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Vol. X. NO. 20 ~ EINet News Briefs ~ Oct 05, 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)
- Indonesia (Jakarta): Man's death pushes Indonesia's H5N1 fatality toll to 86
- Australia (Adelaide): Mumps outbreak among students
- Australia (Queensland): Increase in human cases of Ross River virus infection
- Malaysia (Selangor): Hand, foot and mouth disease cases increase
- Russia (Rostov): Rabies kills 2 persons so far in 2007
- Russia (Volgograd, Rostov): West Nile fever incidence still increasing
- Russia (Yamalo-Nenetsky): Outbreak of Yersiniosis in children
- Viet Nam (Ho Chi Minh): Increase in cases of hand, foot and mouth disease
- Canada (Saskatchewan): Update on avian influenza H7N3 outbreak in poultry
- USA: Ground beef recall expands as more E coli illnesses probed
- USA (Connecticut): Anthrax still present in home; crews to determine contaminants' disposal
- USA (New Mexico): Fifth human case of bubonic plague in 2007

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

2. Articles
- CDC EID Journal, Volume 13, Number 10--Oct 2007
- College and University Planning for Pandemic Influenza: A Survey of Philadelphia Schools
- Validity of Parental Report of Influenza Vaccination in Children 6 to 59 Months of Age
- Effectiveness of Influenza Vaccine in the Community-Dwelling Elderly
- Treatment with Convalescent Plasma for Influenza A (H5N1) Infection
- Update on Vaccine-Derived Polioviruses--Worldwide, January 2006--August 2007
- Salmonella Oranienburg Infections Associated with Fruit Salad Served in

3. Notifications
- Clinical Vaccinology Course--November 9--11, 2007
- Australia Pledges $93 million Support to Global Fund (fwd)
- High-containment biosafety laboratories: preliminary observations on the oversight of the proliferation of BSL-3 and BSL-4 laboratories in the United States


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 / 32 (28)
Laos / 2 (2)
Nigeria / 1 (1)
Viet Nam 7 (4)
Total / 66 (43)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 329 (201).
(WHO 10/2/07 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 9/10/07)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 9/28/07): http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 9/11/07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.

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Asia
Indonesia (Jakarta): Man's death pushes Indonesia's H5N1 fatality toll to 86
Indonesia's health ministry announced that a 21-year-old man who lived near Jakarta died of H5N1 avian influenza. Joko Suyanto, an official from Indonesia's bird flu center, said the man, who lived in West Jakarta, died Sep 28, 2007. He is Indonesia's 107th case-patient and its 86th death. The man got sick Sep 18 and was admitted to hospital Sep 25. The case was an egg seller in a traditional market. All of the contacts remain healthy, where they will continue to be monitored for 10 days after their last contact with the case. In Jan 2007, Indonesia banned backyard poultry in the country's capital after a string of 5 H5N1 deaths among residents of Jakarta and its suburbs. Indonesia has the world's highest number of H5N1 cases and deaths.
(CIDRAP 10/1/07; Promed 10/2/07)

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Australia (Adelaide): Mumps outbreak among students
A mumps outbreak has been identified among university students in Adelaide. The highly infectious disease has been diagnosed in at least 8 students in the past 2 weeks. All lived in the same student accommodation, which houses about 180 people. Authorities have advised the university on isolating those affected and have offered mumps vaccine to all unvaccinated residents. Mumps in adults is an uncommon condition which in rare cases can lead to meningitis, hearing loss and sterility. The disease could take up to 3 weeks to become evident after being exposed. Most of those affected have been overseas students aged 18 to 24. Symptoms include swelling of the sides of the face and jaw line. Inflammation of the testicles occurs in about 20 per cent of adult male cases and inflammation of the ovaries in 5 per cent of adult females. Almost a third of people will have mild or no symptoms but will still be infectious. These apparently well students could be infecting others who will not show signs of the disease for a fortnight or more. None of the ill students had required hospital treatment. Many were not fully protected because they received only 1 of the required 2 courses of vaccine in childhood. Although more than 50 doses of vaccine had since been administered to students, it will take weeks for them to develop immunity. Treatment for those affected includes paracetamol for pain and fever and isolation until 9 days after symptoms disappear.
(Promed 9/30/07)

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Australia (Queensland): Increase in human cases of Ross River virus infection
Unusually high numbers of mosquitoes are spreading the debilitating Ross River virus across the state, with the number of cases soaring by almost 300 percent. The virus is usually more prevalent in the tropical north, but figures show the number of people infected in the southern Brisbane area in the past 4 weeks is almost 450 percent higher than in the same period in 2006. Officials are warning people to take precautions against being bitten and are stepping up spraying programs. They say the long dry spell and the unseasonable downpours in Aug 2007 have caused mosquitoes to breed early. There were 93 reported cases of Ross River infection in the past 4 weeks, compared with an average 32 cases in the same period for each of the past 5 years [2002-2006]. Queensland Health said the numbers were unusually high for this time of year, with the highest numbers usually occurring in late summer and early autumn.

Symptoms of Ross River virus include a mild fever, rash, and joint pain. Symptoms can vary but the disease could often become debilitating, causing people to take months off work. The infection cannot be spread human to human but can be spread from animals to humans via mosquitoes. Councils across the state are already spending millions in a bid to control the mosquitoes before the summer hits. Aerial and land-based spraying has already been carried out across the state. Health officers at Brisbane City Council have launched an AUD 3.4 million [USD 3 million] mosquito prevention program. On the Sunshine Coast, councils are dumping large amounts of hormone-laced sand on mosquito breeding grounds as part of an AUD 1 million [USD 885 000] outbreak prevention project. The hormone stunts the growth of juvenile mosquitoes but doesn't harm other insects.

Ross River virus is endemic in most coastal regions of Australia and since the 1980's appears to have extended its geographical range to include most of the island communities of the South Pacific. The animal reservoir species are various, and humans exhibit a significant viraemia such that some epidemics are maintained in a human-mosquito-human transmission cycle. Fortunately, illness in humans -- although occasionally prolonged and painful -- is not fatal, and recovery is complete.
(Promed 9/30/07)

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Malaysia (Selangor): Hand, foot and mouth disease cases increase
The number of hand, foot and mouth disease (HFMD) cases in Klang has increased, and people have been advised to seek immediate medical treatment if symptoms occur. 502 HFMD cases had already been reported in the first half of 2007 compared with 300 cases in all of 2006. Parents and kindergarten operators in Klang have been advised to look out for symptoms of HFMD in children. Kindergartens in Bandar Bukit Tinggi, Taman Eng Ann and Taman Pendamar Indah had to be closed to control the spread of the disease. Doctors testing samples of the HFMD [cases] found the virus strain was different from the one in Sarawak. HFMD can be caused by several enteric picornaviruses: Human enterovirus 71, Human coxsackievirus A16, Human echovirus 11 and Human echovirus 4 being the most frequent. HFMD disease, although present worldwide, has caused most concern in China, Japan, Malaysia and South-east Asia.
(Promed 9/24/07)

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Russia (Rostov): Rabies kills 2 persons so far in 2007
Since the beginning of 2007, 78 cases of rabies infection in animals have been recorded in the Rostov Oblast. This figure exceeds that of 2006 by 87 per cent. During the past 8 months, 2 fatal cases of rabies in humans have been recorded. These 2 victims had not sought medical aid. Expansion of natural foci of rabies has been observed in 2007 in various regions of Russia. It is partly connected with atypical warm weather during the winter, which has led to growth of the red fox population, and partly connected with insufficient prophylaxis of rabies among wild animals in the different regions of NIS (Newly Independent States), especially beyond the borders of Russia.
(Promed 9/21/07)

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Russia (Volgograd, Rostov): West Nile fever incidence still increasing
Since the beginning of July 2007 in Volgograd oblast [region], the number of people with West Nile fever (WNF) has increased to 54, as reported by IA Regnum. 44 cases were registered in Volgograd city, 8 in Volgsky region, 1 in Leninsk, and 1 in Sredneakhtubinsky region. 75 per cent of patients are older than 50 years. 2 patients with WNF died. WNF is a virus infection; birds are the reservoir of the virus. The virus is transmitted to humans by mosquitoes. The increasing number of mosquitoes carrying the virus is the result of an abnormally hot summer. Most of the patients were infected in the countryside or in summer residences. In order to prevent new cases of WNF, sanitization of ponds and insecticide treatment of basements are being carried out in the region.
(Promed 9/23/07)

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Russia (Yamalo-Nenetsky): Outbreak of Yersiniosis in children
Schoolchildren in Noviy Urengoy [in the Yamalo-Nenetsky autonomous district of western Siberia] have become infected with pseudotuberculosis [Yersinia pseudotuberculosis]. The diagnosis has been laboratory confirmed. This infection can be transmitted by eating raw vegetables. The outbreak of pseudotuberculosis was detected 18 Sep 2007 in the settlement of Noviy Urengoy when 20 schoolchildren were admitted to the hospital and 77 received out patient care. A preliminary analysis suggested that fresh vegetables for salad were a possible cause of infection. The overall number of affected people has increased to 121 with 38 of them admitted to hospital. An investigation has been launched to assess the outbreak.

Infection with Yersinia pseudotuberculosis is a zoonosis with reservoirs in many animals, including rodents, rabbits, deer, and various birds. Most individuals affected are children or young adults. The most common presentation of this infection is mesenteric lymphadenitis, with fever and right lower quadrant abdominal pain. A febrile gastroenteritis may also occur, which has been described as Izumi syndrome in Japan. Late complications may be a reactive arthritis or erythema nodosum. Although many associations had been previously made, one of the strongest studies of the relationship of Y. pseudotuberculosis and food (fresh produce) was published in 2004 from Finland. The diagnosis of infection with this bacterium can be made by isolation of the organism from lymph node or stool.
(Promed 10/1/07)

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Viet Nam (Ho Chi Minh): Increase in cases of hand, foot and mouth disease
Since the beginning of Sep 2007, more than 170 infants have been hospitalized every week with hand, foot and mouth disease, 30 percent of them with serious complications, the Ho Chi Minh (HCM) City Health Department reports. Dr. Tran Thi Thuy, of the infectious diseases ward at Children's Hospital II in Ho Chi Minh city, says more than half of the ward's 213 infants have the disease, and a dozen of them are suffering from brain complications. Since hand, foot and mouth develops rapidly, 2 infants have died before they could be taken to the emergency unit. The disease has broken out much earlier than in previous years, when it peaked in March or November. Dr. Le Truong Giang, Deputy Director of the HCMC Health Department, is urging the authorities to take urgent action to contain and eliminate hand, foot and mouth, above all by sanitizing every school and classroom. Doctors are advising parents to seek medical help if their child has a fever and especially if they notice blisters on the hands and feet and ulcers in the mouth.

Hand, foot and mouth disease (HFMD) is a common viral illness, most frequently affecting children under 10 years of age and infants. HFMD is characterised by fever and vesicles in the mouth and on distal extremities. Complications are uncommon in most outbreaks, in contrast to the current outbreak in Viet Nam. HFMD is moderately contagious. Infection is spread from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. A child is most contagious during the first week of the illness. Individual cases and outbreaks of HFMD occur worldwide, more frequently in summer and early autumn. A variety of enteric picornaviruses have been associated with HFMD in the past, the most frequently observed being Human coxsackievirus A16 and Human enterovirus 71. Currently, outbreaks of relatively mild HFMD in India and Malaysia have been reported. In the recent past, serious outbreaks of HFMD and encephalitis attributable to human enterovirus 71 have been reported in Southeast Asia (Malaysia, 1997; Taiwan, 1998).
(Promed 9/26/07)

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Americas
Canada (Saskatchewan): Update on avian influenza H7N3 outbreak in poultry
The Canadian Food Inspection Agency (CFIA) has put another Saskatchewan chicken farm under quarantine, but says the move is only a precautionary measure. The small farm affected by the decision 28 Sep 2007 is less than 3 km away from Pedigree Poultry, a much larger operation just north of Regina, where officials on 27 Sep 2007 found a strain of avian influenza. CFIA said the quarantine measures are standard given the close proximity of the 2 farms. It said the 20 chickens tested on what the agency calls a "small backyard operation" have shown no signs of disease. The H7N3 strain of avian influenza is a potential zoonosis with low risk of transmission, causing mild conjunctivitis in 2 heavily exposed people in the 2004 outbreak of highly pathogenic H7N3 in the Fraser Valley, British Columbia, Canada. The concern is that people co-infected with avian and human influenza viruses could serve as mixing vessels for viral recombination and subsequent development of human adapted, virulent strains of influenza.

More than 50 000 chickens at the Pedigree Poultry operation near Regina Beach were to be killed and all equipment thoroughly sanitized. In 2006, no H5 or H7 strains were detected in samples from 56 ducks (primarily northern pintails) in southern Saskatchewan, although there were 6 positives for non H5/H7, low pathogenicity influenza A viruses (based on PCR). Canada-wide, no H7 subtypes or highly pathogenic strains were detected in 4268 samples from wild ducks in 2005, nor in over 12,000 samples from wild birds in Canada in 2006.

Excerpts from the official OIE report:
Information received 28 Sep 2007 from Canadian Food Inspection Agency:

Start date 23 Sep 2007; Report date 28 Sep 2007; Date of previous occurrence 2004
Manifestation of disease: Clinical disease
Causal agent: Avian influenza virus; Serotype H7N3
Nature of diagnosis Clinical, Laboratory (basic), Laboratory (advanced)

Outbreak: Regina Beach, Regina, SASKATCHEWAN
Outbreak status: Continuing (or date resolved not submitted)
Epidemiological unit: Farm; Species Birds
Susceptible 49100; Cases 560; Deaths 560; Destroyed 0; Slaughtered 0

Affected population Chicken broiler breeder flock. The operation consists of 10 barns. There are 1100 roosters housed within 2 barns. In close proximity are 3 barns which house a total of 16 000 10-week-old broiler breeder pullets. Approximately 400 metres away are 4 laying barns which house a total of 16 000 52-week-old broiler breeders and 16 000 29-week-old broiler breeders. Approximately 540 roosters have died in one barn containing approximately 600 birds (approximately 90 percent mortality). There are currently fewer than 60 birds remaining in this barn.

Source of infection--Unknown or inconclusive; Contact with wild species suspected but not confirmed

CFIA will apply restrictions on the movement of poultry and poultry products within 3 km of the infected premises. As an additional safeguard, any poultry operations within 10 km of the infected premises will be closely and regularly monitored for signs of illness. Control measures: Measures already applied -- Movement control inside the country; Screening; Quarantine; Vaccination prohibited; No treatment of affected animals. Measures to be applied: Disinfection of infected premises/establishment(s); Stamping out.

Tests by competitive ELISA (c-ELISA), neuraminidase inhibition assay, polymerase chain reaction (PCR), haemagglutination inhibition test (HIT), virus isolation positive.
(Promed 9/29/07; 10/1/07)

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USA: Ground beef recall expands as more E coli illnesses probed
A New Jersey meat company recently expanded a recall of its ground beef to include 21.7 million pounds of frozen products that have been linked to as many as 28 Escherichia coli O157:H7 infections in 8 states. The recall was first announced by Topps Meat Company Sep 25, 2007 but was expanded Sep 29 after the New York Department of Health (NYDH) found more of the company's product samples were positive for E coli O157:H7, according to the US Department of Agriculture (USDA) Food Safety and Inspection Service (FSIS). Additional reports of illnesses and a food safety assessment from the FSIS also contributed to the expanded recall. The company, the leading American manufacturer of frozen hamburgers, said this was its first recall in its 65-year history. It was also one of the larger meat recalls of recent years.

The initial recall of 331,582 pounds of the company's frozen ground beef products was prompted by an investigation by the NYDH and CDC into a reported cluster of illnesses in northeastern states. Products that are the subject of the recall were distributed to grocery stores and food service institutions throughout the US. The recalled products have "sell by" or "best if used by" dates ranging from Sep 25, 2007 to Sep 25, 2008. All recalled products have the USDA establishment number EST 9748 printed on the back panel of the package or within the USDA label. A full list of the recalled products is available at http://www.toppsmeat.com/. There has been no report of how the beef became contaminated.

Investigators compared the DNA fingerprint patterns of E. coli O157 strains found in ground beef with DNA fingerprint patterns of E. coli O157 strains isolated from ill persons. As of 2 Oct 2007, 28 cases of E. coli O157:H7 infection have been identified with PFGE patterns that match at least one of the patterns of E. coli strains found in Topp's brand frozen ground beef patties. 17 (94 percent) of 18 patients with a detailed food history consumed ground beef. 3 illnesses have confirmed associations with recalled products because the strain isolated from the person was also isolated from the meat in their home. The first reported illness began 5 Jul 2007, and the last began 11 Sep 2007. Among 15 ill persons for whom hospitalization status is known, 10 (67 percent) patients were hospitalized. 1 patient developed hemolytic-uremic syndrome (HUS). No deaths have been reported. 12 (43 percent) patients are female. The ages of patients range from 3 to 77 years; 33 percent are between 15 and 24 years old.

Topps said it believes that most of the recalled product has already been consumed. The cases include patients from Connecticut, Florida, Indiana, Maine, New Jersey, New York, Ohio, and Pennsylvania. Recent major outbreaks of E coli O157:H7 have been linked with fresh produce, but overall the pathogen has more commonly been found in ground beef. The strain produces a toxin that causes diarrhea—often bloody—and abdominal cramps but typically no fever. The illness usually resolves in 5 to 10 days, but it can cause HUS, potentially leading to kidney failure or death, in 2% to 7% of patients. Following a massive ground beef recall in 2002, USDA required meatpacking plants to review their safety systems and take specific steps to reduce E coli contamination. The agency said the steps led to declines in contamination found by USDA sampling and fewer ground beef recalls. However, officials are concerned that some of the safety gains have eroded. US meat producers have issued 8 recalls related to E coli contamination so far this year, which is more than they issued during all of 2006.
(CIDRAP 10/1/07; Promed 9/26/07, 9/27/07, 10/1/07, 10/3/07)

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USA (Connecticut): Anthrax still present in home; crews to determine contaminants' disposal
People driving by an anthrax-contaminated home on Padanaram Road in Danbury, CT, may see people working there over the next few weeks. For the moment, at least, the cleanup of the site will go into a minor key mode that won't involve routing traffic away from the house. "The road won't be closed down," Michael Nalipinski, the on-site coordinator for the federal Environmental Protection Agency (EPA), said 27 Sep 2007. Instead, crews will be on the scene on and off over the next few weeks to do some basic cleanup tasks. They'll take samples from a barn behind the house to make sure it's free of anthrax spores. Crews will also be trying to figure out how to best dispose of the waste materials the previous work generated. That waste includes used decontamination suits and the chlorine-based solution used to wash the spores off walls and household objects.

EPA and its partners in the cleanup -- the city and the state Department of Public Health and Department of Environmental Protection -- still haven't set a time line for cleaning the spores out of the house on the site. But he said the EPA's first choice for the work still remains fumigation -- building a big tent around the entire house, then pumping a gas into it that will kill all the spores. The house and barn and the trunk of a car became contaminated with anthrax spores in Aug 2007 when an African drum-maker purchased goat skins in New York City. Unbeknownst to him, the skins, which came from West Africa, were infected with anthrax spores. Health officials learned of the situation in Sep [2007] when the drum-maker and a family member came down with cutaneous anthrax -- a form of the disease that occurs when the spores get under the skin and the bacteria come alive. That caused a black-scabbed sore to break out on the man's arm, which doctors diagnosed as anthrax. As soon as officials learned of the anthrax contamination there, the family had to vacate and officials sealed the home off from the public. The investigation of the contamination and the first phase of the cleanup closed a section Padanaram Road for 6 days and cost several hundreds of thousands of dollars.
(Promed 9/28/07)

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USA (New Mexico): Fifth human case of bubonic plague in 2007
The state Department of Health reports that a woman is the state's fifth confirmed case of human bubonic plague in 2007. The 58-year-old woman's plague was confirmed 27 Sep 2007. She is currently hospitalized and recovering. The 4 other cases of plague confirmed in the state in 2007 occurred in Santa Fe, Torrance, San Juan, and Bernalillo counties. A Bernalillo County boy died of the disease Jun 2007. Health Department officials are currently working with the Albuquerque Environmental health department to determine where the woman may have contracted the disease. "We are determining whether others are at risk, alerting physicians that plague is in the area, and providing information to neighbors in a door-to-door educational campaign," state epidemiologist Mack Sewell said. Previous plague cases in 2007 have been associated with flea bites. Sewell suggests that people use a flea control product on their pets to minimize the likelihood off introducing fleas to their environments. New Mexico experienced 8 human plague cases in 2006, 2 of them fatal.
(Promed 9/29/07)

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1. Updates
Avian/Pandemic influenza updates
- UN: http://www.un-influenza.org/ : article “UN Secretary-General urges global cooperation to secure better health for all.” 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. 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/.
- Health Canada: information on pandemic influenza: http://www.influenza.gc.ca/index_e.html. Updates on Saskatchewan H7N3 outbreak.
- 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 28 Sep 2007 with information on H7N3 outbreak in Canada.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

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Dengue
China (Fujian)
On 30 Sep 2007, authorities said 39 dengue fever cases have been confirmed in Putian City of east China's Fujian Province. Thus far, 26 of the 39 patients in Hanjiang District of Putian City have been cured and the others are in stable condition. The city has adopted "comprehensive prevention and control measures" to curb the spread of the disease. All medical and health institutions in the province have also strengthened monitoring on the disease. The department reminded citizens of household sanitation and the prevention of proliferation of mosquitoes, which transmit the disease [virus].
(Promed 10/1/07)

Philippines
The number of dengue cases in the 9 months to Sep 2007 dropped 4.6 percent from the same period in 2006, the Department of Health (DoH) said. The DoH's National Epidemiology Center (NEC) said 18 705 dengue cases were recorded from Jan to Sep 2007. A total of 19 601 cases were recorded during the same period in 2006. NEC data showed that while the ages of those stricken with dengue ranged from 18 days to 98 years old, the bulk of cases -- 77 percent -- involved people between the ages of 1 and 20. No dengue hotspots were identified in the latest NEC data but the clustering of cases was noted in Manila, Malabon, Quezon, Caloocan, Muntinlupa, Paranaque, San Juan, and Valenzuela in the National Capital Region. Health Secretary Francisco Duque III reminded officials to sustain clean-up activities and continue the improvement in the agency's drive against the disease. Barangays are expected to remove non-essential containers in their areas that can hold [water] and become breeding places of mosquitoes.
(Promed 9/24/07)

Singapore
The number of dengue cases reported in the 9-15 Sep week [2007] was 203, which is significantly lower than in previous months. But there were still 29 clusters, which have more than 10 cases each. The public is advised to remain vigilant to prevent the Aedes mosquito from breeding. Bukit Batok remained the worst-hit, with 97 cases reported.
(Promed 9/24/07)

Viet Nam
The incidence of dengue fever in Viet Nam has risen by almost 50 percent in 2007 against 2006. About 68 000 people had been stricken with the mosquito-borne disease, Preventative Health Department director Nguyen Huy Nga said 24 Sep 2007; 60 had died. Most infections had occurred in southern Dong Thap, An Giang, Tien Giang, and Ben Tre provinces and the total increase was about 48 percent. Ho Chi Minh [HCM] City-based Pasteur Institute National Dengue Fever Programme representative Luong Chan Quang said more than 58 000 people had been infected in the Cuu Long (Mekong) Delta provinces by the end of Aug 2007. Deaths were put at 54-40 percent more than 2006. Infections in Tien Giang Province totalled 9800 with 9 deaths, Dong Thap 8700 with 9 deaths, and An Giang 6000 with 6 deaths. In HCM City, almost 5400 people had been stricken with dengue fever -- 40 percent more than 2006 -- and 6 had died. Quang warned that another serious outbreak was likely in the southern delta before the end of the year [2007] if effective preventive measures were not taken because people regularly stored water to prepare for the dry season. About 350 people were being admitted to hospital each week with dengue fever. HCM City Tropical Diseases Hospital figures show that of about 150 people admitted to the hospital with dengue fever each week, more than 100 were adults.
(Promed 10/1/07)

Latin America
Dengue fever is spreading across Latin America and the Caribbean in one of the worst outbreaks in decades, causing agonizing joint pain for hundreds of thousands of people and killing nearly 200 so far in 2007. CDC has posted advisories for people visiting Latin American and Caribbean destinations to use mosquito repellant and stay inside screened areas whenever possible. Dengue has already damaged the economies of countries across the region by driving away tourists. Some countries have focused mosquito eradication efforts on areas popular with tourists. Mexico sent hundreds of workers to the resorts of Puerto Vallarta, Cancun, and Acapulco this year to try to avert outbreaks.

The tropical virus was once thought to have been nearly eliminated from Latin America, but it has steadily gained strength since the early 1980s. Now, officials fear it could emerge as a pandemic similar to one that became a leading killer of children in Southeast Asia following World War II. Officials say the virus is likely to grow deadlier in part because tourism and migration are circulating 4 different strains across the region. A person exposed to one strain may develop immunity to that strain -- but subsequent exposure to another strain makes it more likely the person will develop the hemorrhagic form. So far this year [2007], 630 356 dengue cases have been reported in the Americas with 12 147 cases of hemorrhagic fever and 183 deaths. In Puerto Rico, where 5592 suspected cases and 3 deaths have been reported, some lawmakers called this week for the health secretary to resign.

The only way to stop the virus is to contain the mosquito population -- a task that relies of countless, relentless individual efforts including installing screen doors and making sure mosquitoes are not breeding in garbage. While dengue is increasing around the developing world, the problem is most dramatic in the Americas. Mexico has been struggling with an alarming increase in the deadly hemorrhagic form of dengue, which now accounts for roughly 1 in 4 cases. The government has confirmed 3249 cases of hemorrhagic dengue for the year through 15 Sep [2007], up from 1924 in 2006. CDC says there is no drug to treat hemorrhagic dengue, but proper treatment, including rest, fluids, and pain relief, can reduce death rates to about one percent.
(Promed 10/1/07)

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West Nile Virus
Canada
Human cases were reported for week 36 (as of 8 Sep 2007) from the following provinces: Province / Neurological / Non-Neurological / Unclassified-Unspecified / Total / Asymptomatic

Ontario / 1 / 9 / 0 / 10 / 3
Manitoba / 55 / 343 / 145 / 543 / 8
Saskatchewan / 40 / 423 / 844 / 1307 / 14
Alberta / 18 / 271 / 0 / 289 / 2
British Columbia / 6 / 5 / 5 / 16* / 0
TOTALS / 120 / 1051 / 994 / 2165 / 27
* Infection acquired while traveling outside the province
(Promed 10/4/07)

USA
2007 West Nile virus activity in the United States (through 18 Sep 2007) State / Neuroinvasion/West Nile fever/ Other, Unspecified/ Total/ Fatalities:

Alabama / 12 / 1 / 0 / 13 / 3
Arizona / 10 / 4 / 17 / 31 / 0
Arkansas / 9 / 2 / 0 / 11 / 1
California / 118 / 161 / 11 / 290 / 14
Colorado / 79 / 378 / 0 / 457 / 5
Connecticut / 3 / 1 / 0 / 4 / 0
Delaware / 1 / 0 / 0 / 1 / 0
Florida / 3 / 0 / 0 / 3 / 1
Georgia / 18 / 12 / 2 / 32 / 1
Idaho / 1 / 69 / 0 / 70 / 0
Illinois / 34 / 9 / 5 / 48 / 4
Indiana / 6 / 4 / 0 / 10 / 1
Iowa / 6 / 9 / 2 / 17 / 1
Kansas / 9 / 18 / 0 / 27 / 0
Kentucky / 3 / 0 / 0 / 3 / 0
Louisiana / 1 / 1 / 0 / 2 / 0
Maryland / 3 / 3 / 1 / 7 / 0
Massachusetts / 1 / 2 / 0 / 3 / 0
Michigan / 8 / 0 / 0 / 8 / 0
Minnesota / 36 / 53 / 0 / 89 / 0
Mississippi / 34 / 51 / 0 / 85 / 3
Missouri / 37 / 8 / 0 / 45 / 1
Montana / 32 / 139 / 0 / 171 / 3
Nebraska / 9 / 72 / 0 / 81 / 3
Nevada / 2 / 4 / 4 / 10 / 0
New Mexico / 33 / 18 / 0 / 51 / 3
New York / 5 / 0 / 0 / 5 / 1
North Dakota / 44 / 280 / 0 / 324 / 2
Ohio / 6 / 3 / 1 / 10 / 0
Oklahoma / 41 / 27 / 1 / 69 / 5
Oregon / 3 / 14 / 0 / 17 / 0
Pennsylvania / 2 / 1 / 0 / 3 / 0
Rhode Island / 0 / 1 / 0 / 1 / 0
South Carolina / 2 / 2 / 0 / 4 / 0
South Dakota / 44 / 152 / 0 / 196 / 4
Tennessee / 2 / 1 / 1 / 4 / 1
Texas / 75 / 16 / 0 / 91 / 5
Utah / 17 / 20 / 0 / 37 / 1
Virginia / 2 / 1 / 0 / 3 / 0
Wisconsin / 2 / 2 / 0 / 4 / 0
Wyoming / 13 / 145 / 16 / 174 / 1
TOTALS / 766 / 1684 / 61 / 2511 / 64
(Promed 10/4/07)

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2. Articles
CDC EID Journal, Volume 13, Number 10--Oct 2007
CDC Emerging Infectious Diseases Journal Oct 2007 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. Special issue on Global Poverty and Human Development. Policy Review article: Global Public Health Security by G. Rodier et al. Perspective: Preparedness for Highly Pathogenic Avian Influenza Pandemic in Africa by R.F. Breiman et al. Expedited articles can be viewed at: http://www.cdc.gov/ncidod/eid/upcoming.htm.

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College and University Planning for Pandemic Influenza: A Survey of Philadelphia Schools
Lori Uscher-Pines et al. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 2007, 5(3): 249-254. doi:10.1089/bsp.2007.0023. http://www.liebertonline.com/doi/abs/10.1089/bsp.2007.0023
Abstract: Objectives: This study was undertaken to assess the current state of college and university planning for pandemic influenza and to inform guidance for these institutions. Methods: The Philadelphia Department of Public Health developed an interview guide based on CDC guidance and conducted in-depth structured interviews with college and university pandemic planners in Philadelphia. Results: Thirteen of 14 schools contacted participated in interviews. Six schools, or slightly fewer than half, reported having a draft pandemic influenza plan. Schools noted barriers such as insufficient information and financial resources and institutional support. They reported that they lacked concrete policy recommendations suited to different types of institutions (e.g., small colleges) and lacked the political will to tackle a hypothetical threat. Schools requested further guidance on triggers for campus closure, materials to stockpile, and policies for refunding tuition and adjusting credits for missed coursework. Conclusions: School pandemic planning is in its early stages. Local government can provide recommendations as to the appropriate level of planning detail, disseminate examples of best practices planning, and continue to emphasize the importance of all-hazards approaches to emergency planning.

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Validity of Parental Report of Influenza Vaccination in Children 6 to 59 Months of Age
Myrick C. Shinall, Jr, et al. PEDIATRICS Vol. 120 No. 4 October 2007, pp. e783-e787 (doi:10.1542/peds.2007-0052) http://pediatrics.aappublications.org/cgi/content/abstract/120/4/e783
Abstract: PATIENTS AND METHODS. A cross-sectional study of children who were 6 to 59 months of age and presented to a large, pediatric residency clinic from February through April 2005 was performed. A standardized, parental questionnaire ascertained the influenza vaccination status of children during the 2004–2005 influenza season and was compared with the medical chart, the criterion standard. Children were classified as being at high risk when they had a specific influenza vaccine recommendation in 2004–2005 by age (6–23 months of age) or by chronic medical condition. RESULTS. Of 218 parents approached in the pediatric residency clinic, 198 (95%) children who were 6 to 59 months of age were enrolled, and 84 (42%) were vaccinated according to the medical chart. More children who were 6 to 23 months than those who were 24 to 59 months of age were vaccinated (63% vs 21%). Children with chronic medical conditions were more likely to be vaccinated than healthy children who were 24 to 59 months of age (57% vs 11%), but no difference was observed for children who were 6 to 23 months of age (79% vs 60%). In comparison with the medical chart, parental report of influenza vaccination had a sensitivity of 88%, a specificity of 90%, and a coefficient of 0.78. For children who were 6 to 23 months of age or had a chronic medical condition (n = 123), parental report had a sensitivity of 89%, a specificity of 81%, and a coefficient of 0.71. CONCLUSIONS. Parental report of influenza vaccination among children who were 6 to 59 months of age had reasonable sensitivity, specificity, and reliability as compared with the medical chart in this study population.

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Effectiveness of Influenza Vaccine in the Community-Dwelling Elderly
Kristin L. Nichol et al. NEJM. Volume 357:1373-1381. October 4, 2007. Number 14. http://content.nejm.org/cgi/content/full/357/14/1373
Abstract: Background Reliable estimates of the effectiveness of influenza vaccine among persons 65 years of age and older are important for informed vaccination policies and programs. Short-term studies may provide misleading pictures of long-term benefits, and residual confounding may have biased past results. This study examined the effectiveness of influenza vaccine in seniors over the long term while addressing potential bias and residual confounding in the results. Methods Data were pooled from 18 cohorts of community-dwelling elderly members of one U.S. health maintenance organization (HMO) for 1990–1991 through 1999–2000 and of two other HMOs for 1996–1997 through 1999–2000. Logistic regression was used to estimate the effectiveness of the vaccine for the prevention of hospitalization for pneumonia or influenza and death after adjustment for important covariates. Additional analyses explored for evidence of bias and the potential effect of residual confounding. Results There were 713,872 person-seasons of observation. Most high-risk medical conditions that were measured were more prevalent among vaccinated than among unvaccinated persons. Vaccination was associated with a 27% reduction in the risk of hospitalization for pneumonia or influenza (adjusted odds ratio, 0.73; 95% confidence interval [CI], 0.68 to 0.77) and a 48% reduction in the risk of death (adjusted odds ratio, 0.52; 95% CI, 0.50 to 0.55). Estimates were generally stable across age and risk subgroups. In the sensitivity analyses, we modeled the effect of a hypothetical unmeasured confounder that would have caused overestimation of vaccine effectiveness in the main analysis; vaccination was still associated with statistically significant — though lower — reductions in the risks of both hospitalization and death. Conclusions During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved.

Editorial on this article by John D. Treanor: http://content.nejm.org/cgi/content/full/357/14/1439

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Treatment with Convalescent Plasma for Influenza A (H5N1) Infection
Boping Zhou et al. NEJM. Volume 357:1450-1451. October 4, 2007. Number 14 http://content.nejm.org/cgi/content/full/357/14/1450
To the Editor: “A previously healthy 31-year-old male van driver presented to a local clinic in Shenzhen, in southern China, on June 7, 2006, with a 4-day history of a high fever (temperature, 39.9°C), chills, and a cough with clear sputum. A chest radiograph obtained on June 9 revealed large opacities in the lower lobe of the left lung. A reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay and an isolate from a tracheal aspirate were positive for influenza A (H5N1) virus. Treatment with 150 mg of oseltamivir twice daily was started at 2 a.m. on June 12. After 2 days, there was increased consolidation in the right lung and only slight improvement in the left lung. Quantitative RT-PCR revealed a high viral load (1.31x105 copies per milliliter) when it was first measured (at 4 a.m. on June 13), 26 hours after the patient began to receive oseltamivir. The viral load continued to increase and was 1.68x105 copies per milliliter by 10 a.m. on June 14, despite the continuation of oseltamivir treatment. Although oseltamivir resistance during the treatment of influenza A (H5N1) virus infection has been reported, no genetic evidence of resistance to oseltamivir was observed in our patient. . .”

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Update on Vaccine-Derived Polioviruses--Worldwide, January 2006--August 2007
In 1988, the World Health Assembly resolved to eradicate poliomyelitis worldwide. Subsequently, the Global Polio Eradication Initiative of the World Health Organization (WHO) reduced the global incidence of polio associated with wild polioviruses (WPVs) from an estimated 350,000 cases in 1988 to 1,998 reported cases in 2006 and reduced the number of countries that have never succeeded in interrupting WPV transmission to four (Afghanistan, India, Nigeria, and Pakistan). However, because vaccine-derived polioviruses (VDPVs) can produce polio outbreaks in areas with low rates of Sabin oral poliovirus vaccine (OPV) coverage and can replicate for years in immunodeficient persons, enhanced strategies are needed to limit emergence of VDPVs and stop all use of OPV once WPV transmission is eliminated. This report updates a summary of VDPV activity published in 2006 and describes VDPVs detected during January 2006--August 2007. . .
http://cdc.gov/mmwr/preview/mmwrhtml/mm5638a3.htm
(MMWR September 28, 2007 / 56(38);996-1001)

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Salmonella Oranienburg Infections Associated with Fruit Salad Served in
Health-Care Facilities--Northeastern United States and Canada, 2006 During June--July 2006, a total of 41 culture-confirmed Salmonella serotype Oranienburg infections were diagnosed in persons in 10 northeastern U.S. states and one Canadian province. This report describes the epidemiologic, environmental, and laboratory investigations of this outbreak by federal, state, and local health agencies; the Food and Drug Administration (FDA); and the Canadian Food Inspection Agency. The results of the investigations determined that illness was associated with eating fruit salad in health-care facilities. Although the fruit salads were produced by one processing plant, the source of contamination was not determined. This outbreak highlights the importance of laboratory-based surveillance of Salmonella, including molecular subtyping, and timely communication of public health information. . .
http://cdc.gov/mmwr/preview/mmwrhtml/mm5639a3.htm
(MMWR October 5, 2007 / 56(39);1025-1028)

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3. Notifications
Clinical Vaccinology Course--November 9--11, 2007
CDC and 4 other national organizations are collaborating with the National Foundation for Infectious Diseases (NFID), Emory University School of Medicine, and the Emory Vaccine Center to sponsor a Clinical Vaccinology Course, Nov 9--11, 2007, in Bethesda, Maryland. The course will focus on new developments and concerns related to the use of vaccines in pediatric, adolescent, and adult populations. Leading infectious-disease experts will present information on newly available vaccines, vaccines under development, and older vaccines whose continued administration is essential to improving disease prevention. This course is specifically designed for physicians, nurses, nurse practitioners, physician assistants, vaccine-program administrators, and other health-care professionals interested in the clinical aspects of vaccinology. The course also might be useful for health-care professionals involved in prevention and control of infectious diseases. For more information: http://www.nfid.org/conferences/idcourse07, or by e-mail (idcourse@nfid.org), fax (301-907-0878), telephone (301-656-0003, ext. 19), or mail (NFID, 4733 Bethesda Avenue, Suite 750, Bethesda, MD 20814-5228).
http://cdc.gov/mmwr/preview/mmwrhtml/mm5638a6.htm
(MMWR September 28, 2007 / 56(38);1005)

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Australia Pledges $93 million Support to Global Fund (fwd)
Australia has made a major new commitment to combat AIDS, tuberculosis (TB) and malaria in the Asia-Pacific. Australia's new pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria is a specific allocation under the government's existing $1 billion commitment to the global fight against HIV/AIDS. Australia pledged $93 million over 2 years from 2008-09 to the Global Fund, building on the $42 million already committed this year. This new commitment follows Australia's previous 4-year pledge of $75 million which was completed this year. Australia's support to the Global Fund has helped save the lives of more than 1.8 million people. Since it was established 5 years ago, the Global Fund has provided more than 1 million people with anti-retroviral treatment for HIV, 2.8 million people with TB treatment and distributed 30 million bed nets for the prevention of malaria.

The 3 diseases have hit the Asia-Pacific region hard--more than 8.6 million people are living with HIV, there are 5 million new cases of TB each year and malaria is endemic in 20 countries. In Asia and the Pacific, resources from the Global Fund purchase much-needed commodities such as pharmaceuticals, mosquito bed nets and other medical supplies. Global Fund resources are used to improve diagnosis and treatment facilities in the region and provide training for health professionals. For example, in Papua New Guinea, a Global Fund grant is scaling up testing, treatment and care for people living with HIV and for the prevention of mother-to-child transmission of HIV.
(AIDS ASIA 9/30/07)

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High-containment biosafety laboratories: preliminary observations on the oversight of the proliferation of BSL-3 and BSL-4 laboratories in the United States
Government Accountability Office, Congressional testimony released Oct 4, 2007.
http://www.gao.gov/new.items/d08108t.pdf
What GAO Found: A major proliferation of high-containment BSL-3 and BSL-4 labs is taking place in the United States, according to the literature, federal agency officials, and experts. The expansion is taking place across many sectors—federal, academic, state, and private—and all over the United States. Concerning BSL-4 labs, which handle the most dangerous agents, the number of these labs has increased from 5—before the terrorist attacks of 2001—to 15, including at least 1 in planning stage. Information on expansion is available about high-containment labs that are registered with the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Agriculture’s (USDA) Select Agent Program, and that are federally funded. However, much less is known about the expansion of labs outside the Select Agent Program, as well as the nonfederally funded labs, including location, activities, and ownership. No single federal agency, according to 12 agencies’ responses to our survey, has the mission to track the overall number of BSL-3 and BSL-4 labs in the United States. Though several agencies have a need to know, no one agency knows the number and location of these labs in the United States. Consequently, no agency is responsible for determining the risks associated with the proliferation of these labs. We identified six lessons from three recent incidents: failure to report to CDC exposures to select agents by Texas A&M University (TAMU); power outage at the CDC’s new BSL-4 lab in Atlanta, Georgia; and release of foot-and-mouth disease virus at Pirbright in the United Kingdom. These lessons highlight the importance of (1) identifying and overcoming barriers to reporting in order to enhance biosafety through shared learning from mistakes and to assure the public that accidents are examined and contained; (2) training lab staff in general biosafety, as well as in specific agents being used in the labs to ensure maximum protection; (3) developing mechanisms for informing medical providers about all the agents that lab staff work with to ensure quick diagnosis and effective treatment; (4) addressing confusion over the definition of exposure to aid in the consistency of reporting; (5) ensuring that BSL-4 labs’ safety and security measures are commensurate with the level of risk these labs present; and (6) maintenance of high-containment labs to ensure integrity of physical infrastructure over time.

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 apecein@u.washington.edu