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Vol. XI No. 11 ~EINet News Brief ~ 30 May 2008 ~ EINet News Briefs ~ May 30, 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: Evolution of influenza strains points to higher risk of pandemic
- Global: WHO reports progress on intellectual property issues
- Bangladesh: WHO confirms first case of human H5N1 avian influenza infection
- China: Officials say hand-foot-mouth disease infections may have peaked
- China (Sichuan): Gas gangrene found in injured earthquake survivors
- Indonesia: Officials claim wide support for virus-sharing stance
- Indonesia (Jambi): Concern over sudden poultry deaths, avian influenza H5N1 suspected
2. Infectious Disease News
- Hong Kong: Officials confirm 12th imported dengue fever case
- Philippines: Health officials concerned over rise in dengue fever cases
- Russia: Rise in Crimean-Congo hemorrhagic fever sparks increased control efforts
- Russia (Rostov): A rise in botulism causes concern for officials
- Viet Nam (Ho Chi Minh City): Dengue fever on the rise in children
- Viet Nam: Death toll from hand-foot-mouth disease reaches 10
- Canada (Alberta): Chinook Health announces first confirmed case of hantavirus disease
- USA (Washington): New case of measles in Grant County, outbreak continues
- AVIAN/PANDEMIC INFLUENZA
- The evolutionary genetics and emergence of avian influenza viruses in wild birds
- Experimental infection of cattle with highly pathogenic avian influenza virus (H5N1)
- Contemporary North American influenza H7 viruses possess human receptor specificity: Implications for virus transmissibility
- General practice and pandemic influenza: a framework for planning and comparison of plans in five countries.
- Household responses to school closure resulting from outbreak of influenza B, North Carolina
- Prevention of the spread of infection—the need for a family-centered approach to hygiene promotion
- Increased detections and severe neonatal disease associated with coxsackievirus B1 infection—United States, 2007
- World Vaccine Congress Asia 2008
- International Meeting On Emerging Diseases and Surveillance (IMED 2009)
1. Influenza News
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Bangladesh / 1 (0)
China / 3 (3)
Egypt / 7 (3)
Indonesia / 16 (13)
Viet Nam / 5 (5)
Total / 31 (24)
Total no. confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 383 (241).
Avian influenza age distribution data from WHO/WPRO: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm.
WHO maps showing world’s areas affected by H5N1 avian influenza (last updated 5.6.08): http://gamapserver.who.int/mapLibrary/
WHO timeline of important H5N1-related events (last updated 5.20.08): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html
Global: Evolution of influenza strains points to higher risk of pandemic
But one strain of the H7N2 virus, a low pathogenic avian flu strain isolated from a man in New York in 2003, replicated in the ferret’s respiratory tract and was passed between infected and uninfected ferrets suggesting it could be transmissible in humans.
The investigators said the evidence suggests that the virus could be evolving toward the same strong sugar-binding properties of the three worldwide viral pandemics in 1918, 1957 and 1968.
“These findings suggest that the H7 class of viruses are partially adapted to recognize the receptors that are preferred by the human influenza virus,” said Terrence Tumpey, a senior microbiologist with the US Centers for Disease Control and Prevention.
The authors said that if the viruses continue to evolve in this direction, the avian flu viruses could travel more easily between other animals and humans. They called for strict surveillance of avian flu viruses and continuing federal preparations for a possible future pandemic. The study appears in the Proceedings of the National Academy of Sciences (please refer to the Articles section of this bulletin).
Global: WHO reports progress on intellectual property issues
Intellectual property rights have become a hot-button issue in global health circles, spurred by Indonesia’s decision in early 2007 to cease sharing its H5N1 avian influenza virus samples. The country’s stance has raised the possibility that it and other countries affected by H5N1 influenza might claim legal ownership of flu virus samples. Samples are needed to track viruses’ transmissibility and drug susceptibility and to develop vaccines. The WHO’s recent work on intellectual property issues is related to but separate from its efforts to broker a virus-sharing agreement.
When the WHO’s intellectual property working group met in early April 2008, members reached consensus on all but about 20 of 107 proposed actions. US Health and Human Services Secretary Mike Leavitt addressed the US government’s concerns in a May 19 2008 press conference during the assembly. Leavitt said the United States was eager to finalize the agreement, but was seeking to maintain strong principles on items such as the need for innovation.
“We obviously have very strong views that intellectual property is the seed or foundation for innovation, and that compromising to the point that innovation is in any way stymied will ultimately cost lives, and that’s not an area where we think compromise should be made,” he said.
Despite the lack of a final action plan, the WHA approved a strategy that defines the WHO’s roles regarding public health innovation and intellectual property. “WHO’s member states have recognized that market-driven research and development should be expanded to include additional incentives for health needs–driven research and development, and to make these advances affordable and accessible to developing countries,” the WHO said.
Aside from balancing innovation with health needs and greater access to treatments and diagnostic tools, the strategy lays out a framework to:
Bangladesh: WHO confirms first case of human H5N1 avian influenza infection
WHO on 23 May 2008 confirmed the first human case of bird flu in Bangladesh, a baby boy who has recovered, bringing the number of countries that have recorded human infections to 15. Bangladesh authorities announced the case on 22 May 2008, and the WHO said it had been confirmed by the US CDC.
“The case was confirmed by CDC in Atlanta. It is the first in Bangladesh,” WHO spokesman Gregory Hartl said.
The 16-month-old boy was infected in January 2008 and has since recovered, he said. Bangladesh authorities informed the United Nations agency promptly about the case, but it took time for the international laboratory testing to be completed, Hartl said.
The H5N1 virus was first detected in Bangladesh in Mar 2007, and since then, authorities have culled two million chickens and destroyed more than two million eggs. Avian influenza has spread through 47 of Bangladesh’s 64 districts, causing losses of about 45 billion taka (USD 650 million) for the growing poultry sector, which accounts for 1.6 percent of the impoverished nation’s gross domestic product.
“When a disease is so widespread in poultry, it is really a matter of time before you get a human case. It shows the need to control the disease in animals if you are going to reduce the chances of transmission to humans,” Hartl said.
China: Officials say hand-foot-mouth disease infections may have peaked
According to the Ministry of Health, HFMD can be caused by a host of intestinal viruses, but human enterovirus 71 (EV71) and coxsackievirus (Cox A16) are the most common. HFMD usually starts with a slight fever followed by blisters and ulcers in the mouth and rashes on the hands and feet. Those with EV71 often show serious symptoms. It can also lead to meningitis, encephalitis, pulmonary edema, and paralysis in some children. There is no vaccine.
Elsewhere in China, according to the city’s Health Bureau, 10 more enterovirus cases were confirmed in Macao, on 29 May 2008, bringing the total number to 283 so far. These enterovirus cases comprise cases of HFMD and cases of herpangina (mouth blisters), but none of the patients was in serious condition, the bureau said. Among the detected cases in Macao, 34 have been confirmed as EV71 infections as of 29 May 2008.
The Chinese Center for Disease Control and Prevention, in collaboration with the WHO Representative Office in China, has released a preliminary report on the HFMD outbreak due to EV71 in Fuyang City, Anhui Province, the most severely affected locale. Reporting on the occurrence of HFMD in Anhui province and the rest of the country will now take place on a monthly basis together with other notifiable diseases in China. As part of the efforts to implement the International Health Regulations, IHR (2005), China will further strengthen the early warning system by immediate notification of clustering of clinically abnormal and severe cases, as well as increasing international collaboration and information exchange. An English version of the preliminary report can be downloaded from the World Health Organization China Office website:
China (Sichuan): Gas gangrene found in injured earthquake survivors
Five patients diagnosed with gas gangrene disease on 14 May 2008 are in a stable condition, according to Shi Yingkang, the dean of Huaxi Hospital. Gas gangrene is a bacterial infection that produces gas within gangrenous tissue. People with open fractures are particularly susceptible. It is caused by the clostridium bacteria and if left untreated is usually fatal within 12 hours. Isolation of patients and effective disinfection can prevent cross infection. It takes about five minutes to diagnose the disease by testing wound secretions.
There have been no cases of cross infection in Huaxi Hospital so far. But rescuers in the quake-hit region have been warned not to make direct contact with survivors’ skin, and to follow effective disinfection procedures.
Experts from Chinese Center for Disease Control and Prevention say isolation wards should be set up in all hospitals receiving patients from the quake-hit area. All injured persons transferred from the quake area should be first sent to isolation wards to be checked for gas gangrene. If gas gangrene is suspected, treatment must begin immediately. Thoroughly cleaning wounds, removing foreign objects and dead tissue is the best way to prevent clostridium infection.
Indonesia: Officials claim wide support for virus-sharing stance
“We received moral and political support from health ministers from England, Russia, Iran, and Australia,” Supari said. The NAM Web site does not list England or Australia among its 118 member countries.
During the WHO’s annual World Health Assembly, Supari urged world health officials to replace the WHO’s virus-sharing system, saying it favors developed nations. Also during the meeting, she met with US Health and Human Services Secretary Mike Leavitt to discuss possible solutions to the virus-sharing impasse, in a continuation of talks that had begun in April 2008. Leavitt mentioned the latest talks at a May 19 2008 press conference.
“Actually, not a great deal changed as a result of our meeting today,” he told reporters, according to a transcript published on the US State Department Web site. He emphasized that the United States wants to help forge needed improvements in the sample-sharing system. “What we aren’t willing, of course, to do is engage in any system that would involve compensation for virus samples,” he said. “This is a 60-year-old tradition. That’s one of the greatest public health successes in history.”
A progress report on multilateral efforts to settle the sample-sharing issue, including ideas raised at the World Health Assembly, is expected in July 2008, Leavitt said. A WHO working group dedicated to solving the problem, which has met several times, will meet again in November. “And we’re hopeful that by November of this year we’ll have a protocol under which that (virus sharing) can be done,” Leavitt said.
In a recent book, Supari accused the United States of planning to make a biological weapon out of the H5N1 virus and charged that the United States and the WHO have conspired to profit from H5N1 vaccines.
Indonesia recently announced it would begin sharing H5N1 viral sequences with a new public database, the Global Initiative on Sharing Avian Influenza Data (GISAID), which was formed by a group of 70 scientists and health officials to promote greater sharing of H5N1 sequences. GISAID has said the public can freely access the database, which includes both human and animal H5N1 sequences, after they register and agree to share and credit the use of others’ data, analyze findings jointly, publish results collaboratively, and refrain from pressing intellectual property rights issues that relate to diagnostic, drug, and vaccine developments.
Experts have praised the new development, but some have said that having actual H5N1 isolates is more useful because they are needed to make seed strains for vaccines and are critical for determining antigenicity, transmissibility, and pathogenicity.
Indonesia (Jambi): Concern over sudden poultry deaths, avian influenza H5N1 suspected
“We're also calling on all members of the community to report to the community health centers should their neighbors, friends, or family members become sick,” head of Tebo health office Haflin said 20 May 2008. Haflin said his office has worked hand-in-hand with the husbandry office to take preventive measures including providing (veterinary) vaccines, spraying disinfectant, and culling possibly infected poultry. Disinfectant has been sprayed and medicine distributed within a 1 km radius of the areas where the sudden deaths occurred.
2. Infectious Disease News
Hong Kong: Officials confirm 12th imported dengue fever case
The Centre for Health Protection on 20 May 2008 confirmed the year’s 12th imported dengue fever case involving a 39-year-old man who traveled to the Maldives 5-13 Apr 2008. He was admitted to St Teresa’s Hospital on 28 Apr 2008 and has been discharged. He came down with a fever, sore throat, joint pain and a rash on 22 Apr 2008. His four travel companions also had similar symptoms. Of them, a 30-year-old man was confirmed to have dengue fever on 30 Apr 2008.
Philippines: Health officials concerned over rise in dengue fever cases
“This is 29.4 percent higher compared to the same period last year (2007), when it stood at 7384 cases,” the report stated. The report also noted that deaths due to dengue stood at 111, which is higher by as much as 29 fatalities as compared to 2007, the report said.
According to the report, National Capital Region (NCR) posted the bulk of the dengue cases with 2,443 victims. Of the 2,443 Metro victims, the city of Manila had the most number of cases with 687 followed by Quezon City and Caloocan City with 362 and 328, respectively. The same report also showed that Central Visayas (1384), Central Luzon (1221), Calabarzon (881), Zamboanga (805), and Soccsksargen (655) likewise recorded high number of dengue cases. Dr Lyndon Lee Suy, DOH Emerging and Reemerging Disease Prevention National Program manager, advised the public to continuously search for areas where dengue-carrying mosquitoes thrive and subsequently clean such breeding grounds.
“We must always practice the search and destroy strategy. It remains to be the best way to combat dengue fever,” Lee Suy told reporters, adding that the public to continue self-protection measures and immediately seek medical consultation at the first signs of dengue.
Russia: Rise in Crimean-Congo hemorrhagic fever sparks increased control efforts
In another case an 11-year-old girl contracted CCHF following a tick bite and died subsequently. The diagnosis was established only after the worsening of the girl’s condition. Her parents sought medical treatment for her in the local health clinic, but the tick bite was not detected immediately.
(According to Internet sources, four fatal cases of CCHF have been registered in the South Federal Okrug so far the 2008 season. This is equal to the mortality rate for CCHF for the whole of 2007. Morbidity has increased 1.7-fold in comparison to 2007. The low ranking of CCHF in differential diagnosis has contributed to the death of the child in Kalmykia and the woman in Stavrapol. In some situations where there is no history of tick bite, physicians need to be more aware of the possibility of CCHF.)
Russia (Rostov): A rise in botulism causes concern for officials
The last cases were in the Morozowsk settlement in April 2008. Two people fell sick after eating dried bream. The last outbreak was in the city of Belaya Kalitwa, where three people got sick and two of them died. Rospotrebnadzor reports that the most common food that causes botulism is homemade products like dried fish, mushroom marinades, and vegetable cans. These dangerous goods are also sold in local non-authorized markets.
The testing of food specimens taken from cases revealed botulinum toxin in 70-75 percent of cases and the producing organism in 10-30 percent of cases. The epidemiological analysis showed that the most risk for botulism is coming from homemade products for self-use and from products sold in non-authorized markets.
Viet Nam (Ho Chi Minh City): Dengue fever on the rise in children
Viet Nam: Death toll from hand-foot-mouth disease reaches 10
Dr. Luong Chan Quang of the HCM City Pasteur Institute warned that it is difficult to diagnose HFMD in children because not all patients have typical symptoms — water spots on their bodies. Patients who experience mental complications or encephalitis may suffer after-effects though they recover. Quang said that seven of the 10 deaths from HFMD in the south were in HCM City. The doctor said that this epidemic boomed in HCM City for the first time in 2003, returned to the city for the second time in 2006 and broke out again in late 2007. Most southern provinces don’t have supervising systems for this epidemic. So far this year, only seven of 20 southern provinces have released reports on HFMD: Ben Tre with 215 patients, Can To 124, Dong Nai 197, Dong Thap 322, Kien Giang 261, HCM City 1018 and Vinh Long 220.
The HCM City Pasteur Institute set up a network to supervise the disease early in 2008. According to reports from three large hospitals in HCM City Children’s Hospitals 1 and 2 and the Tropical Disease Hospital the total number of HFMD patients in 2007 was 2,988, a 30 percent from 2006. The local department of health said that 16 died from the disease in 2007 and only three in 2006. By 8 May 2008, the city had 755 children with HFMD.
Canada (Alberta): Chinook Health announces first confirmed case of hantavirus disease
Chinook Health recently announced that the first case of hantavirus disease has been confirmed in this region, although since 1989, twenty-eight cases throughout Alberta have been reported. Dr. Vanessa Maclean, acting medical officer of health, said given the largely rural population, the potential for someone to contract the virus is always a possibility. Maclean adds the individual has since recovered, but the public needs to remain cautious, as the virus can be aggressive and has a fatality rate of 30 percent.
Contracted primarily when an individual inhales rodent urine and feces, Chinook Health says it's important to not disturb contaminated dry materials.
“Any time people are working in areas inhabited by mice they need to be extra cautious,” says Maclean. The affected individual contracted the virus when cleaning out a barn. Chinook Health says the most effective precaution against infection is to keep rodents out of homes and work areas.
USA (Washington): New case of measles in Grant County, outbreak continues
Measles cases in the United States are reported by state health departments preliminarily to CDC, and confirmed cases are reported officially via the National Notifiable Disease Surveillance System, using standard case definitions and case classifications. Cases are considered importation associated if they are: 1) acquired outside the United States (that is, international importation), or 2) acquired inside the United States and either epidemiologically linked via a chain of transmission to an importation or accompanied by virologic evidence of importation (that is, a chain of transmission from which a measles virus is identified that is not endemic in the United States). Other US cases are classified as having an unknown source.
Between 1 Jan 2008-25 Apr 2008, a total of 64 preliminary confirmed measles cases were reported from the following areas: New York City (22 cases), Arizona (15), California (12), Michigan and Wisconsin (4 each), Hawaii (3), and Illinois, New York state, Pennsylvania, and Virginia (1 each). Patients ranged in age from five months to 71 years; 14 patients were aged <12 months, 18 were aged 1-4 years, 11 were aged 5-19 years, 18 were aged 20-49 years, and 3 were aged >50 years, including one US resident born before 1957. Fourteen (22 percent) patients were hospitalized; no deaths were reported. Transmission occurred in both health-care and community settings. One of the 44 patients for whom transmission setting was known was an unvaccinated health care worker who was infected in a hospital. Seventeen (39 percent) were infected while visiting a health care facility, including a child aged 12 months who was exposed in a physician’s office when receiving a routine dose of measles, mumps, and rubella (MMR) vaccine.
Fifty-four (84 percent) of the 64 measles cases were importation associated: 10 (16 percent) of the 64 were importations (5 in visitors to the United States and 5 in US residents traveling abroad) from Switzerland (3), Israel (3), Belgium (2), and India and Italy (one each); 29 (45 percent) cases were epidemiologically linked to importations; and 15 (23 percent) cases had virologic evidence of importation. The remaining 10 (16 percent) cases were from unknown sources; however, all occurred in communities with importation-associated cases. Specimens from 14 patients were genotyped at CDC, and four different genotypes were identified: three from Arizona (genotype D5), three from California (D5), five from New York City (one in a case epidemiologically linked to an imported case from Belgium and four in cases in communities where importations from Israel had occurred; all D4), two from Wisconsin (H1), and one from Michigan (D5).
Fifty-six of the 64 measles cases reported in 2008 have occurred in five outbreaks (defined as three or more cases linked in time or place). In New York City, an outbreak of 22 cases has been reported, including four importations and 18 other cases (10 importation associated). In Arizona, 15 cases have been reported; the index patient was an unvaccinated adult visitor from Switzerland. In San Diego, California, 11 cases have been reported, and an additional case spread to Hawaii; the index patient in the San Diego outbreak was an unvaccinated child who had traveled to Switzerland. In Michigan, four cases have been reported; the index patient was an unvaccinated youth aged 13 years with an unknown source of infection. In Wisconsin, four cases have been reported; the index patient was a person aged 37 years with unknown vaccination status who likely was exposed to a Chinese visitor with measles-compatible illness. 63 of the 64 patients were unvaccinated or had unknown or undocumented vaccination status, and one patient had documentation of receiving two doses of MMR vaccine. None of the five patients who were visitors to the United States had been vaccinated. Among the 59 patients who were US residents, 13 were aged <12 months and too young to be vaccinated routinely, seven were children aged 12-15 months and had not yet received vaccination, 21 were children aged 16 months-19 years, including 14 (67 percent) who claimed exemptions because of religious or personal beliefs. Among the 18 patients aged >20 years, 14 had unknown or undocumented vaccination status, two had claimed exemptions and acquired measles in Europe, one had evidence of immunity because of birth before 1957, and one had documentation of receiving two doses of MMR vaccine.
Of the five US residents with measles who were vaccine eligible and had traveled abroad, all were unvaccinated. One was a child aged 15 months who was not vaccinated before travel, and two were adults who were unvaccinated because of personal belief exemptions. For two adults, the reason for not being vaccinated was unknown.
The evolutionary genetics and emergence of avian influenza viruses in wild birds
Dugan VG, et al. PLoS Pathog. 2008;4(5):e1000076.
We surveyed the genetic diversity among avian influenza virus (AIV) in wild birds, comprising 167 complete viral genomes from 14 bird species sampled in four locations across the United States. These isolates represented 29 type A influenza virus hemagglutinin (HA) and neuraminidase (NA) subtype combinations, with up to 26% of isolates showing evidence of mixed subtype infection. Through a phylogenetic analysis of the largest data set of AIV genomes compiled to date, we were able to document a remarkably high rate of genome reassortment, with no clear pattern of gene segment association and occasional inter-hemisphere gene segment migration and reassortment. From this, we propose that AIV in wild birds forms transient “genome constellations,” continually reshuffled by reassortment, in contrast to the spread of a limited number of stable genome constellations that characterizes the evolution of mammalian-adapted influenza A viruses.
Experimental infection of cattle with highly pathogenic avian influenza virus (H5N1)
Contemporary North American influenza H7 viruses possess human receptor specificity: Implications for virus transmissibility
General practice and pandemic influenza: a framework for planning and comparison of plans in five countries.
Household responses to school closure resulting from outbreak of influenza B, North Carolina
Prevention of the spread of infection—the need for a family-centered approach to hygiene promotion
Increased detections and severe neonatal disease associated with coxsackievirus B1 infection—United States, 2007
World Vaccine Congress Asia 2008
2-5 June 2008; Singapore
Meet vaccine experts from NGOs (e.g. Bill & Melinda Gates, PATH, WHO, IVI) and top vaccine companies such as Green Cross, 9Bio, Novartis, Intercell, Dynavax, Sanofi Pasteur, CNBG, AdImmune, NasVax, Vaxine, Serum Institute of India, IVAC, Shantha Biotechnics, Panacea Biotec and more.
13-16 Feb 2009; Vienna, Austria
ProMED, the Program for Monitoring Emerging Diseases, is pleased to invite you to the International Meeting on Emerging Diseases and Surveillance 2009. Along with our co-sponsors, the European Centers for Disease Control, the World Organization for Animal Health, the European Commission, and the Wildlife Conservation Society, we are developing a conference that will bring together the public health community, scientists, health care workers and other leaders in the field of emerging infectious diseases. The meeting will embrace the ‘One Medicine, One Health’ concept recognizing that, just as diseases reach across national boundaries, so do they transcend species barriers. We therefore welcome the full participation of both the human and animal health communities.
IMED 2009 will be organized by the International Society for Infectious Diseases, which has over 20 years experience in planning and implementing international biomedical meetings. Because of the enthusiastic response to the inaugural meeting, IMED 2007, which attracted over 600 participants from 65 countries, IMED 2009 will expand to three full days of sessions and include more opportunities for oral presentations of submitted abstracts.
Abstract Submission: The deadline for abstract submission is December 1, 2008.
Target Audience: ProMED-mail participants, physicians, veterinarians and other health care workers, public health workers, scientists, pharmaceutical and biotechnology industry, journalists, other interested persons.