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Vol. X. NO. 10 ~ EINet News Briefs ~ May 11, 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: APEC Avian Influenza Ministerial Meeting Concludes with Release of Action Plan
- Global: WHO equivocal on prepandemic use of H5N1 vaccines
- Bangladesh (Savar): 8500 chickens culled in 3 farms after detection of avian influenza
- Indonesia (Riau): 75th human death from avian influenza H5N1 infection
- India (West Bengal): Suspected avian influenza infection in chickens
- Viet Nam (Nghe An): Avian influenza in ducks
- China (Guangdong): Undiagnosed fatal porcine disease
- Russia (Yugra): 11 people hospitalized with yersiniosis
- Russia (Astrakhan): Cases of Crimean-Congo Hemorrhagic Fever
- Canada (Alberta): Ginseng product incorporated into pandemic stockpile
- USA: CDC Interim Guidance for Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic
- USA: FDA Clears First Respirators for Use in Public Health Medical Emergencies
- USA: Agencies to test fewer wild birds for avian flu this year
- USA: Department of Defense releases pandemic flu implementation plan
- USA: Poll shows many unready for public health crisis
- Canada: Increased mumps incidence
- Canada (Alberta): Rabies transmitted by bat kills man
- USA (Pennsylvania): Unidentified gastrointestinal illness
- USA (Florida): Three cases of measles
- USA (New Mexico): Confirmed case of septicemic plague
- Australia (Victoria): Testing for arenavirus proposed for transplant organs

1. Updates
- Avian/Pandemic influenza updates
- Dengue

2. Articles
- Pandemic influenza planning: Shouldn't swine and poultry workers be included?
- The Next Influenza Pandemic: Can It Be Predicted?
- Spatial, Temporal, and Species Variation in Prevalence of Influenza A Viruses in Wild Migratory
- Identification of a Novel Polyomavirus from Patients with Acute Respiratory Tract Infections
- Prevention, control, and elimination of neglected diseases in the Americas: Pathways to integrated, inter-programmatic, inter-sectoral action for health and development.
- Hemagglutinin Protein Is a Primary Target of the Measles Virus–Specific HLA-A2–Restricted CD8+ T Cell Response during Measles and after Vaccination
- Influence of Leishmania (Viannia) Species on the Response to Antimonial Treatment in Patients with American Tegumentary Leishmaniasis
- Vulvar Vaccinia Infection After Sexual Contact with a Military Smallpox Vaccinee--Alaska, 2006
- Progress in Hepatitis B Prevention Through Universal Infant Vaccination--China, 1997—2006
- Characteristics of Persons with Chronic Hepatitis B--San Francisco, California, 2006

3. Notifications
- USA: CDC Requests Information on Influenza-Associated Pediatric Mortality and the Increase of Staphylococcus aureus co-infection
- EU approves Novartis's 'mock-up' pandemic vaccine
- Wellcome Trust offers malaria curriculum on CD-ROM
- Hepatitis Awareness Month --- May 2007
- Update on Supply of Vaccines Containing Varicella-Zoster Virus
- Public Health Information Network Conference, August 27--29, 2007


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 5/7/07): http://gamapserver.who.int/mapLibrary/

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

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Global: APEC Avian Influenza Ministerial Meeting Concludes with Release of Action Plan
APEC Ministers have adopted an Action Plan that will strengthen the ability of Member Economies to detect and respond to outbreaks of Avian Influenza in the Asia-Pacific. At the conclusion, on May 5, 2007, of a meeting held in Viet Nam, attended by Ministers and Senior Officials from Agricultural and Health Departments from around the APEC Region, Ministers endorsed the "APEC Action Plan on the Prevention and Response to Avian and Influenza Pandemics." Covering 5 specific areas, the Action Plan lays down directives and requirements that will now be implemented at a domestic level by APEC Member Economies. Viet Nam's Minister for Agriculture and Rural Development and Co-Chair of the ministerial meeting, Mr. Cao Duc Phat, said Ministers recognize that the only way to defeat the threat posed by an Avian Influenza Pandemic is to work across sectors and across borders. "The Action plan will enhance the region's capacity to deal with Avian Influenza outbreaks by increasing cross-border cooperation and sharing information between governments departments," Mr. Cao said. "The Action Plan also recognizes that reducing the massive economic and social costs associated with Avian Influenza also requires a high level of cooperation between government and business. The five areas covered by the Action Plan are:

* Multi-sectoral cooperation and coordination on avian and pandemic influenza
* Establishing best practices and common approaches to risk communications
* Mitigating negative effects of avian influenza on agriculture and trade
* Working with the private sector to help ensure continuity of business, trade and essential services
* Strengthening regional and international cooperation
The full text of the Action Plan is available for download at http://www.apec.org/apec/news___media/media_releases/050506_vn_aipministerialconcludes.html
(APEC 5/5/07)

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Global: WHO equivocal on prepandemic use of H5N1 vaccines
WHO said May 9, 2007 that "a number" of human vaccines against the H5N1 avian influenza may become available soon, but declined to say whether they should be used before a flu pandemic arises. Besides the H5N1 vaccine approved by the US Food and Drug Administration in Apr 2007, "a number of the most advanced candidate vaccines against H5N1 avian influenza might be registered within 6 months to 2 years," WHO said in a question-and-answer bulletin on pandemic flu vaccines. The original bulletin can be accessed at http://www.who.int/immunization/newsroom/PI_QAs/en/index.html. As they become available, "prepandemic" vaccines for H5N1 could be used in poultry workers, healthcare workers, or even whole populations, WHO said, but the agency stopped short of recommending that step in advance of an actual pandemic. "WHO's expert groups point out that the pandemic virus may be quite different than what people are immunized against and therefore the vaccine may not be protective, and that any decision about whether to use avian flu vaccines as a hedge against pandemic influenza must be done so with full knowledge of this fundamental uncertainty," the statement said. WHO said a rapid increase in flu vaccine production capacity is likely in the next few years but cautioned that a universal flu vaccine may be more than a decade away.
(CIDRAP 5/10/07, http://cidrap.umn.edu )

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Asia
Bangladesh (Savar): 8500 chickens culled in 3 farms after detection of avian influenza
Some 8500 chickens were culled in 3 poultry farms in Unb, Savar on May 4, 2007, following detection of bird flu in a nearby farm. Joint forces and livestock officials culled 4000 chickens in Masum Poultry Farm of Abdul Karim, 2500 chickens in Lamia Poultry Farm of Anwar Hossain and 2000 chickens in Patuakhali Poultry Farm-2 of Joynal Abedin. A day earlier, 1500 chickens had been culled in Patuakhali Poultry Farm in Rajason area following detection of bird flu. The latest culling come after a government mandate to cull all chickens on farms within a 1 km radius of the first affected farm. Local authorities also imposed a ban on transportation of poultry products in the affected area. Avian influenza seems to continue its spread in Bangladesh, where it reportedly started 5 Feb 2007, was confirmed 22 March 2007, and was notified to the OIE 30 Mar 2007.
(ProMED 5/6/07, http://www.promedmail.org )

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Indonesia (Riau): 75th human death from avian influenza H5N1 infection
Bird flu has killed a woman in Indonesia, taking the death toll in the country worst hit by the virus to 75, a health ministry official said May 7, 2007. 2 series of tests confirmed that the 29-year-old woman was infected with the H5N1 strain of the virus. The woman was admitted to the International Hospital in Medan in northern Sumatra, 2 May 2007, and died 2 days later. It remains unclear how the woman contracted the virus, as she did not have any known contact with sick poultry, the most common form of infection. The latest death comes as Indonesia is embroiled in a dispute with WHO over delays on resuming sharing bird flu samples with WHO. Indonesia agreed in Mar 2007 to an immediate resumption -- after reaching a breakthrough agreement in international talks with WHO to develop a new mechanism on sample-sharing. But more than 4 weeks later, samples have not been sent. Indonesia stopped sending samples, aimed at fighting the disease, in Dec 2006, over concerns that drug firms would use them to develop costly vaccines beyond the budgets of poorer countries. The Indonesian ministry of health in this report gives the total number of deaths in Indonesia as 75, including the latest case in Sumatra. In contrast, WHO's cumulative table of avian influenza deaths (last updated 11 April 2007) gives the number of confirmed deaths in Indonesia as 63 and the global total as 172. This most recent cases represent the first human cases of avian influenza H5N1 reported worldwide in almost 1 month.
(ProMED 5/7/07, 5/9/07, http://www.promedmail.org, CIDRAP 5/7/07, http://cidrap.umn.edu )

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India (West Bengal): Suspected avian influenza infection in chickens
The death of more than 2500 chickens at a Siliguri poultry farm has created a bird flu scare. Officials are not taking the death of the chickens lightly, especially because a bird flu alert has been sounded at the Indo-Bangla border areas in the region. The Raj Aziz Poultry Farm at Patharghata village in Matigara on the outskirts of Siliguri town has been witnessing death of its chickens in bulk since 3 May 2007. Administrative sources confirmed that the chicks were supplied to the farm from Malda and thus run the suspicion that those might had been imported from Bangladesh, where confirmed cases of bird flu were reported recently. Animal husbandry officials, however, have refused to comment on the nature of the disease that led to the death of a large number of chickens. India recorded its first outbreak of HPAI (highly pathogenic avian influenza) H5N1, in Maharashtra Province, on 20 Feb 2006. The infection was also reported from Gujarat and Madhya Pradesh Provinces both in backyard and commercial poultry.
(ProMED 5/8/07, http://www.promedmail.org )

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Viet Nam (Nghe An): Avian influenza in ducks
Since May 1, 2007, bird flu has killed almost 250 ducks in central Viet Nam, in the country's first outbreak of the disease in more than a month, local health authorities reported. Animal health staff in Nghe An Province have culled the remaining 360 ducks from the infected flock. The flock had not been vaccinated against bird flu. Dien Tho commune, where the flock was raised, has now been quarantined and disinfected. Tests showed the ducks were infected with H5 virus, and further tests will be carried out to determine whether it is H5N1.
(ProMED 5/6/07, http://www.promedmail.org )

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China (Guangdong): Undiagnosed fatal porcine disease
A mysterious epidemic is killing pigs in southeastern China, but international and Hong Kong authorities said May 7 that the Chinese government is providing little information about it. Because pigs can catch many of the same diseases as people, including avian influenza, UN agencies maintain global networks to track and investigate unexplained patterns of pig deaths. Hong Kong media provided accounts of pigs staggering around with blood pouring from their bodies in Gaoyao and neighboring Yunfu, both in Guangdong Province. Reportedly, as many as 80 per cent of the pigs in the area had died, farmers were selling ailing animals at deep discounts, and pig carcasses were floating in a river. The reports in Hong Kong said the disease began killing pigs after the Chinese New Year celebrations Feb 2007 and that it is now spreading. But state-controlled news outlets in China have reported almost nothing about the pig deaths. Medical experts said that the extent of the bleeding from the pigs, including reports of bloody skin lesions, did not sound like the usual symptoms of bird flu but added that the pig deaths nonetheless needed to be investigated. A spokesman for the Hong Kong Agriculture, Fisheries and Conservation Department said that there were no signs of suspicious deaths among Hong Kong's pigs. This information may be related to reports of "pig high fever disease" [PHFD], described in China since summer 2006 and subsequently notified to the Office International des Epizooties as an emerging, multifactorial condition. The mentioned disease agents were classical swine fever [CSF], porcine reproductive and respiratory syndrome [PRRS], and porcine circovirus [PCV-2]. In addition, some samples were positive for Aujeszky's disease, Streptococcus suis, pasteurellosis, and porcine contagious pleuropneumonia infection.
(ProMED 5/7/07, http://www.promedmail.org )

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Russia (Yugra): 11 people hospitalized with yersiniosis
A total of 11 inhabitants of Megion were hospitalized with the acute infectious disease known yersiniosis. Reservoirs of this infection are animals, birds, and rodents. The disease occurs when people ingest contaminated food. As deputy chief of the territorial management of Rospotrebnadzor (Federal Service for Surveillance of Consumer Rights and Human Welfare) explained, the affected people lived in a hostel without a refrigerator. They stored food on a floor. Thus, rodents easily could infect foodstuffs. Experts of the Rospotrebnadzor check shops and companies that deliver food to the city's general educational establishments. Experts advised to carefully wash vegetables and fruit with hot water.
(ProMED, 5/1/07, http://www.promedmail.org)

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Russia (Astrakhan): Cases of Crimean-Congo Hemorrhagic Fever
The first cases of Crimean-Congo hemorrhagic fever (CCHF) have been observed in the Astrakhan region. Reportedly, on 3 May 2007, residents of the village of Colenoye Zaymische in the Chernojarskiy district were admitted to hospital with characteristic symptoms of CCHF: i.e. an acute fever, symptoms of intoxication, and severe hemorrhagic symptoms. Ticks are the source of the infection. 16 cases of CCHF were recorded last year in Russia, including 1 fatality. According to the Federal Service for Surveillance of Consumer Rights and Human Welfare, favorable weather conditions contributed to a marked increase in the density of the tick population. CCHF is caused by infection with a tick-borne virus belonging to the genus Nairovirus of the family Bunyaviridae. The disease was first characterized in the Crimea in 1944 and given the name Crimean hemorrhagic fever. It was then later recognized in 1969 as the cause of illness in the Congo, thus resulting in the current name of the disease. Crimean-Congo hemorrhagic fever (CCHF) is found in Eastern Europe, particularly in Russia and the countries of the former Soviet Union. It is also distributed throughout the Mediterranean, in northwestern China, central Asia, southern Europe, Africa, the Middle East, and the Indian subcontinent.
(ProMED 5/6/07, http://www.promedmail.org )

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Americas
Canada (Alberta): Ginseng product incorporated into pandemic stockpile
The city of Edmonton, Alberta, recently announced that it was stockpiling an herbal supplement in the hope of boosting the immunity of police, firefighters, and other essential workers during an influenza pandemic. By buying a ginseng product from CV Technologies, Inc., a company based in Edmonton, the city has become the first in North America to add an herbal supplement to its pandemic stockpile, according to media reports. The supplement, COLD-fX, is a proprietary extract of North American ginseng that contains what the company calls unique polysaccharide components. It is Canada's top-selling over-the-counter cold and flu remedy, according to an April 23 company press release. Some randomized, double-blind, placebo-controlled studies have suggested that COLD-fX can help people reduce their number of colds and the duration and severity of symptoms.
(CIDRAP 5/11/07, http://cidrap.umn.edu )

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USA: CDC Interim Guidance for Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic
This document describes interim guidance for the use of facemasks and respirators in certain public settings during an influenza pandemic. Very little information is available about the effectiveness of facemasks and respirators in controlling the spread of pandemic influenza in community settings. In the absence of scientific data, this document offers interim recommendations that are based on public health judgment and on the historical use of facemasks and respirators in other settings. In brief, these interim recommendations advise the following:

* Whenever possible, rather than relying on the use of facemasks or respirators, close contact and crowded conditions should be avoided during an influenza pandemic.
* Facemasks should be considered for use by individuals who enter crowded settings, both to protect their nose and mouth from other people's coughs and to reduce the wearers' likelihood of coughing on others. The time spent in crowded settings should be as short as possible.
* Respirators should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must take care of a sick person (e.g., family member with a respiratory infection) at home.

Facemasks and respirators should be used in combination with other preventive measures, such as hand hygiene and social distancing, to help reduce the risk for influenza infection during a pandemic. This interim guidance will be updated as new information becomes available.
http://www.pandemicflu.gov/plan/community/maskguidancecommunity.html

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USA: FDA Clears First Respirators for Use in Public Health Medical Emergencies
The U.S. Food and Drug Administration (FDA) today cleared for marketing the first respirators that can help reduce the user's exposure to airborne germs during a public health medical emergency, such as an influenza pandemic. The two filtering facepiece respirators, manufactured by St. Paul, Minn.-based 3M Company (and called the 3M Respirator 8612F and 8670F), will be available to the general public without a prescription. The devices are also certified as N95 filtering facepiece respirators by the National Institute for Occupational Safety and Health (NIOSH). NIOSH certifies respirators for use in occupational settings in accordance with an appropriate respiratory protection program. FDA will soon issue a guidance document outlining its regulatory approach to this new type of device. Inhaling particles is just one route of exposure to disease-causing organisms. Others include touching contaminated surfaces and coming into close contact with those who have infectious diseases. A total approach to personal protection includes hand hygiene, cough etiquette and other protection practices such as avoiding crowded settings.
http://www.fda.gov/bbs/topics/NEWS/2007/NEW01630.html

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USA: Agencies to test fewer wild birds for avian flu this year
US government agencies said May 8 that they will test fewer wild birds for the H5N1 avian influenza virus in the 2007 season than they did last season, while focusing on the highest-risk species and locations. The two agencies that monitor wild birds—the US Department of Agriculture (USDA) and the Department of the Interior (DOI)—collected about 109,000 samples from birds during the 2006 season, which ran from Apr 1, 2006, to Mar 31, 2007, said Karen Eggert, a spokeswoman for the USDA's Animal and Plant Health Inspection Service (APHIS). The 2 agencies plan to collect about 77,000 bird samples for the 2007 season, about 32,000 fewer than in 2006, Eggert said. She said the agencies also plan to test 25,000 fecal environmental samples, down from 50,000 tested last season. Based on information collected last season, the USDA's strategy for this year will focus on sick and dead birds from duck species believed to be the most likely carriers of H5N1: mallards, American wigeons, and northern pintails. The agencies will focus on the Pacific, Atlantic, Central, and Mississippi flyways, as well as Hawaii in the South Pacific.
(CIDRAP 5/7/07, http://cidrap.umn.edu)

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USA: Department of Defense releases pandemic flu implementation plan
The Defense Department is teaming with other federal agencies to prepare the nation to deal with a potential pandemic outbreak of influenza, a senior official said May 8, 2007. The Defense Department is rolling out its Pandemic Influenza Implementation Plan to the public, part of the president’s initiative to prepare the nation for a potential mass outbreak of deadly influenza virus or other threats. Deputy Defense Secretary Gordon R. England signed off on the defense department’s portion of the interagency plan Aug 2006. The plan includes information on how people can help curtail the spread and mitigate the effects of a possible flu pandemic. The Defense Department also teams with the U.S. departments of Homeland Security, Health and Human Services, and State, the Centers for Disease Control and Prevention, WHO, and other groups to monitor possible pandemic-causing maladies such as the avian flu.
(Department of Defense, http://www.defenselink.mil/news/newsarticle.aspx?id=45950)

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USA: Poll shows many unready for public health crisis
A recent survey sponsored by the American Public Health Association (APHA) indicates that about a third of Americans have made no preparations for a public health emergency and nearly 90% have prepared less than they think they should. The APHA survey, released Apr 2007 at an expert roundtable discussion during National Public Health Week, was recently posted on the association's Web site. The online survey was conducted Feb 2007 by Peter D. Hart Research Associates. It included 925 adults and sought the input of several specific groups, including mothers with children younger than 5, hourly wageworkers, and adults who have chronic medical conditions. Among the study’s finding: 32 percent of the public have taken no special steps to prepare for a public health emergency that could leave them short of food, water, or medication, and an 87% majority said they knew they had not done enough and could do more to prepare for a public health emergency. Only 26% of respondents thought that a public health crisis would affect their family in the next year or two, but 57% thought a severe storm might strike their area in the next few years, 47% thought an infectious disease outbreak such as the flu is likely, and 43% believed a foodborne disease outbreak is likely. In other findings, researchers reported that only 37% of employers believed that a public health crisis would affect their business during the next few years, and only 18% said they could continue paying their employees if business operations were interrupted.
(CIDRAP 5/8/07, http://cidrap.umn.edu )

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Canada: Increased mumps incidence
Increased mumps activity is currently being reported in several Canadian provinces (Nova Scotia, New Brunswick, Ontario and Prince Edward Island). At least 241 cases have been reported, with 203 of them in Nova Scotia. Confirmed cases include both laboratory-confirmed cases as well as clinically confirmed cases that are linked to laboratory-confirmed cases. The majority of cases were reported from only one or 2 public health authorities with limited activity seen elsewhere in these provinces, and a majority of the cases are associated with university settings. The viral strain in these outbreaks is identical to the strain (genotype G) detected from the 2005-06 Nova Scotia outbreaks, the United States' multi-state outbreak in 2006, and the United Kingdom epidemic between 2004 and 2006. The majority of cases are occurring among university-aged individuals. The reason for the particular susceptibility among this cohort is multifactorial. The very social and mobile lifestyle of this age group appears to be facilitating disease transmission and is posing barriers to the adherence of isolation requests. Communication efforts are increasing as the post-secondary academic year ends and students disperse. Additional cases in this demographic group and possibly other jurisdictions would not be unexpected. However, during previous outbreaks in Canada, this has not resulted in sustained transmission or large outbreaks. The 2004 national immunization coverage survey (NICS) found that 94 percent of Canadian children had received single dose of the MMR vaccine by their second birthday. Coverage estimates for the second dose of the MMR (Measles, Mumps and Rubella) vaccine by 7 years of age was 79 percent. 93 percent of Canadians had received one or more doses of mumps vaccine by their 17th birthday. Cases are asked to self-isolate for a period of 9 days following onset of symptoms. The vaccine status of close contacts is assessed and updated so that they receive 2 doses of MMR. Reportedly health officials are considering a re-vaccination campaign for mumps.
(ProMED 5/1/07, 5/5/07, 5/10/07 http://www.promedmail.org )

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Canada (Alberta): Rabies transmitted by bat kills man
A 73-year-old man with rabies encephalitis succumbed to the illness after an 8 week ICU stay. After the diagnosis was confirmed Mar 1, 2007 by nuchal biopsy DFA, he was treated with the Wisconsin protocol (which successfully treated a girl with rabies). He had slow development of a neutralizing antibody response in blood and CSF. After withdrawal of all sedation, he continued to meet clinical criteria for brain death, although cerebral perfusion was maintained by nuclear imaging. Supportive care was continued as the reported unvaccinated survivor had a similar clinical picture for a time after development of an antibody response. However, after progressive worsening of his neuro-imaging and a complete lack of neurologic recovery over weeks, care was withdrawn, and he died Apr 26 2007. Postmortem results on the pathology of the progressive neurologic inflammation are pending. This man had received rabies vaccination after he had established encephalitic disease, presented with advanced disease, and was of older age. It is unclear, but these factors may have further altered his neurologic course adversely. Success of the Wisconsin protocol is yet to be replicated. The bat bite occurred Aug 2006, and the patient developed prodromal symptoms (pain at the bite site) Jan 2007. Variant typing of the virus responsible for this infection has been completed, and it is typical of those known to circulate in silver haired bats in the US and Canada, This variant has been implicated in a significant number of indigenously-acquired human rabies cases in the US in recent years and was the strain responsible for the Quebec case in 2000.
(ProMED 4/30/07, http://www.promedmail.org )

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USA (Pennsylvania): Unidentified gastrointestinal illness
More than 100 elementary school students were absent from school on a single day last week after experiencing gastroenteritis-like symptoms. An additional 11 students were sent home after getting sick during school. All told, approximately 20 percent of the school's 642 students were absent. Although the cause of sickness has yet to be determined, the Pennsylvania Department of Health said a gastrointestinal virus may be to blame. Samples of some of the students' vomit were collected by the department and will be tested to determine a cause. No students were hospitalized, and there was no quarantine of the school. The outbreak shows some of the characteristics of an outbreak of sudden-onset short duration gastroenteritis caused by a norovirus. Norovirus outbreaks often occur in institutional settings, such as schools, childcare facilities, and nursing homes, and can occur in other group settings such as banquet halls, cruise ships, dormitories, and campgrounds.
(ProMED, 4/28/07, http://www.promedmail.org )

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USA (Florida): Three cases of measles
There are 3 cases of a highly contagious virus in Alachua county, Florida, including one University of Florida (UF) student. This is the first outbreak of the measles virus in this community in the last 20 years. The ill student was never vaccinated for measles due to religious reasons. The Director of the Alachua County Health Department, Tom Belcoure, says there is a big concern about the virus spreading. As a precautionary measure, the University is making sure the infected student stays off campus as well as anyone not vaccinated. The infected student also had contact with the Hare Krishna religious community at UF, which serves lunches; the university has asked the Krishna's to stop serving lunch for at least 30 days.
(ProMED 5/3/07, http://www.promedmail.org )

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USA (New Mexico): Confirmed case of septicemic plague
The New Mexico State Department of Health confirmed a case of septicemic plague in a 49-year-old San Juan County man. It is the first case of 2007 in New Mexico and the first in a San Juan County resident since 1999. Plague is generally transmitted to humans through bites of infected fleas. It can also be transmitted by direct contact with infected animals, including rodents, wildlife and pets. Septicemic plague occurs when the bacteria multiply in the blood.
(ProMED 5/4/07, http://www.promedmail.org )

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Australia (Victoria): Testing for arenavirus proposed for transplant organs
Health authorities will consider introducing routine testing for a previously unknown virus that caused the deaths of 3 organ transplant recipients in Victoria earlier this year. The virus was discovered after the deaths of 3 women, aged 63, 64 and 44. They had received the liver and kidneys of a 57-year-old organ donor who died of a brain hemorrhage Dec 2006, shortly after returning to Australia from an extended stay in Europe. The women died within a week of each other Jan 2007, about a month after receiving the organs. The Victoria Infectious Diseases Reference Laboratory, in collaboration with the Greene Infectious Disease Laboratory at New York's Columbia University, uncovered a link to the lymphocytic choriomeningitis virus (LCMV). Further testing on tissue samples from the 3 patients confirmed a new type of arenavirus, a family of mainly rodent viruses that occasionally affect humans. LCMV, which the virus most closely resembles and which caused similar transplant deaths in the US in 2003 and 2005, usually causes only minor symptoms in humans. Organ transplant recipients, however, do not have the immunity to fight it off. Victoria's acting chief health officer John Carnie said the virus was not transmissible between humans in normal circumstances and that transplant patients should retain confidence in the system. Further studies on the as yet unnamed virus are being conducted in Victoria and the US.
(ProMED, 4/30/07, http://www.promedmail.org )

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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.
- US CDC: http://www.cdc.gov/flu/avian/index.htm.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Information on the Community/Non-Occupational Mask Guidance plan.
- 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
Hong Kong/Indonesia
The Centre for Health Protection has confirmed an imported dengue fever case, involving a 59-year-old North Point woman. She traveled to Indonesia 29 March-15 April, 2007 and came down with fever, headache, and a rash 11 Apr 2007. She was admitted to Ruttonjee Hospital 15 Apr 2007 and discharged 23 April 2007. Her travel companion had no symptoms. This is the sixth imported dengue fever case reported this year.
(ProMED, 5/1/07, http://www.promedmail.org )

Malaysia (Tuaran)
The dengue situation in the Tuaran district is under control due to the actions taken by the Health Department here, said Local Government and Housing Minister Datuk Hajiji Mohd Noor. He said the situation would be continuously monitored so that appropriate measures would be taken immediately to contain the spread of the disease. During Apr 2007, dengue claimed the life of a woman in her 60s in the district. The Health Department had also recorded 6 other dengue cases in the district so far this year. 15 villages in the district have been identified as breeding grounds for the Aedes mosquito that transmits dengue virus.
(ProMED, 5/4/07, http://www.promedmail.org)

Philippines (Manila)
The dengue epidemic has killed 54 people in the Philippines so far this year and is threatening several neighborhoods of Metro Manila as well as some provinces, said the Philippine Department of Health. The DOH's latest Dengue Surveillance Report said the barangays (neighborhoods) with cluster of dengue cases, where more than 1 case of dengue in 1 family has been reported, are located in Malabon, Navotas and Quezon City of Metro Manila and Bangui in Ilocos Norte, northern Philippines, and Cabantian and Sasa in Davao City in the south. The DOH also said, from Jan to 21 Apr [2007], a total of 4858 dengue cases were admitted in different sentinel hospitals nationwide. There were 54 reported deaths. This year's figure is 14.7 percent lower compared to the same period last year of 5696 cases with 78 deaths, said DOH. Dengue prevention and control measures include searching and destroying all possible breeding of the mosquito vector, self-protection measures like the use of mosquito repellent and other protective gear, seeking early consultation and management of cases and saying no to indiscriminate fogging, which can only be done if there is an outbreak of dengue. While dengue is considered an all year-round disease, the number of cases increases mainly during rainy days when there are more breeding places of the mosquito. (ProMED, 5/4/07, http://www.promedmail.org)

Thailand (Trat)
The Thai health ministry is on full alert to prevent the spread of dengue fever, after the disease claimed 4 lives so far this year. The number of dengue fever patients nationwide has reportedly risen to 6000. The focus of the outbreak is in Trat province, 400 km southeast of Bangkok on the Cambodian border, and in the southernmost provinces along the Malaysian border. Earlier than usual rains has meant that dengue is a greater concern this year than before, Public Health Minister Mongkol Na Songkhla said. The insurgency in the far South means that anti-mosquito measures are more difficult to apply. More breeding grounds for dengue-carrying mosquitoes emerge during the rainy season, especially in the 3 southernmost provinces where heavier rainfall contributes to a higher population of mosquitoes than in the country's other regions. The outbreak could become a severe problem in the border provinces as health officials cannot implement pro-active strategies to fight the disease due to the ongoing violence. The number of dengue fever patients is normally higher from May to August—the rainy season. So far there have been 6070 dengue-fever patients in the first 4 months of this year.
(ProMED, 5/4/07, http://www.promedmail.org)

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2. Articles
Pandemic influenza planning: Shouldn't swine and poultry workers be included?
Gray GC, Trampel DW, and Roth JA. Vaccine. 2007 May 30;25(22):4376-4381. Epub 2007 Apr 4.
Abstract: Recent research has demonstrated that swine and poultry professionals, especially those who work in large confinement facilities, are at markedly increased risk of zoonotic influenza virus infections. In serving as a bridging population for influenza virus spread between animals and man, these workers may introduce zoonotic influenza virus into their homes and communities as well as expose domestic swine and poultry to human influenza viruses. Prolonged and intense occupational exposures of humans working in swine or poultry confinement buildings could facilitate the generation of novel influenza viruses, as well as accelerate human influenza epidemics. Because of their potential bridging role, we posit that such workers should be recognized as a priority target group for annual influenza vaccines and receive special training to reduce the risk of influenza transmission. They should also be considered for increased surveillance and priority receipt of pandemic vaccines and antivirals.

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The Next Influenza Pandemic: Can It Be Predicted?
Taubenberger JK, Morens DM, Fauci AS. JAMA. 2007; 297:2025-2027.
Excerpt: Although most experts believe another influenza pandemic will occur, it is difficult to predict when or where it will appear or how severe it will be. Neither is there agreement about the subtype of the next pandemic influenza virus. However, the continuing spread of H5N1 highly pathogenic avian influenza A (HPAI) among poultry on several continents, associated with an increasing number of severe and fatal human infections, has raised the pandemic stakes. Genetically and antigenically divergent H5N1 HPAI strains appeared in 1997 and have been spreading globally since 2003. To date, epizootics in approximately 60 countries have caused a reported 291 human cases with 172 deaths. Do these unique features predict an impending H5N1 pandemic?

Section Headings:
How the H5N1 Virus May Be Evolving
Can the H5N1 Virus Become Adapted to and Transmissible Between Humans?
What Has Been Learned From Past Pandemics
The Next Pandemic
Conclusions

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Spatial, Temporal, and Species Variation in Prevalence of Influenza A Viruses in Wild Migratory
Munster VJ, Baas C, Lexmond P, Waldenström J, Wallensten A, et al. (2007) PLoS Pathog 3(5): e61
Abstract: Although extensive data exist on avian influenza in wild birds in North America, limited information is available from elsewhere, including Europe. Here, molecular diagnostic tools were employed for high-throughput surveillance of migratory birds, as an alternative to classical labor-intensive methods of virus isolation in eggs. This study included 36,809 samples from 323 bird species belonging to 18 orders, of which only 25 species of three orders were positive for influenza A virus. Information on species, locations, and timing is provided for all samples tested. Seven previously unknown host species for avian influenza virus were identified: barnacle goose, bean goose, brent goose, pink-footed goose, bewick's swan, common gull, and guillemot. Dabbling ducks were more frequently infected than other ducks and Anseriformes; this distinction was probably related to bird behavior rather than population sizes. Waders did not appear to play a role in the epidemiology of avian influenza in Europe, in contrast to the Americas. The high virus prevalence in ducks in Europe in spring as compared with North America could explain the differences in virus–host ecology between these continents. Most influenza A virus subtypes were detected in ducks, but H13 and H16 subtypes were detected primarily in gulls. Viruses of subtype H6 were more promiscuous in host range than other subtypes. Temporal and spatial variation in influenza virus prevalence in wild birds was observed, with influenza A virus prevalence varying by sampling location; this is probably related to migration patterns from northeast to southwest and a higher prevalence farther north along the flyways. We discuss the ecology and epidemiology of avian influenza A virus in wild birds in relation to host ecology and compare our results with published studies. These data are useful for designing new surveillance programs and are particularly relevant due to increased interest in avian influenza in wild birds. http://pathogens.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.ppat.0030061

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Identification of a Novel Polyomavirus from Patients with Acute Respiratory Tract Infections
Gaynor AM, Nissen MD, Whiley DM, Mackay IM, Lambert SB, et al. (2007) PLoS Pathog 3(5): e64.
Abstract: We report the identification of a novel polyomavirus present in respiratory secretions from human patients with symptoms of acute respiratory tract infection. The virus was initially detected in a nasopharyngeal aspirate from a 3-year-old child from Australia diagnosed with pneumonia. A random library was generated from nucleic acids extracted from the nasopharyngeal aspirate and analyzed by high throughput DNA sequencing. Multiple DNA fragments were cloned that possessed limited homology to known polyomaviruses. We subsequently sequenced the entire virus genome of 5,229 bp, henceforth referred to as WU virus, and found it to have genomic features characteristic of the family Polyomaviridae. The genome was predicted to encode small T antigen, large T antigen, and three capsid proteins: VP1, VP2, and VP3. Phylogenetic analysis clearly revealed that the WU virus was divergent from all known polyomaviruses. Screening of 2,135 patients with acute respiratory tract infections in Brisbane, Queensland, Australia, and St. Louis, Missouri, United States, using WU virus–specific PCR primers resulted in the detection of 43 additional specimens that contained WU virus. The presence of multiple instances of the virus in two continents suggests that this virus is geographically widespread in the human population and raises the possibility that the WU virus may be a human pathogen.
http://pathogens.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.ppat.0030064

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Prevention, control, and elimination of neglected diseases in the Americas: Pathways to integrated, inter-programmatic, inter-sectoral action for health and development.
Holveck JC et al. BMC Public Health 2007, 7:6. http://www.biomedcentral.com/1471-2458/7/6
Abstract: Background: In the Latin America and Caribbean region over 210 million people live below the poverty line. These impoverished and marginalized populations are heavily burdened with neglected communicable diseases. These diseases continue to enact a toll, not only on families and communities, but on the economically constrained countries themselves. Discussion: As national public health priorities, neglected communicable diseases typically maintain a low profile and are often left out when public health agendas are formulated. While many of the neglected diseases do not directly cause high rates of mortality, they contribute to an enormous rate of morbidity and a drastic reduction in income for the most poverty-stricken families and communities. The persistence of this "vicious cycle" between poverty and poor health demonstrates the importance of linking the activities of the health sector with those of other sectors such as education, housing, water and sanitation, labor, public works, transportation, agriculture, industry, and economic development. Summary: The purpose of this paper is three fold. First, it focuses on a need for integrated "pro-poor" approaches and policies to be developed in order to more adequately address the multi-faceted nature of neglected diseases. This represents a move away from traditional disease-centered approaches to a holistic approach that looks at the overarching causes and mechanisms that influence the health and well being of communities. The second objective of the paper outlines the need for a specific strategy for addressing these diseases and offers several programmatic entry points in the context of broad public health measures involving multiple sectors. Finally, the paper presents several current Pan American Health Organization and other institutional initiatives that already document the importance of integrated, inter-programmatic, and inter-sectoral approaches. They provide the framework for a renewed effort toward the efficient use of resources and the development of a comprehensive integrated solution to neglected communicable diseases found in the context of poverty, and tailored to the needs of local communities.

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Hemagglutinin Protein Is a Primary Target of the Measles Virus–Specific HLA-A2–Restricted CD8+ T Cell Response during Measles and after Vaccination
Ota MO, et al. The Journal of Infectious Diseases. 2007;195:000.
Abstract: To characterize the measles virus (MV)–specific T cell responses important for evaluation of measles vaccines, human leukocyte antigen (HLA)–A2–positive and –negative adults immunized with measles-mumps-rubella vaccine were studied. Both groups developed increases in antibody and in interferon (IFN)-γ–producing cells in response to pooled hemagglutinin (H) and fusion peptides. HLA-A2–binding peptides were predicted for all MV-encoded proteins and confirmed by T2 cell stabilization. Twenty-nine peptides were tested, and 19 (6 from H) stimulated increased IFN-γ secretion in a majority of vaccinees. Peptide-loaded HLA-A2 tetramers or immunoglobulin dimers documented MV-specific CD8+ T cell responses after vaccination and during measles and confirmed new A2 epitopes in H (250–259 and 516–525 aa) and matrix (M; 50–58 aa) protein and previously described epitopes in H (30–38 aa), M (211–219 aa), and nonstructural protein C (84–92 aa). No single peptide dominated the response. We conclude that H is an important stimulus for CD8+ T cell as well as for antibody responses in HLA-A2–positive individuals.

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Influence of Leishmania (Viannia) Species on the Response to Antimonial Treatment in Patients with American Tegumentary Leishmaniasis
Arevalo, J, et al. The Journal of Infectious Diseases. 2007;195:000
Abstract: Background: Pentavalent antimonials (SbV) are the first-line chemotherapy for American tegumentary leishmaniasis (ATL). There are, however, reports of the occurrence of treatment failure with these drugs. Few studies in Latin America have compared the response to SbV treatment in ATL caused by different Leishmania species. Methods: Clinical parameters and response to SbV chemotherapy were studied in 103 patients with cutaneous leishmaniasis (CL) in Peru. Leishmania isolates were collected before treatment and typed by multilocus polymerase-chain-reaction restriction fragment–length polymorphism analysis. Results: The 103 isolates were identified as L. (Viannia) peruviana (47.6%), L. (V.) guyanensis (23.3%), L. (V.) braziliensis (22.3%), L. (V.) lainsoni (4.9%), L. (Leishmania) mexicana (1%), and a putative hybrid, L. (V.) braziliensis/L. (V.) peruviana (1%). L. (V.) guyanensis was most abundant in central Peru. Of patients infected with the 3 former species, 21 (21.9%) did not respond to SbV chemotherapy. The proportions of treatment failure (after 12 months of follow-up) were 30.4%, 24.5%, and 8.3% in patients infected with L. (V.) braziliensis, L. (V.) peruviana, and L. (V.) guyanensis, respectively. Infection with L. (V.) guyanensis was associated with significantly less treatment failure than L. (V.) braziliensis, as determined by multiple logistic regression analysis (odds ratio, 0.07 [95% confidence interval, 0.007–0.8]; P = .03). Conclusions: Leishmania species can influence SbV treatment outcome in patients with CL. Therefore, parasite identification is of utmost clinical importance, because it should lead to a species-oriented treatment.

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Vulvar Vaccinia Infection After Sexual Contact with a Military Smallpox Vaccinee--Alaska, 2006
“On October 10, 2006, an otherwise healthy woman visited a public health clinic in Alaska after vaginal tears that she had first experienced 10 days before became increasingly painful. The patient reported having a new male sex partner during September 22--October 1, 2006. A viral swab specimen from a labial lesion of the woman was submitted to the Alaska State Virology Laboratory (ASVL) for viral culture. The viral isolate could not be identified initially and subsequently was sent to CDC on January 9, 2007, where the isolate was identified as a vaccine-strain vaccinia virus. After vaccinia was identified, investigators interviewed the woman more closely and learned that her new sex partner was a male U.S. military service member stationed at a local military base. Further investigation determined that the service member had been vaccinated for smallpox 3 days before beginning his relationship with the woman. This report describes the clinical evaluation of the woman and laboratory testing performed to identify the isolate. Health-care providers should be aware of the possibility of vaccinia infection in persons with clinically compatible genital lesions who have had recent contact with smallpox vaccinees. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5617a1.htm
(MMWR May 4, 2007 / 56(17);417-419)

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Progress in Hepatitis B Prevention Through Universal Infant Vaccination--China, 1997—2006
(references removed)
“Hepatitis B virus (HBV) infection is a leading cause of illness and death in China. Approximately 60% of the population has a history of HBV infection, and 9.8% of persons in China are chronically infected with HBV and at risk for premature death from liver disease. Each year, an estimated 263,000 persons in China die from HBV-related liver cancer or cirrhosis, accounting for 37%--50% of HBV-related deaths worldwide. Because most HBV infections occur during infancy or early childhood, when HBV infection is most likely to become chronic, vaccination of infants beginning at birth is the key strategy for preventing chronic HBV infection. This report describes China's progress in increasing coverage among infants with hepatitis B vaccine (HepB) and timely administration of the HepB birth dose (i.e., within 24 hours of birth). Infant vaccination coverage with both the timely birth dose and the complete vaccine series was substantially higher among children born during 2003 than among those born during 1997; timely birth-dose coverage increased from 29.1% to 75.8%, and HepB series completion increased from 70.7% to 89.8%. Furthermore, in economically disadvantaged populations in western and middle provinces targeted by the China-Global Alliance for Vaccines and Immunization (China-GAVI) project, reported coverage with timely HepB birth dose increased from 64% in 2004 to 81% in 2006, and coverage with the complete HepB series increased from 52% in 2001 to 92% in 2006. China has established a goal to reduce chronic HBV infection among children aged <5 years to <1% by 2010. Achieving this goal will require continued commitment to increasing vaccination coverage in impoverished regions and ensuring that infants born at home are vaccinated within 24 hours of birth. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a2.htm
(MMWR May 11, 2007 / 56(18);441-445)

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Characteristics of Persons with Chronic Hepatitis B--San Francisco, California, 2006
(references removed)
“Chronic hepatitis B is the most common cause of cirrhosis and liver cancer worldwide. Approximately 45% of the world's population lives in regions where chronic hepatitis B virus (HBV) infection is endemic, including most of Asia and the Pacific Islands, Africa, and the Middle East. Nearly one fourth of the population of San Francisco was born in Asia and the Pacific Islands. In 2006, the San Francisco Department of Public Health (SFDPH) received reports consistent with probable chronic HBV infection for 2,238 persons. To characterize persons with reported confirmed chronic HBV infection in San Francisco in 2006, SFDPH collected additional data on a subset of 567 cases reported to the SFDPH chronic hepatitis B registry. 84 percent of the persons were Asians/Pacific Islanders (A/PIs), 80% of whom were foreign born. Fewer than half had been referred to a gastroenterologist/hepatologist for evaluation at the time of reporting. Persons with chronic HBV infection can benefit from medical care by providers with expertise in viral hepatitis. In addition, close contacts of infected persons should be screened and offered vaccination if found to be susceptible to HBV infection. Culturally appropriate counseling for and follow-up of persons with chronic HBV infection and their contacts could help reduce the transmission of HBV infection. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a3.htm
(MMWR May 11, 2007 / 56(18);446-448)

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3. Notifications
USA: CDC Requests Information on Influenza-Associated Pediatric Mortality and the Increase of Staphylococcus aureus co-infection
While the number of pediatric influenza associated deaths is similar to that reported during the two previous years, there has been an increase in the number of deaths in which both influenza and pneumonia or bacteremia due to S. aureus were identified. Only one influenza and S. aureus co-infection was identified in 2004-2005, and 3 were identified in 2005-2006. Of the 16 children reported with S. aureus so far in 2006-2007, 11 children had methicillin-resistant (MRSA) isolated from a sterile site (9) or sputum (2), and 5 had methicillin-susceptible S.aureus isolated from a sterile site (3) or sputum (2). The median age of children with S. aureus co-infection was older than children without S.aureus co-infection (11 years versus 4 years, p<.01). Children with influenza and S. aureus co-infections were reported to be in good health before illness onset but progressed rapidly to severe illness. Influenza strains isolated from these children have not been different from common strains circulating in the community and the MRSA strains have been typical of those associated with MRSA skin infection outbreaks in the United States. Healthcare providers should be alerted to the possibility of bacterial co-infection among children with influenza, and request bacterial cultures when bacterial co-infection is suspected. Clinicians, clinical agencies and medical examiners are asked to contact their local or state health department as soon as possible when deaths among children due to laboratory-confirmed influenza are identified. CDC requests that all cases of pediatric influenza-associated deaths be reported promptly by state health departments to CDC through http://sdn.cdc.gov and that information about bacterial pathogens isolated from sterile sites and/or from sputum or endotracheal aspirates be completed on the Influenza-Associated Pediatric Mortality Surveillance System case report form. If the influenza death was complicated by S. aureus infection, please contact the clinical agency to determine if the S. aureus isolate is available. CDC is interested in receiving S. aureus isolates to better characterize those from fatal cases of influenza in children.
(CDC 5/9/07, http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00259)

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EU approves Novartis's 'mock-up' pandemic vaccine
The European Union (EU) this week approved a "mock-up" influenza vaccine made by Novartis to permit a faster start on vaccine production in the event of a flu pandemic. When WHO declares a flu pandemic, the vaccine, called Focetria, will be adapted to contain the pandemic virus, the Swiss-based drug company announced. The vaccine will not be manufactured until a pandemic is declared. The European Medicines Agency's (EMEA's) Committee for Medicinal Products for Human Use (CHMP) recommended approval of Focetria Feb 22, 2007. A CHMP statement on that date said the vaccine was based on a 2004 strain of H5N1 avian flu from Vietnam. The vaccine contains Novartis's proprietary adjuvant MF59, an immune-boosting chemical, which can reduce the amount of active ingredient needed in each dose, the company says. The dose used in the approved mock-up vaccine is 15 micrograms (mcg), according to the CHMP. Novartis said it is also seeking EU approval for a prepandemic H5N1 vaccine that includes MF59 and is based on the same technology as Focetria. The vaccine is intended for use before a pandemic declaration to help "prime" the immune system to fight off H5N1 infections, the company says. Once a pandemic flu strain is identified, it will take at least 6 months to adapt the virus for production in eggs and start producing the vaccine in quantity. In April the FDA approved an H5N1 vaccine made by Sanofi Pasteur, despite only modest immunogenicity demonstrated in clinical trials. The Department of Health and Human Services has been stockpiling the vaccine for use in a pandemic.
(CIDRAP 5/9/07, http://cidrap.umn.edu)

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Wellcome Trust offers malaria curriculum on CD-ROM
A third edition of the Wellcome Trust's award-winning educational CD-ROM on malaria is now available. The CD gives an overview of the subject from parasite and vector biology, through clinical aspects, immunity, pathogenesis and epidemiology to latest treatment and control guidelines. Accessible and authoritative, the content has been reviewed by malaria experts worldwide. Topics include: artemisinin-based combination therapies, treatment of severe malaria, control of malaria in pregnancy,the role of rapid diagnostic tests, and long-lasting insecticidal nets. 'Malaria 3rd edition' is suitable for anyone teaching malaria or for new researchers wanting an accessible, current introduction to the topic. It is also useful for healthcare professionals. The CD is priced at 5 pounds for those based or working in developing countries, and 30 for those in developed countries.
Available from http://www.wellcome.ac.uk/node5816.html

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Hepatitis Awareness Month --- May 2007
May 2007 marks the 12th anniversary of Hepatitis Awareness Month. This issue of MMWR highlights public health measures to vaccinate and protect children from hepatitis B virus (HBV) infection in China and to monitor the characteristics of persons with chronic hepatitis B in San Francisco, USA. Worldwide, 370 million persons have chronic HBV infection, and 500,000--700,000 persons die annually from HBV-related liver disease; approximately 75% of HBV infections occur in Asia (WHO, unpublished data, 2006). In the US, approximately half of the 1 million persons with chronic HBV infection are Asians/Pacific Islanders, most of whom became infected with HBV before arriving in the US, including many who remain unaware of their infection. The HBV-related death rate among Asians/Pacific Islanders is 7 times greater than the rate among whites. Persons with chronic HBV infection are at risk for premature death from liver cirrhosis and cancer. Hepatitis B vaccination of infants worldwide will protect successive generations from chronic HBV infection and associated liver disease. Persons already infected with HBV can benefit from HBV screening, care, and treatment to protect their health and prevent transmission to others.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a1.htm
(MMWR May 11, 2007 / 56(18);441)

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Update on Supply of Vaccines Containing Varicella-Zoster Virus
In Feb 2007, CDC received notice from Merck & Co., Inc., that because of lower than expected amounts of varicella-zoster virus (VZV) in its recently manufactured bulk vaccine, Merck was prioritizing production of varicella (Varivax®) and zoster vaccines (Zostavax®) over production of MMR-V vaccine (ProQuad®). In May 2007, CDC received further notice from Merck that current projections of orders indicate ProQuad will be unavailable beginning in July 2007, although timing will depend on market demand. This might cause extended back orders for the next few months. After depletion of the existing supply, ProQuad is not expected to be available for the remainder of 2007. Merck is requesting that customers begin transitioning from ProQuad to M-M-R II® and Varivax at their earliest convenience. Merck expects to continue to meet demands for Varivax and M-M-R II to fully implement the recommended immunization schedule. This will allow for continued use of varicella vaccine for all age groups, including the routine 2-dose schedule for children aged 12--15 months and 4--6 years, catch-up vaccination with the second dose for children or adolescents who received only 1 dose, and vaccination with 2 doses for other children, adolescents, and adults without evidence of immunity. For zoster vaccine, the supply of Zostavax is expected to be adequate for routine vaccination of adults aged >60 years. Updates on vaccine shortages and delays are available from CDC at http://www.cdc.gov/nip/news/shortages/default.htm.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a6.htm
(MMWR May 11, 2007 / 56(18);453)

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Public Health Information Network Conference, August 27--29, 2007
The fifth annual Public Health Information Network (PHIN) Conference will be held Aug 27--29, 2007, in Atlanta, Georgia, at the Omni Hotel at CNN Center. The theme for this year's conference is Harmonizing Public Health Voices in National Health Information Technology (IT). Sponsored by CDC and the National Association of County & City Health Officials, the conference will feature workshops on knowledge management and standards implementation; training on informatics by the American Medical Informatics Association; opportunities for networking with informatics professionals from local, state, national, and international levels; and opportunities to provide input to CDC on how to implement the PHIN initiative in the context of the larger national Health IT Initiative. The goals of this year's conference are 1) to accelerate the development of a community that facilitates innovation and collaboration in public health informatics and the national Health IT Initiative and 2) to improve the ability of public health stakeholders to advance CDC's PHIN initiative and the national Health IT Initiative. The call for abstracts, conference registration, and hotel registration are available online at the conference website: http://wwwlink.cdc.gov/phinconference. The deadline for abstract submission is May 18, 2007. The deadline for online registration is Aug 6, 2007.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a5.htm
(MMWR May 11, 2007 / 56(18);452)

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 apecein@u.washington.edu