Login   

Vol. X. NO. 13 ~ EINet News Briefs ~ Jun 22, 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: New global disease-control rules take effect
- UK: Excerpts from OIE report on low pathogenic avian influenza in poultry
- Czech Republic: Report of poultry avian influenza H5N1 outbreak
- Bangladesh: New outbreaks of avian influenza in poultry
- Indonesia: Report of 100th human case of avian influenza H5N1 case
- Japan: Researchers to study behavioral effects of Tamiflu
- Russia (Siberia): Wild ducks reportedly infected with avian influenza
- Viet Nam: New avian influenza H5N1 infections in humans and poultry
- Vietnam: Launch of avian influenza H5N1 vaccine trial
- China: Update on rabies deaths, May 2007
- Japan: Measles outbreak update
- Taipei: Sapovirus sickens 55 at college
- Taipei: New case of measles associated with Japan outbreak
- Thailand: Malaria patients from Myanmar
- Russia (Primorsky)/China: More people infected with measles
- Russia (Stavropol): Crimean-Congo hemorrhagic fever update
- USA: Influenza vaccine makers get HHS funds to prepare for pandemic
- Canada (Quebec City): Clostridium difficile outbreak kills 8 persons
- Canada (Ontario): Restaurant-associated E. coli outbreak
- USA (New York): Physician-associated cluster of Hepatitis C
- USA (Oregon): Measles imported from Japan
- USA (New Mexico): New human case of septicemic plague
- USA: 6-state E coli outbreak blamed on ground beef
- USA (North Carolina): E. coli O157 cases associated with restaurant; goat slaughter
- USA: FDA to hunt for causes of tomato contamination
- Ghana (Volta): Avian influenza H5N1 reportedly confirmed in poultry

1. Updates
- Avian/Pandemic influenza updates
- Dengue
- West Nile Virus

2. Articles
- Influenza Pandemic: Efforts to Forestall Onset Are Under Way; Identifying Countries at Greatest Risk Entails Challenges
- Infection due to 3 avian influenza subtypes in United States veterinarians.
- A survey of human cases of H5N1 avian influenza reported by the WHO before June 2006 for infection control
- Optimizing the Dose of Pre-Pandemic Influenza Vaccines to Reduce the Infection Attack Rate
- Simple Models of Influenza Progression Within a Heterogeneous Population
- Lyme Disease --- United States, 2003—2005
- Rapid HIV Testing in Emergency Departments--Three U.S. Sites, January 2005--March 2006
- Rapid HIV testing among racial/ethnic minority men at gay pride events--nine U.S. cities, 2004-2006

3. Notifications
- International Conference on Options for the Control of Influenza
- Pandemic flu guidance for unions
- National HIV Testing Day --- June 27, 2007
- MMWR Recommendations and Reports: Prevention of Varicella
- MMWR Surveillance Summaries ; Malaria Surveillance, United States, 2005
- FDA Releases New Software Tool to Help Keep Food Facilities Safe from Attack


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 / 18 (5)
Indonesia / 25 (22)
Laos / 2 (2)
Nigeria / 1 (1)
Total / 50 (33)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 313 (191). (WHO 6/15/07 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 6/15/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 6/18/07): http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 6/21/07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.

^top

Global: New global disease-control rules take effect
The revised International Health Regulations, substantially updated for the first time since 1969, take effect 15 Jun 2007, aiming to help protect the world from a host of emerging diseases and health threats. The revised rules, approved by WHO member countries May 2005, spell out the commitments and responsibilities of countries and WHO for limiting the global impact of epidemics and other public health emergencies. WHO Director-General Margaret Chan said SARS was a wake-up call concerning the world's vulnerability to the quick spread of new diseases. "Today, the greatest threat to international public health security would be an influenza pandemic," Chan said. "The threat of a pandemic has not receded, but implementation of the IHR will help the world to be better prepared for the possibility of a pandemic." The new rules say that smallpox, polio, SARS, and new human influenza strains must be reported immediately to WHO. In addition, the rules call for reporting several other diseases, including cholera, pneumonic plague, yellow fever, and viral hemorrhagic fevers, if they cause a serious public health impact or pose a risk of international spread. Countries must also report natural, accidental, or deliberate use of biological or chemical agents or radionuclear material.

To encourage more openness about health threats and to speed the international response, the new rules require member countries to: Notify international officials of a public health emergency within 24 hours of assessment; Designate a national IHR focal point to stay in constant communication with the WHO; Develop and maintain core public health capacities for monitoring and responding to emerging threats, including those related to chemicals, radiologics, and food; Report health measures, such as border screening and quarantine, implemented in response to disease outbreaks, with a focus on measures that could impair international trade or travel. WHO will assist countries that have difficulty complying with the new rules, said David Heymann, WHO assistant director-general for communicable diseases. Also, the IHR set forth human rights provisions for international travelers who need medical interventions to prevent the global spread of disease.
(CIDRAP 6/15/07)

^top


Europe/Near East
UK: Excerpts from OIE report on low pathogenic avian influenza in poultry
Start date: 08 Jun 2007
Date submitted to OIE: 15 Jun 2007
Manifestation of disease: Sub-clinical infection
Causal agent: Low pathogenic avian influenza virus; Serotype: H7N2

Total outbreaks: 1; Outbreak Location: ENGLAND (St. Helens, St. Helens, Merseyside)
Total birds affected: Susceptible: 34; Deaths: 0; Destroyed: 34; Slaughtered: 0

Source of infection: Introduction of new live animals; Legal movement of animals. A link has been established via market tracing between this outbreak and the index case of LPAI H7N2 in Wales. The date of last occurrence in this zone (England) corresponds to an outbreak of LPAI H7N3 reported in 2006 in the county of Norfolk, England. Measures already applied: Movement control inside the country; Screening; Disinfection of infected premises/establishment(s); Stamping out; Vaccination prohibited; No treatment of affected animals.

Tests and results: 1.haemagglutination inhibition test (HIT), 07 Jun 2007: Positive; 2.intracerebral pathogenicity index (ICPI) test, 08 Jun 2007: Negative.

***Department for Environment, Food and Rural Affairs (Defra) lifted the temporary ban on chicken and duck sales and Chelford Agricultural Centre ran its first poultry market following the scare as normal 11 Jun 2007. The market had suspended all poultry sales as a "responsible" measure.
(Promed 6/15/07)

^top

Czech Republic: Report of poultry avian influenza H5N1 outbreak
Agriculture officials in the Czech Republic confirmed the country's first H5N1 avian influenza outbreak in poultry. Josef Vitasek, a Czech veterinary official, said the virus infected nearly 2,000 turkeys in a 6,000-bird flock near the village of Tisova in east Bohemia. He said the remaining birds would be culled and that authorities have imposed 3- and 10-km security zones around the farm. Reportedly none of the turkeys from the farm have been distributed to retail outlets. The turkey outbreak marks the second confirmed appearance of H5N1 in the Czech Republic. The first case of avian influenza H5N1 in the Czech Republic was reported Mar 2006, when 13 cases of the disease were registered in swans. The country has never had a confirmed human H5N1 case.
(CIDRAP 6/21/07; Promed 6/21/07)

^top


Asia
Bangladesh: New outbreaks of avian influenza in poultry
Some 5205 chickens and ducks were culled at Narayanpur village and surrounding areas in Panchbib Upazila, following detection of bird flu 16 Jun 2007. District livestock office sources said that since some chickens in Narayanpur village died due to unknown causes 14 Jun 2007, he took 1 of the dead chickens to the livestock disease laboratory for testing. As further tests confirmed avian influenza in the chicken, a team was formed and culled 5205 chickens and ducks in the village and surrounding areas. Reportedly, avian influenza also spread to 2 farms in Jaipurhat district, prompting the culling of 7,000 chickens. The H5N1 outbreak in Bangladesh started 5 Feb 2007, was confirmed 22 Mar 2007 and initially reported to the OIE 30 Mar 2007. Until 25 May 2007 (last available follow-up report), 23 outbreaks have been recorded, affecting commercial layer flocks and backyard poultry farms. Vaccination against avian influenza is currently prohibited in Bangladesh. Bangladesh has had no confirmed human H5N1 cases.
(Promed 6/17/07; CIDRAP 6/18/07)

^top

Indonesia: Report of 100th human case of avian influenza H5N1 case
Indonesia's toll of people struck by H5N1 avian influenza has risen to 100, including 80 deaths, with the report that a 26-year-old man from Sumatra died of the disease Jun 12, 2007. The Indonesian health ministry said the man from Riau province fell ill Jun 3, 2007 and was hospitalized Jun 6, according to WHO. Investigators found he had been exposed to sick and dead poultry. Indonesia's first human H5N1 illness cases were reported Jul 2005. The country only recently surpassed Vietnam for having the greatest number of cases. By the WHO count, Vietnam has had 93 cases and 42 deaths.
(CIDRAP 6/15/07)

^top

Japan: Researchers to study behavioral effects of Tamiflu
The company that markets oseltamivir (Tamiflu) in Japan has announced it will launch new studies to explore whether the antiviral drug contributes to adverse events in teenagers. On Jun 18, 2007, Chugai Pharmaceutical Co. said it has received several reports of serious psychiatric or neurologic events since oseltamivir's 2001 launch in Japan. Though no link between the adverse events and the drug was established, in May 2004 Chugai added information about the reported symptoms to its packing inserts. The company imports oseltamivir from Roche and markets it in Japan. 4 months ago Chugai said it received a report of 2 teenage flu patients who fell to their deaths after taking oseltamivir. After the accidents, Japan's health ministry warned that children with the flu could show adverse behavioral effects, whether or not they were receiving oseltamivir, and advised doctors to avoid prescribing it to teenagers.

Oseltamivir is used for both treatment and prevention. Because experts regard it as the best available drug for combating a potential pandemic flu strain, many countries are stockpiling it. Chugai said it is examining adverse event reports to determine if any patterns emerge in the patient histories, timing of the drug, or onset of any abnormal behaviors. Chugai and Roche will immediately conduct new research on the drug's safety. In preclinical trials, the companies will use rats to gauge the drug's effects on the brain. A clinical research arm of the studies will assess the effect of oseltamivir on subjects' sleep and look at transport of the drug to the cerebrospinal fluid.

Chugai also will proceed with epidemiologic studies of patients treated with oseltamivir, to examine what other drugs they take, their flu symptoms and clinical course, and their medical history. A 2006 report by the US Food and Drug Administration concluded it was unclear if neuropsychiatric events in those treated with oseltamivir were related only to the drug, only to the flu, or to both. Roche has said that clinical trials in the US and Japan showed similar rates of psychiatric symptoms in children with flu who took oseltamivir and in peers who didn't take it. The company also said US health insurance data showed that patients treated with the drug had a lower likelihood of events such as delirium, confusion, and hallucination than patients who were not treated.
(CIDRAP 6/20/07)

^top

Russia (Siberia): Wild ducks reportedly infected with avian influenza
Wild ducks that had been infected with bird flu, but recovered from it, were registered in the Altai territory, the Tomsk region, Buryatia and the Ust-Ordyn Buryat autonomous district, a regional department of the Russian agriculture watchdog said 19 Jun 2007. "These birds either had contact with infected birds or carried the virus themselves to recover," the source said. "47 probes exposed genetic material of the virus and presence of antibodies in blood serum." Measures are being taken throughout Siberia to prevent a bird flu outbreak. As of 19 Jun 2007, no bird flu cases of poultry have been registered so far," the source said. Around 6 million poultry are located in high-risk zones of the Siberian federal district. Around 4.4 million of them have already been vaccinated.
(Promed 6/20/07)

^top

Viet Nam: New avian influenza H5N1 infections in humans and poultry
The Health Ministry confirmed a woman's bird flu test result and 4 others, including the result of a 20-year old man from the northern province of Ha Tay, who died 10 Jun 2007. The 28-year-old woman died of an H5N1 infection. He was the country's first death from the disease in about 18 months. He fell ill Jun 2, 2007 and died Jun 10. Reportedly, the man's family raised poultry. The woman appears to be 1 of the 2 recent H5N1 case-patients announced by Vietnam Jun 12, 2007. She was from Ha Nam province and was previously reported to be in critical condition at the Hospital for Tropical Diseases in Hanoi. Nguyen Hong Ha, deputy hospital director, said she died after 13 days in the hospital. The woman had had contact with sick poultry. With the woman's death, Vietnam's apparent H5N1 human toll is 98 cases with 44 deaths. WHO has not yet confirmed 5 cases, including 2 fatal ones, reported by Vietnam recently. 2 Vietnamese patients who were recently diagnosed with H5N1 infections have been reportedly released from hospitals. All are from northern provinces, and all were reported to have had contact with poultry.

The Animal Health Department said 18 Jun 2007 that 690 ducks and chickens died 14,15 Jun 2007 at 8 farms in Bac Giang province, and officials slaughtered the remaining birds after tests found the dead birds had the H5N1 virus. WHO described the government as "committed and alert" to the dangers of bird flu's spread but that carrying out all effective measures in the provinces was still a challenge. Vietnam has been battling several poultry H5N1 outbreaks since early May 2007. The UN Food and Agriculture Organization (FAO) recently published a report on its investigation of Vietnam's recent bird outbreaks. It attributed the unseasonable outbreaks to an increase in the numbers of ducks, many unvaccinated, that were released to graze on newly harvested rice paddies. Prime Minister Nguyen Tan Dung approved an order to import another batch of 200 million doses of vaccine to battle outbreaks in poultry.
(Promed 6/18/07, 6/21/07; CIDRAP 6/18/07, 6/21/07)

^top

Vietnam: Launch of avian influenza H5N1 vaccine trial
Vietnam said the country was set to launch the first human trial of its own H5N1 avian flu vaccine. Nguyen Tran Hien, director of the National Institute of Hygiene and Epidemiology (NIHE), said the trial will begin as early as Jul 2007, with the health ministry's approval, and should be finished next year. He said researchers will enroll 20 to 30 volunteers for the study. Experts from the US will provide Vietnam with technical assistance to develop the vaccine, US health attaché Michael Iademarco said. The US has provided $1 million to Vabiotech, a company with ties to NIHE, apparently to support the development of the vaccine, Iademarco said.
(CIDRAP 6/20/07)

^top

China: Update on rabies deaths, May 2007
Rabies killed 201 people in China in May 2007, staying at the top of the list of the most deadly infectious diseases in the country, state media said 12 Jun 2007. Rabies has topped the list for the last 13 months, except in March when tuberculosis came first. Beijing has introduced a "one family, one dog" policy and last year launched a campaign against unregistered dogs. The State Food and Drug Administration also said it would severely punish companies that produce fake and poor quality rabies vaccines, after several people reportedly died from substandard vaccines. Last year, Shanghai implanted digital chips in the ears of 65 000 dogs to improve "canine management" and prevent the spread of rabies. Pet dogs were shunned in the days of Mao Zedong as a symbol of bourgeois decadence but have become increasingly popular.
(Promed 6/12/07)

^top

Japan: Measles outbreak update
For updated measles situation in Japan: http://idsc.nih.go.jp/disease/measles_e/idwr200721.html
Infectious Disease Surveillance Center, National Institute of Infectious Diseases: Between 1 Jan 2007 and 27 May 2007, a total of 1121 measles cases from 3000 pediatric sentinels have been reported nationwide. 657 cases of them (59 per cent) were reported from southern Kanto area including Tokyo. Age distribution is characteristic; fewer cases are seen among 0 to 4 years old (N=426, 38 per cent) than in average year (55 to 67 per cent) and more cases are reported from 10 to 14 years old (N=358, 32 per cent) than in average year (5 to 15 per cent). In 21st epidemiological week (21 to 27 May [2007]), 215 new cases from pediatric sentinels have been reported from 27 prefectures in Japan; 108 cases from southern Kanto area, 35 cases from northern part of Japan including Miyagi and Hokkaido. This was the highest number of cases reported per week in 2007.

Regarding adult measles (cases of 15 year old and older), between 1 Jan 2007 and 27 May 2007, a total of 387 cases have been reported from 450 hospital sentinels; 139 cases from Tokyo, 45 cases from Kanagawa, 40 cases from Miyagi and 34 cases from Saitama. The numbers of reported adult cases were also highest since the surveillance system started in 1999. Cases reported from southern Kanto area are increasing continuously. This report also indicates that the outbreak is spreading to the northern part of Japan. From the result of hospital sentinels, 33 per cent (N=129) of cases are among 20 to 24 year old, 23 per cent (N=90) are among 25 to 29 year old, and 21 per cent (N=83) are among 15 to 19 year old. Roughly 91 per cent (N=352) of them were reported from the group under 35 years old.

According to the Ministry of Health, Labor and Welfare, between 1 [Apr 2007] and 26 May 2007, a total of 103 schools were closed completely (78) or partially (25) due to measles outbreak. 64 of them were high schools (33) or colleges/ universities (31). About 70 per cent of them were reported from Kanto area. A total of 3 cases of encephalitis related to measles have been reported in 2007. All of the sequenced measles viruses (N=21) have been identified as D5 strain.

Information regarding the recent situation of measles epidemic has been rapidly provided to the public; Public sensitization has been conducted regarding the importance of the vaccination, especially to the people who are at highest risk (those who have had neither measles infection nor vaccination in the past). Routine vaccination, especially the 1st dose, was enhanced; As of 16 May 2007, 37 out of 131 local governments nationwide reported that they have started notifiable surveillance system for measles cases; 500 000 doses of measles-containing vaccine and 600 000 diagnostic kits will additionally be supplied to health care facilities and diagnostic laboratories by the end of June 2007.
(Promed 6/9/07)

^top

Taipei: Sapovirus sickens 55 at college
The Centers for Disease Control (Taiwan CDC) reported 12 Jun 2007 that 55 faculty members of a college in Taipei County had been diagnosed with Sapovirus infections, the first known cases of such infections in Taiwan. Sapoviruses are caliciviruses which, together with the noroviruses, are the leading causes of acute viral gastroenteritis in humans. The virus is named after Sapporo, Japan, where the virus was first recognized during an outbreak at an orphanage. It generally causes only mild gastroenteritis in young children. CDC officials said that the virus is hard to diagnose and that the center only became capable of testing for the virus after cooperating last year with Japan's National Epidemiological Surveillance of Infectious Diseases. The officials said they were not ruling out the possibility that others might have been infected with the virus at an earlier date, but that such an outbreak had gone unrecognized. Officials said they were notified by the Taipei County Government Department of Health May 2007 that a cluster of 55 people had exhibited symptoms of nausea, vomiting and diarrhea, and that the possibility of food poisoning had initially been ruled out. Fecal specimens from 8 infected people were sent to a laboratory for a series of tests that presented negative results to the initial battery of tests. The samples were then retested using the recently developed test for Sapovirus and 7 of the 8 showed a positive result. The virus is often transmitted through feces and oral contact, and cases often arise in nurseries and kindergartens, but only rarely in colleges and universities.
(Promed 6/13/07)

^top

Taipei: New case of measles associated with Japan outbreak
A Taipei County resident has developed measles after a recent visit to Japan, the second overseas measles infection this year, health officials said 12 Jun 2007. The patient, a 26-year-old woman living in Banciao, is a Chinese national who has not been vaccinated against measles. The woman visited Japan with her Taiwanese husband May 2007, when she probably contracted the disease as Japan has been affected by a measles outbreak since last month. The patient is receiving treatment in an isolation ward at a local hospital, while officials are contacting other members of the woman's tour group. Taiwan has undertaken the goal of measles elimination by 2010. At present, the People's Republic of China and Japan have ongoing measles activity and have been associated with importations into other countries.
(Promed 6/14/07)

^top

Thailand: Malaria patients from Myanmar
The number of malaria patients has sharply increased in Jun 2007 among communities of Burmese refugees and migrants on the Thailand-Burma border, said a senior medical worker in Mae Sot, Thailand. "More than 50 malaria patients come to the clinic every day, and half of them have to be hospitalized for proper treatment," said Khin May, a senior medic at the Mae Tao Clinic in Mae Sot, which provides health services to Burmese communities in Mae Sot and also inside Burma. "Since last month [May 2007], the hospital has accommodated more than 300 malaria patients. With no doubt, there will be more patients coming," Khin May said 11 Jun 2007. 7 Burmese have died from malaria near the Three Pagodas Pass, on the border with Thailand's Kanchanaburi Province. Several health organizations and NGOs used to operate in the area in past years, but several have since pulled out. The current increase in malaria cases has created a shortage of medicine and available space at Mae Tao. Officials in Burma maintain that the military government has made improvements in the treatment and prevention of malaria.
(Promed 6/18/07)

^top

Russia (Primorsky)/China: More people infected with measles
The second stage of preventive measures was not completed in Primorsky kray [region] last year [referring to a second round of vaccination activities?]. As a result, an epidemic zone was formed in 2007 that led to 11 cases of measles: 10 among adults (from Vladivostok and Ussuriysk cities) and 1 in a teenager from Ussuriysk, of whom 8 were laboratory confirmed. It is assumed that infection was imported from China, since the first 3 people to develop measles were part of a tourist group returning from China. Measles cases occurred among those adults that did not have a history of vaccination. The infection spread among those adults with inadequate measles vaccination: by Jan 2007, only 93.3 percent of adults aged 18-35 had some immunity against measles, out of them 2.6 percent already had measles, 39 percent had a history of 2 doses of measles containing vaccine, and 51.8 percent were vaccinated once. As of 1 Jan 2007, 38 293 adults aged 18-35 years in the Primorsky Krai were not vaccinated against measles and were susceptible and 295 987 individuals had a history of 1 dose of vaccine. The chief sanitary physician of Primorsky kray has issued a local decree to conduct a supplementary vaccination among adults up through age 35 who had inadequate vaccination histories.
(Promed 6/15/07)

^top

Russia (Stavropol): Crimean-Congo hemorrhagic fever update
The incidence of Crimean-Congo hemorrhagic fever (CCHF) in Stavropol is 2 times higher than it was 2006. On 13 Jun 2007, there are 23 registered cases of CCHF in 12 districts of Stavropol; 73 percent of the cases were infected through contact with animals, 27 percent in natural conditions (in the fields) -- 16 people were bitten by ticks, and 5 people had removed ticks with unprotected hands. Experts are associating such high tick activity with the dry, hot weather. A preliminary diagnosis of CCHF was made of 165 people hospitalized in the region; that is 6 percent higher than the same indicator for 2006. A total of 3866 persons applied for care due to tick bites, including 1512 children. The number of children with tick bites has increased 10 percent compared with 2006. Experts and health officials have emphasized the importance of treating summer camps for children and other recreational areas with anti-tick solutions, as well as educating the population about the methods of protection against ticks.
(Promed 6/21/07)

^top


Americas
USA: Influenza vaccine makers get HHS funds to prepare for pandemic
Federal health officials announced the awarding of contracts totaling $132.5 million to help 2 vaccine producers get ready to start churning out vaccines in the event of a flu pandemic. The Department of Health and Human Services (HHS) awarded $77.4 million to Sanofi Pasteur and $55.1 million to MedImmune Inc. to retrofit existing vaccine production facilities and keep them in ready condition for 2 years to produce pandemic flu vaccines, with an option to extend the time to 5 years. The goal is that when the retrofitting is done, the facilities together will be capable of producing about 100 million doses of a pandemic vaccine within 6 months of the start of a pandemic, according to Marc Wolfson, a spokesman for HHS's Office of the Assistant Secretary for Preparedness and Response. That amount represents about 16% of the HHS goal of having enough domestic capacity to make 600 million doses of pandemic flu vaccine—enough for 300 million people—within 6 months after a pandemic hits. The renovations also will equip the companies to produce prepandemic vaccines year-round, HHS said.

Sanofi Pasteur has been the leading producer of seasonal flu vaccine for the US market in recent years. MedImmune makes the nasal-spray seasonal flu vaccine FluMist, which uses a live, attenuated virus. Sanofi makes the only prepandemic H5N1 flu vaccine licensed so far by the Food and Drug Administration. HHS has stockpiled the equivalent of 14.5 million 90-microgram doses of the vaccine. That's enough for about 7.25 million people at 2 doses each. HHS has a goal of stockpiling enough prepandemic flu vaccine for 20 million people. Wolfson said the current US annual production capacity for prepandemic flu vaccines is 16.5 million doses. GlaxoSmithKline and Novartis are also making prepandemic H5N1 vaccines for the US stockpile.

Sanofi is building a new flu vaccine plant and hopes to have it completed in time for the 2008-09 flu season. The company will contribute about $25 million to the renovation of its existing plant scheduled under the HHS contract. The renovated plant will use the conventional production method of growing flu viruses in eggs. MedImmune will contribute about $14 million to the retrofitting of its facilities under the HHS contract. MedImmune uses an egg-based system to make its intranasal vaccine. The same approach will be used to make pandemic vaccines, though the company is developing a cell-based system.
(CIDRAP 6/20/07)

^top

Canada (Quebec City): Clostridium difficile outbreak kills 8 persons
A Clostridium difficile outbreak in a Quebec City hospital has claimed 8 lives. A total of 52 patients have been infected by the bacterium in the last 3 months, officials at St. Francois d'Assise hospital said 13 Jun 2007. Most of these patients are seniors averaging 83 years old who suffered various ailments before contracting C. difficile. An investigation into the outbreak has begun. The hospital did report an improvement in the number of new cases of C. difficile in the last 3 weeks, when only 3 patients were diagnosed, and none proved fatal. This is the first time a Quebec City hospital has been hit with this many C. difficile cases. Earlier in 2007, the Honore Mercier hospital in Ste. Hyacinthe was struck with 2 outbreaks of the disease, causing 16 deaths. C. difficile control in the health care setting involves not only aggressive infection control measures but also prudent control of the overuse of antimicrobial agents.
(Promed 6/13/07)

^top

Canada (Ontario): Restaurant-associated E. coli outbreak
An Eschericha coli [O157] outbreak at a St. Catharines, ON, restaurant that made several people seriously ill was likely caused by improperly handled food. Public health officials allege the E. coli contamination began when the restaurant continued to operate during an 18 hour period 19 May 2007 when its water supply was cut off by the city for repairs to a broken water main. With no clean water flowing to the restaurant, it would have been impossible for those preparing food to properly clean bacteria from their hands, utensils and surfaces touched by raw meats and other food items, said Dr. Doug Sider, Niagara's associate medical officer of health. Officials blame the E. coli outbreak on improper hygiene, not on the water itself. The health department closed the restaurant 5 Jun 2007 after receiving numerous reports of people sick with symptoms of infection with E. coli O157. A total of 9 people who ate at the restaurant between 17 May and 5 Jun 2007 have been confirmed to be ill with the bacterial infection, including 5 who were hospitalized. All of the victims, most of them young children and youths, have been released from hospital and are recovering. About 25 others who ate at the restaurant are listed as probable cases of E. coli infection. Traces of E. coli O157 were found in samples of chicken shawarma and a carving knife from the restaurant, Sider said. "Our investigation indicates there were probably more food sources than the chicken shawarma that were contaminated with E. coli," Sider said.
(Promed 6/20/07)

^top

USA (New York): Physician-associated cluster of Hepatitis C
Authorities urged 4500 people treated by a local anesthesiologist to get tested for hepatitis, saying 3 patients may have been infected with the liver-damaging disease while the doctor was giving them anesthesia. The New York City Department of Health and Mental Hygiene said 14 Jun 2007 it was mailing letters to everyone at risk and noted that the disease cannot be spread by casual contact. At total of 3 people treated by the doctor in Aug 2006 were diagnosed with hepatitis C in recent months. Lab tests and other evidence suggest they were infected while getting intravenous anesthesia drugs during outpatient medical procedures. A state Health Department spokeswoman, Claudia Hutton, said the agency had not established "that the doctor is guilty of doing anything wrong." City authorities said they were contacting everyone treated by the same anesthesiologist while he or she practiced at 10 different medical offices in New York City, 1 Dec 2003 - 1 May 2007. Hepatitis C (HCV) is a virus that can cause scarring or other damage to the liver. Some people experience flu-like symptoms, a yellowing of the skin and the whites of the eyes, dark urine and pale feces. There are several treatments.
(Promed 6/16/07)

^top

USA (Oregon): Measles imported from Japan
Lane County Public Health officials announced 4 Jun 2007 they have confirmed a second case of measles in Eugene [Oregon, USA]. A 21 year old Eugene man was treated at Sacred Heart Medical Center 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 man, also in his early 20s. The second man became infected 28 May 2007. Local health authorities have been working around the clock to contact hundreds of people who may have come into contact with the 2 men. Although nurses told the second man to stay at home because he could spread the disease, he went to public places, Dr. Sarah Hendrickson with Lane County Public Health said. Oregon law requires children to be vaccinated against measles, and most children get shots by the time they're at least 1 year old. Parents can decline for their children to be vaccinated for religious reasons. About 4 per cent of Lane County schoolchildren do not receive the vaccination. Officials said college students should check their immunization records. Hendrickson said those who are infected should stay at home for at least 3 weeks after exposure. Since the Americas region has made great progress towards the goal of interruption of indigenous transmission of measles virus, importation remains the primary route of introduction of measles into the region.
(Promed 6/8/07)

^top

USA (New Mexico): New human case of septicemic plague
State health investigators plan to trap rodents in a rural area south of Santa Fe, in hopes of discovering how a 50-year-old woman got plague. They will also distribute brochures explaining how to avoid contracting the severe infection, which is commonly spread to humans from fleas that have feasted on infected rodents. The woman has recovered after being hospitalized. The woman had septicemic plague, a blood infection that can cause death. Symptoms can include fever, vomiting, diarrhea, abdominal pain, low blood pressure, blood-clotting problems, and organ failure. Prairie dogs and rock squirrels, common carriers of the plague, may have swelled in number over the past couple of years because of wetter than usual seasons, Dr. Paul Ettestad, a public health veterinarian for the New Mexico Health Department, said. "There are ways to protect you and your pets from plague: Prevent your pets from roaming and hunting rodents, use a flea control product on all your pets, and do not allow them to sleep in bed with you," Ettestad said.
(Promed 6/12/07)

^top

USA: 6-state E coli outbreak blamed on ground beef
A recent ground beef recall has been expanded to 5.7 million pounds following the identification of 14 Escherichia coli O157:H7 cases in 6 states, according the US Department of Agriculture (USDA). The products, which include fresh and frozen ground beef packaged under a variety of store brands and other major labels, are no longer on store shelves, but they may still be in consumers' freezers, the US Department of Agriculture's (USDA's) Food Safety and Inspection Service (FSIS) said Jun 9. Of the 14 patients whose E coli infections have been linked to the contaminated beef, 6 are from Arizona, 3 are from California, 2 from Colorado, and 1 each from Idaho, Utah, and Wyoming. All the patients have recovered. The beef subject to recall was produced by United Food Group, LLC. The company first recalled 75,000 pounds of ground beef Jun 3, 2007 because of sampling done by California and Colorado health departments when investigating illnesses. The firm expanded the recall to 370,000 pounds, incorporating meat produced on an earlier date.

The fresh and frozen ground beef was processed between Apr 6 and Apr 20 and distributed to retail stores in Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. Todd Waldman, United Food Group's senior vice president, said all of the illnesses have been linked so far to the company's fresh ground beef purchased during a short time frame, rather than its frozen products. E coli O157:H7 produces a toxin that causes diarrhea—often bloody—and abdominal cramps, but typically no fever. The illness usually resolves in 5 to 10 days, but it can cause hemolytic uremic syndrome, potentially leading to kidney failure or death, in 2% to 7% of patients.
(CIDRAP 6/11/07)

^top

USA (North Carolina): E. coli O157 cases associated with restaurant; goat slaughter
Health officials closed a China Grove, NC, restaurant linked to an Escherichia coli outbreak 18 Jun 2007 after learning some employees slaughtered a goat there May 2007. Rowan County Health Director Leonard Wood said that on 15 Jun 2007 a former employee of Captain's Galley Seafood Restaurant in China Grove told officials a goat had been slaughtered in the kitchen. On 14 Jun 2007 an 86-year-old Salisbury resident died of complications related to an infection of E. coli [O157:H7]. She was 1 of 21 people who got sick after eating at the restaurant, Wood said. Health officials said they interviewed 26 employees. The goat was slaughtered sometime between 11 and 20 May 2007. Restaurant patrons got sick between 26 May and 3 Jun 2007. Health officials cannot prove the outbreak was caused by the goat slaughter. Officials announced the E. coli outbreak 7 Jun 2007. Officials said they learned of another suspected case of E. coli 18 June 2007, bringing the total to 8 confirmed cases and 13 suspected cases.
(Promed 6/20/07)

^top

USA: FDA to hunt for causes of tomato contamination
A series of illness outbreaks linked to tomatoes over the last decade prompted the US Food and Drug Administration (FDA) to announce an initiative to explore contamination causes and develop better guidance to reduce the number of tomato-related illnesses. Over the past 10 years, fresh tomatoes have been linked to 12 outbreaks that resulted in 1,840 confirmed illnesses. Most of outbreaks involved Salmonella. FDA traced most of the outbreaks to tomatoes from Florida and Virginia. FDA said its investigators would collaborate with health and agriculture officials to identify practices or conditions at tomato farms and packing facilities that lead to contamination. The initiative will begin during this year's growing season. Officials will be examining irrigation water, wells, chemical mixing procedures, droughts and floods, and animal proximity to growing fields. "Produce is an important part of a healthy diet, and FDA wants to improve its safety by better understanding the causes of foodborne illnesses and by promoting more effective methods of safe food production, delivery, and preparation, said Robert Brackett, director of the FDA's Center for Food Safety and Applied Nutrition. The findings of the investigation will not only help the FDA improve its tomato safety guidance and policy, but also suggest areas for further research, education, and outreach, the agency said.
(CIDRAP 6/19/07)

^top


Africa
Ghana (Volta): Avian influenza H5N1 reportedly confirmed in poultry
Agriculture officials in Ghana said the H5N1 virus has been confirmed in poultry in the Volta region town of Aflao, bringing the number of affected regions to 3. The discovery led to the culling of 1,100 birds in the area around Aflao. Ghana reported its first H5N1 outbreak May 2007, making it the ninth African country to be hit by the disease. No human cases have been confirmed.
(CIDRAP 6/21/07)

^top


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. Link to “Canada's Third Annual Wild Bird Survey For Avian Influenza is Underway”.
- 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 from 22 Jun 2007.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

^top

Dengue
China (Guangzhou)/Southeast Asia
The local health authority confirmed 7 Jun 2007 that 11 people have contracted dengue fever and 2 more have tested positive after a work-related trip to Southeast Asia. The 13 were among 23 employees of a Guangzhou-based survey company who left China Mar 2007 to conduct preliminary surveys for a hydropower project in a Southeast Asian country. Of the 13 employees, 11 suffered high fevers, joint pains, nausea, and rashes between 11 Apr and 14 May 2007. The company called back the group in 2 batches: 2 people arrived 14 Apr and the other 21 on 30 May 2007. Of the first 2 arrivals, 1 came down with dengue fever 16 Apr. The municipal disease control and prevention center found 12 of the 21 people arriving 30 May 2007 carried the dengue-causing virus, and confirmed 10 had just recovered from an infection. The other 2 positive cases showed no symptoms of the disease. The health bureau ruled out the possibility of the disease spreading, as the most recent case 14 May 2007 had recovered and no suspected cases were reported in the past 3 weeks of observation. The city's health bureau has told all local health, quarantine and inspection, tourism and foreign trade authorities to be on heightened alert.
(Promed 6/12/07)

Malaysia
A total of 994 dengue cases were reported in Malaysia during 28 May-3 Jun 2007, Health Ministry Disease Control Director, Datuk Dr Hassan Abdul Rahman, has said. On 6 Jun 2007, the national news agency Bernama quoted Dr Rahman as saying there are 20 areas inspected nationwide. From 22 May to 2 Jun 2007, Selangor reported 338 dengue cases. Kuala Lumpur was second on the list, with 127 cases, while Kelantan reported 80. Johor, Kedah, Perak, Negeri Sembilan, and Sarawak reported more dengue cases compared to the previous period. "Dengue cases in Kuala Lumpur dropped from 145 to 127. Pahang, Melaka, Sabah, and Terengganu also showed decreases," Dr Hassan said.
(Promed 6/12/07)

Philippines
In a town in southern Negros Occidental, dengue has killed at least 3 residents and infected at least 28 others as of 12 Jun 2007. It was reported 14 Jun 2007 the victims all hailed from Hinoba-an town in southern Negros. Negros Occidental provincial health officer, Luisa Efren, said the 3 dengue patients were brought to the Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH) in Bacolod and to Dumaguete City. She said she would send a team of experts to Hinoba-an 13 Jun 2007 to assess the situation. Provincial health officer Romulo Rhoel Mogul said he sent dextrose fluids to Hinoba-an for immediate use for dengue patients there. Reportedly, dengue also killed a 6-year-old boy 15 Jun 2007, in Camarines Norte. The Department of Health Bicol has listed around 400 dengue cases in Albay between Jan and May 2007. Naga City, in Camarines Sur, tops the list for the most number of dengue cases.
(Promed 6/20/07)

Singapore
Another dengue death has occurred, making it the second case in 2007. A 63-year-old man living in Hougang died 6 Jun 2007, authorities said 10 Jun 2007. The man had sought medical attention for a fever from a general practitioner last week, but his condition worsened and he was admitted to hospital, where he was tested and found to have an acute dengue virus infection. He died from dengue shock syndrome. The latest death occurred in a week when dengue infections were on the rise again (293), compared to 227 cases the week before. The number of active dengue clusters has also gone up to 54, 4 more than last week. Some 2014 homes were found to be breeding mosquitoes between Jan and May 2007 -- an increase of about 80 percent compared to the same period in 2006. In addition, for every 1000 homes inspected by the NEA (National Environment Agency) in Apr and May 2007, 6.3 and 5.6 homes respectively were found to be breeding mosquitoes -- a sharp increase from Feb and Mar 2007. So far, 2472 cases of dengue infection have been reported in 2007, an 89 percent jump over the same period in 2006.
(Promed 6/12/07)

Taipei/Viet Nam
Of a group of 5 people who traveled to Viet Nam earlier in Jun 2007 to broker a marriage between a Taiwanese man and a Vietnamese woman, 4 were confirmed to have been infected with dengue fever, the Department of Health (DOH) said 15 Jun 2007. On 12 Jun 2007, health officials said that the group was from Chiayi County and that a 50-year-old man was reported to have been infected. Officials later found that a young man and his mother, both friends of the 50-year-old, and a Taiwanese man and his Vietnamese wife, had developed the symptoms for dengue fever -- a high fever, aching bones, and headaches. Tests found that 3 of them had been infected, while the other was still being tested. Nantou County also reported a case of dengue hemorrhagic fever a day earlier. The patient, a 6-year-old girl who went with her mother to Viet Nam 10 May - 7 June 2007, developed a fever the day she returned to Taiwan. Her high fever persisted and she also developed a rash on her face and body. Lin Ting, deputy director of the DOH's Center for Disease Control, said that there have been 36 imported dengue fever cases so far in 2007, 22 of which were caught in Indonesia, followed by 9 cases from Viet Nam, and 3 from Thailand. He urged the public to remove any standing water from close to their homes.
(Promed 6/20/07)

Thailand
Thailand's Ministry of Public Health announced 7 Jun 2007 that the number of dengue fever patients nationwide has risen to over 10 000 and 14 people have been killed by the disease this year. Until 7 Jun 2007, a total of 11 574 dengue fever patients, most of them between 10-24 [years of age], have been found across the country. The high-danger season of dengue fever is July but earlier-than-usual rains has meant that dengue is a greater concern this year than before, an official said, adding that the insurgency in the far South means that anti-mosquito measures are more difficult to apply. More breeding grounds for dengue-carrying mosquitoes emerge during the rainy season, he explained, especially in the 3 southernmost provinces, where heavier rainfall contributes to a higher population of mosquitoes.
(Promed 6/12/07)

^top

West Nile Virus
USA
Human cases have been reported from:
State / Neuroinvasion/West Nile fever/ Other, Unspecified/ Total/ Fatalities:

Iowa / 0 / 1 / 0 / 1 / 0
Mississippi / 3 / 1 / 0 / 4 / 1
South Dakota / 0 / 1 / 0 / 1 / 0
TOTALS / 3 / 3 / 0 / 6 / 1
(Promed 6/14/07)

^top


2. Articles
Influenza Pandemic: Efforts to Forestall Onset Are Under Way; Identifying Countries at Greatest Risk Entails Challenges
What GAO (Government Accountability Office) found: “Assessments by U.S. agencies and international organizations have identified widespread risks of the emergence of pandemic influenza and the US has identified priority countries for assistance, but information gaps limit the capacity for comprehensive comparisons of risk levels by country. Several assessments we examined, which have considered environmental or preparedness-related risks or both, illustrate these gaps. For example, a U.S. Agency for International Development (USAID) assessment categorized countries according to the level of environmental risk—considering factors such as disease presence and the likelihood of transmission from nearby countries, but factors such as limited understanding of the role of poultry trade or wild birds constrain the reliability of the conclusions. Further, USAID, the State Department, and the United Nations have administered questionnaires to assess country preparedness and World Bank-led missions have gathered detailed information in some countries, but these efforts do not provide a basis for making comprehensive global comparisons. Efforts to get better information are under way but will take time. The U.S. Homeland Security Council has designated priority countries for assistance, and agencies have further identified several countries as meriting the most extensive efforts, but officials acknowledge that these designations are based on limited information. . .”
(GAO 6/20/07 http://www.gao.gov/new.items/d07604.pdf )

^top

Infection due to 3 avian influenza subtypes in United States veterinarians.
Myers KP et al. Clin Infect Dis 2007 Jul 1;45:4-9
Abstract: “Background. Pandemic influenza virus strains originate in avian species. We examined veterinarians in the United States for evidence of previous avian influenza virus infection. Methods. We performed a controlled, cross-sectional seroprevalence study among 42 veterinarians and 66 healthy control subjects using serum samples collected from 2002 through 2004. Serum samples were tested using a microneutralization assay against 9 influenza A virus strains. Results. Using multivariable logistic regression modeling, veterinarians exposed to birds demonstrated statistically significant elevated titers against the H5, H6, and H7 avian influenza virus isolates, compared with control subjects. Conclusions. These data suggest that occupational exposure to avian species may increase veterinarians' risk of avian influenza virus infection. Veterinarians should be considered for priority access to vaccines and antiviral drugs in pandemic planning.”

^top

A survey of human cases of H5N1 avian influenza reported by the WHO before June 2006 for infection control
Ji-Ming Chen, et al. AJIC. Volume 35, Issue 5, Pages 351-353 (June 2007).
Abstract: “H5N1 avian influenza has been widely spreading in fowls in the Eastern Hemisphere and caused hundreds of severe human cases. Here, the information of the 224 human cases of H5N1 avian influenza reported by the World Health Organization before June 2006 were surveyed and analyzed. The results suggested that human infections escalated in the past 3 years, and control of animal H5N1 influenza, avoidance of high-risk behaviors, and proper disposal of diseased or dead fowls are vital for the prevention of the human infections. Age distribution of the human cases demonstrated that older people are more immune to the infection, possibly because of the cross protectivity induced by their previous infections with human influenza A viruses. This survey also suggested that live vaccines against human influenza may be of utility in the prevention of the avian influenza virus infections in humans, and new preventive measures should be considered for the control of animal H5N1 influenza epidemics, which are likely more serious than indicated by official reports.” http://www.ajicjournal.org/article/PIIS0196655307001319/abstract

^top

Optimizing the Dose of Pre-Pandemic Influenza Vaccines to Reduce the Infection Attack Rate
Steven Riley et al. PLoS Medicine Vol. 4, No. 6, e218 doi:10.1371/journal.pmed.0040218.
Abstract: “Background. The recent spread of avian influenza in wild birds and poultry may be a precursor to the emergence of a 1918-like human pandemic. Therefore, stockpiles of human pre-pandemic vaccine (targeted at avian strains) are being considered. For many countries, the principal constraint for these vaccine stockpiles will be the total mass of antigen maintained. We tested the hypothesis that lower individual doses (i.e., less than the recommended dose for maximum protection) may provide substantial extra community-level benefits because they would permit wider vaccine coverage for a given total size of antigen stockpile. Methods and Findings. We used a mathematical model to predict infection attack rates under different policies. The model incorporated both an individual's response to vaccination at different doses and the process of person-to-person transmission of pandemic influenza. We found that substantial reductions in the attack rate are likely if vaccines are given to more people at lower doses. These results are applicable to all three vaccine candidates for which data are available. As a guide to the magnitude of the effect, we simulated epidemics based on historical studies of immunogenicity. For example, for one of the vaccines for which data are available, the attack rate would drop from 67.6% to 58.7% if 160 out of the total US population of 300 million were given an optimal dose rather than 20 out of 300 million given the maximally protective dose (as promulgated in the US National Pandemic Preparedness Plan). Our results are conservative with respect to a number of alternative assumptions about the precise nature of vaccine protection. We also considered a model variant that includes a single high-risk subgroup representing children. For smaller stockpile sizes that allow vaccine to be offered only to the high-risk group at the optimal dose, the predicted benefits of using the homogenous model formed a lower bound in the presence of a risk group, even when the high-risk group was twice as infective and twice as susceptible. Conclusions. In addition to individual-level protection (i.e., vaccine efficacy), the population-level implications of pre-pandemic vaccine programs should be considered when deciding on stockpile size and dose. Our results suggest that a lower vaccine dose may be justified in order to increase population coverage, thereby reducing the infection attack rate overall.”

For a perspective on this article, read: Influenza Pandemic Vaccines: Spread Them Thin? Fraser C PLoS Medicine Vol. 4, No. 6, e228 doi:10.1371/journal.pmed.0040228.

^top

Simple Models of Influenza Progression Within a Heterogeneous Population
Richard C. Larson. OPERATIONS RESEARCH. Vol. 55, No. 3, May–June 2007, pp. 399–412
Abstract: “The focus of this “OR framing paper” is to introduce the operations research (OR) community to the need for new mathematical modeling of an influenza pandemic and its control. By reviewing relevant history and literature, one key concern that emerges relates to how a population’s heterogeneity may affect disease progression. Another is to explore within a modeling framework “social distancing” as a disease progression control method, where social distancing refers to steps aimed at reducing the frequency and intensity of daily human-to-human contacts. To depict social contact behavior of a heterogeneous population susceptible to infection, a nonhomogeneous probabilistic mixing model is developed. Partitioning the population of susceptibles into subgroups, based on frequency of daily human contacts and infection propensities, a stylistic difference equation model is then developed depicting the day-to-day evolution of the disease. This simple model is then used to develop a preliminary set of results. Two key findings are (1) early exponential growth of the disease may be dominated by susceptibles with high human contact frequencies and may not be indicative of the general population’s susceptibility to the disease, and (2) social distancing may be an effective nonmedical way to limit and perhaps even eradicate the disease. Much more decision-focused research needs to be done before any of these preliminary findings may be used in practice.”

^top

Lyme Disease --- United States, 2003—2005
(References removed)
“Lyme disease is caused by the spirochete Borrelia burgdorferi and is transmitted to humans by the bite of infected blacklegged ticks (Ixodes spp.). Early manifestations of infection include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. Left untreated, late manifestations involving the joints, heart, and nervous system can occur. A Healthy People 2010 objective is to reduce the annual incidence of Lyme disease to 9.7 new cases per 100,000 population in 10 reference states where the disease is endemic (Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin). This report summarizes surveillance data for 64,382 Lyme disease cases reported to CDC during 2003--2005, of which 59,770 cases (93%) were reported from the 10 reference states. The average annual rate in these 10 reference states for the 3-year period (29.2 cases per 100,000 population) was approximately three times the Healthy People 2010 target. Persons living in Lyme disease--endemic areas can take steps to reduce their risk for infection, including daily self-examination for ticks, selective use of acaricides and tick repellents, use of landscaping practices that reduce tick populations in yards and play areas, and avoidance of tick-infested areas. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5623a1.htm
(MMWR June 15, 2007 / 56(23);573-576)

^top

Rapid HIV Testing in Emergency Departments--Three U.S. Sites, January 2005--March 2006
(references removed)
“Approximately one fourth of the estimated 1 million persons living with human immunodeficiency virus (HIV) in the United States are unaware that they are infected with HIV and at risk for transmitting the virus to others. In April 2003, CDC announced a new initiative, Advancing HIV Prevention: New Strategies for a Changing Epidemic, aimed at reducing barriers to early diagnosis of HIV infection and increasing access of persons infected with HIV to medical care and prevention services. A priority strategy of this initiative is to make HIV testing a routine part of medical care. In April 2004, HIV testing was implemented in one emergency department (ED) in Los Angeles, California, and one in New York, New York, to determine the feasibility and acceptability of offering rapid HIV testing as a routine part of health care in EDs. In January 2005, an ED in Oakland, California, also began offering HIV testing routinely. This report summarizes the preliminary results of integrating rapid HIV testing into the health-care services routinely offered in the three EDs during January 2005--March 2006. Those results indicated that, of 9,365 persons tested, 97 (1.0%) ED patients had newly diagnosed HIV infection, and 85 (88%) of those 97 were linked after diagnosis to HIV care and treatment. EDs should consider integrating rapid HIV testing into their routine medical services to identify patients who are unaware that they are infected with HIV and link them to health and prevention services. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5624a2.htm
(MMWR June 22, 2007 / 56(24);597-601)

^top

Rapid HIV testing among racial/ethnic minority men at gay pride events--nine U.S. cities, 2004-2006
(References removed)
“In the United States, human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) disproportionately affect men from racial/ethnic minority groups. Approximately half of the HIV/AIDS cases among non-Hispanic black and Hispanic males reported by 33 states using name-based HIV surveillance during 2001--2005 were among men who have sex with men (MSM). Each year, approximately 100 gay pride events are held in cities across the United States to celebrate diversity, demonstrate solidarity of the gay community, and heighten awareness of topics of importance to the gay community. These events are attended by several hundred to several hundred thousand MSM. Certain gay pride events are focused on celebrating solidarity in the minority gay community and are attended primarily by MSM from racial/ethnic minority groups. These events offer an opportunity for community-based organizations (CBOs) and health departments to provide HIV-prevention education and outreach. In 2004, CBOs and health departments, with technical assistance from CDC, began conducting rapid behavioral assessments at gay pride events and at minority gay pride events. This report describes the results of assessments and rapid HIV testing conducted at 11 events in nine U.S. cities during 2004--2006; most of these events were attended primarily by MSM from racial/ethnic minority groups. A total of 543 attendees who participated in the assessments reported at the time of the event that they had not had HIV infection diagnosed previously. Of these, 133 (24%) were tested for HIV during the event, and eight (6%) of those tested during the event had a positive rapid test result. All eight were subsequently confirmed to be HIV positive by Western blot testing. Testing at gay pride events provides an opportunity to identify new HIV infections among MSM outside of health-care settings, particularly those from racial/ethnic minority groups. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5624a3.htm
(MMWR June 22, 2007 / 56(24);602-604)

^top


3. Notifications
International Conference on Options for the Control of Influenza
International Conference on Options for the Control of Influenza New disease-control rules follow reminders of risks The Options for the Control of Influenza Conference took place in Toronto this week on the 10th anniversary of the first human cases of H5N1 flu. About 1,400 experts from 65 countries are attending. The conference's opening ceremonies came 2 days after WHO's new International Health Regulations took effect. The voluntary contract marks the first time that WHO's 193 member states have agreed to immediately acknowledge and attempt to control any public health emergencies—in their own country or any other territory—that could provoke international concern. The new regulations improve on the old regulations not only by emphasizing more diseases but also by committing states to building up their public health infrastructure so they can detect and respond to outbreaks, and to maintaining real-time surveillance of health information so that it can be transmitted to WHO within 24 hours. The new rules also encourage countries to enforce disease control at their borders while respecting the rights of international travelers. WHO will now accept reports of outbreaks not only from national governments but also from third parties ranging from Internet search engines to other states.

The continuing debate over developing countries' ability to afford pandemic-influenza vaccines has produced a disturbing complication: the possibility that Indonesia and other countries affected by H5N1 avian flu will assert legal ownership of the viral isolates on which the vaccines would be based. The prospect of a territorial or intellectual-property claim on the isolates—which are used both to track the movement and evolution of the virus and to develop vaccines against it—is roiling senior members of the international flu community. If such a claim were successful, it could both disrupt the fragile and relatively low-profit flu vaccine system. "The need to balance the sharing of viruses through global surveillance and the need to make the access to vaccines and those sorts of technologies broadly available should not come as a surprise," Dr. Keiji Fukuda of WHO's Global Influenza Programme said. An ongoing series of international meetings extending into next autumn has been set up in hopes of defusing the situation, Fukuda and other WHO officials said.

Also, declining public interest in the H5N1 strain of avian influenza and its pandemic potential has sparked alarm among animal-health experts, who worry that shifting priorities will derail the funding still needed to control the disease in birds. Prominent veterinary scientists urged their colleagues to remember that the virus will remain a human health threat as long as it circulates in birds and mammals. Despite investments by international aid agencies, the animal-health system in Africa remains so poorly funded that "we have had several experiences of samples being stuck in countries for weeks when they should have been sent to reference laboratories," said Dr. Stella Chungong of WHO.

Moreover, vaccinating poultry and ducks to contain avian flu has been controversial. It reduces birds' clinical symptoms, keeping them alive and preserving their economic value—though not necessarily their utility as a trade good, because some countries refuse to import vaccinated chicken. It decreases viral shedding, slowing disease transmission, but it does not block infection entirely, potentially allowing the virus to spread silently. And, vaccination may be driving the virus's evolution. Isolates gathered in northern Vietnam in Dec 2005 are not only more virulent than earlier samples, but less likely to be controlled by vaccines that once contained the virus successfully, said Dr. David Suarez of the Southeast Poultry Research Laboratory.
(CIDRAP 6/18/07, 6/19/07, 6/21/07)

^top

Pandemic flu guidance for unions
“. . .The possibility of an influenza pandemic is more than just a public health issue. It will have a major effect in the workplace. Large numbers of people are likely to be absent at any one time. In the event of schools closing (which is a high possibility) many workers with children will find it impossible to go to work. Likewise, those who have partners or dependents who become ill may also not come to work. This would have a major impact on all aspects of health and social care, as well as on the economy as whole. The TUC believes that trade unions and employers, working together, can make a significant difference in ensuring that the effects of a pandemic are minimised, that the workforce are educated and informed on transmission issues, and in helping ensure there is no panic. Unions will also have a major part to play in ensuring that those workers who are ill as a result of infection stay at home and do not come in to work either through misplaced loyalty or employer pressure. In addition, it is important that the effect of any pandemic does not hit those who are more vulnerable hardest, such as the low paid, those who don’t have permanent employment or sick pay schemes and those who have dependents. . .”
http://www.tuc.org.uk/extras/fluguidance.pdf

^top

National HIV Testing Day --- June 27, 2007
Initiated in 1995, National HIV Testing Day is held each year Jun 27. This event increases awareness of HIV/AIDS and promotes early diagnosis and testing for HIV. CDC researchers have studied the feasibility and effectiveness of HIV testing in diverse settings, including emergency departments and minority gay pride events, 2 settings featured in this issue of MMWR. In 2006, CDC called for routine, voluntary HIV testing of persons aged 13--64 years in health-care settings. In 2007, CDC launched a heightened national response to the HIV/AIDS crisis among African Americans, with a goal to increase opportunities for diagnosis and testing. Persons who know they are infected with HIV can begin treatment at an early stage of infection and take steps to prevent transmitting HIV to others.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5624a1.htm
(MMWR June 22, 2007 / 56(24);597)

^top

MMWR Recommendations and Reports: Prevention of Varicella
June 22, 2007 / Vol. 56 / No. RR–4;
In 1995, ACIP recommended routine vaccination of children aged 12--18 months, catch-up vaccination of susceptible children aged 19 months--12 years, and vaccination of susceptible persons who have close contact with persons at high risk for serious complications. 1 dose of vaccine was recommended for children aged 12 months--12 years and 2 doses, 4--8 weeks apart, for persons aged >13 years. In 1999, ACIP updated the recommendations to include establishing child care and school entry requirements, use of the vaccine following exposure, use of the vaccine for certain children infected with HIV, and vaccination of adolescents and adults at high risk for exposure or transmission. This report revises, updates, and replaces the 1996 and 1999 ACIP statements for prevention of varicella.

New recommendations include 1) implementation of a routine 2-dose varicella vaccination program, with the first dose administered at age 12--15 months and the second dose at age 4--6 years; 2) a second dose catch-up varicella vaccination for children, adolescents, and adults who previously had received 1 dose; 3) routine vaccination of all healthy persons aged ≥13 years without evidence of immunity; 4) prenatal assessment and postpartum vaccination; 5) expanding the use of the varicella vaccine for HIV-infected children with age-specific CD4+T lymphocyte percentages of 15%--24% and adolescents and adults with CD4+ lymphocyte counts >200µL; and 6) establishing middle school, high school, and college entry immunization requirements. ACIP also approved new criteria for evidence of immunity to varicella.
http://www.cdc.gov/mmwr/pdf/rr/rr5604.pdf

^top

MMWR Surveillance Summaries ; Malaria Surveillance, United States, 2005
June 8, 2007 / Vol. 56 / No. SS–6
The majority of malaria infections in the United States occur among persons who have traveled to areas with ongoing malaria transmission. This report summarizes cases in persons with onset of illness in 2005 and summarizes trends during previous years. CDC received reports of 1,528 cases of malaria, including 7 fatal cases, with an onset of symptoms in 2005 among persons in the United States or one of its territories. This number represents an increase of 15.4% from the 1,324 cases reported for 2004, primarily reflecting the increased number of cases reported from Asia and the Middle East and from the Americas. In the majority of reported cases, U.S. civilians who acquired infection abroad had not adhered to a chemoprophylaxis regimen that was appropriate for the country in which they acquired malaria. U.S. civilians traveling to West Africa had the highest estimated relative case rate. Persons traveling to a malarious area should take one of the recommended chemoprophylaxis regimens appropriate for the region of travel and use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and who subsequently has a fever or influenza-like symptoms should seek medical care immediately and report their travel history to the clinician.
www.cdc.gov/mmwr

^top

FDA Releases New Software Tool to Help Keep Food Facilities Safe from Attack
The U.S. Food and Drug Administration (FDA) released a new tool to help growers, packers, processors, manufacturers, warehousers, transporters, and retailers in the food industry determine the vulnerability of individual food facilities to biological, chemical, or radiological attack. The software program, called the CARVER + Shock Software Tool, is a science-based prevention strategy to safeguard the food supply. FDA Assistant Commissioner for Food Protection David Acheson, said, "The relative risk-ranking methodology used by the CARVER + Shock software tool has been designed to assist facility operators in identifying potential vulnerabilities and assist in providing preventive measures to increase the defense of products and operations." CARVER + Shock was developed by FDA's Center for Food Safety and Applied Nutrition, in collaboration with Sandia National Laboratories, the Institute of Food Technologists, U.S. Department of Agriculture's Food Safety and Inspection Service, National Center for Food Protection and Defense, State representatives, and private industry representatives.

The name of the risk assessment software is derived from the acronym CARVER, which refers to 6 attributes used to evaluate targets for attack: 1) Criticality: What impact would an attack have on public health and the economy? 2) Accessibility: How easily can a terrorist access a target? 3) Recuperability: How well could a system recover from an attack? 4) Vulnerability: How easily could an attack be accomplished? 5) Effect: What would be the direct loss from an attack, as measured by loss in production? 6) Recognizability: How easily could a terrorist identify a target? The CARVER tool also evaluates a seventh attribute—the psychological impacts of an attack or "shock" attributes of a target. FDA has worked closely with its partners to assess existing food defense measures and augment them for improved protection. One such effort, the Strategic Partnership Program Agroterrorism Initiative, helps identify sector-specific vulnerabilities, determine research gaps and needs, and increase coordination between the federal government and industry stakeholders. In 2006, FDA launched the ALERT Initiative, designed to raise industry awareness of food defense and preparedness issues. CARVER + Shock builds on ALERT, and allows a more formal and detailed food defense assessment.
(FDA 6/15/07 http://www.fda.gov/bbs/topics/NEWS/2007/NEW01652.html )

^top

 apecein@u.washington.edu