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Vol. Vol. XI No. 8 ~EINet News Brief ~ 18 April 2008 ~ EINet News Briefs ~ Apr 18, 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)
- Japan: Economy on the verge of approving plan to give pre-pandemic vaccine to healthcare workers
- Russia (Primorye): Agricultural Ministry confirms outbreak of avian influenza in poultry
- South Korea: Officials investigate H5N1 avian influenza cases
- South Korea: Poultry infected with H5N1 avian influenza illegally taken from quarantined zones
- USA: Experimental H5N1 avian influenza vaccine uses cold virus
- USA: Health and Human Services Secretary blogs on impasse with Indonesia
- Egypt (Cairo): WHO confirms country's 49th case (22nd death) from H5N1 avian influenza
- Egypt: Two-year-old boy infected with H5N1 avian influenza, country's 50th case

2. Infectious Disease News
- Japan: Man diagnosed with murine typhus after Indonesian surf trip
- Russia (Kirov Region): Two cases of tissue dirofilariasis recorded in 2008
- Russia: Crimean-Congo hemorrahgic fever (CCHF) on the rise
- Russia (Udmurtia): Troubling forecast for hemorrhagic fever with renal syndrome (HFRS)
- Canada (Toronto): Officials fear measles carrier may still be at large
- Canada (British Columbia): Metapneumovirus infection possibly linked to death of four seniors
- Peru: Researchers find high levels of MDR and XDR tuberculosis
- Peru: Researchers find new species of Leptospira in the Peruvian Amazon
- USA: New cases of progressive inflammatory neuropathy in pork plant workers
- USA: Investigators find toxic elements in dietary supplements
- USA (Wisconsin): Two new cases of measles confirmed
- USA: Man dies from human lymphocytic choriomeningitis virus infection, widow sues Petsmart Inc.
- USA: Rabies found in multiple states, human exposure
- USA (Colorado): Tests of the water supply find presence of two illness causing protozoa
- USA (Mississippi): Officials report State's first case of West Nile virus in 2008
- USA (Florida): Officials investigate outbreak of Staphylococcus aureus infections among 12 people
- Hong Kong: Officials urge vigilance against viral hepatitis E infection

3. Updates
- AVIAN PANDEMIC INFLUENZA
- CHOLERA, DIARRHEA, & DYSENTERY
- DENGUE

4. Articles
- Confronting an influenza pandemic with inexpensive generic agents: Can it be done?
- Willingness to volunteer during an influenza pandemic: perspectives from students and staff at a large Canadian university
- Pathology, Molecular Biology, and Pathogenesis of Avian Influenza A (H5N1) Infection in Humans
- Evidence for avian influenza A infections among Iowa’s agricultural workers
- Human-Like Receptor Specificity Does Not Affect the Neuraminidase-Inhibitor Susceptibility of H5N1 Influenza Viruses

5. Notifications
- APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
- Eleventh Annual Conference on Vaccine Research
- ASTHO offers guidelines for protecting vulnerable groups during a pandemic
- AI.COMMuniqué: Preparedness for Influenza Pandemic


1. Influenza News

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

2008
China / 3 (3)
Egypt / 7 (3)
Indonesia / 15 (12)
Viet Nam / 5 (5)
Total / 30 (23)

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
China / 1 (1)
Viet Nam / 3 (3)
Total / 4 (4)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 381(240).
(WHO 4.17.08 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 4.15.08)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 4.14.08): http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 4.11.08): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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Asia
Japan: Economy on the verge of approving plan to give pre-pandemic vaccine to healthcare workers
Japan's health ministry on 15 Apr 2008 said it was on the verge of approving a plan to administer pre-pandemic vaccine to healthcare workers, which would make it the world's first country to tap its national stockpile for this purpose. Kishiko Yamaguchi, an official from Japan's health and welfare ministry, said the plan, which awaits approval on 16 Apr 2008, would allow the vaccination of about 6000 quarantine officials and healthcare workers by the end of 2008. Japan has already approved and stockpiled pandemic vaccines for 10 million people that are based on H5N1 viruses from China, Indonesia, and Viet Nam. The Research Foundation for Microbial Diseases of Osaka University and the Kitasato Institute made the vaccines.

In a November 2005 presentation for the WHO that summarized clinical study results for Japan's pandemic vaccine, Masato Tashiro, MD, PhD, with the National Institute of Infectious Diseases, revealed that the project is supported by the government, and the same formulation of the alum-adjuvanted whole-virus vaccine is produced by all of the manufacturers. Yamaguchi said that if initial tests show that the pre-pandemic vaccine is safe and effective, the ministry would consider vaccinating 10 million more people, including such vital workers as lawmakers, police, and other healthcare workers. The second vaccination wave would also include those who maintain infrastructure networks such as gas and electricity.

International health officials have been cautious about taking steps toward vaccination in advance of a pandemic because researchers are uncertain whether vaccines that are currently in national stockpiles will offer cross-protection against a future pandemic strain. Also, it's not clear whether any adverse events would arise from the use of the vaccine, which makes it difficult to weigh the usefulness of the strategy.

In a May 2007 bulletin, WHO acknowledged that as pre-pandemic vaccines become available, they could be used in poultry workers, healthcare workers, and whole populations. However, WHO did not recommend that countries undertake the strategy. Gregory Hartl, a spokesman for WHO, said that pre-pandemic vaccination is "a big roll of the dice" but said WHO doesn't oppose countries using the vaccines. The European Centre for Disease Prevention and Control in 2007 praised the development of pre-pandemic vaccines but said it did not support countries using them until WHO elevates its pandemic phase to five or six (from the current phase three), which would indicate that significant human-to-human transmission is occurring.
(ProMED 4.17.08)

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Russia (Primorye): Agricultural Ministry confirms outbreak of avian influenza in poultry
Russia's agriculture ministry confirmed a bird flu outbreak in a village in the Far East region of Primorye, which was quarantined after scores of chickens died. In two days, 28 out of 42 hens and guinea fowl died on a farm in the village of Vozdvizhenka, 110 km north of Vladivostok, the ministry's veterinary control unit reported 10 Apr 2008. The dead birds had been incinerated, it added. A regional laboratory made the discovery after testing samples taken from sick birds, and a national laboratory was due to determine if it was the H5N1 strain of the virus. Authorities cordoned off the village, killed all other fowl on the farm and vaccinated birds in the village and nearby areas, the ministry said.
(ProMED 4.12.08)

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South Korea: Officials investigate H5N1 avian influenza cases
South Korea said 15 Apr 2008 it was investigating four new suspected cases of bird flu, including one near Seoul, adding to a string of recent outbreaks and raising concerns the disease may be spreading across the country. In less than two weeks, South Korea has confirmed 11 cases of the H5N1 strain, but all have been contained to the southwest of the country — North and South Jeolla provinces, some 320 km south of Seoul.

"We have received four fresh reports of suspected bird flu cases on 14 Apr 2008 and one is from a poultry farm in Pyongtaek city in Kyonggi province," the Farm Ministry said.

The ministry said that the farm in Pyongtaek, around 60 km south of Seoul, tested positive for H5 and more detailed results would be available on 17 Apr 2008. It said more than 2,000 birds at the farm would be slaughtered on 15 Apr 2008 and it had stopped the shipment of birds within a 10-km radius of the affected site.

South Korea, which has culled nearly two million poultry in April 2008, said it would continue quarantine work in suspected areas and encourage poultry consumption amid rising consumer concern. Duck and chicken prices have dropped 10 percent this month, while chicken sales at four major retailers surveyed by the ministry showed a 20 percent decline. South Korea had seven outbreaks of H5N1 between November 2006 and March 2007 and spent 58 billion won (USD 59.22 million) on quarantine measures.
(ProMED 4.15.08)

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South Korea: Poultry infected with H5N1 avian influenza illegally taken from quarantined zones
Amid a series of reports regarding outbreaks of the H5N1 bird flu, the government confirmed that ducks infected with the virus had been illegally taken out from the quarantine zone. The Ministry for Food, Agriculture, Forestry and Fisheries announced on 14 Apr 2008 that it is thoroughly investigating a possible outbreak of the bird flu at a chicken-breeding farm in Iksan, North Jeolla Province, and a duck-breeding farm in Hampyeong, South Jeolla Province. Both cases were reported on 13 Apr 2008.

In regards to the chicken farm, doubts have risen over quarantine management as the farm in Iksan was visited by a retail dealer who had been in contact with bird flu-infected ducks. According to the ministry and the Gimje Police Station, the 37-year-old dealer identified only by his surname (Park) had sold the H5N1 positive ducks to a restaurant in Geumsan-myeon, Gimje, from a farm located in Yongji-myeon, Gimje, which was included in the alert zone after a suspected outbreak had been reported there. Park bought 600 ducks from the farm between 4 and 6 Apr 2008, and sold some 40 of them to a duck seller. The probe found that Park sold 360 ducks among the remaining 560 to some 20 restaurants in six cities and districts including Jeonju, Gimje, Buan and Jeongeup, and buried the remainders.
(ProMED 4.15.08)

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Americas
USA: Experimental H5N1 avian influenza vaccine uses cold virus
An experimental bird flu vaccine that uses a common cold virus and bits of DNA from the H5N1 virus appears to stimulate an immune response in mice, U.S. researchers said on 17 Apr 2008. They said their experiment is a first step towards developing a next-generation bird flu vaccine that does not need to be grown for months in chicken eggs and that could protect against mutated versions of the virus.

"We want to have a vaccine that can be stored in advance and have the potential to provide protection for a period of time until we can change the vaccine to match the latest form of avian influenza," said Suresh Mittal of Purdue University in Indiana, who worked on the study. "The combination of flu genes that we've used to produce the vaccine, I think, will provide that capability."

At least 16 companies are working on vaccines to prevent bird flu infection in people, but the process is problematic. Flu vaccines are hard to make because they must be grown in chicken eggs for months, and the viruses themselves mutate every year. The seasonal flu vaccine must be reformulated every year and no one knows what would happen if H5N1 mutated into a form that people could transmit easily to one another.

If a pandemic broke out, using current technology it would be close to a year before anyone could be vaccinated. Suresh Mittal, Mary Hoelscher of the U.S. CDC and colleagues worked with H5N1 virus samples from Vietnam and Indonesia to make a vaccine that they hoped would work against even "drifted," or mutated, strains. They used a common cold virus, known as an adenovirus, to carry H5N1's hemagglutinin gene, which give flu strains the "H" of their names. Most current flu vaccines also focus on hemagglutinin. They also used another gene called nucleoprotein or NP, which has not been used in flu vaccines. The hope is that the NP gene will both promote an immune response against flu, and perhaps be a bit more stable than the highly mutation-prone hemagglutinin.

So far the researchers have only tested mice, but the vaccine caused a strong immune response that lasted at least a year.

"In humans we want a vaccine to be fully effective for at least a year," Mittal said. "This approach may prevent severe illness and death or shorten the course of future infection with H5N1 virus strains that are antigenically distinct from currently circulating strains, and it may offer stockpiling advantages that overcome the limitations associated with storage of egg-derived vaccines," the researchers wrote. Their technology has been licensed to PaxVax Inc, a privately held corporation.
(Reuters 4.18.08)

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USA: Health and Human Services Secretary blogs on impasse with Indonesia
US Health and Human Services (HHS) Secretary Mike Leavitt, in Vietnam on 17 Apr 2008 on the second leg of a 10-day tour of Southeast Asia, revealed new details on his blog (Leavitt has maintained a blog on the HHS Web site since August 2007) about his talks with Indonesian officials on two controversial issues: the country's refusal to freely share H5N1 virus samples and the status of the US Navy's medical laboratory unit, NAMRU-2.

In early 2007, Indonesia announced it had stopped sharing H5N1 virus samples with the World Health Organization (WHO) to protest, in its view, that poorer developing countries that share samples will not have access to or afford the pandemic vaccines that pharmaceutical companies in developed nations will manufacture using the samples. The US Navy's medical unit in Jakarta (NAMRU-2) is a WHO-collaborating laboratory, and its status in the country has been uncertain since Indonesia stopped sharing its H5N1 samples. However, on 10 Apr 2008 Kyodo News, a Japanese news service, reported that Indonesia's health ministry had banned NAMRU-2 from operating in the country.

In his blog post, which he wrote while still in Indonesia but posted on 17 Apr 2008, Leavitt said that NAMRU-2 can help any Southeast Asian country identify virus samples in the event of communicable disease outbreaks. He added that the laboratory has operated in Indonesia for decades; however, the memorandum of understanding (MOU) between Indonesia and the United States expired two years ago, and efforts to renew the agreement have been unsuccessful.

Leavitt wrote that much of his time was spent discussing virus-sharing issues and the status of NAMRU-2 with Supari. A WHO working group on virus sharing has been trying to hammer out a virus-sharing agreement between global health officials and developing countries, but has made little progress. The group last met in November 2007, and a smaller version of the group may meet again in May 2008 in advance of the WHO's World Health Assembly.

"The minister's main point is that what she wants should not be considered 'royalties' or 'compensation,'" he wrote. "What she says she wants is for the contributing countries to be eligible for some share of the value commercial companies create out of the influenza samples they provide."

Leavitt acknowledged Supari's legitimate concerns about her country's access to medicine and vaccines, but emphasized that health officials need to retain incentives that enable pharmaceutical companies to develop new countermeasures. Leavitt said linking sample sharing to payment would erode the world's ability to make any vaccines, "because the slope is slippery, and there will be no end to the demands."

Indonesia's coordinating minister Aburizal Bakrie suggested that the United States and Indonesia spend the next two months working on a solution to the impasse, Leavitt reported. He said he instructed his representative Bill Steiger and ambassador John Lange, the State Department's special representative for avian and pandemic influenza, to continue discussions with Indonesia. Leavitt warned that, despite the new negotiations, the situation might never be resolved.

"If we haven't been successful in resolving the matter, I think it will be time for the world to just accept Indonesia's unwillingness to participate in the WHO influenza system and move on to other ways of making the world safer."
(CIDRAP 4.17.08)

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Africa
Egypt (Cairo): WHO confirms country's 49th case (22nd death) from H5N1 avian influenza
The Ministry of Health and Population of Egypt has announced a new human case of avian influenza A (H5N1) virus infection. The case is a 30-year-old female from Al-Matarya, Cairo Governorate. She developed symptoms on 2 Apr 2008 and was hospitalized and died on 11 Apr 2008. The case was confirmed as being infected with A (H5N1) by the Central Public Health Laboratories and by Cairo-based US Naval Medical Research Unit 3 (NAMRU-3). Investigations into the source of her infection indicate a history of contact with sick and dead poultry. Of the 49 cases confirmed to date in Egypt, 22 have been fatal.
(ProMED 4.17.08)

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Egypt: Two-year-old boy infected with H5N1 avian influenza, country's 50th case
A two-year-old Egyptian boy has been infected with the H5N1 bird flu virus, bringing the number of cases in the most populous Arab country to 50. Authorities identified the child as Mahmoud Ibrahim Ramadan from the Nile Delta province of Sharkia. It said he had been infected after exposure to household birds. The boy started showing symptoms of the illness on 13 Apr 2008 and was taken to hospital the next day where he was treated with the anti-viral drug Tamiflu. He was in stable condition.
(ProMED 4.17.08)

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2. Infectious Disease News

Asia
Japan: Man diagnosed with murine typhus after Indonesian surf trip
A 23-year-old Japanese man who returned from Bali, Indonesia, was diagnosed and confirmed to have murine typhus on 10 Apr 2008.

While staying on Bali from 20 Jan 2008 to 11 Mar 2008, he often went surfing at Madewi and Kuta beaches. He was admitted to the hospital on 24 Mar 2008 (on the seventh day of illness). Fever, thrombocytopenia, and renal impairment were seen on admission. Rickettsiosis was suspected since erythematous rash appeared on his eighth day of illness. Rickettsia typhi DNA was detected from his blood and skin specimen by PCR at the National Institute for Infectious Diseases (NIID), Japan. An indirect immunofluorescence assay (IFA) and immunoperoxidase assay (IP) for antibodies reactive with R. typhi antigens showed raised levels of IgM and IgG. He was given minocycline and completely recovered.

Another case of murine typhus was reported in Chiba, Japan, in April 2008. The NIID detected R. typhi DNA from the patient's blood. Murine typhus is not believed to be endemic in Japan. Considering the incubation period of murine typhus, they contracted the disease abroad. Further investigation of the second case is continuing. These two consecutive cases of imported murine typhus in Japan suggest that murine typhus may be endemic at some surf spots in Bali.
(ProMED 4.10.08)

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Russia (Kirov Region): Two cases of tissue dirofilariasis recorded in 2008
In 2008 two cases of human dirofilariasis have been recorded in the Kirov region, the first human cases in the region according to the press-service of Rospotrebnadzor (Federal Service for Consumer Protection and Human Well-Being) in the Kirov region. The two cases were found in the Kotelnichsky district of the Kirov region. The two patients are believed to have been infected by mosquito bites. The reservoir of infection is infected domestic dogs, cats and rarely wild carnivorous (wolves, foxes etc.). Transmission to humans and animals is seen from May to September.
(ProMED 4.8.08)

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Russia: Crimean-Congo hemorrahgic fever (CCHF) on the rise
Spread of Crimean-Congo hemorrhagic fever (CCHF) has been observed in recent years throughout southern Russia and Rospotrebnadzor (The Agency for Protection of Consumer Affairs) is predicting a worsening of the situation in 2008. The agency reports that from 1999 to 2007 outbreaks of CCHF were recorded in seven out of 13 territories in the Southern Federal Okrug. More than 90 percent of cases have occurred in rural areas, where the population is engaged in farming and agriculture. The urban population is exposed to infection only when visiting summer cottages. All age groups are affected but those between 20 and 60 years are at greatest risk. The infection as a rule happens as the result of a tick bite or during handling ticks without proper protection.
(ProMED 4.6.08)

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Russia (Udmurtia): Troubling forecast for hemorrhagic fever with renal syndrome (HFRS)
The epidemiological forecast for hemorrhagic fever with renal syndrome (HFRS) in Udmurtia is not favorable for 2008, as more cases among rodents are expected and because of this, more cases among humans as well. This happens every three to four years, according to the Rospotrebnadzor (Territorial Directorate of the Federal Services for Consumer Protection and Human Welfare). During the past year, 383 cases of HFRS have been registered in Udmurtia. The morbidity in rural population is 2.9 times higher than in urban population.

To escape the risk of infection officials recommend taking measures to prevent incursion of rodents. This includes paying attention to sanitation, eradication of garbage dumps, clearing undergrowth from nearby forest, and active rodent control measures. Gardens require special attention, as every fifth infection occurs there. The most dangerous time for infection is the first visit to the cottages after the winter months. Only wet methods are recommended for cleaning cottages. The most frequent mode of infection is air-dust in up to 85 percent of cases. It is necessary also to ventilate the rooms thoroughly. The food should be protected and rodent-exposed food should not be used. Hand washing is mandatory before meals and smoking. Bed linens should be exposed to sunlight for two-three hours. All these simple measures will prevent infection.
(ProMED 4.11.08)

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Americas
Canada (Toronto): Officials fear measles carrier may still be at large
Public health officials are concerned the original carrier of a recent outbreak of measles may still be at large after it was determined that none of four reportedly infected people has traveled recently, effectively ruling them out as the source.

Officials said measles continues to have potentially serious consequences, and a warning will be in effect for the Greater Toronto Area at least until the end of April 2008 should no new cases be reported. Despite obvious concern, the risk to the general public is described as low, thanks to extremely high immunization levels.

"When we know that measles was acquired in the city, that's what concerns us because that means that some people somewhere have the infection and are transmitting it to others unknowingly," said Vinita Dubey, associate medical officer of health for Toronto Public Health.

The first case was confirmed on 1 Apr 2008, when an Oakville man in his 30s was diagnosed. Since then, three cases have sprung up in Toronto in a 10-year-old girl, a 34-year-old woman, and a 42-year-old man. A fourth is being investigated.
(ProMED 4.11.08)

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Canada (British Columbia): Metapneumovirus infection possibly linked to death of four seniors
A mutation of the common cold could have played a role in the death of four seniors at a care home, according to health officials on Vancouver Island. In early January 2008, the Vancouver Island Health Authority declared an outbreak of human metapneumovirus [infection] at the Dufferin Place extended-care facility in Nanaimo. More than 60 of 150 residents at the facility were infected with the virus and four eventually died. But Vancouver Island Health Authority spokesperson Suzanne Germain said there is no way of knowing if the virus was directly responsible for the deaths. The outbreak lasted around six weeks, said Germain, who added outbreaks of various kinds are common in residential care homes. Human metapneumovirus is a human respiratory pathogen first discovered in 2001. It can cause both upper and lower tract disease and can lead to serious illness in the young, those with suppressed immune systems, and the chronically ill.
(ProMED 4.5.08)

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Peru: Researchers find high levels of MDR and XDR tuberculosis
The Mycobacteria Laboratory of the Peruvian Institute of Health (Instituto Nacional de Salud, INS) implemented susceptibility testing for first-and second-line antituberculous drugs using the agar plate method, according to international standards, under the supervision of the Public Health Laboratory in the USA, one of the supranational laboratories currently working with WHO.

Because of the occurrence of resistance to second-line antituberculous drugs, defined as extensively resistant tuberculosis (XDR TB, M. tuberculosis strains simultaneously resistant to isoniazid, rifampin, a fluoroquinolone and a parenteral second-line drug), during 2007 INS performed susceptibility tests for first- and second-line antituberculous drugs for all M. tuberculosis isolates received from the Public Health Laboratory Network, according to the regulations issued by the Sanitary Strategy for TB Prevention and Control. From January to June 2007, 2,235 results of susceptibility tests of isolates from 1,895 patients throughout Peru were assessed. Of these, 698 (36.8 percent) had multidrug resistant TB (MDR, defined as resistance at least to rifampin and isoniazid); and 45 were reported as XDR TB (2.4 percent of the total number of patients and 6.4 percent of all MDR TB patients).

XDR TB is a form of the disease produced by bacteria resistant to all effective antituberculous drugs, and it is generally resistant to every first-line drug and to most second-line drugs. The occurrence of XDR TB strains reflects the deficiency of resistant TB control and therapy programs. The high mortality rates associated with these strains, particularly in those places with a high prevalence of HIV infection, as it is the case for South Africa, has led international sanitary authorities to declare a worldwide alert because of the emergence of these micro-organisms, and recommendations for their control have been issued.

Such measures include strengthening the laboratory services in order to perform M. tuberculosis susceptibility testing in places with a high incidence of MDR TB. This is the reason why the INS will soon transfer tests for a rapid diagnosis of MDR TB to the regions where this disease is highly prevalent. Since MDR TB represents a threat for public health in Peru, it is urgent to implement the measures recommended by WHO, including isolation of these patients in safe places until their infectiousness state is controlled.
(ProMED 4.12.08)

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Peru: Researchers find new species of Leptospira in the Peruvian Amazon
While investigating the tropical disease leptospirosis in the Peruvian Amazon, an infectious disease specialist from the University of California, San Diego School of Medicine has uncovered new, emerging bacteria that may be responsible for up to 40 percent of cases of the disease.

Patients with severe forms of leptospirosis have jaundice, renal failure, and lung hemorrhage, with high fatality rates. Joseph Vinetz, MD, professor of medicine in UC San Diego's Division of Infectious Diseases, working in collaboration with colleagues from Universidad Peruana Cayetano Heredia in Lima, Peru, and others, headed the study that led to discovery of the new species in the family of pathogens, Leptospira, which is spread from animals to humans. Leptospirosis is a severe, water-borne disease transmitted from animals to humans, with tens of millions of human cases worldwide each year. Fatality rates can range as high as 20 to 25 percent in some regions. It is particularly prevalent in tropical countries where poor people live under highly crowded condition, or in rural areas where people are exposed to water contaminated by the urine of Leptospira-infected animals such as rats.

The new species reflects Amazonian biodiversity, according to Vinetz, and the pathogen has apparently evolved to become an important cause of leptospirosis in the Peruvian Amazon region of Iquitos. There, Vinetz leads an international team of physicians from the United States and Peru in an National Institutes of Health (NIH)-funded training program studying malaria, leptospirosis, and other infectious diseases that impact disadvantaged populations in developing countries. The researchers found that the new species, Leptospira licerasiae, cultured from a very small number of patients, as well as eight rats, is significantly different from other forms of the bacteria at a genomic level and has novel biological features.

"This strain has fundamentally different characteristics," said Vinetz, adding that the next step is to sequence its genome. "We think that hundreds of patients are infected with this pathogen, which is so unique that antibodies for the disease don't react to the regular tests for leptospirosis."

In testing 881 patients in a prospective clinical study of fever, the researchers found that 41 percent of them had antibodies that reacted only to this new strain of the bacteria, showing a much higher incidence of leptospirosis than previously suspected. "This observation is relevant to other regions of the world where leptospirosis is likely to be common, because it's necessary to identify the right strain of the Leptospira in order to make the correct diagnosis," Vinetz said.
(ProMED 4.7.08)

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USA: New cases of progressive inflammatory neuropathy in pork plant workers
The number of mysterious neurological illnesses among workers who processed pig brains at pork plants in three states has grown to as many as 24, and other possible cases are being evaluated, researchers said on 16 Apr 2008.

Dr. Daniel Lachance, a Mayo Clinic neurologist, said there are now 18 confirmed cases among people who have worked at the Quality Pork Processors plant in Austin, Minnesota. That's up from 13 cases reported as of February 2008. Lachance also said there are now about five cases among workers at a pork plant in Indiana, compared with two confirmed earlier, and one recently identified case at a plant in Nebraska. Officials have not publicly named the Indiana and Nebraska plants.

Researchers don't think the general public is at risk. "It doesn't appear that the slaughtered pigs have been ill," said Dr. James Sejvar, a neurologist and epidemiologist at the CDC. "It doesn't appear that this is in any way a foodborne illness. And it doesn't appear as if this particular illness can be transmitted person to person."

Lachance said none of the patients have recovered completely, though all have improved or stabilized to a degree. He also said some have had relapses. Some of the patients have required only pain medication, while the most seriously ill have undergone drug treatments to suppress their immune systems.

The three plants are the only ones investigators have found in the United States that used compressed air to harvest pig brains, which are considered a delicacy in some Asian countries. Sejvar said the CDC has been working with WHO to see whether the procedure has been used in any plants abroad. So far, they haven't identified any. Even if the illness turns out to be an isolated problem, Lachance said he hopes researchers will be able to apply what they've learned to other auto-immune illnesses. Scientists still don't know what triggers many of them, he said.
(ProMED 4.17.08)

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USA: Investigators find toxic elements in dietary supplements
The U.S. Food and Drug Administration (FDA) announced that it has found hazardous levels of selenium in samples of certain flavors of the dietary supplement products "Total Body Formula" and "Total Body Mega Formula."

The FDA has received 43 reports of persons from nine states who experienced serious adverse reactions using these products. On 27 Mar 2008, the FDA warned consumers not to purchase or use Total Body Formula in flavors Tropical Orange and Peach Nectar and Total Body Mega Formula in the Orange/Tangerine flavor of these products after receiving reports of adverse reactions in users in Florida and Tennessee. The adverse reactions generally occurred after five to 10 days of daily ingestion of the product, and included significant hair loss, muscle cramps, diarrhea, joint pain, deformed fingernails, and fatigue.

Selenium, a naturally occurring mineral, is needed only in very small amounts for good health. Selenium can boost the immune system. Generally, normal consumption of food and water provides adequate selenium to support good health. Excessive intake of selenium is known to cause symptoms to include significant hair loss, muscle cramps, diarrhea, joint pain, fatigue, loss of fingernails, and blistering skin. Analyses of samples of the products by FDA laboratories have now found most of the samples contain extremely high levels of selenium — up to 40,800 micrograms per recommended serving, or more than 200 times the amount of selenium per serving (i.e., 200 micrograms) indicated on the labels of the products. Presently, the FDA has 43 reports of adverse reactions including cases from Alabama, Florida, Georgia, Kentucky, Michigan, New Jersey, North Carolina, Tennessee, and Texas.
(ProMED 4.15.08)

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USA (Wisconsin): Two new cases of measles confirmed
Two new cases of the highly contagious measles have been confirmed in the Milwaukee area, bringing the total to four, the most the state has seen in more than a decade, a state official said on 10 Apr 2008.

"We would consider even one case of measles to be of the greatest concern, that's why we are being aggressive on case investigation," said Dan Hopfensperger, director of the Wisconsin Immunization Program, which is part of the state Division of Public Health.

Authorities were alerted on 9 Apr 2008 of a five-month-old and a 12-month-old with early symptoms of measles. Both children came in contact with a 23-month-old whose case was reported to authorities 4 Apr 2008, Hopfensperger said. All three children attended a Greenfield daycare, and its workers and other children have now been quarantined in their homes, he said. A 37-year-old Milwaukee man also is infected, but his case has not been connected with the children. The 23-month-old Franklin girl's symptoms started before 4 Apr 2008, Hopfensperger said. The man's symptoms started in mid-March 2008. One of the new cases lives in Milwaukee, according to the Milwaukee Health Department. Health officials are trying to determine where the man and the 23-month-old picked up the measles. No other people in the state have been infected since 2005.
(ProMED 4.13.08)

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USA: Man dies from human lymphocytic choriomeningitis virus infection, widow sues Petsmart Inc.
A widow is suing Petsmart Inc, saying that her husband died after a liver transplant that was contaminated by a sick hamster sold by the largest U.S. specialty pet retailer to the organ donor. The suit, filed in Massachusetts Superior Court in February 2008, seeking unspecified damages, moved up to U.S. District Court in Boston the week of 7-11 Apr 2008. Nancy Magee charged that a Petsmart in Warwick, RI, in March 2005 sold a hamster infected with lymphocytic choriomeningitis virus (LCMV) to a woman not named in the suit. That woman later died of stroke and her liver was implanted in Magee's husband, Thomas, in April 2005. A month later, Thomas Magee died of LCMV infection. In addition, two other people who received organs from this woman died and one became seriously ill, the suit says, noting that medical authorities later tracked down the hamster in question and found it to be infected with LCMV. Petsmart spokeswoman Jessica Douglas said the company does not comment on pending litigation.
(ProMED 4.12.08)

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USA: Rabies found in multiple states, human exposure
In New York, a Lake George man was bitten and scratched by a rabid fox on 7 Apr 2008 as he attempted to fend off repeated attacks while he and his fiancée walked up the steps to their second-floor apartment. Later that night, the fox repeatedly bit the right front tire of an SUV driven by a responding officer with the state Department of Environmental Conservation. It was the first confirmed case in 2008 of a rabid animal attack in Warren County.

In Arizona, the Pinal County Public Health Services District is issuing an advisory for animal rabies to all residents of Pinal County. On 31 Mar 2008, a bobcat bagged in the Peppersauce campgrounds near Oracle tested positive for rabies at the Arizona State Public Health Laboratory. The bobcat attacked and exposed at least two individuals at the campsite. Both individuals are currently receiving a series of shots to prevent contracting the rabies virus. This is the fifth animal to test positive in Pinal County in 2008. p> In Georgia, a bite from a rabid fox in Whitfield County underscores the need to aggressively combat the deadly disease, officials in Georgia and Tennessee say. Chad Mulkey, environmental county manager in Whitfield for the North Georgia Health District, said the attack illustrates how development crowds wild animals and humans closer together. Mr. Mulkey wasn't surprised Jimmy Cooper encountered a fox near his home during the week of 31 Mar - 4 Apr 2008. "Up there where this bite occurred, I'd say the habitat being destroyed is what pushed this fox out," Mr. Mulkey said.
(ProMED 4.10.08)

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USA (Colorado): Tests of the water supply find presence of two illness causing protozoa
On 8 Apr 2008, the Colorado Department of Public Health and Environment received results of water sampling in Alamosa performed by CDC. The results showed the presence of Giardia and Cryptosporidirs, two protozoa that also can cause diarrheal illness.

These samples were drawn by CDC before the water system was flushed and disinfected. More sampling is needed to confirm that the parasites have been eliminated.

New water samples were taken on 9 Apr 2008 by the state's Water Quality Control Division. Once testing shows the water is suitable for drinking, the state's boil order will be lifted. But lab results are not expected on the latest samples until the weekend of 12-13 Apr 2008 at the earliest. As of 8 Apr 2008, there were 389 total cases of salmonella, with 107 of these culture-confirmed and 16 hospitalized.
(ProMED 4.10.08)

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USA (Mississippi): Officials report State's first case of West Nile virus in 2008
The Mississippi State Department of Health confirmed on 31 Mar 2008 that the first human case of West Nile virus in the state this year 2008 has been reported in Lincoln County. Details about the patient and other aspects of the case were not disclosed. Also, the Lincoln County case is only the second human case reported in the nation for 2008.

"This just means we've got West Nile in that area, and likely it's in other areas of the state, too," said State Epidemiologist Dr Mary Currier. Although a March case of West Nile virus is atypical, as the season for the virus extends from mid-summer through fall, Currier said cases have been reported as early as January and as late as December. "It can happen at any time of the year," she said. "Mosquitoes can be around at any time of the year, and we all need to take precautions."
(ProMED 4.7.08)

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USA (Florida): Officials investigate outbreak of Staphylococcus aureus infections among 12 people
The Florida Department of Health is waiting on the results of lab tests to determine what caused an outbreak of Staphylococcus aureus infections among 12 people treated at a Tallahassee pain clinic. Officials from the Leon County Health Department, who have been tracking the cases, say they are not MRSA, the drug-resistant form of the bacterium. Four other patients were hospitalized for observations but were not confirmed as having staphylococcal infections, said Page Jolly, spokesperson for the Leon County Health Department. Infectious disease specialists who inspected the Pain Institute of North Florida ruled out skin contact or unsanitary equipment as a cause, said Dr. George Arcos, who runs the institute, and the main focus of the investigation is a batch of medicine that was likely contaminated. Lab results are expected to arrive early next week, said Page Jolly. Seventeen people were hospitalized for observation or treatment in connection with the outbreak. Arcos said that based on the nature of the infections, the outbreak was likely caused by contaminated medicine. "These injuries were at the site where the medicine was deposited," he said. "They're deep in the tissues."
(ProMED 4.7.08)

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Hong Kong: Officials urge vigilance against viral hepatitis E infection
The Centre for Health Protection (CHP) of the Department of Health on 14 Apr 2008 urged members of the public to be on the alert against viral hepatitis E infection and to strictly observe good personal, food, and environmental hygiene. The appeal was made in view of the higher incidence of viral hepatitis E infection recently. The Consultant, Community Medicine, of CHP, Dr. S. K. Chuang, said a total of 45 cases had been reported to CHP so far in 2008, while the figure for the same period in 2007 was 25. The figures for the whole year of 2005, 2006, and 2007 were 33, 34, and 64 respectively.

The cases were distributed throughout Hong Kong and involved patients aged between 16 and 84. So far, the food histories provided by the patients have not shown a single common source outbreak related to any particular food premises, Dr. Chuang said. Dr. Chuang said hepatitis E was acquired by ingestion of contaminated food or water and, therefore, is preventable by observing good personal and food hygiene. The incubation period ranges from 15 to 64 days before onset of symptoms. Hepatitis E is usually more active during the winter and spring seasons. Clinical features of acute hepatitis E resemble those of other types of viral hepatitis, including anorexia, malaise, fever, and vomiting, followed by jaundice, passing tea-colored urine, and hepatomegaly.
(ProMED 4.15.08)

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

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CHOLERA, DIARRHEA, & DYSENTERY
Hong Kong
The Centre for Health Protection has confirmed 2008's first cholera case involving a 26-year-old Wong Tai Sin (district) woman who fell ill during her visit to the Philippines. She traveled to the country from 29 Mar 2008 to 2 Apr 2008 and developed diarrhea, abdominal pain, dizziness, and vomiting on 31 Mar 2008. She is now stable at Queen Elizabeth Hospital. She tested positive for Vibrio cholerae biotype Ogawa. There were three cholera cases in 2007, one in 2006, five in 2005, five in 2004, and seven in 2003.
(ProMed 4.9.08)

Japan (Saitama)
Prefectural government officials said 10 people have been diagnosed with food poisoning caused by a cholera outbreak after dining at a restaurant in Saitama Prefecture. This is the first time that a cholera case has been confirmed in Japan since an outbreak in Aomori Prefecture in 2002. Those affected complained that they suffered diarrhea and nausea after eating sashimi and other food at Shozaburo, a Japanese-style restaurant in Kisai, Saitama Prefecture. Eight of them received treatment and three were hospitalized. None are in a serious condition.
(ProMED 4.15.08)

USA (Indiana)
Marion County's shigella outbreak is now into its sixth month and health officials are worried the highly contagious disease is going to become more widespread because kids are coming back from spring break. The health department learned of 31 new cases in the two weeks since 15 Apr 2008. The most effective way to stop the spread of shigellosis is thorough and frequent hand washing.
(ProMED 4.15.08)

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DENGUE
Malaysia
Malaysia continues to battle a steady rise in the number of dengue cases for the first three months of 2008 as the death toll from the mosquito-borne disease reached 26, a news report said on 5 Apr 2008. From January-March 2008, a total of 9,889 people were diagnosed with dengue and 26 of them died, the ministry's director of disease control Hasan Abdul Rahman said. In 2007, there were a total 13,949 cases with 34 deaths from January to March 2007. Hasan said although the number of cases in 2008 was lower than in 2007 (during the same time period), the number of dengue victims increased from each month.

The government has been holding campaigns to educate the public as well as to check residential and construction sites in efforts to stem the steady rise in dengue cases. However, despite the efforts, the number of cases and deaths continue to rise each year.
(ProMED 4.14.08)

New Zealand
At least 23 New Zealanders have contracted the viral disease dengue, which is spread through infected mosquitoes. Auckland Medical Officer of Health Dr. Simon Baker said two of the people have had to be hospitalized. "It's an ongoing outbreak in Tonga and people need to be cautious there," Dr Baker said.
(ProMED 4.7.08)

Philippines (Negros Oriental)
According to the Department of Health (DOH), cases of dengue in Negros Oriental have decreased by 50 percent in March 2008. The Epidemiology Surveillance Unit of the DOH shows that there were only 34 cases of dengue from 1-26 Mar 2008 compared to 70 cases in February 2008. The survey also showed that the 70 cases of dengue in February 2008 are lower by 45 percent compared to the 130 cases recorded in January. Although the number of cases has been falling during 2008, there were 234 cases from January to 26 Mar 2008 compared to 134 during the same period last year in 2007.
(ProMED 4.7.08)

Singapore
Dengue fever infections are mounting alarmingly in Singapore due to a change to a more deadly strain of the disease, sparking fears of the city-state's potentially worst epidemic yet news reports said on 8 Apr 2008. Unless the trend of infections is halted, health officials warn that the number of sick people could hit record levels within three years. The number of infections from January through March 2008 is already 60 percent higher than during the first quarter of 2007, said news reports. "If nothing is done to stop the spread, the number of cases will increase very significantly," said Dr. Ng Lee Ching, head of the Environmental Health Institute.

The city-state is spending 200,000 Singapore dollars (USD 145,000) a day in a massive effort to destroy breeding sites and a targeted war against mosquitoes in areas where two or more people fall ill. In 2007, more than 5,000 homeowners were fined 200 Singapore dollars (USD 145) for allowing mosquitoes to breed. Construction sites found with the insect pests breeding are fined 2,000 Singapore dollars (USD 1459). “We cannot understand why the numbers are climbing,” Ng said.
(ProMED 4.14.08)

Taipei
The Department of Health confirmed the first imported cluster cases of dengue fever discovered in a family, 9 Apr 2008. Chou Chih-hao, deputy director of the DOH's Centers for Disease Control, said the patients were four children born to a Tongese mother who was married to a Taiwanese man living in Taipei County. Chou said the mother took her four children to visit Tonga, a South Pacific island nation near New Zealand, and brought the children back to Taiwan on 24 Mar 2008. Her four-year-old son was found to have a fever at the airport and was confirmed to have been infected with the mosquito-borne disease. Taipei County health authorities then took specimens from the mother and her three daughters aged eight, 10, and 13. Tests confirmed that the three sisters were also infected, although the mother was not. But "only one sister showed symptoms of fever on 28 Mar 2008, and the two others had no symptoms," Chou said, adding that all four children recovered after taking medicine. The centers estimated that there have been 24 imported dengue fever cases so far in 2008, compared with only 15 imported cases during the same period in 2007.
(ProMED 4.14.08)

Thailand
Thailand's Public Health Minister Chaiya Sasomsub on 8 Apr 2008 warned the public to keep alert to dengue fever, as during the first three months of 2008, the cumulative number of patients soared to 7,413, with 99 percent of them completely recovered. However, there were nine fatalities in eight provinces, he said. The number of victims increased from the same period in 2007, when there were 4,209 patients and four dengue fatalities, the minister said. Chaiya said he had instructed local health officials nationwide to maintain the campaign to eradicate the mosquito breeding habitats.
(ProMED 4.14.08)

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4. Articles
Confronting an influenza pandemic with inexpensive generic agents: Can it be done?
Fedson DS. The Lancet Infectious Diseases. Early Online Publication, 16 April 2008
http://www.thelancet.com/journals/laninf/article/PIIS1473309908700707/abstract?iseop=true

Summary
Avian influenza A H5N1 presents a serious and possibly imminent pandemic threat. In such an event, adequate supplies of affordable vaccines and antiviral agents will be unavailable to most people in the world. In view of the overwhelming need for effective alternatives, generic agents that target the host immune response or the pandemic virus should be considered. Many scientists doubt the effectiveness of these agents. Nonetheless, several studies suggest that statins improve outcomes in patients with bacteraemia and pneumonia and might be similarly effective against influenza. An experimental study has shown that the fibrate gemfibrozil, a peroxisome proliferator-activated receptor (PPAR) α agonist, reduces mortality in H2N2 influenza virus-infected mice. There is substantial molecular cross-talk between statins and PPAR agonists, and their clinical effects are additive in patients with cardiovascular diseases. Chloroquine increases endosomal pH, impairing influenza virus release into the cytosol. Statins, fibrates, and chloroquine are produced as generic medications in developing countries. They are inexpensive, could be stockpiled, and would be available on the first pandemic day. With a lack of realistic alternatives for confronting the next pandemic, research is urgently needed to determine whether these and other generic agents could mitigate the effects of what might otherwise become an unprecedented global public-health crisis.
(CIDRAP 4.16.08)

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Willingness to volunteer during an influenza pandemic: perspectives from students and staff at a large Canadian university
Rosychuk RJ, Bailey T, et al. Influenza and Other Respiratory Viruses. 2008;2(2):71–79
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1750-2659.2008.00042.x

Background
A future influenza pandemic will require greater demand on numerous essential services and a reduced capacity to meet that demand. Recruitment of volunteers is an important issue for pre-pandemic planning.

Objectives
To identify factors and attitudes towards volunteerism in the event of a pandemic of influenza. Participants/methods A 42-item web-questionnaire was administered to all faculty, staff and students at the University of Alberta. Respondents indicated their willingness to volunteer. Responses were dichotomized and logistic regression models were developed to capture the association between willingness to volunteer and (i) demographic and information source variables, (ii) risk perception and general knowledge, and (iii) volunteering attitudes and priority access variables.

Results
Many factors predicted willingness to volunteer and several involved interactions with other variables. Older individuals relied on University Health Centre information and who had past volunteerism experience were generally more likely to be willing to volunteer. Those willing to volunteer were more likely to think spread could be prevented by covering mouth when coughing/sneezing, and treatment would include drinking fluids. Those who thought influenza would be treated by antibiotics were less willing to volunteer. Likely volunteers thought that healthcare students should be encouraged to volunteer if there was a healthcare worker shortage.

Conclusion
This study provides guidance for those who are preparing universities to deal with pandemic influenza. The results suggest factors that might be important in the recruitment of volunteers during an influenza pandemic and these factors might be relevant for other sectors as well.
(CIDRAP 4.14.08)

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Pathology, Molecular Biology, and Pathogenesis of Avian Influenza A (H5N1) Infection in Humans
(Uncorrected Version)
Korteweg C, Gu J. The American Journal of Pathology. 2008;172(5):1155-1170
http://ajp.amjpathol.org/cgi/rapidpdf/ajpath.2008.070791v1

Introduction
H5N1 avian influenza is a highly fatal infectious disease that could cause a potentially devastating pandemic if the H5N1 virus mutates into a form that spreads efficiently among humans. Recent findings have led to a basic understanding of cell and organ histopathology caused by the H5N1 virus. Here we review the pathology of H5N1 avian influenza reported in postmortem and clinical studies and discuss the key pathogenetic mechanisms.
(CIDRAP 4.13.08)

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Evidence for avian influenza A infections among Iowa’s agricultural workers
Gray GC, McCarthy T. Influenza and Other Respiratory Viruses. 2008;2(2):61–69
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1750-2659.2008.00041.x

Background
Identifying risk factors for zoonotic influenza transmission may aid public health officials in pandemic influenza planning.

Objectives
We sought to evaluate rural Iowan agriculture workers exposed to poultry for previous evidence of avian influenza virus infection.

Methods
In 2004, we enrolled 803 rural adult Iowans in a 2-year prospective study of zoonotic influenza transmission. Their enrollment data and sera were compared with those of 66 adult controls enrolled at the University of Iowa in 2006 by using proportional odds modeling.

Results
Of the 803 participants 58·8% were male with a mean age of 55·6 years. Forty-eight percent reported previous poultry exposure. Sera were studied by microneutralization techniques for antibodies against avian H4, H5, H6, H7 and H9 viruses. Touching live birds was associated (OR 1·2; 95% CI 1·02–1·8) with increased antibody titer against H5 virus. Similarly, participants who reported hunting wild birds had increased antibody titers against H7 virus (OR 2·8; 95%CI 1·2–6·5) and subjects who reported recent exposure to poultry had increased antibody titers against H6 (OR 3·4; 95% CI 1·4–8·5) and H7 viruses (OR 2·5, 95% CI 1·1–5·7). There was no evidence of elevated antibody against avian H4 or H9 viruses.

Conclusions
These data suggest that hunting and exposure to poultry may be important risk factors for avian influenza virus infection among rural US populations. Agriculture workers should be included in influenza pandemic plans.
(CIDRAP 4.12.08)

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Human-Like Receptor Specificity Does Not Affect the Neuraminidase-Inhibitor Susceptibility of H5N1 Influenza Viruses
Ilyushina NA, Govorkova EA, et al. PLoS Pathog. 2008;4(4): e1000043.
http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1000043

Author Summary
If the avian influenza H5N1 viruses adapt to human hosts, the first step is likely to be a switch in the preference of their viral hemagglutinin (HA) glycoprotein to bind to human rather than avian cell receptors. Such a switch may also alter virus susceptibility to neuraminidase (NA) inhibitors, which are anti-influenza drugs that are likely to be the first line of defense against a pandemic. We generated recombinant A/Vietnam/1203/04-like (H5N1) viruses carrying HA mutations previously shown to alter receptor specificity or affinity. We also discovered a previously unknown route (three simultaneous HA amino acid substitutions) by which highly pathogenic H5N1 viruses can adapt to human receptors. We then used a novel cell-culture–based system (differentiated human airway epithelial NHBE cells) to evaluate the recombinant viruses' resistance to NA inhibitors. None of the HA-mutant recombinants showed reduced drug susceptibility. Our results indicate that the tested HA mutations are unlikely to cause resistance to NA inhibitors in vivo. The NHBE system meets the need for an appropriate cell-culture–based system for phenotypic characterization of drug resistance.
(CIDRAP 4.11.08)

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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 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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Eleventh Annual Conference on Vaccine Research

http://www.nfid.org/conferences/vaccine08/
Date: May 5 - May 7, 2008
Location: Baltimore, Maryland

Conference Overview
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.

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ASTHO offers guidelines for protecting vulnerable groups during a pandemic
Acting on the premise that "disasters discriminate," the Association of State and Territorial Health Officials (ASTHO) and several partner groups on 15 Apr 08 released a lengthy set of proposed guidelines for protecting the most vulnerable people during an influenza pandemic. The 105-page document posted on the ASTHO Web site contains recommendations on how state, local, territorial, and tribal health agencies can prepare to help at-risk groups — such as people who can't afford to stockpile food, don't speak English, or need assistance with daily activities — get through a pandemic. "In the face of a pandemic we have to recognize that some of those services that serve them [vulnerable groups] today may be able to expand to meet the need, but some of them will break down," ASTHO Executive Director Paul E. Jarris, MD, MBA, said. "How will we provide basic services to people who are homebound, for example, making sure they have food and water and care? This won't happen by accident."

ASTHO officials credit Toby Merlin, MD, deputy director of the CDC's Influenza Coordinating Unit, for coming up with the idea for the At-Risk Populations Project, which they describe as unique because it is federal guidance developed by non-federal groups. "Toby Merlin came to us to ask ASTHO to organize, with CIDRAP and Keystone, a process for developing guidance outside the federal government, and also including the very important component of community engagement," said Jarris. "We've had community engagements around pandemic community mitigation measures and vaccine prioritization before, but what was really new was moving the engagement outside the federal government."

ASTHO is inviting the public to comment on the guidance document for 30 days (from 15 Apr 08). After that, plans call for editing the document and releasing the final version by 31 May 08, according to Anna DeBlois, ASTHO's senior director for immunization and infectious disease. The project has been on a tight schedule because of CDC budgetary considerations, said Jarris.

A few examples of the many recommendations in the guidance document:

  • To identify at-risk groups, use data from transportation and mass-transit planners to find local groups who need help to use public transit.
  • To build collaborations, reach out to community leaders without formal roles, such as elderly people or hairdressers.
  • Offer mini-grants to community-based and faith-based organizations for pandemic preparedness planning, if budgets permit.
  • Provide preparedness workshops for people who support at-risk individuals, including family, friends, and paid caregivers.
  • Encourage community-based and faith-based organizations to develop contracts or memoranda of understanding to provide essential services and supplies during a pandemic.
  • Consider the pros and cons of developing a community registry in which at-risk groups would describe the services and equipment they would need during a pandemic, and work with first responders to make sure the registry provides them useful information.
Read full article at:
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/apr1608atrisk.html
(CIDRAP 4.16.08)

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AI.COMMuniqué: Preparedness for Influenza Pandemic
AI.COMMuniqué is a monthly series of notes on avian influenza communication and the unique challenges and issues it presents. The series is intended to serve as a reliable source on avian influenza communication issues, as well as to spark discussion and thinking for people who are actively involved or interested in avian influenza work. If you would like to subscribe to the newsletter, please contact avianflu@comminit.com.

Please see The Communication Initiative's Avian Influenza Theme Site at: http://www.comminit.com/avianinfluenza.html for a full display of avian influenza communication knowledge in support of your work. Also see the Academy for Educational Development's Avian Influenza Web site at http://www.avianflu.aed.org.

AI.COMMuniqué is very interested in your knowledge and experience in avian influenza communication - your projects and programs, strategic thinking, support materials, and any other relevant documentation. Please contact avianflu@comminit.com with any input.

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 apecein@u.washington.edu