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Vol. X. NO. 15 ~ EINet News Briefs ~ Jul 20, 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: Countries urged to be more vigilant about food safety
- Czech Republic: Healthy chicken to be culled as prevention in Orlice area
- Germany: Avian influenza surveillance report update
- Bangladesh: Poultry culled in Naogaon after samples test positive for avian influenza
- Indonesia: Latest death from avian influenza linked to sick chickens
- Viet Nam: Production of local avian influenza vaccine
- Australia (South Australia): Additional case of Q fever at abattoir
- Australia (Melbourne): Imported case of Poliomyelitis from Pakistan
- China: More cases of hand-foot-mouth disease in Beijing
- China (Jilin): Report of 30 cases of Guillain-Barre Syndrome
- Japan: Students to get second measles inoculation
- Philippines (Mindanao): Typhoid fever outbreak affects 200 persons
- Russia: Update on Tick-borne encephalitis situation
- Russia (Kalmykia, Stavropol): Update on Crimean-Congo hemorrhagic fever situation
- Russia (Khabarovsk): Viral meningitis associated with use of river water
- Russia (Tambov): Reported cases of Norwegian scabies
- USA (Virginia): Confirmation of low-pathogenic avian influenza H5N1 in turkeys
- USA: White House issues 1-year status report on pandemic planning
- USA: HHS, DHS fund public health preparedness and emergency response
- USA: HHS updates pandemic stockpile totals and planning efforts
- Canada: E. coli O157 cases associated with ground beef
- Canada (Ontario): E. coli O157 outbreak associated with student picnic
- Canada: Decision to widen BSE-related feed ban
- USA (Illinois): Salmonella outbreak associated with food festival
- USA (Multi-state): Salmonellosis outbreak associated with snack
- USA (Alabama): E. coli O157 outbreak sickens 18 persons
- USA (Colorado): E. coli outbreak affects 70 prisoners
- USA: Botulism cases associated with chili sauce
- USA (Missouri): 14 cases of viral meningitis
- USA (Utah, New Jersey): Confirmed cases of Tularemia
- USA (Texas): Man suffering from Vibrio vulnificus infection
- USA (Texas, California, Colorado), Canada (Alberta): Hantavirus infections

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

2. Articles
- Inhibiting cytokine response might not reverse H5N1 infections
- New Approaches to Confronting an Imminent Influenza Pandemic
- Handling mass death by integrating the management of disasters and pandemics: lessons from the Indian Ocean tsunami, the Spanish flu and other incidents
- Perinatal Group B Streptococcal Disease After Universal Screening Recommendations--United States, 20032005
- Multistate Outbreak of Norovirus Gastroenteritis Among Attendees at a Family Reunion--Grant County, West Virginia, October 2006
- Hepatitis A Vaccination Coverage Among Children Aged 24--35 Months--United States, 2004-2005

3. Notifications
- Satellite Broadcast and Webcast: Immunization Update 2007
- CDC releases updated "Yellow Book" on international travel
- Revised International Health Regulations Effective for the United States
- Malaria Rapid Diagnostic Test
- Fourth Congress of the European Society for Emerging Infections
- Converging Technologies to Combat Emerging Infectious Diseases (Phase II)


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 / 27 (23)
Laos / 2 (2)
Nigeria / 1 (1)
Viet Nam 2 (0)
Total / 55 (34)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 318 (192).
(WHO 7/11/07 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 6/29/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 7/18/07): http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 7/3/07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.

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Global: Countries urged to be more vigilant about food safety
The Food and Agriculture Organization (FAO) and WHO are urging all countries to strengthen their food safety systems. Weak food safety systems can lead to a higher incidence of food safety problems and diseases caused by micro-organisms, by residues of agricultural chemicals and by the use of unauthorized food additives. Diarrhoeal diseases alone, due mainly to unsafe food and water, kill 1.8 million children every year. Food production systems in developing countries are facing a series of challenges: population growth and urbanization, changing dietary patterns, intensification and industrialization of food and agricultural production. Climate conditions, poor sanitation and weak public infrastructure compound these difficulties. Food safety legislation in many developing countries is often incomplete or obsolete or not in line with international requirements. Responsibility for food safety and control tends to be dispersed across many institutions. Laboratories lack essential equipment and supplies.

Many developed countries are in similar situations with fragmented food safety systems that often do not include or cover primary production where many food safety issues originate. For example the spread in recent years of new Salmonella strains in poultry originated in developed countries and was spread globally through trade. Producers and traders should be held accountable for safe food production throughout the food chain. The rules of the World Trade Organization stipulate that developed countries help exporting developing countries to achieve the necessary high level of food safety for international trade. FAO and WHO are supporting national governments to improve the institutional set-up and the performance of food inspection, enforcement, laboratory analysis and diagnosis, certification, food-borne disease surveillance, emergency preparedness and response. They also provide advice on many food safety issues. The Codex Alimentarius Commission develops science- and risk-based food safety standards that are a reference in international trade and a model for countries to use in their legislation.
(WHO 7/19/07 http://www.who.int/mediacentre/news/releases/2007/pr39/en/index.html )

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Europe/Near East
Czech Republic: Healthy chicken to be culled as prevention in Orlice area
Czech vets decided, after having consulted the European Commission and the Czech Agriculture Ministry, to liquidate healthy poultry at 3 chicken farms in the area where the emergence of the H5N1 bird flu virus strain was confirmed 11 Jul 2007. The poultry will be culled at 2 farms in the village of Loucky and at a farm in the village of Zarecka Lhota. In all, 68 000 birds will be culled though no virus has been discovered among them. Approximately the same number of ill chickens has been liquidated at the poultry farms in Kosorin and Netreby, east Bohemia, where the H5N1 strain was detected.
(Promed 7/13/07)

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Germany: Avian influenza surveillance report update
So far during 2007, 240 wild birds have been found avian influenza (AI) positive. Of these, 72 were found H5N1 positive by the Friedrich-Loeffler-Institute, Federal Research Institute for Animal Health on the Island of Riems, while 168 wild birds were found H5-positive by veterinary laboratories elsewhere. There are epidemiological grounds to assume that these birds were also infected by the HPAI H5N1 virus.
(Promed 7/16/07)

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Asia
Bangladesh: Poultry culled in Naogaon after samples test positive for avian influenza
Some 1500 domestic fowls were culled in the district town 12 Jul 2007 following detection of avian influenza. Teams searched local houses at Pramanikpara, Mandolpara, Mollapara and Shibpur areas and culled the birds. On 12 Jul 2007, reportedly Bangladesh Livestock Research Institute said that poultry birds and pigeons in the areas have been affected with bird flu. The most recent report to OIE from Bangladesh is dated 5 Jul 2007. In that report, there is mention of 5 outbreaks -- 4 located in private farms in Rajshahi Division, and 1 a farm in Dhaka Division, with dates of onset in May 2007.
(Promed 7/13/07)

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Indonesia: Latest death from avian influenza linked to sick chickens
An Indonesian child who died of bird flu 8 Jul 2007 appears to have caught the virus from dead or sick chickens in the area carrying the disease. "She had indirect contact with dead chickens near her school," Joko Suyono, an official at the Ministry's bird flu centre, said 14 Jul 2007. The victim, from the city of Cilegon in Banten province, had initially been identified as a 6-year-old boy, but Suyono said this was due to a mix up between the hospital where she was treated and a laboratory. The official said that tests on dead chickens found near the girl's school showed they were infected with bird flu. Suyono said tests for the virus on people who may have had contact with the girl had proved negative and also said the findings in this case ruled out the possibility of the virus being transmitted between humans. Indonesia has had 81 confirmed human deaths from bird flu, the most of any country in the world.
(Promed 7/14/07)

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Viet Nam: Production of local avian influenza vaccine
According to the Central Veterinary Diagnosis Centre, as of June 2008, bird flu vaccine produced by Viet Nam will be partly used in the national bird flu vaccination programme. The research and production of bird flu vaccine in Viet Nam is conducted by scientists of the Institute for Science and Technology and the Veterinary Institute. Dr. To Long Thanh, Deputy Director of the Central Veterinary Diagnosis Centre, said that scientists have initially finalised the first step, creating a vaccine from an imported virus. The Veterinary Agency has tested the vaccine on fowls to have the accurate conclusion on the resemblance between vaccine virus types and newly separated virus types from ill fowls in Viet Nam. Based on the testing results, the Veterinary Agency will allow the experimental use on a narrow scale. Mr. Thanh said that if everything goes smoothly, around Jun 2008, locally produced bird flu vaccine can participate in the national bird flu vaccination programme 2007-2008. Viet Nam is spending hundreds of billion dong to import H5N1 and H5N2 vaccine, mainly from China, and H5N9 from Italy to vaccinate for fowls. [1 billion Dong is 61 996.85 US Dollars]. Viet Nam plans to import around 500 million doses of the vaccine in 2007-2008. However, in mid-2007, provinces used most of the volume of vaccine imported for the year so the country has to import an additional 200 million doses.
(Promed 7/13/07)

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Australia (South Australia): Additional case of Q fever at abattoir
Another case of Q fever has been confirmed in the South Australian Riverland, taking to 5 the number of recent cases. An outbreak of the disease has been linked to a Waikerie goat abattoir. Q fever is carried by animals and can cause flu-like symptoms in people. The abattoir linked to the outbreak has suspended its operations. The abattoir's operator says the facility has been used to process goat, sheep and cattle. Some forms of The Q fever agent Coxiella burnetii can be resistant to heat, drying, and many common disinfectants. These features enable the bacterium to survive for long periods in the environment and spread via aerosol. Ongoing drought in the area may produce more cases related to easier aerosolization.
(Promed 7/13/07)

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Australia (Melbourne): Imported case of Poliomyelitis from Pakistan
Hospital emergency departments were put on alert 12 Jul 2007 after the first case of polio was detected in Australia in 21 years. A 22-year-old man carrying the disease was in isolation in a Melbourne hospital and health authorities were trying to track down the 249 passengers who shared his [2 Jul 2007] Thai Airlines flight from Bangkok to Melbourne. The man is a student living in Melbourne and had been home to Pakistan. He was admitted to hospital with symptoms including fever, vomiting, and muscle stiffness. His condition was improving. The Chief Medical Officer, John Horvath, issued the alert saying while the risk of infection in Australia was low, polio was highly infectious. The Western Pacific Region was certified as polio-free in 2000 "so any case of polio is a significant public health concern", he said. "The patient, who has recovered from his initial paralysis, will remain in hospital in isolation until he is diagnosed polio free and his household contacts will be asked to remain in home quarantine until it is established that they are not infected," he said. While most Australians are vaccinated against polio as children, some older people and immigrants have not been. Professor Horvath said passengers on the flight "are considered to be at low risk of contracting the disease" and the risk of transmission to the community is also low. Polio vaccines currently available have a vaccine efficacy in the 95 to 99 percent range. Australia switched from using the attenuated oral poliovaccine (OPV) to using the injectable inactivated poliovaccine (IPV) Nov 2005. In spite of excellent vaccination coverages these days, there are most likely pockets of 'susceptibles'.
(Promed 7/13/07)

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China: More cases of hand-foot-mouth disease in Beijing
On 12 Jul 2007 Beijing reported 1025 cases of hand, foot and mouth disease (HFMD), a 9.51 percent increase over the same period last week, according to the Municipal Health Bureau. A total of 4657 people have been infected in the city so far this year, 83 percent of them children under age 5. The city had reported 1092 cases in the year to 19 Jun 2007. HFMD, also known as coxsackievirus infection, is a common childhood illness that mainly affects children under the age of 10. Symptoms include fever, sores in the mouth and a rash with blisters. Moderately contagious, the disease, more common in summer and autumn, can be transmitted through nose and throat discharges. It can sometimes be fatal if complications occur. In Linyi city, eastern Shandong Province, 2 boys and a girl, all under the age of 2, have died from the disease in 2007. HFMD can be caused by several enteric viruses. Human enterovirus 71 (HEV) 71 and Human coxsackievirus A16 are the moist frequent pathogens.
(Promed 7/13/07)

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China (Jilin): Report of 30 cases of Guillain-Barre Syndrome
30 cases of Guillain-Barre syndrome [GBS], an inflammatory disorder that may cause paralysis and breathing difficulties, have been reported since Jun 2007 in Jilin. Most of the hospitalized patients, all from Shuangyang District in Changchun are in stable condition. No deaths have been reported. The syndrome, in which the immune system attacks nerves, has initial symptoms of fever, aching throat, diarrhea and then weakness of legs and arms. In serious cases, one's whole body can become paralyzed. The exact cause of the disease is unknown. The potentially deadly disorder occurs most often in young adults and the elderly. The health authorities of Changchun have strengthened inspection on food and drinking water safety and advised citizens not to eat untidy food or drink un-boiled water.

GBS is an acute, immune-mediated paralytic disorder of the peripheral nervous system. Estimates of the annual incidence of GBS range from 0.4 to 4.0 cases per 100 000 population. About 2/3 of GBS cases occur several days or weeks after an infectious event, commonly a diarrheal illness or a virus-like upper-respiratory infection. From 20 percent to 40 percent of all GBS cases are associated with Campylobacter jejuni infections. Exposure to certain vaccines has also been associated with an increased risk for GBS. The characteristic clinical feature of GBS is an acute, rapidly progressive, symmetrical weakness, with loss of deep tendon reflexes, possible tingling in the feet and hands, and muscle aches. Approximately 85 percent of patients will return to normal functioning within 6 to 9 months, but some patients experience relapses or a prolonged disease course. The mortality rate is 3-5 percent.
(Promed 7/9/07)

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Japan: Students to get second measles inoculation
Students will begin receiving their second measles inoculation in middle school and high school next academic year, the Health, Labor and Welfare Ministry said 10 Jul 2007. In light of May's [2007] measles outbreak among university students, a ministry panel tasked with discussing vaccinations has come up with the 5-year plan, which calls for first-year middle schoolers and third-year high-schoolers to receive the vaccination. The measure, to take effect Apr [2008?], is aimed at strengthening the immunity to measles in young people who have only been inoculated once. The panel, led by Tatsuo Kato, president of the National Center for Child Health and Development, will further discuss the introduction of a system by which all cases of measles are reported and vaccinations will be offered at schools. In line with many developed countries, which administer the measles vaccine twice, Japan introduced Apr 2006 the double vaccination, first [dose] for children 12 to 24 months old and then again before being admitted to primary school. Children in second grade or older, however, have only received 1 measles vaccination. Due to the lack of exposure to the virus thanks to the increased rate of inoculation, fewer people are developing immunity to measles. The most recent update (4-10 Jun 2007) on measles is available in English from the Japan National Institute of Health: http://idsc.nih.go.jp/disease/measles_e/idwr200723.html.
(Promed 7/10/07)

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Philippines (Mindanao): Typhoid fever outbreak affects 200 persons
The typhoid fever outbreak that has affected at least 6 villages in Santa Cruz, Davao del Sur [Province], has been traced to a spring water-impounding project where residents draw their drinking water, officials said 14 Jul 2007. Mahelinde Colminares, Davao del Sur health chief, said water samples taken from the spring in 'sitio Ragobrob' in Saliducon village turned out positive for the bacterium that causes typhoid fever. Colminares said they have advised residents to refrain from drawing water there. At least 200 people have been affected by the outbreak that started 3 weeks ago. Colminares said they found out that residents near the spring failed to practice proper waste disposal. She said bacteria that grow on human waste could seep underground and contaminate water sources.
(Promed 7/16/07)

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Russia: Update on Tick-borne encephalitis situation
A case of tick-borne encephalitis has been recorded in Moscow. However, as on previous occasions, it was an imported case. The victim was infected in the Kostroma region. Also, an outbreak of encephalitis has been recorded in Vologda Station. The source of infection, as in a case in the Yaroslavl region a month ago, was un-boiled goat milk. 9 people were admitted to hospital on suspicion of [contracting tick-borne encephalitis (TBE)] as a result of consumption of un-pasteurized goat milk. The owner of the goat who sold the milk has also contracted the infection. A public health notice is being distributed to the population to warn against consumption of un-boiled milk.

Elsewhere, 22 persons have contracted TBE (no fatalities) in the Chelyabinsk region. 58 cases of TBE have been registered in the Irkutsk region. This represents a 2-fold increase over last year. As of 5 Jul 2007, 58 cases of tick-borne encephalitis have been registered in the Kirov region. Since the beginning of 2007, 15 persons fell ill with TBE in the Leningradskaya region.

As of 12 Jul 2007, 5346 persons have experienced tick-bites in the Arkhangelsk Oblast. A total of 2841 persons have received immune preventive treatment against TBE, representing 53 per cent of those with tick-bites who have sought treatment. Among the adult population, 1513 people have received immune preventive treatment.

Reportedly 2 elderly men have died from TBE in the Novosibirsk Oblast. Reportedly, the number of people who have died as a result of TBE during the current epidemic season has increased to 6. At the present time, there are 446 persons in hospital with a tentative diagnosis of TBE in the Novosibirsk Oblast. The number of tick bites recorded in Novosibirsk has exceeded the numbers recorded during any of the past 10 years. Epidemiologists associate the activity of ticks with a warm winter and an increase in rodents. To prevent the disease, doctors recommend vaccination, which is available year round.
(Promed 7/9/07, 7/12/07, 7/16/07)

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Russia (Kalmykia, Stavropol): Update on Crimean-Congo hemorrhagic fever situation
As of 6 Jul 2007, a total of 6892 tick bites have been recorded in the Republic of Kalmykia, including 131 involving children. This represents an increase of 60 cases in comparison with the same period in 2006. A total of 87 persons have been admitted to hospital on suspicion of having contracted Crimean-Congo hemorrhagic fever (CCHF), and a diagnosis of CCHF was confirmed in 57 cases, which included 1 fatality. Cases of CCHF are recorded predominantly among those living in rural environments. Herding of livestock and inadequate stock-rearing practices facilitate the spread of foci of CCHF.

CCHF has been diagnosed in 45 patients in the Stavropol region. Cases of CCHF have been reported from 18 districts in the region. While 40 persons have been discharged from hospital, 5 are still receiving treatment in hospital. The majority of patients contracted CCHF by tick bite through their work with agricultural livestock; 26 percent of patients received tick-bites during recreational activities. During 25 Jun-1 Jul 2007, 550 persons received treatment for tick-bites.
(Promed 7/10/07)

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Russia (Khabarovsk): Viral meningitis associated with use of river water
An increased incidence of viral meningitis morbidity has been observed in settlements along the Amur coast. As of 11 Jul 2007, 59 patients have been admitted to Khabarovsk hospitals on suspicion of viral meningitis. The diagnosis has been confirmed in 18 cases. All cases of infection originated in the city of Komsomolsk-na-Amure and the surrounding area. Hepatitis A virus and rotaviruses have been detected in samples of river water. Between 1 Jun and 10 Jul 2007, the number of cases of viral meningitis recorded in Komsomolsk-na-Amure was more than 4 times greater than the average. Laboratory analysis for 35 percent of patient samples was enterovirus-positive. During the first 6 months of 2007, hepatitis A virus and rotavirus antigens had been detected in every 10th sample from the river Amur.
(Promed 7/16/07)

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Russia (Tambov): Reported cases of Norwegian scabies
The Tambov regional administration communicated that local authorities had started an investigation in connection with the infection with scabies of more than 10 healthcare workers. The infections occurred in the third municipal hospital, which serves as a base for emergency care. A woman who died in the hospital because of pulmonary complications 13 Jul 2007 was reportedly infected by Norwegian scabies, a disease, which is caused by the [scabies mite Sarcoptes scabiei.] This disease occurs usually in weak and emaciated people, in patients with TB or HIV and in patients receiving steroids and cytostatics. The crusts contain huge amounts of parasites. It is assumed that the woman admitted from a village was the source of infection in the hospital. The quarantine was announced from 16 Jul 2007, and anti-epidemic treatment of the rooms and of personnel is under way. This report is not based on an official diagnosis. Norwegian scabies is a rare disease. It is easily treated with ivermection.
(Promed 7/19/07)

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Americas
USA (Virginia): Confirmation of low-pathogenic avian influenza H5N1 in turkeys
The US Department of Agriculture (USDA) confirmed that turkeys at a Virginia farm were exposed to the low-pathogenic North American strain of the H5N1 avian flu virus. The announcement follows the finding that the birds had antibodies to an H5N1 virus, indicating they were possibly exposed to a low-pathogenic strain. Preslaughter testing had revealed that samples from the birds suggested they had antibodies to an H5 influenza virus, but none of the birds were ill. State and industry officials have culled about 54,000 turkeys at the farm, and because the poultry producer participates in the expanded National Poultry Improvement Plan, it will be reimbursed 100% for the costs associated with the cull. Surveillance in the area surrounding the affected Shenandoah Valley farm is continuing, but so far all tests have been negative. The North American H5N1 strain is commonly detected in apparently healthy birds.
(CIDRAP 7/17/07)

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USA: White House issues 1-year status report on pandemic planning
The White House Homeland Security Council released a 1-year update on the federal government's pandemic influenza preparedness strategy, reporting that it has met 86% of the objectives it set for itself a year ago. The report details work completed on the goals federal officials outlined when they released the National Strategy for Pandemic Influenza: Implementation Plan May 2006. Work on the remaining 14% of the actions is in progress and should be completed by the 18-month mark, the White House said.

The US has spearheaded several efforts to control the international spread of the H5N1 avian influenza virus, the report says. Among them, the US government has provided H5N1 surveillance and response training to more than 129,000 animal health workers and 17,000 healthcare workers. The US has donated 300,000 personal protective equipment kits to surveillance and outbreak response workers in more than 70 countries, and it has prepositioned overseas stocks of protective supplies, decontamination kits, and antiviral medication. The US has provided assistance to 39 of 60 countries that have been affected by H5N1 outbreaks. 75 countries have received US support for improved laboratory diagnosis and early warning networks. The US has sequenced more than 2,250 human and avian isolates.

In the past year, the US has invested more than $1 billion to develop new vaccine technologies, such as cell-based vaccine production and research on new adjuvants. In Apr, the US Food and Drug Administration (FDA) approved the first prepandemic H5N1 vaccine, and officials have stockpiled enough doses to treat 6 million people. Since May 2006 the government has invested $600 million for state and local preparedness efforts, which support the development of community mitigation strategies, medical surge plans, and mass vaccination strategies. It has launched new guidelines to improve emergency medical service delivery and 911 service in a pandemic setting. Major pandemic planning guidance reports that addressed 3 key categories have been released: community mitigation, mass medical care with scarce resources, and response and recovery for critical infrastructure.

The report says despite notable progress over the past year, work must continue in several important areas, such as strengthening disease detection and biosurveillance. Despite investment in medical surge capacity, more work is needed to ensure that communities can treat the high number of sick patients in a severe pandemic. Globally, the US government can still do more to collaborate with pharmaceutical companies, international partners, and WHO to boost global vaccine development and improve nations' access to vaccines. Also, federal officials need to continue working with nongovernmental stakeholders to implement community mitigation strategies and build community resilience.

Based on the feedback it received, HHS said they would develop toolkits, tailored to 4 community sectors, that leaders can use to teach people more about pandemic flu and what they can do to prepare. In the fall, HHS will launch more intensive communication preparedness campaigns tailored to 10 to 15 diverse communities. There are 3 critical areas that need more intensive federal efforts: assuring that states and localities develop medical surge capacity, helping many community sectors adapt to community mitigation guidelines, including those that address respirator use, and providing a steady funding stream for state and local pandemic preparedness efforts.

White House press release: http://www.whitehouse.gov/news/releases/2007/07/20070717-5.html
To read the report: http://www.whitehouse.gov/homeland/pandemic-influenza-oneyear.html
(CIDRAP 7/17/07)

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USA: HHS, DHS fund public health preparedness and emergency response
The US Department of Health and Human Services (HHS) announced it was providing states, US territories, and 4 metropolitan areas with $896.7 million in public health preparedness funding. The bulk of the money is allocated toward Public Health Emergency Cooperative Agreements, which public health departments use to build capacity. HHS secretary Mike Leavitt said the funding represents the next step toward boosting state and local public health preparedness and emergency response. The funding amount also includes $175 million for pandemic influenza preparedness. The preparedness funds include: $57.3 million to support the Cities Readiness Initiative, a program designed to help 72 major US cities and metropolitan areas respond to bioterrorism and other large-scale public health events by dispensing oral medications to the entire population; $35 million to help poison control centers improve their early detection, surveillance, and investigative capabilities in the event of a chemical, biological, radiological, or nuclear event; $5.4 million to help states that border Mexico and Canada develop and implement programs to detect, investigate, and report urgent infectious disease cases.

Also, US Commerce secretary Carlos Gutierrez and DHS secretary Michael Chertoff announced $986 million in Public Safety Interoperable Communication grants to help first responders improve and coordinate communications during natural or manmade disasters. The one-time grants is designed to help public service agencies acquire, deploy, and train for interoperable voice, data, and video communications systems. Different jurisdictions and agencies use different communications technologies, which can impair critical communication during a disaster, the DHS said.
(CIDRAP 7/18/07)

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USA: HHS updates pandemic stockpile totals and planning efforts
In an update on pandemic preparedness efforts, the US Department of Health and Human Services (HHS) said it had stockpiled enough H5N1 avian influenza vaccine to protect about 6 million people and that federal and state supplies contain enough antiviral medication to treat more than 48 million. HHS Secretary Mike Leavitt said in the report that the department has stockpiled 12 million doses of the H5N1 vaccine that was approved by the US Food and Drug Administration (FDA) in Apr 2007 as the first human avian flu vaccine. The 2-dose schedule for the vaccine, which is based on a clade 1 virus isolated from a Vietnamese patient in 2004, would allow vaccination of 6 million people.

The report reviewed other federal efforts to boost supply and develop other H5N1 vaccines. In Dec 2006 the National Institute of Allergy and Infectious Diseases (NIAID) launched human trials of a DNA vaccine that contains no infectious material but only portions of the influenza virus's genetic material. In Jan 2007 the HHS awarded $132.5 million contract to 3 vaccine companies to develop adjuvants to stretch the supply of existing vaccine supplies and possibly protect against a wider range of influenza viruses. HHS has awarded 5 contracts totaling $1 billion to develop cell-based technologies for making flu vaccines, which would speed production compared with traditional egg-based methods.

For antivirals, HHS has said its goal is to stockpile enough to treat 81 million people: 50 million from the HHS and 31 from state supplies. Leavitt said HHS has 36 million treatment courses on hand. He said nearly all states have enrolled in a federally subsidized program to purchase their own antiviral supplies, and purchases so far total 12 million treatment courses. Leavitt said Jan 2007 the HHS awarded $103 to develop peramivir, an injectable or intravenously administered neuraminidase inhibitor that has shown promising results against a range of influenza strains. The department has purchased 104 million N-95 respirators and 52 million surgical masks and has allocated $100 million to buy ventilators, syringes, and intravenous antibiotics.

By Dec 2006, 59 states, territories, and tribes had held pandemic planning conferences, supported by $325 million from HHS. The department said it has provided another $250 million for groups to hold pandemic preparedness exercises. In addition, HHS has: Issued interim guidance on facemask and respirator use; Released an advisory report on community mitigation strategies, which includes a pandemic severity index to guide the implementation of specific measures; Hosted a leadership summit and blog series for community leaders to discuss how to promote personal pandemic preparedness; Launched a series of public service announcements in English and Spanish to raise awareness about pandemic influenza and preparedness; Distributed 19 checklists and guidances for governments, businesses, educational institutions, and individuals and families on www.pandemicflu.gov.

HHS "Pandemic Planning Update IV": http://www.pandemicflu.gov/plan/panflureport4.html
(CIDRAP 7/19/07)

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Canada: E. coli O157 cases associated with ground beef
Canada is warning the public not to consume certain fresh and frozen ground beef products because the products may be contaminated with E. coli O157:H7 bacteria. The following products are affected by this alert: 1. Fresh ground beef (lean, regular, extra lean and market trim); 2. Butcher's Cut frozen ground beef patties 1.13 kg; 3. Sunny Dawn frozen ground beef patties. There have been 5 reported illnesses associated with the consumption of these products. Canada Safeway is voluntarily recalling the affected products from the marketplace.
(Promed 7/10/07)

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Canada (Ontario): E. coli O157 outbreak associated with student picnic
Toronto Public Health is investigating an outbreak of E. coli O157 among individuals who attended a picnic in Scarborough's Morningside Park 1 Jul 2007. Several hundred people attended the event, which was a reunion event. So far, 6 cases of E. coli 0157 have been confirmed. 4 individuals were hospitalized, with 1 developing serious kidney complications. Symptoms include diarrhea, bloody diarrhea, abdominal pain, nausea, or vomiting. The exact source of contamination in this outbreak is under investigation.
(Promed 7/13/07)

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Canada: Decision to widen BSE-related feed ban
Canada broadened its safeguards against bovine spongiform encephalopathy (BSE), or mad cow disease, by banning the use of cattle brains, spinal cords, and certain other body parts from all animal feeds, pet foods, and fertilizer. The step will speed up the elimination of BSE from Canadian cattle, government officials said, but for now some say it is creating a major waste-disposal challenge and bureaucratic headaches. The Canadian rule applies to "specified risk materials" (SRM), meaning cattle parts that are likely to contain the BSE agent if the animal is infected. They include the skull, brain, eyes, tonsils, spinal cord, and certain nerve bundles in cattle 30 months or older, plus the distal ileum of all cattle. The collective weight of all those materials is estimated at more than 100,000 tons per year in Canada.

The reason for banning SRM from animal feed and pet food is to prevent the possible spread of BSE through accidental mixing of ruminant and nonruminant feed during feed manufacturing or through misfeeding of nonruminant feed to ruminants. The ban means producers can no longer feed any products containing SRM to livestock, and slaughterhouses must identify SRM so they can be removed from the feed system. In addition, those who handle, transport, or dispose of cattle carcasses and certain cattle tissues must have a CFIA permit. To help industry set up the infrastructure for SRM disposal, the Canadian government is providing $80 million for provincial disposal programs. SRM must now be removed with special equipment, hauled away in dedicated trucks, processed, and then buried in landfills, burned in high-temperature incinerators, or dumped into composters and bioenergy plants.
(CIDRAP 7/13/07)

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USA (Illinois): Salmonella outbreak associated with food festival
More people are reporting illnesses related to a salmonella (serotype Heidelberg) outbreak connected to the Taste of Chicago festival. As of 17 Jul 2007, a total of 636 people reported they became sick after they ate food purchased from the Pars Cove Persian Cuisine booth, according to the Chicago Department of Public Health. Of the 636, 66 are lab-confirmed cases of salmonellosis, with more results pending. At least 15 people have been hospitalized. Commissioner Terry Mason said the increase in reported cases is a result of the city's outreach efforts. The only dish linked so far to the outbreak is an herb, tomato, and cucumber salad that was served on hummus. Pars Cove has been asked to stop serving hummus.
(Promed 7/16/07, 7/18/07)

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USA (Multi-state): Salmonellosis outbreak associated with snack
Federal and private labs have narrowed the source of the salmonella-contaminated seasonings in the Veggie Booty snacks to 2 New Jersey (NJ) subcontractors that provided some of its ingredients. The seasoning is made by Atlantic Quality Spice & Seasonings. Company president Stan Gorski said the seasoning is a mixture of ingredients purchased from 4 subcontractors, though the contaminant itself probably originated in China. The ingredients provided by 2 of the 4 subcontractors have been cleared of Salmonella contaminants, Gorski said. The contaminated seasonings were found only on batches of Veggie Booty produced Jan 2007, he noted. The most likely original source of contamination was vegetable ingredients purchased from China by the subcontractors. In the past, Gorski's company depended on certification from suppliers that the ingredients were free of bacterial contamination. From now on both the seasoning company and Robert's American Gourmet have announced that they will do independent testing of their products to ensure that they are not contaminated.

Interviews comparing foods eaten by ill and well persons showed that consumption of Robert's American Gourmet brand Veggie Booty was statistically associated with illness and, therefore, the most likely source of the outbreak. As of 10 Jul 2007, 60 persons infected with S. Wandsworth have been reported to CDC from 19 states. Among the patients for whom clinical information is available, 77 percent developed bloody diarrhea and 10 percent were hospitalized. No deaths have been reported. Onset dates, which are known for 58 patients, ranged from 4 Mar to 15 Jun 2007. Most (90 percent) cases have occurred in children aged 10 months to 3 years. After being informed about the outbreak by FDA, the company that manufactures the product issued a voluntary recall. The Minnesota Department of Agriculture Laboratory has isolated the outbreak strain of S. Wandsworth from 4 sealed bags of Veggie Booty. On 2 Jul 2007, the company expanded the recall to include Super Veggie Tings Crunchy Corn Sticks.
(Promed 7/12/07, 7/17/07)

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USA (Alabama): E. coli O157 outbreak sickens 18 persons
A rare E. coli O157:H7 outbreak in Huntsville has continued to spread, with a total to 18 cases. Dr. Debra Williams, the Huntsville-Madison County Health Department's assistant director, said 2 other people are suffering kidney failure, a potential complication of the illness, but continue to test negative for the E. coli. The victims are 5 to 48 years old. CDC said about 8 percent of people sickened by E. coli O157:H7 bacteria develop kidney failure. Besides the 5-year-old, 4 other area residents remain hospitalized. Most infections in the USA are linked to eating undercooked ground beef. Other known sources: sprouts, lettuce, salami, unpasteurized milk, and juice, and swimming in or drinking sewage-tainted water. Lettuce is thought to be the likely source of an E. coli outbreak. Many of those sickened ate at 'Little Rosie's Taqueria' June 2007, but others had not visited the popular restaurant.
(Promed 7/10/07)

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USA (Colorado): E. coli outbreak affects 70 prisoners
The Jefferson County Sheriff's Office, in conjunction with the Jefferson County Department of Health and Environment (JCDHE) and the Colorado Department of Health and Environment (CDPHE), announced that the current illness outbreak at the Jefferson County jail is a foodborne illness caused by Shiga toxin-producing Escherichia coli (E. coli) (STEC) bacteria [also called verotoxin-producing E. coli, VTEC]. Lab results from collected specimens confirmed evidence of Shiga toxin-producing E. coli. STEC is a collective term used for bacteria that produce Shiga toxins including E. coli O157:H7, and more than 100 other non-O157 strains. Thus far, approximately 70 inmates have reported symptoms; 37 are currently ill and 1 person is still hospitalized. Authorities are working together on prevention and control measures: identifying and isolating ill inmates; testing specimens; collecting data to identify possible sources; review of procedures including laundry washing; and providing food safety and hygiene education to ensure sanitary conditions in kitchen, eating, and cell block areas.
(Promed 7/14/07)

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USA: Botulism cases associated with chili sauce
The Food and Drug Administration (FDA) is warning consumers not to eat 10-ounce cans of Castleberry's Hot Dog Chili Sauce, Austex Hot Dog Chili Sauce, and Kroger Hot Dog Chili Sauce with "best by" dates 30 Apr 2009 - 22 May 2009, due to possible botulism contamination. Botulism can be fatal. Consumers who have any of these products or any foods made with these products should throw them away. As of 18 Jul 2007, 2 children in Texas and an Indiana couple who ate these products had become seriously ill and been hospitalized. Symptoms of botulism poisoning can begin from 6 hours to 2 weeks after eating food that contains the toxin. Symptoms may include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness that moves progressively down the body. Botulism poisoning can also cause paralysis of the breathing muscles, which can result in death. All of the products cited are manufactured by the Castleberry Food Company. Castleberry has informed FDA that it is voluntarily recalling all of the potentially contaminated products.
(Promed 7/19/07)

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USA (Missouri): 14 cases of viral meningitis
There have been 14 confirmed cases of viral meningitis in Perry County in less than a month. Viral meningitis is the less serious form of meningitis. It can be spread in a variety of ways: through water, through saliva, mucus or fecal matter of an infected person. Right now, they have not isolated a common cause among the 14 cases. Meningitis is an illness in which there is inflammation of the tissues that cover the brain and spinal cord. Viral or "aseptic" meningitis, which is the most common type, is caused by an infection with viruses. In the US, there are between 25 000 and 50 000 hospitalizations due to viral meningitis each year. The more common symptoms of meningitis are fever, severe headache, stiff neck, bright lights hurting the eyes, drowsiness or confusion, and nausea and vomiting. Viral meningitis is serious but rarely fatal in persons with normal immune systems. Usually, the symptoms last 7 to 10 days, and the patient recovers completely. Bacterial meningitis, on the other hand, can be very serious and result in disability or death if not treated promptly. About 90 percent of cases of viral meningitis are caused by enteroviruses, such as coxsackieviruses and echoviruses. Herpesviruses and mumps virus can also cause viral meningitis. There is no specific treatment for viral meningitis other than supportive care.
(Promed 7/16/07)

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USA (Utah, New Jersey): Confirmed cases of Tularemia
Francisella tularensis is being blamed for 13 cases of tularemia. All of the people infected camped on Utah Lake between Jun - early Jul 2007. The Utah Department of Health has only confirmed that 2 of the cases are tularemia. The remaining cases are suspected with patients showing clinical signs of the bacterial infection. Symptoms include sudden fever, headaches, ulcers on the skin or mouth, and swollen and painful glands. There are [normally] only 2 or 3 cases per year in Utah.

The Cape May County Department of Health was notified 12 Jul 2007 that a 14-year-old county resident has contracted tularemia. The American dog tick and the Lone star tick, both found in Cape May County, are known to carry tularemia. To protect against all tick-borne disease, residents should follow these guidelines when outside with known ticks: Wear light-colored, tightly woven clothing to make it easier to spot ticks; tuck shirts into pants and pants into socks; wear closed shoes/sneakers rather than open sandals. Use a tick repellent as directed. Products should contain DEET (for clothing or skin) or Permethrin (for clothing only).

Tularemia is a rare, potentially serious illness caused by the bacterium Francisella tularensis and can affect animals, particularly rodents and rabbits. Tularemia can be acquired in multiple ways: such as being bitten by an infected tick; handling infected animal carcasses; eating or drinking contaminated food or water; or inhaling the bacteria. The signs and symptoms people develop depend on how they are exposed to tularemia. Possible symptoms include skin ulcers, swollen and painful lymph glands, inflamed eyes, sore throat, mouth sores, diarrhea or pneumonia. If the bacteria are inhaled, symptoms can include abrupt onset of fever, chills, headache, muscle aches, joint pain, dry cough, and progressive weakness. The infection responds well to appropriate antibiotics once diagnosed. If untreated, it can be fatal.
(Promed 7/16/07, 7/18/07)

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USA (Texas): Man suffering from Vibrio vulnificus infection
A 58-year-old man, who was infected by a bacterium while swimming off Galveston County's Crystal Beach, still faces the threat of losing a leg, and possibly his life, despite 3 surgeries. The man has necrotizing fasciitis [often called the flesh-eating disease] caused by the bacterium Vibrio vulnificus. The man also is suffering from multiple organ failure because the disease has caused a blood infection. The bacterium thrives in warm salt water and is most prevalent during summer months. Swimmers with compromised immune systems are most susceptible to more severe disease. To be contracted through contaminated water, the bacteria need a point of entry, such as an open wound. The patient, who is diabetic, had an ulcer on his lower leg when he went swimming 8 Jul 2007. His leg became infected 3 days later and he began running a high fever. Diseases caused by Vibrio vulnificus are rare, but most cases occur along the Gulf Coast. The bacterium also can infect people who eat contaminated seafood and causes nearly all seafood-related deaths in the USA. Vibrio vulnificus, an opportunistic pathogen, is found in estuarine environments and associated with various marine species such as plankton, shellfish, and finfish. It may be normal flora in salt water and acquiring this organism from shellfish or water exposure does not imply that the water is contaminated by sewage.
(Promed 7/19/07)

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USA (Texas, California, Colorado), Canada (Alberta): Hantavirus infections
Texas Department of State Health Services is recommending precautions after 2 Texas residents developed hantavirus pulmonary syndrome in 2007. One person has recovered but the other has died. In California, a Mono County man was diagnosed with the first case of hantavirus pulmonary syndrome in California in 2007. Authorities said they did not know how the man was exposed to the virus but said he had completely recovered since he fell ill Jun 2007. This year, 4 people have died from hantavirus in Colorado, including 3 this week, tying the record of fatalities from the disease set in 1993. There have been 61 documented cases of hantavirus pulmonary syndrome since the department began tracking the virus in 1993. Of those cases, 23 have been fatal. Besides the 4 deaths, 2 non-fatal cases have been documented this year.

In Canada, a previously well 50 year old American Indian man was suffering from progressive hypoxia of 5 days duration in spite of 3 days of treatment with oral azithromycin. The patient denied any recognized contact with mice. He required high flow oxygen by reservoir mask, but his pulmonary gas exchange improved and he ultimately made a full recovery. The most likely source was felt to be a shed in the patient's yard which was found to contain mouse droppings. Alberta has had the largest number of cases of pulmonary hantavirus syndrome of the Canadian provinces.

Hantavirus causes a respiratory disease that spreads when people inhale dirt or dust that has been contaminated with urine and feces of deer mice. People usually contract hantavirus after working in buildings infested with deer mice. A mix of one cup of bleach in a gallon of water should be used to spray down mice-infested areas and prevent stirring up dust. No effective treatment exists for hantavirus, so early detection and admission to a hospital is key. But the best approach is to prevent sickness by looking for a surge in the mouse population at home.
(Promed 7/17/07, 7/18/07)

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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.
- 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. News on federal updates.
- 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.
- CIDRAP: http://www.cidrap.umn.edu/.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm. The website has been updated.
- US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp. Updated 20 Jul 2007.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

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Dengue
Malaysia
The outbreak of dengue fever has claimed 57 lives in Malaysia it was reported 12 Jul 2007. 1044 cases [of dengue fever] were reported the week of 24 June 2007, topping the 1000 mark for the second time in a month, signaling an epidemic. The health ministry has spent over 10 million ringgit (nearly USD 3 million) since 2004 on dengue fever prevention and control measures. Most of the money was spent on chemicals including pesticides and larvicides, fogging machines, personal protection apparatus, educational tools, and conducting training programmes.
(Promed 7/10/07, 7/19/07)

Philippines
With the rainy season now here, the incidence of dengue has started to rise. Rizal Medical Center in Manila recorded 19 cases from 1-8 Jul 2007, most of the victims being children. It said the patients include 4 who tested positive for dengue, and a 10-year-old child with stage-2 hemorrhagic fever. Most of the patients were from Pasig City. Also, the Amang Rodriguez Medical Center in Marikina City recorded at least 6 cases so far in Jul 2007. In Aklan, dengue claimed its first victim on the first week of Jul 2007, and cases in Aklan province continue to rise, bringing to a total of 78 from Jan 2007 to the first 7 days of Jul 2007. During 1-7 Jul 2007, 23 cases were already reported. In Negros Occidental, dengue deaths climbed to 4 after the death of a 4-year-old patient in a hospital 10 Jul 2007. The figure could be higher if some dengue deaths that reportedly occurred in homes were verified and recorded.
(Promed 7/19/07)

Singapore
Singapore says the number of people infected with dengue in a single week has risen to the year's highest level. The National Environment Agency says more than 430 cases were reported, well above the official epidemic level. The current outbreak has caused 2 deaths, evoking local leader's memories of the 2005 epidemic, in which 25 people died and thousands of persons were infected.
(Promed 7/6/07, 7/19/07)

Taipei
The Ministry of Heath confirmed 6 Jul 2007 the first indigenous case of dengue hemorrhagic fever in Taiwan this year. A 68-year-old woman from Tainan is now in a stable condition after treatment. She developed gastrointestinal hemorrhage, bloody stool, pleura effusion, and platelets count decreasing on Jun 27. Numerous cases of dengue fever are reported in Taiwan each year. The hemorrhagic variation of the disease can be particularly life threatening if patients do not receive quick treatment. A further 14 cases of indigenous dengue fever have been reported in the same district in Tainan. Among this year’s confirmed dengue fever cases, 52 were classified as imported cases and 31 were indigenous cases. The origins of the imported cases: 28 from Indonesia; 14 from Vietnam; 3 from Thailand; 2 from the Philippines; 2 from Cambodia; and 1 each from Singapore, Myanmar and Malaysia.
(Promed 7/10/07; Taiwan CDC 7/9/07)

Viet Nam
Vietnam's health minister has raised concerns about a spreading dengue outbreak, citing 27 deaths this year and a jump in the number of cases. Dengue infected 24 255 Vietnamese in the first half of 2007, up 23 percent from a year earlier. The tropical viral fever has killed 27 people, compared with 17 deaths from the fever in the first half of 2006. Health centers in the Mekong Delta are overloaded with dengue fever patients as some provinces have registered upwards of 200 cases a week over the past few months. Since the beginning of 2007, Dong Thap province has seen over 3000 dengue cases while Kien Giang and An Giang have been hit with 2350 and 2200 cases, respectively. Phu Quoc island's district hospital has received 20-30 dengue patients a day over the past few weeks.
(Promed 7/10/07)

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West Nile Virus
Canada
Human cases were reported for week 27 (as of 7 Jul 2007) from the following provinces:
Province / Neurological / Non-Neurological / Unclassified-Unspecified/ Total/ Asymptomatic
Manitoba / 0 / 2 / 0 / 2 / 1
TOTALS / 0 / 2 / 0 / 2 / 1

USA
Human cases have been reported from (through 10 Jul 2007): State / Neuroinvasion/West Nile fever/ Other, Unspecified/ Total/ Fatalities:

Arizona / 0 / 1 / 6 / 7 / 0
Arkansas / 1 / 0 / 0 / 1 / 0
California / 2 / 6 / 1 / 9 / 1
Colorado / 0 / 2 / 0 / 2/ 0
Illinois / 1 / 0 / 1 / 2 / 0
Iowa / 1 / 1 / 0 / 2 / 0
Mississippi / 4 / 4 / 0 / 8 / 1
Nebraska / 0 / 2 / 0 / 2 / 0
Nevada / 0 / 1 / 0 / 1 / 0
North Dakota / 2 / 6 / 0 / 8 / 0
South Dakota / 0 / 7 / 0 / 7 / 0
Texas / 0 / 1 / 0 / 1 / 0
Utah / 1 / 0 / 0 / 1 / 0
Virginia / 0 / 0 / 1 / 1 / 0
Wyoming / 0 / 1 / 0 / 1/ / 0
TOTALS / 13 / 32 / 9 / 54 / 2
(Promed 7/19/07)

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2. Articles
Inhibiting cytokine response might not reverse H5N1 infections
Scientists have hoped that disabling the body's destructive immune-system overreaction to the H5N1 avian influenza virus, known as "cytokine storm," could lead to new lifesaving treatments, but according to a new study, trials testing the strategy didn't protect mice infected with the disease. The study was conducted by Robert G. Webster et al. They report that groups of mice genetically programmed to lack 1 of 3 important inflammatory cytokines died after they were exposed to a Vietnamese H5N1 virus strain. Also, they found that mortality rates were high in nonaltered mice that were given glucocorticoids to suppress cytokine production after exposure to the H5N1 virus. Scientists have suggested that the cytokine storm contributed to the high death rate in the 1918 Spanish flu pandemic and is playing a similar role in human cases of H5N1 infection. Autopsies of some H5N1 flu victims in the current outbreaks have revealed lungs choked with debris from excessive inflammation triggered by the virus.

The authors used mice that were genetically altered to lack 1 of 3 cytokines: TNF-alpha, a proinflammatory molecule that appears to direct lymphocyte-mediated lung injury during influenza infection; IL-6, which is known to be elevated during H5N1 virus infection; and CC chemokine ligand 2 (CCL2), a chemocytokine that recruits leukocytes to infection sites. They found that H5N1-infected mice deficient in TNF-alpha or its receptors had mortality rates and weight loss similar to infected wild-type mice. After H5N1 inoculation the IL-6–deficient mice lost nearly the same amount of weight as the wild-type mice, and all died. Similar mortality and weight loss results were seen in the mice with the CCL2 defect. Infected mice that were treated with glucocorticoids didn't lose as much weight, but the researchers found that the mortality rates were similar to those in the other groups.

The researchers concluded that deficiency of any of the 3 key cytokines alone does not protect mammal hosts from H5N1 avian influenza death and that glucocorticoids do not reduce the lethality of the H5N1 infection. "These results refute the popular paradigm that the cytokine storm is the cause of death during H5N1 infection," the authors state, adding that more research is needed to examine the contribution of each cytokine to factors other than weight loss and mortality. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said that though the study appears to create some doubt about the role of high cytokine levels in the pathogenesis of H5N1 infection, "It probably tells us a bit of truth about both hypotheses. When the researchers genetically manipulated the system, the mice still did badly," he said. "You have to be careful when interpreting mouse studies. . ." Fauci said.

To read the article: Salomon R, Hoffmann E, Webster RG. Inhibition of the cytokine response does not protect against lethal H5N1 influenza infection. Proc Natl Acad Sci 2007 (published online Jul 17): http://www.pnas.org/cgi/content/abstract/0705289104v1
(CIDRAP 7/16/07)

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New Approaches to Confronting an Imminent Influenza Pandemic
David S Fedson and Peter Dunnill. The Permanente Journal. Summer 2007/Vol. 11, No. 3.
http://xnet.kp.org/permanentejournal/SUM07/influenza-pandemic.html
Abstract: "Scientists and health officials are concerned that an H5N1 influenza pandemic could be both imminent and catastrophic. Managing it will be difficult. Supplies of antiviral agents will be limited and expensive. Clinical development of adjuvant-combined, antigen-sparing, inactivated vaccines has been slow; the vaccines will take several months to produce and the global capacity to produce them will remain limited for several years. People who live in countries without vaccine companies--more than 85% of humankind--will have little prospect for being immunized. Thus, new approaches are needed to confront an imminent pandemic. The interventions must be scientifically promising and already licensed or near licensure. Moreover, the global industrial capacity to produce them must be large and already in place. Three interventions meet these criteria. Within a few months, several billion doses of live-attenuated H5N1 vaccines could be produced in existing egg-based or cell culture production facilities and several billion doses of an H5 recombinant hemagglutinin (rHA) vaccine could be produced in existing pharmaceutical bioreactors. In addition, generic medications such as statins might be able to moderate the aberrant innate immune response that characterizes human cases of H5N1 influenza. Statins would be affordable and available worldwide on the first day of the pandemic. Given the limitations of current efforts to develop and produce antivirals and conventional vaccines, urgent attention must be given these promising new approaches to pandemic control."

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Handling mass death by integrating the management of disasters and pandemics: lessons from the Indian Ocean tsunami, the Spanish flu and other incidents
Joseph Scanlon, Terry McMahon, Coen van Haastert. Journal of Contingencies and Crisis Management. Volume 15 Issue 2 Page 80-94, June 2007. http://www.blackwell-synergy.com/doi/abs/10.1111/j.1468-5973.2007.00511.x
Abstract: "At first glance, there appear to be significant differences between mass death from disasters and catastrophes and mass death from pandemics. In a disaster or catastrophe the major problem is identifying the dead and, sometimes, determining cause of death. This can be very frustrating for next of kin. In a pandemic, the identity of the dead is usually known as is the cause of their death. There is an immediate certainty in pandemic death. Despite these major differences there are many similarities. Because it takes time to identify the dead after a disaster or catastrophe, there is a steady release of bodies for cremation or burial, just as in a pandemic. In both types of incidents, there tends to be a shortage of supplies and personnel and, therefore, a need for use of volunteers. There are also massive amounts of paper work. This would suggest a need in both cases for stockpiling and for training of volunteers. And, although this does not always happen, both types of incidents tend to strike harder among the poorer elements in cities yet both create serious economic problems. Despite these many similarities, planning for the first tends to be done by emergency agencies, especially the police; planning for the second by health agencies. Given the many similarities this separation makes no sense. Since both types of mass death incidents lead to similar problems, it would make sense to take an all-hazards approach to planning for dealing with mass death."

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Perinatal Group B Streptococcal Disease After Universal Screening Recommendations--United States, 20032005
(References removed)
"Group B streptococcus (GBS) is a leading cause of neonatal morbidity and mortality in the United States. . .To examine rates of neonatal and pregnancy-associated GBS disease after the revised guidelines were issued, CDC analyzed surveillance data from the Active Bacterial Core surveillance (ABCs) system from the period 2003--2005 and compared them with data from 2000--2001, the period immediately preceding the universal screening recommendations. This report describes the results of that analysis, which indicated that annual incidence of early onset GBS disease (i.e., in infants aged 0--6 days) was 33% lower during 2003--2005 than during 2000--2001. However, although incidence among white infants decreased steadily during 2003--2005, incidence increased 70% among black infants. Incidence of GBS disease among infants aged 7--89 days (i.e., late-onset disease) and pregnant women remained stable after revised universal screening guidelines were issued. Continued surveillance is needed to monitor the impact of the guidelines on perinatal GBS disease and trends in racial disparities and to guide interventions to reduce disparities. . ."
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5628a1.htm
(MMWR July 20, 2007 / 56(28);701-705)

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Multistate Outbreak of Norovirus Gastroenteritis Among Attendees at a Family Reunion--Grant County, West Virginia, October 2006
"On October 17, 2006, the West Virginia Department of Health and Human Resources (WVDHHR) was notified of an outbreak of acute gastroenteritis, characterized by vomiting and diarrhea, among attendees at a family reunion. The outbreak initially was reported by a group of attendees to their local health department in Garrett County, Maryland. The same day, the information was relayed to the Grant County Health Department in West Virginia and subsequently to WVDHHR. The reunion was held on October 14 at a private residence in Grant County, West Virginia, and the 53 identified attendees included residents from Florida, Maryland, New York, Pennsylvania, Virginia, and West Virginia. This report describes a collaborative, multijurisdictional epidemiologic investigation using a cohort study and laboratory analyses to determine the source of infection and appropriate control measures. The results indicated that a combination of person-to-person and foodborne transmission of two strains of norovirus, likely introduced by persons from two different states and subsequently at least two food items, was the probable cause of these illnesses, highlighting the challenge of investigating and controlling norovirus outbreaks. During periods of peak norovirus activity, public health officials should emphasize the importance of appropriate handwashing and the exclusion of ill persons from social gatherings. . ."
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5627a1.htm
(MMWR July 13, 2007 / 56(27);673-678)

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Hepatitis A Vaccination Coverage Among Children Aged 24--35 Months--United States, 2004-2005
(References removed)
"After the licensure of hepatitis A vaccine in 1995 for children aged >24 months, the Advisory Committee on Immunization Practices (ACIP) incrementally expanded the proportion of children for whom it recommended the vaccine. . .National estimates of hepatitis A vaccination coverage were first made available through the 2003 National Immunization Survey (NIS), which indicated an overall national 1-dose coverage level of 16.0% (range: 6.4%--72.7%) among children aged 24--35 months. The estimates in this report update those findings by including 2 additional years of data (2004 and 2005). National 1-dose vaccination-coverage levels among children aged 24--35 months increased from 17.6% in 2004 to 21.3% in 2005. Coverage in states where vaccination was recommended (overall in 2005: 56.5%; range: 12.9%--71.0%) was below those for other recommended childhood vaccinations, such as varicella (87.5% in 2004). Despite low hepatitis A vaccination-coverage levels compared with other recommended childhood vaccinations, incidence of acute HAV infections have declined to the lowest level ever recorded. . ."
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5627a2.htm
(MMWR July 13, 2007 / 56(27);678-681)

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3. Notifications
Satellite Broadcast and Webcast: Immunization Update 2007
CDC and the Public Health Training Network will present a satellite broadcast and webcast, Immunization Update 2007, Aug 9, 2007. The 2.5 hour broadcast will occur live during 9:00-11:30 a.m. EST and will be rebroadcast the same day during 12:00-2:30 p.m. EST. Both broadcasts will feature a live question-and-answer session. Anticipated topics include influenza, rotavirus, varicella, and zoster vaccines and other emerging vaccine topics. For more informiation: http://www2a.cdc.gov/phtn/immup-2007. Information for site administrators about establishing and registering a viewing location is available at http://www.cdc.gov/phtnonline. No registration is necessary to view the webcasts via the Internet; the link to the live webcast is available at http://www2a.cdc.gov/phtn/webcast/immup-2007.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5628a4.htm
(MMWR July 20, 2007 / 56(28);712)

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CDC releases updated "Yellow Book" on international travel
The US CDC has released its biennial revision of the "Yellow Book," a health guide for international travel. The book describes travel-related infections and diseases endemic to each region. Changes in the latest edition include updates on recommended immunizations, developments in malaria treatment and prevention, advice for avoiding deep vein thrombosis while flying, and a section on avian influenza. The yellow-covered book, officially titled "CDC Health Informationfor International Travel 2007-2008," is available free at: http://wwwn.cdc.gov/travel/ybToc.aspx. It can also be purchased in bookstores.
(Promed 7/17/07)

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Revised International Health Regulations Effective for the United States
On July 18, 2007, the revised International Health Regulations (IHRs) entered into effect for the United States. IHRs are an international legal framework designed to help contain or prevent serious risks to public health while discouraging unnecessary or excessive restrictions on travel or trade. The revised IHRs 1) describe the obligations of WHO member states to assess and manage serious health threats that have the potential to spread beyond their borders and 2) provide guidance for meeting those obligations. Under the revised IHRs, member states must report to WHO cases of smallpox, poliomyelitis caused by wild-type poliovirus, human influenza caused by a new virus subtype, and severe acute respiratory syndrome. In addition, member states must notify WHO in a timely way of any threat that qualifies as a public health emergency of international concern, whether that threat is associated with an infectious, chemical, biologic, or radiologic agent.

The U.S. Department of Health and Human Services has assumed the lead role in carrying out the reporting requirements. The US will build upon existing state and local reporting and response networks, including the National Notifiable Diseases Surveillance System, to receive information at the federal level. Check http://www.who.int/csr/ihr/en/index.html and http://www.globalhealth.gov/ihr.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5628a5.htm
(MMWR July 20, 2007 / 56(28);712-713)

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Malaria Rapid Diagnostic Test
On June 13, 2007, the Food and Drug Administration approved BinaxNOW Malaria (Inverness Medical Professional Diagnostics), the first malaria rapid diagnostic test (RDT) authorized for use in the US. Malaria RDTs, which detect circulating malaria-specific antigens, already are available in other countries and often are used in settings where malaria microscopy is not available. In the US, use of the RDT can decrease the amount of time required to determine whether a patient is infected with malaria. BinaxNOW Malaria is approved for use by hospital and commercial laboratories, not by individual clinicians or by patients themselves. The RDT detects 2 different malaria antigens: HRP2, which is specific to Plasmodium falciparum, and a malaria aldolase found in all 4 human species of malaria parasites. Use of a malaria RDT does not eliminate the need to examine thick blood smears.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5627a4.htm
(MMWR July 13, 2007 / 56(27);686)

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Fourth Congress of the European Society for Emerging Infections
30 Sep-3 Oct 2007; Lisbon, Portugal
The European Society for Emerging Infections (ESEI) is rapidly expanding its area of activities in most fields of recent public interest. Both the medical and veterinary professions can meet. After the Official Welcome, Luc Montagnier (Academies des Sciences et de Medecine and UNESCO, Paris, France) will give the Opening Lecture entitled "Nano elements from pathogenic micro-organisms." The Congress scientific program will include symposia lead by experts in their fields, and organized around 4 major themes: emerging respiratory diseases; emerging vector-borne diseases; emerging food-borne diseases; antibiotic resistance in man and animal. The ESEI Scientific Committee invites the submission of research abstracts in all areas related to emerging infectious diseases, for oral or poster presentation. For more information: <http://www.esei2007.com/default.html>
(Promed 7/6/07)

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Converging Technologies to Combat Emerging Infectious Diseases (Phase II)
An APEC-Wide Foresight Project—excerpts from the Summary report
First Technology Roadmapping Workshop: 22-24 May 2007
Emerging and re-emerging infectious diseases is high on the agenda of APEC. For APEC to have sufficient preparedness, all control options - pharmaceutical or non-pharmaceutical, must be considered and fully explored. In most cases these options require new technological developments and/or convergence between existing technologies. This project aims to enhance the region’s capacity in using converging technologies, i.e. two or more disparate technologies or disciplines that come together, to contribute to the prevention and management of emerging infectious diseases.

In phase I, late 2006--Feb 2007, the project had identified a group of converging technologies. Participants developed 4 scenarios of the Emerging Infectious Diseases in 2017: “Malaria in Miami 2017”, “20,000 People now confirmed dead from Mystery Disease”, “Mysterious death” and “Emerging Rainforest Syndrome”. 3 research domains which have high impact on combating emerging infectious diseases were identified: Ubiquitous computing, Treatments and Diagnostic kits.

There were 42 participants attending the workshop, where 3 technology roadmaps for each research domain were developed. The key user requirements of the roadmaps focus on improving accuracy of the technologies. For the ubiquitous computing, real time monitoring including forecasting model also needed in the long terms. In order to achieve this, data collection, data mining, data sharing and modelling are necessary. Reducing side effect and providing proper treatment is an urgent need for treatments technology application, where finding the new pharmacological agents (to reduce side effects), purify all the ineffective components are required. For the medium and long terms, effective, safe, stable, long lasting and affordable drugs are needed. For these requirements, new drug ingredients or developing new process may be needed. For diagnosis, apart from improving accuracy of the equipments, it should be rapid, easy to use in field. In the long term, continuous microbial monitoring system and risk management are very important (high risk elimination + separate severe/normal cases). The main challenges to achieve the target of the three roadmaps are education, good infrastructure, information sharing and finance.
(From Ponpiboon Satangput, APEC Center for Technology Foresight, 7/11/07)

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 apecein@u.washington.edu