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Vol. X. NO. 9 ~ EINet News Briefs ~ Apr 27, 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: WHO facilitates influenza vaccine technology transfer to developing countries
- Global: WHO warns against steroids for H5N1 patients
- Kuwait (Wafra): Reports of new case of avian influenza H5N1 in ostrich
- Japan (Kumamoto Prefecture): Avian influenza H5N1 in hawk was Qinghai strain
- Myanmar (Rangoon): Outbreaks of avian influenza H5N1 at 7 poultry farms
- Australia (Victoria): Fatal salmonellosis in a nursing home
- Australia (Victoria): Novel virus responsible for deaths of organ donation recipients
- Indonesia (Nusa, Tenggara, Timor): 8 fatal anthrax cases
- Japan (Tokyo, Saitama): Measles outbreak
- Russia (Krasnoyarsk): Increase in incidence of Trichinellosis
- Russia (Rostov): Botulism through canned mushrooms
- Singapore: 688 cases of hand, foot and mouth disease in 1 week
- USA: Record flu vaccine supply expected for next season
- USA: Two companies outline employee Tamiflu programs
- USA (Multistate): Recall of ground beef contaminated with E. Coli
- USA (California): Infant Botulism and Baby Food Recall
- USA (Alaska): Emergence of non-vaccine strain of streptococcus pneumoniae
- USA (Mississippi): West Nile virus human cases, first in 2007, confirmed
- USA: Danish firm expects to sell smallpox vaccine to US

1. Updates
- Avian/Pandemic influenza updates
- Dengue

2. Articles
- Genome Analysis Linking Recent European and African Influenza (H5N1) Viruses
- The generation of influenza outbreaks by a network of host immune responses against a limited set of antigenic types
- Risk Maps for the Spread of Highly Pathogenic Avian Influenza in Poultry
- Expanding Bioshield: A Call for Caution
- Public Health Response to An Anthrax Attack: An Evaluation of Vaccination Policy Options
- Development of a recombinant vaccine against aerosolized plague.
- Dengue and Relative Bradycardia
- Dengue Virus Evolution and Virulence Models
- Natural History of Plasma Leakage in Dengue Hemorrhagic Fever: A Serial Ultrasonographic Study
- Human Rabies --- Indiana and California, 2006
- Brief Report: Gastroenteritis Among Attendees at a Summer Camp--Wyoming, June-July 2006

3. Notifications
- Respirators recommended potentially inadequate to protect users from pandemic
- Converging Technologies to Combat Emerging Infectious Disease (EID)
- IMED 2007 Abstracts and Presentations Available
- Congresses of Parasitology, Microbiology and Tropical Medicine to be held Dec 4-7, 2007
- FAO/WHO expert meeting on viruses in food May 21-24, 2007
- APEC Members Move to Harmonize Food Safety
- WHO meeting on ‘forgotten’ tropical diseases
- New WHO online database to help fight infectious diseases
- WHO uses web-based approach to revise global disease standards (ICD)
- US Department of Health and Human Services offers plan for defense against biological threats
- Countries Gear Up for Vaccination Week in the Americas, April 21-28


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 / 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 4/11/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 4/216/07):
http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 4/20/07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.

FAO map showing outbreaks among poultry (last updated 3/26/2007):
http://www.fao.org/avianflu/en/maps.html

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Global: WHO facilitates influenza vaccine technology transfer to developing countries
As part of a concerted effort to ensure more equitable access to a potential pandemic influenza vaccine, six developing countries are being awarded grants to establish in-country manufacturing capacity for influenza vaccine. The countries are Brazil, India, Indonesia, Mexico, Thailand and Viet Nam. Up to US$ 2.5 million from the governments of Japan and the US will go towards each of the six countries as immediate funding to begin the process of acquiring the needed technology. Japan has provided US$ 8 million and the United States US$ 10 million for technology transfer. The grants are part of the implementation of the Global Pandemic Influenza Action Plan, which aims to close the influenza vaccine production gap of several billion doses. It will take a minimum of three to five years for the grant recipient countries to begin producing vaccine locally. Until then, these countries will require support in the shorter term to ensure they can access vaccine to protect their populations. In this context, WHO is hosting a meeting on 25 April to examine options. The meeting will bring together representatives of countries with human H5N1 infections, donor countries, and vaccine manufacturers in developed and developing countries.
(WHO 4/24/07 http://www.who.int/mediacentre/news/notes/2007/np18/en/index.html )

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Global: WHO warns against steroids for H5N1 patients
WHO has modified its recommendations on treatment for patients with H5N1 avian influenza by strengthening a warning against corticosteroids and suggesting the option of using higher doses of oseltamivir in some cases. In previous treatment advice in May 2006, WHO warned against routine use of corticosteroids except in the context of randomized trials. In its new statement, the agency said corticosteroids have not been effective, "and prolonged or high-dose corticosteroids can result in serious adverse effects in H5N1 patients, including opportunistic infections. Corticosteroids should not be used routinely, except for persistent septic shock with suspected adrenal insufficiency."

WHO offered additional conclusions about treating H5N1 patients: Early treatment with oseltamivir (Tamiflu) is useful for reducing mortality, and treatment is warranted even when the drug is started late, because evidence suggests prolonged virus replication; Modified regimens of oseltamivir treatment, including 2-fold higher dosage, longer duration, and possibly combination therapy with amantadine (in countries where the H5N1 virus is susceptible to the drug), "may be considered on a case-by-case basis," especially in patients who have pneumonia or worsening disease; Antibiotic prophylaxis should not be used. However, antibiotics are appropriate for the initial treatment of patients who have pneumonia, using evidence-based guidelines for treating community-acquired pneumonia. When possible, microbiologic studies should guide antibiotic use in H5N1 patients; Therapy for H5N1-associated acute respiratory distress syndrome (ARDS) should follow evidence-based guidelines for treating sepsis-associated ARDS and should involve mechanical ventilation with low tidal volume.
(CIDRAP 4/20/07, http://cidrap.umn.edu )

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Europe/Near East
Kuwait (Wafra): Reports of new case of avian influenza H5N1 in ostrich
Kuwait said Apr 22, 2007 that it has found a new case of H5N1 in the south of the Gulf Arab state, near the Saudi border. "We now have 46 infected focal points after the latest finding in an ostrich in Wafra," said health ministry spokesman Ahmed al-Shatti. "We no longer count individual cases. We concentrate on focal points or areas where the disease has been found, like farms, domestic cages or pens," he added. Kuwait has culled around 1.7 million birds, banned import of live birds, closed down the country's zoo as well as poultry shops in residential areas since the first case was reported this year in Feb 2007. Reportedly, in Apr 2007, poultry sales have fallen around 40 percent since the outbreak of the disease.
(ProMED 4/22/07, http://promedmail.org )

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Asia
Japan (Kumamoto Prefecture): Avian influenza H5N1 in hawk was Qinghai strain
The Ministry of the Environment announced 18 Apr 2007 that a wild Mountain Hawk Eagle -- which had been found alive Jan 2007 in the village of Sagara, Kumamoto Prefecture, Kyusyu, but which had died shortly afterwards -- was found to be infected by H5N1 virus belonging to the Qinghai Lake strain. This strain was similar to the strain found in 2 chicken farms in Miyazaki and Okayama Prefecture earlier in 2007. Confirmation was by gene analysis by the team of Tottori University. A task force concluded that the H5N1 strain identified in 4 farms was identical to the one that killed thousands of wild birds at Qinghai Lake in western China starting in 2005. The strain was also similar to one found in duck droppings in South Korea Jan 2007. Koichi Otsuki, a professor of veterinary microbiology at Kyoto Sangyo University, was quoted saying that it was possible the virus was brought to western Japan by a route that went through China and the Korean Peninsula.
(ProMED 4/22/07, http://promedmail.org )

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Myanmar (Rangoon): Outbreaks of avian influenza H5N1 at 7 poultry farms
7 poultry farms in Rangoon's neighboring townships have been hit by outbreaks of the H5N1 virus since Feb 2007, leading to the culling of 65 812 birds. According to laboratory tests, 24 samples out of 675 samples from the affected farms were infected, while the virus was also detected in 6 samples of the dead crows out of 561 samples taken of wild birds, reportedly. The cullings and sample tests have been conducted in cooperation with the UN Food and Agriculture Organization and US Agency for International Development, between 6 Mar and 21 Apr 2007. Restrictions on transport and sale of poultry and poultry products in the 5 townships have since been lifted. The government has requested the people and breeders to come forward with information on the dead birds, in order to be able to prevent the recurrence of bird flu.
(ProMED 4/22/07, http://promedmail.org )

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Australia (Victoria): Fatal salmonellosis in a nursing home
At least 3 residents ill with gastroenteritis at a Melbourne nursing home were infected with salmonellosis. Tests confirmed the bacterium in 2 elderly residents at Broughton Hall nursing home and hostel as the death toll rose to 5. The Camberwell nursing home claimed that the illness, which affected 21 residents, was not food poisoning, citing only 1 confirmed case of salmonella in a patient. But tests of fecal samples by the Department of Human Service (DHS) confirmed another 2 cases of salmonellosis. A total of 5 residents have died since the outbreak began early Apr 2007 and 3 remain in hospital. The kitchen at Broughton Hall remains closed while the source of the outbreak is investigated.
(ProMED 4/17/07, http://promedmail.org )

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Australia (Victoria): Novel virus responsible for deaths of organ donation recipients
A virus unknown to medical science was behind the deaths of 3 Victorians who received organs from the one donor. After baffling local scientists, experts from US’s Columbia University were called in to help solve the mystery of the multiple transplant deaths being investigated by the coroner. Initial investigations and tests had been unable to determine any common link between the donor and the 3 recipients. The presence of the virus in the recipients is thought to be a world first. A member of the New York team said: "The discovery of this virus is of national and international significance." The male donor whose organs carried the suspected killer bug had died in Dandenong Hospital of a brain hemorrhage Dec 2006 after returning from overseas; it is believed most of his trip was spent in Europe. The virus is part of the rodent-borne arenavirus family. The previously unknown virus, which is related to lymphocytic choriomeningitis virus (LCMV), was found using rapid sequencing technology. Known strains of LCMV have been implicated in a small number of cases of disease transmission by organ transplantation, however, the newly discovered virus is sufficiently different that it could not be detected using existing screening methods.
(ProMED 4/23/07, http://promedmail.org )

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Indonesia (Nusa, Tenggara, Timor): 8 fatal anthrax cases
A total of 8 people died and 6 others were hospitalized after consuming beef contaminated by anthrax in the Indonesian island of Sumba. The casualties have prompted the local government to isolate the Kodi district in the impoverished East Nusa Tenggara province from cattle traffic to prevent the spread of the animal-borne disease. Laboratory tests have confirmed that the casualties and the ill persons were positive for having anthrax. All cattle in the area, about 1500 km east of Jakarta, have been vaccinated. The area had been quarantined, and approximately 90 families are under surveillance for signs of the illness.
(ProMED 4/14/07, 4/17/07, 4/20/07, http://promedmail.org )

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Japan (Tokyo, Saitama): Measles outbreak
A measles epidemic is gradually spreading in Tokyo and Saitama Prefectures, government researchers said. Researchers at the National Institute of Infectious Diseases (NIID) said the measles is highly contagious and that the number of patients could surpass the 280 000 recorded in 2001. The institute is warning of an epidemic, fearing that holidaymakers may spread the disease across the country by traveling in various areas during the Golden Week holiday period, late Apr to early May. The number of reported cases of measles began to increase Feb 2007, and the number of adult patients (whose condition tends to be serious) has been sharply increasing since mid-Mar, according to researchers.
(ProMED 4/24/07, http://promedmail.org )

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Russia (Krasnoyarsk): Increase in incidence of Trichinellosis
The number of people infected with trichinellosis has increased in the Krasnoyarsk region. In 2006, 37 cases of trichinellosis were registered in the region, and, for the same period, the total number of cases registered in Russia was 206. The source of infection is meat from wild animals. The clinical course of trichinellosis in humans is severe and frequently has a lethal outcome. Symptoms include fever, periorbital edema, muscle pain and often skin rash, headaches, and diarrhea. Experts from the Federal Agency for Veterinary and Phytosanitary Supervision warn inhabitants that consumption of meat from wild boars, bears and badgers without veterinary examination can lead to infection.
(ProMED 4/22/07, http://promedmail.org )

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Russia (Rostov): Botulism through canned mushrooms
A cluster of botulism cases has been reported in the Dubovsky district of the Rostov region. The Federal Service for Surveillance of Consumer Rights and Human Welfare in the Rostov region reported 16 Apr 2007 that 6 local residents were hospitalized in the Central Regional Hospital of the Dubovsky district with symptoms of botulism. It was established that all patients had consumed home-canned mushrooms that had been picked in a forest belt near the village. Since the beginning of 2007, 8 persons have been hospitalized with botulism in hospitals in the Rostov region, where annually 25-30 persons contract the disease. During 2005-2006, 10 inhabitants of the Rostov region died from botulism. As yet, no deaths have been registered in 2007. The vehicles for transmission of the disease are commonly canned mushrooms and vegetables and smoked fish prepared in domestic conditions.
(ProMED 4/20/07, http://promedmail.org )

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Singapore: 688 cases of hand, foot and mouth disease in 1 week
There were 688 cases of hand, foot and mouth disease (HFMD) recorded between April 15 and 21, 2007, the highest number recorded so far this year. The figure was 70 percent higher compared to the 398 cases recorded in the same period last year. The number of cases has exceeded the epidemic threshold the Health Ministry has set for HFMD. The last HFMD epidemic in Singapore took place Mar 2006, when 784 cases were recorded in a week. A total of 3 child-care centres had to be closed during the outbreak. The Ministry said the present strain is CA16. This is unlike the EV71 virus, which is more likely to cause complications. And although the number of HFMD cases reported to Health Ministry has increased, the number of cases seeking treatment or admission to hospitals has dropped compared to the previous week. The Ministries of Health and Community Development Youth and Sports have sent out alert letters to child-care centres and schools with reported clusters of HFMD cases.
(ProMED 4/24/07, http://promedmail.org )

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Americas
USA: Record flu vaccine supply expected for next season
Influenza vaccine producers have projected they will make 127 million to 132 million doses for the US market for the 2007-08 flu season, a record amount that would top the nearly 121 million doses produced for the 2006-07 season, according to CDC. The projection follows a glut of flu vaccine this season, in which more than 18 million doses went unsold, according to Curtis Allen, a spokesman for the CDC's National Immunization Program in Atlanta. Estimates of vaccine production from the 4 US suppliers are: Sanofi Pasteur, 50 million doses; Novartis, 40 million doses; GlaxoSmithKline, 30 million to 35 million doses; and MedImmune, 7 million doses. Production for 2007-08 could be even higher if the Food and Drug Administration approves a seasonal flu vaccine from a fifth manufacturer, CSL Biotherapies, the US branch of an Australian company. CSL announced April 3 it had applied for FDA approval for its vaccine.
(CIDRAP 4/24/07, http://cidrap.umn.edu )

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USA: Two companies outline employee Tamiflu programs
Faced with the reality that an effective vaccine is not likely to be available for at least the first several months of an influenza pandemic, some corporations are buying antiviral medications for their employees—both to protect them and to improve the chances that the company could keep providing vital products and services through a pandemic. Few companies have revealed their plans concerning the use of antivirals, but two of them recently described their plans to supply employees with oseltamivir (Tamiflu): the US division of Roche, the company that makes Tamiflu, and Public Service Enterprise Group (PSEG), an energy company that serves nearly 2 million electric customers and 1.6 million gas customers in New Jersey. Roche and PSEG are among the first large companies to supply their employees with Tamiflu, and their experiences may hold lessons for other companies considering such programs.
(CIDRAP 4/20/07, http://cidrap.umn.edu )

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USA (Multistate): Recall of ground beef contaminated with E. Coli
California state health officials announced a recall in 5 states of frozen ground beef patties after at least 3 Napa County children who ate at Little League baseball snack shacks were sickened by E. coli. The recall was issued for about 45 360 kg of frozen patties produced by Richwood Meat Co. Inc. from Apr to May 2006, and distributed in California, Arizona, Idaho, Oregon, and Washington. The children all fell ill after eating hamburgers, and have since recovered. Those cases were reported 3-4 Apr 2007 and 2 other possible cases are being investigated in California.

In an apparently unrelated outbreak, the Pennsylvania Department of Health (PDH) said Apr20 that it was investigating 5 cases of E coli O157:H7 infection in people from 4 counties who ate rare or medium-rare steak at 4 different Hoss's Steak and Sea House restaurants. The products being recalled in connection with the California cases are hamburger patties and ground beef sold under the brands Fireriver, Chef's Pride, Ritz Food, Blackwood Farms, California Pacific Associates, C&C Distributing, Golbon, and Richwood.
(ProMED 4/24/07, 4/26/07 http://promedmail.org, CIDRAP 4/23/07, http://cidrap.umn.edu )

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USA (California): Infant Botulism and Baby Food Recall
A Mendocino County child is recovering and doing well after being diagnosed with infant botulism earlier in Apr 2007, the Public Health Department reported April 17, 2007. Reportedly, the child's mother reported that, in addition to being breastfed, the infant was fed Earth's Best Organic baby food. While there is no confirmed link between this case and the baby food, the FDA (U.S. Food and Drug Administration) has initiated an ongoing recall for several types of jars of Earth's Best baby food because of the risk of contamination with Clostridium botulinum, the bacterium that can cause botulism.
(ProMED 4/20/07, http://promedmail.org)’

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USA (Alaska): Emergence of non-vaccine strain of streptococcus pneumoniae
While a new vaccine has all but eradicated common causes of pneumonia, meningitis, and ear infections in children, new strains of bacteria not covered by the vaccine have emerged, researchers said, Apr 24, 2007. Since the introduction of Wyeth's successful vaccine Prevnar in 2000, doctors have been waiting and watching for the arrival of replacement bacteria that could undo its progress. Researchers from the CDC have noted an increase in the rates of bacterial infections not covered by the current pneumococcal vaccine among native children in Alaska. The CDC's Dr. Rosalyn Singleton and colleagues studied pneumococcal infections such as pneumonia, meningitis, or blood infections known as bacteremia that occurred from 1995 to 2006. They found that in the 3 years after the introduction of Prevnar, from 2001 through 2003, these diseases fell by 67 percent among native Alaskan children younger than age 2 and 61 percent in non-native children. Between 2001-2003 and 2004-2006, these infection rates remained stable in non-native Alaskan children younger than 2 but jumped 82 percent among Alaska native children, who are more prone to the infections. Since 2004, diseases caused by strains of bacteria not covered by the vaccine have risen by 140 percent compared with the pre-vaccine period. During the same period, diseases caused by the vaccine-covered strains fell by 96 percent.
(ProMED 4/25/07, http://promedmail.org )

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USA (Mississippi): West Nile virus human cases, first in 2007, confirmed
The Mississippi Department of Health today confirmed the state's first human cases of West Nile virus this year. West Nile virus is a year-round virus, according to interim State Epidemiologist Dr. Lovetta Brown.
(ProMED 4/13/07, http://promedmail.org )

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USA: Danish firm expects to sell smallpox vaccine to US
Bavarian Nordic, a Danish company, announced that the US government plans to buy 20 million doses of the company's Imvamune smallpox vaccine, but a US official said no decision has been made yet. Imvamune is Bavarian's version of modified vaccinia Ankara (MVA), which is considered safer than the conventional smallpox vaccine, particularly for people with weakened immune systems, pregnant women, and children. Bavarian Nordic and the British drug company Acambis each received an HHS contract in early 2003 to develop and test a vaccine based on MVA. In Sep 2004 HHS awarded each company a further contract calling for production of 500,000 doses of the vaccine and clinical trials. But Acambis announced Nov 2006 that HHS had notified it that the company's vaccine was too expensive. Bavarian said it has built a facility that can produce at least 40 million doses of Imvamune annually.
(CIDRAP 4/18/07, http://cidrap.umn.edu )

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1. Updates
Avian/Pandemic influenza updates
- UN: http://influenza.un.org/. UN response to avian influenza and the pandemic threat. Also, http://www.irinnews.org/Birdflu.asp provides information on avian influenza in order to help the humanitarian community.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html.
- OIE: http://www.oie.int/eng/en_index.htm. Link to the avian influenza web portal.
- 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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Dengue
Australia
Another person in Townsville and Thuringowa in north Queensland has been confirmed to have dengue fever, taking the number of cases 17. The initial outbreak occurred in South Townsville at the end of Mar 2007. Townsville's Tropical Population Health Unit says work is continuing in the region to place mosquito traps and remove potential breeding areas. More cases are expected before the current outbreak is over.
(ProMED 4/16/07, http://promedmail.org )

Indonesia
In Jakarta, 42 people have died of dengue in 2007, and thousands of people in the capital of Indonesia have been infected during this period. The Jakarta government considers this dengue outbreak to be "an extraordinary situation," according to the Subdirector of Regional Health Services, Salimar Salim. In Mar 2007 alone, 4423 cases have been registered in Jakarta, compared to 2249 registered during the same period last year. Jakarta has not lived through a similar dengue outbreak for 3 years, when the disease caused 90 deaths in the city, with 20 640 individuals infected.
(ProMED 4/16/07, http://promedmail.org )

Mexico
Mexican officials are concerned about an alarming rise in dengue fever, as cases have risen 600 percent in the country since 2001, and they recently dispatched teams to coastal resorts to spray pesticides and clear pockets of standing water where mosquitoes multiply. Particularly concerning is an increase in deadly hemorrhagic dengue, which reportedly now accounts for 1 in 4 cases.
(ProMED 4/16/07, http://promedmail.org )

Philippines
The incidence of dengue fever has stabilized, 2 weeks after the implementation of anti-dengue initiatives by the City Health Office (CHO). City health officer Dr. Rodel Agbulos said the number of dengue admissions in hospitals decreased to 10 per week from 15 a week after the "Dengue Noise Barrage" and heightened information and education campaign were conducted. Although lower than the previous weeks, Agbulos said the weekly dengue cases are still higher than the average 8 cases per week during the same time last year. As of the first week of Apr 2007, 154 dengue patients had been admitted to hospitals this year; this number is 57% higher than the figure for the same period in 2006. Meanwhile, in Tacloban City, the illness has broken seasonal patterns and 880 dengue cases were reported in Metro Manila from Jan to 15 Mar 2007. Economywide, 3509 cases were reported from Jan to 15 Mar 2007, of which 32 died.
(ProMED 4/16/07, 4/22/07, http://promedmail.org )

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2. Articles
Genome Analysis Linking Recent European and African Influenza (H5N1) Viruses
Steven L. Salzberg et al., Emerging Infectious Diseases, Volume 13, Number 5, May 2007.
Abstract: “To better understand the ecology and epidemiology of the highly pathogenic avian influenza virus in its transcontinental spread, we sequenced and analyzed the complete genomes of 36 recent influenza A (H5N1) viruses collected from birds in Europe, northern Africa, and southeastern Asia. These sequences, among the first complete genomes of influenza (H5N1) viruses outside Asia, clearly depict the lineages now infecting wild and domestic birds in Europe and Africa and show the relationships among these isolates and other strains affecting both birds and humans. The isolates fall into 3 distinct lineages, 1 of which contains all known non-Asian isolates. This new Euro-African lineage, which was the cause of several recent (2006) fatal human infections in Egypt and Iraq, has been introduced at least 3 times into the European-African region and has split into 3 distinct, independently evolving sublineages. One isolate provides evidence that 2 of these sublineages have recently reassorted.”
http://www.cdc.gov/eid/content/13/5/713.htm

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The generation of influenza outbreaks by a network of host immune responses against a limited set of antigenic types
Mario Recker et al. Proc. Natl. Acad. Sci. USA, 10.1073/pnas.0702154104.
Abstract: “It is commonly believed that influenza epidemics arise through the incremental accumulation of viral mutations, culminating in a novel antigenic type that is able to escape host immunity. Successive epidemic strains therefore become increasingly antigenically distant from a founding strain. Here, we present an alternative explanation where, because of functional constraints on the defining epitopes, the virus population is characterized by a limited set of antigenic types, all of which may be continuously generated by mutation from preexisting strains and other processes. Under these circumstances, influenza outbreaks arise as a consequence of host immune selection in a manner that is independent of the mode and tempo of viral mutation. By contrast with existing paradigms, antigenic distance between epidemic strains does not necessarily accumulate with time in our model, and it is the changing profile of host population immunity that creates the conditions for the emergence of the next influenza strain rather than the mutational capabilities of the virus.”

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Risk Maps for the Spread of Highly Pathogenic Avian Influenza in Poultry
Boender GJ et al. PLoS Comput Biol 3(4): e71 doi:10.1371/journal.pcbi.0030071.
Abstract: “Devastating epidemics of highly contagious animal diseases such as avian influenza, classical swine fever, and foot-and-mouth disease underline the need for improved understanding of the factors promoting the spread of these pathogens. Here the authors present a spatial analysis of the between-farm transmission of a highly pathogenic H7N7 avian influenza virus that caused a large epidemic in The Netherlands in 2003. The authors developed a method to estimate key parameters determining the spread of highly transmissible animal diseases between farms based on outbreak data. The method allows for the identification of high-risk areas for propagating spread in an epidemiologically underpinned manner. A central concept is the transmission kernel, which determines the probability of pathogen transmission from infected to uninfected farms as a function of interfarm distance. The authors show how an estimate of the transmission kernel naturally provides estimates of the critical farm density and local reproduction numbers, which allows one to evaluate the effectiveness of control strategies. For avian influenza, the analyses show that there are two poultry-dense areas in The Netherlands where epidemic spread is possible, and in which local control measures are unlikely to be able to halt an unfolding epidemic. In these regions an epidemic can only be brought to an end by the depletion of susceptible farms by infection or massive culling. The analyses provide an estimate of the spatial range over which highly pathogenic avian influenza viruses spread between farms, and emphasize that control measures aimed at controlling such outbreaks need to take into account the local density of farms.”

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Expanding Bioshield: A Call for Caution
May, Thomas. American Journal of Public Health, 10.2105/AJPH.2005.077453.
Abstract: “The Bioshield Initiative seeks to stimulate development of new drugs and vaccines to prevent and treat diseases caused by biological agents likely to be used by terrorists, and recent proposals have sought to expand patent protections in this context. To the extent that patent protections are needed as part of the incentive structure for new drug and vaccine development, it may be better to strengthen patent protections on nonterror-related drugs and vaccines to avoid production capacity problems, as well as follow-up research and development problems. However, at the same time, both practical and ethical considerations argue that the good that might be achieved through expanded patent protections come at costs that make this strategy unacceptable.”
http://www.ajph.org/cgi/content/abstract/AJPH.2005.077453v1

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Public Health Response to An Anthrax Attack: An Evaluation of Vaccination Policy Options
Prasith Baccam and Michael Boechler. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. Apr 2007, Vol. 5, No. 1 : 26 -34.
Abstract: “A discrete-time, deterministic, compartmental model was developed and analyzed to provide insight into how the use of anthrax vaccine before or after a large-scale attack can reduce casualties. The model accounts for important response and protection factors such as antibiotic and vaccine efficacy, the protective effects of buildings, the timing of emergency response, and antibiotic adherence and vaccine coverage in the population prior to the attack. The relative benefit of pre- versus post-exposure vaccination is influenced by the timing of the post-exposure antibiotic distribution campaign as well as assumptions of antibiotic adherence. The results indicate that, regardless of which vaccination policy is adopted, a rapid and effective post-attack medical response has a large impact on the number of lives that can be saved by a post-exposure prophylaxis (PEP) campaign. A sensitivity analysis of the model indicates that uncertainty in medical efficacy and the time to initiate a PEP campaign are the model parameters that have the greatest impact on the number of predicted deaths. It is shown that for each day that a mass prophylaxis campaign is delayed, more casualties and deaths result than for each day that the completion of the campaign is delayed.”
http://www.liebertonline.com/doi/abs/10.1089/bsp.2006.0001

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Development of a recombinant vaccine against aerosolized plague.
Morris SR. Development of a recombinant vaccine against aerosolized plague. Vaccine. 2007 Apr 20;25(16):3115-7. Epub 2007 Jan 30.
Abstract: “Although few diseases have had a greater impact on human history, currently there is no vaccine available for protection against plague that is licensed by the Food and Drug Administration (FDA). DynPort Vaccine Company LLC, a CSC company (DVC), is managing the advanced development of a recombinant plague vaccine (rF1V) for the United States Department of Defense that will provide protection against plague aerosols, the most likely form a biological weapon would take. The vaccine was originally developed at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID). To meet the requirements for licensure in the shortest possible time, DVC developed a strategy for the integration of data from USAMRIID with data from clinical and nonclinical studies conducted by DVC. This strategy is based on the parallel development and validation of assays for the analysis of animal and human immune responses to the vaccine that facilitated the transfer of the candidate from the developing lab at USAMRIID. These assays also form the foundation of our approach to the licensure of the rF1V vaccine using the FDA Animal Rule.”

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Dengue and Relative Bradycardia
Aisha Lateef et al. EID. Volume 13, Number 4–April 2007.
To the Editor: “We have found that relative bradycardia is a notable clinical feature of dengue fever in Singapore. To our knowledge, this sign has not been previously associated with dengue. Awareness of this possible clinical finding could help in the early recognition of dengue and potentially reduce complications and death associated with dengue virus infection. Clinical features that can be used in the initial assessment of febrile patients are essential tools for clinicians, especially in limited resource settings. . .”
http://www.cdc.gov/eid/content/13/4/650.htm

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Dengue Virus Evolution and Virulence Models
Rebeca Rico-Hesse. Clinical Infectious Diseases 2007;44:000.
Abstract: “Dengue virus transmission has increased dramatically in the past 2 decades, making this virus one of the most important mosquito-borne human pathogens. The emergence of dengue hemorrhagic fever in most tropical countries has made its control a public health priority, but no vaccines or treatments exist. Little is understood about dengue virus pathogenesis, because no other animals develop symptoms of disease, and research, therefore, has been limited to studies involving patients. Although epidemiologic and evolutionary studies have pointed to host and viral factors in determining disease outcome, only recently developed models could prove the importance of viral genotypes in causing severe epidemics. The influence of host immune status and mosquito vectorial capacity are also being tested in mathematical models to determine virus population dynamics. Therefore, new technologies are allowing us to better understand how specific virus variants cause more disease than others, and these virus variants should be targeted for detection, control, and treatment.”
http://www.journals.uchicago.edu/CID/journal/issues/v44n11/50159/brief/50159.abstract.html

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Natural History of Plasma Leakage in Dengue Hemorrhagic Fever: A Serial Ultrasonographic Study
Srikiatkhachorn, Anon et al. Pediatric Infectious Disease Journal. 26(4):283-290, April 2007.
Abstract: “Background: Although plasma leakage is the major cause of mortality and morbidity in patients with dengue hemorrhagic fever (DHF), a detailed assessment of the natural course of this process is still lacking. We employed serial ultrasound examination to delineate the locations and the timing of plasma leakage and to evaluate the usefulness of ultrasound in detecting plasma leakage in DHF. Method: Daily ultrasound examinations of the abdomen and right thorax were performed in 158 suspected dengue cases to detect ascites, thickened gall bladder wall and pleural effusions. Cases were classified into dengue fever (DF), DHF or other febrile illness (OFI) based on serology and evidence of plasma leakage including hemoconcentration and pleural effusion detected by chest radiograph. Results: Ultrasonographic evidence of plasma leakage was detected in DHF cases starting from 2 days before defervescence and was detected in some cases within 3 days after fever onset. Pleural effusion was the most common ultrasonographic sign of plasma leakage (62% of DHF cases one day after defervescence). Thickening of the gallbladder wall and ascites were detected less frequently (43% and 52% of DHF cases respectively) and resolved more rapidly than pleural effusions. The size of pleural effusions, ascites and gall bladder wall thickness in DHF grade I and II were smaller than those of grade III patients. Ultrasound detected plasma leakage in 12 of 17 DHF cases who did not meet the criteria for significant hemoconcentration. Conclusions: Ultrasound examinations detected plasma leakage in multiple body compartments around the time of defervescence. Ultrasonographic signs of plasma leakage were detectable before changes in hematocrits. Ultrasound is a useful tool for detecting plasma leakage in dengue infection.”

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Human Rabies --- Indiana and California, 2006
(References removed)
“Rabies is a viral infection that causes acute, progressive encephalitis and is considered to be universally fatal. However, during 2004, an unvaccinated Wisconsin patient received a new medical treatment and became the first documented survivor of rabies who had not received preexposure vaccination or postexposure prophylaxis (PEP), suggesting the possibility of successful future interventions. This report describes two recent patients with rabies who were treated using therapy similar to that used for the Wisconsin patient; both treatments were unsuccessful. The report also describes the concomitant epidemiologic investigations by the Indiana State Department of Health (ISDH), California Department of Health Services (CDHS), and CDC, and the local public health responses in Marshall County, Indiana, and San Joaquin and Alameda counties in California. The findings in this report underscore the continuing need for enhanced clinical awareness of possible rabies exposure to ensure prompt PEP and timely diagnosis of rabies, especially if treatment is attempted. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5615a1.htm
(MMWR April 20, 2007 / 56(15);361-365)

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Brief Report: Gastroenteritis Among Attendees at a Summer Camp--Wyoming, June-July 2006
“On July 19, 2006, the Environmental Protection Agency (EPA) notified the Wyoming Department of Health (WDH) of an Escherichia coli-positive well-water sample, indicating fecal contamination, that had been submitted from a Wyoming summer youth camp after the camp manager noticed cases of gastroenteritis among campers and staff members. This report describes the subsequent investigation by WDH, the Wyoming Department of Agriculture (WDA), and the Wyoming Department of Environmental Quality (WDEQ), which identified Norovirus and Campylobacter species as the etiologic agents. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5615a4.htm
(MMWR April 20, 2007 / 56(15);368-370)

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3. Notifications
Respirators recommended potentially inadequate to protect users from pandemic
The Centers for Disease Control (CDC), World Health Organization (WHO), and National Institute for Occupational Safety and Health (NIOSH) all recommend the use of N95 respirators. These respirators are unlikely to be effective at properly protecting users against H5N1 Avian Influenza, according to a respirator distributor. The CDC, WHO and NIOSH suggest that people use an NIOSH-approved N95 respirator that has 95% efficiency in filtering out particles greater than 0.3 micron under normal rate of respiration. The N95s were originally created to protect workers from industrial dust & particulates but will likely prove ineffective against airborne viral threats. However, the NIOSH certification process does not include an evaluation of viral filtration efficiency. Furthermore, recent studies suggest that NIOSH approved respirators do not stop biological particles less than 0.3 microns in size with 95% filtration efficiency as it was historically assumed. The N95 disposable respirators are inadequate to ensure that the wearer is protected during airborne viral exposures such as the H5N1 virus.
(FluRadar 4/25/07, http://fluradar.com )

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Converging Technologies to Combat Emerging Infectious Disease (EID)
The APEC Center for Technology Foresight is running a project on Roadmapping Converging Technologies to Combat Emerging Infectious Diseases. The Center’s Scenario workshop was recently held, and the details on the workshop, including the summary report, can be found at: http://www.apecforesight.org/apec_wide/EID/eid_scenario_workshop.cfm.

The Center is currently organizing a technology roadmapping workshop, the phase II of the whole project. The information can be found at http://www.nistep.go.jp/index-e.html and http://www.nistep.go.jp/notice/nt070522.html. The workshop will be held 22-24 May 2007 in Tokyo, Japan and there is no registration fee. Technology roadmaps for specific technology applications to combat Emerging Infectious Diseases will be developed to help APEC combat Emerging Infectious Diseases.

For more information, contact:
Ponpiboon Satangput, Ph.D, Policy Researcher
APEC Center for Technology Foresight
73/1 Rama 6 Road, Rajadhevee, Bangkok 10400, Thailand
Tel. ++662 644 8150 Ext. 768; Fax. ++662 644 8191
URL: www.apecforesight.org ; E-mail: ponpiboon@nstda.or.th
(APEC Center for Tehcnology Foresight 4/27/07)

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IMED 2007 Abstracts and Presentations Available
The inaugural International Meeting on Emerging Diseases and Surveillance (IMED 2007) was held in Vienna 23-25 Feb 2007. Over 600 individuals from more than 60 countries attended the conference. The scientific program included over 40 talks and 300 abstracts presented in either poster or oral form. Co-sponsored by ProMED-mail, OIE (World Animal Health Organization), WHO Regional Office for Europe, the European Center for Disease Prevention and Control, and the European Commission, the major themes of the conference included mechanisms for disease surveillance, emerging animal and zoonotic diseases, and emerging diseases in the European region. The organizers have now made the presentations available for download at http://imed.isid.org/symposia.shtml. Abstracts are also available for download.
(ProMED 4/24/07, http://promedmail.org )

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Congresses of Parasitology, Microbiology and Tropical Medicine to be held Dec 4-7, 2007
The Pedro Kouri Tropical Medicine Institute (IPK) in Havana Cuba, is pleased to announce the VIII Central American and Caribbean Congress of Parasitology and Tropical Medicine, the VII Cuban Congress of Microbiology and Parasitology, the IV National Congress of Tropical Medicine, and IPK's 70th Anniversary Congress, to be held at the Institute's headquarters from 4 to 7 Dec 2007. For more information, go to:
http://www.ipk.sld.cu/eventosipk/cong2007/index.htm.
(ProMED 4/20/07, http://promedmail.org)

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FAO/WHO expert meeting on viruses in food May 21-24, 2007
The Codex Alimentarius Commission is considering the types of risk management tools that can be developed to assist countries in their efforts to protect consumer health from food-borne viral illness. WHO and the Food and Agriculture Organization of the UN (FAO) are organizing this expert meeting, scheduled for 21-24 May 2007 in Bilthoven, Netherlands, at the request of the Codex Committee for Food Hygiene. The objectives of the meeting are to: review the current state of knowledge on viruses in food and their public health and trade impact; review availability and feasibility and the practical consequences of using analytical methods for detecting viruses; and review existing risk profiles (including the state of knowledge on current or future risk management options) and other relevant information pertinent to the evaluation of risks associated with viruses in food.
(WHO 4/07, http://who.int/en )

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APEC Members Move to Harmonize Food Safety
As the global population grows and pressure on food and water supplies increases, cases of food-borne illness will multiply, the inaugural APEC Food Safety Cooperation Forum was told. Dr. Gardner Murray, special adviser to the Australian Department of Agriculture, Fisheries and Forestry, told the Forum meeting in Australia that climate change and increasing variations in the ecology of environments will force food scientists and regulators to revise their understanding of food pathogens. "With environmental damage and climatic variations we are already seeing new diseases emerging and 75% of them are zoonotic diseases (animal diseases that humans can catch)," Dr. Murray said.

In Australia, for example, bat Lyssavirus has been around for thousands of years but only recently, as bat and human populations are pushed closer together in land and property developments, has the disease begun appearing in humans. Similarly, research in Vietnam on the spread of the H5N1 flu virus showed that outbreaks spiked during the Tet holiday when people moved about the country with their poultry. Communicating information about new disease threats to their populations will become more important for food regulators, whose risk analyses and communication messages must be simple, transparent and easy to understand. "For example, in Korea, health authorities put food safety messages on the back of commonly sold packs of toothpicks in restaurants."

"As a result of increasing global trade, people movements and the industrialization of production and processing, consumers are potentially exposed to a greater number of food safety hazards than in the past," Dr Murray said. "Dealing with this threat requires a thorough risk analysis process, the key elements of which are to identify and characterize hazards, assess the risk, manage it and communicate it publicly."
(APEC 4/5/07 http://www.apec.org/ )

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WHO meeting on ‘forgotten’ tropical diseases
WHO and key partners met Apr 19 and 20, in an unprecedented showing of commitment to combat the so-called neglected tropical diseases. Most of the neglected diseases are caused by parasites that thrive in impoverished settings, where water supply, sanitation, and housing are poor. Apart from this strong link to poverty, the diseases form a group because they permanently deform and disable large numbers of poor people, trapping them in poverty. Worldwide, an estimated 1 billion people – one sixth of the world’s population – are affected by one or more of these diseases. Recent evidence of their severe impact on socioeconomic development has spurred unprecedented commitment to reduce this burden. Control of these diseases is now considered part of the global drive to reduce poverty. Substantial progress has already been made in the fight to control and eliminate many neglected tropical diseases: The number of leprosy cases has decreased from 5.2 million in 1985 to less than 220 000 cases today and 14.5 million people have been cured of this disease. Guinea worm disease is set for eradication. Previously, only one disease - smallpox - has ever been eradicated.
(WHO 4/19/07, http://who.int/en )

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New WHO online database to help fight infectious diseases
An international network of researchers announced the release of a new web-based resource designed to facilitate the development of medicines to fight infectious diseases afflicting the developing world. The Drug Target Prioritization Database may be accessed at http://TDRtargets.org. "This is the first time that any group has assembled such a comprehensive set of information pertinent to drug target discovery, for such a diverse array of parasitic and bacterial diseases," says Dr. Wesley Van Voorhis from the University of Washington, who coordinates the Drug Target Prioritization Network, established in 2005 by the Special Programme for Research and Training in Tropical diseases (TDR) of WHO. The consortium includes a global team of academic laboratories, research centres and industry scientists, focusing on the pathogens responsible for malaria, tuberculosis, African sleeping sickness, leishmaniasis, Chagas disease and worm infections such as schistosomiasis and filariasis -- all of which are in desperate need of new treatments. The network's goal is to identify and prioritize drug targets against diseases that predominantly affect developing countries. The database is unique in that it allows any researcher -- in both developed and developing countries -- to have access to this kind of information. The database is building on a decade of intensive international investment that has already resulted in the complete genome sequences for organisms responsible for five tropical diseases, with more anticipated for the parasitic worms known as helminths. Pharmaceutical firms have extensive libraries of chemicals that might act against the disease pathogens. The missing step, which this initiative takes, is to make available a list of proposed and validated drug targets, in addition to allowing users to define their own search criteria.
(WHO 4/16/07, http://who.int/en )

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WHO uses web-based approach to revise global disease standards (ICD)
WHO is launching a major online project to revise the global standard for medical and health statistics - the International Classification of Diseases (ICD). For the first time, WHO is inviting stakeholders to participate in the ICD revision through an Internet platform. This update is vital in order to keep up with recent progress in medicine and the use of information technology in the field of health, and to improve the basis for international comparisons. The last version of ICD was adopted in 1990 by all WHO Member States, which have formally agreed to use it as a standard to report diseases and deaths. The first meeting of a steering group to oversee the revision took place in Japan from 16 to 18 April 2007. Any user can enter suggestions to improve the ICD via a new web application called "ICD-10 Plus" (http://extranet.who.int/icdrevision ). Any user who registers can contribute to the revision and back his or her proposal with evidence. Emerging diseases and scientific developments, combined with advances in service delivery and health information systems, require a revision of this global classification system. One major need is to improve the relevance of the ICD in primary care settings (clinics, doctors' offices and frontline health services), as that is where most people are treated. Another key driver is the development of computerized health information systems that require classifying electronic patient records according to the ICD.
(WHO 4/16/07, http://who.int/en )

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US Department of Health and Human Services offers plan for defense against biological threats
The US Department of Health and Human Services (HHS) recently unveiled its plan for developing and buying medical countermeasures against a range of biological, chemical, and other threats, with new anthrax and smallpox vaccines among the near-term priorities. The 21-page implementation plan, released April 20 on the HHS Web site and in the Federal Register, details how the agency will acquire countermeasures against 14 threats on its priority list, which include 9 category A biological agents, 2 category B biological agents, typhus, certain volatile nerve agents, and radiological and nuclear agents.
(CIDRAP 4/25/07, http://cidrap.umn.edu )

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Countries Gear Up for Vaccination Week in the Americas, April 21-28
The countries of the Americas are preparing a huge promotional effort for the fifth year of Vaccination Week in the Americas, which this year aims to immunize some 55 million persons. The regional launching of the initiative took place Apr 21 in Puerto Iguazu, on the tri-national border between Argentina, Brazil, and Paraguay, with the Ministers of Health of the 3 countries joining Pan American Health Organization Director and other officials. 45 countries and territories are participating in the week by launching a variety of vaccination campaigns, along with other health activities and social communication campaigns to increase awareness of the importance of immunization. The focus of Vaccination Week is to improve vaccination coverage in areas where it is low, to immunize indigenous communities, and to promote the use of new and existing vaccines. Endorsed by all member countries of PAHO in 2003, the effort has already succeeded in reaching over 147 million children, women, men, and older adults, especially in difficult to reach populations, isolated border communities and municipalities with low immunization coverage.

***To view the CDC’s MMWR article on vaccination week, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5615a6.htm.
(PAHO 4/23/07, http://www.paho.org )

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 apecein@u.washington.edu