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Vol. XI No. 1 ~ EINet News Briefs ~ Jan 11, 2008


*****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
- Cumulative number of human cases of avian influenza A/(H5N1)
- Israel (Binyamina): Mass culling in response to outbreak in kindergarten petting zoo
- Portugal (Mafra): H5 strain detected in poultry farm near Lisbon
- UK (Dorset): Defra confirms H5N1 infection in dead swans
- Australia (New South Wales): Outbreaks of salmonella infection sicken over 60 people
- China (Jiangsu): Latest human case of avian influenza transmitted by close contact with ill son
- Indonesia (West Java): 12-year-old boy hospitalized with suspect infectioned H5N1 avian influenza
- Pakistan: US man, member of Pakistan avian influenza family, never contracted virus
- Singapore: QIAGEN to supply Ministry of Health with avian influenza surveillance solutions
- Dominican Republic: Authorities sacrifice birds after H5N2 avian influenza discovery
- Dominican Republic: Outbreak disrupts Puerto Rico's cockfighting industry

2. Infectious Disease News
- Indonesia (Bandarlampung): Thousands fall ill in chikungunya outbreak
- Taipei: CDC identifies two imported cases of chikungunya
- Taipei (Kaohsiung): Enterovirus (E71) kills 18-month-old boy
- Taipei (Kaohsiung): Suspected outbreak of amoebic dysentery at mental institution
- USA (California): UC Irvine researchers find possible alternative to existing smallpox vaccine
- USA: Incurable dengue disease could spread
- USA (Massachusetts): Norovirus sickens dozens at Boston hospitals
- USA (Multi-state): Officials attempt to pinpoint source of multi-state salmonella outbreak
- USA (Pennsylvania): Potter County Woman tests positive for botulism
- USA (Oregon): Cryptococcus gattii sickens Junction City woman
- USA: Woman infected with MDR Tuberculosis travels to US — possible transmission to others
- USA (California): Prison officials concerned over recent outbreaks of valley fever
- USA (North Carolina): Listeriosis infections prompt health warning for pregnant women
- USA (Massachusetts): Dairy farm suspected in listeriosis deaths

3. Updates
- AVIAN PANDEMIC INFLUENZA

4. Articles
- Has Retail Chicken Played a Role in the Decline of Human Campylobacteriosis?
- Epidemics of Gastroenteritis during 2006 Were Associated with the Spread of Norovirus GII.4 Variants 2006a and 2006b
- Plasmodium knowlesi malaria in humans is widely distributed and potentially life threatening
- Glycan topology determines human adaptation of avian H5N1 virus hemagglutinin
- Amantadine-resistance among H5N1 avian influenza viruses isolated in Northern
- Receptivity to mandatory influenza vaccination policies for healthcare workers among registered nurses working on inpatient units
- Ambulatory short-course high-dose oral amoxicillin for treatment of severe pneumonia in children: a randomized equivalency trial

5. Notifications
- 2nd International Conference On Dengue/Dengue Hemorrhagic Fever, Thailand, October 2008
- 12th Annual Transmissible Spongiform Encephalopathies Conference
- Bangkok International Conference on Avian Influenza 2008: Integration from Knowledge to Control


1. Influenza News

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

2007 Cambodia/ 1 (1)
China / 5 (3)
Egypt / 25 (9)
Indonesia / 41 (36)
Laos / 2 (2)
Myanmar / 1 (0)
Nigeria / 1 (1)
Pakistan / 1 (1)
Viet Nam 8 (5)
Total / 85 (58)

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: 348 (216).
(WHO 1.3.07 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 1.3.07 http://www.who.int/csr/disease/avian_influenza/en/index.html)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 12.10.07):
http://gamapserver.who.int/mapLibrary/
(WHO 1.3.07 http://www.who.int/csr/disease/avian_influenza/en/index.html)

WHO’s timeline of important H5N1-related events (last updated 1.2.07):
http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.

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Europe/Near East
Israel (Binyamina): Mass culling in response to outbreak in kindergarten petting zoo
Inspectors from the Agriculture Ministry's Veterinary Service began the process of culling some 4,000 chickens and turkeys at Moshav Beit Hanania on 4 Jan 2008 in an effort to contain the bird flu outbreak detected in a Binyamina kindergarten petting zoo.

The process, which was expected to be completed before Shabbat enters sundown, will be carried out at a chicken coop belonging to the Muchersky family, the only one located within a two-mile (three-km) radius of the kindergarten. On 3 Jan 2008 some 200 chickens were culled in Binyamina.

The Agriculture Ministry said lab tests of samples taken from chicken coops in the area were negative, but it will go ahead with the culling as a safety measure against the spreading of the bird flu virus. The Poultry Breeders Association demanded an immediate increase of 25 percent in the monetary compensation for farmers, should the state order mass culling. The Ministry said the chicken co-op owners will be compensated.

A four-year-old girl who attended the kindergarten was admitted to the Hillel Jaffe Medical Center in Hadera 3 Jan 2008 with flu-like symptoms. Lab results showed that she had not contracted the bird-flu virus but was rather suffering from the Respiratory Syncytial Virus (RSV), the most common cause of bronchiolitis and pneumonia among young children.
(ProMED 1.4.08)

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Portugal (Mafra): H5 strain detected in poultry farm near Lisbon
The culling of more than 16,000 chickens on a farm belonging to the Mafra town council, 40 km (24.8 miles) from Lisbon, began on 31 Dec 2007 after detection of the H5 strain of avian influenza, according to information released by the office of the Portuguese Veterinary Director General (DGV).

The official note signaled that the farm is located within the security perimeter established by the DGV after another avian influenza virus strain of H5 — not the virulent H5N1 strain — was detected on 21 Dec 2007 in a farm raising partridges. The Portuguese authorities announced that they have established a new security perimeter one km around the new outbreak, among other sanitary measures.
(ProMED 1.5.08)

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UK (Dorset): Defra confirms H5N1 infection in dead swans
On 10 Jan 2008 Defra confirmed avian influenza in three dead wild mute swans in the Chesil Beach area in Dorset, following positive test results from the Veterinary Laboratories Agency for the highly pathogenic strain of H5N1. These birds were found and tested following our routine surveillance program.

A Wild Bird Control Area and a Monitoring Area are being established around the premises, encompassing Chesil Beach and Portland Bill, and the shape of these is based on expert ornithological advice. Inside these areas bird keepers are required to house their birds or otherwise isolate them from contact with wild birds, bird movements will be restricted, and bird gatherings are banned.

Defra is also working closely with ornithological and other experts to consider what wider measures may be needed. No disease has been found in domestic birds, and a program of surveillance is being carried out in the local wild bird population. There will be no culling of wild birds because such action may disperse birds further and would not aid control.

Acting Chief Veterinary Officer, Fred Landeg said: "While this is obviously unwelcome news, we have always said that Britain is at a constant low level of risk of introduction of Avian influenza. Our message to all bird keepers, particularly those in the area, is that they must be vigilant, report any signs of disease immediately, and practice the highest levels of biosecurity." A full epidemiological investigation is underway. All poultry keepers on the GB Poultry Register are being notified, and the EU Commission has been informed.
(ProMED 1.10.08)

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Asia
Australia (New South Wales): Outbreaks of salmonella infection sicken over 60 people
No doubt the dinner party of 35 at Wagga Wagga had looked forward to the fried ice cream dessert, until the raw egg batter gave them all food poisoning and the host was left with egg on her face. Now NSW (New South Wales) Health and the NSW Food Authority have the difficult task of trying to track down the poultry culprits, possibly from a large Victorian producer, and are investigating whether the incident and three others in Sydney affecting 25 more people are linked.

"In terms of cases of salmonella from home preparation using raw eggs, we've had four times the year's average in the past six weeks," Peter Sutherland, director of food safety programs at the NSW Food Authority, said on 26 Dec 2007.

The investigation comes as the authority hopes to introduce regulations in 2008 making NSW the second state, after Queensland, requiring individuals eggs to be stamped so they can be easily traced to their farms, thus making producers more accountable for quality. Mr. Sutherland said the other salmonella poisoning cases were: 11 people who fell ill from eating Caesar salad made with raw egg dressing at a dinner party at a Carlingford home; three children sick from drinking an eggnog at home in Thornleigh; and, most recently, a cafe in Auburn where 11 people had food poisoning after apparently eating cheesecake.

The investigation includes DNA testing on stool samples taken by physicians of some of the sick people to determine whether they fell ill from the same strain of salmonella. "It's strictly hypothetical but this batch of eggs may have come from a producer in Victoria," a NSW Food Authority spokesman said.

Most major producers get their eggs from a large number of farms. The authority has been working on its new regulation for the past eight months, which will also make it mandatory for transporters and retailers to refrigerate eggs, and hopes to take it to the NSW Primary Industries Minister, Ian MacDonald, for approval early in 2008, the spokesman said.

Based on the epidemiology, laboratory results, and traceback information provided by the NSW Food Authority, the NSW Department of Health does not have evidence that these outbreaks are related at this time. NSW DoH is currently using both MLVA (multiple-locus variable-number tandem repeat analysis) and phage typing for Salmonella (enterica serotype) Typhimurium isolates. These are the results for the possible egg related outbreaks:

S. Typhimurium 44 (MLVA 3-10-8-9-523): 11 cases consumed a variety of cakes from a single cake shop over a weekend. Raw eggs were used in some of the cakes, cross contamination is the likely source of the other infections. STM 44 is an established egg-related serovar in Australia.

S. Typhimurium 9 (MLVA 3-20-17-11-523): unknown source, no individual case data collected. Multiple foods consumed. Raw eggs were used in batter for fried ice cream.

S. Typhimurium 9 (MLVA 3-10-14-11-496): 11/13 people ill. Commonly consumed foods were raw egg mayonnaise and mousse. This MLVA pattern was previously associated with a large egg outbreak in NSW.

S. Typhimurium 29 (MLVA 3-11-10-8-523): 3/3 ill after consuming eggnog.
(ProMED 12.29.07 & 1.4.08)

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China (Jiangsu): Latest human case of avian influenza transmitted by close contact with ill son
Health authorities confirmed here on 10 Jan 2008 that the latest human case of bird flu in the eastern province of Jiangsu, which involved a 52-year-old father, came from close contact with his infected son and not a viral mutation. The cases took place in the provincial capital, Nanjing.

The son, 24, was the first to be infected and died on 2 Dec 2007. The father was later confirmed to be infected with the H5N1 virus, which causes bird flu. At the time, the ministry said experts had found that the virus that infected the son had originated with poultry and had not mutated. But it remained unclear how the son was infected in the first place, as neither man had any known contact with dead poultry — the primary known source of the ailment for humans.

The young man, surnamed Lu, developed fever, chills and other symptoms on 24 Nov 2007 and was hospitalized on 27 Nov 2007 after being diagnosed with lower left lobe pneumonia. His father developed a fever and was hospitalized for lower lobe pneumonia on 3 Dec 2007, the day after his son's death.

"The father has recovered," Mao said, adding that the cases have been effectively contained. Local authorities had kept 83 people who had close contact with either man under close observation but none have shown unusual symptoms so far, according to the ministry. The case of the Lu family, although unusual, is not the only one of its kind. In December 2007 a similar case occurred in Pakistan.
(ProMED 1.10.08)

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Indonesia (West Java): 12-year-old boy hospitalized with suspect infectioned H5N1 avian influenza
A 12-year-old boy was hospitalized in Indonesia for developing bird flu symptoms and on the basis of earlier contacts with a dead chicken, local press said on 9 Jan 2008. He was admitted to the Hasan Sadikin Hospital in the West Java capital of Bandung on 8 Jan 2008 with high fever, cough and respiratory problems. A relative said the boy had picked up a dead chicken in front of the house with bare hands and threw it to a nearby river. The following day, he became ill.
(ProMED 1.9.08)

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Pakistan: US man, member of Pakistan avian influenza family, never contracted virus
Blood testing has confirmed that a U.S. resident, whose brother was Pakistan's first confirmed case of H5N1 infection, never contracted the disease. The New York State health department revealed that the man's blood showed no antibodies to H5N1, indicating he had not caught the virus while attending his brother's funeral in Pakistan late in 2007.

"His final test came back. He showed no avian flu and no antibodies to avian flu, which means he never got it," Claudia Hutton, the department's director of public affairs, said in an interview from Albany, NY.

The man, who lives on Long Island, is part of a large family of brothers involved in a cluster of confirmed, probable and suspect cases. The other surviving brothers live in Pakistan's North-West Frontier Province. Because of the pattern of illnesses within the family, the World Health Organization believes there was limited person-to-person spread of the virus among the relatives. But initial diagnostic efforts were only able to confirm one case, so follow-up blood work will be needed to determine how many people were actually infected.

One member of the family, a veterinary worker, fell ill in late October 2007 after helping to cull H5N1-infected poultry. While he was sick, at least two of his brothers nursed him, first at home, then at the hospital. The veterinary worker survived but the two brothers died, one in mid-November and the other on 28 Nov 2007. The first man to die was never tested for H5N1. But a specimen taken from the second showed he was infected with the virus. Another brother was also ill and was hospitalized. Still another showed no signs of illness.

The brother from Long Island experienced mild cold-like symptoms after returning from Pakistan. And his young son, who did not make the trip with him, also had a cold; it appeared to get worse after his father's return. The man went to his doctor, the doctor notified local public health authorities and they in turn alerted the state.

The U.S. Centers for Disease Control even sent a plane to New York to collect specimens from the man and his son for testing in the CDC's Atlanta labs. They were both negative. But, a negative test isn't proof positive there was no infection. A test taken too late in the course of an infection could come back negative. To close the book on the incident, authorities collected blood samples from the man and the son to look for the antibodies that would be present if they had been infected with the virus. Both the father and the son were negative in antibody testing. The WHO said this week that blood samples from the surviving family members in Pakistan have been sent to a U.S. Naval laboratory in Cairo that does influenza testing for the WHO. But it could be a couple of weeks or longer before results are available.
(ProMED 1.10.08)

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Singapore: QIAGEN to supply Ministry of Health with avian influenza surveillance solutions
QIAGEN today announced that it has been awarded an exclusive contract by the Singapore Ministry of Health to supply sample preparation solutions and molecular tests for the specific detection of influenza H5N1. For the country's Avian Influenza Preparedness Program, QIAGEN provides both fully automated and manual sample preparation technologies for the extraction of viral nucleic acids. These are complemented by test kits for specific and sensitive detection of the highly pathogenic avian influenza strain.

The contract runs for three years and the volume depends on minimum stockpiling levels as well as the level of intensity of the country's surveillance program. The contract with the Singapore Ministry of Health is the latest supply agreement of QIAGEN with public and private institutions engaged in H5N1 surveillance. More than 80 institutes worldwide are involved in the surveillance of avian flu infection use procedures and reagents developed and offered by QIAGEN.

"This new contract is proof not only of the strong confidence of public health organizations in the performance, quality and reliability of QIAGEN's products, but also of their trust in the capabilities we as a market leader can provide in terms of logistics and safety of supply. Our global infrastructure enables us to deliver high volumes of products within very short periods of time from multiple manufacturing sites," said Peer Schatz, CEO of QIAGEN. "We support the global community in its efforts to expand its early warning systems that can monitor changes in viral infection which could lead to a pandemic. QIAGEN is proud to expand this effort by making its products available also to the Singapore Ministry of Health's surveillance program."
(FOX Business 1.8.08)

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Americas
Dominican Republic: Authorities sacrifice birds after H5N2 avian influenza discovery
Dominican authorities have quarantined and sacrificed a number of birds after detecting a strain of bird flu in December 2007. The World Organization for Animal Health (WHOA) said in a report that 130 birds were slaughtered after authorities discovered a case of the virus near the capital, Santo Domingo, and another some 145 kilometers (90 miles) to the east in the village of Higuey. Officials say the virus is the H5N2 strain, which does not affect humans. Government livestock director Angel Faxas said officials believe the virus reached the Dominican Republic through birds introduced into the country illegally.
(ProMed 1.5.08)

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Dominican Republic: Outbreak disrupts Puerto Rico's cockfighting industry
A ban on bird imports to Puerto Rico has forced the cancellation of more than 100 cockfights, dealing a blow to a lucrative industry in the U.S. territory, an official said on 4 Jan 2008.

Puerto Rico halted all bird imports on 3 Jan 2008 after a rare outbreak of avian flu in the nearby Dominican Republic, where authorities killed more than 100 chickens, including fighting roosters that tested positive for the lethal virus. The cancellation of the fights could cost the industry millions of dollars in lost revenue from people who come to watch or who enter their birds to compete, said Carlos Quinones, the cockfighting director for the island's sports and recreation department. ''The matches were already organized, and people had already requested their visas and made hotel reservations,'' said Quinones, who added that fights involving foreign roosters can draw as many as 900 people.

Cockfighting has been outlawed in 49 U.S. states, and Louisiana — the pastime's last refuge on the U.S. mainland — has approved legislation to make it a crime beginning in August 2008. But in Puerto Rico, the sport is still legal and remains big business. The island has more than 100 licensed cockfighting pits where roosters peck and kick each other with plastic spurs. About 200,000 fights are held each year, with annual ticket sales of up to USD 12 million, Quinones said. The ban could be lifted within as little as one week if Dominican health officials do not report further outbreaks, said Agriculture Minister Gabriel Figueroa. For now, it applies to birds from all countries because it is possible the Dominican birds came from elsewhere, he said. The strain of the virus detected in the Dominican Republic, H5N2, is not a danger to people.
(ProMED 1.6.08)

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2. Infectious Disease News

Asia
Indonesia (Bandarlampung): Thousands fall ill in chikungunya outbreak
Chikungunya disease has infected thousands of people in Bandarlampung during December 2007. In the worst hit area, Waydadi subdistrict in Sukarame, the mosquito-borne disease has struck 500 or so residents in three neighborhood units. Of the residents in the RT 13 neighborhood, 90 percent have been infected by chikungunya virus. There are 94 families in this neighborhood, and in each family, two or three members have been infected by the disease.

"My wife and I also caught it," said RT 13 neighborhood unit chief in Waydadi, on 27 Dec 2007. The infection rate is similarly high in the RT 10 and RT 12 neighborhood units. The neighborhood chief said he had reported the rampant disease to the subdistrict and district chiefs four weeks prior, but had yet to receive a reply. Waydadi district chief Amil Riadi said he was unaware that residents were infected with chikungunya virus. "There were no reports from the subdistrict office or community health centers," said Amil.

The disease spread to a number of districts in Bandarlampung starting in November 2007, as rainy season approached. Aside from Sukarame district, the disease has also infected residents in North and South Telukbetung, Kemiling, Sukaraja, Panjang, and Kedaton districts. Bandarlampung Health Office deputy head Tri Henny Sukemi said her office was coordinating with the provincial health office to carry out a fumigation drive in a number of subdistricts deemed rife with the disease.

The coordinator of the Coalition for a Healthy Lampung (KULS), Herdimansyah, said provincial and city health officials had been sluggish in responding to the outbreak. "The number of patients has climbed into the thousands, but there is not yet any concrete action. The disease in Lampung can be categorized as an extraordinary case now due to its vast spread and the huge number of those affected," he said. Herdimansyah added that the disease had also infected residents in a number of regencies in Lampung, such as Tanggamus and South Lampung.

He said no fatalities had been reported so far in Lampung, but said the disease was very harmful due to its impact on people's productivity. "Those affected by the disease obviously cannot go to work for at least a week. It might not matter if they were civil servants or private sector employees because they would still get paid, but what about the poor people who work as laborers? They cannot earn a living if they're sick," said Herdimansyah.
(ProMED 1.4.08)

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Taipei: CDC identifies two imported cases of chikungunya
Using fever screening upon arrival at international airports, the Taiwan Centers for Disease Control (CDC) identified two imported cases with chikungunya fever on 28 and 30 Dec 2007.

One of these patients is an Indonesian worker; the other is also an Indonesian, who came to visit his relatives. Their disease onsets were 20 and 27 Dec 2007 respectively. After fever was identified, blood samples were taken. Chikungunya was identified by PCR (polymerase chain reaction). The Taiwan CDC has included chikungunya fever as a Category II communicable disease in order to increase awareness of the disease and prevent outbreaks. In addition, people should be reminded to prevent chikungunya infection when traveling to endemic areas.

[This is yet another example of rapid movement of chikungunya virus infected individuals into distant areas where competent vectors are present (Taiwan reported dengue transmission in 2007). The Taiwan CDC is to be commended for the effectiveness of their surveillance system in detecting these incoming chikungunya cases. It is not clear if these infected individuals were staying in areas where the chikungunya virus vectors Aedes aegypti or Ae. albopictus were present and active.]
(ProMED 1.9.08)

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Taipei (Kaohsiung): Enterovirus (E71) kills 18-month-old boy
Officials from the Kaohsiung City Department of Health warned the public on 4 Jan 2008 to remain on guard against enterovirus even during the winter — a time when the highly contagious virus is usually less prevalent. The officials urged the public to improve personal hygiene and wash their hands often to keep enterovirus away all year round.

They made the call in the wake of a report of a death from human enterovirus type 71 (E71) infection in Kaohsiung on 27 Dec 2007. The case was confirmed as the sixth E71 infection in Taipei in 2007, and the only one resulting in death. The case involved an 18-month-old boy who came down with a fever, vomiting and hand-foot-mouth syndrome on 24 Dec 2007 and was hospitalized on 26 Dec 2007 after developing other symptoms, including twitching and a rash. The child died the next day of pulmonary edema and respiratory failure — complications caused by the infection, said Chang Hung-tai, emergency room director at Kaohsiung Veterans General Hospital.

The deceased child's four-year-old older sister also came down with a fever, vomiting, and hand-foot-mouth syndrome on 26 Dec 2007, Chang said. After she was hospitalized in intensive care on 27 Dec 2007, her condition stabilized, he said. Enteroviruses are the most common cause of aseptic meningitis and can be serious, especially in infants. An E71 outbreak in 2005 infected 145 children and killed 15.
(ProMED 1.9.08)

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Taipei (Kaohsiung): Suspected outbreak of amoebic dysentery at mental institution
Health officials of the Kaohsiung county government said on 25 Dec 2007, 14 patients in a mental institution in the southern Taipei county of Kaohsiung are suspected to have been infected with amoebic dysentery.

The officials said that they were informed on 19 Dec 2007 by Hualien County that nine patients from Kaohsiung's Liang Jen Hospital who were recently transferred to a Yuli sanatorium in the county had a high level of Entamoeba histolytica antibodies in their blood. Further tests showed that three out of the nine have been infected with the disease. The officials said that they immediately began disinfection work at Liang Jen Hospital and conducted tests on 105 patients.

Fourteen patients were suspected to have been infected, although they have shown no symptoms of diarrhea. Stool samples of the 14 patients will be collected three times to determine whether they have been infected, the officials said.
(ProMED 12.31.07)

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Americas
USA (California): UC Irvine researchers find possible alternative to existing smallpox vaccine
University of California, Irvine infectious disease researchers have shown the effectiveness of a potential alternative to the existing smallpox vaccine that can replace the current biodefense stockpile for this lethal virus.

Philip Felgner and Huw Davies with the Department of Medicine found that the modified vaccinia virus Ankara (MVA) produced the same antiviral response in human and animal studies as the current smallpox vaccine, Dryvax. The study is part of a national effort to develop a replacement for the Dryvax vaccine, which causes serious complications in some people.

“Studies have shown MVA to be a much safer vaccine product that takes advantage of modern technology,” Felgner said. “We are pleased that our advanced analytical methods may help to bring an effective and safer vaccine to the public.” Smallpox was declared eradicated worldwide in 1980; the last naturally occurring case in the world was in Somalia in 1977. Routine vaccination against smallpox in the United States stopped in 1972, and Dryvax production was halted in 1982. Both Dryvax and MVA are strains of vaccinia virus, which is related to the smallpox virus.

The antibodies created by vaccinia virus infection protect a person against a lethal smallpox infection, making it suitable for use as a vaccine. Unlike smallpox virus, vaccinia creates a very mild infection and is completely safe for healthy individuals. Although Dryvax was effective during the eradication campaign in the '60s and ’70s, its manufacturing methods are outdated by today’s standards, and it is also associated with significant risk of adverse reactions for immune-compromised individuals. The National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, identified MVA as a possible candidate to replace Dryvax. MVA was first developed in the 1970s and has been administered to animal species and humans with little or no adverse side effects.

In the study, Felgner and Davies applied blood serum samples taken from both humans and animals given the MVA or Dryvax vaccines to “microarray” chips containing more than 200 vaccinia virus proteins, on which they simultaneously studied how the serum antibodies responded to all the vaccinia proteins.

The researchers found that these antibody responses were similar in both the animal and human subjects regardless whether they were given MVA or Dryvax, suggesting that MVA contains antiviral properties similar to those in Dryvax. This similarity is vital, Davies says, because if a vaccine initiates an immune response in humans that matches the one in animals that are protected against lethal pox viruses, then public health officials will have more confidence that the vaccine will be effective in humans.

“This is particularly important for vaccines against lethal infections like smallpox, where human clinical trials cannot be done,” he added. The study marked a collaboration between UC Irvine and ImmPORT Therapeutics Inc. in Irvine, who manufacture the arrays. The animal tests were done by the NIAID, and human studies were held at Saint Louis University. The NIH supported the study.
(Science News 1.9.08)

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USA: Incurable dengue disease could spread
Incurable, mosquito-borne dengue disease could spread from subtropical areas into the United States through global warming, requiring greater efforts to combat it, health authorities said Tuesday.

"Widespread appearance of dengue in the continental United States is a real possibility," said National Institute of Allergy and Infectious Diseases director Anthony Fauci, in a commentary published in the Journal of the American Medical Association. Dengue fever, a flu-like illness especially dangerous in children and the elderly, "is becoming a much more serious problem along the US-Mexico border and in ... Puerto Rico," said the text co-authored by Fauci's senior scientific advisor David Morens. While dengue-related illness in the United States "is presently minimal," global warming and poor efforts to control mosquito populations responsible for its spread could accelerate the disease's propagation northward, the experts said.

"Worldwide, dengue is among the most important reemerging infectious diseases with an estimated 50 to 100 million annual cases ... (and) 22,000 deaths," the two physicians said. "Public health officials need to take the threat seriously ... because no specific treatments or vaccines for dengue are available," they warned. "The formidable challenges of understanding dengue pathogenesis and of developing effective therapies and vaccines must be met," they urged.

Dengue fever can cause fatal internal bleeding. It is transmitted by a bite of the white-spotted mosquito, Aedes aegypti. The World Health Organization believes 2007 could be on a par with 1998, when nearly 1,500 people died in Asia of dengue fever. The illness is endemic to Malaysia, which has seen cases surge 16 percent every year since 2003. Fatalities from dengue in Malaysia reached record levels in 2004, when 102 people died.
(AFP 1.9.08)

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USA (Massachusetts): Norovirus sickens dozens at Boston hospitals
Public health officials are urging hospitals to do a better job of promoting hand-washing after dozens of people were sickened by norovirus at three Boston hospitals in recent weeks. At Massachusetts General Hospital, 31 staffers and 13 patients fell ill with the gastrointestinal disease, which causes vomiting and diarrhea but generally leaves no lasting health effects.

Brigham and Women's Hospital reported that eight patients and 22 staff members contracted norovirus infection. And an outbreak at a Children's Hospital day-care facility left 33 children and adults sick. While the virus is difficult to stop entirely, experts say hospitals can slow its spread by encouraging employees to vigorously wash their hands with alcohol-based gel or soap after treating patients.

[Norovirus is living up to its reputation as the "winter vomiting bug" and hospitals are particularly vulnerable at this time of year. This year promises to be a vintage year for outbreaks of norovirus-associated disease. Currently at least 56 hospital wards in England and Wales have been closed to new admissions and it has been estimated that more than 100,000 people a week in the UK are contracting norovirus infection.

It should be noted that noroviruses (and caliciviruses in general) are resistant to inactivation by organic solvents and therefore alcohol-based cleansing agents may not have any additional advantage over conventional soap and water hand cleansing in controlling the spread of infection.]
(ProMED 1.9.08)

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USA (Multi-state): Officials attempt to pinpoint source of multi-state salmonella outbreak
Some people in Yellowstone County, WY are infected with salmonella, the same strain that is making people sick in states as far away as Texas and Pennsylvania. Now the Yellowstone County Health Department is trying to figure out how they are connected. A communicable disease specialist at the health department said they are conducting interviews with the people infected here, and other states are doing the same with their cases.

The information will then be sent to the Centers for Disease Control and Prevention (CDC), where experts will pinpoint the source of contamination. "The CDC will run it through an EPI program, and it's like a sorting program that goes through all the interviews and sorts through what item it could be," said Tamalee Taylor, communicable disease specialist at Yellowstone County Health Department.
(ProMED 1.7.08)

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USA (Pennsylvania): Potter County Woman tests positive for botulism
Consumers who purchased or were given "home-canned" soup or other canned products from the Schumacher's Inn in Austin, Potter County, should not open the jars due to the risk of botulism contamination, Health Secretary Dr. Calvin B. Johnson said on 3 Jan 2008.

The state became involved after a 43-year-old Potter County woman, and some of the chicken soup she said she purchased from the restaurant, tested positive for botulism. The Department of Agriculture, which oversees food safety, has quarantined the product and ordered the restaurant not to sell or give away any canned product. Any soup or other products canned by this restaurant should be submitted to the state for testing.
(ProMED 1.3.08)

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USA (Oregon): Cryptococcus gattii sickens Junction City woman
The fungus Cryptococcus gattii has afflicted a handful of Oregonians in recent years. Most recently, the fungus sickened a Junction City woman, who was hospitalized for more than four months in the fall of 2007.

The epicenter for the organism in the Northwest is Vancouver Island, Canada, where it was first detected in 1999. Since then, the fungus has sickened about 180 British Columbians and killed eight, said Karen Bartlett, associate professor of environmental health at the University of British Columbia.

The disease caused by the fungus is still extremely rare, but the rate in British Columbia is 36 cases per one million [of] population — far higher than other parts of the world where the fungus exists. About 25 people get sick each year in British Columbia from the fungus, and one dies, according to the BC Centre for Disease Control. Before it was detected on Vancouver Island, the fungus was associated with tropical and subtropical climates such as those in Australia, New Zealand, India, Africa and South America. Scientists are trying to figure out why and how Cryptococcus gattii emerged over the past decade in the Pacific Northwest.
(ProMED 1.3.08)

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USA: Woman infected with MDR Tuberculosis travels to US — possible transmission to others
Federal health officials recently issued an alert about a woman with multidrug-resistant tuberculosis (MDR TB) who flew from India to the United States in mid-December 2007, and efforts are under way to locate and test several of her fellow passengers for the disease.

The US Centers for Disease Control and Prevention (CDC) in a statement sent to clinicians on 29 Dec 2007 said the patient, who was not named, was diagnosed in India with MDR TB and traveled from New Delhi to Chicago on 13 Dec 2007 on American Airlines Flight 293, and then took a shorter flight within the United States. The patient is a 30-year-old woman whose final destination on 13 Dec 2007 was San Francisco and who is recovering in an isolation ward at a Bay Area hospital.

About a week after the flight the woman went to the emergency department at Stanford University Hospital with advanced symptoms of the disease. The CDC said the woman sought treatment for hemoptysis (cough productive of bloody sputum), fever and chest pain.

"These and other findings indicated a potential for transmission of drug-resistant TB to others," the agency added. Marty Fenstersheib, MD, MPH, health director for Santa Clara County, California, told the Times that the woman had symptoms during the flight, including coughing.

MDR TB is defined as TB that resists at least two key drugs that are considered first-line treatments for people who have TB infections: isoniazid and rifampicin, according to the CDC. Because of the risk of infection and according to World Health Organization (WHO) guidelines, the CDC is recommending TB testing for passengers who sat within two rows of the infected woman as well as airline crew members who worked in the cabin during the flight. The group includes 44 passengers.

The CDC has asked health officials in 17 states to contact the patients who have been flagged for testing.

All forms of TB are believed to spread when TB bacilli from a person with the disease become aerosolized as a result of coughing, sneezing, speaking or singing, the CDC said in its statement. The bacilli can float in the air for several hours, and people who breathe them in can become infected. Those who become infected have usually been exposed for several hours or days in poorly ventilated or crowded environments.
(ProMED 1.3.08)

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USA (California): Prison officials concerned over recent outbreaks of valley fever
When any of the 5300 inmates at Pleasant Valley State Prison begin coughing and running a fever, doctors do not think flu, bronchitis or even the common cold. They think valley fever; and, more often than they would like, they are right.

In the past three years, more than 900 inmates at the prison have contracted the fever, a fungal infection that has been both widespread and lethal. At least a dozen inmates in Central California have died from the disease, which is on the rise in other Western states, including Arizona, where the health department declared an epidemic after more than 5,500 cases were reported in 2006, including 33 deaths. Endemic to parts of the Southwest, valley fever has been reported in recent years in a widening belt from South Texas to Northern California. The disease has infected archaeologists digging at the Dinosaur National Monument in Utah and dogs that have inhaled the spores while sniffing for illegal drugs along the Mexican border.

In most cases, the infection starts in the lungs and is usually handled by the body without permanent damage. But serious complications can arise, including meningitis; and, at Pleasant Valley, the scope of the outbreak has left some inmates permanently disabled, confined to wheelchairs, and interned in expensive long-term hospital stays. About 80 prison employees have also contracted the fever, Pleasant Valley officials say, including a corrections officer who died of the disease in 2005.

What makes the disease more troubling is that its cause is literally underfoot: the spores that cause the infection reside in the region's soil. When that soil is disturbed, something that happens regularly where houses are being built, crops are being sown, and a steady wind churns, those spores are inhaled. The spores can also be kicked up by Mother Nature including earthquakes and dust storms.

The epidemic at the prison has led to a clash of priorities for a correctional system that is dealing with below average medical care and chronic overcrowding. In the fall of 2007, heeding advice from local health officials and a federal receiver charged with improving the state's prison medical care, the Department of Corrections and Rehabilitation delayed plans to add 600 new beds out of concern that the construction might stir up more spores. Officials at the prison blame the construction of a state hospital nearby for causing a spike in valley fever. The construction was under way from 2001 to 2005, and valley fever hit its peak here in 2006, when the disease was diagnosed in 514 inmates. In 2007, about 300 cases have been diagnosed among inmates at the prison, which sits along a highway lined with almond groves and signs advertising new "semi-custom homes." Felix Igbinosa, the prison's medical director, said "the Number one reason" was thought to be the soil disturbance from new construction.
(ProMED 12.31.07)

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USA (North Carolina): Listeriosis infections prompt health warning for pregnant women
Officials with the North Carolina Division of Public Health are cautioning pregnant women against consumption of soft cheeses, hot dogs and deli-style meats and prepared salads. The warning comes after three cases of listeriosis were identified in Moore, Durham and Mecklenburg counties and a probable case was identified in Buncombe County. The three confirmed cases all involved Latinas; two (Durham and Mecklenburg counties) of them were pregnant women whose pregnancies resulted in miscarriages as result of the infection. The third case (Moore County) involved a pregnant woman as well. As a result of the disease, she delivered early, but she and the baby are doing well. The probable case (Buncombe County) involves another pregnant Latina who also lost her baby. All four had consumed soft cheeses from a variety of sources.

Listeriosis is a serious infection caused by eating food contaminated with the bacterium Listeria monocytogenes. Listeriosis outbreaks have been associated with consumption of unpasteurized (raw) milk and contaminated soft cheeses, vegetables and ready-to-eat meats. The disease affects primarily pregnant women, newborns and people with weakened immune systems.

"This is a tragedy, which could have been avoided," said State Epidemiologist Dr. Jeff Engel. "Listeriosis can be prevented by avoiding unpasteurized milk and other potentially contaminated food, especially among vulnerable people."

Although the cases occurred close together in time, data from molecular testing conducted at the State Laboratory of Public Health showed that different strains were involved, and therefore a single product does not seem to be the source of these cases, prompting public health officials to issue a general listeria warning.
(ProMED 12.30.07)

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USA (Massachusetts): Dairy farm suspected in listeriosis deaths
State health officials warned consumers not to drink milk produced by a Massachusetts dairy, saying it was the likely source of a bacterial illness that killed two men and sickened two others.

Whittier Farms suspended operations and distribution, said Dr. Alfred DeMaria, the state director of communicable disease control. Most of its customers live in Worcester County. The Department of Public Health issued the warning on 27 Dec 2007 after identifying four cases of listeriosis. Two of the victims, a 78-year-old man and a 75-year-old man, died in June and October 2007.

Investigators have not identified the exact source of the contamination in the production process, DeMaria said. But milk samples gathered last week at one of the dairy's two retail stores tested positive for listeria. Testing showed that the bacteria causing the infections in the four victims likely came from the same source.

The dairy has a processing plant in Shrewsbury and operates two retail stores. A message left on an answering machine at the Sutton store said it was closed and that information to date was ''inconclusive.'' The message said the owners would be addressing the issue as soon as possible. Whittier Farms' milk products are sold under several brand names, including Whittier, Schultz, Balance Rock, Spring Brook, and Maple, state health officials said.
(ProMED 12.30.07)

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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.ht ml. 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. Read about: Rapid Response Training: The Role of Public Health in a Multi-Agency Response to Avian Influenza in the United States. 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)

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4. Articles
Has Retail Chicken Played a Role in the Decline of Human Campylobacteriosis?
Gormley FJ, et al. Applied and Environmental Microbiology, January 2008, p. 383-390, Vol. 74, No. 2
http://aem.asm.org/cgi/content/abstract/74/2/383

Between 2001 and 2006, the incidence of human Campylobacter infections decreased by 10 and 27% in Scotland and the Grampian region of Scotland, respectively. Contemporaneous collection and analyses of human and retail-chicken isolates from Grampian were carried out over a 10-week period in 2001 and again in 2006 in order to determine whether the fall in the incidence of human infections was related to the retail-chicken exposure route. Rates of carriage of Campylobacter on chicken carcasses from retail outlets in Grampian in 2001 and 2006 were estimated. Chicken-derived Campylobacter isolates from 2001 (n = 84) and 2006 (n = 105) and human-derived isolates from patients with clinical cases of infection in 2001 (n = 172) and 2006 (n = 119) were typed by multilocus sequence typing. We found no evidence for statistically significant changes in prevalence and counts per carcass. We found by rarefaction that although the degree of diversity in humans tended to be higher than that in chickens, these differences were not significant. The genetic distance between chicken and human isolates from 2001 according to sequence type, clonal complex (CC), or allele composition was not significant, whereas the distances between 2006 isolates at the CC and allele levels were significant. This difference was attributable to a lower proportion of CC-21's being found in retail-chicken isolates from 2006 than in chicken isolates from 2001. We conclude that human exposure to Campylobacter via retail chicken is important and that changes in the population structure of campylobacters in this reservoir need to be taken into account in investigating human infection.
(CIDRAP 1.6.08)

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Epidemics of Gastroenteritis during 2006 Were Associated with the Spread of Norovirus GII.4 Variants 2006a and 2006b
GII.4 Variants 2006a and 2006b Elise T, et al. Clinical Infectious Diseases 2008;46:413–420
http://www.journals.uchicago.edu/doi/full/10.1086/525259

Background
Acute gastroenteritis is commonly associated with norovirus genogroup II (GII) infection. Norovirus GII has 17 classified genotypes (GII.1–GII.17), but only 1 norovirus genotype (GII.4) is associated with global epidemics of gastroenteritis. In 2006, an increase in global norovirus activity was observed.

Methods
During the period from December 2005 through August 2006, a total of 231 fecal samples were obtained from patients with acute gastroenteritis from Australia and New Zealand. Norovirus RNA was amplified and sequenced to determine norovirus genotype and relatedness to known epidemic norovirus GII.4 variants.

Results
The GII.4 variants, designated 2006a and 2006b, were identified in 61.8% and 11.3%, respectively, of the 186 cases investigated. Norovirus 2006a and 2006b have also been implicated as the predominant causes of norovirus–associated gastroenteritis across Europe in 2006.

Conclusions
The global increase in norovirus–associated gastroenteritis in 2006 was linked to the emergence of two novel GII.4 variants, 2006a and 2006b.
(CIDRAP 1.4.08)

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Plasmodium knowlesi malaria in humans is widely distributed and potentially life threatening
By Dr. Michael Bangs

Commentary Cox-Singh et al. have presented intriguing and important findings as follow-up to an earlier published article on this phenomenon [Singh et al. 2004. Lancet 363: 1017-1024]. Commentary provided by ProMED and by NJ White [CID 2008:46: 172-3] following the recent subject paper [CID 2008: 46: 165- 71] aptly proposed that P. knowlesi be considered the 5th human malaria parasite. Given this parasite's impressive frequency and contribution to the overall percentage of slide-confirmed malaria cases in the focus of study [Sarawak and Sabah (Borneo), and Pahang State, Malaysia] and the fact that gametocytes develop in human infection, this proposal will likely prove correct; however, definitive evidence awaits confirmation that human-vector-human transmission (i.e., exclusive of monkey-derived infections) occurs naturally.

Further investigation on the true extent of the distribution of P. knowlesi will surely be forthcoming.

In Southeast Asia, the reach of this parasite will likely broaden to areas where the respective natural mammalian hosts reside. This is especially true in Indonesia where P. knowlesi is a common parasite in a number of nonhuman primates (both cercopithecine and colobine monkeys), most notably Macaca fascicularis (Long-tailed macaque). This primate species is common on the islands of Sumatra, Java, Bali, Lombok, Sumbawa, Kalimantan and Sulawesi, and not infrequently becomes a commensal pest of humans.

Given this species' relatively close association with humans and the availability of monkey and human-feeding anopheline vectors, these areas would likely be conducive for established P. knowlesi transmission. The true geographical distribution of P. malariae has justifiably been called into question, and future genetic studies should help clarify its true global presence.

This clarification is important both epidemiologically and clinically, as P. knowlesi infection is associated with greater frequency of severe disease compared to P. malariae malaria. Interestingly, there are areas in the eastern reaches of Southeast Asia and western Oceania that have significant foci of P. malariae infection yet which have no indigenous or introduced nonhuman primates present there. This is particularly true on the large island of New Guinea, where isolated foci of P. malariae have been reported at a relatively high prevalence (Anthony et al. 1992 Am. J. Trop. Med. Hyg. 47: 346-356).

[Original article citation: Cox Singh J, Davis T, et al: Plasmodium knowlesi malaria in humans is widely distributed and potentially life threatening. Clinical Infectious Diseases 2008; 46:165-171; DOI: 10.1086/524888; electronically published 3 December 2007]
(ProMED 1.7.08)

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Glycan topology determines human adaptation of avian H5N1 virus hemagglutinin
Chandrasekaran A, et al. Nature Biotechnology. 2007;26:107 – 113. Published online: 6 January 2008 | doi:10.1038/nbt1375
http://www.nature.com/nbt/journal/v26/n1/abs/nbt1375.html

Abstract
A switch in specificity of avian influenza A viruses' hemagglutinin (HA) from avian-like (2-3 sialylated glycans) to human-like (2-6 sialylated glycans) receptors is believed to be associated with their adaptation to infect humans. We show that a characteristic structural topology — and not the 2-6 linkage itself — enables specific binding of HA to 2-6 sialylated glycans and that recognition of this topology may be critical for adaptation of HA to bind glycans in the upper respiratory tract of humans. An integrated biochemical, analytical and data mining approach demonstrates that HAs from the human-adapted H1N1 and H3N2 viruses, but not H5N1 (bird flu) viruses, specifically bind to long 2-6 sialylated glycans with this topology. This could explain why H5N1 viruses have not yet gained a foothold in the human population. Our findings will enable the development of additional strategies for effective surveillance and potential therapeutic interventions for H5N1 and possibly other influenza A viruses.
(CIDRAP 1.6.08)

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Amantadine-resistance among H5N1 avian influenza viruses isolated in Northern
He G, et al. Antiviral Res. 2008 Jan; 77(1):72-6. Epub 2007 Sep 12.

Abstract
We tested the amantadine-resistance among avian influenza A (H5N1) viruses isolated from chicken in Hebei Province of Northern China from 2001 to 2005, and investigated the amantadine use in this area. Plague reduction assay in MDCK cells showed that 83.3% isolates (5/6) were amantadine- resistant strains. The M2 sequence analysis revealed that four of five resistant isolates contained the point mutations (Ser to Asn) at position 31 that could confer resistance to amantadine. These results indicated that the incidence of amantadine-resistant viruses isolated in Northern China was particularly high. In the investigation of amantadine use, we found that amantadine was used extensively in poultry farms in this area, which maybe was one of reasons of the high amantadine-resistance incidence.
(CIDRAP 1.6.08)

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Receptivity to mandatory influenza vaccination policies for healthcare workers among registered nurses working on inpatient units
Poland G, et al. Infect Control Hosp Epidemiol 2008;29:170–173
http://www.journals.uchicago.edu/doi/abs/10.1086/526432

Abstract
A survey that included questions about preferred methods of influenza prevention was completed by 513 registered nurses working on inpatient units. Vaccination was the preferred influenza prevention method among 83.0% of respondents. Of 506 respondents, 283 (56.0%) stated that mandatory influenza vaccination was appropriate for healthcare workers, and 394 (59.4%) of 512 RNs reported that they would support a policy requiring annual influenza vaccination for healthcare workers that allowed for informed declination.
(CIDRAP 1.6.08)

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Ambulatory short-course high-dose oral amoxicillin for treatment of severe pneumonia in children: a randomized equivalency trial
Hazir T, et al. The Lancet. Volume 371, Issue 9606, 5 January 2008-11 January 2008, Pages 49-56

Background
WHO case management guidelines for severe pneumonia involve referral to hospital for treatment with parenteral antibiotics. If equally as effective as parenteral treatment, home-based oral antibiotic treatment could reduce referral, admission, and treatment costs. Our aim was to determine whether home treatment with high-dose oral amoxicillin and inpatient treatment with parenteral ampicillin were equivalent for the treatment of severe pneumonia in children.

Methods
This randomized, open-label equivalency trial was done at seven study sites in Pakistan. 2,037 children aged 3–59 months with severe pneumonia were randomly allocated to either initial hospitalization and parenteral ampicillin (100 mg/kg per day in four doses) for 48 h, followed by three days of oral amoxicillin (80–90 mg/kg per day; n=1012) or to home-based treatment for five days with oral amoxicillin (80–90 mg/kg per day in two doses; n=1025). Follow-up assessments were done at 1, 3, 6 and 14 days after enrollment. The primary outcome was treatment failure (clinical deterioration) by day six. Analyses were done per protocol and by intention to treat. This trial is registered, ISRCTN95821329.

Findings
In the per-protocol population, 36 individuals were excluded from the hospitalized group and 37 from the ambulatory group, mainly because of protocol violations or loss to follow-up. There were 87 (8·6%) treatment failures in the hospitalized group and 77 (7·5%) in the ambulatory group (risk difference 1·1%; 95% CI −1·3 to 3·5) by day six. Five (0·2%) children died within 14 days of enrollment, one in the ambulatory group and four in the hospitalized group. In each case, treatment failure was declared before death and the antibiotic had been changed. None of the deaths were considered to be associated with treatment allocation; there were no serious adverse events reported in the trial.

Interpretation
Home treatment with high-dose oral amoxicillin is equivalent to currently recommended hospitalisation and parenteral ampicillin for treatment of severe pneumonia without underlying complications, suggesting that WHO recommendations for treatment of severe pneumonia need to be revised.
(WHO 1.4.08)

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5. Notifications
2nd International Conference On Dengue/Dengue Hemorrhagic Fever, Thailand, October 2008
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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12th Annual Transmissible Spongiform Encephalopathies Conference
Location: Baltimore, Maryland, USA Venue: Sheraton Inner Harbor Hotel Dates: 11-12 Feb 2008

Cambridge Healthtech Institute's Transmissible Spongiform Encephalopathies is the longest running meeting of its kind in the world. This 12th Annual meeting will address the ongoing progress in the science of prion diseases, as well as the newest developments in the fields of pathophysiology, transmission, detection, removal/inactivation, treatment and prevention. This conference will present the newest data on TSEs in the context of its application to the pharmaceutical, biological, environmental and device industries.

Confirm your registration by 11 Jan 2008 to qualify for the advanced registration discount.

To register, visit the conference Web site at http://www.healthtech.com/2008/tse/ or call 781-972- 5400. Mention priority code TSEPRO and save an additional USD100 off your conference registration.
(ProMED 1.3.08)

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Bangkok International Conference on Avian Influenza 2008: Integration from Knowledge to Control
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 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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 apecein@u.washington.edu