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Vol. XI No. 5 ~ EINet News Briefs ~ Mar 07, 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
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- Iraq (Basra): H5N1 avian influenza found in poultry
- UK (Dorset): H5N1 avian influenza discovered in dead goose
- Egypt: Three new cases of H5N1 avian influenza, one death
- Indonesia: Recent H5N1 avian influenza viruses show no mutation
2. Infectious Disease News
- Brunei Darussalam: Seminar participants hit by food poisoning
- China (Xinjiang Uygur): Measles kills 10 and sickens thousands in January 2008
- Philippines (Eastern Samar): High rates of diarrheal illness, deaths reported
- Peru: Several districts on alert in dengue epidemic
- USA (Nevada): Deadly toxin ricin found in motel room, 57-year-old occupant in critical condition
- USA (Hawaii): Local restaurant produces cluster of E. coli cases
- USA (Nevada): Unsafe injection practices associated with transmission of bloodborne pathogens
- USA (Colorado): 3-day-old baby recovers from infant botulism
- Global: Report finds highest rates ever of MDR-TB
- Philippines (Laguna): Typhoid on the rise, officials declare a state of calamity
- Russia (Chelyabinsk): 45-year-old woman dies, health officials suspect rabies
- AVIAN PANDEMIC INFLUENZA
- Effect of Surgical Masks Worn Concurrently Over N95 Filtering Facepiece Respirators: Extended Service Life Versus Increased User Burden.
- Pandemic Economics: The 1918 Influenza and Its Modern-Day Implications
- Responding to Simulated Pandemic Influenza in San Antonio, Texas
- Effects of Adjuvants on the Safety and Immunogenicity of an Avian Influenza H5N1 Vaccine in Adults
- Flu Virus Research Yields Results but No Magic Bullet for Pandemic
- Integrated Food Chain Surveillance System for Salmonella spp. in Mexico
- Presence of Clostridium botulinum spores in Matricaria chamomilla (chamomile) and its relationship with infant botulism.
- APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
- Eleventh Annual Conference on Vaccine Research
- Public Health – Seattle & King County: Business Not As Usual: Preparing for Pandemic Flu (video)
- HHS advisor, William Raub, fields online pandemic preparedness queries
1. Influenza News
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 371 (235). (WHO 3.5.07 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 2.28.08)
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 3.3.08): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 2.25.07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html .
Iraq (Basra): H5N1 avian influenza found in poultry
A case of bird flu was discovered on 2 Mar 2008 in the southern Iraqi city of Basra. An Iraqi higher committee Secretariat in combating bird flu said the new discovery is in Al-Fedagiya village in the Fao area. The committee, based on the discovery, prohibited all transfers of poultry and live birds to other provinces before getting permission from local vet hospitals. The committee also issued an order prohibiting the selling and dealing of birds and poultry in the area, including taking all the precautionary measures needed. The committee also called on citizens in the area to avoid bird hunting in the area for their own safety.
The remains of the bird were discovered around 1km (0.6m) from Abbotsbury Swannery in Dorset, where a number of swans have been found with the disease. The Department for the Environment, Food and Rural Affairs (Defra) said the Canadian goose was the 11th wild bird in the area to test positive for H5N1. Restrictions on the movement of poultry have now been introduced in the area. Defra said the decision was based on veterinary advice. Poultry keepers will not be able to move birds from their premises except under license. A spokeswoman said that the latest case of bird flu was "not unexpected." She said H5N1 was active at a very low level among wild birds in the area, and there was no evidence of the virus in domestic poultry locally. Regular surveillance was continuing, she added, with patrols looking for dead birds. A Wild Bird Monitoring Area is in place around the affected area, where keepers are required to keep domestic poultry away from wild birds. Owners have been urged to stay vigilant and report any signs of the disease.
Egypt: Three new cases of H5N1 avian influenza, one death
The second case (Egypt's 45th) was a 25-year-old female from Sennoris district, Al Fayyum governorate. She developed symptoms on 24 Feb 2008 and was hospitalized on 27 Feb 2008. Her death has now been confirmed by the Ministry of Health and Population. Investigations into the source of her infection indicate that she had contact with sick poultry prior to becoming unwell.
The third case (Egypt's 46th) is an 11-year-old male from Menof District, Menofia [Al Minufiyah] governorate. He was hospitalized with symptoms on 26 Feb 2008 and was confirmed as being infected with A (H5N1) by the Central Public Health Laboratory and NAMRU-3 on 4 Mar 2008. He remains in critical condition. Investigations into the source of his infection indicate a history of contact with sick and dead poultry. Of the 46 cases confirmed to date in Egypt, 20 have been fatal.
Indonesia: Recent H5N1 avian influenza viruses show no mutation
Indonesia's health ministry said that H5N1 avian influenza virus samples it sent to a World Health Organization (WHO) laboratory in the United States in February 2008 showed no signs of dangerous mutations.
On Feb 22 2008, Nancy Cox, PhD, chief of the influenza division at the US Centers for Disease Control and Prevention (CDC), said Indonesia's health ministry shipped 15 clinical samples to the CDC lab, which is a WHO collaborating facility. She said the samples were from two patients whose infections were confirmed by the WHO on 5 Feb and 12 Feb 2008. Lily Sulistyowati, spokeswoman for Indonesia's health ministry, said the CDC has run tests on the samples. "The result is it is still H5N1. It hasn't mutated, meaning it is endemic among fowl and can be transferred from fowl to human," Sulistyowati said. Since flu viruses evolve and mutate constantly, Sulistyowati apparently meant that the viral isolates showed no mutations that would enable them to spread more easily from person to person. Most human H5N1 cases have resulted from contact with poultry; person-to-person transmission of the virus has been rare.
It's unclear if the recently shared samples signal that Indonesia has unilaterally ended its boycott of the international virus-sharing system. A WHO group that met to resolve the virus-sharing issue in November 2007 failed to draft an agreement between developing nations and the developed countries that are home to the world's' largest vaccine producers.
2. Infectious Disease News
Brunei Darussalam: Seminar participants hit by food poisoning
A total of seven people were admitted to the RIPAS emergency ward on 25 Feb 2008 where they were diagnosed with food poisoning in what appears to be the result of bad 'nasi ayam' that was served to participants attending a University Brunei Darussalam (UBD) seminar. Teachers and librarians from around the nation were invited for the seminar. "They were serving food there, like nasi ayam which tasted quite good actually," said a teacher who was diagnosed with food poisoning at the emergency ward. He said participants who did not eat the nasi ayam were "okay" and were not afflicted by any of the symptoms.
"About two hours after eating it, I started feeling dizzy and had a stomach ache. I started vomiting a lot and so my wife took me to the emergency ward. It was here I met some other patients with food poisoning who also attended the seminar," said the teacher. "We have taken samples for testing and so far we know of seven people from the seminar who were infected," he said. Some 300 people attended the seminar.
China (Xinjiang Uygur): Measles kills 10 and sickens thousands in January 2008
Philippines (Eastern Samar): High rates of diarrheal illness, deaths reported
Peru: Several districts on alert in dengue epidemic
In epidemiological week six week of 10 Feb 2008, there has been notification of 1406 classical dengue cases, 59 percent from the Loreto health district. To date, 16 health directorates have reported locally acquired dengue cases. The Lima health district has reported 23 cases, of which four have been confirmed, but these have been imported from Loreto (three cases) and Ucayali (one case), areas where there are outbreaks currently. The remainder of these (Lima) cases are probable. Of these, 12 are probable classical dengue cases. They have not been outside of Lima and are currently under investigation. An analysis of the dengue epidemiological situation countrywide indicates that there are dengue epidemic alert situations in the health directorates of Loreto, La Libertad and Ucayali. There also has been a case of DHF in Loreto and in Ucayali. In the Loreto district, there has been notification of 831 classical dengue cases through epidemiological week six.
USA (Nevada): Deadly toxin ricin found in motel room, 57-year-old occupant in critical condition
The room was previously occupied by a 57-year-old man who has been hospitalized with breathing problems and was in critical condition since 14 Feb 2008. Captain Joseph Lombardo said on 29 Feb 2008 that the book was tabbed at a spot with information about ricin. Lombardo did not give more information about the book or specify what kinds of weapons were found. Las Vegas police said there was no apparent link to terrorist activity and no indication of any spread of the deadly substance beyond the several vials of powder found in a plastic bag in the man's room on 28 Feb 2008. But what the ricin was doing there remained a mystery.
An American Medical Response paramedic crew that took the man to the hospital 14 Feb 2008 had no indication of ricin poisoning, AMR general manager John Wilson said. Greg Evans, director of the Institute for Biosecurity at Saint Louis University in Missouri, said the fact that the man suffered respiratory illness suggested he was exposed to a powder fine enough to float in the air. Multiple vials would probably contain enough ricin to sicken many people if it was spread, for example, around a buffet table or sprayed in a closed room. "If it was aerosolized in a confined space then it certainly could harm dozens of people," he said.
USA (Hawaii): Local restaurant produces cluster of E. coli cases
The customers who fell ill went to their doctors, who then ordered stool samples, Effler said. Technicians at the state laboratory created a "DNA fingerprint" of each sample that was checked against a nationwide database on the Mainland, Effler said. "They didn't match anything else on the Mainland," he said, "but they matched each other, which suggests a common source." In each of the six cases, the patients had eaten at Sekiya's within seven days of their symptoms. "This was not a coincidence," Effler said.
(Major deviations from what is appropriate for kitchen hygiene have been observed in this situation. However, one might have expected not just O157 disease, but rather a variety of food-associated diseases to be found. What is missing from this report is the analysis of a food history among the seven affected people as compared with a control group who did not get ill. Such an analysis may go a long way in establishing the presumed food reservoir involved here.)
USA (Nevada): Unsafe injection practices associated with transmission of bloodborne pathogens
Most people infected with hepatitis C virus do not develop symptoms and do not know that they have been infected. As a result, these infections would not have been reported to the health district. An infection with hepatitis C that results in the patient developing symptoms (acute disease) is rare, so it is an unusual occurrence that brought this problem to the attention of the health district. On average, two cases of acute hepatitis C are reported each year in Clark County; six cases have been identified in relation to this investigation.
A syringe (not a needle) that was used to administer medication to a patient was reused on the same patient to draw up additional medication. The process of redrawing medication using the same syringe could have contaminated the vial from which the medicine was drawn with the blood of the patient. The vial, which was not labeled for use on multiple patients, was then used for a second patient (with a clean needle and syringe). If that vial was contaminated with the blood of the first patient, any subsequent patients given medication from that vial could have been exposed to bloodborne pathogens.
Investigation of the clinic identified common practices that would allow disease to be transmitted in this manner. The unsafe injection practices associated with these cases were identified during the investigation conducted in mid-January 2008. The injection practices that led to the exposure have been corrected, so no new patient exposures should be occurring. As it can take several months for the symptoms of hepatitis C to appear, additional cases might be identified despite no ongoing transmission of disease. The investigation revealed practices that could have exposed patients to the blood of another patient. Officials are also concerned about the potential transmission of hepatitis B and HIV due to these unsafe injection practices.
USA (Colorado): 3-day-old baby recovers from infant botulism
There are three main kinds of botulism: foodborne, wound, and infant. In each case, bacteria produce a neurotoxin that can cause paralysis, muscle weakness, and other serious symptoms. The foodborne version occurs when the toxin is pre-formed and ingested in a food product. In infant botulism and in wound botulism, the toxin is produced in situ. Infant botulism, the commonest kind of botulism in the USA, represents about two-thirds of all cases.
The El Paso County child had a rare strain known as type F, one of just 10 such cases worldwide. The strain type is insignificant to patients, who experience the same symptoms and outcomes regardless of the type, said Dr Bernadette Albanese, medical director for the health department. Type F appears to be associated with younger infants than other strains, she said. In 2005, the most recent year for which national statistics are available, there were 145 cases of botulism nationally, 96 in infants. Colorado had only one that year. In 2008, there have been two cases in Colorado, both infants. The other was in Douglas County.
Global: Report finds highest rates ever of MDR-TB
Based on the analysis of the survey data, WHO estimates there are nearly half a million new cases of MDR-TB a year, which is about five percent of nine million new TB cases of all types. The highest rate was recorded in Baku, the capital of Azerbaijan, where nearly a quarter of all new TB cases (22.3 percent) were reported as multidrug-resistant. Proportions of MDR-TB among new TB cases were 19.4 percent in Moldova, 16 percent in Donetsk in Ukraine, 15 percent in Tomsk Oblast in the Russian Federation, and 14.8 percent in Tashkent in Uzbekistan. These rates surpass the highest levels of drug resistance published in the last WHO report in 2004. Surveys in China also suggest that MDR-TB is widespread there. "TB drug resistance needs a frontal assault. If countries and the international community fail to address it aggressively now we will lose this battle," said Dr Mario Raviglione, director of the WHO Stop TB Department. "In addition to specifically confronting drug-resistant TB and saving lives, programs worldwide must immediately improve their performance in diagnosing all TB cases rapidly and treating them until cured, which is the best way to prevent the development of drug resistance."
WHO estimates that USD 4.8 billion is needed for overall TB control in low- and middle-income countries in 2008, with USD one billion for MDR-TB and XDR-TB. But there is a total finance gap of USD 2.5 billion, including a USD 500 million gap for MDR-TB and XDR-TB. "The threat created by TB drug resistance demands that we fill these gaps, as laid out in the Global Plan to Stop TB, a roadmap for halving TB prevalence and deaths compared with 1990 levels by 2015," said Dr Marcos Espinal, executive secretary of the Stop TB Partnership. "The Plan also calls for another imperative -- sufficient resources for research to find new diagnostics, new drugs effective against resistant strains and an effective TB vaccine."
Philippines (Laguna): Typhoid on the rise, officials declare a state of calamity
The outbreak was concentrated in five adjacent villages in Calamba, about 34 miles from Manila, and the salmonella bacteria that caused the illness may have been spread via the water system, based on the speed at which the outbreak grew, he said. But Labro was hopeful that the outbreak was under control. "There are still cases coming in, but these are fewer in number compared to the past few days," he said. Labro also said the city's 50-bed government-run hospital was so swamped when the outbreak peaked 25-27 Feb 2008 that corridors were used to accommodate patients. The city declared a state of calamity 3 Mar 2008, allowing it to immediately withdraw emergency funds for antibiotics and intravenous drips, he said. The Red Cross and the health department also sent medicine and doctors.
Russia (Chelyabinsk): 45-year-old woman dies, health officials suspect rabies
AVIAN PANDEMIC INFLUENZA
Effect of Surgical Masks Worn Concurrently Over N95 Filtering Facepiece Respirators: Extended Service Life Versus Increased User Burden.
Raymond R. Journal of Public Health Management and Practice. 14(2):E19-E26, March/April 2008.
Pandemic Economics: The 1918 Influenza and Its Modern-Day Implications
Responding to Simulated Pandemic Influenza in San Antonio, Texas
Effects of Adjuvants on the Safety and Immunogenicity of an Avian Influenza H5N1 Vaccine in Adults
Flu Virus Research Yields Results but No Magic Bullet for Pandemic
But H5N1 hasn't gone away--and increasingly, say scientists, the virus appears to be here to stay. "H5N1 is going to be with us for a long time," says Les Sims, a veterinary consultant based in Palm Cove, Australia, continuing to devastate poultry flocks and posing an ongoing threat to human health.
Integrated Food Chain Surveillance System for Salmonella spp. in Mexico
Presence of Clostridium botulinum spores in Matricaria chamomilla (chamomile) and its relationship with infant botulism.
APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
APEC EINet is pleased to host a special videoconference on pandemic influenza preparedness. This videoconference is a follow-up to our first “virtual symposium”, which was conducted in January 2006 with great success (participating economies were Australia, Canada, China, Korea, Philippines, Singapore, Chinese Taipei, Thailand, USA, and Viet Nam). You can view a five-minute video clip of our previous virtual symposium at: http://depts.washington.edu/einet/symposium.html. Our upcoming videoconference will be held in late May 2008. It will take place during the evening hours of 29 May in the Americas and in the morning hours of 30 May in Asia, for approximately 3.5 hours. Our objective is to describe how private and public sectors in the APEC region can cooperate and work effectively to prepare for and respond to an influenza pandemic.
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:
The remarkable pace of biotechnology discovery is continuing unabated. New cytokines are identified, immune regulatory pathways unraveled, promising adjuvants reported, and investigational products revealed to have high degrees of protection for humans against viral diseases not yet vaccine preventable. The tools of vaccination are also being applied therapeutically for various cancers and chronic conditions. The Annual Conference on Vaccine Research provides high quality, current reports of scientific progress featured in both invited presentations and submitted abstracts. The disparate fields covered in both human and veterinary vaccinology encourage valuable cross-fertilization of ideas and approaches among researchers otherwise focused on specific diseases or methods. The Conference has become the largest scientific meeting devoted exclusively to research on vaccines and associated technologies for disease prevention and treatment through immunization. The Eleventh Annual Conference promises to maintain this tradition as the premier venue for cutting edge topics and issues. International experts will lead seminars and panel discussions on topical areas of basic immunology, product development, clinical testing, regulation, and other aspects of vaccine research. Opportunities for networking and scientific collaboration critical to advancing vaccine science and development will be available through audience discussions, poster presentations, meet the expert breakfast sessions, sponsored exhibits, and evening ceremonies and receptions.
This training video explains the effects of a possible pandemic, the importance of social distancing, business planning, and preventing food and energy shortages.
FluWiki members asked Raub if funeral directors and other mass-casualty personnel, as well as their families, would be considered a priority in the federal vaccine allocation plan. He responded that a federal working group is evaluating public comments it received, which included concerns about mass-casualty workers, and that the group will release an updated plan within the next several months. Responding to questions about vaccine development, Raub wrote that most experts believe that a viable pandemic vaccine using DNA or other emerging technologies is more than five years away, but that HHS is currently reviewing contract proposals for advanced development of a DNA vaccine.
Another query dealt with how local groups can promote community mitigation plans without clear messages from the government about the importance of measures such as school closures. Raub responded that the challenge in engaging the public is more difficult than it was two years ago, because the public's' interest in avian flu seems to have diminished.
"The Web site Pandemicflu.gov will remain the lynchpin of our messaging machinery. But we recognize that we need multiple modalities to promulgate and reinforce preparedness messages," Raub responded. He added that HHS values the input from FluWiki's online community.