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Vol. X No. 24 ~ EINet News Briefs ~ Nov 30, 2007


*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- Global: Virus-sharing pact eludes WHO group, but works continues
- Romania (Tulcae): Avian influenza H5N1 found in hens and ducks
- Saudi Arabia (Riyadh): Avian influenza H5N1 detected at egg producing facilities
- Saudi Arabia (al-Karj): More cases of avian influenza H5N1 found in al-Karj farm
- UK: Avian influenza H5N1 outbreak may be linked to wild birds, lax biosecurity
- Hong Kong: Sick egret tests positive for avian influenza H5N1
- Myanmar (Shan): Avian influenza detected among chickens
- South Korea (Gwangju): Latest outbreak caused by low pathogenic avian influenza H7 strain
- China (Hankou): Outbreak in school is still a mystery
- Indonesia (Jakarta): Outbreak of diarrhea kills six infants and one adult
- Indonesia: Conflict over unspecified HPV samples
- Indonesia (Java): Suspected Chikungunya outbreak spreads through Java
- New Zealand: (Canterbury): Yersiniosis caused by cocktail sausages
- Philippines (Northern Samar): Contaminated water leads to outbreak of diarrhea
- Russia (Tyumen): Outbreak of dysentery at boarding school
- Taipei (Taichung): Confirmed cases of bacillary dysentery increase to 38
- Thailand: Hand, foot, and mouth disease shuts down schools in Lampang and Chon Buri
- Viet Nam: More cholera cases found in the northern provinces
- Canada (Ontario): Confirmed cases in salmonella outbreak stand at 85
- Canada (Alberta): New campaign to encourage mumps vaccination
- USA: American Foods Group recall of beef due to E. coli contamination
- USA (Michigan): Sick restaurant workers infect hundreds with a norovirus
- USA (Maine): Rise in mumps infections causes update in vaccine recommendations
- USA (Virginia): Botulism suspected in two deaths
- USA: Salmonellosis in frozen poultry pies sparks recall
- USA (Multistate): Update on adenovirus serotype 14 cluster
-

1. Updates
- AVIAN/PANDEMIC INFLUENZA
- CHOLERA
- DENGUE

2. Articles
- CDC EID Journal, Volume 13, Number 12--Dec 2007
- Pandemic test undertaken by financial services paints dire scenario
- Remember the pandemic threat? (Some) IT planners do
- Where High-Risk Adults Receive Influenza Vaccine During a Shortage
- Expansion of Use of Live Attenuated Influenza Vaccine (FluMist®) to Children Aged 2--4 Years and Other FluMist Changes for the 2007--08 Influenza Season
- Where High-Risk Adults Receive Influenza Vaccine During a Shortage

3. Notifications
- National Influenza Vaccination Week: 26 November - 2 December 2007
- New support to pandemic vaccine supply
- Quarterly newsletter of AIDS Society of Asia and the Pacific (ASAP)


Global
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)

2007
Cambodia/ 1 (1)
China / 3 (2)
Egypt / 20 (5)
Indonesia / 38 (33)
Laos / 2 (2)
Nigeria / 1 (1)
Viet Nam 7 (4)
Total / 72 (48)

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)

2005
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 17 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 95 (41)

2004
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)

2003
Viet Nam / 3 (3)
Total / 3 (3)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 335 (206).
(WHO 11.12.07 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 11.12.07)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 11.21.07):
http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 11.22.07):
http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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Global: Virus-sharing pact eludes WHO group, but works continues
A World Health Organization (WHO) group that recently met to work out an agreement to ease the global sharing of H5N1 avian influenza viruses failed to resolve the issue, but signaled that work on the issues would continue.

The WHO working group on virus sharing met in Geneva from 20 Nov 2007 through 23 Nov 2007. An impasse over the virus-sharing issue began last December when Indonesia, the nation hardest hit by the H5N1 virus, stopped sending samples to WHO collaborating centers to protest the high cost and lack of access to vaccines that pharmaceutical companies are developing from the strains the country has shared.

Indonesia, represented by its health minister Siti Fadilah Supari, pushed for a material transfer agreement (MTA) for each virus sample it sends outside the country, specifying that the sample be used only for diagnostic purposes. Commercial use of the virus would require the permission of the country that provided the sample. The country's health minister has said that retaining the intellectual property rights to the H5N1 samples would ensure its citizens greater access to global pandemic vaccine stockpiles at more affordable prices. Health ministry spokeswoman Lily Sulistiowati said that Indonesia hopes negotiations over H5N1 sample sharing will continue. However, she said the demand for an MTA was nonnegotiable. "We will not send samples overseas without an MTA," Sulistiowati said.

However, John Lange, the United States' special representative for avian and pandemic influenza, said that he opposed automatic rewards for each sample a country shares. He maintained that it is important to protect patents related to the H5N1 virus, because vaccine development is risky, time-consuming, and expensive for pharmaceutical companies.

Gregory Hartl, WHO spokesman, said the next step for work on the virus-sharing issue is not clear, but officials will probably meet in a smaller working group in May ahead of the WHO's World Health Assembly (WHA) that month. He said a full working group session would be required after the WHA to finalize a virus-sharing agreement.
(CIDRAP 11.26.07)

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Europe/Near East
Romania (Tulcae): Avian influenza H5N1 found in hens and ducks
Romania discovered an outbreak of the H5N1 avian flu virus in the Danube river delta at a small farm on 28 Nov 2007, officials said.

The head of the National Sanitary Veterinary Agency (ANSV), Radu Roatis, said tests taken on samples from the dead birds revealed the presence of the H5N1 virus.

"The suspicion for H5N1 was confirmed by the national laboratory. We discovered the virus in hens and ducks," said Roatis. The Tulcae region, the site of the current outbreak, is within the Danube delta. This is the very same area where a large epizootic of H5N1 took place in October-November 2005, involving wild birds, predominantly swans, as well as domestic fowl.
(ProMED 11.28.07)

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Saudi Arabia (Riyadh): Avian influenza H5N1 detected at egg producing facilities
Saudi Arabia's agriculture ministry on 28 Nov 2007 said two new cases of avian influenza were detected at separate egg production facilities in the capital Riyadh (Thadiq and Kharj governorates).

The agriculture ministry, together with the interior ministry, hospitals and local governments in the affected region, killed all birds at the two sites. The facilities were also cleaned before these were closed down. The ministry ordered poultry breeders and producers from the two facilities to take measures to prevent the spread of the disease by making sure that migrating birds don't enter sheds, fodder or drinking and cooling water. Owners of poultry farms and residents are urged to report suspicious cases through a toll-free hotline or to the nearest branch of the agriculture ministry.

The severe measures applied by the Saudi authorities to control the H5N1 outbreaks, cull the affected holdings, and prevent further events are dictated by the timetable of the upcoming mass-celebrations, when millions of worshippers are expected in the kingdom. The annual Hajj is due to begin 18 Dec 2007; the Eid Al-Adha festival begins on 20 Dec 2007.
(ProMED 11.26.07)

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Saudi Arabia (al-Karj): More cases of avian influenza H5N1 found in al-Karj farm
More cases of H5N1 bird flu have been found at a poultry farm in Saudi Arabia the Ministry of Agriculture said on 26 Nov 2007. All birds at the farm at al-Kharj, 150 km south of Riyadh were culled after the H5N1 strain was found there. Saudi authorities killed 50,000 birds in al-Kharj earlier this month after 1,500 birds died of unspecified causes, and inspection teams have since then culled thousands more at markets around the capital of around 4 million people.
(ProMED 11.26.07)

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UK: Avian influenza H5N1 outbreak may be linked to wild birds, lax biosecurity
The initial epidemiologic report, released today, on the United Kingdom's recent outbreaks of H5N1 avian influenza in Suffolk said the source of the virus is unknown but could have been wild birds.

The 24-page report from the UK Department for Environment, Food and Rural Affairs (DEFRA), released on the department's Web site, said the H5N1 virus infected poultry at the Redgrave Farm facility near Diss, then was transmitted by vehicles, people, or other means to a second farm owned by the same company.

Investigators have so far ruled out the possibility that infected poultry or poultry products, or the vehicles or people transporting them from other counties, played a role in spreading the virus to the commercial farm, which housed turkeys, ducks, and geese.

"Wild birds cannot be ruled out as a source of infection," DEFRA said. "To date, there is no evidence of H5N1 infection in the local wild bird population or in GB [Great Britain] as a whole, but the continued surveillance may help clarify the infection status of the wild bird population."

Among other details in the report, most of the infected birds on the first farm were turkeys, but a few ducks were sick as well. The findings suggest an initial introduction of the virus into one of the groups of turkeys, rather than widespread exposure of poultry on the farm. Genetic analysis of virus samples from birds on the two affected farms revealed that the birds were infected from a single source and that the virus most closely resembled an isolate from wild birds from the Czech Republic that was detected in mid 2007, the report said. Samples from poultry on the farms that supplied birds to the two Redgrave Farm facilities tested negative, and all of the birds were hatched in Great Britain, the report said.

Investigators identified two key biosecurity concerns. One was that farm workers who traveled between the facilities did not follow simple measures such as changing clothing, disinfecting their boots, and sanitizing the feed buckets they carried to feed birds. Another was that the first affected farm, a free-range facility, was likely to attract not only migratory waterfowl from a nearby ornamental farm but also "bridge" species such as gulls.
(CIDRAP 11.29.07)

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Asia
Hong Kong: Sick egret tests positive for avian influenza H5N1
A sick egret found in Hong Kong last week has tested positive for the virulent H5N1 strain of bird flu, the government said 24 Nov 2007. The bird, which was collected from a park and died the next day, was confirmed to have had the disease after several laboratory tests, the Agriculture, Fisheries and Conservation Department said in a statement.

Hong Kong has occasionally found avian influenza in wild birds but hasn't suffered a major outbreak of the disease lately. Hong Kong aggressively monitors bird flu because the first documented cases of the disease in humans occurred in the territory. An outbreak of H5N1 in 1997 killed six people. That prompted the government to slaughter the entire poultry population of about 1.5 million birds.
(ProMED 11.26.07)

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Myanmar (Shan): Avian influenza detected among chickens
Officials in Burma say a new outbreak of bird flu has been detected among chickens in an eastern district near the Chinese border. The outbreak was found at a farm in Kentung township in eastern Shan state on 18 Nov 2007, after a farmer reported an unusual number of deaths in his chickens.

Officials culled an unknown number of birds at the farm. A statement from the Myanmar Livestock and Veterinary Department urged people to prevent the entry of poultry and birds from neighboring countries into Burma.
(ProMED 11.26.07)

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South Korea (Gwangju): Latest outbreak caused by low pathogenic avian influenza H7 strain
South Korea's first bird flu outbreak in eight months forced the slaughter of thousands of ducks in the country's south on 24 Nov 2007, although the H5N1 virus was not involved, the government said.

The virus that caused the latest outbreak was a "low pathogenic" H7 strain that has not been known to spread to humans, said an official at the Ministry of Agriculture and Forestry. Quarantine workers slaughtered about 17,000 ducks at the farm in Gwangju, about 330 km southwest of the capital, Seoul. The outbreak, South Korea's first since March, was confirmed on 23 Nov 2007.

A total of seven outbreaks of the lethal H5N1 virus hit poultry farms across South Korea between November 2006 and March 2007, resulting in the slaughter of about 2.8 million birds. The country declared itself free of bird flu in June 2007 after reporting no new outbreaks for three months. The latest outbreak does not affect South Korea's bird flu-free status because it involves a "low pathogenic" virus, a ministry official said.
(ProMED 11.24.07)

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China (Hankou): Outbreak in school is still a mystery
About 20 pupils from a single class in a nursery school in Jiayuan District in Hankou have fallen ill, and the class has been suspended. A parent explained that his three-year old is in the school's fifth class.

On the morning of 20 Nov 2007, the child suddenly had pain in his mouth. His parents brought him to Wuhan Municipal Children's Hospital where it was discovered that the inside of his mouth was covered with ulcers, rashes had appeared on his extremities, and he had a mild fever. Inside the hospital, the family encountered eight other pupils and their parents from the same class. All of the pupils' symptoms were very similar. The parents estimate that about 20 pupils in the school's fifth class have contracted this type of illness.

On 22 Nov 2007, the classroom was found to be completely empty. This information was reported to the Wuhan Disease Control Center. On 23 Nov 2007, an official with the nursery school told reporters that from 19 Nov 2007, pupils had been developing this strange type of illness. To avoid further transmission, the school asked that all students in the fifth class stay home to rest. An official with the Epidemic Prevention Department of Jiangan District Disease Control Center said that about 20 pupils have fallen ill and that the diagnosis cannot yet be confirmed. Workers have already disinfected the nursery school and arrangements were made for experts to conduct observation.
(ProMED 11.24.07)

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Indonesia (Jakarta): Outbreak of diarrhea kills six infants and one adult
The city administration is currently investigating the cause of a diarrhea outbreak in North Jakarta. Deputy Governor Prijanto said on 28 Nov 2007 he suspected refill water as the main cause of the outbreak, which had killed seven people as of that morning.

As many as 86 infants and eight adults were being treated at Koja Hospital in North Jakarta for diarrhea on 27 Nov 2007, according to City Health Agency deputy head Salimar Salim. The number of patients at the hospital had increased from a total of 33 on 22 Nov 2007 to 43 and 81 on successive days and peaked on 26 Nov 2007 with 113 patients, including 105 babies and eight adults. The outbreak has killed six infants and an adult.

"The babies were admitted to the hospital too late, and they were severely dehydrated," Salimar said.

Most of the patients being treated are from Rawa Badak and Lagoa subdistricts in Koja district, and Tanjung Priok subdistrict in Tanjung Priok district. Salimar said other diarrhea patients were also being treated in a number of hospitals, including North Jakarta Islam Hospital, Tanjung Priok Port Hospital and Sulianti Saroso Hospital, all in North Jakarta, as well as Tarakan Hospital in Central Jakarta. The number of diarrhea patients at Tarakan Hospital was also high, she said, reaching 36 as of 27 Nov 2007.
(ProMED 11.28.07)

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Indonesia: Conflict over unspecified HPV samples
An Indonesian fisherman who developed tree-like growths on his hands and feet is at the center of an international medical spat after his country's health minister criticized doctors trying to treat him.

Indonesia's Health Minister, Siti Fadilah Supari, lambasted the US doctor currently treating the 35-year-old man, who has the rare affliction apparently caused by a human papilloma virus. Mrs. Supari is angry that Dr. Anthony Gaspari has taken blood and tissue samples out of the country to the United States in a bid to diagnose the illness. She claims such samples could be used in the future to make vaccines that the poor could not afford. Developing nations such as Indonesia risk exploitation unless they maintain control over their virus strains, Mrs. Supari said. But her comments have now offended Dr. Gaspari, an American dermatologist at the University of Maryland, who maintains that, while he took the samples without permission, his sole motivation was getting treatment for the man.

The man (known as “Dede”), who lives in a village south of Jakarta, has massive root-like warts growing from his arms and legs which have gone untreated for years.

"We did take samples, and the reason we did was to render a diagnosis. We did it for humanitarian reasons, to help the patient," Dr. Gaspari said, stressing his willingness to put in writing that the samples were not for commercial use.

Mrs. Supari, who has famously refused to share bird flu samples with international scientists, made her comments on 25 Nov 2007 after returning from a World Health Organisation (WHO) conference. "We are offended because the samples were taken from Dede without our permission," she said at the hospital where the man was being treated. "If they are taken abroad, they could become lucrative commodities." The intergovernmental conference was aimed at rebuilding a global system for sharing viruses.
(ProMED 11.27.07)

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Indonesia (Java): Suspected Chikungunya outbreak spreads through Java
Seventeen sufferers of suspected chikungunya in the area of the Loji Subdistrict, Kota Bogor, gradually recovered. Curungrejo Village, Kecamatan Kepanjen, Kabupaten Malang, East Java was declared an Extra Ordinary Incident due to a suspected chikungunya outbreak, after 26 local residents came down with what officials believe is the illness.

The health service carried out fogging/fumigation. Fumigation was done to kill chikungunya vector mosquitoes, the service head of the Kesehatan Regional Government, Malang, East Java, Muhammad Fauzi, said 25 Nov 2007. Apart from the Kepanjen Subdistrict, in the Malang Regency, two other subdistricts, Gondanglegi and Kalipare, had suspected chikungunya virus outbreaks.

Suspected chikungunya attacked several areas in the Bogor Regency in the weeks of 11 and 18 Nov 2007. Hundreds of residents were reported to be infected by the illness that was spread by mosquitoes. Dozens of villagers of Loji Kota Bogor have been infected by the suspected chikungunya. In the Bogor Regency, the same plague attacked hundreds of residents in two subdistricts, namely the Ciampea Subdistrict and Darmaga. In the Ciampea Subdistrict, suspected chikungunya spread in Bojongrangkas village, Cihideung Ilir, and Cinangneng, affecting residents there. In the Darmaga Subdistrict that neighbors the Ciampea area, approximately 60 people were affected by suspected chikungunya. However, to confirm whether they were affected by chikungunya or not, officials are still awaiting results of the tests on the blood that was sent by us to Jakarta, he said. Eulis also said, based on symptoms seen in the sufferers, they were indeed suspected to be ill with chikungunya.

The week of 19-25 Nov 2007, the illness spread in Purwahamba Village, Kecamatan Suradadi, Tegal, Central Java. This illness mostly attacked children. The sufferers of chikungunya generally experienced high fever accompanied by joint pain.

[This outbreak appears to be spreading. There is still no information about laboratory confirmation of these Java outbreaks as due to chikungunya virus].
(ProMED 11.28.07 & 11.26.07 & 11.25.07 & 11.24.07)

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New Zealand: (Canterbury): Yersiniosis caused by cocktail sausages
Canterbury's Medical Officer of Health is urging people to thoroughly heat cocktail sausages before eating them following an outbreak of an illness among children who had consumed them.

Dr. Ramon Pink says cocktail sausages (also known as cheerios or saveloys) should be heated before they are eaten and should not be offered cold to children at butcher shops or delicatessens. An investigation by the Canterbury District Health Board's Community and Public Health division has found six children under five years old with yersiniosis had eaten cocktail sausages. Symptoms of the infection usually last about 48 hours and include diarrhea, possibly stomach pains, but usually no vomiting.

Most of the children lived in the south Christchurch area and the suspected food was purchased in this area. The problem appears to have occurred from mid Oct to early Nov 2007. It is believed more people, particularly children, could have been affected by the illness. The cocktail sausages were given to most of the children over the counter, a common practice, which has been associated with outbreaks of Salmonella and Campylobacter in Christchurch in the past.

While cocktail sausages are cooked during their preparation they are not ready-to-eat foods. Further heating before eating is required to destroy any bacteria that may have contaminated them after they were made. As the scale of the outbreak is unknown, Dr. Pink says anyone who has eaten cocktail sausages purchased from the south Christchurch area during October-November 2007 and has developed diarrhea and possibly stomach pains should contact a Community and Public Health Protection Officer.
(ProMED 11.28.07)

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Philippines (Northern Samar): Contaminated water leads to outbreak of diarrhea
At least 47 diarrhea cases from the same barangay [district] in Mondragon, Northern Samar, were reported by the Provincial Health Office of Northern Samar. The dirty source of drinking water that is also prevalent in the neighboring municipalities was pinpointed as the cause of the diarrhea cases.

Several children were the victims, 13 of whom were confined at the Northern Samar Provincial Hospital in Catarman. It was reported that open dug wells and jetmatic pumps are the source of drinking water, all of which are exposed to the elements and bacteria. More so, these sources of drinking water are not treated with chlorine. Because of the continuous rains that were experienced for several days due to typhoon Lando, the drinking water sources have been rendered unsafe for drinking. As a safety measure, the Northern Samar Provincial Health Office advised the villagers to boil or put chlorine in the water that they use for drinking.
(ProMED 11.26.07)

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Russia (Tyumen): Outbreak of dysentery at boarding school
An investigation has been launched in Tyumen related to an outbreak of dysentery at a boarding school. The first cases appeared on 13 Nov 2007 when only four children were referred to the hospital. By the evening of 17 Nov 2007 the number of affected children had grown to 51. The preliminary diagnosis was announced as acute dysentery and all the children received appropriate treatment.
(ProMED 11.26.07)

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Taipei (Taichung): Confirmed cases of bacillary dysentery increase to 38
Officials of the Center for Disease Control (CDC) said confirmed cases of bacillary dysentery in the central city of Taichung have increased to 38. But they said the whole situation is under control and denied the outbreak has spread to neighboring communities as reported by the media. Most of the 38 cases were samples gathered from pupils of Beitun Elementary School in Taichung before preventive strategies were applied on 23 Nov 2007. All four members of the same family were among the confirmed cases. Both parents were on the faculty at the school, while their two children are pupils in different grades. Officials said two children of one of the cooks at the school, one studying at the same elementary school and the other at a private senior high school, checked into the Chinese Medical University Hospital last week.

Although the hospital reported that both showed symptoms of bacillary dysentery, the CDC will have to make a further examination to clarify the cases in three or four days. There were an additional 114 samples gathered from pupils on 24-25 Nov 2007 that have to be verified. But they stressed that no new pupils have reported any signs related to bacillary dysentery so far, suggesting the situation is now under control. Contaminated water is suspected as the source of infection.
(ProMED 11.26.07 & 28)

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Thailand: Hand, foot, and mouth disease shuts down schools in Lampang and Chon Buri
Several schools in central and northern Thailand have been ordered to close after the outbreak of hand, foot & mouth disease (HFMD). The Public Health Office in northern Lampang Province 23 Nov 2007 ordered several schools to close after outbreaks of the disease.

Meanwhile, in central Chon Buri Province, several schools in Sattahib district were ordered to be on alert following an outbreak of HFMD. About 10 students of Ban Sattahib School got the disease and received treatment at two hospitals in the district, prompting the district health office to inform other schools to be on alert.
(ProMED 11.23.07)

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Viet Nam: More cholera cases found in the northern provinces
The Ministry of Health reported on 21 Nov 2007 eight more cases of acute diarrhea, of these four tested positive for cholera. Since the beginning of the outbreak, the country has reported 1941 cases of acute diarrhea in northern provinces, of which 261 tested positive for cholera, according to the ministry.

New cases have appeared in Ha Noi as well as Ha Tay Province. Deputy health minister Trinh Quan Huan said he was worried about the scattered cases of cholera in areas that were believed to be adequately treated. Health preventive centers in Ha Noi and Ha Tay Province would need to strengthen inspections and treatment in infected locations, he said. Ha Tay is a major supplier of foodstuff and produce to Ha Noi and neighboring provinces, so it is in danger of becoming a hot spot for the spread of the epidemic.
(ProMED 11.26.07)

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Americas
Canada (Ontario): Confirmed cases in salmonella outbreak stand at 85
The salmonella outbreak in London, Ontario has been confirmed as Salmonella enterica serotype Typhimurium, Phage Type 108, Pulsed Field Gel Electrophoresis pattern STXAI.0312. The number of people hit by salmonella food poisoning at the University of Western Ontario has jumped by another eight confirmed cases on 26 Nov 2007. The total sickened now officially stands at 85.
(ProMED 11.25.07 & 11.27.07)

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Canada (Alberta): New campaign to encourage mumps vaccination
Mumps is spreading among young adults in Calgary, local health officials confirmed on 15 Nov 2007, as they unveiled a racy marketing campaign aimed at combating the viral disease.

Dr. Judy MacDonald, deputy medical officer of health for the Calgary Health Region, said 19 cases of the mumps have been identified in Calgary-area patients in the past month and a half, bringing the total number of cases so far in 2007 to 33. That’s a significant increase over six confirmed cases in all of 2006. The new Calgary mumps cases come as Lethbridge also battles an outbreak of the illness in post-secondary students. At least 27 people in the southern Alberta city, most of them at the city’s university and college, have suspected or confirmed cases of the mumps.

In Calgary, students will be told about upcoming vaccination clinics through a controversial advertising campaign that was used in Nova Scotia, where there was a mumps outbreak earlier this year 2007. One of the posters depicts a pair of flaming basketballs, an apparent reference to testicular swelling and pain common to the disease.

The reappearance of mumps in Western Canada is a consequence of past deficiencies in vaccination coverage and efficacy. This has left a small number of young adults of post-secondary and college age without adequate protection against this potentially dangerous infection. Vaccination programs are in progress to address the situation. Fortunately, there have been no reports so far of serious disability following recovery from mumps virus infection in these age-groups in the current outbreaks.
(ProMED 11.17.07)

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USA: American Foods Group recall of beef due to E. coli contamination
American Foods Group, LLC, a Green Bay, WI, firm, is voluntarily recalling approximately 95,927 pounds of various coarse and fine ground beef products because they may be contaminated with E. coli. The ground beef products subject to recall were produced on 10 Oct 2007, and were distributed to retail establishments and distributors in Indiana, Kentucky, Maryland, Ohio, Tennessee, Wisconsin, and Virginia. The problem was discovered through an investigation into 2 illnesses that was initiated by the Illinois Department of Public Health. Anyone concerned about an illness should contact a physician.
(ProMED 11.26.07)

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USA (Michigan): Sick restaurant workers infect hundreds with a norovirus
Three staff members at a Michigan restaurant who showed up to work sick with a stomach virus infected more than 360 people in the space of a few days, health officials reported 21 Nov 2007. The case demonstrates how easily and quickly a virus — in this case a norovirus — can spread and shows how standard cleaning does a poor job of eliminating viruses. One of the workers vomited into a trash can and then continued preparing food, including an appetizer platter. A third of the people who ate there became ill that day, Brenda Brennan and Susan Bohm of the Michigan Department of Health reported.
(ProMED 11.23.07)

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USA (Maine): Rise in mumps infections causes update in vaccine recommendations
With confirmed and suspected cases of mumps on the rise in Maine— including a suspected case in an employee at Eastern Maine Medical Center in Bangor — and a much more serious outbreak just across the border in Canada, Maine's chief public health officer on 19 Nov 2007 issued updated recommendations for vaccination against the potentially serious illness.

"Because this outbreak [in Maine] has spread, we are updating vaccination recommendations, especially among children, college and university students and hospital workers," said Dr Dora Anne Mills, head of the Maine Center for Disease Control and Prevention (CDC).

Because of the environments where they live and work, such individuals are most likely to contract and spread the virus, Mills said. Since September 2007, seven cases of mumps have been confirmed in southern and central Maine, four of them in November 2007 alone. The state is awaiting the results of lab tests on as many as 24 more suspected cases, according to the Maine CDC.

On 19 Nov 2007, a housekeeper at EMMC was given a preliminary diagnosis of mumps pending confirmation by laboratory testing. Donna Dunton, director of infection control at EMMC, confirmed that the housekeeper has been asked to stay out of work until lab reports of her mumps-like symptoms are complete. The employee is not thought to have been in close enough contact with any patients to have spread the virus, Dunton stressed, and routine infection control measures such as hand washing are likely to have minimized the possibility of transmission.
(ProMED 11.21.07)

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USA (Virginia): Botulism suspected in two deaths
The Virginia Department of Health has confirmed a second death connected to the recent investigation of two possible botulism cases. A 75 year old retired anesthesiologist, who lived in Roanoke County, was diagnosed with botulism and died 16 Nov 2007. The death of his wife, a 57 year old female physician, on 12 November 2007 was said to be "related to botulism poisoning" Authorities have not said if botulism was responsible for the first death or connected to the second, unconfirmed, case.
(ProMED 11.21.07)

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USA: Salmonellosis in frozen poultry pies sparks recall
The Illinois Department of Public Health is again warning consumers to throw out frozen pot pies that could be linked to a multistate salmonellosis outbreak. ConAgra Foods voluntarily recalled all varieties of frozen pot pie products in October 2007, produced under multiple brand names. Consumers still should discard all pot pies with the following brand names: Kroger, Banquet, Albertson's, Food Lion, Great Value, Hill Economy Fare, Kirkwood, Meijer and Western Family. "If you currently have pot pies in the freezer, even if you bought them a couple months ago, you need to pay attention to this recall," Damon Arnold, state public health director, said 16 Nov 2007. The department continues to receive reports of those sickened by eating the recalled food during the past month. To date, Illinois has seen 15 cases of salmonellosis believed to be associated with eating the recalled pot pies.
(ProMED 11.19.07)

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USA (Multistate): Update on adenovirus serotype 14 cluster
Adenovirus serotype 14 (Ad14) is a rarely reported but emerging serotype of adenovirus that can cause severe and sometimes fatal respiratory illness in patients of all ages, including healthy young adults. In May 2006, an infant in New York aged 12 days died from respiratory illness caused by Ad14. During March-June 2007, a total of 140 additional cases of confirmed Ad14 respiratory illness were identified in clusters of patients in Oregon, Washington, and Texas. 53 (38 percent) of these patients were hospitalized, including 24 (17 percent) who were admitted to intensive care units (ICUs); nine (five percent) patients died. Ad14 isolates from all four states were identical by sequence data from the full hexon and fiber genes. However, the isolates were distinct from the Ad14 reference strain from 1955, suggesting the emergence and spread of a new Ad14 variant in the United States. No epidemiologic evidence of direct transmission linking the New York case or any of the clusters was identified. State and local public health departments should be alert to the possibility of outbreaks caused by Ad14.
(ProMED 11.16.07)

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1. Updates
AVIAN/PANDEMIC INFLUENZA
- UN: http://www.un-influenza.org/: latest news on avian influenza. 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.
- OIE: http://www.oie.int/eng/info_ev/en_AI_avianinfluenza.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.
- CIDRAP: http://www.cidrap.umn.edu/: Read the series, “The Pandemic Vaccine Puzzle”.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp. Updated 30 Nov 2007.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

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CHOLERA
Thailand
The Public Health Ministry is keeping a close eye on 12 provinces for signs of cholera after several people died from eating half-cooked food. Disease Control Department (DCD) director general Dr Thawat Suntrajarn said 19 Nov 2007 checks had been made on the spread of cholera across the country from January to November 2007. It uncovered 761 people with severe diarrhea caused by cholera, seven of whom had died. Thawat said the ministry had brought the disease under control but close monitoring was needed in Khon Kaen, Udon Thani, Sakhon Nakhon, Lamphun, Roi Et, Maha Sarakham, Kalasin, Nakhon Phanom, Samut Sakhon, Nong Khai, Ayutthaya, and Mukdahan. Most people in the provinces still ate half cooked food like cockles, which was sometimes tainted with cholera bacteria.
(ProMED 11.26.07)

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DENGUE
Philippines
As of 9 Nov 2007, Capiz registered some 332 dengue cases with five deaths. Records from the Provincial Health Office (PHO) of Capiz show that from 70 dengue cases in September 2007, these have significantly declined to 25 cases in October with one death. Sanitary inspector Jane delos Reyes disclosed that from 1-9 Nov 2007 alone, the province has registered two deaths due to the day-biting mosquito carrying dengue virus. In the 11-month period in 2007, the highest number of cases was registered in August with 87 cases, followed by 83 and 70 cases in July and September, respectively, delos Reyes revealed. She said that January 2007 registered the lowest number of dengue cases, which were noted at two, followed by five cases each in March and April, and six cases each in February and May. From January to 9 Nov 2007, Roxas City posted the highest number of cases — 121 with one death — delos Reyes said, adding that the Mambusao town registered 38 cases also with one death, followed by Dumalag with 36 cases. Sapian has recorded 22 and Dumarao has also 22 cases with one death, while the municipalities of Cuartero, Dao, and Panitan have 12 cases each, she said.

The other mortalities were recorded in Maayon and Ivisan, she said. In October 2007, the Department of Health (DOH) issued a nationwide dengue fever alert after recording more than 4000 cases in the second week of September. The Department recorded 24,689 cases of the mosquito-borne disease since January 2007, with 283 deaths. Dr Eric Tayag, head of the National Epidemiology Center, said that a sharp increase in the number of cases in September and October 2007 was expected because it was during that period that the disease proliferated. (ProMED 11.26.07)

Indonesia (Java)
In the Kediri regency since early in the year, there were 1201 dengue sufferers, including 18 fatalities. In the Mojokerto Regency, 129 villages were maintained as endemic for dengue. From 18 subdistricts in the Mojokerto Regency, only Trawas was declared free of the disease. The Jatirejo area had 12 of the most seriously affected dengue villages, followed by 11 villages in the Sooko subdistrict and 10 villages in the Kutorejo subdistrict.

[Interestingly, Java also has an outbreak of febrile disease attributed to infection by chikungunya virus. Assuming both viruses are circulating, this possible situation of two simultaneous outbreaks of viruses, which produce similar symptoms underscores the need for laboratory confirmation. However, the approach for disease control, Aedes vector mosquito reduction, would be the same].
(ProMED 11.26.07)

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2. Articles
CDC EID Journal, Volume 13, Number 12--Dec 2007
CDC Emerging Infectious Diseases Journal Dec 2007 issue is now available at:
http://www.cdc.gov/ncidod/eid Selected expedited article: Influenza Virus Samples, International Law, and Global Health Diplomacy, by DP Fidler.

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Pandemic test undertaken by financial services paints dire scenario
http://www.computerworld.com/action/article.do?command=viewArticleBasic&articleId=9044021&intsrc=hm_list
If a pandemic strikes the U.S., it will kill about 1.7 million people, hospitalize 9

million, exhaust antiviral medications and reduce basic food supplies, according to a planning scenario developed by financial service firms preparing for such a catastrophe. This particular disaster occurred only on paper. But those grim numbers are some of the pandemic planning assumptions used by nearly 3,000 banks, insurance companies and security firms in a just-concluded, three-week, paper-based exercise that may have been the largest pandemic test of its kind. In each week of this drill, participants — some 10,000 people were involved — received an updated scenario and were asked to assess their capability to deliver services as the pandemic deepened and then abated.

"We wanted to look at the impact a pandemic can have on our sector," said George Hender, chairman of the Financial Services Coordinating Council. "One of the things that we tried to do is put some real stress on the firms."

During the height of the pandemic, which was estimated to occur midway through the scenario, participants were asked to consider operating with an absentee rate of nearly 50%— above the 35% to 40% rate federal officials believe may actually happen, said Hender. "We deliberately took the rate up much higher to see where their stress points were," he said. The financial services groups are now sharing the pandemic flu exercise information, and all the scenarios are available for download.

The U.S. Department of Treasury is also a sponsor of the test, and Valerie Abend, deputy assistant secretary for critical infrastructure protection and compliance at the department, said the financial services industry has been "thinking long and hard about a pandemic. We are one of the most prepared, I would argue, if not the most prepared of the critical infrastructures that are out there," said Abend.

But the financial services firms won't really know how prepared they are until the end of the year. The thousands of pages of data collected during the test, which began in the last week of September, are still being analyzed and a final report is due at year's end. But based on some preliminary feedback from participants, the financial service firms weren't handing out too many gold stars for readiness.

When asked "based on the lessons learned from the exercise, how effective are your organization's business continuity plans for a pandemic," 56% answered "moderately," the next highest group was "minimally," at 28%. Only 12% said their business continuity planning was very effective. The three-week scenario compresses the 12-week period a pandemic wave would likely last. Among the other things that may happen in an actual pandemic are school closings, as well as blackouts or brownouts in major metro areas because of degraded service as a result of absenteeism. Internet service throughput could be reduced by 50% due to congestion, and Web browsing timeouts would become common. Airlines would cut schedules, and garbage would pile up on streets. Many frustrations would arise. Working ATMs might be scarce, and call centers may not have enough staff to help. Health insurance claim volume would rise 20%. Auto claims are expected to fall 10%, since there would be less traffic on the road. But for those who are driving, gas prices would be high and fuel supplies reduced.

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Remember the pandemic threat? (Some) IT planners do
http://www.computerworld.com/action/article.do?command=viewArticleBasic&articleId=9049438&pageNumber=2

Media interest in the threat of a pandemic has fallen off. In a report this summer about pandemic planning, the White House said that attention to the pandemic has "waned in the media," while "the threat of avian influenza and the potential for an influenza pandemic has not." The U.S. Government Accountability Office followed up in a report last month, and said the challenge for many organizations is "maintaining a focus on pandemic planning due to the uncertainty of when a pandemic may occur" and the need to address more immediate issues.

"There's been a bit of what we call pandemic fatigue," says Myles Druckman, vice president of medical assistance of International SOS, a health and safety consulting service with some 4,500 employees worldwide. "When it fell out of the media, it also fell out of a lot of clients' priority lists. . .because now they weren't being pushed, not only by the media but by their employees," he says. In interviews of attendees at Gartner Inc.'s data center conference this week in Las Vegas, IT managers said they were nonetheless continuing to prepare for the potential.

Bob Kallas, director of computer support services at a company he didn't want named, says his firm conducted a test a few months ago to see how many workers it could support remotely. The company picked a day and then told several hundred employees to work from home. "We want to measure readiness to be able to support the company," he says.

Richard Siedzik, director of computer and telecommunications services at Bryant University in Smithfield, R.I., says pandemic planning continues at his university, with bimonthly meetings held specifically to address the issue. From an IT perspective, he says, the major planning issue remains continuing operations if the university is forced to close, which mostly means ensuring there's enough remote access capacity on various systems. But Siedzik says IT is only a small part of the overall planning challenge. For instance, the university has to prepare for the possibility that some students won't be able to return home because of quarantines in their community. "We have to make arrangements to sustain students on our campus," he says.

Chuck Conway, IT operations manager at an energy firm he didn't identify, says pandemic planning has become part of the company's overall business continuity planning, and he says it has examined its capacity to support remote workers and have developed scenarios. He says increased media attention on this issue may prompt more IT spending to build out even more capacity, but for now "we can live with what we have."

Earlier this fall, financial services groups along with the U.S. Department of Treasury conducted a three-week planning scenario, and planned for pandemic that would kill about 1.7 million people in the U.S. and hospitalize 9 million. About 10,000 people from 3,000 companies participated in what may have been largest test of its kind in the world. But when organizers held a press conference to announce preliminary details from the test, it received little in the way of press attention, except from trade publications, says Jim Binder, a spokesman for The Options Clearing Corp., a Chicago-based provider of derivatives clearing and settlement service. Binder was involved in the overall organizing effort. "It's not as sensational to talk about the bird flu today as it was a year ago," he says.

The avian flu remains a focal point of several diligent blogs. Among them is the H5N1 blog maintained by Crawford Kilian, a writer who teaches at a Canadian college. In response to some questions, he wrote in a note: "Business planning for a pandemic is like making your will — because you have to contemplate something awful, you'd rather not contemplate it at all. So if the media aren't nagging us, we'll put it off. The catch-22 is that they won't nag us unless people are dying daily and in growing numbers."

Expansion of Use of Live Attenuated Influenza Vaccine (FluMist®) to Children Aged 2–4 Years and Other FluMist Changes for the 2007–08 Influenza Season
On September 19, 2007, MedImmune Vaccines (Gaithersburg, Maryland) received approval from the Food and Drug Administration (FDA) to expand the use of FluMist®, a live, attenuated influenza vaccine (LAIV), to children aged 2--4 years (i.e., 24—49 months). FluMist is an intranasally administered influenza vaccine that was first licensed by the FDA in 2003 for healthy, nonpregnant persons aged 5—49 years. Expanding the age indications to include healthy children aged 2—4 years provides another influenza vaccination option for young children. In granting the new approval, FDA emphasized that FluMist is not approved for vaccination of children aged <2 years or adults aged >49 years, and that FluMist safety has not been established in persons with underlying medical conditions predisposing them to influenza-related complications. In addition, FluMist should not be administered to persons with asthma or children aged <5 years with recurrent wheezing.
(MMWR. November 23, 2007 / 56(46);1217;1219)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5646a4.htm

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Where High-Risk Adults Receive Influenza Vaccine During a Shortage
Ru-Chien Chi, et al. Arch Intern Med. 2007;167(21):2366-2368.
http://archinte.ama-assn.org/cgi/content/extract/167/21/2366

Introduction: The United States has recently experienced influenza vaccine shortages because of manufacturing problems and distribution delays. During the 2004-2005 season, only 61 of the expected 100 million influenza vaccine doses were available to the US market after 1 of the 2 licensed companies withdrew their product. The Centers for Disease Control and Prevention (CDC) recommended that available vaccine be reserved for persons at high risk for influenza-related complications and close contacts of high-risk persons. That year, vaccine coverage levels were lower among those prioritized for influenza vaccination, including older adults, long-term care residents, and health care workers. Only 63% of elderly persons and 46% of adults with chronic conditions who tried were able to obtain the influenza vaccine. . .

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Expansion of Use of Live Attenuated Influenza Vaccine (FluMist®) to Children Aged 2--4 Years and Other FluMist Changes for the 2007--08 Influenza Season
On September 19, 2007, MedImmune Vaccines (Gaithersburg, Maryland) received approval from the Food and Drug Administration (FDA) to expand the use of FluMist®, a live, attenuated influenza vaccine (LAIV), to children aged 2–4 years (i.e., 24–49 months). FluMist is an intranasally administered influenza vaccine that was first licensed by the FDA in 2003 for healthy, nonpregnant persons aged 5–49 years. Expanding the age indications to include healthy children aged 2–4 years provides another influenza vaccination option for young children. In granting the new approval, FDA emphasized that FluMist is not approved for vaccination of children aged <2 years or adults aged >49 years, and that FluMist safety has not been established in persons with underlying medical conditions predisposing them to influenza-related complications. In addition, FluMist should not be administered to persons with asthma or children aged <5 years with recurrent wheezing. (MMWR. November 23, 2007 / 56(46);1217;1219) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5646a4.htm

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Where High-Risk Adults Receive Influenza Vaccine During a Shortage
Ru-Chien Chi, et al. Arch Intern Med. 2007;167(21):2366-2368.
http://archinte.ama-assn.org/cgi/content/extract/167/21/2366

Introduction: The United States has recently experienced influenza vaccine shortages because of manufacturing problems and distribution delays. During the 2004-2005 season, only 61 of the expected 100 million influenza vaccine doses were available to the US market after 1 of the 2 licensed companies withdrew their product. The Centers for Disease Control and Prevention (CDC) recommended that available vaccine be reserved for persons at high risk for influenza-related complications and close contacts of high-risk persons. That year, vaccine coverage levels were lower among those prioritized for influenza vaccination, including older adults, long-term care residents, and health care workers. Only 63% of elderly persons and 46% of adults with chronic conditions who tried were able to obtain the influenza vaccine. . .

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3. Notifications
National Influenza Vaccination Week: 26 November - 2 December 2007
To help raise awareness regarding the importance of obtaining influenza vaccination throughout the entire influenza season, the U.S. Department of Health and Human Services, National Influenza Vaccine Summit, CDC, and other partners are conducting activities during the second annual National Influenza Vaccination Week (NIVW), November 26–December 2.

Influenza vaccination coverage in all groups recommended for vaccination remains suboptimal. Despite the timing of the peak of influenza disease, administration of vaccine decreases substantially after November. According to results from the National Health Interview Survey regarding the two most recent influenza seasons, approximately 84% of all influenza vaccinations were administered during September–November. Among persons aged >65 years, the percentage of September–November vaccinations was even higher, at 92% (CDC, unpublished data, 2007). Because many persons recommended for vaccination remain unvaccinated at the end of November, CDC is encouraging public-health partners and health-care providers to conduct vaccination clinics and other activities that promote influenza vaccination during NIVW and throughout the remainder of the influenza season.

NIVW posters and other influenza educational materials are available to download for local printing and distribution at http://www.cdc.gov/flu/professionals/flugallery. Other influenza-related tools and information for health-care professionals and patients are available at http://www.cdc.gov/flu.

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New support to pandemic vaccine supply
The United Kingdom of Great Britain and Northern Ireland's contribution of 2 million pounds to support the WHO global pandemic influenza action plan to increase vaccine supply is very much appreciated and is a gesture of global solidarity. This will serve to help establish critical influenza vaccine manufacturing capacity in developing countries and is a step towards better health security for all countries.

WHO salutes the financial support of the United States of America, Japan, Canada, the United Kingdom and the Asian Development Bank in helping to close the gap between the supply of pandemic influenza vaccines and the expected high demand for vaccine doses in the event of an influenza pandemic.

We must strive for greater and more equitable distribution of pandemic influenza vaccines. Additional funding is needed to fully protect the world's population from pandemic influenza. We call on all well-off countries to step up to the plate and assist with our USD 10 billion effort. Vaccines are the best insurance policy for public health. This investment will save many lives: now from seasonal influenza and later when an influenza pandemic strikes.
(WHO http://www.who.int/mediacentre/news/statements/2007/s17/en/index.html )

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Quarterly newsletter of AIDS Society of Asia and the Pacific (ASAP)
The quarterly newsletter of AIDS Society of Asia and the Pacific (ASAP) which is the World AIDS Day special edition, is now available at: http://www.hdnet.org/v2/file_uploads/users/bobby/QU_04-07_Final.pdf This document can also be downloaded from ASAP's website after 1 Dec 2007 (www.aidssocietyap.org).

This newsletter has a special section on the review of Eighth International Congress on AIDS in Asia and the Pacific (ICAAP). It also features an interview with the Chief Executive Office of Standard Chartered Bank in Colombo, Sri Lanka, on the launch of the Sri Lanka Business Coalition on AIDS recently at ICAAP. 'Making Visible the Invisible' is another feature-article written by Shivananda Khan OBE, Naz Foundation International (NFI). It focuses on mainstreaming male-to-male sex and HIV prevention, treatment, care and support services.

Scott Hearnden, Executive Director, AIDS Society of Asia and the Pacific (ASAP) (SEA-AIDS eForum 2007 sea-aids@eforums.healthdev.org 11.30.07)

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 apecein@u.washington.edu