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Vol. Vol. XI No. 7 ~EINet News Brief ~ 4 April 2008 ~ EINet News Briefs ~ Apr 04, 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)
- Global: Nearly 3,000 financial services organizations test their pandemic influenza preparedness
- China: Economy approves its first H5N1 avian influenza vaccine
- Indonesia: Three new cases of H5N1 avian influenza, two deaths
- Korea: Outbreak of avian influenza suspected in poultry farm
- Pakistan (Peshwar): WHO reports on 2007 family cluster of H5N1 avian influenza

2. Infectious Disease News
- Australia: Officials see sharp increase in dengue infection in those that travel to Indonesia
- Australia (Sydney): 81-year-old man dies from food poisoning, Bacillus cereus
- Indonesia (Java): Dengue infections continue to increase
- Indonesia (Papua): Undiagnosed respiratory disease found in remote area
- Malaysia: Dengue infections on the rise, Selangor hard hit
- Papua New Guinea (Morobe): Five people die of dysentery in remote province
- Philippines (Ilocos): Officials report two deaths due to dengue infection in 2008
- Taipei: Officials report 61 cases of scrub typhus, one fatality
- Peru: Investigation fails to find link between yellow fever vaccine and increased illnesses, deaths
- Peru: Officials report another probable case of yellow fever
- USA (Arizona): Maricopa County records first case of West Nile virus this season
- USA (Arizona): Confirmed cases of measles in Pima County
- USA (New York): Norovirus suspected in outbreak of gastrointestinal illness
- USA (Washington): Boy infected with Japanese encephalitis in Southeast Asia recovers in Seattle
- USA (Montana): Native American clinics uncover high rate of hepatitis C
- USA (California): Santa Maria teenager dies of human rabies
- USA (Colorado): Salmonella in water system
- USA: Chinese officials find contaminant in batches of heparin supplied to United States
- USA: Honduran cantaloupes cause salmonella outbreak in United States and Canada

3. Updates
- AVIAN PANDEMIC INFLUENZA
- MUMPS

4. Articles
- Major issues and challenges of influenza pandemic preparedness in developing countries
- Pandemic influenza planning in the United States from a health disparities perspective
- Public response to community mitigation measures for pandemic influenza
- The Influenza Primer Design Resource: A new tool for translating influenza sequence data into effective diagnostics
- Transmission of avian influenza virus (H3N2) to dogs

5. Notifications
- APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
- BirdFlu 2008: Avian Influenza and Human Health


1. Influenza News

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

2008
China / 3 (3)
Egypt / 4 (1)
Indonesia / 15 (12)
Viet Nam / 5 (5)
Total / 27 (21)

2007 Cambodia / 1 (1)
China / 5 (3)
Egypt / 25 (9)
Indonesia / 42 (37)
Laos / 2 (2)
Myanmar / 1 (0)
Nigeria / 1 (1)
Pakistan / 3 (1)
Viet Nam 8 (5)
Total / 88 (59)

2006
Azerbaijan / 8 (5)
Cambodia / 2 (2)
China / 13 (8)
Djibouti / 1 (0)
Egypt / 18 (10)
Indonesia / 55(45)
Iraq / 3 (2)
Thailand / 3 (3)
Turkey / 12 (4)
Total / 115 (79)

2005
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 20 (13)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 98 (43)

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: 378(238). (WHO 4.3.08 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 3.18.08)

WHO's world maps showing areas affected by H5N1 avian influenza (last updated 3.18.08):
http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 3.25.08):
http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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Global: Nearly 3,000 financial services organizations test their pandemic influenza preparedness
Nearly 3,000 financial services organizations tested their answers to pandemic flu preparedness with a disaster drill in September 2007. The exercise showed that the financial sector could continue to operate during a pandemic, but it also revealed stress points throughout the industry. For instance, many recovery plans laid the groundwork for employees to telecommute — a smart move in a scenario that could leave thousands homebound — but the existing infrastructure couldn't handle the increased traffic.

"When you have (so many more) people working from home, the Internet is going to slow to a crawl, and that's if it's even recoverable in all parts of the country," says Nick Benvenuto, managing director and global head of business continuity at Protiviti Inc., a risk management consulting firm in Menlo Park, Calif.

That drill highlighted the status of many companies vis-à-vis disaster recovery: They have disaster plans, but those plans aren't adequately designed to handle an actual event. Instead, many business executives, including top IT managers, are relying on old procedures and technologies that might work for small-scale, brief disasters — a regional power outage, for example — but would fall woefully short during a catastrophe like another major hurricane or terrorist attack. Moreover, many companies can't claim to have real confidence in their disaster recovery plans because they fail to test and update those plans often enough to guarantee that their procedures and technologies are keeping pace with business changes.

In a 2007 report from Cambridge, Mass.-based Forrester Research Inc., only 33 percent of 124 data center decision-makers surveyed said they believe they're very prepared to recover their data centers in the event of a failure or disaster. Meanwhile, 37 percent said they were prepared, 27 percent said they were somewhat prepared, and 3 percent admitted that they weren't prepared. However, there are leaders out there. In particular, organizations that have survived recent, massive disasters have internalized their hard-earned lessons in recovery and are now better prepared for what might come next.

And the news isn't all bad. Experts say that although companies need to work harder on disaster recovery planning and testing, they're still doing better than they have in the past.

"If you went back 10 years, things were far worse. There has been great improvement," says Jonathan Gossels, president and CEO of SystemExperts Corp., an IT compliance and network security consulting firm in Sudbury, Mass. "But not enough companies are doing enough."

In a recent survey conducted by Gartner Inc., more than half the 359 participants from the United States, Canada and the United Kingdom. said they planned for natural disasters, power outages, fires, IT outages, computer virus attacks, and failures at key service providers. And 50 percent of the respondents said they planned for terrorist attacks. But the survey also found that less than half have plans for dealing with labor strikes, civil unrest, denial-of-service attacks or pandemics. And only 45 percent have plans for long-term facility outages —that is, outages lasting more than a week. Gartner analyst Roberta Witty questions whether disaster plans are adequate, considering the fact that some recent events, such as Hurricane Katrina, took out power for much longer than a week. Witty says organizations also fail to adequately plan for disruptions in services provided by third parties.
(Computerworld 3.31.08)

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Asia
China: Economy approves its first H5N1 avian influenza vaccine
China's State Food and Drug Administration (SFDA) on 2 Apr 2008 approved the country's first pre-pandemic H5N1 influenza vaccine, an inactivated whole-virus product made by Sinovac, a Beijing-based biotechnology company. China's approval of Sinovac's Panflu vaccine marks the third H5N1 vaccine to win approval from national or international regulatory bodies. In April 2007, the US Food and Drug Administration approved a Sanofi Pasteur H5N1 vaccine. A month later, the European Union approved a mock-up pandemic flu vaccine made by Novartis (it is designed to speed vaccine production when a pandemic emerges and will not be manufactured until then). Sinovac said its vaccine is approved only to supply China's national vaccine stockpile and will not be available for commercial sale. In 2006 the company said it planned to produce 20 million doses of the vaccine over the next few years, according to a previous report. The latest information gave no production estimate. The Sinovac vaccine contains an inactivated Vietnam strain of H5N1 virus and an aluminum hydroxide (alum) adjuvant.

In other vaccine developments, Vietnamese researchers said on 3 Apr 08 that clinical trials began for an H5N1 vaccine that the country is developing. The vaccine is based on a Vietnam strain of H5N1 virus. The vaccine is being tested in 11 volunteers, all of whom are researchers. They received their second dose of the vaccine 3 Apr 08 at the National Institute of Hygiene and Epidemiology in Hanoi. Nguyen Tuyet Nga, an epidemiologist and virologist who is leading the trial, said that the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have helped with the project, though no foreign pharmaceutical firms are involved in the study.

Vaccine experts say there is no guarantee that vaccines based on current H5N1 strains will be effective if a pandemic H5N1 virus emerges, but they hope such vaccines will provide some protection and buy time while a vaccine specifically matched to the pandemic strain is developed.
(CIDRAP 4.3.08)

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Indonesia: Three new cases of H5N1 avian influenza, two deaths
The Ministry of Health of Indonesia has announced three new cases of human H5N1 avian influenza infection. The cases are not linked epidemiologically. The first is a 15-year-old male student from Subang District, West Java Province who developed symptoms on 19 Mar 2008, was hospitalized on 22 Mar 2008, and died on 26 Mar 2008.

The second case is an 11-year-old female student from Bekasi City, West Java Province who developed symptoms on 19 Mar 2008, was hospitalized on 23 Mar 2008, and died on 28 Mar 2008.

The third case is a 21-month-old female from Bukit Tinggi, West Sumatra Province who developed symptoms on 17 Mar 2008 and was hospitalized on 22 Mar 2008. She is presently recovering in hospital.

The source of infection for all three cases is still under investigation. Of the 132 cases confirmed to date in Indonesia, 107 have been fatal.
(ProMED 4.4.08)

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Korea: Outbreak of avian influenza suspected in poultry farm
A suspected case of avian influenza has been reported at a farm in Gimje, North Jeolla Province, the government said on 2 Apr 2008. The Ministry of Food, Agriculture, Forestry and Fisheries said the owner of the farm reported that 150,000 poultry died suddenly on 1 Apr 2008. The ministry has conducted a preliminary test and said it has a positive diagnosis for the virus. It will announce the results of further tests to discover the strain of the bird flu on 4 Apr 2008. The government immediately banned the distribution of chickens and eggs from the farm and 12 others nearby. This is the first outbreak of avian influenza in 2008; the last confirmed case was in March 2007.
(Korea Times 4.2.08)

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Pakistan (Peshwar): WHO reports on 2007 family cluster of H5N1 avian influenza
Two additional H5N1 cases were confirmed by serological testing, thus providing final H5N1 infection test results on a previously reported family cluster in Peshawar. WHO H5 Reference Laboratory in Cairo, Egypt and the WHO Collaborating Centre for Reference and Research on Influenza in Atlanta, USA conducted the tests.

The preliminary risk assessment found no evidence of sustained or community human–to-human transmission. All identified close contacts, including the other members of the affected family and involved health care workers, remain asymptomatic and have been removed from close medical observation. These laboratory test results support the epidemiological findings from the outbreak investigation in December 2007 and the final risk assessment that suggested limited human-to-human transmission likely occurred among some of the family members, which is consistent with some human-to-human transmission events reported previously. This outbreak did not extend into the community, and appropriate steps were taken to reduce future risks of human infections. Below are the details for each case:

Case 1: Onset date 29 Oct 2007 / full recovery / direct contact with sick or dead poultry / confirmed by serology

Case 2: Onset 12 Nov 2007 / died (19 Nov 2007) / close contact with Case 1, no known contact with sick or dead poultry / status unknown (no sample available)

Case 3: Onset 21 Nov 2007 / died (28 Nov 2007) / close contact with Case 1 and 2, no known direct contact with sick or dead poultry / confirmed by PCR

Case 4: Onset 21 Nov 2007 / full recovery / close contact with Case 1 and 2, no known direct contact with sick or dead poultry / confirmed by serology br>(ProMED 4.4.08)

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2. Infectious Disease News
Australia: Officials see sharp increase in dengue infection in those that travel to Indonesia
The Health Department in West Australia (WA Health) says there is a sharp increase in the mosquito-borne viral infection dengue fever in people returning from Indonesia. WA Health says in 2007, 54 West Australians contracted the disease, almost four times the usual number, and almost 60 percent of people infected in the last 13 months had traveled to Indonesia, primarily Bali; 16 cases were reported in January 2008. Dr. Gary Dowse, the acting Director of Communicable Disease Control, says while most of those infected had traveled to Bali, people traveling to Thailand, Singapore, India, Viet Nam, Philippines, or anywhere in Southeast Asia should take precautions.

In far north Queensland, the Mossman and Port Douglas regions are also on high alert for dengue, with 16 confirmed cases up to 13 Mar 2008. As this is a dengue type 3 outbreak, Queensland Health's Tropical Population Health Unit says the outbreak poses a serious health risk to anyone in Mossman or Port Douglas who previously had dengue. Port Douglas and Mossman residents are being urged to take immediate steps to prevent being bitten, and Queensland Health is working with local and community councils to manage the outbreak according to the Dengue Fever Management Plan.
(ProMED 3.24.08)

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Australia (Sydney): 81-year-old man dies from food poisoning, Bacillus cereus
It was not the fish of the day that killed an 81-year-old male retiree but, just 12 hours after dining with his wife, at the upmarket Tables restaurant in Pymble (a Sydney suburb) on 12 Jan 2007, he was dead. He had suffered from severe vomiting and diarrhea within an hour of leaving the Pacific Highway restaurant. An investigation by the NSW Food Authority had discovered the toxic vegetable pathogen Bacillus cereus in an asparagus cream sauce served to him and 14 other customers that night who had ordered the fish of the day, snapper, Inspector Dean Lindley of Hornsby police said. It is alleged the sauce, a sample of which was seized by a Food Authority inspector hours after the case's wife found her husband dead the next morning, was up to 48 hours old when it was served to him.

"The sauce had subsequently been analyzed by the Division of Analytical Laboratories and had been found to contain the pathogen Bacillus cereus at a level of 9.8 million parts," Lindley said. The toxic level of this pathogen is 1 million parts.

During the criminal trial, when the restaurant's co-owner, Daniel Brukark, entered the witness box, counsel for the Food Authority counsel, Patrick Saidi, revealed the authority was prosecuting Mr. Brukark's company, Dan Brook Investments, for failing to place labels with dates on its sauce containers, an offense that carries a two-year prison term if a director or chef is convicted.
(ProMED 3.28.08)

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Indonesia (Java): Dengue infections continue to increase
The number of dengue cases in Yogyakarta up to mid-March 2008 has continued to increase, with some 64 sufferers now being treated at the Regional General Hospital (RSUD), a hospital official said. The number of people in Yogyakarta, Bantul and Sleman districts infected with dengue had increased from 14 in January 2008 to 39 in February 2008, RSUD chief for public service Agus Sudrajat said on 19 Mar 2008.

The RSUD currently has a sufficient stock of blood components, drugs, as well as intravenous fluids to treat patients, Sudrajat said. He guaranteed poor people from Yogyakarta and the environs seeking treatment for dengue at RSUD would not have to pay anything.

"The treatment fees are covered by the Yogyakarta government as well as the Yogyakarta Social Prosperity Insurance office (Jamkesos)," Sudrajat said.

Meanwhile, Yogyakarta Red Cross chief Adi Heru Husodo said the dengue pandemic had depleted its blood component stocks. To replenish its stock, the Yogyakarta Red Cross had requested blood supplies from other regions including Magelang, Purworejo (Central Java), and Ngawi (East Java) as well as Bandung, he said.
(ProMED 3.24.08)

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Indonesia (Papua): Undiagnosed respiratory disease found in remote area
At least 23 people from four villages in Pegunungan Bintang regency, Papua have died from acute respiratory infection since January 2008.

"This is not an extraordinary situation, and health workers have been providing medical care in the four villages," Pegunungan Bintang Health Office head Darius Salamuk said on 24 Mar 2008.

The affected villages are Okteneng, Kaeb, Kokiabakon and Bakonaib, all in Kiwirok district. Salamuk said respiratory diseases were a major problem in Papua's central mountain areas. One reason for this, he said, is that people sleep near the fire in their "honai" homes due to the cold weather, exposing them to smoke (A honai is a hut made of sticks and thatch.). "This is a common health condition suffered by most of the people in remote villages. Sufferers could be cured if they sought medical treatment immediately, but because they're beyond the reach of medical services, some of them cannot be saved," said Salamuk. Medical workers must walk for days or use small planes to reach the remote villages.

(Without a more detailed description of the condition of the patients and an indication of their ages, it is difficult to infer the possible identity of the acute respiratory disease afflicting these villagers. Their poor standard of living, exposure to cold night temperatures and smoke inhalation, as well as their poor nutritional status make them vulnerable to a wide range of respiratory pathogens.)
(ProMED 3.26.08)

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Malaysia: Dengue infections on the rise, Selangor hard hit
Nationally, three more people in Malaysia lost their lives to dengue between 16 - 22 Mar 2008, bringing the number of confirmed fatalities due to the disease to eight so far in 2008. The first fatality happened in the third week of January, another two in the second of February and two more in the first week of March. Disease Control Division Director Datuk Dr Hasan Abdul Rahman, however, said despite the fatalities recorded in the third week of March, the number of cases reported that week showed a drop, from 643 cases in week two to 573 cases, which translated into a 10.6 percent decrease.

In Selangor, one of the hardest hit states, there are an average of 40 reported dengue cases daily. In 2008, (through 29 Mar), Selangor reported 3,743 cases. Of that figure, 3,550 cases of fever were recorded while there were 193 cases of dengue hemorrhagic fever.
(ProMED 3.31.08)

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Papua New Guinea (Morobe): Five people die of dysentery in remote province
Five people have died of dysentery in a remote area of Morobe Province in Papua New Guinea. Health officials had initially thought the five, in a village near Bulolo and Wau, had had typhoid, but investigations revealed it was dysentery. The Provincial health adviser, Dr. Likei Theo, said that medical teams were sent into the area in February 2008 to verify the disease and determine the causes. He says the outbreak was caused by the village water supply being contaminated with human and animal waste.
(ProMED 3.31.08)

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Philippines (Ilocos): Officials report two deaths due to dengue infection in 2008
The number of persons recorded in 2008 to be affected by dengue fever in Ilocos Norte has already reached 90 with two confirmed to have died from the deadly disease. The present figure was triple the number recorded in the first quarter of 2007. Batac City was reported to have had the highest number of cases with 27. Laoag City was second with 12 cases.
(ProMED 3.31.08)

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Taipei: Officials report 61 cases of scrub typhus, one fatality
Sixty-one cases of scrub typhus have been reported in 2008, one of which has proved fatal, a Department of Health (DOH) official said on 25 Mar 2008. Lin Ting, deputy director of the DOH's Centers for Disease Control, called for the public to be on guard, especially during Tombsweeping Day, which falls on 4 Apr 2008, when people sweep the tombs of their ancestors, often in rural areas.

Lin noted that the fatal case involved a 36-year-old man living in southern Taipei. He displayed none of the classic symptoms of scrub typhus and reported that he was not active outdoors and that his workplace was not rat-infested. Rats are the host of scrub typhus. He became sick on 24 Feb 2008 and sought medical treatment 1 Mar 2008, but died on 11 Mar 2008 of multiple organ failure. There has also been a cluster infection of scrub typhus in 2008 involving students from a foreign school and their parents who went on a creek exploration activity in Shanmin village in southern Taipei's Kaohsiung County in January 2008. Local health officials reported seven suspected cases, five of which were later confirmed as scrub typhus.
(ProMED 3.26.08)

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Americas
Peru: Investigation fails to find link between yellow fever vaccine and increased illnesses, deaths
From November 2007 - March 2008, the Pan American Health Organization and the World Health Organization (PAHO/WHO) assisted the Ministry of Health in Peru to investigate serious adverse events, including four deaths, which occurred during a yellow fever vaccination campaign from 23 Sep to 6 Oct 2007 in the Ica Region, south of Lima.

An expert panel concluded that the incidence of yellow fever vaccine-associated viscerotropic disease in the Ica Region in this event is significantly higher (more than 20 times) than observed previously in other settings. Five cases occurred among 63,174 vaccinated persons for an overall rate of 7.9 per 100,000 [vaccinated persons]. Previous estimates of the overall incidence are about 0.3-0.4/100,000 vaccinated persons. A number of hypotheses to explain the higher rate were considered and eliminated, including the possibility that the vaccine lot 05OVFA121Z contained a genetic change responsible for enhanced virulence and possible host factors that may have contributed to susceptibility in the cases. The investigation showed clinical, virological, and pathological evidence of confirmed viscerotropic disease in four fatal cases and probable viscerotropic disease in one surviving case. The cause of death was an overwhelming infection with 17DD vaccine virus, probably associated with a severe immune response syndrome.

Multiple lines of investigation indicated that there were no changes in the vaccine virus that were responsible for the occurrence of these cases. No evidence could be found to suggest that the vaccine lot 05OVFA121Z had anything inherently wrong with it to explain the higher frequency of viscerotropic disease in persons receiving that lot. All fatal cases had some underlying or concurrent condition that might have contributed to the fatal outcome of the adverse events. The fact that other, non-identified risk factors may have contributed to the increased rate of viscerotropic disease in this region is not ruled out.
(ProMED 4.2.08)

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Peru: Officials report another probable case of yellow fever
In epidemiological week (EW) 11 [09-15 Mar 2008], the Regional Directorate of Health (DIRESA) reported a probable case of sylvatic yellow fever in Peru, in a 24-year-old unvaccinated woman. She is from the Picota district and province in the San Martin department. Through EW 11, two confirmed cases, four probable cases, and three deaths due to yellow fever have been recorded.
(ProMED 4.1.08)

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USA (Arizona): Maricopa County records first case of West Nile virus this season
The 2008 West Nile Virus season is off to a very early start in Arizona. On 26 Mar 2008, the Maricopa County Department of Public Health and Arizona Department of Health Services confirmed that a Southeast Valley man in his 60s is Maricopa County's first human case of West Nile Virus (WNV) in the 2008 season. The man has been released from a local Valley hospital and is currently recovering from the virus infection.

"We recognize that people's first question will be 'Why Maricopa County?' The quick answer is that West Nile virus is now endemic in environments across the nation including Arizona. Because we have a warmer winter and earlier mosquito season than most, it makes sense that we see cases earlier," said Dr. Bob England, director of the Maricopa County Department of Public Health.

In 2007, Maricopa County reported 68 confirmed West Nile virus cases, and four deaths. Maricopa County and the Arizona Department of Health Services continue to have an enhanced surveillance program, which includes sampling and testing of mosquitoes and dead birds, and evaluation of equine neurological illnesses and human cases of meningitis and encephalitis.
(ProMED 3.29.08)

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USA (Arizona): Confirmed cases of measles in Pima County
Concern over a measles outbreak continues as the Pima County Health Department confirms nine active cases of the disease in the area. The Health Department also considers it likely that transmission of the disease will continue in the community as well as in hospitals and other health care settings. "Measles is extremely contagious, so the best way to prevent the disease is to get vaccinated," Pima County chief medical officer Dr. Michelle McDonald said.

"Because of the greater vulnerability to severe disease in infants and very young children," advises Dr. McDonald, "we are recommending an accelerated schedule for vaccinating children." The Health Department recommends a dose of vaccine between the ages of six and 12 months of age, followed by two boosters after the patient's first birthday.
(ProMED 4.1.08)

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USA (New York): Norovirus suspected in outbreak of gastrointestinal illness
State Department of Health officials still don't know exactly what caused a gastrointestinal illness outbreak at the Great Escape Lodge & Indoor Waterpark over the weekend, but the number of reported cases of individuals sickened has risen to nearly 200. More than 300 people have also called the department's hot line to report symptoms of diarrhea and vomiting after visiting the resort or to get information. The Department of Health suspects a norovirus is to blame for the sickness, but officials are still awaiting lab test results.

While health experts await a definitive answer, Great Escape officials seem to be taking more stringent measures to prevent the illness from spreading. On 21 Mar 2008, each person entering the lobby of the lodge was approached by employees offering to squirt sanitizer into their hands. An infectious disease specialist has also been hired to consult with Great Escape on the situation. This specialist said he doesn't believe it's likely that the employees or the currently ill patrons got sick after eating contaminated food.

"This is not typically a food-borne illness," he said. "There's no evidence this was food-borne at all. In fact, many of the guests who have had this illness didn't eat in the lodge at all. The employees could have contracted it, potentially, just by clearing a table or picking up a glass, a plate or a fork," he added.

There also isn't any evidence that the illness was a result of tainted water.
(ProMED 3.26.08)

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USA (Washington): Boy infected with Japanese encephalitis in Southeast Asia recovers in Seattle
A Lydia Hawk Elementary School third-grader who caught a rare virus while visiting family in Southeast Asia is recovering at Children's Hospital in Seattle. The boy, nine, traveled with his father and siblings to Viet Nam and Cambodia in January 2008. He was bitten by a mosquito and infected with Japanese encephalitis [JE], a rare virus that's similar to West Nile virus. Two weeks after the bite, he lost his appetite and got a high fever, said his father, a man from Seattle. The boy lost his ability to speak, suffers from tremors and can't sit up on his own, the father said.

"He cannot respond back. He cannot move his body parts," he said. But the boy is improving; he started sleeping through the night, and his tremors are not as frequent, the father said 23 Mar 2008. The boy also is starting to recognize people and voices. "He understood e-mails from school. I can tell by his eyeballs moving along the lines," the father said.

Japanese encephalitis is transmitted by mosquitoes and can cause mild to severe infections marked by headache, high fever, neck stiffness, coma, tremors and occasional convulsions and paralysis, according to the Centers for Disease Control and Prevention.
(ProMED 3.26.08)

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USA (Montana): Native American clinics uncover high rate of hepatitis C
An epidemiological study conducted at two Indian Health Service (IHS) clinics in Montana uncovered a hepatitis C infection rate that is six times higher than is found in the general population. The finding surprised tribal and state health officials, who responded by creating an educational brochure that targets young American Indians. The 2005-2006 study, authored by IHS epidemiologist Christine Dubray, revealed a six percent hepatitis C infection rate among women who went to the clinics for prenatal care. Only about one percent of people in the US population have hepatitis C, Dubray said.

"We have an unexpected number of young women with hepatitis C infection," she said. "In the general American population, the prevalence of hepatitis C is much lower in young women."

During the 13-month period of Dubray's study, 205 women were screened for the virus, and 13 tested positive. It is thought that the women, who were probably exposed to the virus as teenagers or very young adults, contracted it through intravenous drug use. The study did not examine what kind of drugs might have been used. Although the study examined only American Indian women, it is likely that other groups of young Montanans would also have higher than expected hepatitis C infection rates because of drug use, said Laura Baus, hepatitis C coordinator for the state Department of Public Health and Human Services.

"Whether American Indian or Caucasian, there's no division there," Baus said of hepatitis C infection among the state's youth. "We're seeing it in both populations." Nationwide, the average age at a hepatitis C diagnosis ranges from 40 to 59, Baus said. "What we're seeing in Montana is we're averaging 15 to 24," she said. "We're seeing them younger."

Tribal and state health officials used Dubray's study for the basis of an educational brochure that will be distributed via Montana IHS clinics and other outlets on the state's reservations.

"After Christine's work, it was obvious we needed to do a public-health initiative," said Jennifer Giroux, an epidemiologist with the Rocky Mountain Tribal Epidemiology Center in Billings. "If we don't get the information out there to the public, what good is having looked?"
(ProMED 3.25.08)

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USA (California): Santa Maria teenager dies of human rabies
Santa Barbara County Public Health Department officials say a 16-year-old boy died from rabies on 18 Mar 2008. They say he may have contracted the disease in Mexico, based on the incubation period. The young man was admitted to Marian Medical Center with delirium, hypersalivation and difficulty swallowing. Officials are looking to identify people who had close contact with him, and find a traveling companion who came with him to Santa Maria from Mexico. It is believed the person traveling with the young man may be in Ventura County or Santa Barbara County.
(ProMED 3.24.08)

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USA (Colorado): Salmonella in water system
Dozens of cases of salmonella infection were linked to municipal water in southern Colorado, putting seven people in the hospital. There have been at least 85 confirmed cases of salmonella and 315 people sickened.

An analysis indicates the municipal water system in Alamosa is the source of the bacterial outbreak as suspected, said Ned Calonge, chief medical officer for the state health department. Governor Bill Ritter declared an emergency Friday on 21 Mar 2008 in Alamosa County, activating the National Guard and providing as much as USD 300,000 for response efforts. The city and county have also declared emergencies as officials scrambled to provide safe water and disinfect the system with chlorine. The schools closed on 25 Mar 2008, when officials began pumping high concentrations of chlorine into the water. Adams State College closed on 26 Mar 2008.
(ProMED 3.24.08 & 3.31.08)

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USA: Chinese officials find contaminant in batches of heparin supplied to United States
China has identified a contaminant in batches of blood-thinner heparin supplied by a US-owned plant in China for export to the United States that has been linked to serious reactions and deaths. China's State Food and Drug Administration (SFDA) said that the contaminant was "basically the same" as that found by US health regulators in batches of Baxter International Inc's blood-thinner heparin. The FDA on 19 Mar 2008 said it had identified "over-sulfated chondroitin sulfate" in Baxter's drug, and was investigating whether the chemical was purposely or inadvertently added during manufacturing in China.

The FDA is probing whether the contaminant is the cause of up to 19 deaths and hundreds of serious breathing problems and other reactions reported in the United States. FDA officials said chemically manipulating chondroitin sulfate, which is widely available from animal sources, would be cheaper than getting raw heparin from pig intestines. Scientific Protein Laboratories (SPL) earlier said a consultant working for the plant had concluded the contaminant was not linked to the plant's production but likely occurred earlier in the supply chain. Baxter had also said the contamination had occurred before it reached SPL.
(ProMED 3.23.08)

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USA: Honduran cantaloupes cause salmonella outbreak in United States and Canada
The US Food and Drug Administration (FDA) has issued an import alert regarding entry of cantaloupe from Agropecuaria Montelibano, a Honduran grower and packer, because, based on current information, fruit from this company appears to be associated with a Salmonella [enterica serotype] Litchfield outbreak in the United States and Canada. The import alert advises FDA field offices that all cantaloupes shipped to the United States by this company are to be detained. In addition, the FDA has contacted importers about this action and is advising US grocers, food service operators, and produce processors to remove from their stock any cantaloupes from this company. The FDA also advises consumers who have recently bought cantaloupes to check with the place of purchase to determine if the fruit came from this specific grower and packer. If so, consumers should throw away the cantaloupes.

To date, the FDA has received reports of 50 illnesses in 16 states and nine illnesses in Canada linked to the consumption of cantaloupes. No deaths have been reported; however, 14 people have been hospitalized. The US states are Arizona, California, Colorado, Georgia, Illinois, Missouri, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Tennessee, Utah, Washington, and Wisconsin.
(ProMED 3.23.08)

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3. Updates
AVIAN PANDEMIC INFLUENZA
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

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MUMPS
Canada
As of 5 Mar 2008, 1,284 confirmed cases of mumps have been reported for the period 31 Dec 2006-29 Dec 2007 from 10 out of 13 Canadian provinces and territories. Confirmed cases are either laboratory-confirmed or clinically compatible and linked to a laboratory-confirmed case. There have been ongoing outbreaks centered in the maritime provinces and in the province of Alberta. In addition, several other provinces experienced increased mumps activity in 2007.

Geographical and sex distribution of confirmed mumps cases reported in Canada. Onset 31 Dec 2006-29 Dec 2007 (n=1284):

Province/territory / case count / percentage male
Nova Scotia / 777 / 49
Alberta / 258 / 58
New Brunswick / 124 / 57
Ontario / 48 / 33
British Columbia / 25 / 44
Quebec / 20 / 55
Prince Edward Island / 13 / 73
Newfoundland Labrador / 10 / 40
Manitoba / 7 / 57
Saskatchewan / 2 / 50
Nunavut / 0 / 0
Northwest Territories / 0 / 0
Yukon Territory / 0 / 0
National Total / 1284 / 51

It is assumed that most people born before 1970 (about 40 years old) are immune to mumps, as they were likely naturally exposed to the mumps virus in the period before immunization significantly reduced the amount of mumps virus that was circulating. Most people born between 1990 and 1994 (12 and 17 years old depending on the province/territory of residence) were offered two doses of mumps-containing vaccine due to the introduction of a second dose of measles-mumps-rubella (MMR) vaccine for measles control in 1996-97 in most provinces and territories. This has left a susceptible cohort of people born between 1970 through 1990 (to a lesser extent through 1994) who were only eligible for one dose of mumps-containing vaccine and who are not assumed to have natural immunity. It is important to note that the age at which natural immunity to mumps can be assumed is not known with certainty and that some individuals born prior to 1970 may still be susceptible to mumps.

The majority of cases (58 percent) reported in 2007 were aged 20-29. For those cases where information was reported (n=594), 50 percent were post-secondary students. The reason for the particular susceptibility among those who are college and university-aged is multi-factorial. They are too young for natural immunity and too old for routine two-dose MMR immunization. Mumps has a fairly long infectious period (up to 16 days), a long incubation period (14 to 25 days), and up to 20 percent of infectious cases show no signs or symptoms. In addition, the very social and mobile lifestyles of this age group appear to be facilitating disease transmission and interfering with control measures. This age group tends not to adhere to isolation requests, and they generally do not participate when immunization is offered. Furthermore, post-secondary students often share living/sleeping arrangements, many are involved in competitive sports, they frequent bars/pubs/nightclubs and travel during school holidays and breaks. Additional cases in this demographic group and possibly other jurisdictions would not be unexpected.

Of those mumps cases reported in 2007 with known immunization history (n=586), 8 percent (45) had received two or more doses, 73 percent (430) had received one dose and 19 per cent (111) received no doses of mumps-containing vaccine.
(ProMED 4.3.08)

Australia
Mumps outbreak spreads to Western Australia from Northern Territories
An outbreak of mumps, which appears to have spread to Western Australia (WA) from the Northern Territory (NT), has caused about 10 times the usual number of cases so far in 2008. A total of 46 cases of the childhood infection had been reported to health authorities by the middle of February 20008 compared with four cases at the same time in 2007 and six in early 2006. The Health Department, which is investigating the outbreak, described the number of cases as surprising and well above normal. They appeared to be part of an outbreak that started in a boarding school in the Northern Territory in 2007 and spread into the Kimberley and then into other parts of WA. While most of the 2008 cases have been in the Kimberley and the Goldfields, several have been reported in the Perth metropolitan area.
(ProMED 3.31.08)

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4. Articles
Major issues and challenges of influenza pandemic preparedness in developing countries
Oshitani H, Kamigaki T, Suzuki A. Emerg Infect Dis. 2008 Jun; [Epub ahead of print]
http://www.cdc.gov/eid/content/14/6/pdfs/07-0839.pdf

Abstract
Better preparedness for an influenza pandemic mitigates its impact. Many countries have started developing and implementing national influenza pandemic preparedness plans. However, the level of preparedness varies among countries. Developing countries encounter unique and difficult issues and challenges in preparing for a pandemic. Deaths attributable to an influenza pandemic could be substantially higher in developing countries than in industrialized countries. Pharmaceutical interventions such as vaccines and antiviral agents are less likely to be available in developing countries. The public health and clinical infrastructure of developing countries are often inadequate to deal with a widespread health crisis such as an influenza pandemic. Such an event will inevitably have a global effect. Therefore, improving pandemic preparedness in every country, particularly developing ones, is urgently needed.
(CIDRAP 3.28.08)

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Pandemic influenza planning in the United States from a health disparities perspective
Blumenshine P, Reingold A, et al. Emerg Infect Dis. 2008 May; [Epub ahead of print]
http://www.cdc.gov/eid/content/14/5/pdfs/07-1301.pdf

Abstract
We explored how different socioeconomic and racial/ethnic groups in the United States might fare in an influenza pandemic on the basis of social factors that shape exposure, vulnerability to influenza virus, and timeliness and adequacy of treatment. We discuss policies that might differentially affect social groups’ risk for illness or death. Our purpose is not to establish the precise magnitude of disparities likely to occur; rather, it is to call attention to avoidable disparities that can be expected in the absence of systematic attention to differential social risks in pandemic preparedness plans. Policy makers at the federal, state, and local levels should consider potential sources of socioeconomic and racial/ethnic disparities during a pandemic and formulate specific plans to minimize these disparities.
(CIDRAP 3.28.08)

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Public response to community mitigation measures for pandemic influenza
Blendon RJ, Koonin LM, et al. Emerg Infect Dis. 2008 May; [Epub ahead of print]
http://www.cdc.gov/eid/content/14/5/pdfs/07-1437.pdf

Abstract
We report the results of a national survey conducted to help public health officials understand the public’s response to community mitigation interventions for a severe outbreak of pandemic influenza. Survey results suggest that if community mitigation measures are instituted, most respondents would comply with recommendations but would be challenged to do so if their income or job were severely compromised. The results also indicate that community mitigation measures could cause problems for persons with lower incomes and for racial and ethnic minorities. Twenty-four percent of respondents said that they would not have anyone available to take care of them if they became sick with pandemic influenza. Given these results, planning and public engagement will be needed to encourage the public to be prepared.
(CIDRAP 3.28.08)

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The Influenza Primer Design Resource: A new tool for translating influenza sequence data into effective diagnostics
Bose ME, Littrell JC, et al. Influenza and Other Respiratory Viruses. 2008;2(1):23–31
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1750-2659.2007.00031.x

Background
Recent outbreaks of highly pathogenic avian influenza and multiple occurrences of zoonotic infection and deaths in humans have sparked a dramatic increase in influenza research. In order to rapidly identify and help prevent future influenza outbreaks, numerous laboratories around the world are working to develop new nucleotide-based diagnostics for identifying and subtyping influenza viruses. While there are several databases that have been developed for manipulating the vast amount of influenza genetic data that have been produced, significant progress can still be made in developing tools for translating the genetic data into effective diagnostics.

Description
The Influenza Primer Design Resource (IPDR) is the combination of a comprehensive database of influenza nucleotide sequences and a Web interface that provides several important tools that aid in the development of oligonucleotides that may be used to develop better diagnostics. IPDR’s database can be searched using a variety of criteria, allowing the user to align the subset of influenza sequences that they are interested in. In addition, IPDR reports a consensus sequence for the alignment along with sequence polymorphism information, a summary of most published primers and probes that match the consensus sequence, and a Primer3 analysis of potential primers and probes that could be used for amplifying the sequence subset.

Conclusions
The IPDR is a unique combination of bioinformatics tools that will greatly aid researchers in translating influenza genetic data into diagnostics, which can effectively identify and subtype influenza strains. The website is freely available at http://www.ipdr.mcw.edu.
(CIDRAP 3.28.08)

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Transmission of avian influenza virus (H3N2) to dogs
Song D, Kang B, et al. Emerg Infect Dis. 2008 May; [Epub ahead of print]
http://www.cdc.gov/eid/content/14/5/pdfs/07-1471.pdf

Abstract
In South Korea, where avian influenza virus subtypes H3N2, H5N1, H6N1, and H9N2 circulate or have been detected, 3 genetically similar canine influenza virus (H3N2) strains of avian origin (A/canine/Korea/01/07, A/canine/Korea/02/07, and A/canine/Korea/03/07) were isolated from dogs exhibiting severe respiratory disease. To determine whether the novel canine influenza virus of avian origin was transmitted among dogs, we experimentally infected beagles with this influenza virus (H3N2) isolate. The beagles shed virus through nasal excretion, seroconverted, and became ill with severe necrotizing tracheobronchitis and bronchioalveolitis with accompanying clinical signs (e.g., high fever).

Consistent with histologic observation of lung lesions, large amounts of avian influenza virus binding receptor (SAα 2,3-gal) were identified in canine tracheal, bronchial, and bronchiolar epithelial cells, which suggests potential for direct transmission of avian influenza virus (H3N2) from poultry to dogs. Our data provide evidence that dogs may play a role in interspecies transmission and spread of influenza virus.
(CIDRAP 3.28.08)

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5. Notifications
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 videoclip 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:

  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.

Videoconferencing offers an alternative to in-person conferencing. It cuts down on the time and cost of traditional conferences requiring long-distance travel. Simultaneous communication with multiple sites is possible, with numerous visualization options. Real-time web-based information exchange is also possible, and, during an actual pandemic, the virtual medium would be a safe way to communicate when international travel is limited or prohibited.

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BirdFlu 2008: Avian Influenza and Human Health
http://www.libpubmedia.co.uk/Conferences/BirdFlu2008/Home.htm

Date: 10-11 September 2008 Location: Oxford, UK Venue: St. Hilda's College

The 1st annual Oxford avian influenza conference, BirdFlu2008, will address most aspects of basic and applied research on avian influenza viruses and their potential health and socio-economic impact on humans. The conference is aimed at bringing together leading experts in the field from both academia and industry, veterinarians, postdoctoral researchers, graduate research students, physicians and doctors, research managers and policy makers. Thus this event will provide an international forum to discover the latest research directions and thinking in this field in academic and commercial settings, to exchange data and ideas and to develop new collaborative links.

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 apecein@u.washington.edu