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Vol. X. NO. 12 ~ EINet News Briefs ~ Jun 08, 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: Airline passengers possibly exposed to XDR tuberculosis; index subject isolated
- UK (England, Wales): Low pathogenic avian influenza found in chickens; Wales outbreak waning
- Russia (Stavropol): Food borne salmonellosis hospitalizes 78
- Russia (Volgograd): Crimean-Congo Hemorrhagic Fever outbreak
- China (Fujian): 16th human death from avian influenza H5N1 confirmed
- Hong Kong: Avian influenza H5N1detected in starling bird
- Indonesia (Central Java): 79th fatal human case of avian influenza H5N1
- Indonesia: Potential avian influenza H5N1 Mutation Reported
- Malaysia (Peninsular): Avian influenza H5N1 in chickens and birds
- Viet Nam: Human case of avian influenza H5N1 confirmed
- Viet Nam (Quang Nam): 16th Province affected by avian influenza H5N1
- China (Shanxi): Atypical measles outbreak at a boarding school
- Hong Kong: Gastroenteritis on a cruise ship
- Hong Kong: Hand, Foot, and Mouth Disease outbreak in kindergarten
- Hong Kong: New human case of Streptococcus Suis infection
- Indonesia (Lampung): Chikungunya outbreak affects 100 people
- Philippines (Mindinao): Village quarantined to control malaria
- Canada (Multiprovince): Mumps outbreak continues
- Canada (Ontario): E. coli O157 outbreak hospitalizes 4 persons
- Canada (British Columbia): Imported measles from Japan
- USA: FDA issues guidance on influenza vaccine development
- USA: Danish firm wins US contract for new smallpox vaccine
- USA (Oregon): Imported measles from Japan
- USA (New Mexico): Fatal hantavirus case
- USA (Missouri): Fatal human case of ehlichiosis
- USA (New Mexico): Human case of secondary pneumonic plague
- USA (Washington): Fatal case of drug-related wound botulism
- USA (Multistate): Human and animal rabies cases
- USA (Multistate): Ground beef recall due to E Coli 0157:H7
- Egypt (Qena): New human case of avian influenza H5N1 reported

1. Updates
- Avian/Pandemic influenza updates
- Dengue

2. Articles
- Physician survey shows mixed views on pandemic risk
- Study shows veterinarians at increased risk of avian influeza
- Surveillance of Resistance to Adamantanes among Influenza A(H3N2) and A(H1N1) Viruses Isolated Worldwide
- Antivirals for Influenza
- The Molecular Basis of the Pathogenicity of the Dutch Highly Pathogenic Human Influenza A H7N7 Viruses
- Little evidence for genetic susceptibility to influenza A (H5N1) from family clustering data
- Human influenza A (H5N1) cases, urban areas of People’s Republic of China, 2005–2006
- The Immunogenetics of Smallpox Vaccination
- Antibody Responses to Vaccinia Membrane Proteins after Smallpox Vaccination
- Strategies to reduce person-to-person transmission during widespread Escherichia coli O157:H7 outbreak
- Multistate Outbreak of Salmonella Serotype Tennessee Infections Associated with Peanut Butter--United States, 2006--2007
- Acanthamoeba Keratitis Multiple States, 2005--2007
- West Nile Virus Activity --- United States, 2006

3. Notifications
- 75th Annual General Session of the International Committee of OIE
- National Center of Foreign Animal and Zoonotic Disease Defense


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 / 3 (2)
Egypt / 16 (4)
Indonesia / 24 (21)
Laos / 2 (2)
Nigeria / 1 (1)
Total / 47 (31)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 310 (189).
(WHO 6/6/07 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 6/4/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 6/8/07):
http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 6/6/07):
http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.

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Global: Airline passengers possibly exposed to XDR tuberculosis; index subject isolated
A man infected with extensively drug-resistant tuberculosis (XDR-TB) may have exposed fellow air passengers on 2 trans-Atlantic flights, May 12 and 24, 2007, to the potentially lethal disease. The infected man may have exposed other travelers to a strain of XDR-TB, a lung disease that doesn't respond to most available treatments, U.S. CDC director Julie Gerberding said. The man, a U.S. citizen, was ordered into isolation, she said. Health officials are still trying to determine how the patient became infected with XDR-TB. After flying into Montreal, he re-entered the U.S. by car. He was contacted by CDC officials in New York, and voluntarily reported to a testing center, where he was found to have XDR-TB and ordered into isolation. In the US, about 49 cases of XDR-TB were reported to federal health officials from 1993 through 2006, and each cost about USD 500 000.00 to treat, CDC said Mar 2007. About two-thirds of those infected with XDR-TB die, WHO said. XDR TB is defined as a multidrug-resistant strain (MDR TB) with resistance to the 2 most important first-line drugs isoniazid and rifampin and in addition to the 2 most important second-line antibiotics a fluoroquinolone and an injectable agent (amikacin, kanamycin, or capreomycin). In Feb 2007, the Geneva-based agency asked donor countries and organizations to give USD 650 million to improve diagnosis and treatment of the disease.

WHO guidelines for initiating an airline contact investigation: http://whqlibdoc.who.int/hq/2006/WHO_HTM_TB_2006.363_eng.pdf
(ProMED 5/29/07, 5/30/07, 6/1/07, 6/9/07, http://www.promedmail.org, CIDRAP 5/31/07, http://cidrap.umn.edu )

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Europe/Near East
UK (England, Wales): Low pathogenic avian influenza found in chickens; Wales outbreak waning
A low-risk strain of bird flu has been found at a smallholding near St Helens in Merseyside, England. Laboratory tests confirmed that the birds were infected with a low-pathogenic strain of avian influenza, H7N2. A restriction zone has been placed around the area following the positive tests for the disease. Some of the infected chickens had been bought from the market held in Chelford associated with the recent outbreak in north Wales. All the farm's birds, including peacocks, have been culled. The strain is not thought to pose a human risk. Low pathogenic avian influenza typically causes little or no clinical symptoms in infected birds. The birds included 20 chickens, 3 ducks, 3 peacocks and some peacock chicks. A restricted zone extends 1 km from the holding. People are forbidden from moving poultry or any sort of live birds or eggs through this zone. The 2 people who live on the smallholding have been tested for the disease after exhibiting flu-like symptoms, but results were negative. Animal Health is tracing movements and contacts.

In Wales, meanwhile, much attention has been paid to various outbreaks and suspected outbreaks at small farms across the region. As of 4 Jun 2007, following the confirmation 25 May 2007 of influenza A/H7N2 virus infection in 2 individuals exposed to infected poultry at smallholding Corwen Farm, Conwy, Wales, the National Public Health Service (NPHS) for Wales is continuing with the investigation of the incident and with the implementation of public health measures. Government officials are testing for bird flu at another smallholding after a sick chicken near Chard showed symptoms of the disease. Test results for the H7N2 strain from poultry on a farm on the Llyn Peninsula in Wales have proved negative. Birds on the farm were tested because of a connection with Chelford Market 7 May 2007, which is linked to the Corwen outbreak where H7N2 was confirmed in poultry 24 May 2007. All birds on this site were slaughtered 25 May 2007, and cleansing and disinfection of the site has now been completed.

The first case of avian flu in a human was found in poultry on a smallholding near Cerrigydrudion, Conwy. At its height, 252 people who may have come into contact with the virus were being monitored. The National Public Health Service for Wales (NPHS) said there was "no more risk," but investigations would continue into the outbreak and its causes. Tests were carried out on people who may have come into contact with the farm and eventually, 252 people was monitored. Of those, 17 people suffering conjunctivitis or a flu-like illness were identified with the bird flu virus. Health officials confirmed 5 Jun 2007, that those who had been in possible contact with infected birds, or who had been ill, were now out of the 7 day incubation period for the flu virus.
(ProMED 5/31/07, 6/3/07, 6/4/07, 6/6/07 6/7/07, http://www.promedmail.org )

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Russia (Stavropol): Food borne salmonellosis hospitalizes 78
Another 10 people have been hospitalized with food poisoning in the Stavropol Territory over the past day, bringing the number of hospitalized people to 78, including 15 children. Doctors estimate the condition of the sick people as moderate to severe. The first reports of illness were documented May 26, 2007. It was found out that all hospitalized people had become ill after eating cakes bought at several food stores and small marketplaces. The producer of the implicated products -- a private confectioner's shop -- was found. Laboratory tests showed that salmonella, which cause an acute infectious intestinal disease, were found in the cakes.
(ProMED 6/4/07, http://www.promedmail.org )

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Russia (Volgograd): Crimean-Congo Hemorrhagic Fever outbreak
Cases of Crimean-Congo Hemorrhagic Fever (CCHF) were confirmed in 8 regions of the Stavropol area -- 2 cases each in Budyonovsk and Neftekumsk, and 1 case in each of the Apanasenkovskoe, Blagodarnenskoe, Izobilnenskoe, Ipatovskoe, Krasnogvardeyskoe, and Novoselitskoe districts. At least 1 case was reported to have been fatal. On 11 May 2007, all cattle in the Oktyabrskk region were treated with an anti-acaracide compound. On 18 May 2007, the administration of the Volgograd region established an office to combat the spread of CCHF. The majority of cases have reportedly been transmitted by tick bite occurred during contact with farm animals. In 3 cases, however, the tick bite occurred during excursions into the countryside. Since the beginning of the outbreak, a total of 84 people, including 18 children under 14 years of age, have been admitted to hospital on suspicion of having contracted CCHF. Of the suspected cases, 39, including 1 child, are still in hospital.
(ProMED 5/27/07, 6/1/07 http://www.promedmail.org)

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Asia
China (Fujian): 16th human death from avian influenza H5N1 confirmed
The Ministry of Health in China has informed WHO of the country’s 16th death from H5N1 avian influenza. The 19-year-old male soldier serving in Fujian province died 3 Jun 2007. Of the 25 laboratory-confirmed cases in China, 16 have been fatal.
(WHO 6/4/07, http://who.int/en, ProMED 6/4/07, http://www.promedmail.org )

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Hong Kong: Avian influenza H5N1detected in starling bird
A starling has tested positive for the H5N1 bird flu virus in Hong Kong, agricultural officials said Jun 1 2007. Authorities said the bird, found dead last week in a densely populated central area, was confirmed to be infected with the strain by laboratory tests. It was the 16th wild bird that has been found dead in Hong Kong this year with H5N1. Biologists believe local species of wild birds found dead with the virus could have picked it up from contact with infected flocks in mainland China. Hong Kong was the scene of the world's first reported major bird flu outbreak among humans in 1997, when 6 people died.
(ProMED 6/2/07, http://www.promedmail.org )

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Indonesia (Central Java): 79th fatal human case of avian influenza H5N1
Indonesian officials announced that a 15-year-old girl from Central Java died of H5N1 avian influenza this week. Reportedly the girl fell ill May 21, 2007 and was treated at a local hospital, but was transferred to Karyadi hospital in the Central Java capital of Samarang 4 days later and died there May 29, 2007. The girl was reported to have had contact with sick birds; the girl apparently handled a dead chicken when preparing to cook it. Several chickens died at her home and that of a neighbor. Her death marks Indonesia's third fatal H5N1 case, with all thre3 cases from Central Java, in less than 2 weeks. WHO confirmed this case Jun 6, marking Indonesia's H5N1 99th case, and 79th death.
(CIDRAP 6/1/07, 6/7/07 http:///cidrap.umn.edu )

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Indonesia: Potential avian influenza H5N1 Mutation Reported
Officials from Indonesia's avian flu commission said that the H5N1 avian influenza virus may have mutated in a way that makes it more transmissible from birds to humans, but a WHO official said WHO had seen no evidence of such a change. Wayan Teguh Wibawan, a microbiologist from Indonesia's avian flu commission, said the suspicions of mutation are based on preliminary results of genetic tests at laboratories in Indonesia. The amino acid structure of poultry H5N1 samples is becoming increasingly similar to that seen in human H5N1 samples, he said. The similarity in amino acid structure makes it easier for the virus to attach to receptors on cells that line the throat and lungs. However, Gregory Hartl, a WHO spokesman, said WHO has not seen any evidence that the virus has become more transmissible to humans. WHO has received only 3 Indonesian H5N1 samples, gathered from 2 patients, this year. "Without virus characterization, we cannot say whether the virus has changed or not," he said.
(CIDRAP 6/6/07, http://cidrap.umn.edu, ProMED, 6/7/07, http://www.promedmail.org )

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Malaysia (Peninsular): Avian influenza H5N1 in chickens and birds
A case of the highly pathogenic H5N1 avian flu strain has been detected in a village in Sg Buloh, the first incident in Malaysia after the outbreak in Mar 2006. Teams from the Veterinary Services Department have been dispatched to cull all chickens and birds within a 1 km radius of the village Kg Paya Jaras Hilir, beginning Jun 6, 2007.Also affected were 3 other villages in the surrounding area: Kg Paya Jaras Hulu, Kg Jaras Dalam, and Kg Kubu Gajah. Similarly at risk was the duck breeding center run by the department, located less than 300 metres from the site. An estimated 2000 birds and eggs, including chickens and ducks, will be culled in the operation.
(ProMED 6/6/07, http://www.promedmail.org )

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Viet Nam: Human case of avian influenza H5N1 confirmed
Viet Nam confirmed a new human bird flu case 1 Jun 2007 as the latest outbreak swept through 14 provinces within the last month. A worker at a slaughterhouse in Hanoi had tested positive for the H5N1 virus strain, Nguyen Duc Hien, head of the National Institute for Tropical Diseases, said. He was admitted to the institute 26 May, just 12 days after starting to work at the abattoir. Hien said the man was recovering and his condition stable. Director of Hanoi's Bach Mai Hospital, Tran Thuy Hanh, said in the past 2 days 2 patients had been admitted with typical bird flu symptoms, one of whom had died June 1 2007. The hospital had taken samples from them for tests, she added.
(ProMED 6/2/07, http://www.promedmail.org )

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Viet Nam (Quang Nam): 16th Province affected by avian influenza H5N1
Quang Nam in the central region became the 16th Vietnamese province to report bird flu. In Vinh Nam hamlet in Duy Xuyen district, 370 out of a flock of 400 ducklings raised by a household had been infected 30 May, the province's veterinary bureau said. Specimens tested positive for the H5N1 strain. The central Animal Health Department reported a day earlier that 115 ducks had died on a farm in the Mekong Delta city of Can Tho of H5N1. The infected flocks in Quang Nam and Can Tho were not vaccinated against bird flu and animal health workers slaughtered the remaining 685 birds. The number of birds killed by the virus or slaughtered nationwide has risen to more than 50 000 this month. Local veterinary agencies reported they had culled all fowls in affected flocks, disinfected affected areas, and established quarantine checkpoints around infected areas. The head of the National Steering Committee for Avian Influenza Prevention and Control instructed 31 May 2007 all local agencies to keep an eye on rural farms and backyard poultry to head off possible bird flu outbreaks.
(ProMED 6/2/07, http://www.promedmail.org )

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China (Shanxi): Atypical measles outbreak at a boarding school
Shanxi Provincial Health Bureau said 30 May 2007 that since the middle of May 2007, a febrile illness has occurred among students in Qingxu Middle School in Qingxu County of Shanxi's Taiyuan Municipality. There are now a total of 68 cases. Following treatment, the ill students are stable and there are no patients in serious condition. Temperatures have returned to normal in 64 students. Health department experts have preliminarily determined that the illness is atypical measles. Most ill students are reportedly senior year students, and 59.7 percent are in the same class. A survey shows that illness occurred among those in the same classroom but not in the same dorm. There is no difference in incidence between males and females. After the disease occurred, the Ministry of Health and experts from Shanxi Province went to the site, where water sources, the cafeteria, dorms, wastewater, and other potential environmental sources of disease were investigated. Experts have already ruled out SARS (severe acute respiratory syndrome) and avian influenza, and confirmed atypical measles.
(ProMED 6/1/07, http://www.promedmail.org )

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Hong Kong: Gastroenteritis on a cruise ship
The Hong Kong Department of Health is investigating a gastroenteritis outbreak involving 92 passengers and 4 crew aboard a cruise ship that arrived in Hong Kong May 30, 2007. The passengers, aged 3 to 83, and the 4 crew came down with diarrhea, vomiting and fever between 21 and 29 May 2007. None required hospitalization. 70 have recovered, while the others are in stable condition after treatment by the ship's doctor. The ship, carrying 639 passengers and 465 crew, left Singapore 20 May 2007, stopping in Ko Samui and Bangkok in Thailand as well as Ho Chi Min City and Da Nang in Viet Nam. Port Health Office and Centre for Health Protection staff have inspected the ship and advised control measures. The ship will be thoroughly disinfected before its next cruise. The crew have been advised to observe personal and food hygiene. Laboratory tests on patients' samples were positive for norovirus, a common cause of viral gastroenteritis.
(ProMED 5/30/07, 6/1/07 http://www.promedmail.org )

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Hong Kong: Hand, Foot, and Mouth Disease outbreak in kindergarten
The Centre for Health Protection is investigating a hand-foot-mouth disease (HFMD) outbreak in a kindergarten involving 9 children aged 3 to 6. Between 5 - 28 May 2007, the children developed fever, mouth ulcers, blisters on their feet and hands, abdominal pain, and diarrhoea. A 4-year-old boy was diagnosed with enterovirus-71 (EV71) 26 May 2007. None of the children required hospitalisation and 5, including the boy with EV71, have recovered. The remaining 4 are in stable condition. The Centre has advised the school to suspend lessons for 2 weeks for thorough disinfection. HFMD is a viral infection mainly transmitted via the faecal-oral route. Direct contact with open skin can also spread it.
(ProMED 5/30/07, http://www.promedmail.org )

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Hong Kong: New human case of Streptococcus Suis infection
A part-time Hong Kong butcher has become the third victim of the pig-borne Streptococcus suis in the territory in less than a month. The 54-year-old man developed fever, headache and neck pain nearly 2 weeks ago, but was admitted to hospital only May 22, 2007, and was reported to be in stable condition. All 3 cases in the territory were diagnosed within 8 days and are believed to have been contracted locally. There have been no reported cases of the illness on the Chinese mainland since a deadly outbreak in 2005. The bacterial infection is rarely fatal in humans, but an unusually virulent strain killed more than 30 people in Sichuan province in 2005. 8 cases were reported in 2006 in Hong Kong, with 13 -- 2 of them fatal -- in 2005.
(ProMED 5/27/07, http://www.promedmail.org )

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Indonesia (Lampung): Chikungunya outbreak affects 100 people
About 100 people in Bandarlampung have been affected by an outbreak of chikungunya, a usually non-fatal viral fever spread by mosquitoes. The outbreak has been centered in the village of Langkapura in Kemiling district. Most of those infected have not sought medical treatment because they cannot afford to go to a community health center or see a doctor. Chikungunya, which is similar to dengue fever, is characterized by high fever and severe joint pain, or arthralgia, that can last for up to a week. The virus that causes the disease is spread through the bite of either the Aedes africanus or the Aedes albopictus mosquito, which can also carry dengue fever virus. Further fumigation efforts are reportedly underway to combat transmission.
(ProMED 5/30/07, http://www.promedmail.org )

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Philippines (Mindinao): Village quarantined to control malaria
Health officials in South Cotabato have quarantined an entire village to stop the spread of malaria. Authorities have reportedly placed a mountain village in Lake Sebu town under isolation after noting 80 cases of malaria there. Aside from the village in question, authorities have stepped up their joint malaria border operations in neighboring Ned village, where a malaria outbreak was recorded 2 years ago. The cause of the outbreak was traced from malaria-endemic villages in nearby Sultan Kudarat province. There have been no deaths reported from the outbreak.
(ProMED 6/5/07, http://www.promedmail.org )

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Americas
Canada (Multiprovince): Mumps outbreak continues
Another 2-dozen cases of mumps are being reported in Nova Scotia, bringing the total to 326 since the outbreak began Feb 2007. Medical officer of health, Dr. Robert Strang, said that the peak of the outbreak is over but, as part of the normal cycle, more cases can be expected for weeks or months to come. And Strang says there's the possibility of an "upswing" in mumps cases in Sep, when university students return to classes. Meanwhile, the outbreak appears to have spread to Manitoba. Public health officials have confirmed 2 reported cases of mumps in Winnipeg, both in people in their 20s. Neither has been hospitalized. Officials said the 2 were likely exposed to mumps when an infected student from the east visited the University of Manitoba earlier in May. At the same time, almost an entire crew of a Halifax-based navy ship has been sent home after one of the vessel's crew members came down with a case of mumps. Strang says a vaccination program is being considered for students and a meeting has been scheduled for next week with the presidents of the province's universities. The majority of cases have occurred in people between the ages of 20 and 25. The outbreak in Nova Scotia has also been linked to cases in other provinces. In New Brunswick, there have been dozens of cases. As of 25 May 2007, the number of confirmed cases were: Nova Scotia 326, New Brunswick 56, Prince Edward Island 2, Ontario 12, Alberta 2, Manitoba 2, and British Columbia 2. To see a map of cases: http://www.phac-aspc.gc.ca/mumps-oreillons/prof_e.html.
(ProMED 5/26/07, 5/27/07, 6/2/07, http://www.promedmail.org )

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Canada (Ontario): E. coli O157 outbreak hospitalizes 4 persons
An Escherichia coli outbreak linked to a restaurant has hospitalized 4 young Niagara residents, including a 2 year old. Public health officials closed the restaurant 5 Jun 2007 and are asking anyone who has eaten there since 17 May 2007 to call the health department. The vehicle for transmission of the organism, presumably from the restaurant, is not yet known. So far, 4 young patients, ranging in age from 2 to 16 years, are infected with E. coli O157. 1 of the 4 patients has been sent home, but 3 remain hospitalized.
(ProMED 6/6/07, http://www.promedmail.org )

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Canada (British Columbia): Imported measles from Japan
Canadian officials invoked the Quarantine Act to block a group of 39 Japanese students and 2 of their chaperones from boarding a flight to Tokyo 31 May 2007, when departure screening in Vancouver (British Columbia) revealed 1 girl was ill with symptoms that could be measles. The affected students are part of a larger group of 130 Japanese tourists -- 123 students and 7 chaperones -- who had previously been quarantined by local public health authorities in Banff, Alberta, after 1 student developed measles shortly after arriving in the country 24 May 2007. While in Banff, the entire group was tested to see if they had antibodies to measles and the 39 students and 2 chaperones were identified as having no immunity to the highly contagious disease. No further cases have yet been identified in Canada to date, in relation to this case. It is possible that there will be sporadic cases and only limited transmission to those who are un-immunized or have received only one dose of MMR vaccine.
(ProMED 6/1/07, http://www.promedmail.org )

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USA: FDA issues guidance on influenza vaccine development
The US Food and Drug Administration recently released separate documents outlining the kinds of clinical data required for licensing of new seasonal and pandemic influenza vaccines. In a May 31, 2007 news release, the agency said the guidance documents were designed to facilitate the rapid development and approval of new vaccines by outlining the regulatory pathways for companies. The 2 documents outline approaches for developing vaccines that are "safe, pure, and potent." The recommendations describe conventional and accelerated approaches to vaccine licensing. Companies that choose the conventional pathway must provide clinical evidence that the vaccine actually prevents flu. With the accelerated pathway, a company still must conduct clinical trials but can use a biological indicator, such as antibody response, to predict the effectiveness of the vaccine. Companies will be expected to conduct additional clinical studies if and when the vaccine is used.
(CIDRAP 6/4/07, http://cidrap.umn.edu, FDA 6/4/07 http://www.fda.gov/bbs/topics/NEWS/2007/NEW01645.html )

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USA: Danish firm wins US contract for new smallpox vaccine
US officials have announced the award of a $500 million contract to Bavarian Nordic A/S, a Danish firm, for 20 million doses of a smallpox vaccine that's expected to be safe for people with weakened immune systems. Bavarian Nordic will produce its "next generation" smallpox vaccine, called Imvamune, for the Department of Health and Human Services (HHS). Imvamune is the company's version of modified vaccinia Ankara (MVA). HHS has stockpiled enough conventional smallpox vaccine to protect the entire US population in the event of a release of smallpox by terrorists. But the conventional vaccine uses live vaccinia virus, a cousin of the smallpox virus, and it can cause rare but potentially life-threatening side effects. People who have HIV or are being treated with chemotherapy should not receive the conventional vaccine except in emergencies, HHS said. MVA contains a form of vaccinia virus that has been weakened so that it can't replicate in humans, the agency said. Officials expect that it could be used safely in the estimated 10 million Americans who have limited immunity. The vaccine is being tested with a two-dose immunization schedule.
(CIDRAP 6/5/07, http://cidrap.umn.edu )

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USA (Oregon): Imported measles from Japan
Lane County (Oregon) Public Health officials announced June 4 that they have confirmed a second case of measles in Eugene Oregon, USA. A 21-year- old man was treated 26 May 2007 with a fever and rash after he returned from a trip to Japan. He was diagnosed with measles. After he arrived in Eugene 22 May 2007, he socialized with another Eugene man, also in his early 20s, public health officials said. The second man became infected 28 May 2007. Local authorities continue to work on contact tracing and notification. About 4 per cent of Lane County schoolchildren do not receive the measles vaccination, according to the Health Department. Since the Americas region has made great progress towards the goal of interruption of indigenous transmission of measles virus, importation of measles cases remains the primary route of introduction of measles into the region. Beginning in 2003, all reported outbreaks of measles in the Americas have been importation related, including a major outbreak in Mexico that began in 2003 and continued through 2004.
(ProMED 6/8/07, http://www.promedmail.org )

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USA (New Mexico): Fatal hantavirus case
A Taos County New Mexico woman has died of complications from a hantavirus infection, the state Department of Health says. The 59-year-old woman, who had been treated at the University of New Mexico, is the only person to have been diagnosed with the illness so far this year in New Mexico. The disease is transmitted by infected rodents -- particularly deer mice -- through urine, droppings or saliva. People contract the disease by breathing in the dried particles infected with the virus. Early symptoms include fever and muscle aches, possibly with chills, headache, nausea, vomiting, diarrhea, abdominal pain and a cough. The symptoms develop 1 to 6 weeks after exposure. There is no specific treatment for hantavirus, but officials said the chances for recovery are better if people get medical attention early. The Department advises airing out closed buildings before entering, cleaning up nests and droppings using disinfectant, sealing homes and cabins so mice cannot enter, trapping mice until they are gone, getting rid of trash and junk piles, not leaving pet food and water where mice could get to them and putting wood, hay and compost piles as far as possible from the house. New Mexico had 8 hantavirus cases, 3 of them fatal, in 2006. The state had 1 case in 2005 and 4 in 2004. Since hantavirus was first identified in 1993, there have been 74 cases and 31 deaths in New Mexico. Nationwide, 465 cases have been reported in 31 states, according to CDC. About 35 percent of all reported cases have been fatal.
(ProMED 5/31/07, http://www.promedmail.org )

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USA (Missouri): Fatal human case of ehlichiosis
On 7 Jun 2007, health officials warned Missourians to guard against tick bites, after the death of a child bitten by a tick in a north eastern part of the state. The child became ill after being bitten by a tick and died 23 May 2007, after 10 days of intensive medical care. Tests performed at St Louis Children's Hospital showed the child was infected with ehrlichiosis, a disease related to Rocky Mountain spotted fever, said Dr Howard Pue, Missouri's public health veterinarian. The state health department reports a 2007 rise in tickborne diseases such as ehrlichiosis and Rocky Mountain spotted fever. Other tickborne diseases reported in Missouri in 2007 include tularemia and Lyme-like disease. So far, 16 cases of ehrlichiosis have been reported. In the past 5 years, Missouri has seen an average of 9 cases per year during the same time period. Officials said 54 cases of Rocky Mountain spotted fever have been reported so far, with an average of 22 cases per year over the past 5 years. Other tickborne diseases reported in Missouri in 2007 include 2 cases of tularemia and 10 cases of Lyme-like disease.
(ProMED 6/7/07, http://www.promedmail.org)

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USA (New Mexico): Human case of secondary pneumonic plague
A Torrance County New Mexico woman was listed in critical condition 5 June 2007, with plague. The state Department of Health said the 58 year old woman developed bubonic plague, which progressed to plague pneumonia. Officials are investigating her home to determine if there is a risk to other people. It was the second case of plague confirmed in New Mexico in 2007. A San Juan County man recovered after being infected with septicemic plague Apr 2007. Plague, a bacterial disease of rodents, usually is transmitted to humans through the bites of infected fleas. However, it can also be transmitted by direct contact with infected animals, including rodents, wildlife, and pets. Prompt treatment with antibiotics can greatly reduce the fatality rate. New Mexico had 8 cases of human plague, 2 of them fatal, in 2006. Of these, 5 came from Bernalillo County. Santa Fe, San Miguel, and Torrance counties had a single case each. The state reported 4 human plague cases in 2005, and none in 2004. The department recommends prevention measures, including avoiding sick or dead rodents; teaching children not to play near rodent nests or burrows, treating pets regularly with flea control products, cleaning up areas near houses where rodents could live; and keeping pets from roaming.
(ProMED 6/7/07, http://www.promedmail.org )

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USA (Washington): Fatal case of drug-related wound botulism
A man has died of the second case of wound botulism in 2 months in Yakima County, and health officials believe both are linked to black tar heroin. The latest victim, 22, died 28 May 2007, a week after being diagnosed with botulism in the emergency room at Yakima Regional Medical and Cardiac Center, Yakima Health District officials said. He was homeless and had been living by the Yakima River. The other case occurred Mar 2007, and the victim survived. Wound botulism is caused by neurotoxins following an infection with Clostridium botulinum, a bacterium whose spores sometimes can be found in black tar heroin that is contaminated with soil and feces. Heating heroin before injecting it doesn't necessarily [inactivate] the spores, which can germinate into bacteria that produce toxin once in the body. Marianne Patnode, communicable disease services coordinator, said the county typically sees about 2 cases of wound botulism a year, but they are rarely fatal.
(ProMED 6/3/07, http://www.promedmail.org )

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USA (Multistate): Human and animal rabies cases
So far this year, 10 people have been bitten by rabid animals in Indian County, Florida: 3 by an otter, and the others by raccoons and a stray cat. A rabid otter bit a female golfer at the 7th hole of Grand Harbor's Harbor Course, 7 May 2007, shortly after biting another woman while she was walking her small dog. Both were chased by the unprovoked animal, which later bit a man at his home before being caught and hauled off by county Animal Control. The otter tested positive for rabies, causing all 3 bite victims to begin a series of vaccine injections to prevent a disease that is fatal. Meanwhile, Charlotte-Mecklenburg North Carolina Animal Control officials say they are alarmed that rabies cases might be on the rise again in the area. There were 19 cases in Mecklenburg County between 1 Jul 2006 and 15 May 2007, compared to 16 the year before [2005-2006], and the number is still growing. Mecklenburg's current number is still less than the 50 cases reported in 2003 and the 32 cases in 2004. The last fatal rabies case in North Carolina was in Cherokee County, 54 years ago.
(ProMED 5/29/07, http://www.promedmail.org )

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USA (Multistate): Ground beef recall due to E Coli 0157:H7
A number of people have become ill with Escherichia coli O157:H7 infection, possibly from contaminated ground beef that has been recalled by a California plant. Nationally, 12 people have gotten sick in the outbreak, which prompted United Food Group LLC to recall 34 020 kg of ground beef shipped to distribution centers in Arizona, California, Colorado, Oregon, and Utah. Health officials could not confirm to which local stores the meat was shipped, but they are urging people to get rid of certain types of ground beef with "EST. 1241" printed on the packages. The recalled food has a sell-by date of 6 May 2007, a freeze-by date of 7 May 2007, or a produced-on date of 20 Apr 2007, printed on the packages. It was sold under the brands Moran's All Natural, Inter-American Products, and Stater Bros and can be returned to the store where it was bought.
(ProMED 6/6/07, http://www.promedmail.org )

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Africa
Egypt (Qena): New human case of avian influenza H5N1 reported
A WHO official in Egypt reportedly said a 10-year-old girl is being treated for H5N1 avian influenza and is in critical condition. The girl is from Qena governorate in southern Egypt and was admitted to a hospital after developing flulike symptoms, health ministry spokesman Abdel-Rahman Shahin reportedly announced. If the girl's case is confirmed by WHO, she will be listed as Egypt's 35th case-patient. Egypt has had 14 H5N1 deaths. The girl had a history of contact with backyard birds, John Jabbour, the WHO official in Cairo, said. Reportedly she is on a respirator. Egypt reported 16 human H5N1 cases and 4 deaths in early 2007, most of them in children, but it has not had a WHO-confirmed case or fatality since Apr 11, 2007.
(CIDRAP 6/8/07, http://cidrap.umn.edu, ProMED 6/9/07, 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. 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/.
- 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.
- 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
Philippines
From Jan to 3 Jun this year, Bukidnon registered 212 dengue cases, which is 152 per cent higher than the figure recorded in the same period last year, data from the Regional Epidemic Surveillance Unit (Resu) showed. Slight increases of dengue cases were also observed in Misamis Oriental, Lanao del Norte, and Camiguin provinces, but these were negligible compared to the rise in Bukidnon, which has reached the alert threshold, said Dr. David Mendoza of the Resu. Of the 16 deaths, 6 were recorded in Misamis Oriental and Cagayan de Oro, 5 in Misamis Occidental, while the rest is spread among Bukidnon, Camiguin and Lanao del Norte provinces. Meanwhile, dengue cases this year have already reached 1076 as of 3 Jun 2007, slightly lower than the 1415 cases recorded in 2006. In Iloilo province, 2 persons have died of dengue. The regional Dengue/Malaria Coordinator explained that dengue is common during the rainy season and that it is transmitted by the bite of an infected Aedes mosquito. Dr. Mabasa advised the public to properly dispose of their containers so that these do not become mosquito-breeding places. "Everybody's participation is very important in our drive against the disease," Dr. Mabasa said.
(ProMED 5/26/07, 6/6/07 http://www.promedmail.org )

Singapore
The number of people infected with dengue in a single week in Singapore has risen to the year's highest level, stoking fears of an epidemic, a newspaper said 30 May 2007. A total of 259 dengue cases were reported that week, the highest number of cases this year, and breaching the "warning level" of 256 to 378 cases set by the Health Ministry. Epidemic levels are reached when more than 378 cases are reported in a week. A dengue epidemic hit Singapore in 2005, when 714 cases were reported in a single week.
(ProMED 6/6/07, http://www.promedmail.org )

Viet Nam
Viet Nam's southern region experienced 10 551 dengue fever patients in the first 5 months of this year, a year-on-year rise of 30 per cent, according to the Ho Chi Minh City Pasteur Institute 30 May 2007. 10 cases have been fatal. Weather conditions in the region and local people's habit of storing water in containers at their houses favor the breeding of mosquitoes, the virus's transmitter. Local health care agencies are asking residents to frequently clean up the environment around their accommodations, mainly by keeping water containers closed and clean and killing mosquitoes and their larvae, the institute said. In 2006, Viet Nam faced over 77 800 cases of dengue fever infections, including 68 fatalities. Up to 84 per cent of the infections and 91 per cent of the deaths were reported in the southern region.
(ProMED 6/6/07, http://www.promedmail.org )

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2. Articles
Physician survey shows mixed views on pandemic risk
Fewer than half of physicians who responded to a survey at a recent conference in Europe said they thought an influenza pandemic was very likely in the next few years, according to a report in the journal Archives of Disease in Childhood. The survey was an anonymous electronic poll conducted at a pediatric infectious disease course at Oxford University in England. The group included 161 physicians, mostly from Europe, with half from the UK. The poll was conducted by Nigel Curtis of the University of Melbourne (Australia) and Andrew Pollard of Oxford. The findings, published early online, revealed that only 72 (44.7%) of respondents took the view that an avian influenza pandemic is "almost inevitable" or "very likely" within "the next few years." 73 physicians, or 45.4%, thought a pandemic was "possible" in that time span, while 16 (9.9%) viewed such an event as unlikely or very unlikely. The researchers also asked if attendees had gathered a supply of the antiviral drug oseltamivir for personal or family use. Only 11 (7.9%) of 139 respondents said they had. By training level, only 1 of 27 infectious disease specialists reported having acquired the antiviral, but among those in infectious disease training, 5 of 24 (17.2%) had their own supply. The authors concluded that the survey contains some mixed messages about physicians' perceptions of pandemic risk. Despite widely publicized evidence that the world faces a serious threat of a pandemic, more than half of the respondents "did not believe the risk of an imminent influenza pandemic was more than a possibility," the report says. However, a "significant minority" of the doctors believed the risk was high enough to warrant gathering their own antiviral supply, despite recommendations against personal stockpiling. The letter can be accessed at http://adc.bmj.com/cgi/content/abstract/adc.2007.120469v2.
(CIDRAP 6/6/07, http://cidrap.umn.edu )

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Study shows veterinarians at increased risk of avian influeza
In a study to be released in the July volume of the journal Clinical Infectious Diseases, researchers have reportedly found an increased risk of avian influenza among veterinarians. The investigators examined blood samples from a group of US veterinarians for evidence of previous avian influenza virus infection. The veterinarians all had occupational exposure to live chickens, ducks, turkeys, geese or quail. The study showed that, compared with the control group, the veterinarians who worked with birds had significantly higher levels of antibodies in their blood against the H5, H6 and H7 avian virus strains, indicating previous infections with these viruses. The infections were likely due to the mild forms of avian influenza virus that have occasionally circulated among wild and domestic birds in the United States, according to the researchers. The greatest risk factor for infection reported by veterinarians was examining birds known to be sick with influenza.
(ProMED 6/4/07, Science Daily, http://www.sciencedaily.com/releases/2007/05/070531092715.htm 5/30/07)

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Surveillance of Resistance to Adamantanes among Influenza A(H3N2) and A(H1N1) Viruses Isolated Worldwide
Varough M. Deyde, Xiyan Xu, et al. The Journal of Infectious Diseases 2007;196:000
Abstract: “Our previous reports demonstrated an alarming increase in resistance to adamantanes among influenza A(H3N2) viruses isolated in 2001–2005. To continue monitoring drug resistance, we conducted a comprehensive analysis of influenza A(H3N2) and A(H1N1) viruses isolated globally in 2005–2006. The results obtained by pyrosequencing indicate that 96.4% (n = 761) of A(H3N2) viruses circulating in the United States were adamantane resistant. Drug resistance has reached 100% among isolates from some Asian countries. Analysis of correlation between the appearance of drug resistance and the evolutionary pathway of the hemagglutinin (HA) gene suggests at least 2 separate introductions of resistance into circulating populations that gave rise to identifiable subclades. It also indicates that resistant A(H3N2) viruses may have emerged in Asia in late 2001. Among A(H1N1) viruses isolated worldwide, resistance reached 15.5% in 2005–2006; in the United States alone, it was 4.0%. Phylogenetic analysis of the HA and M genes indicates that the acquisition of resistance in A(H1N1) viruses can be linked to a specific genetic group and was not a result of reassortment between A(H3N2) and A(H1N1) viruses. The results of the study highlight the necessity of close monitoring of resistance to existing antivirals as wells as the need for new therapeutics.”

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Antivirals for Influenza
Adrian K. Ong and Frederick, G. H. The Journal of Infectious Diseases. 2007;196:000
Abstract: “The long history of influenza drug development has both contributed practical advances in antiviral chemotherapy and improved the understanding of influenza pathogenesis and epidemiology. The role played by these antivirals continues to grow with the dual threats of seasonal and pandemic influenza. The neuraminidase inhibitors are proven effective for the chemoprophylaxis and treatment of influenza A and B, although early therapy is essential for disease mitigation. Studies of topically applied zanamivir have demonstrated the importance of viral replication in the lower respiratory tract, even in uncomplicated influenza. Antiviral resistance, especially to the M2 ion channel inhibitors, sometimes limits clinical utility. Oseltamivir-resistant variants may emerge during treatment but have not yet circulated widely and are usually less fit than wild-type virus; most retain susceptibility to zanamivir. The transmission fitness cost of these resistant variants is drug-, neuraminidase subtype–, and mutation-specific. Continued vigilance in drug resistance surveillance is imperative, as is research into the development of new agents that will provide the potential for alternative and combination antiviral therapy.”
http://www.journals.uchicago.edu/JID/journal/issues/v196n2/38244/brief/38244.abstract.html

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The Molecular Basis of the Pathogenicity of the Dutch Highly Pathogenic Human Influenza A H7N7 Viruses
Vincent J. Munster, Emmie de Wit, et al. The Journal of Infectious Diseases. 2007;196:000
Abstract: “During the highly pathogenic avian influenza (HPAI) H7N7 virus outbreak in The Netherlands in 2003, 88 infected persons suffered from mild illnesses, and 1 died of pneumonia. Here, we studied which of the 14 amino acid substitutions observed between the fatal case (FC) virus and a conjunctivitis case (CC) virus determined the differences in virus pathogenicity. In virus-attachment experiments, the CC and FC viruses revealed marked differences in binding to the lower respiratory tract of humans. In a mouse model, the hemagglutinin (HA) gene of the FC virus was a determinant of virus tissue distribution. The lysine at position 627 of basic polymerase 2 (PB2) of the FC virus was the major determinant of pathogenicity and tissue distribution. Thus, remarkable similarities were revealed between recent HPAI H5N1 and H7N7 viruses. We conclude that the influenza virus HA and PB2 genes should be the prime targets for molecular surveillance during outbreaks of zoonotic HPAI viruses.”
http://www.journals.uchicago.edu/JID/journal/issues/v196n2/37640/brief/37640.abstract.html

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Little evidence for genetic susceptibility to influenza A (H5N1) from family clustering data
Pitzer VE, Olsen SJ, Bergstrom CT, Dowell SF, Lipsitch M. Emerg Infect Dis. 2007 Jul; [Epub ahead of print]
Abstract : “The apparent clustering of human cases of influenza A (H5N1) among blood relatives has been considered as evidence of genetic variation in susceptibility. We show that, by chance alone, a high proportion of clusters are expected to be limited to blood relatives when infection is a rare event.”
http://www.cdc.gov/ncidod/EID/

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Human influenza A (H5N1) cases, urban areas of People’s Republic of China, 2005–2006
Yu H et al. Emerg Infect Dis. 2007 Jul; [Epub ahead of print]
Abstract: “We investigated potential sources of infection for 6 confirmed influenza A (H5N1) patients who resided in urban areas of People’s Republic of China. None had known exposure to sick poultry or poultry that died from illness, but all had visited wet poultry markets before illness. Although >280 confirmed human cases of avian influenza A (H5N1) virus infection from 12 countries have been reported, detailed data on sources of infection for most patients are limited. In Vietnam, 8 of 9 patients with influenza A (H5N1) reported close contact with sick or dead poultry. In Thailand, 9 of 12 such patients lived in households where backyard chickens died, and 8 reported direct contact with dead chickens. Case-control studies in Thailand and Vietnam found that the most statistically significant risk factor was recent exposure to sick or dead poultry, especially directly touching dead poultry. Avian influenza (H5N1) poultry outbreaks have been reported in mainland People’s Republic of China since 2004; since late 2005, human cases have also been reported. Most Chinese patients had exposure to backyard poultry, although some had no apparent direct exposure to poultry that were sick or died. We describe findings of investigations of urban patients with influenza A (H5N1), who had no known direct contact with sick poultry or poultry that died of illness in China.”
http://www.cdc.gov/ncidod/EID/

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The Immunogenetics of Smallpox Vaccination
Samuel L. Stanley, Jr.,1,2 Sharon E. Frey et al. The Journal of Infectious Diseases. 2007;196:000
Abstract: “We hypothesized that individuals who develop fever after smallpox vaccination have genetically determined differences in their immune responses to vaccinia virus. We looked for an association between the development of fever and single-nucleotide polymorphisms (SNPs) in 19 candidate genes in 346 individuals previously assessed for clinical responses to smallpox vaccination. Fever after smallpox vaccination is associated with specific haplotypes in the interleukin (IL)–1 gene complex and in the IL18 gene. A haplotype in the IL4 gene was highly significant for reduced susceptibility to the development of fever after vaccination among vaccinia-naive individuals. Our results indicate that certain haplotypes in the IL-1 gene complex and in IL18 and IL4 predict an altered likelihood of the development of fever after smallpox vaccination. Our findings also raise the possibility that these same haplotypes may identify individuals at risk for the development of fever after receipt of other live virus vaccines, providing information that could be useful in anticipating and preventing more-serious adverse events.”
http://www.journals.uchicago.edu/JID/journal/issues/v196n2/37808/brief/37808.abstract.html

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Antibody Responses to Vaccinia Membrane Proteins after Smallpox Vaccination
Steven J. Lawrence, Kathleen R. Lottenbach, et al. The Journal of Infectious Diseases. 2007;196:000
Abstract: “Background. Vaccinia virus (VV) membrane proteins are candidates for orthopoxvirus subunit vaccines and potential targets for therapeutic antibodies. Human antibody responses to these proteins after VV vaccination have not been well characterized. Methods. Pre- and postvaccination (day 26–30) serum specimens from 80 VV vaccine recipients were examined for immunoglobulin G antibodies specific for B5, A33, A27, and L1 by enzyme-linked immunosorbent assay (ELISA). Responses were compared between vaccinia-naive and previously vaccinated (nonnaive) recipients and between nonnaive recipients of undiluted or 1 : 10 diluted vaccine. Results. VV vaccination elicited anti-A33 and anti-A27 antibodies in nearly all vaccinia-naive subjects (100% and 93%, respectively). Preexisting antibodies were commonly detected in nonnaive subjects (for anti-B5, 68%; for anti-A33, 59%; for anti-A27, 38%; and for anti-L1, 10%). Anti-B5 antibodies were strongly boosted by undiluted vaccine (geometric mean titer [GMT], 151 vs. 1010 for pre- vs. postvaccination; P < .001), whereas anti-L1 antibody responses were less robust (detection rate, 31%; GMT, 75) in nonnaive subjects. Diluted vaccine elicited antibody responses that were similar to those elicited by undiluted vaccine. Conclusions. Vaccination with VV elicits long-lived specific antibody responses directed against VV membrane proteins that vary by previous vaccination status but not with respect to 10-fold dilution of vaccine. B5, A33, and A27 should be considered for inclusion in future human orthopoxvirus subunit vaccines.”
http://www.journals.uchicago.edu/JID/journal/issues/v196n2/37767/brief/37767.abstract.html

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Strategies to reduce person-to-person transmission during widespread Escherichia coli O157:H7 outbreak
Seto EYW, Soller JA, Colford JM Jr. Emerg Infect Dis [serial on the Internet]. 2007 Jun 9.
Abstract: “During the Escherichia coli O157:H7 outbreak in 2006 in the United States, the primary strategy to prevent illness was to advise consumers not to eat spinach. No widespread warnings were issued about preventing person-to-person (secondary) transmission. A disease transmission model, fitted to the current data, was used to investigate likely reductions in illnesses that could result from interventions to prevent secondary transmission. The model indicates that exposure to contaminated spinach occurred early in the outbreak and that secondary transmission was similar to that in previous E. coli outbreaks (≈12%). The model also suggests that even a modestly effective strategy to interrupt secondary transmission (prevention of only 2%–3% of secondary illnesses) could result in a reduction of ≈5%–11% of symptomatic cases. This analysis supports the use of widespread public health messages during outbreaks of E. coli O157:H7 with specific advice on how to interrupt secondary transmission.”
http://www.cdc.gov/EID/content/13/6/860.htm

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Multistate Outbreak of Salmonella Serotype Tennessee Infections Associated with Peanut Butter--United States, 2006--2007
“In November 2006, public health officials at CDC and state health departments detected a substantial increase in the reported incidence of isolates of Salmonella serotype Tennessee. In a multistate case-control study conducted during February 5--13, 2007, illness was strongly associated with consumption of either of two brands (Peter Pan or Great Value) of peanut butter produced at the same plant. Based on these findings, the plant ceased production and recalled both products on February 14, 2007. The outbreak strain of Salmonella Tennessee subsequently was isolated from several opened and unopened jars of Peter Pan and Great Value peanut butter and from two environmental samples obtained from the plant. New case reports decreased substantially after the product recall. As of May 22, 2007, a total of 628 persons infected with an outbreak strain of Salmonella serotype Tennessee had been reported from 47 states since August 1, 2006. Local and state public health officials in multiple states, with assistance from CDC and the Food and Drug Administration (FDA), are continuing to investigate this outbreak caused by peanut butter, a new food source for salmonellosis in the United States. All remaining jars of Peter Pan or Great Value peanut butter with a product code beginning with 2111 should be discarded. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5621a1.htm
(MMWR June 1, 2007 / 56(21);521-524)

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Acanthamoeba Keratitis Multiple States, 2005--2007
“In May 2006, the Illinois Department of Public Health (IDPH) informed CDC about a possible increase in Acanthamoeba keratitis (AK) at an ophthalmology center in Illinois during the preceding 3 years. The University of Illinois at Chicago (UIC) was investigating this possible increase. In October 2006, IDPH updated CDC about the ongoing UIC investigation. At that time, CDC informally contacted multiple ophthalmology centers in the United States to assess whether the potential increase in cases extended beyond Illinois. Responses from the ophthalmology centers were inconclusive. In January 2007, CDC initiated a retrospective survey of 22 ophthalmology centers nationwide to assess whether cases were increasing throughout the United States. In March 2007, data received from 13 centers demonstrated an increase in culture-confirmed cases of AK with wide geographic distribution. The increase in cases had begun in 2004 and continued to the present. On March 16, 2007, CDC initiated a multistate investigation to look for risk factors associated with this increase in AK cases. This report summarizes recent preliminary results of that investigation, which, indicated an association with AK in soft contact lens wearers who used Advanced Medical Optics (Santa Ana, California) Complete MoisturePlus (AMOCMP) multipurpose cleaning solution. CDC and the Food and Drug Administration (FDA) are taking steps to notify the public and the medical and public health communities of this preliminary association. The manufacturer has undertaken a voluntary recall of the product. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5621a4.htm
(MMWR June 1, 2007 / 56(21);532-534)

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West Nile Virus Activity --- United States, 2006
“West Nile virus (WNV) is the leading cause of arboviral encephalitis in the United States. Originally discovered in Africa in 1937, WNV was first detected in the western hemisphere in 1999 in New York City. Since then, WNV has caused seasonal epidemics of febrile illness and severe neurologic disease in the United States. This report summarizes provisional WNV surveillance data for 2006 reported to CDC as of April 3, 2007. During 2006, WNV transmission to humans or animals expanded into 52 counties that had not previously reported transmission and recurred in 1,350 counties where transmission had been reported in previous years. In addition, 1,491 cases of WNV neuroinvasive disease (WNND) were reported in the United States during this period, amounting to a 14% increase from 2005 and the largest number reported since 2003. On the basis of extrapolations from past serosurveys, an estimated 41,750 cases of non-neuroinvasive WNV disease occurred in 2006; of these cases, 2,770 were reported. These findings highlight the need for ongoing surveillance, mosquito control, promotion of personal protection from mosquito bites, and research into additional prevention strategies. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5622a3.htm
(MMWR June 8, 2007 / 56(22);556-559)

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3. Notifications
75th Annual General Session of the International Committee of OIE
The 75th Annual General Session of the International Committee of the World Organisation for Animal Health (OIE) was held in Paris from 20 to 25 May 2007. Approximately 600 participants representing the 169 Member Countries, intergovernmental, regional and national organisations took part in the event. Agenda items included: the worldwide zoosanitary situation has been examined and commented in detail; the International Committee confirmed the world situation for highly pathogenic avian influenza H5N1 stabilised but recommended to remain vigilant; cconsistent with the framework of its usual standard-setting activities, the Committee updated and adopted new international standards, aimed at providing better safeguards for the sanitary safety of world trade, as well as guidelines to better implement surveillance of animal diseases and zoonoses in countries; the session validated the Platelia Rabies II diagnostic kit of Bio-Rad laboratory, the first diagnostic kit to undergo the new validation and certification procedure for diagnostic assays and to appear on the OIE assays register; the international Committee accredited the application of 4 new Collaborating Centres and 14 Reference Laboratories, taking the OIE network to a number of 199 worldwide; 2 technical items were presented and debated during the Session and gave rise to Resolutions passed by the International Committee: the use of epidemiological models for the management of animal diseases; the role of Reference Laboratories and Collaborating Centres in providing permanent support for the objectives and mandates of the OIE; the Committee also voted a resolution allowing China to take full part in OIE’s activities.
(OIE, http://oie.int, 6/1/07)

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National Center of Foreign Animal and Zoonotic Disease Defense
The National Center of Foreign Animal and Zoonotic Disease Defense develops products to reduce the risk of engineered and exotic animal diseases to America’s health and economy. The FAZD Center is the integrated, full spectrum center protecting America from exotic and engineered animal diseases that threaten public health and economic stability. Its specific mission is to create products that defend the U.S. from the intentional use of animal-borne diseases to cause catastrophic harm. These products offer the dual benefit of protecting against natural or accidental outbreaks. The center’s focus is on Foot and Mouth Disease, Avian Influenza, and Rift Valley Fever.
The center’s webpage can be found at: http://fazd.tamu.edu/

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 apecein@u.washington.edu