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Vol. X. NO. 11 ~ EINet News Briefs ~ May 25, 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 adopts resolution on influenza virus sharing
- Global: Experts support poultry vaccination for fighting avian influenza
- UK: Low pathogenic avian influenza hits Welsh farm
- Bangladesh: Report of another avian influenza H5N1 outbreak in birds
- China: Reports another avian influenza H5N1 outbreak in birds
- Indonesia (Central Java): New human case of avian influenza H5N1 infection
- Pakistan (Islamabad): Report of new avian influenza outbreak in poultry
- Viet Nam: New case of avian influenza H5N1 in human
- Viet Nam: More avian influenza H5N1 outbreaks among ducks
- Viet Nam: Avian influenza H5N9 vaccine for geese is normal says authorities
- Australia (New South Wales, Victoria): Rise in ocular Syphilis cases
- China (Shandong): Outbreak of hand, foot and mouth disease; 3 deaths
- Hong Kong: Confirmed case of Streptococcus suis
- Japan (multi-prefecture): Large measles outbreak hits young adults
- Russia (Southern Federal District): Increase in Crimean-Congo hemorrhagic fever cases
- Russia (Stavropol): Anthrax kills man; Police hunt anthrax-infected meat
- Taipei: First fatal case of severely complicated enterovirus infection in 2007
- Viet Nam: Suspension of hepatitis vaccine due to 3 deaths
- Canada (Nova Scotia): Begins mumps immunization for health-care workers
- Canada (multi-province): Ongoing Mumps outbreak
- USA: Recall of Beef Linked to E. coli Outbreak
- USA (Colorado): 2 Hantavirus cases confirmed
- USA (New Mexico): Imported case of measles from India
- USA: FDA panel recommends smallpox vaccine approval
- Ghana: Second avian influenza H5N1 outbreak; strain not similar to Asian strains
- Nigeria: Report of new avian influenza H5N1 outbreak; improper vaccinations

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

2. Articles
- Household Transmission of Vaccinia Virus from Contact with a Military Smallpox Vaccinee--Illinois and Indiana, 2007
- Vaccinating to Protect a Vulnerable Subpopulation
- Estimating Variability in the Transmission of Severe Acute Respiratory Syndrome to Household Contacts in Hong Kong, China
- Expedited influenza-related articles from CDC’s EID

3. Notifications
- HHS launches blog on pandemic preparedness
- OSHA releases pandemic flu guidance for healthcare workers
- Avian influenza: Implications for human disease; comprehensive reference from CIDRAP
- OIE: Today most countries overcome avian influenza outbreaks when they occur
- WHO delays destruction of smallpox virus
- Recreational Water Illness Prevention Week --- May 21--27, 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
Cambodia/ 1 (1)
China / 2 (1)
Egypt / 16 (4)
Indonesia / 22 (19)
Laos / 2 (2)
Nigeria / 1 (1)
Total / 44 (28)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 307 (186).
(WHO 5/24/07 http://www.who.int/csr/disease/avian_influenza/en/index.html )

Avian influenza age distribution data from WHO/WPRO:
http://www.wpro.who.int/sites/csr/data/data_Graphs.htm.
(WHO/WPRO 5/16/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 5/24/07):
http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 5/10/07):
http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.

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Global: WHO adopts resolution on influenza virus sharing
WHO approved a resolution on the sharing of influenza viruses and access to pandemic vaccines. The resolution calls on WHO to establish "an international stockpile of vaccines for H5N1 or other influenza viruses of pandemic potential, and to formulate mechanisms and guidelines aimed at ensuring fair and equitable distribution of pandemic-influenza vaccines at affordable prices in the event of a pandemic," WHO said. The resolution also calls for creation of an interdisciplinary working group to draw up new "terms of reference" (TORs) for the sharing of flu viruses by WHO collaborating centers and reference laboratories. "The new TORs will take into account the origin of influenza viruses going into the WHO Global Influenza Surveillance Network and will make their use more transparent," WHO said. "Once finalized, these TORs will be submitted to a special Intergovernmental Meeting of WHO Member States and regional economic organizations." The resolution is a response to Indonesia's recent withholding of H5N1 influenza virus samples to protest the high cost of commercial vaccines derived from such samples. Breaking with a long tradition of free international sharing of flu virus specimens, Indonesia stopped sending samples to WHO Dec 2006. Last week the country said it had resumed supplying viruses, but WHO has said it has received only 3 samples so far. WHO has coordinated the international sharing of flu virus samples by national and WHO collaborating laboratories for more than 50 years.

Countries are expected to continue sharing viruses while the new WHO rules are hammered out. But Dr. David Heymann, the WHO's head of communicable disease control, said the new agreement is voluntary. "If countries wish to make exceptions, they will make exceptions," Heymann said. "We will have an opportunity to see over the next few weeks, as we begin to request the viruses, if there are any conditions on [using] the viruses as they are sent in." Indonesia and other developing countries had proposed that WHO supply H5N1 virus samples to vaccine manufacturers only with the consent of the source country. But the adopted resolution, which emerged from a WHO committee, says that vaccine makers should have full access to viruses from WHO during a public health emergency.

WHO Director-General Margaret Chan reminded the delegates of their responsibilities under the revised International Health Regulations (IHR). The revised regulations, which take effect in June, are designed to stop the international spread of infectious diseases. As the 10-day WHO meeting ended, Heymann warned that current global vaccine production capacity remains far from adequate to protect the world's population in the event of a pandemic. Heymann said vaccine makers can produce enough vaccine for only 1.5 billion people. It will be "a 5-year maximum before we believe we will have enough vaccine to begin to talk about equitable sharing," he said. In other action, the World Health Assembly of WHO members approved a record budget of $4.2 billion for 2008-09, up from $3.3 billion for 2006-07, the agency said.
(CIDRAP 5/22/07, 5/23/07)

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Global: Experts support poultry vaccination for fighting avian influenza
In a report following an international poultry vaccination conference in Verona, Italy, UN’s FAO said disease reporting and control policies have improved, but stressed the importance of poultry vaccination for stamping out the H5N1 virus, particularly in countries where the disease is endemic. The agency said poultry vaccination should be used along with other control measure such as culling flocks and controlling the movement of birds. Poultry vaccination for H5N1 has sometimes been controversial. Experts contend that if poor quality vaccines are used, vaccinated birds can become infected without being visibly sick, which can lead to further spread of the virus. The hallmarks of a successful vaccination program include use of a high-quality vaccine that meets OIE standards, rapid and safe delivery of the vaccine, systematic monitoring of vaccinated flocks, control of poultry movement, and adequate financial resources, FAO said. "Any vaccination policy should include an exit strategy so that countries do not rely on costly long-term vaccination campaigns," FAO said.
(CIDRAP 5/24/07)

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Europe/Near East
UK: Low pathogenic avian influenza hits Welsh farm
Veterinary officials confirmed a low pathogenic H7N2 avian influenza outbreak at a farm near the northern town of Denbighshire. The outbreak in Wales involves Rhode Island Red chickens that the farmers bought 2 weeks ago. The birds began dying the day after they arrived at the farm, and by May 17, 10 of 15 had died. The British Department of Environment, Food and Rural Affairs (DEFRA) said the remaining 30 birds on the farm were being culled, and authorities have placed a 1-km restriction zone around the farm. The source of the outbreak is under investigation, and farm workers and others who may have had contact with the birds were being tested. Reportedly 2 adults who were on the farm have symptoms of influenza and are receiving precautionary treatment. Some countries, including the US, destroy birds infected with any H5 or H7 influenza virus, because mild strains of these subtypes can mutate into highly pathogenic forms. All avian influenzas (H1 to H16) can be low pathogenic but only H5 and H7 have been shown to have the potential to become highly pathogenic. Christianne Glossop, chief veterinary officer for Wales, said authorities don't believe the disease is spreading rapidly. In Feb 2007, England experienced its first H5N1 avian flu outbreak at a turkey farm in Suffolk, which led to the culling of about 152,000 birds. In Apr 2006 a low-pathogenic form of H7N3 avian influenza struck 3 English farms, leading to the culling of 50,000 poultry.
(CIDRAP 5/24/07; Promed 5/24/07)

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Asia
Bangladesh: Report of another avian influenza H5N1 outbreak in birds
Bangladesh continues to deal with a significant avian flu outbreak. Reportedly, officials ordered 8,000 birds in Domar district killed, while another 6,000 had been culled May 10 and May 17 in Jaldhaka. According to a UN Food and Agriculture Organization (FAO) news report, the virus has spread to 11 out of 64 provinces since Feb 2007 and the country needs a long-term strategic plan to keep the virus in check. The country has already had 12 outbreaks, according to the World Organization for Animal Health (OIE). While Bangladesh has prepared a national avian influenza and human pandemic preparedness plan, FAO's Chief Veterinary Officer, Joseph Domenech, said the current situation remains of serious concern and requires further national engagement and coordinated international support. Bangladesh has about 220 million chickens and 37 million ducks. The poultry industry directly employs 5 million people and millions of households rely on poultry production for income generation and nutrition, FAO said. The FAO had several recommendations that include culling at full scale and controlling the movement of people, animals, and goods in affected areas as well as establishing minimum hygiene standards at slaughter points in live bird markets. In addition to targeted vaccination and improving the capacity of veterinary laboratories, FAO's recommendations include the country's initiating public awareness campaigns and developing a scheme to encourage reporting of outbreaks. Bangladesh also should look into potential virus spread through the market chain, for example through the collection of eggs and distribution of day-old chicks and feed.
(CIDRAP 5/21/07l Promed 5/22/07)

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China: Reports another avian influenza H5N1 outbreak in birds
Reportedly, more than 11,000 birds died in China's latest avian influenza outbreak, and another 53,000 birds were culled to bring the outbreak in the southern province of Hunan under control, according to China's Ministry of Agriculture. The country's last outbreak in March in Lhasa, Tibet, killed 680 chickens at a poultry market; about 7,000 birds were culled. In the same month, a 16-year old boy also died from H5N1 in Anhui province. So far, there have been 15 human avian flu fatalities in the country.
(CIDRAP 5/21/07)

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Indonesia (Central Java): New human case of avian influenza H5N1 infection
WHO recognized a fatal human case of H5N1 avian flu that was reported by the Indonesian government yesterday. The illness struck a 5-year-old girl from the Wonogiri district of Central Java. She became ill May 8, was hospitalized May 15, and died 2 days later, the WHO said. Initial investigations indicate she had been exposed to dead poultry. The authorities are still investigating the case, but reportedly at least 20 chickens had died suddenly near her home. The case increased Indonesia's H5N1 toll to 97 cases with 77 deaths and raised the global total to 307 cases with 186 deaths, according to the WHO. WHO announced May 16 that it would accept H5N1 test results from Indonesia's newly accredited national laboratory. Before that, the agency had refused to confirm any cases reported by Indonesia since late Jan 2007, because the country had stopped sending viruses to WHO collaborating labs in Dec 2006.
(CIDRAP 5/23/07, 5/24/07; Promed 5/23/07)

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Pakistan (Islamabad): Report of new avian influenza outbreak in poultry
In Pakistan, officials said that more than 5,000 chickens were culled after an avian influenza outbreak that killed about 6,000 chickens was confirmed on 3 farms near Islamabad. The country's last outbreaks occurred in Apr 2007 in the northwest and in the southern city of Karachi.
(CIDRAP 5/23/07)

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Viet Nam: New case of avian influenza H5N1 in human
Viet Nam confirmed its 1st human bird flu case in more than a year, as the virus continues to spread through the country's poultry stocks. A 30-year-old man from northern Vinh Phuc province remains in a critical condition after testing positive for the H5N1 virus 20 May 2007, said Tran Quy, director of Bach Mai hospital in Hanoi. The man attended his friend's wedding party 1 month ago and he helped slaughter chickens for the party. He began coughing and experiencing respiratory problems 2 days later. Tests show that the man's lungs have become white and the test conducted 3 days ago confirmed that the man was positive for the H5N1 virus. The man's niece had to be hospitalized several days ago and she was also suspected of having caught the H5N1 virus. She took care of her uncle. Tests have shown that the girl is negative for H5N1.

Bird flu has re-emerged in poultry, mostly waterfowl, in 4 northern provinces of Son La, Quang Ninh, Nam Dinh, and Nghe An and the southern Mekong delta city of Can Tho in recent weeks. The Agriculture Ministry warned that outbreaks could spread further and criticized local authorities' and farmers' lax vigilance and failure to vaccinate their waterfowl. Deputy Agriculture Minister, Bui Ba Bong, said vaccinations, disinfecting the environment, and tight control over the transport of birds would be key to keeping the virus from spreading further. If his infection is confirmed, it will be the country's 94th case. With 93 confirmed cases and 42 deaths, Vietnam has the world's second highest H5N1 toll. The virus resurfaced among ducks in several central Mekong Delta and central provinces in December and January. In early May the country began reporting a new rash of poultry outbreaks throughout the country.
(Promed 5/23/07)

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Viet Nam: More avian influenza H5N1 outbreaks among ducks
In Vietnam, more than 2,000 ducks died, and another 6,000 were culled in various areas affected by outbreaks of H5N1. The ducks had not been vaccinated. 5 provinces have been affected since the beginning of May 2007. They are Quang Ninh, Son La, and Nam Dinh in the north, Nghe An in the central region, and Dong Thap in the south. Tests found the H5N1 virus among the samples taken after some 400 ducks died in a farm in Nhan Thanh commune, Nghe An province, 18 May 2007, the local Animal Health Department said. Other nearby farms also reported dead ducks in the following days. Animal health workers have slaughtered the remaining ducks in the commune, disinfected the area, and banned poultry transport from the infected area. UN FAO representative Andrew Speedy said rather than trying to wipe out the virus, which is believed to be widespread in Vietnam's bird population, efforts will focus on vaccination campaigns, which have proved highly effective. The virus emerged again among ducks and chickens in the south late 2006 and earlier in 2007. On 21 May 2007, Viet Nam launched the second round of poultry vaccinations against bird flu nationwide, which targets up to 90 percent of the country's poultry stock. So far, 60 provinces have been implementing the first phase vaccination for 2007, with over 116.6 million birds injected.
(Promed 5/22/07, 5/23/07; CIDRAP 5/23/07)

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Viet Nam: Avian influenza H5N9 vaccine for geese is normal says authorities
Head of the Veterinary Department Bui Quang Anh on 7 May 2007 signed a dispatch on the resumption of the use of the Italian H5N9 vaccine on geese. This decision was made after the Technological Council of the Ministry of Agriculture and Rural Development (MARD) concluded that the vaccine was good in quality. The MARD Technological Council carefully considered the explanation and commitment of the Merial Company, the Italian producer of the H5N9 vaccine, and the latest testing results of this vaccine and concluded that the layer-making phenomenon in vaccine jars was normal and did not affect the quality of the vaccine. With this conclusion, the veterinary sector will not lose the VND 4.5 billion [USD 280 881] it paid for 9 million doses of the H5N9 vaccine. Some 3.8 million doses remaining in warehouses will be not destroyed and 3.2 million geese will not be vaccinated again because each goose needs 2 injections, which are 21-28 days from each other. If this time is exceeded the vaccine will lose its effectiveness.
(Promed 5/19/07)

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Australia (New South Wales, Victoria): Rise in ocular Syphilis cases
Eye specialists have warned of a resurgence in syphilis-related eye infections as cases of the sexually-transmitted disease escalate in gay communities. Ophthalmologists say they are treating growing numbers of men who present with painful, red eyes or hazy vision caused by syphilis infection. "Many of them aren't aware they have the infection because the only symptoms they have are in their eyes," said Dr. Chathri Amaratunge, a specialist at Melbourne's Alfred Hospital. Syphilis rates doubled in New South Wales (NSW) and Victoria between 2001 and 2005 after a 50-year lull in the disease. Homosexual men are most commonly affected. Dr. Amaratunge says eye-related syphilis is relatively uncommon, with 15 cases expected in Victoria in 2007, but numbers are rising fast. Fewer than 10 percent of people who catch the disease develop symptoms in their eyes, causing redness, pain, light sensitivity and loss of vision. But in those who do, 25 percent will have no other symptoms of the syphilis and therefore often have no idea they have the debilitating condition.

Syphilis notifications rose more than 20-fold in inner-Sydney between 1999 and 2003 -- from 6 cases to 162. There were almost 80 cases in the first 3 months of 2007, showing numbers are rising further. Syphilis may result in 3 classic stages: primary, secondary, and tertiary syphilis. Primary syphilis is characterized by the development of a painless chancre (ulcer) at the site of inoculation, typically in the genital area. The lesion appears about 4 weeks after infection, and heals about 6 to 8 weeks later. It may rarely occur on the conjunctiva. Untreated, primary syphilis may progress to secondary syphilis within 4 to 12 months. There is fever and a rash. Ocular complications of inflammation can involve any structure of the eye. Tertiary syphilis may follow untreated secondary syphilis.
(Promed 5/15/07)

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China (Shandong): Outbreak of hand, foot and mouth disease; 3 deaths
The viral disease that has broken out in eastern China's Shandong province has killed a third child, it was reported 24 May 2007. Reportedly, an 11-month-old boy had developed a fever and blisters before dying 22 May 2007 in a hospital in Linyi city, where 1263 cases of hand, foot, and mouth disease (HFMD) have been reported since Apr 2007. The virus had already claimed the lives of a 14-month-old boy earlier May 2007 and a 2-year-old girl 29 Apr 2007. The provincial health bureau said that the outbreak of the virus was "slowing down." The local government has launched a campaign to remind parents to take preventive measures such as frequent hand washing. Shandong [province] reported 2477 cases of HFMD in 2005, including 1 death, and 3030 cases in 2006, 2 of which were fatal.

HFMD is a common illness of infants and children. The disease is highly contagious and transmitted through saliva, air, or skin contact. It can be fatal if complications occur. It is more prevalent and more severe in the countries of Southeast Asia than elsewhere. It is characterized by fever, sores in the mouth, and a rash with blisters. HFMD begins with a mild fever, poor appetite, malaise ("feeling sick"), and frequently a sore throat. The skin rash develops over one to 2 days with flat or raised red spots, some with blisters. The rash does not itch, and it is usually located on the palms of the hands and soles of the feet. It may also appear on the buttocks. The most common cause is coxsackievirus A16, although sometimes HFMD is caused by enterovirus 71 (EV71) or other enteroviruses.
(Promed 5/14/07, 5/16/07, 5/20/07, 5/24/07)

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Hong Kong: Confirmed case of Streptococcus suis
The Centre for Health Protection (CHP) of the Department of Health (DOH) is investigating a case of laboratory confirmed infection of Streptococcus suis, a kind of bacteria isolated from pigs. The case involved a 79-year-old woman living in Chai Wan, who developed fever 7 May 2007. She was admitted to Pamela Youde Nethersole Eastern Hospital 11 May 2007, and is now in critical condition. Reportedly she had no recent travel history and her home contact did not have any symptoms. This is the first reported case of Streptococcus suis infection in 2007. A total of 8 cases were reported in 2006 and 13 cases in 2005. Streptococcus suis infection may present as meningitis (inflammation of the membrane enclosing the brain), septicaemia (blood stream infection), and less commonly endocarditis (inflammation of the inner lining of the heart chambers), arthritis, and bronchopneumonia (a kind of lung infection involving the bronchioles). Streptococcus suis infection can be treated with appropriate antibiotics. To prevent the disease, people are advised to always observe personal and environmental hygiene practices and avoid contact with pigs that are sick or dead from diseases, and their excreta or body fluid.
(Promed 5/17/07)

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Japan (multi-prefecture): Large measles outbreak hits young adults
The rash of measles outbreaks among people in their 30s and younger is believed to have been sparked by weakened immunities to the disease as children have grown up lacking early exposure to the virus, the National Institute of Infectious Diseases (NIID) said 22 May 2007. The Kanto region has recently seen an outbreak of measles, with many major universities calling off classes as a result, affecting at least 150 000 students. A prevailing characteristic is that most of those infected are in their 20s and 30s, an age that some claim never received sufficient vaccinations as children. However, according to a survey by the Health, Labor and Welfare Ministry in 2005, youth vaccination rates have been high, with more than 95 percent of people aged 2 to 19, 89 percent of people in their 20s and 85 percent of people in their 30s having been vaccinated, while just 52.3 percent of people aged 40 and over have been vaccinated.

About 5 percent of people cannot build an immunity with just one vaccination. These people, having since reached adulthood, are contributing to the current spread of the disease, according to the institute. Middle-aged people and the elderly have strong immunities as they have been through many outbreaks and are not as easily affected by this outbreak. A double vaccination system was introduced Apr 2006. Children entering primary school are now subject to the double vaccination system. The institute advises people not vaccinated who have never been infected to get vaccinated. Women wanting to have children in the future are especially advised to get vaccinated, because measles symptoms are more pronounced during pregnancy, risking the lives of both mother and child. However, women who are pregnant cannot receive vaccinations.

The ministry is alerting people by telling them if cold-like symptoms appear to take precautions, such as wearing masks, so as not to pass the disease to others. Stockpiles of measles vaccines decreased by about 160 000 doses in 2 days, more than 30 percent of the total stockpile, the Health, Labor and Welfare Ministry said. The ministry added that there is plenty of vaccine and it will not run out soon. However, the ministry also has called for the wise distribution of vaccine, asking vaccination centers to "please efficiently prevent the disease from spreading by confirming whether a person has immunity before vaccinating."

Excerpted from the Infectious Disease Surveillance Center, NIID: NIID collects data related to measles from approximately 3000 pediatric sentinels around the country through the National Epidemiological Surveillance of Infectious Diseases (NESID) and updates them each week. According to the NESID, 214 cases (0.071 cases per sentinel) from 26 different prefectures were reported in week 19 (7-13 May 2007). This is a huge increase compared to the previous week (88 cases, 0.030 cases per sentinel). Reported cases are apparently increasing in South Kanto region (Tokyo, Saitama, Kanagawa, and Chiba prefecture) and the case-reported area is expanding nationwide. The number of cumulative cases reported from the pediatric sentinels between week 1 through 19 (2007) is 691 and already exceeded the total yearly reported cases in 2005 and 2006 (537, 519 respectively). The weekly reported number of cases became highest in week 19 in all 5 of the highest case-reported prefectures in 2007. There is an increase in the proportion of reported cases among 10- to 14-year-olds (33.9 percent) compared to the previous years, while it is decreasing among 0- to 4-year-olds (39.7 percent).

For adolescents and adults (15 years old and older), data is collected from approximately 450 hospital sentinels across the country. The number of cases reported during week 19 was 53 (0.117 cases per sentinel) and was much higher than the previous week (25 cases, 0.055 cases per sentinel). Tokyo has the highest reported number of cases per week (19 cases), which has been increasing since week 15 [9-15 Apr 2007]. The number of cumulative cases reported from the hospital sentinels between week 1 through 19 2007 is 208 cases, and more than 60 percent (132 cases) are reported from South Kanto. However, reports from other regions are increasing. More than 80 percent of cases were under 29 years of age. The number of reported case of measles both from pediatric sentinels and hospital sentinels has increased dramatically. The center of the epidemic is South Kanto, and cases are increasing, but the trend is being observed nationwide.
(Promed 5/22/07, 5/23/07)

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Russia (Southern Federal District): Increase in Crimean-Congo hemorrhagic fever cases
The risk of contracting Crimean-Congo hemorrhagic fever (CCHF) in the Southern Federal District is increasing. Reportedly, this is mainly a consequence of a mild winter. As a consequence, ticks have been more active than in previous years and tick-bites are being recorded earlier. There is no preventive vaccine or effective method of treatment of the disease. Currently, 55 cases of CCHF have been registered in Rostov, a significant rise in incidence according to Rijkov. In 2006, there were only 19 cases in Rostov. To date, more than 400 cases of tick-bites have been recorded in the Southern Federal District.
(Promed 5/15/07)

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Russia (Stavropol): Anthrax kills man; Police hunt anthrax-infected meat
An outbreak of anthrax has been reported in the Kursk region of Stavropol oblast. Local police and agriculture inspectors in southern Russia are searching for itinerant gypsies [Roma] who may have contracted anthrax when they bought contaminated meat from a local farm, authorities said 22 May 2007. Investigators, who followed medical workers cleaning the farm of Apatovo in Stavropol Territory of an anthrax case that killed a local resident 12 May 2007, learned that the man who had killed an infected ox 6 days earlier sold part of its meat to gypsies [Roma]. Anti-epidemic, organizational, and anti epizootic measures are being taken. The main prophylactic measures are the immunization of animals and compliance with veterinarian-sanitary rules for preparation, storage, transportation, and processing of materials [of animal origin.] Outbreaks of anthrax, a potentially fatal disease affecting animals and humans periodically occur on the rural steppes, part of which includes the Stavropol Territory neighboring Chechnya.
(Promed 5/18/07, 5/22/07)

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Taipei: First fatal case of severely complicated enterovirus infection in 2007
Taiwan’s CDC has confirmed this year’s first fatal case of severely complicated enterovirus infection. It was a newborn baby girl from Yunlin County in the South, who had experienced abdominal distention since birth Apr 26, 2007. On Apr 29, she began to show the clinical symptoms of milk spillage, anxiety, and fever, and died May 2. The hospital reported her as a suspect case of severe enterovirus infection. On May 8, Echovirus 6 of the enterovirus family was isolated from her specimen, and CDC confirmed the case. An investigation by the authorities showed that people who had been in close contact with the baby were all in good health, and a preliminary assessment indicated that there was no risk for disease spread. The health authorities will continue to monitor the health status of the baby’s close contacts. The epidemic period for enterovirus infection in Taiwan is from April to October. According to CDC’s Sentinel Surveillance System, the rate of outpatient visits for enterovirus infection has increased for the seventh consecutive week. CDC’s Laboratory Surveillance System showed that in the past six weeks, the most common virus strain was Coxsackie virus A4, followed by Echovirus 6. Taiwan is in the subtropical region, where enterovirus infection cases occur throughout the year. Infection in babies and young children might lead to the sequela of widespread central nervous system (CNS) damage or even death.
(Taiwan IHR Focal Point 5/17/07)

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Viet Nam: Suspension of hepatitis vaccine due to 3 deaths
WHO has suspended the use of a hepatitis B vaccine worldwide after 3 newborns died and another became seriously ill in Viet Nam after getting shots in the last few weeks. Nguyen Tran Hien, head of a council set up in Viet Nam to investigate the cases, said that 2 international experts from WHO would arrive in Viet Nam 19 May 2007 to work with local investigators. The cases occurred between 23 Apr and 7 May 2007 in Ho Chi Minh City, Ha Tinh Province, and Thanh Hoa Province. 1 baby fully recovered after taking ill. The WHO-approved vaccine is made by South Korea's LG Life Sciences and distributed in Viet Nam through a UN program. Earlier in May 2007, Viet Nam instructed all localities nationwide to stop using the vaccine. WHO's Department of Immunization, Vaccines and Biologicals has asked that countries around the world stop using shots from the affected batches until the cause of the illness can be determined.

Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. Children under 12 months of age have been vaccinated against hepatitis B under the national vaccination programme since 1997, with the programme expanding to all regions of Viet Nam by 2003. With close to 1.5 million children being vaccinated annually, hepatitis B vaccine has been used on millions of Vietnamese children to date. Drugs from the same lots had been shipped to 24 countries, but no other adverse reactions had been reported to date from any of them.
(Promed 5/18/07, 5/21/07)

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Americas
Canada (Nova Scotia): Begins mumps immunization for health-care workers
With the number of mumps cases rising in the province, the Nova Scotian government announced it will begin immunizing thousands of health-care workers against the virus. As of 11 May 2007, 222 confirmed cases had been reported in Nova Scotia, up 19 from 203 the previous week. Shelly Sarwal, the province's medical officer of health, said about 40 000 doses of the measles, mumps and rubella (MMR) vaccine are being made available on a voluntary basis to health-care workers, with the aim of protecting health services in the province. "Providing this vaccine now to health-care workers isn't going to do much for the current outbreak," Dr. Sarwal said. "It's for preventing future outbreaks similar to this and for making sure that our population is properly immunized. The purpose of this program is to maintain our health-care system and the staffing within the health-care system," she said. About 900 of the province's 30 000-plus health providers have been exposed to mumps, and currently 130 are off the job, she said. Any worker who has come into contact with an infected person could potentially be off work for 2 weeks or more because the incubation period for the virus is 14 to 25 days. While the number of new cases in the Halifax region is declining, elsewhere across Nova Scotia cases were up. The Nova Scotia mumps outbreak began Feb 2007, likely among university-aged students with inadequate immunity to the virus. Cases have begun springing up elsewhere, as those exposed to the disease return to their home provinces. The latest province to join the mumps hit list is British Columbia (BC), which has one confirmed case reported.
(Promed 5/14/07)

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Canada (multi-province): Ongoing Mumps outbreak
Canada's ongoing outbreak of mumps has hit the country's biggest city. And Toronto's public health officials expect the current case count of 3 infections to climb. "I think we may see more cases," Dr. Barbara Yaffe, Director of communicable disease control for Toronto Public Health, said 15 May 2007. That's because one of the infected young adults spent a number of hours 10 May 2007 at a crowded nightspot. "We know it's a very popular place. There were probably around 300 people there, so they may have been exposed to mumps," said Yaffe. Toronto Public Health called a news conference to [alert] both to young people who were at the bar and city doctors who may soon be diagnosing a disease many would not have seen in a very long time, if ever. Yaffe said. "We're. . .telling people in general, and particularly in that age group -- the university age group -- to try and modify their behaviour; to do less sharing of saliva. . .don't share drinks. Don't share water bottles. Because that is a great way of spreading infections, including mumps."

As of May 11 2007, the Public Health Agency of Canada was reporting 271 cases. The public health agency reports cases in 4 provinces: Nova Scotia, New Brunswick, Prince Edward Island, and Ontario. The vast majority of the infections -- 222 as of 11 May 2007 -- have occurred in Nova Scotia, where cases first started cropping up in Halifax Feb 2007. Yaffe said 2 of the 3 Toronto cases are students who attend university in Halifax who came home. The third was a person exposed to one of the 2 cases. University aged young adults make up the majority of the cases. They appear to be at greatest risk because they would have only received 1 dose of measles, mumps, and vaccine rubella (MMRV) in childhood. Symptoms of mumps include aches, pains, fever, loss of appetite and, in about 40 percent of cases, the hugely swollen saliva glands. In males past puberty the virus can also infect one or both testicles, leading to a painful condition known as orchitis. Other potential, if rare, side effects include meningitis and encephalitis and women who become infected during the first trimester of pregnancy are at increased risk of miscarrying.
(Promed 5/16/07)

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USA: Recall of Beef Linked to E. coli Outbreak
A Minnesota beef company is voluntarily recalling approximately 117 500 pounds of beef trim products used to make ground beef, due to possible contamination with Escherichia coli [E. coli] O157:H7, the U.S. Department of Agriculture's [USDA] announced. The recall includes Arizona. The recall comes after an E. coli outbreak that has sickened 7 residents in Minnesota, who purchased and ate ground beef from local stores there. The trim was produced 27 Mar 2007, and shipped to distributors and retail outlets in Arizona, Illinois, Iowa, Michigan, Minnesota, Ohio, Virginia and Wisconsin. Because these products later became ground beef sold under many different retail brand names, consumers have been advised to check with their local retailer to determine whether they may have purchased any of the products subject to recall. E. coli 0157:H7 is a potentially deadly strain of bacterium. Symptoms of E. coli include stomach cramps and diarrhea that may turn bloody. E. coli can sometimes lead to complications including kidney failure. The USDA urges all consumers to thoroughly cook their beef.
(Promed 5/14/07)

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USA (Colorado): 2 Hantavirus cases confirmed
The second hantavirus case this year in Colorado has been confirmed in a 30-year-old Weld County man who is now recovering. A Colorado Department of Public Health and Environment laboratory confirmed the disease by serologic testing. Hantavirus pulmonary syndrome is a respiratory disease transmitted by rural deer mice that can infect humans. Health department officials believe the man was exposed in northeastern Colorado Apr 2007. An environmental assessment is still underway to definitively determine the origin of the virus. He was treated at North Colorado Medical Center. Earlier this month, a 28-year-old Alamosa County woman died from the syndrome. A preliminary investigation indicated she contracted the virus in her home. While the deer mice that transmit the disease are extremely common in Colorado, human cases are rare, said John Pape, an epidemiologist with Colorado Department of Public Health and Environment. Statewide, only 6 people suffered from the illness in 2006. The human cases tend to peak in May and June because mouse populations increase during these months.

The Health Department is urging caution among residents while doing spring cleaning around barns and sheds. The disease is transmitted to people when they inhale contaminated urine or feces or come into contact with infected mice. Early symptoms include fever, headache and muscle pain, severe abdominal, joint and lower back pain, nausea and vomiting. A cough and shortness of breath usually develops after the onset of symptoms. The illness progresses quickly to difficulty breathing. There is no treatment for the virus itself, but early hospital admission for suspected cases improves survival. There have been 51 cases of hantavirus pulmonary syndrome in Colorado during the period 1985 to 2006 and 17 fatalities (35 percent).
(Promed 5/15/07, 5/23/07)

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USA (New Mexico): Imported case of measles from India
A 15-year-old girl from India who was visiting for the Intel International Science and Engineering Fair has been hospitalized with measles, and New Mexico health officials say she was likely infectious when she was traveling and while at the fair. The New Mexico Health Department's lab confirmed the measles case. Officials said the girl, who traveled from India to Atlanta and then to Albuquerque, was admitted to a local hospital. The Health Department said it is concerned about possible exposure at the science fair, and hotels where the girl stayed. The department plans to hold a vaccination clinic 25 May 2007 for fair attendees. A separate clinic will be held for other members of the public who think they may have been exposed. Health officials said the girl stayed at the MCM Elegante hotel 12 - 16 May 2007 and the Fairfield Inn 16 and 17 May 2007. She also went to a Wal-Mart store at Carlisle and Menaul 14 May 2007. The Health Department also is working with CDC to identify people who may have been exposed during plane flights or at airports. Measles, though eradicated in the US and some other countries, still exists in many parts of the world.
(Promed 5/21/07)

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USA: FDA panel recommends smallpox vaccine approval
A US Food and Drug Administration (FDA) panel recommended that the agency approve a smallpox vaccine made by British biotechnology company Acambis plc that is currently being stockpiled for the US government. The panel unanimously voted that ACAM2000 is both safe and effective, Karen Reilly, an FDA spokesperson, said. Acambis has a contract with the US Department of Health and Human Services (HHS) to make 209 million doses of smallpox vaccine for the Strategic National Stockpile (SNS) to use in the event of a terrorist release of smallpox virus. Marc Wolfson, a spokesman for the HHS Office of Public Health Emergency Preparedness, said the company has delivered 192.5 million doses of ACAM2000 so far and has been paid $573,650,000. ACAM2000 uses vaccinia virus, a close relative of smallpox, and is grown in cell culture. It is derived from Dryvax, a first-generation vaccine that was used in global smallpox eradication programs. The newer vaccine is grown in cell culture rather than on the skin of calves, which is thought to produce a purer and safer vaccine that has less risk of rare but serious complications. The positive recommendation came despite some concerns panel members raised about the side effects of the vaccine.

In 2004 Acambis temporarily halted one of its phase 3 trials comparing ACAM2000 with Dryvax, the currently licensed smallpox vaccine that is no longer produced, after myopericarditis developed in at least 3 of the research subjects. Panelists said they had to weigh the risks of heart inflammation, which would be unacceptable for routine vaccination, against the threat that US military personnel and others in high-risk settings. Panel members said if the FDA approves the vaccine it should require the company to continue clinical trials and other measures. The HHS said it was planning to stockpile a weaker version of the smallpox vaccine—modified vaccinia Ankara (MVA)—for certain groups, such as pregnant women and immuncompromised people, who can't receive the conventional smallpox vaccine.
(CIDRAP 5/18/07)

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Africa
Ghana: Second avian influenza H5N1 outbreak; strain not similar to Asian strains
Ghana reported its second outbreak of the H5N1 virus on a farm in Sunyani, 400km north of the capital, Accra. Gary Quarcoo, the agriculture ministry's head of veterinary services, said veterinary officials have culled thousands of birds in the area and destroyed animal feed and farm equipment. Ghana's first outbreak H5N1 was detected on a farm near the port city of Tema in Apr 2007. Some local observers are blaming the situation on smuggled live birds from Nigeria. Though the government of Ghana banned the importation of poultry products from Nigeria since the first case was reported in Kano, they say the products have continued to be smuggled into the country's market. However, Ghana's neighbour, Cote d'Ivoire, has also been identified as a likely source of the flu. Ghana's ban on the importation of poultry products also includes other African countries where outbreaks of avian influenza have been previously reported.

The analysis of the H5N1 avian influenza strain isolated from the outbreak occurring in Ghana clearly indicates that it is closely related to other isolates from Sub-Saharan African countries like Ivory Coast, Sudan, Burkina Faso and Nigeria and that it is less similar to the Asian strains currently isolated. "The sequencing of the Ghana strain indicates that there is a similarity range between 98.8 percent and 99.6 percent to other isolates from Sub-Saharan African countries," the Director general of the OIE, Dr. Bernard Vallat, said 18 May 2007. "That would indicate that there has been no introduction of a new virus strain to Ghana," he added. Ghana authorities were quick to notify the OIE of the occurrence of the outbreak in their territory 12 May 2007; samples were sent in a timely manner, and the sequencing of the virus was finalized by the OIE Reference Laboratory for avian influenza 16 May 2007.
(Promed 5/19/07, 5/21/07, 5/23/07; CIDRAP 5/23/07)

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Nigeria: Report of new avian influenza H5N1 outbreak; improper vaccinations
Health officials in Nigeria confirmed an H5N1 outbreak in birds in Namaturu village in the country's northern state of Zamfara. Aminu Abdulrazak, a state health minister, said 200 birds were culled and the area was disinfected to curb the spread of the disease. Nigeria's last outbreak occurred Jan 2007. The disease is now considered endemic in the country. In Feb 2007, Nigeria reported its first human H5N1 case, in a 22-year-old woman who fell ill and died after helping butcher an infected chicken. Reportedly, in Nigeria, commercial poultry farmers are vaccinating their birds despite a government ban, the UN Integrated Regional Information Networks (IRIN) reported. Mohammad Saidu, head of Nigeria's World Bank-funded avian flu control program, warned that improper vaccination practices can contribute to the spread of H5N1. He added that Nigerian avian flu experts are concerned about reports that poultry farmers are buying vaccines from local markets that offer poorly regulated imported vaccines or fake products.
(CIDRAP 5/24/07)

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1. Updates
Avian/Pandemic influenza updates
- UN: http://influenza.un.org/. UN response to avian influenza and the pandemic threat. Also, http://www.irinnews.org/Birdflu.asp provides information on avian influenza in order to help the humanitarian community.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html.
- OIE: http://www.oie.int/eng/en_index.htm. Link to upcoming Paris Anti-avian influenza conference.
- US CDC: http://www.cdc.gov/flu/avian/index.htm.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. New updates on the pandemic influenza blog and World Health Assembly’s influenza virus sharing resolutions.
- Health Canada: information on pandemic influenza: http://www.influenza.gc.ca/index_e.html. New travel Health Advisory: Avian Influenza A (H5N1) released.
- 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 11 May 2007.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

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Seasonal Influenza
USA
Influenza activity in the US peaked in mid-February and continued to decrease during week 20 (May 13 – 19, 2007). Data from the U.S. WHO and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories indicated a decrease in the number of specimens testing positive for influenza. The percentage of visits for ILI to sentinel providers decreased during week 20 and was below the national baseline for the ninth consecutive week. New York City and 20 states reported sporadic activity; and the District of Columbia and 30 states reported no influenza activity. The percent of deaths due to pneumonia and influenza has remained below baseline levels for the entire influenza season to date.
(CDC 5/19/07 http://www.cdc.gov/flu/weekly/ )

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Dengue
Indonesia (Central Java)
3 people have died in a dengue outbreak that has affected more than 200 people in Cilacap regency, Central Java over the last 5 months. "The rate of infection is higher than [last] year [2006] [when] only 1 patient died, and 37 people were affected," Mariah Chilfati of the Cilacap Health Office said 9 May 2007. Mariah blamed the severity of this year's outbreak on the number of rain-filled potholes in the regency, which provide an ideal breeding ground for mosquitoes. She said authorities had ordered a massive fumigation campaign across the regency to halt the spread of the disease.
(Promed 5/14/07)

Indonesia (Bali)
Dengue fever outbreak has struck Bali, one of the world's top tourist destinations. Health official Subrata said "Most of those who have fallen ill come from parts of the island that have a high population density and where it is difficult to control garbage collection, such as the town of Denpasar and the districts of Badung and Gianyar." The main tourist centers on Bali fall under [the jurisdiction] of the Denpasar municipality], and hygienic and sanitary conditions are of a higher level than in other parts of the island. At least 10 more people every day have been treated for dengue fever in the island's main Sanglah Hospital since the outbreak began Jan 2007. The lack of space at [the hospital] forcing many of the patients to lie in beds placed in the hospital's corridors. Subrata said more than 1163 cases of dengue fever have been identified since Jan 2007, with 8 people dying of the disease.
(Promed 5/21/07)

Malaysia
The current hot and rainy spell has caused a rise in dengue cases in almost all States during the week of 6 May 2007. There were 916 cases between 6-12 May 2007 compared with 799 registered 29 Apr - 5 May 2007. The Health Ministry's disease control director, Datuk Dr Hasan Abdul Rahman, said 869 of the victims suffered dengue fever and 47, dengue hemorrhagic fever [DHF]. Between 1 Jan and 12 May [2007], a total of 18 645 dengue cases were reported, compared with 11 821 cases during the same period in 2006. So far in 2007, 47 people have died of the disease. Dr Hasan said health authorities still reported that construction sites were the main culprits for the breeding of Aedes mosquitoes followed by factories, schools, and rubbish dumps. During week of 6 May 2007, authorities issued 255 notices and 370 compounds to those caught breeding Aedes and collected RM 61 510 in fines [USD 18 127].
(Promed 5/21/07)

Singapore
During the week of 13 May 2007, 180 new cases of dengue were reported, an all-time high and mirroring trends in 2005, when the disease hit epidemic proportions in Singapore. For the first 19 weeks of 2007, there were close to 1500 dengue cases. That is nearly 50 percent higher than the corresponding period in 2006. The Health Ministry says the spike may be due to a new dengue [virus] strain in Singapore -- dengue 2, which is responsible for 60 percent of all dengue cases [in the country] so far. "Singaporeans who have contracted dengue are mostly immune to dengue 1 but they will be susceptible to dengue 2." Health Minister, Khaw Boon Wan, said, "For many years, Singapore's [has largely been] dengue [virus] 1, although dengue [virus] 2 is quite common in our neighbours. The government says the National Environment Agency (NEA), Town Councils, and grassroots organizations have been activated to search and eradicate potential sources of mosquito breeding in residential areas. The NEA will also be working with shipyards, construction sites, and other industries to stop mosquitoes from breeding. But the public too will need to do their part. The NEA has started the second part of what it calls its "Intensified Source Reduction Exercise," in which officers will target homes in 44 areas which are prone to outbreaks. So far in 2007, there have been no deaths from dengue in Singapore.
(Promed 5/14/07, 5/21/07)

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2. Articles
Household Transmission of Vaccinia Virus from Contact with a Military Smallpox Vaccinee--Illinois and Indiana, 2007
(References removed)
“On March 7, 2007, the Chicago Department of Public Health and the University of Chicago Pediatric Infectious Disease Service and Infection Control Program notified CDC of a child with presumed eczema vaccinatum (EV), a life-threatening complication of vaccinia virus infection. This is the first reported EV case in the United States since 1988. This report summarizes the epidemiologic and environmental investigations conducted by local, state, and federal public health authorities in Illinois and Indiana to determine the source of exposure and to identify and monitor other persons at risk for vaccinia virus infection. This case highlights the need for clinicians to maintain a high index of suspicion when evaluating recently vaccinated patients and their family members with vesiculopustular rash. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5619a4.htm
(MMWR May 18, 2007 / 56(19);478-481)

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Vaccinating to Protect a Vulnerable Subpopulation
Jonathan Dushoff et al. PLoS Med 4(5): e174. doi:10.1371/journal. pmed.0040174.
Abstract: “Background: Epidemic influenza causes serious mortality and morbidity in temperate countries each winter. Research suggests that schoolchildren are critical in the spread of influenza virus, while the elderly and the very young are most vulnerable to the disease. Under these conditions, it is unclear how best to focus prevention efforts in order to protect the population. Here we investigate the question of how to protect a population against a disease when one group is particularly effective at spreading disease and another group is more vulnerable to the effects of the disease. Methods and Findings: We developed a simple mathematical model of an epidemic that includes assortative mixing between groups of hosts. We evaluate the impact of different vaccine allocation strategies across a wide range of parameter values. With this model we demonstrate that the optimal vaccination strategy is extremely sensitive to the assortativity of population mixing, as well as to the reproductive number of the disease in each group. Small differences in parameter values can change the best vaccination strategy from one focused on the most vulnerable individuals to one focused on the most transmissive individuals. Conclusions: Given the limited amount of information about relevant parameters, we suggest that changes in vaccination strategy, while potentially promising, should be approached with caution. In particular, we find that, while switching vaccine to more active groups may protect vulnerable groups in many cases, switching too much vaccine, or switching vaccine under slightly different conditions, may lead to large increases in disease in the vulnerable group. This outcome is more likely when vaccine limitation.”
http://medicine.plosjournals.org/archive/1549-1676/4/5/pdf/10.1371_journal.pmed.0040174-S.pdf

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Estimating Variability in the Transmission of Severe Acute Respiratory Syndrome to Household Contacts in Hong Kong, China
Pitzer VE, Leung GM, Lipsitch M. Am J Epidemiol. 2007 May 10; [Epub ahead of print].
Abstract: “The extensive data collection and contact tracing that occurred during the 2003 outbreak of severe acute respiratory syndrome (SARS) in Hong Kong, China, allowed the authors to examine how the probability of transmission varied from the date of symptom onset to the date of hospitalization for household contacts of SARS patients. Using a discrete-time likelihood model, the authors estimated the transmission probability per contact for each day following the onset of symptoms. The results suggested that there may be two peaks in the probability of SARS transmission, the first occurring around day 2 after symptom onset and the second occurring approximately 10 days after symptom onset. Index patients who were aged 60 years or older or whose lactate dehydrogenase level was elevated upon admission to the hospital (indicating higher viral loads) were more likely to transmit SARS to their contacts. There was little variation in the daily transmission probabilities before versus after the introduction of public health interventions on or around March 26, 2003. This study suggests that the probability of transmission of SARS is dependent upon characteristics of the index patients and does not simply reflect temporal variability in the viral load of SARS cases.”
http://aje.oxfordjournals.org/cgi/content/abstract/kwm082v1

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Expedited influenza-related articles from CDC’s EID
CDC’s Emerging Infectious Diseases Journal, Volume 13, Number 5—May 2007 issue contains the following expedited articles on influenza: Live poultry exposures, Hong Kong and Hanoi, 2006; Blood screening for influenza; Effects of internal border control on spread of pandemic influenza.
http://www.cdc.gov/ncidod/eid/

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3. Notifications
HHS launches blog on pandemic preparedness
To encourage the public to join discussions on pandemic influenza preparedness, the US Department of Health and Human Services (HHS) launched a 5-week blog on the topic in conjunction with a Jun 13, 2007 leadership forum. The "Pandemic Flu Leadership Blog," hosted on the government's Pandemicflu.gov Web site, features writings by a group of 13 experts from public health, medicine, disaster preparedness, government, business, communications, and online media. The public is invited to comment on the contributors' entries. The invited contributors will address 5 weekly themes over the course of the blog, which is to run through Jun 27. The topics include the need to prepare, leadership roles, convincing people to prepare, results of the leadership forum, and steps for moving forward. The blog will include live posts from the Jun 13 forum. One of the blog contributors is HHS Secretary Mike Leavitt. In his first post, he wrote that the Jun 13 leadership forum is designed to bring together influential leaders from business, faith, civic, and healthcare communities to discuss how to help Americans better prepare for an influenza pandemic. Greg Dworkin, MD, one of the editors of the FluWiki, an interactive pandemic planning Web site, is also a contributor to the HHS blog and has been invited to take part in the leadership forum. Some other contributors to the HHS blog are Georges C. Benjamin, MD, executive director of the American Public Health Association; Michael Coston, former paramedic and author of the "Avian Flu Diary" blog; Ann M. Beauchesne, head of the US Chamber of Commerce's homeland security division; and Pierre Omidyar, founder and chairman of eBay.
(CIDRAP 5/22/07)

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OSHA releases pandemic flu guidance for healthcare workers
Experts predict that an influenza pandemic will place a long and heavy burden on the medical community, which prompted the US Department of Labor (DOL) to develop guidance for healthcare worker safety. The guidelines, released on the Occupational Safety and Health Administration (OSHA) Web site (http://www.osha.gov/Publications/OSHA_pandemic_health.pdf ), cover a range of healthcare settings, from emergency departments to ambulances to temporary patient care facilities. The 100-page document is a follow-up to guidelines released by OSHA in Feb that provided general guidance for all types of workplaces. The OSHA guidelines are based on traditional infection control and occupational hygiene principles but may need to be modified or supplemented as more details become known about the transmission once a pandemic strain emerges, Edwin G. Foulke Jr, assistant secretary of labor for OSHA, said.

The guidance for healthcare workers is divided into 4 sections that cover clinical information on influenza, infection control, pandemic influenza preparedness, and specific OSHA standards. Donald Wright, director of OSHA's office of occupational medicine, said he anticipates that healthcare workers will be most interested in the infection control section. A focus of the infection control section is the "weak links" in hospital infection control, such as hand hygiene and respiratory protection compliance. The section stresses that it's not enough to question employees about hygiene practices; institutions need to observe employee behavior, implement strategies to promote the recommended practices, and cultivate a safety climate that promotes good infection control behaviors.

OSHA suggests several surveillance activities that would be helpful for hospitals in a pandemic, such as tracking employees who have cared for patients with suspected or confirmed influenza or screening workers each day for influenzalike symptoms. Guidance on personal protective equipment is consistent with other OSHA and US Department of Health and Human Services (HHS) advisories. Though the HHS pandemic influenza plan does not recommend goggles and face shields for routine care of patients with pandemic influenza, OSHA advises that workers who are within 3 feet of a coughing patient should wear those items. OSHA strongly urges healthcare institutions to stockpile N-95 respirators and other protective equipment, warning that the items will be scarce once a pandemic strikes.

The guidelines recognized that when supplies are scarce, employees may need to consider reusing their respirators. Reuse of disposable respirators should be limited to a single wearer, be labeled with the employee's name, and include clear instruction about how to avoid spreading contamination from the outside of the respirator. Wearing a face shield over the respirator may help keep the exterior of the device clean, the OSHA guidance suggests. Several other institutional issues are addressed, such as cleaning patient care equipment, disinfecting patient rooms, and disposing of solid waste. Extensive appendices include several resources for healthcare institutions, such as communication tools for promoting employee infection control practices, strategies for planning respiratory protections programs, triage algorithms, supply and pandemic planning checklists, and even a crisis communication guide for handling questions from the media.
(CIDRAP 5/21/07)

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Avian influenza: Implications for human disease; comprehensive reference from CIDRAP
A comprehensive reference document covering all aspects of the biology of human avian influenza H5N1 virus updated 16 May 2007 is available at CIDRAP. Topics are: Agent; Laboratory Testing for Avian Influenza in Humans; Summary of Avian Influenza in Humans; The Current Outbreak of H5N1 in Birds and Other Animals; H5N1 in Humans: Epidemiologic Features; H5N1 in Humans: Clinical Features; Treatment and Prophylaxis; Current Status of H5N1 Candidate Vaccines; Current WHO and CDC Travel Recommendations; Use of Seasonal Flu Vaccine in Humans at Risk for H5N1 Infection; Surveillance Considerations; Influenza Pandemic Considerations; Infection Control Recommendations; Guidance to Protect Workers from Avian Influenza Viruses; Food Safety Issues.
http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/biofacts/avflu_human.html#_Agent
(CIDRAP 5/16/07 www.cidrap.umn.edu )

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OIE: Today most countries overcome avian influenza outbreaks when they occur
59 countries have reported outbreaks of the H5N1 strain of avian influenza from 2003 to date. The Veterinary Services (VS) in the majority of these countries have successfully dealt with these outbreaks. Globally, countries have improved governance on implementation of preventive measures as recommended by the World Organisation for Animal Health (OIE), the UN Food and Agriculture Organisation (FAO) and WHO to avert the disease. "In the first half of 2007, countries reported fewer deaths of wild and migratory birds, which could indicate the disease is coming closer to the end of a cycle. Reversely poultry flocks still continue to be infected in some countries and that shows the international community needs to keep up its high level of prevention and control measures of the disease in animals," commented Dr Bernard Vallat, Director General of the OIE. The disease remains endemic in at least 3 countries (Indonesia , Nigeria and Egypt) and continues to appear in previously unaffected countries. These events offer valuable opportunity to further identify the complex issues in dealing with the disease.
(OIE http://www.oie.int/eng/press/en_070521.htm 5/21/07)

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WHO delays destruction of smallpox virus
WHO announced 18 May 2007 that it is postponing for at least 4 years any decision on when to destroy the world's last known stockpiles of smallpox [virus], a virus eradicated nearly 30 years go. There is no treatment for the [viral disease] that killed millions of people a year as recently as the 1960s and left many more blind and scarred. In 1979, it became the first disease officially stamped out after a worldwide vaccination campaign. The US and Russia, however, which hold the only known stockpiles of the virus in high-security laboratories, have long resisted calls to destroy them in case smallpox is found to exist elsewhere. The 60th annual World Health Assembly reaffirmed a previous commitment to destroy the remaining stockpiles, but agreed to postpone any decision on when this should happen until its 2011 meeting. In 2010, WHO secretariat will carry out a review of all research undertaken and still planned, in order that the "64th World Health Assembly may reach global consensus on the timing of the destruction of existing variola [smallpox] virus stocks." A previous 2002 deadline for destroying smallpox [virus] was delayed by WHO until new vaccines or treatments for smallpox were found, after the US said it would keep stocks on hand to combat any re-emergence of the disease.
(Promed 5/19/07)

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Recreational Water Illness Prevention Week --- May 21--27, 2007
The third annual National Recreational Water Illness Prevention Week is scheduled for May 21--27, 2007, at the onset of swimming season, to raise awareness regarding the potential for spread of infectious diseases at swimming venues and the need to improve prevention measures. Each year, U.S. residents make an estimated 360 million visits to recreational water venues, making swimming the second most common physical activity (after walking) in the country and the most common among children. The number of waterparks has increased to approximately 1,000 in North America, with another 600 elsewhere around the world. Recreational water illnesses (RWIs) are spread by swallowing, breathing, or having contact with contaminated water from swimming pools, spas, lakes, rivers, or oceans. The most commonly reported RWI is diarrhea caused by pathogens such as Cryptosporidium, Giardia, Shigella, and Escherichia coli O157:H7. Children, pregnant women, and persons with compromised immune systems are at greatest risk. Infection with Cryptosporidium can be life threatening to persons with weakened immune systems. Other RWIs can cause various ailments, including skin, ear, eye, respiratory, wound, and neurologic infections.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5619a5.htm
(MMWR May 18, 2007 / 56(19);481)

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 apecein@u.washington.edu