pneumonia Associated with Influenza--Louisiana and Georgia, December 2006--January 2007
“Staphylococcus aureus infection has been reported infrequently as a cause of community-acquired pneumonia (CAP) and typically has been associated with influenza virus infection or influenza-like illness (ILI). During the 2003--04 influenza season, methicillin-resistant S. aureus (MRSA) gained attention as a cause of 15 cases of influenza-associated CAP. No formal surveillance has been conducted, and few additional cases of MRSA CAP were reported to CDC during the 2004--05 and 2005--06 influenza seasons. However, in January 2007, CDC received reports of 10 cases of severe MRSA CAP, including six deaths, among previously healthy children and adults in Louisiana and Georgia during December 2006--January 2007. These were the first reported cases of severe MRSA CAP during the 2006--07 influenza season in the two states, and 10 was a higher number than expected for the 2-month period. A case of severe MRSA CAP was defined as pneumonia requiring hospitalization or resulting in the death of a patient from whom a specimen. . .yielded MRSA when collected <48 hours after hospitalization or arrival at an emergency department (ED). . .This report describes three of the MRSA CAP cases as examples and summarizes all 10 of the reported cases. These cases underscore the need for health-care providers to be vigilant, especially during the influenza season, for severe cases of CAP that might be caused by MRSA. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a1.htm
(MMWR April 13, 2007 / 56(14);325-329)

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Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food--10 States, 2006
(References removed)
“. . .The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program collects data from 10 U.S. states regarding diseases caused by enteric pathogens transmitted commonly through food. FoodNet quantifies and monitors the incidence of these infections by conducting active, population-based surveillance for laboratory-confirmed illnesses. This report describes preliminary surveillance data for 2006 and compares them with baseline data from the period 1996--1998. Incidence of infections caused by Campylobacter, Listeria, Shigella, and Yersinia has declined since the baseline period. Incidence of infections caused by Shiga toxin-producing Escherichia coli O157 (STEC O157) and Salmonella, however, did not decrease significantly, and Vibrio infections have increased, indicating that further measures are needed to prevent foodborne illness and achieve national health objectives. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a4.htm
(MMWR April 13, 2007 / 56(14);336-339)

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Respirator donning in post-hurricane New Orleans.
Cummings KJ et al. EID. Volume 13, Number 5–May 2007.
http://www.cdc.gov/eid/content/13/5/06-1490.htm
Abstract: “We evaluated correctness of N95 FF respirator donning by the public in post-hurricane New Orleans, where respirators were recommended for mold remediation. We randomly selected, interviewed, and observed 538 participants, using multiple logistic regression for analysis. Only 129 (24%) participants demonstrated proper donning. Errors included nose clip not tightened (71%) and straps incorrectly placed (52%); 22% put on the respirator upside down. Factors independently associated with proper donning were as follows: ever having used a mask or respirator (odds ratio [OR] 5.28; 95% confidence interval [CI], 1.79–22.64); ever having had a respirator fit test (OR 4.40; 95% CI, 2.52–7.81); being male (OR 2.44; 95% CI, 1.50–4.03); Caucasian race (OR 2.09; 95% CI, 1.32–3.33); having a certified respirator (OR 1.99, 95% CI 1.20–3.28); and having participated in mold clean-up (OR 1.82; 95% CI,1.00–3.41). Interventions to improve respirator donning should be considered in planning for influenza epidemics and disasters.”

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Optimizing Severe Acute Respiratory Syndrome Response Strategies: Lessons Learned From Quarantine
Tsung-Hsi Wang et al. American Journal of Public Health, 10.2105/AJPH.2005.082115.
http://www.ajph.org/cgi/content/abstract/AJPH.2005.082115v1
Abstract: “Taiwan used quarantine as 1 of numerous interventions implemented to control the outbreak of severe acute respiratory syndrome in 2003. From March 18 to July 31, 2003, 147526 persons were placed under quarantine. Quarantining only persons with known exposure to people infected with severe acute respiratory syndrome could have reduced the number of persons quarantined by approximately 64%. Focusing quarantine efforts on persons with known or suspected exposure can greatly decrease the number of persons placed under quarantine, without substantially compromising its yield and effectiveness.”

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Responding to a Small-scale Bioterrorist Anthrax Attack
Brian Schmitt, et al. Arch Intern Med. 2007;167:655-662.
http://archinte.ama-assn.org/cgi/content/abstract/167/7/655
Abstract: “Background In 2001, a small-scale bioterrorism-related anthrax attack was perpetrated via the US mail. The optimal future response may require strategies different from those required in a large-scale attack. Methods We conducted a cost-effectiveness analysis using Monte Carlo simulation during a 10-year time frame from a societal perspective to determine the optimal response strategy for a small-scale anthrax attack perpetrated against US Postal Service distribution centers in a large metropolitan area. Three strategies were compared: preattack vaccination of all US distribution center postal workers, postattack antibiotic therapy followed by vaccination of exposed personnel, and postattack antibiotic therapy without vaccination of exposed personnel. Outcome measures were costs, quality-adjusted life-years, and incremental cost-effectiveness. The probabilities for anthrax exposure and infection; vaccine and antibiotic benefits, risks, and costs; and associated clinical outcomes were derived from the medical literature and from bioterrorism experts. Results Postattack antibiotic therapy and vaccination of exposed postal workers is the most cost-effective response compared with other strategies. The incremental cost-effectiveness is $59 558 per quality-adjusted life-year compared with postattack antibiotic therapy alone. Preattack vaccination of all distribution center workers is less effective and more costly than the other 2 strategies. Assuming complete adherence to preattack vaccination, the incremental cost-effectiveness compared with postattack antibiotic therapy alone is almost $2.6 million per quality-adjusted life-year. Conclusion Despite uncertainties about a future anthrax attack and exposure risk, postattack antibiotic therapy and vaccination of exposed personnel seems to be the optimal response to an attack perpetrated through the US Postal Service.”

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3. Notifications
Attendees of School Planning Summit for Bird Flu Preparedness Announced
The Bird Flu School Planning Summit will be staged in New Jersey May 21, 2007 to prepare communities meet the threat of a possible bird flu pandemic. A number of school administrators and educators, composed of school superintendents, principals, school directors, deans of students, pupil personnel, district nurses, school nurses, health aides, risk managers, parent-teacher coordinators, lead teachers, and student leaders, have confirmed their participation. A similar event was organized in California last year. The topics and program of the May summit have been designed to help school officials prepare a comprehensive and effective response to the bird flu pandemic threat. The summit program, which stresses hands on planning, has also been designed to enhance the capacities of school administrators and communities to create bird flu preparedness plans. For more information about the conference, please visit www.new-fields.com
(Bird Flu Summit 4/10/07)

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Webcast: Is the Bird Flu Threat Still Real and Are We Prepared?
Speakers: Bruce Gellin, Director, National Vaccine Program Office, Office of Public Health and Science, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services; Michael T. Osterholm, Director, Center for Infectious Disease Research and Policy; Professor, School of Public Health, University of Minnesota; Presider: Laurie Garrett, Senior Fellow for Global Health, Council on Foreign Relations. The archived video of the event can be viewed. To access this file, you will need Windows Media Player, Real Player, or QuickTime Player. You can download the player for free.
(Council on Foreign Relations: http://www.cfr.org/publication/13000/ )

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CCOHS: Pandemic Planning
Web site from Canadian Centre for Occupational Health and Safety (CCOHS), launched Apr 2, 2007. Browse the Pandemic Planning site for helpful documents and tools. Use the Links section to find out more information on various aspects of this situation.
(CCOHS http://www.ccohs.ca/pandemic/ )

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OIE Avian influenza Web Portal
The current global avian influenza (AI) disease situation has focused the attention of the international community over several years now. The science-based standards, guidelines and recommendations issued by the OIE are designated as the international reference in dealing with avian influenza. The OIE through its experts and world network of Reference Laboratories and Collaborating Centers , and in cooperation with the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) provides policy advice, strategy design and technical assistance for the control and eradication of avian influenza. This website provides critical information to national veterinary services and veterinary professionals, farmers, media and the general public.
(OIE http://www.oie.int/eng/info_ev/en_avianinfluenza.htm )

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New Promed RSS Reader
In an effort to make Promed-mail reports more accessible and useful, Promed is making an RSS ("Really Simple Syndication") feed of their reports available on a free trial basis. After the free trial, it will become a part of their Premium Subscription Package that is available for a USD 39 annual fee. RSS allows users to see new reports from chosen websites -- such as ProMED-mail -- as soon as they have been posted, without needing to check their e-mail or go to the website. To receive reports in this way, you will need an RSS reader, a separate software application on your computer that will display each report. A click on the title of an individual report in the RSS reader will then take you directly to a full web version of the report. ProMED-mail's RSS is available by entering the following URL into your RSS reader: http://ww2.isid.org/rss/xmlrpc_client.php. ProMED-mail acknowledges Herman Tolentino, MD who is a Senior Fellow in the Public Health Informatics Fellowship Program at the U.S. CDC for designing this RSS system. ***Dr. Tolentino has also helped us on our APEC EINet projects.
(Promed 4/3/07)

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Preventing HIV/AIDS Among Men Who Have Sex with Men: Challenges and Innovations
CDC and the Public Health Training Network will present the satellite broadcast and webcast, "Preventing HIV/AIDS Among Men Who Have Sex with Men: Challenges and Innovations," May 17, 2007, at 1 p.m. EDT. The 2-hour broadcast is designed to 1) raise awareness of the ongoing crisis of HIV/AIDS among gay, bisexual, and other men who have sex with men (MSM); 2) promote greater understanding of the behaviors that affect HIV/AIDS risk among MSM; and 3) encourage providers of HIV-prevention services to implement effective interventions and strategies to reduce HIV transmission among MSM. Organizations are responsible for setting up their own viewing locations and are encouraged to register their locations as soon as possible so that potential viewers can access information online. For more information go to: http://www.cdcnpin-broadcast.org. The broadcast also can be viewed at http://www2.cdc.gov/phtn.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5613a5.htm
(MMWR April 6, 2007 / 56(13);308)

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Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections
In the US, gonorrhea is the second most commonly reported notifiable disease, with 339,593 cases documented in 2005. Since 1993, fluoroquinolones (i.e., ciprofloxacin, ofloxacin, or levofloxacin) have been used frequently in the treatment of gonorrhea. However, prevalence of fluoroquinolone resistance in Neisseria gonorrhoeae has been increasing and is becoming widespread in the US. In 2004, CDC recommended that fluoroquinolones not be used in the US to treat gonorrhea in men who have sex with men (MSM). This report summarizes data on fluoroquinolone-resistant N. gonorrhoeae (QRNG) in heterosexual males and in MSM throughout the US. On the basis of the most recent evidence, CDC no longer recommends the use of fluoroquinolones for the treatment of gonococcal infections and associated conditions such as pelvic inflammatory disease (PID). Consequently, only one class of drugs, the cephalosporins, is still recommended and available for the treatment of gonorrhea.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm
(MMWR April 13, 2007 / 56(14);332-336)

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 apecein@u.washington.edu