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Vol. X No. 26 ~ EINet News Briefs ~ Dec 28, 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:

1. Influenza News
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- Global: Study shows regular flu vaccine may help against H5N1
- Germany: New outbreak in poultry
- Russia (Rostov): Fifth case of H5N1 avian influenza confirmed
- China: H5N1 avian influenza transmission may have been the result of very close contact
- Indonesia: 24-year-old woman dies of H5N1 avian influenza infection
- Indonesia: Suspected bird flu patients moved to avian influenza center
- Pakistan (Peshwar): WHO confirms country's first human H5N1 avian influenza infection
- Vietnam (Son La): Suspected case in four-year-old boy
- Vietnam: Avian influenza H7N3 strain makes appearance
- Egypt: Officials report two human cases of H5N1 avian influenza
- Egypt (Beni Suweif): Woman succumbs to H5N1 avian influenza

2. Infectious Disease News
- India (Mysore): City is showing signs of a chikungunya epidemic
- Indonesia (Java): Outbreak of chikungunya causes concern
- Japan: 34th case of Mad Cow Disease, milk replacers may be the culprit
- Singapore: Thirteen construction workers infected with dengue fever
- Canada: Officials report 11th Bovine Spongiform Encephalitis case
- USA: Fresh ground beef products contaminated with multi-drug resistant salmonellosis
- USA (Massachusetts): Mumps outbreak worries officials
- USA: Serratia marcescens bacteria found in heparin-filled syringes
- USA (New York): "Dried Roach" fish may be contaminated with botulism
- USA: Botulism alert for canned green beans
- US, UK, Canada: Wounded soldiers bring back drug-resistant bacterium

3. Updates
- AVIAN PANDEMIC INFLUENZA
- DENGUE

4. Articles
- Avian Flu: FAO in Action (December 2007 – No. 7)
- Emerging Infectious Diseases – Volume 14, Number 1 – January 2008
- Molecular typing of Japanese Escherichia coli O157: H7 isolates from clinical specimens by multilocus variable-number tandem repeat analysis and PFGE
- Cross-subtype immunity against avian influenza in persons recently vaccinated for influenza
- Avian influenza virus (H5N1) replication in feathers of domestic waterfowl
- Experimental infection of swans and geese with highly pathogenic avian influenza virus (H5N1) of Asian lineage
- Human infections associated with wild birds
- New swine flu virus supports 'mixing vessel' theory

5. Notifications
- Bangkok International Conference on Avian Influenza 2008: Integration from Knowledge to Control
- 2nd International Conference On Dengue/Dengue Hemorrhagic Fever
- 2008 International Conference On Biocontainment Facilities
- Where You Live


1. Influenza News

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

2007
Cambodia/ 1 (1)
China / 5 (3)
Egypt / 23 (6)
Indonesia / 41 (36)
Laos / 2 (2)
Myanmar / 1 (0)
Nigeria / 1 (1)
Pakistan / 1 (1)
Viet Nam 8 (5)
Total / 83 (55)

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: 346 (213). (WHO 12.28.07 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 12.18.07)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 12.10.07): http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 12.17.07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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Global: Study shows regular flu vaccine may help against H5N1
Ordinary seasonal flu vaccines may provide a small amount of protection against bird flu, Italian researchers reported on 26 Dec 2007. Their study is among the first to support the idea that getting an annual flu shot may help people's bodies fight off the H5N1 virus, which has killed 210 people in 13 countries and infected 341.

Cristiana Gioia, Maria Capobianchi and colleagues at the National Institute for Infectious Diseases Lazzaro Spallanzani in Rome tested the blood of 42 volunteers who had been vaccinated against seasonal influenza. In the laboratory, they added H5N1 virus to the blood and found that in some of the volunteers immune system proteins called antibodies acted against the bird flu virus. They also found a few immune cells called CD4 T-cells seemed to recognize and act against H5N1 virus "and seasonal vaccine administration enhanced the frequency of such reactive CD4 T-cells," they wrote in the journal Emerging Infectious Diseases.

"Our findings indicate that seasonal vaccination can raise neutralizing immunity against (H5N1 avian influenza) virus," the researchers concluded.

This could help explain why H5N1, which only rarely affects people, is even rarer among the elderly, Gioia's team wrote. "This finding may be explained by hypothesizing that older people, although not previously exposed to H5N1 subtype, may have gained protective immunity by previous infections sustained by circulating influenza virus strains," they wrote.
(Reuters 12.26.07)

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Europe/Near East
Germany: New outbreak in poultry
A fresh bird flu outbreak has been discovered in Germany, with a state laboratory confirming the presence of the H5N1 virus, an official veterinarian said on 20 Dec 2007.

The infected bird was in a private hen run at Bensdorf, a village 85 km west of Berlin, said state of Brandenburg vet Hans-Georg Hurttig. All 30 fowl were immediately killed and removed.

Scientists believed it was a spot outbreak only. The case would only be declared official when a federal laboratory confirmed it. A Brandenburg spokesman said it was still officially considered a "suspected case".

A second case was also discovered at Altglobsow, 75 km north of Berlin, in a hen run with 11 birds. A third case was discovered on a small poultry farm resulting in the culling of 46 chickens. The property's owner was also looking after a neighboring property with 31 chickens over the Christmas period. As a precaution, the chickens on both properties were destroyed. The three-km area has been shut off around the properties, which is dominated by small private holdings. Poultry in the surrounding area are now being held in closed pens with owners having been told to immediately report any signs of illness among their birds to local veterinary authorities.
(ProMED 12.22.07 & 12.26.07)

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Russia (Rostov): Fifth case of H5N1 avian influenza confirmed
A fifth case of bird flu was confirmed at a farm in the Rostov Region, southern Russia, close to the site of previous outbreaks, the regional emergencies ministry said.

"The outbreak at two small holdings was registered on 22 Dec 2007; samples were taken and sent for analysis; they came back positive for bird flu," the ministry said. All 79 birds on the small holding have been culled. A quarantine zone was introduced in the Tselinsky district near the site of the first case of the deadly virus.

The first bird flu outbreak was discovered in late November 2007 at the Gulyai-Borisovskaya poultry farm in the Rostov Region. The farm's entire population of 500,000 chickens was culled. Later, a bird flu outbreak was registered at a small holding close to the farm. Another outbreak was then discovered at a farm in the Tselinsky district.

The Rostov Region is particularly vulnerable to bird flu as part of the Krasnodar Territory, which is on a route taken by migrating birds in winter. In September 2007, the region was hit by the H5N1 strain, and 230,000 birds were culled. In February 2007, dead poultry with traces of the lethal virus were found in Moscow, in eight nearby areas. All cases were traced to a single market in southwest Moscow.
(ProMED 12.26.07)

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Asia
China: H5N1 avian influenza transmission may have been the result of very close contact
The World Health Organization said on 21 Dec 2007 that it was impossible to say whether a case of bird flu in China in a 52-year-old man was due to human-to-human transmission, but, even if it was, it was down to very close contact between the victims.

The assistant director-general for health security at WHO, Dr. David Heymann, said the only proven transmission of this nature so far, in Indonesia and Thailand, had been as a result of very "close contact" in a "very circumscribed area".

In China, both the man and his 24-year-old son, who died on 2 Dec 2007, had been exposed to the same common source. Infection had also occurred during the incubation period. There had been close contact with another 600 people, but blood tests had confirmed they were free from the virus.

Heymann said: "Even if there had been human-to-human transmission, it was limited and did not continue. It was not sustained, and it's that which is very important."

However, though the H5N1 strain of bird flu has not jumped the species barrier in a way that would cause a major outbreak so far, the scientific community remains convinced there is a real possibility of an influenza pandemic in the future, but it cannot say whether H5N1 will be the source or another flu variant.
(ProMED 12.22.07)

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Indonesia: 24-year-old woman dies of H5N1 avian influenza infection
A 24-year-old Indonesian woman from West Jakarta has died from avian influenza, putting the total fatalities in the country to 94, the Indonesian Health Ministry said on 25 Dec 2007.

The woman died on the morning of 25 Dec 2007 at Cengkareng Hospital in the capital, and both of her laboratory tests showed that she was positively infected by the H5N1 virus, said Nyoman Kandun, director of the ministry.

He said that it is not clear whether the woman had historical contact with fowl, as investigation is underway. The woman first showed the symptoms of the disease on 14 Dec 2007, and six days later, she was treated at the hospital, said Kandun.
(ProMED 12.26.07)

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Indonesia: Suspected bird flu patients moved to avian influenza center
After three days of medical treatment at the Serang General Hospital, six suspected bird flu patients were moved to the special avian influenza (AI) center at the Jakarta-based Persahabatan Hospital by ambulance on 21 Dec 2007.

The six were rushed to the general hospital on 19 Dec 2007 after being treated at a local health service post. The father of the first three patients said his children were suffering from fever with respiratory difficulty and cough before being taken to the health service post. He said that, a day before they fell ill, about 60 ducks and chickens owned by him and his neighbors had died suddenly.

"Local agriculture officers who checked the dead fowl said they tested positive for bird flu," he said.

Indonesia has now cleared the sick individuals, a health official said on Sat 22 Dec 2007. Two sets of laboratory tests showed the six patients admitted to a hospital in Jakarta on Fri 21 Dec 2007 did not have the H5N1 virus, said Nyoman Kandun, director-general of communicable disease control at Indonesia's health ministry. "Clearly, it's not a cluster. We do not even have a confirmed bird flu case here," Kandun said by telephone. Authorities treat cases where family members living together show symptoms of bird flu with particular care since it could point to human-to-human transmission of the virus.

[There is some confusion over the number of suspected influenza victims. For the purposes of this article, we have used six.]
(ProMED 12.22.07 & 12.23.07)

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Pakistan (Peshwar): WHO confirms country's first human H5N1 avian influenza infection
Limited human-to-human bird flu transmission may have occurred in Pakistan, but no new infections have been reported for two weeks, and there appears to be no threat of further spread, a top World Health Organization official said on 21 Dec 2007.

A WHO team has finished its initial investigation in Pakistan after up to nine patients, including several family members, were suspected of being infected with the H5N1 bird flu virus in areas north of Islamabad. They were the country's first reported human cases. The experts were expected back in Geneva to begin piecing together how the virus may have spread, but they found no evidence of anyone currently sickened by the virus, Dr. David Heymann, WHO's top flu official in Geneva, told The Associated Press by telephone.

"I think the team right now feels on initial analysis that this might be a small chain of human-to-human, non-sustained transmission," he said, stressing that there was no cause for alarm. He said the last reported case was on 6 Dec 2007. Pakistani health officials have conducted initial testing on the samples and found them to be positive, but WHO has sent the specimens to one of its collaborating laboratories for confirmation.

In the latest news, WHO has confirmed one case of human infection with H5N1 avian influenza. Laboratory tests conducted by the WHO H5 Reference Laboratory in Cairo, Egypt and WHO Collaborating Center for Reference and Research on Influenza, in London, United Kingdom, have confirmed the presence of avian influenza virus strain A (H5N1) in samples collected from one case in an affected family. Additional laboratory analysis, including gene sequencing, is ongoing.
(ProMED 12.22.07 & 12.27.07)

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Vietnam (Son La): Suspected case in four-year-old boy
Doctors suspect bird flu may have killed a four-year-old child in northern Vietnam. A Health Ministry official told a government meeting on 25 Dec 2007 the child had a fever and serious pneumonia after eating chicken that had died of unknown causes in the mountainous province of Son La. Doctors were testing to see whether the H5N1 bird flu virus was the killer, the ministry official was quoted as saying.

Vietnam last reported outbreaks among poultry in October 2007, but Son La was not on the government's bird flu watch list. The H5N1 virus killed four of the seven Vietnamese who have caught it this year, taking the country's death toll since late 2003 to 46. Health officials had worried that winter in northern Vietnam might trigger a new wave of outbreaks among poultry, as the virus seems to thrive best in cool temperatures. The Agriculture Ministry said 63 of Vietnam's 64 provinces had been vaccinating birds against the virus this year.
(ProMED 12.26.07)

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Vietnam: Avian influenza H7N3 strain makes appearance
The dangerous, human-transmissible avian influenza A (H7N3) strain, previously recorded in Korea, Canada and Holland, has re-emerged in several Asian countries including Vietnam, according to the National Steering Committee for Avian Influenza Prevention and Control. The committee held a conference on 18 Dec 2007 in Hanoi to discuss the country's response to the recent reoccurrence of the deadly bird flu.

The H7N3 virus found in Vietnam, however, is classified as low-pathogenic, not readily transmitted to humans. The committee has made plans already to import more H7N3 avian influenza vaccines to prevent possible outbreaks.

According to the Ministry of Agriculture and Rural Development, the H5N1 strain re-appeared in the northern Cao Bang province's Bao Lam District. Lower temperatures and poultry smuggling from China in the northern provinces have also increased the risk of another outbreak of bird flu in several provinces there.

The committee is directing local officials to improve environmental sanitation in high-risk areas and tighten control over the transportation of poultry through borders.
(ProMED 12.24.07)

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Africa
Egypt: Officials report two human cases of H5N1 avian influenza
Two Egyptians have tested positive for the deadly H5N1 bird flu virus, a day after an Egyptian woman died of the disease, Egypt's Health Ministry said on 27 Dec 2007.

"There are two cases today, one in Damietta and one in Menoufia . . . Today lab results confirmed that they are infected with bird flu," Amr Kandeel, head of communicable disease control at the Health Ministry said.

The two new cases, both of whom are currently receiving treatment in hospital, bring the total number of human bird flu cases in Egypt to 41, Kandeel added. State news agency MENA said the Menoufia case was a 22-year-old, but gave no details for the second case.

The H5N1 virus which causes bird flu tends to lie dormant during the summer and Egyptian officials had hoped that after two years of outbreaks it would not re-occur this winter. But John Jabbour, an official at the World Health Organization, said the new cases were not surprising. "The agent is there... Since July [2007] we've had no human cases and many things calmed down, so people returned to dealing with live birds as usual. Since the virus is there, we expect to have human cases. It's not a surprise at all," Jabbour said.

MENA reported on 27 Dec 2007 that veterinary authorities in Sharkia province had culled 12,000 chickens after tests found the flock had been infected with bird flu. Most of those who have fallen ill in Egypt were reported to have had contact with sick or dead household birds, primarily in northern Egypt where the weather is cooler than in the south.

The government still finds it hard to enforce restrictions on the movement and sale of live poultry. The death toll is the highest for any country outside Asia and could reflect the high population density in agricultural parts of Egypt. Around five million households in Egypt depend on poultry as a main source of food and income and the government has said this makes it unlikely the disease can be eradicated.
(ProMED 12.27.07)

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Egypt (Beni Suweif): Woman succumbs to H5N1 avian influenza
A 25-year-old woman has died of bird flu in Egypt, the country's Health Ministry spokesman said on 26 Dec 2007. According to the ministry, the woman who contracted the virus in the Beni Suweif province 130 km south of the capital Cairo was hospitalized on 21 Dec 2007 with a fever and breathing difficulties.

Abdul Rahman Shahin said this was the 16th victim of the deadly H5N1 bird flu virus since the first case was reported in February 2006. Of 39 Egyptians infected with bird flu, mostly women and children who contracted the virus after coming into contact with infected poultry, 16 have died.
(ProMED 12.26.07)

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2. Infectious Disease News

Asia
India (Mysore): City is showing signs of a chikungunya epidemic
The chikungunya epidemic is showing signs of spreading again in the city. The infection has affected more than 100 people. Individuals suffering from the disease have been identified in Ghousianagar, Kyatamaranahalli, Jyothinagara, Udayagiri, Raghavendranagar, Lourdnagar, Vidyaranyapuram and other extensions.
(ProMED 12.22.07)

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Indonesia (Java): Outbreak of chikungunya causes concern
From 10-15 Dec 2007 approximately 997 residents of the Jepara Regency, Central Java, were attacked by chikungunya virus. The estimated number of patients was still increasing, worrying the community.

The Health Service of the Jepara Regency determined that this condition was an emergency. Nevertheless, the Section Head Health Service of the Jepara Regency, Agus Salim, who was contacted on 15 Dec 2007 asked the community to not panic because chikungunya not was classified as a deadly illness. Although the illness that resulted from virus transmission by Aedes albopictus could cause paralysis for 3-5 days, within 10 days it would be resolved automatically.

He added that dengue fever was also present in Jepara. Between January 2007 and 10 Dec 2007 there were more than 2,000 dengue fever cases in Jepara. With the emergency status due to chikungunya, as well as the number of dengue fever sufferers, Jepara Regent Hendro Martojo instructed the community to further increase eradication efforts of the mosquitoes breeding sites in their respective environments.

[Apparently there are concurrent dengue and chikungunya epidemics occurring in this part of Java. It is not clear if these two viral infections are being differentiated by laboratory tests or only on clinical grounds.
(ProMED 12.17.07)

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Japan: 34th case of Mad Cow Disease, milk replacers may be the culprit
The Fisheries Ministry said on 21 Dec 2007 that a cow in northern Japan's Hokkaido had tested positive for Mad Cow Disease. It was the 34th case of Mad Cow Disease confirmed so far in the country.

According to the ministry's press release, the 15-year-old cow was born in western Japan's Shimane Prefecture and was raised in Hokkaido. After it was killed on 19 Dec 2007, the beef tested positive for mad cow disease during check-up by a local meat inspection institution. The result was confirmed shortly after further testing at Hokkaido University and another farming college nearby.

The cow was the oldest one in all the Mad Cow Disease cases in Japan. All of the cow's meat and gut were incinerated before entering market.

The Japanese Agriculture, Forestry and Fisheries Ministry reports there may be a link between some of the BSE-infected cattle in their country and milk replacer. In March 2007, a professor at Hiroshima University argued that some of the Japanese cattle were infected shortly after birth, before they were exposed to contaminated meat and bone meal. He suggested the exposure may have come from contaminated milk replacer ingredients from the Netherlands. He pointed out the infections occurred in 1995 and 1996 at a time when there was a sudden increase in BSE cases in the Netherlands and Germany.

The Japanese Ministry investigated 32 BSE-infected cows in the country and says 13 of the cases could be linked to powdered animal fat produced by the same feed plant in the Netherlands. However, the Ministry stresses the results are not definite and the Netherlands says the animal fat was not contaminated with BSE.
(ProMED 12.23.07)

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Singapore: Thirteen construction workers infected with dengue fever
Thirteen construction workers have been infected with dengue virus. They were working at a construction site at the junction of East Coast Road and Lorong N Telok Kurau. This is the second construction site that has recorded 10 or more cases of dengue in 2007.

Of the affected workers, four live near the construction site. Workers at the site said their colleagues had been sent to Tan Tock Seng Hospital and they have since recovered. They added that the workers might return to work in the next two days. The workers also said that officials from the Health Ministry and the National Environment Agency have searched the site, but apparently could not find any mosquito breeding ground.
(ProMED 12.18.07)

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Americas
Canada: Officials report 11th Bovine Spongiform Encephalitis case
Canadian officials today reported the country's 11th case of Bovine Spongiform Encephalopathy (BSE), or Mad Cow Disease, but said it will not affect Canada's BSE risk status as defined by the World Organization for Animal Health (OIE).

The disease was found in a 13-year-old beef cow from Alberta, the Canadian Food Inspection Agency (CFIA) announced. "The animal's carcass is under CFIA control, and no part of it entered the human food or animal feed systems," the agency said in a news release.

The cow's age means it was born before Canada and the United States banned the use of ruminant animal protein in cattle feed in 1997. Cattle are believed to contract BSE by eating feed containing material from infected animals. People who eat meat from BSE-infected cattle may run a risk of contracting the human equivalent of the brain-wasting disease—variant Creutzfeldt-Jakob disease.

In recognition of Canada's BSE surveillance and control measures, the OIE classified the country as a "controlled risk" country for BSE in May of 2007. "This case will not affect Canada's risk status," the CFIA said.

Canada's latest BSE precaution was to ban the use of cattle-derived "specified risk materials," such as the brain and spinal cord, from animal feeds, pet foods and fertilizers. The ban took effect 12 July. US officials have been considering a similar step for more than two years. Both countries banned specified risk materials from human food previously.

"The CFIA expects to detect a small number of [BSE] cases over the next 10 years as Canada progresses towards its goal of eliminating the disease from the national cattle herd," the CFIA stated. The latest case was detected by the national BSE surveillance program, which has discovered all of Canada's cases so far, the agency said. Targeting cattle deemed to have an increased risk of BSE, the program has tested about 190,000 since 2003, when the first case was found. Canadian officials are working to find the infected cow's herd mates at the time of birth and to determine how it might have been infected, the CFIA said.

The latest BSE case is Canada's third this year. The disease was found in a six-year-old bull from an Alberta farm in February and in a five-year-old dairy cow from British Columbia in May.

The US Department of Agriculture (USDA) banned the importation of Canadian cattle and beef when Canada's first BSE case surfaced in May 2003. The ban on meat from young (less than 30 months) cattle was lifted soon afterward, but the ban on live cattle continued until July 2005, when young cattle were again admitted.
(CIDRAP 12.18.07)

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USA: Fresh ground beef products contaminated with multi-drug resistant salmonellosis
The US Department of Agriculture's Food Safety and Inspection Service (FSIS) is issuing a public health alert due to illnesses from Salmonella enterica serotype Newport associated with fresh ground beef products contaminated with multi-drug resistant salmonellosis that may have been ground and sold at Safeway supermarkets in Arizona, California, Hawaii, Nevada and New Mexico between 19 Sep and 5 Nov 2007.

This public health alert was initiated after epidemiological investigations and a case-control study conducted by the California Department of Public Health, Arizona Department of Health Services and the Centers for Disease Control and Prevention (CDC) determined that there is an association between the fresh ground beef products and 38 illnesses reported in Arizona (16), California (18), Idaho (1), and Nevada (3). The illnesses were linked through the epidemiological investigation by their rare PFGE pattern found in PulseNet, a database maintained by CDC.

This alert is being issued after an exhaustive and continuing investigation whereby FSIS could not identify specific establishments, lots and products that would be subject to a recall. FSIS has no reason to believe that these products are still available for sale in commerce. Consumers who may have purchased these fresh ground beef products between 19 Sep and 5 Nov 2007 and stored them in the freezer should look for and discard or destroy these products if they find them.
(ProMED 12.21.07)

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USA (Massachusetts): Mumps outbreak worries officials
Massachusetts health authorities are on high alert for cases of mumps, the painful viral illness that has re-emerged in Maine and Maritime Canada in recent months, despite decades of vaccinations.

Before the outbreak, Maine had not reported a case in at least 20 years. Now mumps has spread across the state, reaching its southernmost county and making nearly 75 children and adults sick statewide since September 2007. Disease trackers suspect that the Maine outbreak was imported from Canada, where 1,140 people have fallen ill in 2007, 14 times the average for recent years. Most of the cases have been reported by three eastern provinces — Nova Scotia, New Brunswick and Prince Edward Island.

Specialists in Massachusetts are watching the migration of mumps with increasing concern, knowing that many of the patients in Maine and Canada are college students, a group particularly susceptible because they are mobile and live in tight quarters, an ideal combination for disease transmission.

"We are exploring every possible mumps case," said Dr. Alfred DeMaria, director of communicable disease control for the Department of Public Health in Massachusetts, where only three cases have been reported this year. "We're going to be especially vigilant after the holidays," he said, because Boston students may have contact with students from Maine schools during the break.

"Mumps is essentially endemic in the rest of the world," said Dr. James Alexander, a medical epidemiologist at the US Centers for Disease Control and Prevention (CDC). "Canada and the United States were the two countries where mumps was close to being eliminated."

"Mumps has undoubtedly been with us for millennia, and it's not likely to disappear just because we develop an effective vaccine," said Dr. Kenneth McIntosh, a disease specialist at Children's Hospital Boston.

One pivotal lesson derived from the return of the mumps in the late 1980s: a single dose of vaccine did not provide enough of a shield. It was then that disease specialists began recommending that children receive two doses and that schools bar students who were not vaccinated.

As Canadian specialists began investigating this year's outbreak, they quickly homed in on the vaccination history of patients, unearthing important clues. Nearly 73 percent had received only a single dose of vaccine, while 19 percent had no vaccination at all. Those who received at least one dose generally had milder cases. "I like to compare this disease to a heat-seeking missile," said Jeannette Macey, an epidemiologist with the Public Health Agency of Canada. "If there are people in the population who are not protected, it's going to find them."

In Maine, authorities are collecting comparable data, but they know already that many of the adults who became infected probably only got a single dose earlier in life. At the University of Southern Maine, where many of the students are older, at least 10 people have fallen ill, a spokeswoman said. Disease specialists from Maine and CDC are also continuing to investigate exactly where the virus came from, running sophisticated genetic testing and conducting extensive interviews.

"It's not surprising that Maine would have cases," said Dr. Dora Mills, director of Maine's CDC. "New Brunswick is adjacent to Maine, and Nova Scotia might as well be, because there are several boats that go back and forth every day."
(ProMED 12.20.07)

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USA: Serratia marcescens bacteria found in heparin-filled syringes
Federal health officials said on 18 Dec 2007 that they are investigating dozens of blood infections in at least two states that have been linked to medical syringes contaminated with bacteria.

About 40 people have been sickened in Illinois and Texas, including 20 outpatients from Rush University Medical Center in Chicago. No deaths have been reported. Rush doctors traced the infections earlier in December 2007 to heparin-filled syringes the patients used during home treatment for cancer and other ailments.

Heparin is a blood thinner, and the syringes are used to keep clear catheters and intravenous lines. The infections were caused by bacteria called Serratia marcescens, found in a single batch of heparin-filled syringes made in Angier, NC, by a company called Sierra Pre-Filled.

Syringes from that batch also were sent to Colorado, Florida and Pennsylvania but infections so far have turned up only in Illinois and Texas.* The infections can cause fever and chills. They can be serious but generally respond well to antibiotics. There have been no known deaths, Srinivasan said.

Of the 20 Rush outpatients who fell ill, 14 required hospitalization. All responded quickly to antibiotic treatment, and only one remained in hospital on 18 Dec 2007, said Dr. John Segreti, hospital epidemiologist.

The president of Sierra Pre-Filled, Dushyant Patel, said the company is working with CDC and the Food and Drug Administration and has voluntarily recalled the implicated lot. "There's nothing out there anymore," Patel said. The affected lot is 070926H, Srinivasan said. He said that CDC is working to make sure doctors are alerted about the contamination and that more cases could surface. He said bacteria were found in fluid from the pre-filled syringes, but it is uncertain if the original contamination was in the heparin, the saline used to dilute the drug or the syringes themselves.

"We'll be working to perform genetic fingerprinting on the bacteria to confirm a link between bacteria in the syringes and the case patients," Srinivasan said.

Patel said the heparin in his company's pre-filled syringes comes from a different company.

*[Update − Initially, infections had turned up only in Illinois and Texas; Florida is now the third state to report cases in this cluster. Florida received contaminated syringes, and cases have been reported in several counties. In addition to Polk County, cases are being examined in Escambia, Duval, Volusia, Hillsborough and Palm Beach counties. Colorado and Pennsylvania also received syringes from the contaminated batch but, so far, no cases have been reported].
(ProMED 12.19.07 & 12.22.07)

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USA (New York): "Dried Roach" fish may be contaminated with botulism
Royal Seafood Baza Inc, located in Far Rockaway, NY is recalling packages of "Dried Roach" (fish) because the product may be contaminated with Clostridium botulinum, which can cause botulism, a serious and potentially fatal foodborne illness. The sale of this type of fish is prohibited under New York State Department of Agriculture and Markets regulations because Clostridium botulinum spores are more likely to be concentrated in the viscera than in any other portion of fish.

Uneviscerated fish has been linked to outbreaks of botulism poisoning. Symptoms of botulism include blurred or double vision, general weakness, and poor reflexes, difficulty swallowing and respiratory paralysis. The recalled "Dried Roach" (fish) was distributed to Net Cost Market stores located in Brooklyn and Staten Island, New York and Philadelphia, Pennsylvania. The product comes in clear plastic pouches of various weights with a product code 20.03.08. It is a product of Latvia. No illnesses have been reported to date in connection with this problem. Consumers who have "Dried Roach" (fish) are urged to return it to the place of purchase for full refund. Consumers with questions should contact the company at 1-888-776-3958.
(ProMED 12.21.07)

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USA: Botulism alert for canned green beans
New Era Canning Company of New Era, MI is voluntarily recalling 171 cases of Fancy Blue Lake Cut Green Beans because they may be contaminated with Clostridium botulinum, a bacterium which can cause life-threatening illness or death from botulism.

Consumers are warned not to use the product even if it does not look or smell spoiled. The canned green beans were distributed to foodservice customers in Alabama, Arkansas, Georgia, Illinois, Indiana, Kentucky, Mississippi, Missouri, North Carolina, Tennessee and Virginia and sold through GFS Marketplace stores in Indiana, Kentucky and Tennessee. The canned green beans are packaged in six lbs, five oz cans under the GFS brand (GFS reorder #118737; UPC 93901 11873) with lot code 19H7FL printed on the end of the can. No other re-order numbers or lots are included in this recall.

No illnesses have been reported to date in connection with this problem. The potential contamination of the product was found through testing by the Food and Drug Administration. New Era Canning in conjunction with the US Food and Drug Administration and the Michigan Department of Agriculture is thoroughly evaluating all processes and procedures to determine the cause of the problem.

Any food that may be contaminated should be disposed of carefully. Even tiny amounts of toxins ingested, inhaled or absorbed through the eye or a break in the skin can cause serious illness. Skin contact should be avoided as much as possible, and the hands should be washed immediately after handling the food. Customers should not be encouraged to return product to Gordon Food Service. Customers who have the product or any foods made with these products should throw them away immediately. Double bag the cans in plastic bags that are tightly closed then place in a trash receptacle for non-recyclable trash outside of the home. Restaurants and institutions are encouraged to assure that such products are only placed in locked receptacles which are not accessible to the public.
(ProMED 12.22.07)

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US, UK, Canada: Wounded soldiers bring back drug-resistant bacterium
The UK, the US and Canada are facing growing fears over a drug-resistant bacterium being brought back by wounded soldiers from Afghanistan and Iraq that threatens to contaminate civilian hospitals.

The intensified concern comes amid sharply rising infection rates in the United States and fresh worries in Canada that the bug could be imported into its civilian healthcare system. Military health officials who have studied the bacterium in Afghanistan believe the infection of wounded British soldiers in field hospitals there is probably inevitable. The US military originally thought the bug came from contaminated Iraqi soil, but troops in Afghanistan have also been infected.

Canada's public health service last week revealed it had ordered the screening of all its wounded soldiers being repatriated from Afghanistan. The bacterium, Acinetobacter baumannii, first emerged as an infection afflicting US service personnel returning from the war in Iraq in 2003-04. It was described by a scientific journal specializing in hospital epidemiology as the "most important emerging hospital-acquired pathogen worldwide." The journal added that it was potentially a major threat to public health due to its ability to mutate rapidly and develop a resistance to all known drugs.

Although different types of Acinetobacter have been known for decades in hospitals, the new T strain identified in the injured troops is particularly virulent and has been observed to appear in US servicemen within two hours of being admitted to a field hospital. Equally worrying is its resilience, as it can be extremely difficult to eliminate from medical facilities once established.

Canadian military doctors investigated the infection in Canadian troops at an intensive care unit in Kandahar and published a report in the journal BMC Infectious Diseases earlier in 2007. The officers warned that their findings about the infection risk were "equally applicable to US and British military field hospitals as well," adding that "the environmental and logistical problems that faced [the medical units involved] are common across field hospitals in Afghanistan and Iraq." They added that "unrestricted use of antibiotics" at the field hospitals to compensate for poor environmental conditions had contributed to the emergence of the new strain. In addition to a new screening regime, Canadian infectious disease officials will meet in early 2008 to develop a national strategy to deal with the risk of the new strain spreading to civilian hospitals. One of the report's authors, Major Homer Tien, told The Observer from Kandahar on 15 Dec 2007 that further outbreaks appeared inevitable. Concern is all the higher because, as in the UK, injured Canadian troops are treated in the civilian healthcare system, while most Americans are treated in an extensive network of military hospitals.

Infection rates have risen steeply in the United States. In 2001 and 2002, around two percent of admissions were infected at a specialist army burns unit in Texas. By 2003, the rate had risen to six percent, then 12 percent by 2005, a rate consistent with other facilities. So far, 27 servicemen have died from the infection.

In stark contrast to Canada and the United States, the attitude towards the threat in the UK has been sanguine and low-key. An MoD spokesmen last week insisted there had not been a case since November 2004 and that it employed "robust and stringent infection control procedures which fully meet NHS requirements adequate to deal with the problem."
(ProMED 12.16.07)

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3. 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 Read about the 4-6 Dec 2007 International Ministerial Conference on Avian and Pandemic Influenza.

- OIE: http://www.oie.int/eng/info_ev/en_AI_avianinfluenza.htm

- US CDC: http://www.cdc.gov/flu/avian/index.htm. Updated news from December 2007.

- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Use the toolkit to prepare your community for a possible flu pandemic.

- Health Canada: information on pandemic influenza: http://www.influenza.gc.ca/index_e.html

- CIDRAP: http://www.cidrap.umn.edu/

- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm. Link to the avian influenza portal.

- US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

Global
Despite recent spikes in H5N1 avian influenza activity in humans and birds, there have been fewer bird outbreaks in fewer countries in 2007 than in 2006, according to a preliminary report from the United Nations Food and Agriculture Organization (FAO).

As of 10 Dec 2007, 30 countries had reported H5N1 cases in birds in 2007, compared with 54 in 2006, the FAO reported. This year, five countries have reported their first outbreaks: Bangladesh, Benin, Ghana, Saudi Arabia and Togo. Except for sporadic outbreaks in wild birds, most of the H5N1 cases this year occurred in domestic poultry, such as chickens, turkeys, geese, ducks and quail. The H5N1 outbreaks seemed to follow a seasonal pattern, in line with evidence that cooler temperatures are more favorable to influenza viruses. The FAO said outbreak numbers in 2007 were high between January and April, declined until September, and then started rising again in November and December.

Increased awareness and improved disease surveillance have enabled countries such as India, Romania, Malaysia and Turkey to detect and control the spread of the H5N1 virus, the FAO reported. However, the disease persists in Asia, Africa and Europe and poses a risk for countries that have controlled outbreaks in the past and those that have not experienced infections yet, the organization stated.

The FAO said Indonesia is still having a large number of H5N1 outbreaks in poultry, which largely reflects a new "participatory disease search" program designed to detect infections in backyard poultry. The program, with support from the FAO, is operating in 162 districts and nine provinces.

Among other Asian hot spots for the disease, Vietnam reported H5N1 outbreaks in 22 provinces in May 2007, the FAO reported. It said the disease appears to be endemic in Bangladesh. China had H5N1 outbreaks in Tibet in March 2007, Hunan province in May 2007, and Guangdong province in September 2007, the agency said. In addition, routine surveillance detected the virus in March and April 2007 in the southern Chinese provinces of Fujian, Guangdong, Hunan, Hubei, Sichuan and Chongqing, the FAO reported. Also, wild bird deaths were reported in Hong Kong but not in mainland China.

The only Middle Eastern country reporting an H5N1 outbreak in 2007 has been Saudi Arabia, which had its first cases in March 2007, followed by several outbreaks near Riyadh in November 2007.

In Africa, four countries have reported H5N1 outbreaks in 2007, and the FAO said the virus is considered endemic in Egypt and possibly in Nigeria. "Several countries in West, Central, South and North Africa are at risk of becoming infected, and early warning, surveillance and preventive measures should urgently be taken," the organization reported.

Eight European countries have reported H5N1 outbreaks in 2007, the FAO noted [These are the Czech Republic, France, Germany, Hungary, Poland, Romania, Russia and UK. - Mod.AS].
(ProMED 12.26.07)

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DENGUE
Philippines (Cebu City)
At least 48 deaths were attributed to mosquito-borne dengue fever in Cebu City in 2007, with 101 more residents falling ill because of the virus, health officials said. There were 1946 cases recorded from 1 Jan − 18 Dec 2007. Despite the continuous increase in the number of cases, the Cebu City Dengue Task Force decided not to heed the mayor's suggestion of pouring used oil into a suspected breeding site of dengue-carrying mosquitoes in Barangay Labangon. Instead of using used oil, the City Health Department and the task force will use chlorine or larvacide, whichever is more effective and economical and safer to use.
(ProMED 12.27.07)

Indonesia
The Health Service of Central Java (DINKES) released the dengue fever (DBD) data from January until December 2007; there were 11,636 inhabitants infected including 217 people who died. The DINKES head, Dr. Hartanto, mentioned that the number of people who had dengue from 2006 only reached 10,924, including 220 who died. The incidence of dengue cases in Central Java during January-November 2007 was 4.95 per 10,000 inhabitants, higher when compared with 2006, which was 3.37 per 10,000 inhabitants. Thus, numbers of dengue cases over the past two years have increased. The spread of the dengue epidemic was greatest in 35 regencies in the city. In case mapping by the Health Service, the epidemic area currently spreads in 33 regencies of the city except Banjarnegara and Wonosobo. This does not mean that Banjarnegara and Wonosobo have been completely dengue free. Although there were some infected people, the case number did not reach the numbers for epidemic status. With the current spreading, the epidemic area was no longer in the urban areas such as Semarang City, Solo, Salatiga, Kota Tegal, Kota Pekalongan and the Magelang City. However, currently the rural areas have not escaped breeding of Aedes aegypti mosquitoes.

Dr. Hartanto said that the eradication of dengue could not only rely on fogging or fumigation as these actions only killed mature mosquitoes, not larvae. Therefore, community efforts with the 3M approach was needed: drain water catchments, close breeding sites, bury articles that can hold water and completely clean out larval mosquitoes.
(ProMED 12.27.07)

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4. Articles
Avian Flu: FAO in Action (December 2007 – No. 7)
As more has become known about the disease (HPAI), its ecology and its epidemiology, and as more experience has been gained in fighting it, the rapidity and effectiveness of response to new outbreaks have improved enormously ... there is no doubt that FAO has played an important role in this positive evolution. See the full report at:
http://www.fao.org/docs/eims/upload//237235/news_faoinaction_dec07_en.pdf

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Emerging Infectious Diseases – Volume 14, Number 1 – January 2008
This issue includes articles on pandemic influenza in pregnant women, multidrug resistant bacteria in the arctic, dogs as sources and sentinels of parasites in Northern Canada, and many other infectious disease topics. New issue online at: http://www.cdc.gov/ncidod/eid/

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Molecular typing of Japanese Escherichia coli O157: H7 isolates from clinical specimens by multilocus variable-number tandem repeat analysis and PFGE
Kawamori F, Hiroi M, Ohashi N, et al. Journal of Medical Microbiology. 57 (2008), 58-63; DOI: 10.1099/jmm.0.47213-0
http://jmm.sgmjournals.org/cgi/content/abstract/57/1/58

Abstract
The multilocus variable-number tandem repeat analysis (MLVA) method to target eight variable-number tandem repeat loci, based on agarose gel electrophoresis separation of multiplexed PCR products, and the PFGE method were applied to clinical isolates of Escherichia coli O157:H7 with the aim of comparing their performance as methods of typing this bacterium. Using MLVA, a total of 57 isolates from patients in Shizuoka prefecture, Japan, were divided into 20 types and classified into 23 PFGE types. Twenty-four isolates from four sporadic infections, four household contact infections and one outbreak that occurred in central parts of Shizuoka prefecture during August to November in 2005 were shown to be the same MLVA type, and most of the isolates had identical PFGE banding patterns, suggesting the diffuse outbreak in these parts of Japan. Thus, there was a good correlation between MLVA types and PFGE types, with both methods displaying broadly similar discriminatory powers. However, the MLVA typing proved to be a much easier and more rapid method for the analysis of E. coli O157:H7 strain relatedness to identify transmission routes. Hence, our MLVA method would be a suitable technique for routine typing in many laboratories, including public health agencies, and even in hospitals.
(CIDRAP 12.21.07)

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Cross-subtype immunity against avian influenza in persons recently vaccinated for influenza
Gioia C, Castilletti C, Tempestilli M, Piacentini P, Bordi L, Chiappini R, et al Emerg Infect Dis [serial on the Internet]. 2008 Jan.
http://www.cdc.gov/EID/14/1/121.htm

Abstract
Avian influenza virus (H5N1) can be transmitted to humans, resulting in a severe or fatal disease. The aim of this study was to evaluate the immune cross-reactivity between human and avian influenza (H5N1) strains in healthy donors vaccinated for seasonal influenza A (H1N1)/(H3N2). A small frequency of CD4 T-cells specific for subtype H5N1 was detected in several persons at baseline, and seasonal vaccine administration enhanced the frequency of such reactive CD4 T- cells. We also observed that seasonal vaccination is able to raise neutralizing immunity against influenza (H5N1) in a large number of donors. No correlation between influenza-specific CD4 T- cells and humoral responses was observed. N1 may possibly be a target for both cellular and humoral cross-type immunity, but additional experiments are needed to clarify this point. These findings highlight the possibility of boosting cross-type cellular and humoral immunity against highly pathogenic avian influenza A virus subtype H5N1 by seasonal influenza vaccination.
(CIDRAP 12.21.07)

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Avian influenza virus (H5N1) replication in feathers of domestic waterfowl
Yamamoto Y, Nakamura K, Okamatsu M, Yamada M, Mase M. Emerg Infect Dis [serial on the Internet]. 2008 Jan. http://www.cdc.gov/EID/content/14/1/149.htm

Abstract
We examined feathers of domestic ducks and geese inoculated with 2 different avian influenza virus (H5N1) genotypes. Together with virus isolation from the skin, the detection of viral antigens and ultrastructural observation of the virions in the feather epidermis raise the possibility of feathers as sources of infection.
(CIDRAP 12.21.07)

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Experimental infection of swans and geese with highly pathogenic avian influenza virus (H5N1) of Asian lineage
Brown JD, Stalknecht DE, Swayne DE. Emerg Infect Dis [serial on the Internet]. 2008 Jan.
http://www.cdc.gov/EID/content/14/1/136.htm

Abstract
The role of wild birds in the epidemiology of the Asian lineage highly pathogenic avian influenza (HPAI) virus subtype H5N1 epizootic and their contribution to the spread of the responsible viruses in Eurasia and Africa are unclear. To better understand the potential role of swans and geese in the epidemiology of this virus, we infected 4 species of swans and 2 species of geese with an HPAI virus of Asian lineage recovered from a whooper swan in Mongolia in 2005, A/whooper swan/Mongolia/244/2005 (H5N1). The highest mortality rates were observed in swans, and species-related differences in clinical illness and viral shedding were evident. These results suggest that the potential for HPAI (H5N1) viral shedding and the movement of infected birds may be species-dependent and can help explain observed deaths associated with HPAI (H5N1) infection in anseriforms in Eurasia.
(CIDRAP 12.21.07)

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Human infections associated with wild birds
Tsiodras S, Kelesidis T, et al. Journal of Infection. published online 21 December 2007.
http://www.journalofinfection.com/article/PIIS0163445307008122/abstract

Introduction
Wild birds and especially migratory species can become long-distance vectors for a wide range of microorganisms. The objective of the current paper is to summarize available literature on pathogens causing human disease that have been associated with wild bird species.

Methods
A systematic literature search was performed to identify specific pathogens known to be associated with wild and migratory birds. The evidence for direct transmission of an avian borne pathogen to a human was assessed. Transmission to humans was classified as direct if there is published evidence for such transmission from the avian species to a person or indirect if the transmission requires a vector other than the avian species.

Results
Several wild and migratory birds serve as reservoirs and/or mechanical vectors (simply carrying a pathogen or dispersing infected arthropod vectors) for numerous infectious agents. An association with transmission from birds to humans was identified for 10 pathogens. Wild birds including migratory species may play a significant role in the epidemiology of influenza A virus, arboviruses such as West Nile virus and enteric bacterial pathogens. Nevertheless only one case of direct transmission from wild birds to humans was found.

Conclusion
The available evidence suggests wild birds play a limited role in human infectious diseases. Direct transmission of an infectious agent from wild birds to humans is rarely identified. Potential factors and mechanisms involved in the transmission of infectious agents from birds to humans need further elucidation.

Q&A: Siti Fadilah Supar
Butler D, Nature 450, 1137 (2007) | doi:10.1038/4501137a
Indonesia has been hit by more human deaths from the H5N1 bird flu virus than any other country, yet it refuses to share its virus samples with the World Health Organization. Declan Butler talks to Indonesia's health minister. Article at:
http://www.nature.com/news/2007/071219/full/4501137a.html
(CIDRAP 12.20.07)

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New swine flu virus supports 'mixing vessel' theory
http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/dec2007swine.html Robert Roos

A new influenza virus discovered in Missouri pigs has a combination of genes from avian and swine flu viruses, supporting the theory that pigs can serve as a mixing vessel for flu viruses and a potential source for a human pandemic strain, according to a report published on 19 Dec 2007. Researchers found that the virus, an H2N3 subtype, caused illness in experimentally infected mice and was transmissible in swine and ferrets, suggesting it has adapted to mammals, according to the report, published in the Proceedings of the National Academy of Sciences (PNAS). In addition, genetic analysis showed the virus has a mutation linked with an increased ability to infect mammals. The discovery marks the first identification of an H2 virus in swine, according to the authors of the report. The flu pandemic of 1957-58 was caused by an H2 virus, namely H2N2. That virus was replaced by an H3N2 strain in the pandemic of 1968-69, and H2 viruses have not circulated in humans since then. Hence, people younger than 40 have little immunity to H2 viruses, scientists say. "Our results provide further evidence for the potential of swine to promote reassortment between different influenza viruses, and the genetic and biologic properties of the H2N3 viruses described suggest that it would be prudent to establish vigilant surveillance in pigs and in workers who have occupational exposure," states the PNAS report.

The discovery of the new virus began with an illness outbreak in pigs at a Missouri swine nursery in September 2006, according to the report. The pigs' lungs showed obvious signs of pneumonia, and tests showed the presence of an influenza gene, but the subtype could not be determined. Samples were submitted to the ARS in Ames, where genetic sequencing and a search of a flu sequence database showed the virus subtype to be H2N3. After the virus was subtyped, a record search revealed that another unidentified virus had been submitted in April 2006, from a 12-week-old pig at another Missouri swine farm, according to the report. Analysis by the ARS showed that this isolate too was an H2N3, and the two viruses were nearly identical. The two outbreak sites are about eight miles apart, according to Marie Gramer of the University of Minnesota College of Veterinary Medicine in St. Paul, a coauthor of the report. She said there was no connection between the two operations.

The authors write that their findings are "of considerable concern to public health." In particular, the H2N3 viruses' mutation associated with an affinity for human-type cell-surface receptors and their ability to replicate and spread in swine and ferrets "suggests that the swine H2N3 viruses have undergone adaptation to the mammalian host and as such have the ability for sustained transmission." However, the report also says that "receptor-binding changes" are not sufficient by themselves to permit avian flu viruses to successfully adapt to humans. For example, swine H1N1 flu viruses prefer human-type receptors and have occasionally infected humans but have not become established in human populations. Gramer told CIDRAP News that no illnesses were reported among farm workers in connection with the swine cases, and no workers were tested at the time. However, serologic testing of the workers is currently being conducted under a grant from the Centers for Disease Control and Prevention, she reported. When asked whether the newfound virus currently represents a threat to humans, Gramer replied, "No more than any other influenza virus in the world. Transmission of flu from pigs to humans is likely rare. This flu itself is rare and we don't know if it is currently circulating in this farm or any other farm in the USA. We haven't found it again." Although pigs have long been regarded as a viral mixing vessel that could potentially produce human pandemic strains, whether this has ever happened is unclear, the PNAS report states. The 1957 and 1968 pandemic viruses both resulted from genetic reassortment of human and avian strains, but the mixing might have occurred in humans, pigs, quail or some other host, it says.

The report suggests that state and federal public health officials should work "aggressively" with the swine and poultry industries to study the prevalence of the new virus and find out whether it is infecting humans and to set up coordinated surveillance programs, said Gray, who is director of the Center for Emerging Infectious Diseases at the University of Iowa in Iowa City. Much effort is currently devoted to the hunt for highly pathogenic flu viruses in migratory and aquatic birds, Gray continued. "Influenza surveillance in agriculture is largely managed by the industries. Our agriculture industry and human influenza surveillance are not well coordinated. We might wake up one day to find a virus like the one in this report has become endemic in our agriculture industries and a major threat to the industries as well as to man."

[Orignial article: Ma W, Vincent AL, Gramer MR, et al. Identification of H2N3 influenza A viruses from swine in the United States. Proc Natl Acad Sci 2007 Dec 26;104(52):20949-54]
(CIDRAP 12.20.07)

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5. Notifications
Bangkok International Conference on Avian Influenza 2008: Integration from Knowledge to Control
Date: 23-25 January 2008
Location: The Dusit Thani, Bangkok, Thailand

The Bangkok International Conference on Avian Influenza 2008: Integration from Knowledge to Control is organized by the National Center for Genetic Engineering and Biotechnology (BIOTEC), the National Science and Technology Development Agency (NSTDA) and many allied organizations in Thailand, aiming to provide a forum that scientific experts and scientists working in affected areas can share knowledge, experiences and expertise. The forum will provide ample opportunities for knowledge, particularly those learned during the last three years, to find their ways to applications and controls. It will also facilitate international understanding and collaboration, which is obviously essential for handling this global threat. To facilitate this NSTDA will provide a number of travel funds for the students and scientists in developing, especially the affected countries, Thailand. Because of this many of world leading scientists already committed to participate.

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2nd International Conference On Dengue/Dengue Hemorrhagic Fever
Location: Phuket, Thailand
Venue: Hilton Phuket Arcadia Resort & Spa
Dates: 15-17 Oct 2008

The Ministry of Public Health, Thailand will organize the Second International Conference on Dengue Fever and Dengue Hemorrhagic fever next year. Under the theme of "Global Innovation for Combating Dengue Infection," the conference will serve as a forum for exchanging comprehensive information, practical experience, new skills and techniques, and for conceptualizing and integrating approaches to the prevention and control of the disease. Priorities for research needed to contain the spread of the virus and its vectors will be defined and agreed upon, all with the aim of reducing morbidity and mortality in endemic countries. Improved surveillance and better estimation of disease burden will be stressed, along with methods of improving public commitment to the control and eventual elimination of the disease, a major threat to public health around the world.

More information is available at
http://www.dengue2008phuket.com
(ProMED 12.3.07)

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2008 International Conference On Biocontainment Facilities
Date: 12 Dec 2007
Subject: 2008 International Conference on Biocontainment Facilities
Location: Washington, DC 21-22 Apr 2008

What is on the agenda?

  • Latest lessons learned on biosafety and security
  • Facility operating plans
  • Design and construction details
  • Risk-based planning and management
  • Personnel training and material handling procedures − tracking, SOPs, etc.
  • Construction cost & contracting strategies
  • Commissioning and validation processes
  • New regulatory guidelines and certification requirements

What types of facilities?

  • High containment for research
  • Animal research and diagnostics
  • Biocontainment Patient Care Units (BPCUs) − planning, design, operation
  • Vaccine development and production

Full agenda details will be available in January 2008.

If you have questions or would like a copy of the program, please e-mail BIO2008@tradelineinc.com or call (011) 925 254 1744.

For registration information, see: http://www.TradelineInc.com/BIO2008
(ProMED 12.12.07)

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Where You Live

http://www.pandemicflu.gov/whereyoulive/index.html
An interactive US map is displayed on this Web page. Selecting a state will take you to a page containing:

  • State Agriculture, Health & Wildlife contact information
  • Federal funding assistance for states
  • Links to state pandemic Web site information
  • Federal/state summit information and Memoranda of Understanding (MOUs)
  • 1918 flu historical information
  • Other related information

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 apecein@u.washington.edu