Vol. XI No. 4 ~ EINet News Briefs ~ Feb 22, 2008

2008
China / 1 (1)
Indonesia / 10 (8)
Viet Nam / 2 (2)
Total / 13 (11)

2007
Cambodia / 1 (1)
China / 5 (3)
Egypt / 25 (9)
Indonesia / 42 (36)
Laos / 2 (2)
Myanmar / 1 (0)
Nigeria / 1 (1)
Pakistan / 1 (1)
Viet Nam 8 (5)
Total / 86 (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: 362 (228). (WHO 2.20.07 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 2.15.08)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 2.7.08): http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 2.11.07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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China (Hunan, Guangxi Zhuang): H5N1 avian influenza claims two lives
The Ministry of Health confirmed the death of a Guangxi Zhuang Autonomous Region man on 21 Feb 2008. The 41-year-old man in Nanning City developed fever and headache symptoms on 12 Feb 2008 and died 20 Feb 2008, after all rescue measures proved ineffectual. Tests of the man were H5N1-positive, said China's Center for Disease Control and Prevention.

The earlier case, a 22-year-old male from Jianghua County, Yongzhou Prefecture, Hunan Province, developed symptoms on 16 Jan 2008, was hospitalized on 23 Jan 2008 and died on 24 Jan 2008. The case was confirmed by the national laboratory on 17 Feb 2008. Investigations into the source of his infection are ongoing.
(ProMED 2.21.08)

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China (Tibet): Himalayan region reports its second outbreak of H5N1 avian
The outbreak, which started on 6 Feb 2008 in a village outside the regional capital Lhasa, has killed 132 poultry and led to the culling of 7,698 birds, the Agriculture Ministry said. The National Avian Influenza Reference Laboratory confirmed on 17 Feb 2008 that the virus the birds contracted was a subtype of the H5N1 strain. Authorities have taken emergency measures to bring the epidemic under "effective control." An outbreak of the H5N1 strain in Tibet's Gongga County on 25 Jan 2008 killed 1,000 chickens and ducks. More than 13,000 birds were culled at the time.
(ProMED 2.20.08)

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India (Orissa): Vets refuse to cull poultry
In a significant development that will affect the government's proposed culling of birds within 5-km radius of Orissa-West Bengal border to prevent bird flu in the state, the Orissa Veterinary Association (OVA) decided not to participate in the killing. A decision to this effect was taken in the emergency meeting convened on 13 Feb 2008 to review the present situation. The killing of healthy poultry is quite unethical for a veterinarian and it contravenes the principle of veterinary medical ethics, the association unanimously felt. "All sorts of precautionary measures have been taken since last month and the investigations so far have found not a single bird flu case, there is no need of mass culling of birds," said the general secretary Dr. Muktikanta Bhuyan.
(ProMED 2.15.08)

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Indonesia (Sumatra): H5N1 avian influenza spreads in southern part of the
Bird flu is on the rise in East Lampung, Indonesia, prompting local authorities to order backyard farmers to keep their chickens inside their coops. The avian influenza virus had spread through eight sub districts in East Lampung Districts, said the head of Dewanto, the Participatory Disease Surveillance (PDS) team.

The virus was detected earlier in February 2008 in six sub districts, but now has struck poultry in 12 villages in eight sub districts, and possibly will spread through poultry to other sub districts.
(ProMED 2.15.08)

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Pakistan (Northwest): H5N1 avian influenza infects poultry, culling operation
Livestock officials in Pakistan said on 17 Feb 2008 that the H5N1 avian influenza virus hit chickens in the northwestern part of the country, the region where December outbreaks were linked to suspected human-to-human transmission of the virus and Pakistan's first confirmed human case. Rafiq-ul-Usmani, a food and agriculture ministry official, said samples from a poultry farm near Abbottabad, in Northwest Frontier province, were positive for the H5N1 virus and that culling at the farm had begun. About 5,000 chickens have been culled, Ali Akber Kahn, a Mansehra district livestock minister said. So far no workers at the farm had shown signs of infection.
(CIDRAP 2.18.08)

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Pakistan: WWF researchers maintain wild birds are not to blame for the spread of
Wild migratory birds may suffer from avian influenza, but they are not the main source of the disease outbreak in Pakistan, according to a study statement issued by the World Wildlife Fund (WWF) Lahore chapter on 15 Feb 2008. The statement said that the assertions about migratory birds being the main reason for the latest outbreak of bird flu in Pakistani poultry farms might have serious repercussions against the birds and their habitats. It said since the recent outbreak of bird flu in Sindh, WWF Pakistan had been in contact with BirdLife International, which carried out research on the role of wild birds, including migratory species, in the spread of HPAI H5N1.

The WWF said there were no sound grounds to support the allegations that migratory birds were solely responsible for the spread of H5N1. It said the Food and Agriculture Organization (FAO) collected samples from between 300,000 to 350,000 wild birds across the world. None of these were found H5N1 positive. Likewise, a sampling of 5,000 water birds after the outbreak in Nigeria during 2006 found no traces of the virus. Despite increased sampling around the world, no fully documented migratory wild birds have tested positive for H5N1. The WWF said the mapping of bird flu outbreaks across the world had shown that they followed poultry trade routes rather than the migratory birds' flyways. Therefore, after a comprehensive critical review of recent scientific literature, it was concluded that poultry trade, rather than bird migration, was the main mechanism of the global dispersal of the H5N1 virus. The statement said the organization did not support mass culling of wild birds or the destruction of their habitats. It said the birds' habitats should be left undisturbed so that they do not seek refuge near human settlements.
(ProMED 2.17.08)

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Viet Nam: H5N1 avian influenza causes two more deaths, several more feared sick
Bird flu has killed a second man in Viet Nam during the week of 10-16 Feb 2008, infected a child, and infected poultry in two provinces. A 27-year-old man died on 14 Feb 2008 at a Hanoi hospital after he was taken there from the northern province of Ninh Binh on 12 Feb 2008 with serious pneumonia. On 31 Jan 2008 he slaughtered two sick chickens and fell ill two days later with pneumonia symptoms. His death is Vietnam's third in 2008 from bird flu and the country's 50th fatality.

Doctors also confirmed a seven-year-old child from the northern province of Hai Duong had the H5N1 virus and was being treated at a pediatrics hospital in Hanoi. Hai Duong is also home to a 40-year-old man who died from bird flu on 12 Feb 2008, the 49th fatality of Vietnam's 103 confirmed cases, the World Health Organization (WHO) said. Both provinces of Ninh Binh and Hai Duong are not on the government's bird flu watch list, but health officials said more human infections could emerge as chicken is a popular dish at this time of the year.

"Now it is the start of spring, parties using chicken are numerous," Nguyen Huy Nga, head of the Health Ministry's Preventive Medicine Department. "Many patients will be found in the coming days," he said, criticizing poor communication as people failed to report dead poultry to the authorities. Several people suspected of having bird flu were now being treated in Hanoi, the Vietnam News Agency said without elaborating. The Agriculture Ministry's Animal Health Department also reported cases in the past week at two poultry farms in the northern province of Quang Ninh on the border with China and in the southern province of Long An.
(ProMED 2.16.08)

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Indonesia: Two boys succumb to H5N1 avian influenza infection in the same day
A three-year-old Indonesian boy has died of bird flu, a health official said on 16 Feb 2008, announcing the country's second death from the illness in one day. The two cases, which were apparently unrelated, brought Indonesia's bird flu death toll to 105. The latest victim was identified only as a three-year-old boy from the southern part of the capital, Jakarta. He died on 15 Feb 2008 at a hospital in the city. Senior Health Ministry official Nyoman Kandun confirmed the report and said laboratory tests confirmed the boy had the H5N1 strain of the bird flu virus. It was not clear how he was infected, and Kandun gave no further details.

Earlier on 16 Feb 2008, the Health Ministry said a 16-year-old Indonesian boy from Central Java province died of bird flu. The boy became ill on 3 Feb 2008 with respiratory symptoms. Tests confirmed he had H5N1, the ministry said. The 16-year-old victim's neighbors had sick chickens on their property, and the boy apparently slaughtered some of them before becoming ill.
(ProMED 2.16.08)

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USA: CDC report gives states' preparedness efforts high marks, also identifies
The distribution of more than $5 billion in federal funds since 2001 has greatly improved states' preparedness to deal with disease outbreaks, natural disasters, and other public health emergencies, the Centers for Disease Control and Prevention (CDC) said on 20 Feb 2008 in a first-of-its-kind assessment. The CDC report, titled "Pubic Health Preparedness: Mobilizing State by State," is the agency's first major effort to evaluate and describe what state and local public health agencies have accomplished with the increased federal dollars that flowed to states after the terrorist attacks of 2001. "There has been significant progress toward achieving this goal" of protecting the public from emerging health threats, Dr. Richard Besser, director of the CDC Coordinating Office for Terrorism and Emergency Response, said at a briefing.

Some prime examples of improvement cited in the 164-page report:

• Every state is now equipped to receive and evaluate health emergency reports at all times, whereas only 12 states had "24/7/365" capability in 2001.
• All states have public health laboratories that can communicate quickly with clinical labs today, comparedwith only 20 states in 2001.
• Every state now has a plan to receive and distribute drugs and other supplies from the Strategic National Stockpile.
• All states are now conducting year-round influenza surveillance, considered critically important given the threat of pandemic flu.
• The number of public health epidemiologists working in emergency response has more than doubled, from 115 in 2001 to 232 in 2006.
• Users of the Epidemic Information Exchange, a CDC-based communication system that helps track disease outbreaks, have increased more than 5-fold, from 890 in 2001 to 4,646 in 2006. Most are in state and local public health.

• Disease surveillance systems need strengthening. For example, last year 16 states reported no plans to exchange health data electronically with regional networks of healthcare providers.
• For disease surveillance, health departments need to make sure they have a legal framework permitting them to share health information with other jurisdictions.
• Health departments are having trouble finding and keeping qualified epidemiologists, according to a 2006 survey.
• Though many cities now have systems that allow different response agencies to communicate, more progress is needed in that area.
• While all states now have plans for distributing materials from the Strategic National Stockpile, much more work is needed in that area

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Indonesia (Java): Officials in Central Java report at least 37 deaths due to
At least 37 people died of dengue fever in Central Java province during January 2008, a local official said.

According to the record of the Central Java provincial administration, there were 2,347 cases of dengue fever in January 2008, a decrease from 2,518 cases, with 62 fatalities in January 2007, Hartanto, the head of the Central Java Health Service, said on 16 Feb 2008. During the first two weeks of February 2008 at least 57 local people were infected with the dengue fever virus.
(ProMED 2.18.08)

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Indonesia (Flores): Rabies causes two deaths
Of the 40 people infected with rabies over the last two weeks in West Manggarai regency, East Nusa Tenggara, two have died, an official said on 2 Feb 2008. All of the infections resulted from the victims being bitten by dogs. IG Ngurah Harijaya, head of the West Manggarai Health Office, said the regency's death toll from rabies was now four in 2008. Ngurah said the 40 rabies cases were recorded in five districts. "There was an increase in the number of infections in nearly every district," he said. According to data from the East Nusa Tenggara administration, of about 200,000 dogs in Flores and Lembata, 50,000 have not been vaccinated.
(ProMED 2.15.08)

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Japan: Officials fear imported dumplings were poisoned
Fears have increased in Japan that a batch of dumplings imported from China had been deliberately poisoned, after the tainted food was found to contain a second toxic pesticide. Feelings have been running high in Japan since Japanese health minister Yoichi Masuzoe claimed on 5 Feb 2008 that gyoza dumplings contaminated with the pesticide methamidophos had been deliberately tampered with and that police are treating it as an attempted murder case. Tests yesterday showed that the pesticide dichlorvos was found in dough and fillings used to make the dumplings. To date, several hundred Japanese have visited hospitals complaining of nausea and diarrhea, with one 10-year-old girl in a serious condition after eating the dumplings.

Wei Chuanzhong, the Chinese vice minister of the General Administration of Quality Supervision, Inspection and Quarantine, admitted that "a small group that does not wish for the development of Sino-Japanese friendship may have taken extreme measures." The likelihood of the pesticides being added at the factory in Hebei Province that has been the focus of the joint investigation was "extremely small," both sides agreed, and it is not clear whether the pesticides were added in China or after they were imported to Japan.

The crisis has led to Nissin Food Products withdrawing from a planned merger with the Chinese unit of Japan Tobacco Inc, while chat rooms and editorials in both China and Japan have been inundated with claims and counter-claim of conspiracy between two countries that have a long history of regional rivalry. Both Tokyo and Beijing have called for the rhetoric to be toned down.
(ProMED 2.8.08)

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Papua New Guinea (Morobe): High school student diagnosed with dysentery
There is a reported outbreak of dysentery at Salamaua High School in Morobe province. A Grade 9 student from the school reportedly sought medical treatment in Lae and was diagnosed with dysentery. The student said there were many other students at the school with similar symptoms. The student said they were drinking water from the school's murky water supply, the same water was used for cooking, the water pump was unreliable, and the water source was not safe for human consumption.
(ProMED 2.12.08)

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Philippines (Cebu): High number of dengue cases in 2008
The cities of Toledo and Talisay are recording the highest number of dengue fever cases so far in 2008, with 35 and 28 cases, respectively, as the fever continues to haunt Cebu Province. Officials say the cases are still a continuation from last year's dengue eruption. Since the start of 2008 until 8 Feb 2008, the province has seen 304 dengue cases, seven of which resulted in deaths. January 2008 alone recorded a total of 232 cases, with five deaths.
(ProMED 2.18.08)

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Philippines: New study finds that diarrhea leads to the premature deaths of 31
Some 31 Filipinos, mostly children, die daily from diarrhea due to poor sanitation, according to a recent study of the World Bank (WB) and United States Agency for International Development (USAID). The report cited the Philippines Statistical Yearbook 2008 as stating high incidence of diarrhea cases of more than 38 million per year leads to the premature deaths of 31 Filipinos a day. The report said 27 million Filipinos do not have toilets and are at risk of ingesting human fecal material. The health impacts of water pollution and poor sanitation and hygiene come from contact with human waste through ingestion. The World Bank report said some 13 million Filipinos do not have improved water sources, and only 3.3 percent of the households are connected to sewers leading to the treatment facilities. Access to basic sanitation is 20 percent lower for low-income households, while access to water supply is 17 percent lower, said Rahul Raturi, World Bank sector manager for environment and rural development. The Bank said more than 95 percent of the wastewater in urban areas is deposited untreated into groundwater, canals, and waterways.
(ProMED 2.18.08)

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Russia (Khanty-Mansi): 14 sick and one dead in outbreak of botulism, canned
The specialists of Rospotrebnadzor (Territorial Directorate of the Federal Services for Consumer Protection and Human Welfare) are investigating the causes of an outbreak in Khanty-Mansi among 14 people who were admitted to the hospital recently with botulism. One of the patients died on 5 Feb 2008. According to preliminary data, the source of the outbreak was homemade canned tomatoes. The analysis reported that relatives gathered for a feast on 3 Feb 2008 and all ate canned tomatoes. The specialists of Rospotrebnadzor and other agencies have taken specimens to determine the source of infection.
(ProMED 2.15.08)

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Russia (Tyumen, Buryatia): Homemade, low-quality products to blame for several
During the last five days, 13 cases of botulism, one of them fatal, have been reported in Surgut (in Tyumen Oblast region). The source of the outbreak was the use of homemade, low-quality products. Doctors report that the condition of two patients is very severe, and they are on artificial lung ventilation. In another case, doctors are struggling to save the life of a 12-year-old girl in Buryatia who is suffering from botulism. She was admitted to hospital on 4 Feb 2008 and her condition is extremely critical. The cause of the infection was homemade salted omul, according to the Rospotrebnadzor report. The grandfather of the girl purchased the fish during the fall and salted it in an improper way. The family had been using the fish until the botulism incident. The sanitary services are warning the population not to buy fish from private sources and not to salt it themselves.
(ProMED 2.11.08)

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Singapore: Cluster of chikungunya infections supports fears of local
The first reported local chikungunya case in Singapore was detected through a laboratory-based General Practitioner (GP's) surveillance network, in the middle of January 2008. In the surveillance system, GPs are encouraged to consider chikungunya as a possibility, when they suspect dengue. In addition, samples sent for dengue PCR testing, and found to be negative for dengue, were screened for chikungunya. Prior to the detection of this first local case, about 10 imported cases were detected through an extensive surveillance system that includes the hospitals and GPs. Since the detection of the first case, enhanced surveillance throughout the country along with active case detection around the cluster, have picked up another 12 cases, from about 3,000 samples screened. They are all linked to about a 0.3 sq.km localized area. No new cases have been detected since January 2008. A lack of recent travel among cases and clustering of cases in a small geographic area suggests that there has been local transmission of chikungunya virus through mosquitoes in Singapore.
(ProMED 2.12.08 & 2.16.08)

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Taipei (Pingtung): 21-month-old child stricken with enterovirus released after
The Department of Health (DOH) confirmed on 19 Feb 2008 an enterovirus-71 case involving a 21-month-old child in Pingtung County, bringing the total number of confirmed cases in Taipei to 14 for 2008. Lin Ting, deputy director-general of the Centers for Disease Control under the DOH, said that the girl's parents took her to a Kaohsiung medical center on 4 Feb 2008 after discovering blisters all over her body. The child was released from hospital the next day after her condition improved. However, on 6 Feb 2008, the child developed a fever, symptoms of hand, foot and mouth disease (HFMD), as well as arm and leg spasms, Lin said. The parents brought the child back to the same medical center, and she was immediately admitted to the pediatric intensive care unit. On 19 Feb 2008, after conducting tests, the hospital reported the suspected enterovirus-71 case to the CDC. The child was released from the medical center several days later after her condition had improved. In 2007, there were a total of 49 cases of confirmed enterovirus infections in Taipei, with two fatalities. So far in 2008, there have been 14 cases, with no fatalities.
(ProMED 2.20.08)

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Until recently, researchers thought those people encountered the fungus while traveling on Vancouver Island or in the tropics, not close to home. But six people who had not traveled anywhere the fungus is found were infected between 2004 and 2006 — one from the Sunshine Coast, two from Greater Vancouver, and three from the Fraser Valley. "We are certain they were exposed on the mainland," Dr. Galanis said. Soil, air, and tree sample tests have so far found the fungus is mainly entrenched around Courtenay, Parksville, Duncan, parts of Victoria, and Salt Spring Island. Most Lower Mainland samples taken have come back negative, but transient positive tests show the fungus was at least temporarily present at sites in northern Langley and southern Chilliwack. It is not clear why the fungus has been detected only very rarely and sporadically in the Lower Mainland. "It may only temporarily come to the mainland and does not take hold," Galanis said. "Or it is present here only in patches or low concentrations that we haven't really been able to find easily." It is mainly found in South America, Africa, and Southeast Asia. BC is the first temperate area it has colonized.
(ProMED 2.20.08)

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Canada (Saskatchewan): Outbreak of metapneumovirus found in healthcare facilities
There is now an outbreak of human metapneumovirus (HMPV) at the Palliser Regional Care Centre (PRCC) and a suspected outbreak at Shaunavon Hospital and Care Centre (SHCC). Presently, no visitors are allowed into these facilities. In the PRCC, we have identified the causative organism as HPMV, which is not vaccine-preventable and a relatively new organism. Residents suffering from this illness are in isolation. We are awaiting the identification of the causative organism in the case of the SHCC. Officials caution employees to stay home and visitors to postpone visits if they are feeling unwell. "The Cypress Health Region will continue to communicate outbreak status in the affected facilities with the public through various channels," says Trent Regier, Director of Population Health. "Visitor restriction will be updated on the Cypress Health Region's website, http://www.cypresshealth.ca, and announced though news releases."

Human metapneumovirus (HMPV) was identified first in the Netherlands as a novel human respiratory pathogen in 2001 and subsequently found to be present worldwide. Biologically, HMPV resembles its more distant relative human respiratory syncytial virus, but is less prevalent. HMPV is similarly associated with clinical symptoms in children ranging from upper respiratory tract disease to severe bronchiolitis and pneumonia. Both viruses are responsible for outbreaks of significant respiratory disease, which can be very severe in the elderly.
(ProMED 2.20.08)

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Canada (Montreal): Tourist returns from the Dominican Republic with malaria
Plasmodium falciparum malaria (0.33 percent parasitemia) was diagnosed in Montreal on 12 Feb 2008, in a female tourist returning on 2 Feb 2008 from a two-week holiday in Punta Cana, Dominican Republic. She claims she did not leave the hotel area. There was no other exposure to malaria regions of the world except for the same hotel in 2007.
(ProMED 2.19.08)

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Canada (Northwest): New strain of bacteria found by International Circumpolar
A new strain of bacteria has been found in the North, thanks to a circumpolar health monitoring program that is uncovering bacterial infections that could otherwise have gone undetected. About 31 cases of the Haemophilus influenzae type a bacterial infection have been detected across northern Canada in the past few years, including two cases in the Northwest Territories (NWT), according to monitoring efforts by the International Circumpolar Surveillance System. Cases of infection from H. influenzae type a have been recorded by the surveillance system network, which shares such information across most of the circumpolar North. The system has been monitoring bacterial infections since 1999 from northern regions of Canada, USA, Greenland, Iceland, Norway, Finland, and Sweden. "By designing a system that is looking at the North as a whole, pooling our data for analysis, then we are able to spot some new trends like this earlier," said Dr. Andre Corriveau, the NWT's chief medical health officer.

There is currently no vaccine for the H. influenzae type a bacteria strain, which can cause blood infections and meningitis. A different strain of H. influenzae (type b) underwent a successful vaccination program across the North in the late-1980s and early-1990s, and now that strain is extremely rare. Corriveau said he believes the H. influenzae type a was only spotted because of the recent monitoring. Because of that research, he said scientists and doctors could one day lobby vaccine manufacturers to develop a vaccine for that strain.
(ProMED 2.15.08)

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Peru: Dengue infections on the rise in 2008
Within the country, an increase in the numbers of dengue cases has been observed in regional health directorates. The Loreto Regional Health Directorate (DIRESA) has continued to be in an epidemic situation during the first three weeks of 2008, with 91 percent of the cases from the Iquitos, San Juan Bautista, and Punchana districts. The Jaen and Madre de Dios DIRESAs, after registering outbreaks during the first week of 2008, have shown a decrease in the number of cases. Through the third epidemiological week (EW), 49 districts (16 more districts than the previous EW) have reported dengue cases. The Ucayali DIRESA has reported a total of 100 cases and currently continues to report cases. Of these, 97 percent of the cases are from the districts of Calleria (36 cases), Irazola (39 cases), Yarinacocha (10 cases), and Manantay (12 cases). The Jaen DIRESA has reported dengue cases, with the districts of San Jose del Alto reporting 79 percent of the cases in this health region. Through the third EW, 14 classical dengue cases have been reported. The Madre de Dios DIRESA through EW 03 has reported only eight cases of classical dengue, all from the Tambopata district. The San Martin DIRESA has had 54 cases of classical dengue, 70 percent from the districts of Banda de Shilcayo, Tarapoto, and Caspisapa. This latter district belongs to the Picota Province.
(ProMED 2.11.08)

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USA (Hawaii): Additional cases of salmonella infection due to frozen tuna
More reports of salmonella poisoning, after people ate previously frozen ahi bought from local grocery stores, prompt the State Health Department and US Food and Drug Administration (FDA) to launch an investigation to trace the origin of the infected fish. Health officials traced 11 cases of salmonella poisoning to Choyce Products, who voluntarily recalled close to 5,500 pounds of yellow fin ahi a week ago. Choyce Products representatives say they "unknowingly received the tainted ahi, immediately recalled it and stopped purchases from this specific supplier indefinitely." They continued to say, "The suppliers we buy from test in the government certified labs before shipment.

"They need to go to the larger grocery chains and remove that product or have those grocery chains show that in fact this product is safe," EnviroWatch's Carroll Cox said. "In this case the alarm is greater because this is Paratyphi B associated with fecal matter," Cox added. Health experts say this specific type of salmonella is extremely rare in the United States and most commonly found in Southeast Asia. "Most likely indicates a lack of good manufacturing practices and sanitation. . .you can have all the rules and regulations in place but you need to have the practice," Pacific Management Resources Dr John Kaneko said.
(ProMED 2.18.08)

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USA (Minnesota, North Dakota): Officials find cases of antibiotic-resistant
The nation's first known cases of antibiotic-resistant meningococcal disease surfaced in northwest Minnesota and eastern North Dakota during 2007, according to the Minnesota Department of Health. Health authorities on 8 Feb 2008 asked doctors in the Fargo, North Dakota/Moorhead, Minnesota area to stop using ciprofloxacin for preventive treatment of people in close contact with meningococcal patients and to use antibiotics outside the quinolone family. The drug-resistant strains are the latest evidence of antibiotic overuse, particularly in patients whose colds are viral and not bacterial. "Even though there are other drugs that can be used to prevent meningococcal disease, having one less weapon in our arsenal reminds us of the importance of appropriate antibiotic use," said Dr. Ruth Lynfield, state epidemiologist.

The two Minnesota cases turned up in January 2008, one involving a 53-year-old from Marshall County, Minnesota who died and a second involving a 22-year-old student at Minnesota State University-Moorhead. The North Dakota case in January 2007 involved a child at a Fargo daycare facility. The bacterial strains in all three cases are similar, but the patients had no known connections. Health officials believe these strains are simply circulating in the region. Up to 15 percent of people can have meningococcal bacteria in their throats or noses at any given time, but only a few suffer severe infections. Vaccination for meningococcal meningitis is recommended for the 11-18 year age group and for college freshmen. While a vaccine protects against two-thirds of these bacterial infections, it wouldn't have worked against this particular strain.
(ProMED 2.15.08)

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USA: Baxter Healthcare Corp. temporarily stops manufacturing of multiple-dose
The FDA announced on 11 Feb 2008 that Baxter Healthcare Corporation has temporarily stopped manufacturing multiple-dose vials of the injectable blood-thinning drug heparin due to reports of serious allergic reactions and hypotension (low blood pressure) in patients who receive high bolus doses of the drug. Serious reactions to the drug have included difficulty breathing, nausea, vomiting, excessive sweating, and rapidly falling blood pressure that can lead to life-threatening shock. Four people have died after receiving heparin, although the relationship to the drug is unclear. Heparin sodium, derived from pig intestines, has been marketed in the United States since the 1930s. Millions of patients benefit from the intravenous administration of this drug every year to avoid potentially life-threatening blood clots in the veins, arteries, and lungs.

About 350 adverse events associated with the Baxter product have been reported since the end of 2007 compared to less than 100 reports in 2007. Most of the events have taken place at hemodialysis centers, almost exclusively involving patients receiving a bolus dose, which is a high dose administered over a short time. While most of the reports involve multiple-dose vials, several cases include patients who received a bolus dose after their health care professional combined heparin from single-dose vials. Physicians, dialysis center staff and health care providers are advised to use an alternate source of heparin or another blood-thinning drug when possible. When only the Baxter product is available:

1. Administer the heparin as an infusion (not a bolus) whenever possible. Use the lowest dose necessary at the slowest infusion rate acceptable to obtain the desired clinical effect.
2. Closely monitor the patient for adverse events, particularly hypotension and signs and symptoms of hypersensitivity, and ensure that resuscitation equipment is available.
3. Consider pre-treatment with corticosteroids (cortisone type medicines) or antihistamines (drugs that relieve the symptoms of allergic reactions) although it is not known whether such pre-treatment is effective.

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USA (California): Five more children in San Diego test positive for measles
Five more children in San Diego have tested positive for measles, bringing to 11 the total number of cases in a month-long outbreak that has affected schools, supermarkets, the Del Mar fairgrounds and Hawaii, county officials said on 15 Feb 2008. Public health experts are awaiting test results for a 12th case. They also have discovered two more children suspected of having measles but who don't seem to be linked to the outbreak.

"It is extremely important that people, particularly children, are aware that they may have been exposed to measles," said Dr. Wilma Wooten, the county's public health officer. The potentially fatal and highly contagious disease takes several weeks to run its course.

The outbreak, San Diego County's first since 1991, began in Switzerland and has spanned about half the globe. All the patients, from infants to a nine-year-old, were not vaccinated either because they were younger than one (the minimum age for measles inoculation) or because their parents objected to having them vaccinated. Health officials in San Diego and Hawaii have been toiling into the night to contact the hundreds, perhaps thousands, of individuals potentially exposed to measles. The outbreak began when a seven-year-old returned from a family vacation in Switzerland on 15 Jan 2008 infected with measles. More than 400 cases of measles occur in Switzerland each year, about triple the total in the United States. The seven-year-old goes to the charter school in Linda Vista. The child set off a chain reaction that has infected two siblings and at least four classmates. Dr. Alisa Lawrie, a pediatrician at the Children's Clinic of La Jolla, said on 13 Feb 2008 that "the outbreak should send a clear message to parents about the danger of not vaccinating their children. This could have been prevented if we had a fully vaccinated public; there's a lot of misinformation about vaccines, and more and more parents are choosing not to vaccinate their children."
(ProMED 2.17.08)

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Abstract
Blood-engorged mosquitoes were collected at poultry farms during an outbreak of highly pathogenic avian influenza in Central Thailand during October 2005. These mosquitoes tested positive for H5N1 virus by reverse transcription-polymerase chain reaction (RT-PCR). Results were confirmed by limited sequencing of the H5 and N1 segments. Infection and replication of this virus in the C6/36 mosquito cell line was confirmed by quantitative real-time PCR. However, transmission by mosquitoes was not evaluated, and further research is needed. Collecting and testing mosquitoes engorged with the blood of domestic or wild animals could be a valuable tool for veterinary and public health authorities who conduct surveillance for H5N1 virus spread.
(CIDRAP 2.20.08)

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Quantitative biochemical rationale for differences in transmissibility of 1918
Srinivasan A, et al. Proc. Natl. Acad. Sci. USA. Published online on February 19, 2008.
http://www.pnas.org/cgi/content/abstract/0711963105v1

Abstract
The human adaptation of influenza A viruses is critically governed by the binding specificity of the viral surface hemagglutinin (HA) to long (chain length) 2-6 sialylated glycan (2-6) receptors on the human upper respiratory tissues. A recent study demonstrated that whereas the 1918 H1N1 pandemic virus, A/South Carolina/1/1918 (SC18), with 2-6 binding preference transmitted efficiently, a single amino acid mutation on HA resulted in a mixed 2-3 sialylated glycan (2-3)/2-6 binding virus (NY18) that transmitted inefficiently. To define the biochemical basis for the observed differences in virus transmission, in this study, we have developed an approach to quantify the multivalent HA–glycan interactions. Analysis of the molecular HA–glycan contacts showed subtle changes resulting from the single amino acid variations between SC18 and NY18. The effect of these changes on glycan binding is amplified by multivalency, resulting in quantitative differences in their long 2-6 glycan binding affinities. Furthermore, these differences are also reflected in the markedly distinct binding pattern of SC18 and NY18 HA to the physiological glycans present in human upper respiratory tissues. Thus, the dramatic lower binding affinity of NY18 to long 2-6 glycans, as against a mixed 2-3/6 binding, correlates with its inefficient transmission. In summary, this study establishes a quantitative biochemical correlate for influenza A virus transmission.
(CIDRAP 2.19.08)

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The Current Status of Planning for Pandemic Influenza and Implications for
Bartlett JG, Borio L. Clinical Infectious Diseases 2008;46:919–925
http://www.journals.uchicago.edu/doi/abs/10.1086/528799

Abstract
The United States needs to be better prepared for a large-scale medical catastrophe, be it a natural disaster, a bioterrorism act, or a pandemic. There are substantial planning efforts now devoted to responding to an influenza pandemic. Here, we review these efforts and identify some harsh realities: (1) the US health care system is private, competitive, broke, and at capacity, so that any demand for surge cannot be met with existing economic resources, hospital beds, manpower, or supplies; (2) the emphasis placed on the development and rapid production of an effective vaccine is excellent, but the effort is underfunded to meet global demand; (3) and the Centers for Disease Control and Prevention's community mitigation measures, such as the use nonpharmacological and social interventions (e.g., use of face masks or respirators, social distancing, and closure of schools), lack validation and could have substantial indirect and unintended consequences. Finally, international collaborations are essential for disease surveillance and to assure investigator access to influenza strains, equitable vaccine distribution, and availability of critical supplies from offshore sources.
(CIDRAP 2.14.08)

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Avian and Pandemic Influenza: A Biosocial Approach
Kleinman AM, et al. The Journal of Infectious Diseases 2008;197:S1–S3
http://www.journals.uchicago.edu/doi/abs/10.1086/524992

Abstract
The Harvard University Asian Flus and Avian Influenza Workshop, held in December 2006, introduced a biosocial approach to the preparation for and control of pandemics. A biosocial approach brings together the biological and social sciences to develop an integrative, collaborative response to the threat of pandemic influenza. The articles in this supplement provide a representative sampling of some of the ways in which the workshop worked toward this biosocial vision. These articles address the historical “siting” of epidemics, political and structural pandemic preparedness in China, lessons to be taken from the 1976 “swine flu affair,” possibilities for genetic engineering as an alternative to poultry vaccination, issues to be considered in the control of infectious disease in swine and avian species, the ecology of influenza in migratory birds, and issues of stigma and trust during the control of epidemics. The need to build public trust and public health infrastructure is one of the primary messages of this collection.
(CIDRAP 2.14.08)

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Stigma in the Time of Influenza: Social and Institutional Responses to Pandemic
Barret R, Brown J. The Journal of Infectious Diseases 2008;197:S34–S7
http://www.journals.uchicago.edu/doi/abs/10.1086/524986

Abstract
This article examines the role of stigma in social and institutional responses to infectious disease emergencies, to better understand and minimize these dynamics in the event of a pandemic of virulent influenza. In addition to their impact on human suffering, fear and stigma can seriously delay detection and treatment efforts, cooperation with contact tracing and isolation measures, and the effective distribution of resources for the prevention and control of infectious diseases. These dynamics are illustrated by the Indian plague epidemic of 1994, which occurred in a region where H5N1 influenza has been detected recently. Public fear and stigma also played a significant role in the social and institutional responses to the 1918 influenza pandemic. These historical models provide important lessons for pandemic preparedness and global health policy.
(CIDRAP 2.14.08)

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Genetic Strategy to Prevent Influenza Virus Infections in Animals
Chen J, et al. The Journal of Infectious Diseases 2008;197:S25–S28
http://www.journals.uchicago.edu/doi/abs/10.1086/524987

Abstract
The natural reservoirs of influenza viruses are aquatic birds. After adaptation, avian viruses can acquire the ability to infect humans and cause severe disease. Because domestic poultry serves as a key link between the natural reservoir of influenza viruses and epidemics and pandemics in human populations, an effective measure to control influenza would be to eliminate or reduce influenza virus infection in domestic poultry. The development and distribution of influenza-resistant poultry represents a proactive strategy for controlling the origin of influenza epidemics and pandemics in both poultry and human populations. Recent developments in RNA interference and transgenesis in birds should facilitate the development of influenza-resistant poultry.
(CIDRAP 2.14.08)

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Social contact networks for the spread of pandemic influenza in children and
Glass LM, Glass RJ. BMC Public Health 2008, 8:61doi:10.1186/1471-2458-8-61
http://www.biomedcentral.com/1471-2458/8/61/abstract

Background
Influenza is a viral infection that primarily spreads via fluid droplets from an infected personas coughs and sneezes to others nearby. Social contact networks and the way people interact within them are thus important to its spread. We developed a method to characterize the social contact network for the potential transmission of influenza and then applied the method to school aged children and teenagers.

Conclusions
High-school students may form the local transmission backbone of the next pandemic. Closing schools and keeping students at home during a pandemic would remove the transmission potential within these ages and could be effective at thwarting its spread within a community. Social contact networks characterized as groups and public activities with the time, level of contact and primary links within each, yields a comprehensive view, which if extended to all ages, would allow design of effective community containment for pandemic influenza.
(CIDRAP 2.14.08)

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Global trends in emerging infectious diseases.
Jones KE et al. Nature. 2008 Feb 21;451(7181):990-3.

Abstract
Emerging infectious diseases (EIDs) are a significant burden on global economies and public health. Their emergence is thought to be driven largely by socio-economic, environmental and ecological factors, but no comparative study has explicitly analysed these linkages to understand global temporal and spatial patterns of EIDs. Here we analyse a database of 335 EID 'events' (origins of EIDs) between 1940 and 2004, and demonstrate non-random global patterns. EID events have risen significantly over time after controlling for reporting bias, with their peak incidence (in the 1980s) concomitant with the HIV pandemic. EID events are dominated by zoonoses (60.3% of EIDs): the majority of these (71.8%) originate in wildlife (for example, severe acute respiratory virus, Ebola virus), and are increasing significantly over time. We find that 54.3% of EID events are caused by bacteria or rickettsia, reflecting a large number of drug-resistant microbes in our database. Our results confirm that EID origins are significantly correlated with socio-economic, environmental and ecological factors, and provide a basis for identifying regions where new EIDs are most likely to originate (emerging disease 'hotspots'). They also reveal a substantial risk of wildlife zoonotic and vector-borne EIDs originating at lower latitudes where reporting effort is low. We conclude that global resources to counter disease emergence are poorly allocated, with the majority of the scientific and surveillance effort focused on countries from where the next important EID is least likely to originate.

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Through this videoconference, we hope to promote regional information sharing and collaboration to enhance pandemic preparedness. In order to improve preparedness regionally, it is vital to understand how each economy in the region is undertaking this task. In this process, EINet will:

1. Bring together economies in a dynamic, real-time discussion on preparedness through the collaboration of the health and the business/trade sectors, with a focus on critical systems continuity.
2. Share specific examples of current practices — e.g. scenario exercises, communication drills and policy evaluation.
3. Use innovative technologies (e.g. Access Grid) for real-time, virtual interchange, enhancing their utility for future collaboration and response in the event of a pandemic.

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Questions and Answers with William Raub
Tue Feb 19, 2008 at 07:24:12 AM EST

HHS Secretary Mike Leavitt's science advisor, Dr. William Raub has agreed to an email/blog interview with the Flu Wiki community. Dr. Raub answers questions about responsibility for preparedness efforts, vaccine allocation, new vaccine and antiviral technologies, and much more. See the full text at: http://www.newfluwiki2.com/showDiary.do?diaryId=2179

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2008 International Conference on Biocontainment Facilities (in cooperation with
http://www.TradelineInc.com/BIO2008

Location: Washington, DC
Venue: JW Marriott Hotel, Washington DC
Dates: 21-22 Apr 2008

Agenda

1. Operational- and risk-based facility plans
2. Multi-pathogen/Multi-protocol research programs
3. Integrated BSL-lab/animal facilities
4. Hospital & clinical biocontainment
5. BPCUs
6. Better commissioning, certification, and validation processes
7. Construction cost & contracting strategies
8. Operations and maintenance programs
9. . . .and more If you have questions please email BIO2008@tradelineinc.com.
   (ProMED 2.12.08)

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