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Vol. X. NO. 18 ~ EINet News Briefs ~ Aug 31, 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)
- Germany (Bavaria): Avian influenza H5N1 outbreak in large poultry farm
- Viet Nam: Avian influenza H5N1 strikes more poultry
- Australia (Queensland): Hendra Virus Infects Veterinarian
- Hong Kong: 2 cases of Leptospirosis
- Russia (Stavropol): Foodborne outbreak in kindergartens
- Russia (multi-region) Update on tick-borne encephalitis
- Russia (Khanti-Mansiysky): Tularemia cases prompt prevention campaign
- South Korea: Pink Eye Spreading Quickly Among School Children
- USA: HHS allots $75 million to states for pandemic planning
- Canada (Calgary): Alert regarding Shigellosis associated with baby carrots
- USA (California) Possible Hepatitis A contamination in juice
- USA (Multi-state): Link between dog food, Salmonella cases looks stronger
- USA (Washington, Oregon): E. coli O157 cases associated with ground beef
- USA (New Hampshire) Eastern equine encephalitis infection in human
- USA (California): Concern of Coccidiodomycosis in San Joaquin Valley
- USA (Mississippi): Large number of pertussis cases; CDC help requested
- USA (Washington) 5 Hantavirus cases from single district so far in 2007
- USA (Pennsylvania)/Japan: Imported measles cases at sports tournament

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

2. Articles
- CDC EID Journal, Volume 13, Number 9—Sep 2007
- Emerging Streptococcus suis threat mainly related to occupational exposure
- Trial results for Glaxo's H5N1 vaccine released
- Human and Avian Influenza Viruses Target Different Cells in the Lower Respiratory Tract of Humans and Other Mammals
- An Avian Influenza H5N1 Virus That Binds to a Human-Type Receptor
- Characterization of Low Pathogenicity H5N1 Avian Influenza Viruses from North America
- Norovirus Activity--United States, 2006--2007
- Outbreaks of Respiratory Illness Mistakenly Attributed to Pertussis--New Hampshire, Massachusetts, and Tennessee, 2004--2006
- Salmonella Serotype Enteritidis Infections Among Workers Producing Poultry Vaccine--Maine, November-December 2006
- National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months--United States, 2006
- National Vaccination Coverage Among Adolescents Aged 13-17 Years--United States, 2006

3. Notifications
- Final 2006 Reports of Nationally Notifiable Infectious Diseases
- Call for Letters of Intent: International Harm Reduction Development Program


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 / 20 (5)
Indonesia / 30 (26)
Laos / 2 (2)
Nigeria / 1 (1)
Viet Nam 7 (4)
Total / 59 (37)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 327 (199).
(WHO 8/31/07 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 8/31/07)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 8/22/07): http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 8/27/07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.

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Europe/Near East
Germany (Bavaria): Avian influenza H5N1 outbreak in large poultry farm
More than 165 000 fattening ducks had been culled on a large farm in Bavaria after highly pathogenic avian influenza virus H5N1 was detected on the farm 25 Aug 2007. Epidemiological inquiries, paralleling the culling actions on the farm during the weekend, initiated extensive trace-back investigations. In particular, the hatchery supplying the day-old ducklings, and all farms which had received deliveries from this hatchery, were tested virologically by regional state laboratories. However, no evidence of further infections at other farms connected through trading or located in the restriction zone has been found. Thus, the outbreak appears to be an isolated case.

Full length HA and partial (538 nts) NA sequences have now been established from RNA isolated from the diseased duckling originating from the outbreak holding in Bavaria. The HA sequence fits into the group of sequences of recent EMA-3 like H5N1 variants detected in wild birds in Germany and France and in poultry in the Czech Republic in June/July 2007 (identity 99.1-99.5 percent at the nucleotide level). The sequence is clearly distinct from EMA-1- and -2-like isolates present in Bavaria in 2006 in wild birds. Thus, the outbreak appears to be epidemiologically linked to the presence of EMA-3-like H5N1 viruses detected in central Europe earlier this year [2007].

The farm itself is situated in a so-called HPAIV risk area. Such risk areas have been defined by the federal states of Germany in regions with a potentially high risk of transfer of HPAIV H5N1 from wild aquatic birds. In such areas all poultry has to be kept indoors. HPAIV H5N1 had been detected 6 weeks ago, in a number of wild birds (mute swans, grebes) in several locations in Southeastern Germany. The repeated outbreaks in poultry in central Europe (Hungary/Czech Republic/Bavaria), completely independent in space and time from any wild bird movements, indicates that the virus is continuing to circulate inside the local poultry industry.
(Promed 8/28/07, 8/30/07)

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Asia
Viet Nam: Avian influenza H5N1 strikes more poultry
Animal-health officials recently confirmed H5N1 outbreaks at poultry farms in Dong Thap province in the south and Thai Nguyen province in the north, it was reported Aug 25. In addition, officials announced the virus had spread to Tra Vinh province in the Mekong delta. The outbreak in Thai Nguyen affected ducks and young chickens, while the Dong Thap outbreak struck 250 chicks. In Tra Vinh the outbreak involved unvaccinated ducklings. In mid August the country reported an H5N1 outbreak in Cao Bang, a northern province. Vietnam has reported 7 human H5N1 cases this year, which include 4 deaths.
(Promed 8/25/07; CIDRAP 8/27/07)

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Australia (Queensland): Hendra Virus Infects Veterinarian
A veterinarian infected by Hendra virus was admitted to a hospital in Queensland 27 Aug 2007. The vet contracted the virus after performing an autopsy on a Thoroughbred in his clinic. There are reportedly 2 known current cases of Hendra in the Thoroughbred population in Queensland. In June 2006, the Australian Veterinary Association (AVA) urged horse owners in southeast Queensland to keep feed and water under cover and to stable horses overnight where possible, following the identification of Hendra virus in a horse. An AVA spokesperson at the time said the disease is not highly contagious, and that the public health risk from the disease is limited to those who have exposure to [infected] horses' body fluids. Hendra virus causes symptoms of respiratory illness in horses, including respiratory distress, frothy nasal discharge, and elevated body temperature and heart rate. It is believed fruit bats are the natural host of the virus. The virus can be lethal when transmitted to humans.
(Promed 8/30/07)

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Hong Kong: 2 cases of Leptospirosis
The Centre for Health Protection has confirmed 2 leptospirosis cases involving 2 men aged 46 and 52, bringing the year's [2007] total cases to 5. A 46-year-old Eastern District resident came down with fever and chills 20 Jul 2007 and was admitted to hospital 5 days later. He was discharged 31 Jul 2007. He did not have any recent travel history, and his 4 family contacts do not have any symptoms. A 52-year-old Tai Po man developed fever and muscle pain 20 Jul 2007. He was admitted to hospital 4 days later and was discharged 31 Jul 2007. The patient had traveled to Mainland China early Jul 2007, and his 2 family contacts do not have any symptoms.

Leptospirosis is a zoonosis caused by a spirochete that is transmitted to humans by direct contact of abraded skin or mucous membranes with urine or tissues of an infected animal or, more commonly, by indirect contact with mud or water contaminated by urine of infected animals. Person-to-person spread is not known to occur. The disease is maintained in nature by carrier animals. Leptospirosis may occur sporadically or as large outbreaks, for example, during periods of flooding. The incubation period is about one to 2 weeks after exposure. The initial symptoms are abrupt onset of chills, fever, myalgias, cough, nausea, vomiting, diarrhea, and headache. A second phase of the disease may occur. More than 90 percent of patients have a self-limited illness, but some develop a more severe illness that may be fatal. Early treatment can reduce duration and severity of symptoms. Leptospirosis is usually treated with penicillin or ceftriaxone intravenously for severe disease and doxycycline or amoxicillin for milder disease. Prevention involves wearing waterproof boots when walking on damp soil or water in endemic areas and wearing protective equipment when in contact with contaminated water or mud or infected animals.
(Promed 8/21/07)

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Russia (Stavropol): Foodborne outbreak in kindergartens
The number of children hospitalized with food poisoning rose to 75, 18 Aug 2007 in lagodarny, Stavropol Territory. An adult was hospitalized with the same diagnosis. Another 48 children are being treated at home. The total number of people suffering from food poisoning has already reached 124 (including the adult). Children became ill 17 Aug 2007. Each of them started vomiting, had temperature up to 39 C and a headache. The [condition of the hospitalized] ranges from moderate to serious. All affected children are from various city kindergartens. The adult is a kindergarten cook. It was established that the use of substandard foodstuffs was the reason for the event. Investigation is now in progress.
(Promed 8/20/07)

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Russia (multi-region) Update on tick-borne encephalitis
In the Northwestern Federal District (St. Petersburg, Leningrad Oblast), during the first 7 months of 2007, 26 cases of TBE were registered in the Federal city of St. Petersburg and the Leningrad region [province]. In the Urals Federal District (Sverdlovsk Oblast), the seasonal activity of ticks is continuing. A total of 631 people were hospitalized with a preliminary tick-borne encephalitis diagnosis, 110 of them were children. The diagnosis was confirmed in 158 cases. In the Urals Federal District (Chelyabinsk Oblast), a total of 52 cases of tick-borne encephalitis have been confirmed. All the infected have received appropriate treatment and are being followed-up by specialists. The natural reservoir of the virus is in small mammals such as rodents & shrews, moles & hedgehogs.
(Promed 8/30/07)

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Russia (Khanti-Mansiysky): Tularemia cases prompt prevention campaign
7 cases of tularemia were registered in the settlement of Berezovo from 16 to 23 Aug 2007. 4 cases have been confirmed by laboratory tests. A local authority has commissioned a plan for action to control the spread of infection. The movement of non-immunized people to the areas of risk is prohibited. Mass-information campaigns have been launched to deliver health and prevention information. A non-scheduled immunization for tularemia has been planned. House visits are being performed to identify sick people, to control rodent invasion, and to supply repellents. 191 884 people have received vaccine against tularemia during the last 6 years, 27 400 of them in 2006. During the 6 months of 2007, 51.3 percent of the eligible population have received the vaccine. Sporadic cases of tularemia are common in different regions of Russia. Outbreaks, however, are emergent events, even if of local scale.
(Promed 8/26/07)

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South Korea: Pink Eye Spreading Quickly Among School Children
Public health authorities have issued a warning against epidemic keratoconjunctivitis ("pink eye") and acute hemorrhagic conjunctivitis as the summer vacation ends. The Korea Center for Disease Control and Prevention said 23 Aug 2007 that pink eye has affected a growing number of people in South Jeolla, Gangwon and North Gyeongsang areas Aug 2007. The number of patients suffering has been rising sharply in Ulsan, Gyeongsang and Seoul since last week [13-17 Aug 2007]. KCDCP official Park Ok said that eye diseases rear up every August when school resumes after the summer break. Young people aged 10 to 19 account for 30 percent of all patients. The illnesses are particularly rampant in Ulsan and South Gyeongsang Province. Epidemics of keratoconjunctivitis ("pink eye") and acute hemorrhagic conjunctivitis occur frequently throughout the world during the autumn, caused by a variety of viruses.
(Promed 8/24/07)

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Americas
USA: HHS allots $75 million to states for pandemic planning
The Department of Health and Human Services (HHS) announced an allocation of $75 million in grants to help states, territories, and 4 metropolitan areas prepare for an influenza pandemic. HHS said the money is to be used to establish or expand stockpiles of critical medical equipment and supplies; continue developing plans for maintaining, distributing, and sharing those resources; plan for and develop alternative sites for providing healthcare in a pandemic; and conduct medical surge exercises. The funding will supplement the $430 million allocation HHS announced Jun 28 to help hospitals and other healthcare facilities prepare to respond to bioterrorism attacks, infectious disease outbreaks, and natural disasters that could cause mass casualties. The grants for states range from $352,673 for Wyoming to $5.48 million for California. The metropolitan areas with separate grants include Washington, DC, $364,024; Chicago, $836,685; New York City, $1.9 million; and Los Angeles County, $2.27 million.
(CIDRAP 8/30/07)

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Canada (Calgary): Alert regarding Shigellosis associated with baby carrots
Authorities said 20 Aug 2007, 4 people from Calgary became ill after eating contaminated baby carrots. Costco recalled the carrots after the Canadian Food Inspection Agency issued a public warning 17 Aug 2007, over shigella contamination. All 4 Canadian cases of shigella were reported in the Calgary area. The public warning was updated to include product sold in Manitoba as well as at Costco stores in British Columbia, Alberta, Ontario, Quebec, and Newfoundland. The affected product, Los Angeles Salad Company Genuine Sweet Baby Carrots, is labelled as product of Mexico and imported by Los Angeles Salad Company. Shigellosis infection can cause diarrhea (which may be bloody), fever, nausea, and vomiting. Illness usually lasts from 4 to 14 days. In some persons, especially very young and very old people, and people with compromised immune systems, the diarrhea can be more severe. Infection can occur after eating and drinking food and water that is contaminated with Shigella and can be passed person to person. Fecally contaminated water and unsanitary handling by food handlers are the most common causes of contamination.
(Promed 8/22/07)

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USA (California) Possible Hepatitis A contamination in juice
About 4000 customers could be at risk after a worker at a Jamba Juice store in San Jose, California, developed hepatitis A, the chief medical officer for Santa Clara County said 23 Aug 2007. "During the time she was infectious, she was also working at Jamba Juice, so we were concerned that even though there is a corporate policy of good hand washing, you can't be 100 percent sure," Martin Fenstersheib said. "There is a potential risk for people who were in that facility drinking the Jamba juice during the time she worked," he added. Hepatitis A, a rare occurrence in food service workers, is transmitted through oral and fecal contact. It can cause jaundice, fatigue, stomach cramps, and other ailments. Medical officials are advising anyone who may have been affected to get a vaccination. Fenstersheib based his number of potentially affected customers on data provided by the company for the time the unidentified worker was on the job. Because the disease takes about a month to incubate, there are no other known cases from exposure to the worker at present. The store was closed briefly and has since reopened.
(Promed 8/24/07)

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USA (Multi-state): Link between dog food, Salmonella cases looks stronger
Further investigation has strengthened the evidence of a link between recently recalled dog food products and human Salmonella infections. 66 people in 18 states have been infected with the same strain of Salmonella Schwarzengrund, and reports of new cases are continuing, CDC said. The Food and Drug Administration had said earlier that 2 samples of dry dog food made by Mars Petcare US, Inc., had tested positive for S Schwarzengrund, but no direct link between the company's products and the human cases had been found. CDC, however, said the outbreak strain of S Schwarzengrund was found in fecal specimens from 2 dogs that ate dry pet food in the homes of 2 case-patients. In addition, a multistate case-control study showed a link between illness and the purchase of dry pet foods made by Mars Petcare, the agency said. The company has recalled 5-pound bags of Krasdale Gravy dry dog food and 50-pound bags of Red Flannel Large Breed Adult Formula dry food.

"Households with ill persons were significantly more likely than matched households without ill persons to usually purchase a brand of dry pet food made by Mars Petcare US that may have been produced at a single facility in Pennsylvania," CDC said. In addition, the Pennsylvania Department of Health found the outbreak strain in an environmental sample from the Mars Petcare facility in Pennsylvania. 25 of the 66 salmonellosis cases reported so far occurred in Pennsylvania, with 12 in New York, 6 in Ohio, 5 in Massachusetts, and 1 or 2 in each of the other states affected. Of the patients for whom information was available, 39% were 1 year old or younger and 32% experienced bloody diarrhea. 10 patients were hospitalized, but none died. The agency said investigators are still trying to find out why human cases have been associated with dry pet food. Factors being considered include handling and storage of dry pet food, handwashing practices, exposure of children to dry pet food, and the location where pets are fed.

Salmonella often causes fever, diarrhea (potentially bloody), nausea, vomiting, and abdominal pain in humans and can be serious or fatal in children, the elderly, and those with weakened immunity. In rare cases the pathogen can enter the bloodstream and cause severe disorders, FDA said. Pet owners should wash their hands before and after handling pet food, feed pets somewhere other than the kitchen, wash pet food dishes after each use (preferably not in the kitchen), and dispose of pet food safely. CDC report: http://www.cdc.gov/salmonella/schwarzengrund.html
(CIDRAP 8/28/07, 8/29/07)

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USA (Washington, Oregon): E. coli O157 cases associated with ground beef
State health officials have issued a warning to consumers about beef linked to several E. coli cases in Washington and Oregon. The Washington State Department of Health says the illnesses were reported late Jul and early Aug 2007. A child and 5 adults were sickened in King, Island and Clallam counties; 2 people were hospitalized but have since recovered. The U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) is issuing a public health alert for approximately 41 305 pounds of ground beef products that may be contaminated with E. coli O157:H7 that were produced at Interstate Meat Dist. Inc. The ground beef products were produced on various dates between 19 and 30 Jul 2007 and were distributed to retail establishments in Alaska, Idaho, Oregon and Washington. Based on product shelf life, these products would no longer have been sold in grocery stores after 5 Aug 2007. However, these products could be in consumers' freezers, and it is important that consumers look for and return these products if they find them.
(Promed 8/30/07)

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USA (New Hampshire) Eastern equine encephalitis infection in human
A Newton, New Hampshire person has tested positive for eastern equine encephalitis [virus infection], officials said 20 Aug 2007. It is the first human case of the mosquito-borne illness this year. There were no human cases in 2006, but 7 cases were reported in 2005; 2 of those victims died. Eastern equine encephalitis (EEE) is called "sleeping sickness" because it causes animals infected with it to enter into a coma. Horses that develop it rarely survive. Both EEE and West Nile virus (WNV) are carried in bird populations and transmitted by mosquitoes. The equine virus can infect people but is rare and cannot be directly transmitted from infected horses to other horses or humans. Precautions for people are the same for both viruses and include applying insect repellent and wearing long-sleeve clothing. A combination vaccine of Eastern, Western equine encephalitis and West Nile virus is available in a single injection to protect the horse. There is also a combination vaccine with Eastern, Western and Venezuelan equine encephalitis and West Nile virus all available in a single injection.
(Promed 8/21/07, 8/25/07)

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USA (California): Concern of Coccidiodomycosis in San Joaquin Valley
Public health officials are recommending that California hold off with new prison construction in the southern San Joaquin Valley because it will expose an untold number of inmates to potentially fatal "Valley fever" [Coccidiodomycosis]. "If you put more beds down here, you can pretty much bet that some people will be very sick and perhaps die as a result of that decision," Kings County Public Health Officer Michael MacLean said. Valley fever is caused by molds that grow in the region's soil. When stirred up by construction or other means, its airborne spores can lodge in the lungs and create symptoms ranging from a mild viral illness to respiratory failure. Last year [2006], more than 500 Valley fever cases were reported at the 5000-inmate Pleasant Valley State Prison in Coalinga. A total of 4 inmates at the prison died of Valley fever in 2005.

As a result, health professionals and researchers submitted a report urging the state not to add prison beds "in the hyper-endemic area," where Valley fever spores are prevalent. They also suggested that the state evaluate exposure to the disease and "consider relocating all inmates". The recommendations were generated by a working group and corrections officials said they are preparing a response to the report that will include mitigation measures "in terms of construction and in terms of health care". Inmates last year made up two-thirds of all the Valley fever cases in Fresno and Kings counties. Reported instances of Valley fever among inmates in the southern San Joaquin Valley increased more than 6-fold from 2001 to 2006, to 672 cases last year [2006]. Valley fever is caused by a fungus, Coccidioides immitis, found in soils primarily in southwestern states in the USA.
(Promed 8/17/07)

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USA (Mississippi): Large number of pertussis cases; CDC help requested
More than 80 whooping cough cases have been reported in Mississippi, with most of them clustered in Neshoba, Leake, Lauderdale, Attala, Newton, and Winston counties. Interim state health officer Doctor Ed Thompson said he has asked the CDC for help. Health officials are providing booster vaccines for pertussis, commonly known as whopping cough. Thompson said the outbreak flared rather quickly. The focus now is on containing it. The most obvious symptom of whooping cough is intense coughing spells. Experts say there will normally be 4 to 5 coughs at a time, followed by a deep breath. Other symptoms are runny nose, severe upper respiratory congestion and low grade fever.
(Promed 8/19/07)

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USA (Washington) 5 Hantavirus cases from single district so far in 2007
A 65-year-old Franklin County man is in intensive care in Seattle [Washington] after being diagnosed earlier this week with hantavirus pulmonary syndrome, a health official said 15 Aug 2007. The man is the fifth confirmed case of hantavirus in the Benton-Franklin Health District this year [2007], according to Dr. Larry Jecha, the Benton-Franklin Health District medical director. The district usually doesn't hear of more than 1 case of hantavirus per year, Jecha said, so the health district has warned local health service providers to be on the lookout for symptoms. They include fatigue, fever and muscle aches in the early stages, and later coughing and shortness of breath. The virus can be fatal. "We're alerting people to be careful around droppings," Jecha said, because the virus is transmitted through rodent urine, droppings and saliva. He said the increase in hantavirus cases locally may be because more mice may be carrying the virus. People catch the virus when they breathe contaminated air, typically caused by sweeping in areas likely to contain droppings, such as barns, attics or garages. The 2 other cases reported this week were family members, women aged 45 and 24. They also are from the Benton-Franklin county area. The 24-year-old was admitted to a hospital 14 Aug 2007, Jecha said, while the other woman was treated at a hospital and released. Another 2 cases were reported in the area Jun 2007, Jecha said, adding that the rest of the state has not reported any incidents of the virus in 2007.
(Promed 8/19/07)

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USA (Pennsylvania)/Japan: Imported measles cases at sports tournament
An acquaintance of a Little League player from Japan diagnosed with measles last week at the World Series may have also contracted the contagious illness, the state health department said 24 Aug 2007. Little League spokesman Lance Van Auken said 24 Aug 2007 there was a confirmed second case of measles, and that the person has no connection to the Little League World Series. The player with measles was quarantined 16 Aug 2007, when he was diagnosed. He was released from isolation 19 Aug 2007 after doctors said he was no longer contagious, and has played with the squad this week. He did not have access to the team dormitory complex. After it was confirmed the player had measles, Little League and the state Department of Health implemented a program to ensure any of the estimated 500 people who visited the housing complex since the Japanese team arrived were not infected. The Health Department has been providing free immunizations as well as blood tests that would show whether a person has had measles or been inoculated. Taiwan, Mexico and Japan chose to have their players inoculated. Measles is a highly contagious illness spread by a virus transmitted by direct contact with infectious droplets or, less commonly, through the air. While no longer common in the US, measles is relatively common elsewhere in the world, including some developed countries in Europe and Asia.
(Promed 8/20/07, 8/25/07)

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1. Updates
Avian/Pandemic influenza updates
- UN: http://www.un-influenza.org/ Read article on External Quality Assessment Project. Also, http://www.irinnews.org/Birdflu.asp provides information on avian influenza: link to article: GLOBAL: Microbes don’t know geography.
- 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. Link to supplement to Journal of Wildlife Diseases on avian influenza.
- 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/. Link to North American Plan for Avian and Pandemic Influenza.
- 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. 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. Updated 31 Aug 2007.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

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Seasonal Influenza
Influenza activity in the southern hemisphere: a preliminary look at the winter 2007 season
Content excerpted from http://www.eurosurveillance.org/ew/2007/070823.asp#4
There have been a few unusual and widely reported influenza cases in some parts of the southern hemisphere this [2007] season. In Australia, several states have reported a higher number of cases this winter, with Queensland and New South Wales particularly affected. 6 children under the age of 5 who contracted influenza A this year have died; the cases were in Western Australia, Queensland and New South Wales. The predominant strain circulating in Australia is A(H3N2), although A(H1N1) has also been seen widely in some states. The country has only experienced low levels of influenza B activity this season. In contrast, Chile has had a rise in cases from last year [2006], but not as many as in 2004; incidence has also been falling since week 28. The regular vaccination campaign there targeting the elderly, those with chronic diseases, public health workers, pregnant women, infants and workers in the avian industry was launched in Mar 2007; 3.2 million doses were given. H3N2 has been the predominant strain in Chile this season [2007].

In equatorial regions (where influenza is less seasonal), the experience was also unexceptional. In China, the Philippines, Thailand and Malaysia, the predominant strain this season [2007] has been A (H3N2), with A(H1N1) and B also present. According to the WHO's summary of seasonal influenza activity in the world, last updated in March 2007, Hong Kong saw a high level of A(H3N2) activity in weeks 8-11. In contrast to Australia, New Zealand has been having a relatively mild influenza season in 2007 so far, with a mix of A(H1N1), A(H3N2) and some B viruses circulating.

In summary, therefore, apart from the unusual cases in children in Australia, the 2007 influenza season in the southern hemisphere has not been exceptional, either in the number of cases being reported or the strains circulating. Those strains that have been seen were also seen in the northern hemisphere in its last season [2006], and most of them are included in the current vaccine for the southern hemisphere this season. As was seen in the northern hemisphere's 2006/07 season, A(H3N2) strains in the southern hemisphere have not reacted well to antiserum A/Wisconsin/67/2005.
(Promed 8/26/07)

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Cholera, diarrhea & dysentery
Hong Kong ex Pakistan
The Centre for Health Protection has confirmed an imported case of cholera involving a 23-year-old woman who traveled to Pakistan 6 Jul to 17 Aug 2007. The woman came down with diarrhea and abdominal pain and was admitted to Princess Margaret Hospital 17 Aug 2007. She is still hospitalized and is now in stable condition. This is the second imported cholera case reported in 2007.
(Promed 8/28/07)

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Dengue
Malaysia
Dengue fever cases in the country recorded a slight increase in the 32nd week of this year [2007]. A total of 1010 cases and 5 deaths were registered from 5 - 11 Aug 2007 compared with 994 cases and 2 deaths the previous week, said the Health Ministry's disease control director Datuk Dr Hassan Abdul Rahman. Kelantan recorded the highest increase of 9 per cent, with 158 cases from 145 the previous week. This was followed by Penang, which recorded 72 cases compared with 45 cases the previous week and Sabah, with 35 cases compared with 55 cases the previous week. However, Selangor had recorded a drop, with 243 cases compared with 255 the previous week. The dengue situation is also improving in Kuala Lumpur and Johor. Kuala Lumpur recorded 128 cases (143 cases the previous week) and Johor 88 cases (119 cases).
(Promed 8/21/07)

Philippines (Western Visayas)
The Department of Health (DOH) in Western Visayas has recommended the activation of a local dengue task force following a 163 per cent increase in dengue cases, including 29 deaths, [compared to 2006]. The Regional Epidemiology and Surveillance Unit (RESU) recorded 2064 dengue cases from 1 Jan - 4 Aug [2007]. Last year [2006], The RESU recorded only 776 cases of dengue for the entire region, including 9 deaths. Negros Occidental and Iloilo are the provinces with the highest number of cases, at 507 and 508 respectively. The RESU considered Bacolod City, which had 595 dengue cases and 5 deaths, a hotspot. Iloilo City had 341 cases and 6 deaths this year [2007] compared to 155 last year, with 4 deaths. The RESU report said dengue afflicted both the young and the old. "Age of cases ranged from 2 months to 78 years with median age of 10 years," the report stated.
(Promed 8/21/07)

Thailand (Phuket)
A 9-year-old boy is suspected of becoming the latest victim of dengue fever in Phuket. If the disease is confirmed, he will be the third person in Phuket killed by the disease in 2007. The boy lived in Koh Kaew and died at hospital 4 Aug [2007]. The tests to determine whether dengue hemorrhagic fever was the cause of death will take 2 weeks, officials said. Dr Wanchai Sattayawutthipong, chief of Phuket Provincial Health Office said there has been an outbreak of dengue fever in Thailand this year [2007]. "There have been 2 confirmed deaths by dengue fever in Phuket this year, and this latest case is pending confirmation. The earlier cases were deaths of 2 adults, aged between 25 - 35," he said. Last year [2006], there were no deaths associated with dengue, although 136 people contracted the disease. So far this year [2007], more than 200 people have contracted dengue. Phuket is a major tourist stop in Thailand.
(Promed 8/21/07)

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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/ Travel related
Manitoba / 3 / 14 / 40 / 57 / 0 / 1
Saskatchewan / 6 / 30 / 40 / 76 / 0 / 6
Alberta / 1 / 33 / 1 / 35 / 5 / 0
British Columbia / 0 / 2 / 0 / 2 / 2 / 0
TOTALS / 10 / 79 / 81 / 170 / 7 / 7
(Promed 8/22/07)

USA
Human cases have been reported from (through 10 Jul 2007):
State / Neuroinvasion/West Nile fever/ Other, Unspecified/ Total/ Fatalities:
Alabama / 5 / 2 / 0 / 7 / 1
Arizona / 10 / 4 / 2 / 16 / 0
Arkansas / 3 / 0 / 0 / 3 / 1
California / 43 / 69 / 8 / 120 / 7
Colorado / 10 / 62 / 0 / 72 / 1
Connecticut / 2 / 0 / 0 / 2 / 0
Florida / 3 / 0 / 0 / 6 / 1
Georgia / 2 / 3 / 1 / 6 / 0
Idaho / 1 / 23 / 0 / 24 / 0
Illinois / 8 / 2 / 1 / 11 / 1
Iowa / 1 / 2 / 0 / 3 / 0
Kansas / 3 / 3 / 0 / 6 / 0
Kentucky / 1 / 0 / 0 / 1 / 0
Louisiana / 21 / 1 / 0 / 2 / 0
Minnesota / 11 / 13 / 0 / 24 / 0
Mississippi / 6 / 8 / 0 / 14 / 1
Missouri / 2 / 3 / 0 / 5 / 0
Montana / 1 / 5 / 0 / 6 / 0
Nebraska / 2 / 25 / 0 / 27 / 0
Nevada / 1 / 2 / 0 / 4 / 0
New Mexico / 6 / 5 / 0 / 11 / 0
North Dakota / 8 / 44 / 0 / 52 / 1
Ohio / 1 / 0 / 0 / 1 / 0
Oklahoma / 4 / 4 / 0 / 8 / 1
Pennsylvania / 1 / 0 / 0 / 1 / 0
South Dakota / 25 / 56 / 0 / 81 / 3
Texas / 9 / 4 / 0 / 13 / 0
Utah / 2 / 2 / 0 / 4 / 0
Virginia / 1 / 0 / 0 / 1 / 0
Wyoming / 6 / 39 / 4 / 49 / 1
TOTALS / 179 / 381 / 16 / 576 / 19
(Promed 8/22/07)

West Nile Virus Update--United States, Jan 1-Aug 14, 2007
As of Aug 14, 2007, a total of 27 states have reported 444 cases of human WNV illness to CDC. A total of 241 (54%) cases for which such data were available occurred in males; median age of patients was 48 years (range: 2--96 years). Dates of illness onset ranged from Mar 25 to Aug 5; 15 cases were fatal. A total of 49 presumptive West Nile viremic blood donors (PVDs) have been reported during 2007. Of the 49 PVDs, 15 persons (median age: 49 years [range: 18--79 years]) subsequently had West Nile fever. For more information on WNV activity: http://www.cdc.gov/ncidod/dvbid/westnile/index.htm and http://westnilemaps.usgs.gov.
http://cdc.gov/mmwr/mmwr_wk.html
(MMWR August 17, 2007 / 56(32);821-822)

USA: FDA clears second West Nile blood screening test
The US Food and Drug Administration (FDA) has announced the approval of a second automated test to screen donated blood and organs for West Nile virus (WNV). The cobas TaqScreen WNV test, made by Roche Molecular Systems Inc., detects genetic material of the virus early in the infection, FDA said Aug 28. The Roche test is similar to the Procleix West Nile virus assay, which was approved by the FDA Dec 2005 as the first stand-alone test to detect viral RNA in blood. The TaqScreen test is approved for detecting the virus in plasma specimens from human donors of whole blood and blood components and from living donors of cells, reproductive cells, and other tissues. It is also intended for testing plasma specimens obtained from organ donors while the donor's heart is still beating. WNV is usually transmitted to humans by mosquitoes, but it can also be spread by blood transfusion or organ transplantation. Tranfusion-associated WNV transmission first emerged as a threat to the US blood supply in 2002. The US had 4,269 WNV illnesses cases last year, a 42% increase over the previous year. The number of WNV cases this year has been ahead of last year's pace, but fewer severe cases have been reported. As of Aug 21, CDC had received 58 reports of blood donors who possibly were infected with WNV, FDA said. In 2006, state and local health departments reported 361 presumably viremic blood donors to CDC.
(CIDRAP 8/30/07)

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2. Articles
CDC EID Journal, Volume 13, Number 9—Sep 2007
CDC Emerging Infectious Diseases Journal Sep 2007 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. Expedited articles can be viewed at: http://www.cdc.gov/ncidod/eid/upcoming.htm.

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Emerging Streptococcus suis threat mainly related to occupational exposure
Streptococcus suis, a gram-positive bacterium that is endemic in swine in the US, appears to cause more human infections than has been documented previously, particularly in people who are in close contact with swine. In a report at the annual International Conference on Diseases in Nature Communicable to Man, held 12-14 Aug 2007, Dr. Tara C. Smith described findings from an investigation of whether S. suis is underreported or misdiagnosed as a zoonotic pathogen. In humans, the disease can cause septicemia, pneumonia, endocarditis, arthritis, and permanent hearing loss. Although the disease is more common in Southeast Asia, sporadic human cases have been reported in the UK, The Netherlands, Germany, Croatia, New Zealand, and Greece. The first human case in the US was in 2006 in a farmer.

A 2005 outbreak in China led to more than 200 human cases with about 20 percent mortality. In that outbreak, Dr. Smith noted, the presentation was unusual, with many cases of toxic shock syndrome. She added that there is an ongoing outbreak in Viet Nam, with 45 cases and at least 2 deaths at latest count. The study by Dr. Smith and colleagues at the University of Iowa's Center for Emerging Infectious Diseases looked at the seroprevalence of S. suis antibodies in 73 workers who were regularly exposed to swine (farmers, veterinarians, and meat packers) versus a control group of 67 staff and students at the university. The researchers found that the exposed individuals had higher overall levels of antibodies to serotype 2 (one of 2 serotypes most likely to cause human disease) and consistently higher titers, with the highest antibody levels found in those with the highest or longest exposures. The researchers concluded that S. suis likely infects humans more frequently than currently recognized, particularly among those who are regularly in close contact with swine.
(Promed 8/23/07)

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Trial results for Glaxo's H5N1 vaccine released
The full results of a trial of GlaxoSmithKline's (GSK's) H5N1 influenza vaccine were released, showing that the vaccine in combination with an adjuvant produced an acceptable immune response at a low dose and may provide cross-protection against nonmatching H5N1 strains. Writing in the Aug 18 issue of The Lancet, Isabel Leroux-Roels and colleagues reported that the lowest dose of adjuvanted vaccine, 3.8 micrograms (mcg), induced immune responses after 2 doses that met or exceeded all US and European criteria for vaccine licensing. Further, more than 75% of volunteers who received this low dose of adjuvanted vaccine, based on a clade 1 H5N1 virus, were shown to have neutralizing antibodies against a clade 2 strain. Equal doses of the vaccine with no adjuvant yielded significantly weaker responses.

GSK’s 2006 report raised hopes that adjuvants could substantially boost the supply of prepandemic H5N1 vaccines by reducing the amount of antigen (active ingredient) needed in each dose. Several vaccine trials have shown that the hemagglutinin, or H, component of the H5N1 virus triggers a weak immune response in humans, so vaccines must contain relatively large amounts of it. The first H5N1 vaccine licensed in the US, made by Sanofi Pasteur, required two 90-mcg doses to induce a good immune response in about half of volunteers. With an adjuvant, the vaccine was shown to induce a good immune response in about two thirds of volunteers who received two 30-mcg doses.

The vaccine used in the study was a split-virus formulation derived from a clade 1 H5N1 strain isolated from a Vietnamese patient in 2004. The trial was conducted in Belgium, and involved 400 healthy men and women between the ages of 18 and 60. The volunteers were randomly assigned to receive one of eight vaccine formulations—3.8, 7.5, 15, or 30 mcg, with or without adjuvant. Each person received 2 doses, 21 days apart. The researchers assessed humoral immunity by measuring hemagglutination-inhibition (HI) antibody titers and also testing for the presence of antibodies that could actually neutralize the H5N1 virus in the lab.

All 8 vaccine formulations were well-tolerated, and no serious adverse events were reported. The adjuvanted preparations induced significantly stronger immune responses than the nonadjuvanted preparations at all doses. The 3.8-mcg dose with the adjuvant yielded HI antibody titers of 1:40 or higher in 84% of volunteers and fourfold increases in neutralization titers in 86%. Without adjuvant, 3.8 mcg of vaccine induced similar results in only 16% and 37% of vaccinees. Even at the highest dose, 30 mcg, vaccine without adjuvant triggered similar HI titers and increases in neutralization titers in only 43% and 65% of vaccinees, respectively.

To test the vaccine's ability to induce cross-protection against different H5N1 strains, the investigators assessed the generation of antibodies to an H5N1 virus derived from one isolated from an Indonesian patient in 2005 (a clade 2 virus). They found that after 2 doses, between 20% and 32% of vaccinees in the adjuvant groups generated protective HI titers, versus none of those in the nonadjuvanted groups. The neutralization assay showed a much stronger response, with 67% to 77% of those in the adjuvant groups showing a protective response, compared with less than 9% in the other groups. Mean titers of neutralizing antibodies were 5 to 6 times higher in the adjuvant groups than in the nonadjuvant groups. The researchers write that the cross-clade neutralizing antibody responses imply that the vaccine could be used before the emergence of a pandemic caused by an H5N1 strain.

Leroux-Roels I et al. Antigen sparing and cross-reactive immunity with an adjuvanted rH5N1 prototype pandemic influenza vaccine: a randomized controlled trial. Lancet 2007 Aug 18;370:580-9
(CIDRAP 8/27/07)

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Human and Avian Influenza Viruses Target Different Cells in the Lower Respiratory Tract of Humans and Other Mammals
Debby van Riel, et al. Am J Pathol. 2007 Aug 23; [Epub ahead of print] http://ajp.amjpathol.org/cgi/content/abstract/ajpath.2007.070248v1
Abstract: Viral attachment to the host cell is critical for tissue and species specificity of virus infections. Recently, pattern of viral attachment (PVA) in human respiratory tract was determined for highly pathogenic avian influenza virus of subtype H5N1. However, PVA of human influenza viruses and other avian influenza viruses in either humans or experimental animals is unknown. Therefore, we compared PVA of two human influenza viruses (H1N1 and H3N2) and two low pathogenic avian influenza viruses (H5N9 and H6N1) with that of H5N1 virus in respiratory tract tissues of humans, mice, ferrets, cynomolgus macaques, cats, and pigs by virus histochemistry. We found that human influenza viruses attached more strongly to human trachea and bronchi than H5N1 virus and attached to different cell types than H5N1 virus. These differences correspond to primary diagnoses of tracheobronchitis for human influenza viruses and diffuse alveolar damage for H5N1 virus. The PVA of low pathogenic avian influenza viruses in human respiratory tract resembled that of H5N1 virus, demonstrating that other properties determine its pathogenicity for humans. The PVA in human respiratory tract most closely mirrored that in ferrets and pigs for human influenza viruses and that in ferrets, pigs, and cats for avian influenza viruses.

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An Avian Influenza H5N1 Virus That Binds to a Human-Type Receptor
Prasert Auewarakul et al. J Virol. 2007 Jul 11; [Epub ahead of print] http://jvi.asm.org/cgi/content/abstract/81/18/9950
Abstract: Avian influenza viruses preferentially recognize sialosugar chains terminating in sialic acid- 2,3-galactose (SA 2,3Gal), whereas human influenza viruses preferentially recognize SA 2,6Gal. A conversion to SA 2,6Gal specificity is believed to be one of the changes required for the introduction of new hemagglutinin (HA) subtypes to the human population, which can lead to pandemics. Avian influenza H5N1 virus is a major threat for the emergence of a pandemic virus. As of 12 June 2007, the virus has been reported in 45 countries, and 312 human cases with 190 deaths have been confirmed. We describe here substitutions at position 129 and 134 identified in a virus isolated from a fatal human case that could change the receptor-binding preference of HA of H5N1 virus from SA 2,3Gal to both SA 2,3Gal and SA 2,6Gal. Molecular modeling demonstrated that the mutation may stabilize SA 2,6Gal in its optimal cis conformation in the binding pocket. The mutation was found in approximately half of the viral sequences directly amplified from a respiratory specimen of the patient. Our data confirm the presence of H5N1 virus with the ability to bind to a human-type receptor in this patient and suggest the selection and expansion of the mutant with human-type receptor specificity in the human host environment.

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Characterization of Low Pathogenicity H5N1 Avian Influenza Viruses from North America
Erica Spackman et al. J. Virol. published online ahead of print on 29 August 2007 http://jvi.asm.org/cgi/content/abstract/JVI.01368-07v1
Abstract: Wild bird surveillance in North America for avian influenza (AI) viruses with a goal of early identification of the Asian H5N1 highly pathogenic AI virus has identified at least six low pathogenic H5N1 AI viruses between 2004 and 2006. The hemagglutinin (HA) and neuraminidase (NA) genes from all 6 H5N1 viruses and an additional 38 North American wild bird-origin H5 subtype and 28 N1 subtype viruses, were sequenced and compared with sequence available from GenBank by phylogenetic analysis. Both the HA and NA were phylogenetically distinct from viruses from outside of North America, and from viruses recovered from mammals. Four of the H5N1 AI viruses were characterized as low pathogenicity by standard in vivo pathotyping tests. One of the H5N1 viruses, A/MuteSwan/MI/451072-2/06, was shown to replicate to low titers in chickens, turkeys and ducks. However, transmission of A/MuteSwan/MI/451072-2/06 was more efficient among ducks than chickens or turkeys based on virus shed. The 50% chicken infectious dose for A/MuteSwan/MI/451072-2/06, and three other wild waterfowl origin H5 viruses were also determined and were between 105.3 and 107.5 50% egg infectious doses. Finally, seven H5 viruses, representing different phylogenetic clades were evaluated for their antigenic relatedness by hemagglutination inhibition assay, showing the antigenic relatedness was largely associated with geographic origin. Overall the data supports the conclusion that North American H5 wild bird origin AI viruses are low pathogenicity, wild bird adapted viruses, and are antigenically and genetically distinct from the highly pathogenic Asian H5N1 virus lineage.

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Norovirus Activity--United States, 2006--2007
“In late 2006, CDC began receiving requests from numerous state public health departments for information about a perceived increase in the number of outbreaks of acute gastroenteritis (AGE), especially those involving person-to-person transmission in long-term--care facilities. No national surveillance system exists for AGE outbreaks, including those caused by norovirus, unless foodborne transmission is suspected. In the absence of national surveillance data, CDC attempted to better characterize the outbreaks of AGE by analyzing information from the following sources: 1) detailed data on recent AGE outbreaks in three of the states that had contacted CDC about a possible increase (North Carolina, Wisconsin, and New York); 2) emergency department (ED) syndromic surveillance data from Boston, Massachusetts; 3) basic epidemiologic data on AGE outbreaks from a CDC survey of state health departments; and 4) laboratory data from CDC. The analysis suggests that a national increase has occurred in the frequency of AGE outbreaks caused by norovirus (including fatal cases in long-term--care facilities). Two new cocirculating GII.4 norovirus strains emerged nationwide in 2006 and likely accounted for this increase in activity. Improved national surveillance of outbreaks, including those with person-to-person transmission; development of accessible, affordable, and timely clinical tests; and increased access to a norovirus strain sequencing database at CDC will lead to more accurate assessment of the morbidity and mortality associated with norovirus and more rapid identification of newly emerging norovirus strains.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5633a2.htm
(MMWR August 24, 2007 / 56(33);842-846)

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Outbreaks of Respiratory Illness Mistakenly Attributed to Pertussis--New Hampshire, Massachusetts, and Tennessee, 2004--2006
Pertussis, or whooping cough, is a highly infectious, nationally notifiable respiratory disease associated with prolonged cough illness and paroxysms of coughing, inspiratory "whoop," or posttussive vomiting. Reported pertussis cases have tripled in the United States since 2001, with 25,616 probable or confirmed cases reported in 2005. This increase has been attributed to increased circulation of Bordetella pertussis, waning vaccine-induced immunity among adults and adolescents, heightened awareness of pertussis among health-care providers, increased public health reporting, and increased use of polymerase chain reaction (PCR) testing for diagnosis. To minimize the spread of pertussis, control measures must be implemented early in the course of illness when the risk for transmission is highest. However, diagnosis of pertussis is complicated by nonspecific signs and symptoms, particularly in the early catarrhal stage of disease. In addition, the lack of rapid, sensitive, and specific laboratory tests makes early and accurate identification of pertussis challenging. This report describes two hospital outbreaks and one community outbreak of respiratory illness during 2004--2006 in New Hampshire, Massachusetts, and Tennessee that were attributed initially to pertussis. However, subsequent investigations revealed negative or equivocal laboratory results and epidemiologic and clinical features atypical of pertussis, suggesting that pertussis was not the cause of these outbreaks. The findings in this report underscore the need for thorough epidemiologic and laboratory investigation of suspected pertussis outbreaks when considering extensive control measures.
http://cdc.gov/mmwr/preview/mmwrhtml/mm5633a1.htm
(MMWR August 24, 2007 / 56(33);837-842)

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Salmonella Serotype Enteritidis Infections Among Workers Producing Poultry Vaccine--Maine, November-December 2006
“On November 15, 2006, the Maine Department of Health and Human Services (MDHHS) was notified of a case of salmonellosis (a nationally notifiable disease) in an employee of a facility that produced poultry vaccine. When a second case of salmonellosis in another employee at the same facility was reported on November 25, MDHHS began an outbreak investigation. Results of that investigation suggested that 21 employees of the facility became ill during a 1-month period from exposure to a strain of Salmonella serotype Enteritidis (SE) that was used in vaccine production. Infection was thought to have resulted from environmental contamination after the spill of a liquid containing a high concentration of SE. As a result, MDHHS recommended that the facility improve its infection-control procedures to better protect workers. This outbreak highlights occupational risks that can be associated with the manufacture of veterinary biologics involving human pathogens. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5634a1.htm
(MMWR August 31, 2007 / 56(34);877-879)

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National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months--United States, 2006
“The National Immunization Survey (NIS) provides vaccination coverage estimates among children aged 19--35 months for each of the 50 states and selected urban and county areas. This report describes the findings of the 2006 NIS, which indicated increases in national coverage with pneumococcal conjugate vaccine (PCV) and varicella vaccine (VAR) and a stable coverage level for the 4:3:1:3:3:1 vaccine series (i.e., >4 doses of diphtheria, tetanus toxoid, and any acellular pertussis vaccine [DTaP]; >3 doses of poliovirus vaccine; >1 dose of measles, mumps, and rubella vaccine [MMR]; >3 doses of Haemophilus influenzae type b [Hib] vaccine; >3 doses of hepatitis B vaccine [HepB]; and >1 dose of VAR). However, national coverage estimates remained below the Healthy People 2010 target of 90% coverage for PCV, DTaP, and VAR and below the 80% target for the 4:3:1:3:3:1 vaccine series. No significant racial/ethnic disparities in 4:3:1:3:3:1 series coverage were observed after controlling for family income. State and local immunization programs should continue to identify and target children who are not fully vaccinated, especially because of low socioeconomic status and other barriers. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5634a2.htm
(MMWR August 31, 2007 / 56(34);880-885)

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National Vaccination Coverage Among Adolescents Aged 13-17 Years--United States, 2006
“Before 2005, vaccines were administered during adolescence to "catch up" children with vaccinations not received at a younger age, with the exception of the tetanus and diphtheria (Td) booster. However, since 2005, three new vaccines specifically for older children have been licensed and recommended in the United States: meningococcal conjugate vaccine (MCV4) for those aged 11--12 years and 15 years†; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine for those aged 11--12 years (or at ages 13--18 years if not received at ages 11--12 years); and human papillomavirus (HPV) vaccine for girls aged 11--12 years (or at ages 13--18 years if not received at 11--12 years). Since 1996, the Advisory Committee on Immunization Practices (ACIP) and professional organizations, including the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Medical Association (AMA), have recommended a health-care visit at ages 11--12 years for receipt of recommended vaccinations. In addition, a Healthy People 2010 objective (14-27) is to achieve >90% vaccination coverage among adolescents aged 13--15 years for certain vaccines. In 2006, for the first time, the National Immunization Survey (NIS) collected provider-reported vaccination information for adolescents aged 13--17 years (NIS-Teen). This report describes the results of that survey, which indicated that the Healthy People 2010 target has not been met for any of the vaccines analyzed. HPV vaccination coverage is not included in this report because NIS-Teen was conducted before HPV vaccination recommendations were published in March 2007. Routine health-care visits for adolescents should be encouraged, with emphasis on a visit at ages 11--12 years, and providers should continue to assess the need for vaccinations at every opportunity. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5634a3.htm
(MMWR August 31, 2007 / 56(34);885-888)

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3. Notifications
Final 2006 Reports of Nationally Notifiable Infectious Diseases
The tables listed on pages 853--863 summarize finalized data from the National Notifiable Diseases Surveillance System (NNDSS) for 2006, as of Jun 30, 2007. These data will be published in greater detail in the Summary of Notifiable Diseases, United States, 2006. Because no cases of diphtheria, neuroinvasive or non-neuroinvasive western equine encephalitis virus disease, paralytic poliomyelitis, severe acute respiratory syndrome-associated coronavirus syndrome, smallpox, or yellow fever, and no varicella deaths were reported in the US during 2006, these diseases do not appear in these early release tables. Publication criteria used for the 2006 finalized tables are listed in the "Print Criteria" column of the revised January 2007 NNDSS event code list, available at http://www.cdc.gov/epo/dphsi/phs/infdis.htm. Population estimates for states are from the National Center for Health Statistics. Estimates of the July 1, 2000--July 1, 2005, United States resident population are from the Vintage 2005 postcensal series by year, county, age, sex, race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau and available at http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm.
http://cdc.gov/mmwr/preview/mmwrhtml/mm5633a4.htm
(MMWR August 24, 2007 / 56(33);851,853-863)

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Call for Letters of Intent: International Harm Reduction Development Program
The International Harm Reduction Development Program (IHRD) of the Open Society Institute (OSI) is offering small grants to support the collection and presentation of information that evaluate the health and human rights consequences, with regard to injection drug use-driven and HIV infections, of the resolutions taken at the 1998 UNGeneral Assembly Special Session on Drugs. This project will provide grants of up to $12,000 USD for organizations or networks able to produce a report in English on how law enforcement and drug control have impacted HIV prevention and treatment efforts for drug users in their country or region. The reports, to be gathered from developing/transitional countries with injection-driven HIV epidemics (either majority of cases of HIV due to injection, or significant, concentrated IDU epidemic), will be edited and compiled in a booklet to be published by IHRD during activities leading up to the high-level ministerial meeting in Vienna in 2009 at which countries will reflect on progress since the 1998 UNGASS. Preference will be given to proposals that have a regional, rather than country specific, focus. This document serves as a formal invitation to submit a letter of intent (LoI). This brief concept paper allows you the opportunity to both demonstrate your understanding of the aim of this project and your perspective of how it can be realized in your region. While there are many aspects to health, policing, and drug control, applicants must demonstrate a particular connection to policies and practices tied to HIV and drug use, particularly injecting drug use.

The LoI must: be received by 15 Sep 2007 (NY time), electronically as an attachment; be addressed to IHRD@sorosny.org, with a subject line of UNGASS+10; LoI with a copy to famesq@terra.com.br; be submitted in English, not to exceed three pages, double-spaced, that outlines key issues, existing evidence, and potential sources for more detailed information contain a two-sentence introduction and contact information on each of the individuals submitting the grant. IHRD will review your LoIs and notify you by the end of Sep. If accepted, you will be invited to submit a slightly expanded proposal and budget. We hope to have final proposals by mid-Oct, and decisions by Nov. Any questions about the application process of applying should be addressed to Fabio Mesquita (famesq@terra.com.br).

Kasia Malinowska-Sempruch, Director, International Harm Reduction Development program (IHRD)
Open Society Institute, 400 West 59th Street, New York, NY
Phone: (212) 548-0138; Fax: (212) 548-4666; E-mail: jtraska@sorosny.org
(AIDS ASIA 8/28/07)

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 apecein@u.washington.edu