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Vol. X. NO. 14 ~ EINet News Briefs ~ Jul 06, 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)
- Austria: Wild birds suspected of dying from avian influenza
- France: Avian influenza kills 3 wild swans
- Germany (Thuringia): Avian influenza H5N1 kills wild birds
- Germany: Avian influenza H5N1 virus sequence similar to Czech virus samples
- Indonesia: New human case of avian influenza H5N1 reported
- Viet Nam: WHO confirms 2 of Vietnam's latest avian influenza H5N1 cases
- Australia (South Australia): 3 confirmed cases of Q fever
- Taipei: Third imported measles case from Japan
- Taipei: First Chikungunya fever case in 2007
- Taipei: First indigenous dengue fever case this summer
- Taipei: Cases of rubella related to alien factory workers
- Russia (multi-region): Update on Tickborne encephalitis cases
- Russia (Udmurtia, Tatarstan): Cases of Hemorrhagic fever w/renal syndrome on the rise
- Russia (Kalmykia, Volgograd, Ingushetia): Update on CCHF situation
- Russia (Moscow): Salmonellosis outbreak among construction workers
- USA: IT organizations not ready for pandemic influenza
- USA (multistate): Snack implicated in Salmonella outbreak
- USA: Drugs in Chinese seafood trigger FDA import ban
- USA (New York): Physician-associated cluster of 5 hepatitis C cases
- Africa: OIE provides avian influenza vaccines

1. Updates
- Avian/Pandemic influenza updates
- Cholera, diarrhea & dysentery
- West Nile Virus

2. Articles
- Efficacy and Safety of a Live Attenuated, Cold-Adapted Influenza Vaccine, Trivalent Against Culture-Confirmed Influenza in Young Children in Asia
- Roundtable Discussion: Corporate Pandemic Preparedness
- One-Year Outcomes and Health Care Utilization in Survivors of Severe Acute Respiratory Syndrome
- Turtle-Associated Salmonellosis in Humans --- United States, 2006—2007
- Symptomatic Early Neurosyphilis Among HIV-Positive Men Who Have Sex with Men--Four Cities, United States, January 2002--June 2004
- A previously unknown reovirus of bat origin is associated with an acute respiratory disease in humans

3. Notifications
- Prevention and Control of Influenza: Recommendations of ACIP, 2007
- 13th International Congress on Infectious Diseases


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 / 19 (5)
Indonesia / 26 (22)
Laos / 2 (2)
Nigeria / 1 (1)
Viet Nam 2 (0)
Total / 54 (33)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 317 (191).
(WHO 6/29/07 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 6/25/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 7/6/07): 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.

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Europe/Near East
Austria: Wild birds suspected of dying from avian influenza
Since 3 Jul 2007, 8 dead birds have been found on a promenade in the Austrian town of Altmuenster, which is situated on a lake. The Austrian national authorities have sent samples from these birds to the national reference laboratory.

The H5N1 virus reached the European Union for the first time in 2006, starting in Greece and Italy and reaching birds in France, Germany, and a dozen other nations on the continent. 6 European nations—Russia, England, the Czech Republic, Hungary, France, and Germany—and Turkey have reported H5N1 outbreaks this year. Updated (5 Jul 2007) information on H5N1 in wild birds in Europe is available at: <http://ec.europa.eu/food/animal/diseases/adns/adns_wildbirds2007.pdf>. A map, showing the European regions found infected by H5N1 in wild birds from 1 Jan to 28 Jun 2007, is available at: http://ec.europa.eu/food/animal/diseases/adns/adns_maps_wb_2007.jpg
(CIDRAP 7/5/07; Promed 7/3/07, 7/5/07)

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France: Avian influenza kills 3 wild swans
France found 3 wild swans that died this week had avian flu, suggesting the H5N1 virus is spreading again across Europe. France's agriculture ministry confirmed that 3 swans found dead on a lake in the Moselle region, which borders Germany, died of bird flu. "Michel Barnier, minister of agriculture and fishing, is putting in place the risk-prevention measures corresponding to the shift from the 'moderate' level to the 'high' level," the ministry said. The 'high' level means that birds and poultry in mainland France will either have to be locked up or protected by nets to avoid all contact with wild birds. Pigeon races and other events where birds are gathered will be forbidden. In 98 "humid zones" in France, or around 15 percent of the country, there will be special veterinary checks at poultry farms. Poultry in France's Moselle region has been confined and local wildlife is under observation.

The effect on poultry farming will probably be limited, Alex Thiermann, president of the Code Commission [of the OIE] said. Confinement will not stop bird flu spreading among wild birds, though it does make it tough for the virus to leap from wild to domestic birds, and any cases of infected poultry will be limited to individual farms, Thiermann said. France is Europe's biggest poultry producer. In 2006, the virus was found in more than 60 wild birds and at a farm with 11 000 turkeys in France.

The new findings mark France's second confirmed H5N1 outbreak. In Feb 2006 the country reported finding H5N1 in several wild birds, in Ain department in east-central France. Soon afterward the virus was detected at a nearby turkey farm, which led to the culling of 11,300 birds. This year's outbreaks probably spread through the migration of infected water birds. They leave traces of the virus on the surface water when they touch down on lakes, in turn infecting less transient local birds. Dead swans are often the first sign of an outbreak, said Albert Osterhaus, director of New-Flu Bird, a European project based in the Netherlands bringing together ornithologists and virologists.
(Promed 7/5/07; CIDRAP 7/5/07)

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Germany (Thuringia): Avian influenza H5N1 kills wild birds
Germany said it was raising its assessment of the risk of bird flu following the French announcement and after officials on 4 Jul 2007 discovered more birds that had died of the H5N1 virus. Some 38 wild birds have tested positive for a lethal strain of bird flu in a fourth German state, health authorities said 5 Jul 2007. The birds were found with the H5N1 strain in the eastern state of Thuringia, the Friedrich Loeffler federal animal diseases institute said. They were among 100 birds found dead in an artificial lake on the border between Thuringia and the state of Saxony-Anhalt. Tests were being carried out on the other birds by the disease laboratory on the Baltic Sea island of Riems. Last week [25 Jun-1 Jul 2007], wild swans, geese and ducks were found with H5N1 in Leipzig in the eastern state of Saxony and in the southern city of Nuremberg in Bavaria. In Thuringia, authorities have sealed off a 3-km area around the find and a further 10 km function as an observation perimeter. Thuringian authorities have ordered all poultry within the area to be kept in their pens as a precaution.
(Promed 7/5/07)

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Germany: Avian influenza H5N1 virus sequence similar to Czech virus samples
Further to the reoccurrence of highly pathogenic avian influenza virus subtype H5N1 in wild birds, Germany sequence data of the hemagglutinin genes of 2 isolates obtained from infected mute swans found at Nuremberg, Bavaria, and Frohburg, Saxonia have now been generated at the Friedrich-Loeffler Institut. Preliminary comparisons and database searches demonstrated that these 2 sequences are closely related (at least 99.5 per cent identity) but distinguishable from each other. Other closely related sequences which are publicly available originate from H5N1 isolates made in 2006 from grebes (Podiceps spec.) in southern Siberia and from a whooper swan (Cygnus cygnus) and a common goldeneye (Bucephala clangula) in Mongolia. In a phylogenetic analysis, these viruses form a separate cluster with H5N1 viruses isolated from chickens in Afghanistan. In addition, viruses from the Russian Krasnodar region and a virus detected in 2006 in a mute swan in Italy are associated with this cluster.

In a joint analysis performed with the Community Reference Laboratory at VLA, Weybridge, the H5N1 virus from the outbreak in a turkey holding in the Czech Republic appears to be equidistant yet closely related (99.2 per cent identity) to those from Nuremberg and Frohburg. The Czech Republic notified OIE 29 Jun 2007 that a mute swan from Breclav (Lednice, south Moravia) was found positive for HPAI H5N1 by gene sequencing performed at the State Veterinary Institute (SVI), Prague.
(Promed 6/29/07, 7/1/07)

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Asia
Indonesia: New human case of avian influenza H5N1 reported
A 3-year-old girl in Indonesia's Riau province has tested positive for bird flu, bringing the total number of cases to 101 in the country, local media reported 4 Jul 2007. The young sufferer resides in remote Pesisi district. Indonesia is the hardest hit country, with a bird flu death toll already reaching 80 since the virus was detected in the country in 2003.
(Promed 7/4/07)

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Viet Nam: WHO confirms 2 of Vietnam's latest avian influenza H5N1 cases
WHO confirmed 2 H5N1 cases from Vietnam dating back to late May and early June. The cases raise Vietnam's H5N1 count to 95, while the number of fatalities for now remains at 42. 3 other cases, which include 2 fatalities, have been announced by Vietnamese officials over the past few weeks but have not yet been confirmed by WHO. If WHO confirms all of the cases, Vietnam's avian flu case count would rise to 98 cases and 44 deaths. Both cases have been confirmed by Vietnam's National Institute of Hygiene and Epidemiology and the WHO's reference laboratory at the US CDC. 1 patient, a 29-year-old man from Vinh Phuc province, got sick on May 10, some days after slaughtering chickens for a wedding. He was hospitalized May 15 and discharged Jun 11. The second case involves a 19-year-old man from Thai Nguyen province who got sick May 20 after working in a poultry slaughterhouse. He was hospitalized May 25 where he remains in stable condition. Vietnam has been battling several H5N1 poultry outbreaks since early May. Most have occurred in the northern part of the country.

Also, Vietnam has put in an urgent order to China to buy 50 million doses of H5N1 vaccine for poultry. The country has only 15 million doses left, and Prime Minister Nguyen Tan Dung has approved an order to import 200 million doses of the vaccine for a nationwide control campaign. In the past few months, 18 of the country's provinces have reported poultry outbreaks. Vietnam's agriculture minister, Cao Duc Phat, reportedly said that though outbreaks were declining in the northern region, the southern regions were at serious risk for recurrence of avian flu.
(CIDRAP 6/29/07; CIDRAP 7/5/07)

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Australia (South Australia): 3 confirmed cases of Q fever
The South Australian Department of Health has confirmed a Q fever outbreak at Waikerie in the state's Riverland. The infectious disease causes flu-like symptoms and is carried by livestock. Local residents are claiming a nearby goat abattoir is the cause of the human infection of which there have been 3 confirmed cases and 5 potential.

Coxiella burnetii, the causative agent of Q fever, can be resistant to heat and desiccation and highly infectious by the aerosol route. A single inhaled organism may produce clinical illness. Cattle, sheep, and goats are the primary reservoirs of C. burnetii. Infection has been noted in a wide variety of other animals. Organisms are excreted in milk, urine, and feces of infected animals. Most importantly, during birthing the organisms are shed in high numbers within the amniotic fluids and the placenta. The Q fever organism is a Category B bioterrorism agent. Infection of humans usually occurs by inhalation of these organisms from air that contains airborne barnyard dust contaminated by dried placental material, birth fluids, and excreta of infected herd animals. Humans are often very susceptible to the disease, and very few organisms may be required to cause infection. Ingestion of contaminated milk, followed by regurgitation and inspiration of the contaminated food, is a less common mode of transmission.
(Promed 6/24/07)

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Taipei: Third imported measles case from Japan
Taiwan CDC has identified the third imported case of measles in 2007—a 25-year-old male university student who went to Japan May 19-25. He experienced disease onset Jun 2 and was confirmed to have contracted measles Jun 21. None of his contacts has presented symptoms so far. The prior 2 imported cases of measles this year were confirmed earlier. The first case was a 30-year-old non-immune female who joined a tourist group to Japan May 16-20. She then developed cough, rhinorrhea, fever and rash, and has visited various clinics 8 times since May 24. The second case, a 26-year-old female, joined a travel group with her husband to Tokyo May 17-21, and spent extra days there until May 24. She fell ill with fever Jun 2, and developed skin rash. Investigation of 32 possible contacts of hers has been completed. Among them, another visitor who participated in the same travel group was recognized as showing the symptom of rash. That person has been to the hospital and is under further investigation. The MMR vaccination coverage rate in Taiwan is above 95%. As of Jun 15, 2007, there has been a total of 2 confirmed cases of measles in Taiwan this year. Both were imported from Japan.
(Taiwan CDC 6/22/07)

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Taipei: First Chikungunya fever case in 2007
Taiwan CDC has identified this year’s first case of Chikungunya fever Jun 20. A 5-year-old boy who resides in Tao-Yuan County was detected with fever at the international airport Jun 20 after returning from a trip to Indonesia where he visited some relatives. The RT-PCR examination of his blood confirmed him as a Chikungunya fever positive case Jun 25. Taiwan has registered 2 Chikungunya fever cases in resent 2 years. Both of them were imported cases.
(Taiwan CDC 6/25/07)

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Taipei: First indigenous dengue fever case this summer
Taiwan CDC has identified the summer season’s first indigenous case of dengue fever in a 21-year-old male who resides at An-Nan district in Tainan City. He fell ill with fever and joint pain Jun 9, and was confirmed Jun 24. As of the 25th epidemiological week in 2007, Taiwan has had 366 reported dengue fever cases, of which 56 were laboratory confirmed. Among this year’s confirmed cases, 39 were classified as imported cases and 17 were indigenous cases. The origins of the imported cases were: 23 from Indonesia; 10 from Vietnam; 3 from Thailand; and 1 each from Singapore, Cambodia and Malaysia.
(Taiwan CDC 6/25/07)

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Taipei: Cases of rubella related to alien factory workers
As of 29 Jun 2007, Taiwan CDC has confirmed 2 cases of rubella in Taoyuan and Miaoli counties. After further investigation with the local authorities, Taiwan CDC found incidences of infection among alien workers clustered in factories in the 2 locations. Since Apr 2007, 32 alien workers from a factory in Taoyuan County have developed symptoms that may be due to rubella; test results confirmed 7 positive cases. Since May 2007, 29 alien workers from a factory in Miaoli County have also developed symptoms; test results confirmed 5 positive cases. Authorities have hospitalized and quarantined all infected individuals. All workers in the 2 factories have received emergency rubella vaccinations. So far, the outbreak has been effectively contained. After Taiwan implemented policies for MMR vaccinations, the annual inoculation coverage rate has exceeded 95%.
(Taiwan CDC 7/4/07)

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Russia (multi-region): Update on Tickborne encephalitis cases
In Buryatia Republic, since the beginning of the season of tick activity, 2196 persons have sought medical aid after tick bites. Majority of the persons bitten by ticks were not vaccinated against tickborne encephalitis [virus]. Tickborne encephalitis [TBE], caused by 2 closely related flaviviruses, was confirmed in 14 patients. At the beginning of the [TBE] epidemic season, over 30 000 persons were vaccinated against tickborne encephalitis [virus].

As of 21 Jun [2007], 7986 inhabitants of the Irkutsk region have sought medical aid in connection with tick bites since the beginning of the season. For the week 15-22 Jun [2007], 836 persons have suffered from tick [bites]. 33 cases of tickborne encephalitis have been registered since the beginning of the season.

Since Mar 2007, 4566 persons have suffered from tick bites in the Arkhangelsk region. The diagnosis of tickborne encephalitis was confirmed in 14 patients. The number of tick bites increased 28.6 per cent in comparison with the similar period in 2006. Lethal outcomes after tick bites in the region have not been recorded. 2494 persons have received immune preventive treatment against tickborne encephalitis [virus infection], representing 54.6 per cent of the number of the persons with tick bites who have sought medical aid.

Since the beginning of the "tick" season 23 839 people have sought treatment for tick bites in the Kemerovsk district (Oblast). In the past week [25-29 Jun 2007], 1715 people have sought treatment for tick bite, which according to local epidemiologists is an indication that the risk [of contracting tickborne encephalitis] is decreasing. About 400 people have been admitted to hospital on a provisional diagnosis of tickborne encephalitis. So far tickborne encephalitis has been confirmed for 10 patients. No fatalities have been reported so far.
(Promed 6/28/07, 6/30/07)

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Russia (Udmurtia, Tatarstan): Cases of Hemorrhagic fever w/renal syndrome on the rise
So far in 2007, 99 people have become ill with hemorrhagic fever with renal syndrome (HFRS), the local Rospotrebnadzor [Territorial Directorate of the Federal Services for Consumer Protection and Human Welfare] reported. Humans become infected generally in the countryside after cleaning houses after the winter, during work in the garden, and after visiting the forests. The epidemiologists foresee that this year [2007] may be the peak morbidity year for HFRS [hemorrhagic fever with renal syndrome] for Udmurtia. The peak comes every 3 years and is explained by biological rhythms of the main transmitter -- the red vole. Since the beginning of 2007, 86 cases of HFRS have been registered in Udmurtia, which is 1.9 times more than in 2006. Among the infected individuals are 5 children under 14 years of age. In Tatarstan, since the beginning of 2007, already 100 have fallen ill.
(Promed 6/25/07)

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Russia (Kalmykia, Volgograd, Ingushetia): Update on CCHF situation
Ticks are the reservoir of Crimean-Congo hemorrhagic fever (CCHF) and between 3 Apr and 25 Jun 2007, a total of 178 cases of tick-bites (including 4 children) have been recorded in Elista, the capital of the Republic of Kalmykia. A total of 6 persons have been admitted to hospital in Elista on suspicion of CCHF in recent days, and 2 cases have been confirmed by laboratory diagnosis. A serious situation with regard to CCHF has developed this year [2007] in the Southern Federal District of Russia. CCHF has been reported in 7 of 13 regions of the Southern Federal District: in the Rostov, Volgograd [see below], Astrakhan, and Stavropol regions, and also in the Republics of Dagestan, Kalmykia, and Ingushetia. Cases of CCHF have been recorded predominantly among the inhabitants of rural districts. The airborne spread of infection has been facilitated by herding and inadequate separation of livestock.

CCHF has been confirmed in 14 inhabitants of Volgograd. Since 11 May [2007], 54 persons were hospitalized on suspicion of CCHF. A committee on public health services in the Administration of the Volgograd Region has reported that 463 inhabitants of the region have sustained bites from the ticks that transmit CCHF virus. More than half of all cases have been registered among residents of the Kotelnikovsky and Oktyabrsky districts. Olga Fomina, a spokesperson for the Press Service of the region stated that, "Healthcare workers are trying to prevent new cases of infection in the region by arranging lectures, round tables, and citizen's forums, stressing the necessity for immediate recourse to medical treatment for tick-bites. We should remember that in May [2007], 1 of the CCHF cases in the Volgograd Region had a fatal outcome."

Also a man has died as a result of Crimean-Congo hemorrhagic fever (CCHF) virus infection in Ingushetia. Authorities are striving to alert the general population to the dangers of CCHF virus infection.

CCHF is a tick-borne viral disease. The virus is transmitted by contact with domestic animal products, by contact transmission, and also by tick-bite. The majority of human cases occur in workers in the livestock industry, agriculture, slaughterhouses, and veterinary practice. Clinical manifestations are non-specific and symptoms typically include high fever, headache, malaise, arthralgia, myalgia, nausea, abdominal pain, and non-bloody diarrhea.
(Promed 6/29/07, 7/4/07)

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Russia (Moscow): Salmonellosis outbreak among construction workers
A total of 444 construction workers laid up with salmonellosis remain in hospitals in the Moscow region, the Ministry for Emergency Situations reported. A total of 444 workers employed at Sheremetyevo-3 terminal in Moscow, the IKEA-Khimki Business Park construction sites, had been hospitalized since 20 Jun 2007. Almost all of the workers arrived in Russia from Turkey, Tajikistan, Uzbekistan, and Kyrgyzstan to work on construction sites.
(Promed 6/25/07)

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Americas
USA: IT organizations not ready for pandemic influenza
Last November, Gartner Inc. analyst Ken McGee gave a presentation on the risk of an avian flu pandemic to an audience of IT professionals. He concluded with this recommendation: Complete your pandemic planning by Q2 of 2007. This year's second quarter ended. But despite his admonition, McGee believes that few IT organizations are ready for a possible pandemic. McGee is as concerned as ever about the threat of a pandemic, but he's worried that fears are waning in the U.S. The declining level of concern cited by McGee was backed up by poll results by Ipsos Public Affairs, a research organization. Ipsos conducted an online survey of 1,438 U.S. residents who are over the age of 18. When asked about the issue of avian flu in the U.S., 27% of the respondents said they were "concerned" -- down from 35% in a similar survey last year. 41 percent said they were "not concerned," compared with 31% a year ago. One of the poll questions asked, "How much have you read, heard or seen about bird flu?" In 2006, 74% of the people who were surveyed answered "a lot/some." This year, the percentage of respondents who chose that answer fell to 56%.

Scott McPherson, CIO of the Florida House of Representatives and head of the Florida CIO Pandemic Preparedness Committee, tracks news about the avian flu. McPherson thinks that IT organizations not only need to plan for a potential pandemic but, more important, must have a planning process that can continuously adapt to changing conditions -- thereby remaining flexible. For instance, McPherson said telecommuting programs will ultimately become unworkable if a pandemic occurs because of network-overload problems and a lack of access to broadband connections for many employees. And at government agencies and other organizations where workers need access to paper forms, paper that is potentially laden with the virus will have to be quarantined for up to 24 hours, McPherson said. No one will be able to count on timely deliveries of such forms to workers at their homes, he added. IT managers "need to prepare for what happens after the work-at-home plans implode," McPherson said.
(Computerworld 7/3/07 http://www.computerworld.com/ )

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USA (multistate): Snack implicated in Salmonella outbreak
An epidemiologic investigation of 52 cases of Salmonella infection in 17 states, most of them in children, has prompted a nationwide recall of a snack called Veggie Booty, federal health agencies reported. The US Food and Drug Administration (FDA) advised consumers to throw away any Veggie Booty on hand. The snack is made of puffed rice and corn with a vegetable coating and is sold in 4-ounce, 1-ounce, and half-ounce sizes. "Interviews comparing foods eaten by ill and well persons show that consumption of Robert's American Gourmet brand Veggie Booty was statistically associated with illness and therefore the most likely source of the outbreak," CDC said. An official of Robert's American Gourmet said no samples of the product so far had tested positive for Salmonella. FDA said anyone who has had diarrhea after eating the snack should contact a healthcare provider and report the illness to health authorities. FDA and CDC said the cases began Mar 2007. Almost all the illnesses were in children under age 10, with most of them in toddlers. Most of the patients had bloody diarrhea, and 4 were hospitalized. No deaths have been reported. Only 8 cases were reported before May 1, and the number has gradually increased.

CDC listed the Salmonella serotype identified in the illnesses as Wandsworth, a rare strain. FDA listed the states and numbers of cases in the outbreak as follows: California, 7; Colorado, 5; Connecticut, 1; Georgia, 1; Indiana, 1; Massachusetts, 3; Minnesota, 2; New Hampshire, 2; New Jersey, 2; New York, 13; Oregon, 1, Pennsylvania, 3; Tennessee, 1, Texas, 1; Vermont, 3; Washington, 4; and Wisconsin, 2. Veggie Booty is sold at retail stores in all 50 states and Canada and also over the Internet. Most people infected with Salmonella experience diarrhea, often with fever and abdominal cramps, within 12 to 72 hours after infection, the CDC said. Most people recover in 4 to 7 days without treatment, but elderly people, infants, and those with an impaired immune system may suffer severe illness.
(CIDRAP 6/29/07)

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USA: Drugs in Chinese seafood trigger FDA import ban
The US Food and Drug Administration (FDA) banned importation of 5 types of farmed Chinese seafood because of contamination with outlawed antimicrobial drugs, including 1 that can spawn antibiotic resistance. FDA banned farm-raised catfish, shrimp, eel, dace (a carp-like fish), and basa (similar to catfish) from China after testing over an 8-month period revealed many cases of contamination with drug residues. The contaminants include nitrofuran, malachite green, gentian violet, and fluoroquinolone. The first 3 cause cancer in lab animals with prolonged exposure, while fluoroquinolones are a class of antibiotics whose use in food animals has been known to promote resistant bacteria. All 4 are banned in farmed seafood in the United States. China outlaws the use of nitrofurans and malachite green in fish farming but allows fluoroquinolones, FDA said.

"We've now reached a point where between October 2006 and May 2007 over 15% of samples we tested were positive," David Acheson, the FDA's assistant commissioner for food protection, said. The drug residues have been at low levels, and there is no imminent threat to public health, he said. "However, the substances could cause serious problems if consumed over a long period of time." FDA is not seeking a recall of the Chinese products already in the US or advising consumers to return or destroy products on hand. "FDA is concerned about long term exposure as well as the possible development of antibiotic resistance," the agency said. China accounts for 70% of the global supply of farmed fish and is the third largest exporter of farmed fish to the US, said Acheson. However, he said he couldn't estimate the economic effects of the ban on China. Officials said FDA has been working extensively with Chinese authorities on the problem but still finds it necessary to take action to protect US consumers.
(CIDRAP 6/28/07)

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USA (New York): Physician-associated cluster of 5 hepatitis C cases
2 more people have contracted hepatitis C after receiving intravenous anesthesia from a doctor in New York who is under investigation. [Previously, laboratory tests suggested that 3 of about 4500 potentially exposed patients were infected while getting intravenous anesthesia drugs during outpatient medical procedures.] A 64 year old doctor is accused of spreading the disease by failing to follow proper infection control protocols, local media reported 24 Jun 2007. Hepatitis C infection typically affects drug addicts and the sexually promiscuous. Another woman has notified the city Health Department after contracting hepatitis C after an outpatient procedure. Reportedly that notification brings the number of possible victims to at least 5. There are about 40 thousand new cases of hepatitis C in the US per year. Nonetheless, transmission of hepatitis C in a medical setting is rare and avoidable when standard infection control procedures are followed.
(Promed 6/28/07)

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Africa
Africa: OIE provides avian influenza vaccines
The OIE provided Togo with 1 million doses of avian influenza vaccines from its vaccine bank for protecting adult poultry against the H5N1 avian influenza strain immediately following the confirmation of a first outbreak in this country. In late June officials in Togo announced an H5N1 outbreak at a chicken farm near the country's capital, Lome. The positive findings raised the number of affected African countries to 10. This delivery comes as a result of the OIE partnership with donors to the OIE World Animal Health and Welfare Fund and the Canadian International Development Agency (CIDA). Since its inception May 2006, the vaccine bank delivered vaccines to African countries: Egypt (14 million doses), Mali (1 million), Mauritania and Ghana (2 million), Senegal (1 million) and Mauritius (300 000) within the OIE/Inter-African Bureau for Animal Resources of the African Union (AU-IBAR) partnership, with the financial support of the European Commission (EC) and of Canada. The OIE initially established the virtual vaccine bank for African countries and for rapidly assisting infected countries with vaccinating poultry populations at risk. Countries free of infection but wishing to establish a strategic stockpile can also appeal to it. A strategic stockpile can be used by a country in case of a persistent worsening of the situation. The OIE has succeeded in maintaining and extending this virtual AI Vaccine Bank to other regions of the world. The Canadian International Development Agency (CIDA) has already confirmed a financial participation in this global project for 3 years (2007-2009).
(Promed 7/4/07; CIDRAP 7/5/07)

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1. Updates
Avian/Pandemic influenza updates
- UN: http://influenza.un.org/. UN response to avian influenza and the pandemic threat. Also, http://www.irinnews.org/Birdflu.asp provides information on avian influenza in order to help the humanitarian community.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Read about the International Technical Meeting on Highly Pathogenic Avian Influenza and Human H5N1 Infection.
- OIE: http://www.oie.int/eng/en_index.htm.
- US CDC: http://www.cdc.gov/flu/avian/index.htm.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Read about the Pandemic Flu Leadership Forum and Blog.
- 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/. Pandemic preparedness Webinar recordings available.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm. The website has been updated, with link to National Influenza Centers in PAHO Member States.
- US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

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Cholera, diarrhea & dysentery
Philippines (Mindanao)
Health officials said 3 people have already died and more than a dozen others have been hospitalized in the southern city of Zamboanga. Dr. Ricardo Angeles, head of the local epidemiology and surveillance unit, suspected viral gastroenteritis as the cause of the death of 1 victim. All the victims, from the remote village of Limpapa, suffered diarrhea. "It may due to viral gastroenteritis," he said. The first death was reported 8 Jun 2007, and 10 other villagers were also rushed to hospital. This was followed by 2 more deaths 17 Jun 2007, and 3 more patients, also from the same village, had been rushed to the hospital.
(Promed 6/22/07)

USA/Mexico
Authorities from the CDC have given the all clear for passengers aboard a flight from Merida, Mexico, to Miami, Florida. The plane was being detained at the gate after it arrived at Miami International Airport after 9 passengers claimed to feel ill. AeroMexico flight 420 from Merida arrived with 45 people on board. The ill passengers were students who were on a missionary trip to Mexico. On 11 Jun 2007, before they returned, they reportedly had dinner at a restaurant and some complained they weren't feeling well prior to boarding the flight. CDC [personnel] arrived on the scene as well as local rescue personnel and determined the ill passengers were suffering from dysentery.
(Promed 6/22/07)

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

Arkansas / 1 / 0 / 0 / 1 / 0
California / 0 / 1 / 0 / 1 / 0
Illinois / 1 / 0 / 0 / 1 / 0
Iowa / 0 / 1 / 0 / 1 / 0
Mississippi / 4 / 2 / 0 / 6 / 1
Nebraska / 0 / 1 / 0 / 1 / 0
South Dakota / 0 / 5 / 0 / 5 / 0
Texas / 0 / 1 / 0 / 1 / 0
TOTALS / 6 / 13 / 0 / 19 / 1
(Promed 7/5/07)

Canada (Manitoba)
1 human West Nile (WN) virus infection (undefined clinically) was reported for epidemiological week 25 (17-23 Jun 2007). This is the first human case of WN virus infection in Canada in 2007.
(Promed 7/5/07)

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2. Articles
Efficacy and Safety of a Live Attenuated, Cold-Adapted Influenza Vaccine, Trivalent Against Culture-Confirmed Influenza in Young Children in Asia
Tam, John S. et al. Pediatric Infectious Disease Journal. 26(7):619-628, July 2007.
Abstract: “Background: This study was designed to evaluate the efficacy and safety of cold-adapted influenza vaccine, trivalent (CAIV-T) against culture-confirmed influenza in children 12 to <36 months of age during 2 consecutive influenza seasons at multiple sites in Asia. Methods: In year 1, 3174 children 12 to <36 months of age were randomized to receive 2 doses of CAIV-T (n = 1900) or placebo (n = 1274) intranasally >=28 days apart. In year 2, 2947 subjects were rerandomized to receive 1 dose of CAIV-T or placebo. Results: Mean age at enrollment was 23.5 +/- 7.4 months. In year 1, efficacy of CAIV-T compared with placebo was 72.9% [95% confidence interval (CI): 62.8-80.5%] against antigenically similar influenza subtypes, and 70.1% (95% CI: 60.9-77.3%) against any strain. In year 2, revaccination with CAIV-T demonstrated significant efficacy against antigenically similar (84.3%; 95% CI: 70.1-92.4%) and any (64.2%; 95% CI: 44.2-77.3%) influenza strains. In year 1, fever, runny nose/nasal congestion, decreased activity and appetite, and use of fever medication were more frequent with CAIV-T after dose 1. Runny nose/nasal congestion after dose 2 (year 1) and dose 3 (year 2) and use of fever medication after dose 3 (year 2) were the only other events reported significantly more frequently in CAIV-T recipients. Conclusions: CAIV-T was well tolerated and effective in preventing culture-confirmed influenza illness over multiple and complex influenza seasons in young children in Asia.”

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Roundtable Discussion: Corporate Pandemic Preparedness
Beth Maldin-Morgenthau et al. Biosecurity and Bioterrorism. Volume 5, Number 2, 2007.
Conclusion: “It is clear that businesses have a substantial role to play during public health emergencies, and inevitably governments will be counting on their assistance during an influenza pandemic. Therefore, it is to the benefit of all businesses and governments to work together prior to an emergency, to set expectations and to build the coordination and communication systems necessary to respond. However, this coordination may require businesses to be proactive with local, state, and federal leaders to assure that the necessary resources are directed to building these partnerships. It is essential that business leaders realize that government preparations for a pandemic, whether in the realm of vaccines, antivirals, surveillance, or disease containment, will directly affect their business, their employees, and their own families. The business community can have a tremendously positive impact on government actions, and there has never been a more important time to use their influence.”

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One-Year Outcomes and Health Care Utilization in Survivors of Severe Acute Respiratory Syndrome
Catherine M. Tansey et al. Arch Intern Med. 2007;167:1312-1320. http://archinte.ama-assn.org/cgi/content/abstract/167/12/1312
Abstract: “Background Severe Acute Respiratory Syndrome (SARS) became a global epidemic in 2003. Comprehensive information on 1-year outcomes and health care utilization is lacking. Research conducted during the SARS outbreak may help inform research planning for future public health emergencies. The objective of this study was to evaluate the 1-year outcomes in survivors of SARS and their family caregivers. Method The study was prospective and observational. We evaluated 117 SARS survivors from Toronto, Ontario. Patients were interviewed and underwent physical examination, pulmonary function testing, chest radiography, a 6-minute-walk test, quality-of-life measures, and self-report of health care utilization. At 1 year, informal caregivers were identified for a survey on caregiver burden. Results The enrolled survivors of SARS were young (median age, 42 years), and most were women (67%) and health care workers (65%). At 1 year after hospital discharge, pulmonary function measures were in the normal range, but 18% of patients had a significant reduction in distance walked in 6 minutes. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) domains were 0.3 to 1.0 SD below normal at 1 year. Of the patients, 17% had not returned to work by 1 year. Fifty-one patients required 668 visits to psychiatry or psychology practitioners. During the SARS epidemic, informal caregivers reported a decline of 1.6 SD below normal on the mental component score of the SF-36. Conclusions Most SARS survivors had good physical recovery from their illness, but some patients and their caregivers reported a significant reduction in mental health 1 year later. Strategies to ameliorate the psychological burden of an epidemic on the patient and family caregiver should be considered as part of future pandemic planning.”

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Turtle-Associated Salmonellosis in Humans --- United States, 2006—2007
“Turtles and other reptiles are reservoirs of Salmonella and have long been a recognized source of Salmonella infection in humans. Small turtles have posed a particular danger to young children because these turtles might not be perceived as health hazards and can be handled like toys. Salmonella infections in children can be severe and can result in hospitalization and occasionally in death. The association between Salmonella infection in children and exposure to turtles led to a 1975 law prohibiting the sale or distribution of small turtles (i.e., those with a carapace of <4 inches in length) in the United States. That prohibition led to a substantial decline in human salmonellosis cases associated with turtles. However, because the prohibition is not fully enforced and contains exceptions (e.g., sales for educational purposes), human turtle-associated cases continue to occur. This report describes several recent cases of turtle-associated salmonellosis reported to CDC by state and local health departments since September 2006, including a fatal case in an infant. These cases illustrate that small turtles remain a source of human Salmonella infections. Although ongoing public education measures aimed at preventing reptile-acquired Salmonella infections are helpful, prohibiting the sale of small turtles likely remains the most effective public health action to prevent turtle-associated salmonellosis. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5626a1.htm
(MMWR July 6, 2007 / 56(26);649-652)

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Symptomatic Early Neurosyphilis Among HIV-Positive Men Who Have Sex with Men--Four Cities, United States, January 2002--June 2004
(references removed)
“Symptomatic early neurosyphilis is a rare manifestation of syphilis that usually occurs within the first 12 months of infection. Most neurologic symptoms of early neurosyphilis result from acute or subacute meningitis, abnormalities in cranial nerve function, and inflammatory vasculitis leading to a cerebrovascular accident. Symptomatic early neurosyphilis essentially disappeared in the United States after the introduction of penicillin treatment for syphilis in the late 1940s but reappeared in the 1980s among persons with human immunodeficiency virus (HIV) infection. The disease burden from neurosyphilis is unknown because national reporting of this disease is incomplete. Because the increase in syphilis cases during the past 5 years has occurred primarily among MSM, many of whom were infected with HIV, CDC conducted a review of possible neurosyphilis cases to describe the clinical course of symptomatic early neurosyphilis and to better characterize the risk for this illness among HIV-infected MSM. The review included health department records from four U.S. cities (Los Angeles, California; San Diego, California; Chicago, Illinois; and New York, New York) for the period January 2002--June 2004. This report describes the results of that review, which identified 49 HIV-positive MSM with symptomatic early neurosyphilis during that 30-month period. Among HIV-positive MSM with early syphilis, the estimated risk for having symptomatic early neurosyphilis was 1.7%, and the risk for having early neurosyphilis with persistent symptoms 6 months after treatment was 0.5%. These findings emphasize the importance of preventing syphilis in HIV-infected persons. HIV-infected persons with cranial nerve dysfunction or other unexplained neurologic symptoms should be evaluated for early neurosyphilis. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5625a1.htm
(MMWR June 29, 2007 / 56(25);625-628)

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A previously unknown reovirus of bat origin is associated with an acute respiratory disease in humans
KB Chua et al. Proc Natl Acad Sci USA 10.1073, published online 25 Jun 2007. <http://www.pnas.org/cgi/content/abstract/0701372104v1?etoc>
Abstract: “Respiratory infections constitute the most widespread human infectious disease, and a substantial proportion of them are caused by unknown etiological agents. Reoviruses (respiratory enteric orphan viruses) were first isolated from humans in the early 1950s and so named because they were not associated with any known disease. Here, we report a previously unknown reovirus (named "Melaka virus") isolated from a 39-year-old male patient in Melaka, Malaysia, who was suffering from high fever and acute respiratory disease at the time of virus isolation. Two of his family members developed similar symptoms 1 week later and had serological evidence of infection with the same virus. Epidemiological tracing revealed that the family was exposed to a bat in the house 1 week before the onset of the father's clinical symptoms. Genome sequence analysis indicated a close genetic relationship between Melaka virus and Pulau virus, a reovirus isolated in 1999 from fruit bats in Tioman Island, Malaysia. Screening of sera collected from human volunteers on the island revealed that 14 of 109 (13%) were positive for both Pulau and Melaka viruses. This is the first report of an orthoreovirus in association with acute human respiratory diseases. Melaka virus is serologically not related to the different types of mammalian reoviruses that were known to infect humans asymptomatically. These data indicate that bat-borne reoviruses can be transmitted to and cause clinical diseases in humans.”

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3. Notifications
Prevention and Control of Influenza: Recommendations of ACIP, 2007
Summary: “This report updates the 2006 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine and antiviral agents. . .The groups of persons for whom vaccination is recommended and the antiviral medications recommended for chemoprophylaxis or treatment (oseltamivir or zanamivir) have not changed. Estimated vaccination coverage remains <50% among certain groups for whom routine annual vaccination is recommended, including young children and adults with risk factors for influenza complications, health-care personnel (HCP), and pregnant women. Strategies to improve vaccination coverage, including use of reminder/recall systems and standing orders programs, should be implemented or expanded. The 2007 recommendations include new and updated information. Principal updates and changes include 1) reemphasizing the importance of administering 2 doses of vaccine to all children aged 6 months--8 years if they have not been vaccinated previously at any time with either live, attenuated influenza vaccine (doses separated by >6 weeks) or trivalent inactivated influenza vaccine (doses separated by >4 weeks), with single annual doses in subsequent years; 2) recommending that children aged 6 months--8 years who received only 1 dose in their first year of vaccination receive 2 doses the following year, with single annual doses in subsequent years; 3) highlighting a previous recommendation that all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others should be vaccinated; 4) emphasizing that immunization providers should offer influenza vaccine and schedule immunization clinics throughout the influenza season; 5) recommending that health-care facilities consider the level of vaccination coverage among HCP to be one measure of a patient safety quality program and implement policies to encourage HCP vaccination (e.g., obtaining signed statements from HCP who decline influenza vaccination); and 6) using the 2007--2008 trivalent vaccine virus strains A/Solomon Islands/3/2006 (H1N1)-like (new for this season), A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens. This report and other information are available at CDC's influenza website (http://www.cdc.gov/flu). . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/rr56e629a1.htm
(MMWR June 29, 2007 / 56(Early Release);1-54)

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13th International Congress on Infectious Diseases
Kuala Lumpur, Malaysia ; 19-22 Jun 2008
Sponsored by the 20 000 members of the International Society for Infectious Diseases (ISID), the 19-22 Jun 2008 meeting will host delegates from over 100 countries at a modern Congress Center. Meet the editors and moderators of ProMED-mail, and the plenary speakers include Julie Gerberding of CDC, Bill Nauseef of the University of Iowa, and Bruce Beutler of the Scripps Research Institute in La Jolla. Symposia will include the prevention and control of infections of international importance, including XDR-tuberculosis, HIV, malaria, and pandemic influenza. Creative topics will also be covered in sessions, such as statins and cholesterol in infectious diseases; dengue and chikungunya; international perspectives on palliative care for people with HIV/AIDS; the neglected pathogen: Orientia tsutsugamushi; and evidence-based infection control. For more information visit: http://www.isid.org/13th_icid/.
(Promed 6/27/07)

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 apecein@u.washington.edu