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Vol. XI No. 13 ~EINet News Brief ~ 27 June 2008 ~ EINet News Briefs ~ Jun 27, 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: UN official says bird biosecurity lapses could worsen food crisis
- Global: Leading international health officials say world is not ready for an influenza pandemic
- Indonesia: WHO confirms two deaths from H5N1 avian influenza infection
- Pakistan (Swabi): Government declares H5N1 outbreak; Swabi Poultry Association disagrees
- Viet Nam: FAO advises continuing vaccination program
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- Hong Kong: Officials aim for complete closure of poultry industry
2. Infectious Disease News
- Philippines: Dengue on the rise, authorities step up information campaign for rainy season
- China (Shanghai): Health officials report first child death of hand, foot and mouth disease
- Indonesia: Despite control efforts, dengue is increasing in some provinces
- Philippines: Officials note high incidence of leptospirosis infection
- Russia: Dozens infected with Trichinella after eating bear meat
- Russia: Health officials see a rise in Crimean-Congo hemorrhagic fever
- Vietnam: Southern provinces hit hard by dengue
- Canada: Fraser Valley health officials identify 47 cases of mumps
- USA: Multistate outbreak of Salmonella infection from tomatoes continues
- USA (Ohio & Michigan): Multistate outbreak of E. coli infection may be linked to ground beef
- AVIAN/PANDEMIC INFLUENZA
- WEST NILE VIRUS (North America)
- Influenza Activity — United States and Worldwide, 2007–08 Season
- Virus transfer from personal protective equipment to healthcare employees’ skin and clothing
- An adjuvanted, low-dose, pandemic influenza A (H5N1) vaccine candidate is safe, immunogenic, and induces cross-reactive immune responses in healthy adults
- Immune responses of healthy subjects to a single dose of intramuscular inactivated influenza A/Vietnam/1203/2004 (H5N1) vaccine after priming with an antigenic variant
- Clinical review: Influenza pandemic — physicians and their obligations
- Tackle the problem when it gets here: pandemic preparedness among small and medium businesses
- Mitigating pandemic influenza: ethics of implementing a school closure policy
- Primary care physicians and pandemic influenza: an appraisal of the 1918 experience and an assessment of contemporary planning
- Pharmacokinetics and tolerability of Oseltamivir (Tamiflu®) combined with probenecid
- PHI2008: Envisioning options for integrated public health information systems for low resource settings: components, connections, partners, strategies
- BirdFlu 2008: Avian Influenza and Human Health
1. Influenza News
Global: UN official says bird biosecurity lapses could worsen food crisis
Lax biosecurity measures around poultry in some countries could lead to an increasing number of H5N1 avian influenza outbreaks that could exacerbate the global food crisis, an official from the United Nations Food and Agriculture Organization (FAO) said at an international infectious disease conference in Malaysia on 20 June 2008. Juan Lubroth, senior officer with the FAO’s infectious diseases group, made the comments during symposia on influenza in animals and people at the International Congress on Infectious Diseases (ICID), which started on 19 June 2008 in Kuala Lumpur and runs through 22 June 2008. ICID is the annual meeting of the International Society for Infectious Diseases.
Lubroth said though fewer countries have experienced recent avian flu outbreaks, numerous small outbreaks continue to occur. “It's like a boiling pot, and we need to keep the lid on that before it gets worse” he said.
He said 80 percent of the world’s poor depend on livestock for their livelihood, and poultry has been an inexpensive protein source. However, he added that about 240 million poultry have been slaughtered to control the spread of H5N1. Failure to protect the food supply of the world’s poor only makes worse the effect of rising prices of rice, corn, and other staples, Lubroth said. Global veterinary service capacity needs to be expanded, and more countries need to be transparent regarding disease surveillance and develop surveillance systems and policies to manage the disease, he said. “We fail to see that political commitment.” In the abstract that accompanied the presentation, Lubroth wrote that veterinary experts worry that government officials, in a panic over the threat to human health, are focusing nearly all of their efforts on accumulating antiviral and vaccine stockpiles, “forgetting that the origin of the malady was — and remains — a poultry problem.
These comments from the FAO seem to counter some of the recent comments from a UN official on the state of global pandemic preparedness. On 18 June 2008, David Nabarro, the UN’s influenza coordinator, listed national improvements in poultry biosecurity as a reason behind the organization’s assessment that the world is better prepared for an influenza pandemic, according to an earlier report. He also said more countries are focusing their efforts on the link between human and animal health.
Other pandemic experts, such as Michael T. Osterholm, director of the University of Minnesota Center for Infectious Disease Research and Policy, the publisher of CIDRAP News, disagree that the world is better prepared for a pandemic and say governments have not planned for supply, medicine, and utility disruptions that could severely damage the world’s economy and worsen the impact of the disease on health. Nabarro, however, expressed concern that the virus remains entrenched in several countries, particularly Indonesia, the country that has had the highest number of human cases and deaths.
Global: Leading international health officials say world is not ready for an influenza pandemic
David Heymann, the World Health Organization’s (WHO’s) assistant director-general for health security and environment, said governmental attention to the pandemic threat has waned. “Certainly at higher levels in many governments there is no longer the concern there was five years ago,” Heymann said. He noted that many countries have written pandemic plans and are stockpiling antiviral drugs, but he agreed with Gerberding that the world “is not prepared as far as vaccines go.”
In other news from the Malaysia conference, Heymann said a committee of experts would meet in November 2008 to discuss whether the WHO should plan to build a larger stockpile of prepandemic H5N1 vaccines. So far, two drug companies, GlaxoSmithKline and Sanofi Pasteur, have pledged to provide a total of 110 million doses of H5N1 vaccines for the WHO stockpile. The WHO has said the stockpile would be used to help battle the initial emergence of a potential H5N1 pandemic and to provide vaccine to countries that would have little access to it. Heymann said a WHO advisory committee “will determine whether or not there should be a greater stockpile or even consider vaccinating populations against H5N1 as an insurance policy.” He warned that widespread use of the vaccines could backfire if they cause serious side effects. “If they are severe, it may cause concern and might even derail activities to vaccinate in the future,” he said.
Heymann said the committee would also discuss whether the prepandemic vaccines are safe and whether they provide protection against different H5N1 strains.
Indonesia: WHO confirms two deaths from H5N1 avian influenza infection
As of 19 Jun 2008, The Ministry of Health of Indonesia has announced two new cases of human H5N1 avian influenza infection. The cases are not linked epidemiologically. The first case is a 16-year-old female from South Jakarta, DKI Jakarta Province. She developed symptoms on 7 May 2008, was hospitalized on 12 May 2008 and died on 14 May 2008. Investigations into the source of her infection indicate exposure to sick and dead poultry. The second case is a 34-year-old female from Tangerang District, Banten Province. She developed symptoms on 26 May 2008, and was hospitalized on 2 Jun 2008 and died on 3 Jun 2008. Investigations into the source of her infection are ongoing. Of the 135 cases confirmed to date in Indonesia, 110 have been fatal. (ProMED 6.20.08)
Pakistan (Swabi): Government declares H5N1 outbreak; Swabi Poultry Association disagrees
“The virus was detected after the owner of the farm informed us on 20 Jun 2008 that some 4,000 birds had died within the past few days,” he said. “We got the confirmation on 21 Jun 2008, sealed the farm and culled around 2,000 birds,” he said. All workers on the affected farm were examined by the ministry of health but none was found to have been affected by the virus, he added. Local health officials are monitoring surrounding farms and advised them to take precautionary measures including vaccination of birds, he said.
Swabi Poultry Association (SPA) on 25 Jun 2008 staged a protest demonstration against the District Livestock and Dairy Development Department and the National Research Institute (NRI), Islamabad, for what they called ‘mistaking an H5N9 strain for H5N1’ that caused bird flu. The association’s office-bearers said that they had conducted their own test at the Poultry Research Institute (PRI), Rawalpindi, where the strain was identified as H5N9. The association’s president, Zabiullah, demanded that the government constitute an impartial committee that should take samples for fresh tests. He warned that if the government failed to listen to their demand by 30 Jun 2008, they would hold a hunger strike camp in front of the NWFP Assembly.
Viet Nam: FAO advises continuing vaccination program
The 16-18 Jun 2008 conference was co-organized by the Vietnamese Ministry of Agriculture and Rural Development, the Food and Agriculture Organization of the United Nations (FAO), the US Department of Agriculture (USDA) and the US Agency for International Development (USAID). The conference heard bird flu-related reports by international experts, including a model outlining the risk and progress of the virus, epidemiology research on viruses on different kinds of poultry, and campaigns to raise public awareness about the disease and its prevention.
Addressing the conference, Viet Nam’s Deputy Minister of Agriculture and Rural Development Bui Ba Bong said avian influenza was temporarily under control in the country but that there was a risk the situation could change and become complicated. More research on avian influenza is necessary to bring it under control, he told the meeting, saying that more work was needed to understand the nature of the virus, how it was transmitted and on the production of a vaccine to sustainably control a pandemic and minimize virus transmission to humans. Bong said research should be combined with restructuring of the poultry sector to increase biosecurity and with strengthening of mass education and communication about the disease. He stressed the importance of research in deciding measures to effectively rein in the epidemic and warned Viet Nam to reconsider vaccination, which he said was effective but costly. Do Huu Dung, an epidemiologist in Viet Nam’s Animal Health Department, said that while statistics show that recent outbreaks are small in scale and few in numbers, they are scattered over many different areas throughout the north, the center and the south. “What we need to do is to have a sustainable vaccination strategy to maintain control over bird flu. The current government goals regarding this disease include keeping the frequency and scale of outbreaks at low level, preventing the transmission of the virus to humans and reducing the burden of vaccination on the state.”
Dr. Glibert told participants that two of the country’s biggest challenges were to improve surveillance and to change farming systems. He warned against prescriptive solutions telling people to change and called for a process-driven approach, consulting farmers to listen to their points of view and offering incentives.” So, there is push and pull. They (farmers) will be pushed by legislation but they will be pulled by giving them access to markets. Consumers may be uneasy with chicken but if they are assured that it is of good quality, and for it to be good quality it might cost a little more in a secure market chain, then they have peace of mind, and the farmer feels that he’s doing a service and getting the profit incentive to do that.”
Dr. Anni McLeod, a senior officer with FAO’s Livestock Division, sounded a word of caution about the impact of messages transmitted to people via mass media. She said studies carried out in Viet Nam were showing that repeated mass media messages were losing their effectiveness. “People have said that they hear the messages but they don't really think it’s something meant for them. They feel that they will manage in their own way, and that repeatedly hearing the same messages over and over again does not really have an impact on them.” In response, conference participants concluded that it was important to have much more personal discussion with communities about how they see risks and how they are dealing with the disease rather than constantly giving them the same message over time. “For many people in Viet Nam,” McLeod said, “avian influenza is a part of life, it’s not unusual, so we have to think about more direct ways to communicate with people, ways that are more related to their lives, and involve listening to and talking to people.”
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 385 (243).
Avian influenza age distribution data from WHO/WPRO: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm .
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 5.28.08):
WHO’s timeline of important H5N1-related events (last updated 6.17.08):
Hong Kong: Officials aim for complete closure of poultry industry
Secretary for Food and Health, York Chow Yat-ngok, said this was the government’s final offer after a meeting of the Executive Council on 24 Jun 2008. As well as retailers, Hong Kong has 71 wholesalers, 50 chicken farms, and 266 transport workers who depend on the trade for their livelihood. However, if the retailers accept the buyout deal it will effectively end the businesses of the rest of the sector as well as Hong Kong’s culture of cooking live chickens. The need for central slaughtering by 2011 may also be made redundant. Chow expressed confidence that most of the retailers will accept the deal, which is more than three times the 2005 Voluntary Surrender Scheme.
Many of the traders said they can’t operate under the overnight ban and they are also considering the risk of facing another bird flu outbreak within the next few years, he said. But the government will only approve the offer when 90 percent of the trade accepts it. Another offer will not be offered in the future before central slaughtering, Chow added. A source said the government has improved the deal for retailers with an increase of almost HKD 100 million [USD 12.8 million] or over 20 percent to a total of HKD 513 million [USD 65.7 million].
A source said the increase was justified. “If we terminate the trade’s tools for living out of public health concerns, we must be more reasonable in our offer,” the source said, adding that no further increase is expected after any future negotiations. Retailers who choose to resume operation on 2 Jul 2008 must operate under an overnight ban that requires keeping live chickens in the stalls between 8 pm and 5 am. Violators are subject to a penalty of HKD 50,000 (USD 6,406) and six months’ imprisonment.
2. Infectious Disease News
Philippines: Dengue on the rise, authorities step up information campaign for rainy season
Health officials in Caloocan City have recorded a 100-percent increase in dengue cases in the first five months of 2008, compared to the same period in 2007. The city health officer Claire Clemente said they recorded 630 cases from 1 Jan-29 May 2008. Of the 630 cases, five died. Clemente said most of the dengue victims were males. She said the city government is now stepping up its information campaign against dengue, now that the rainy season is approaching.
In other areas of the Philippines: Bago, Silay, and Talisay had the most number of dengue cases from January-June 2008, a report submitted by Provincial Health officer Luisa Efren to the Office of the Governor stated. The report noted an uncommon rise in dengue cases in Bago City with 56 cases, Silay City with 55, and Talisay City with 52 recorded cases.
China (Shanghai): Health officials report first child death of hand, foot and mouth disease
The Shanghai Health Bureau on 17 Jun 2008 confirmed the city’s first pediatric death of hand, foot and mouth disease (HFMD). A two-year-old boy was sent to the Shanghai Public Health Clinic Center for treatment on the evening of 14 May 2008, where he was diagnosed as having HFMD. Emergency treatment failed and he died a few hours later, according to the bureau.
Shanghai reported 10,340 HFMD cases in the first five months of 2008. The city is not on the Health Ministry’s list of the regions worst hit by the epidemic. The ministry reported earlier last week that there were more than 176,000 HFMD cases reported nationwide in May 2008. Daily reported cases declined from 11,501 at the peak on 14 May 2008 to 3,922 on 5 Jun 2008.
Indonesia: Despite control efforts, dengue is increasing in some provinces
In South Kalimantan Province, during the period January-May 2008, 260 residents were afflicted by dengue fever, including six who died. The number of recorded South Kalimantan residents who contracted dengue in 2007 was 1,000 people spread over 13 cities/regencies in South Kalimantan.
Philippines: Officials note high incidence of leptospirosis infection
Russia: Dozens infected with Trichinella after eating bear meat
In another outbreak, 60 people have trichinellosis in Tomsk (Molodejniy Kargasokskiy district) after eating meat from a Trichinella-infected bear. It is the first time a mass outbreak of trichinellosis has been registered in Tomsk. The bear was illegally shot and slaughtered without proper veterinary inspection. A veterinarian and a local police officer are among the infected people.
(This outbreak took place in two different cities but within the same Siberian Federal District of Russia simultaneously. In both cases, bear meat was the source of the Trichinella, and it is possible that the source of the meat was the same animal. Bear meat is apparently distributed through informal supply chains without proper inspection. Trichinae are not a problem if the meat is sufficiently cooked, but if used uncooked — in sausages, for example —Trichinae can remain infective for years. The arctic strain of Trichinella, Trichinella native, is resistant to freezing.)
Russia: Health officials see a rise in Crimean-Congo hemorrhagic fever
Inhabitants of Volgograd Oblast have contracted CCHF. The Healthcare Committee of the Volgograd Oblast said that two cases of Crimean-Congo hemorrhagic fever (CCHF) were registered in the region on 16 Jun 2008. Both cases have been confirmed by laboratory tests. Since the beginning of spring 334 tick bites have been registered in Volgograd Oblast.
The first case of CCHF has been registered in the Astrakhan Oblast. According to the regional administration of Rospotrebnadzor a 24-year-old woman from Ikryaninskaya region contracted the infection. She has been admitted to a local hospital. Overall 783 people have sought medical treatment because of tick bites in this region in 2008 and half of them were children. The corresponding figure for 2007 was 631.
Vietnam: Southern provinces hit hard by dengue
Tran Van Thoi, Nam Can and Tran Van Thoi General Hospitals in Ca Mau Province were operating past full capacity due to a surge of new patients. Tien Giang Province was also hit hard, with more than 1,000 cases in Go Cong Dong, Cai Lay and Cho Gao Districts and My Tho City. A lack of pesticides and concrete methods for preventing the disease for locals is to blame for the disease's spread, according to health officials in the delta.
Canada: Fraser Valley health officials identify 47 cases of mumps
Health officials are reminding all children and adults to make sure their immunizations are up to date after an outbreak of 47 cases of mumps in the eastern Fraser Valley, most of them in Chilliwack. “Certainly, the number of cases is unusual,” said Dr. Nadine Loewen of the Fraser Health Authority. She said in 2007, there were 11 cases in the area but none in 2003 and 2005, and the second largest outbreak of 34 cases dates back to 1997.
The virus, which affects the salivary glands and causes swollen cheeks, among other symptoms, has affected all ages, from a two-year-old to a 59-year-old, said Loewen. It’s likely a person who wasn’t immunized against mumps picked up the virus in Alberta, where there is also an outbreak, and spread it to others who weren’t immunized. There are also sporadic cases in Abbotsford, Agassiz and Mission, and officials are determining whether they’re connected to the Chilliwack outbreak.
USA: Multistate outbreak of Salmonella infection from tomatoes continues
In particular, one new state, Nevada reported ill persons. The number of ill persons identified in each state is as follows: Arkansas (3 persons), Arizona (34), California (8), Colorado (5), Connecticut (4), Florida (1), Georgia (14), Idaho (3), Illinois (45), Indiana (9), Kansas (9), Kentucky (1), Maryland (18), Massachusetts (14), Michigan (4), Missouri (12), New Hampshire (1), Nevada (4), New Jersey (4), New Mexico (79), New York (18), North Carolina (1), Ohio (3), Oklahoma (17), Oregon (5), Pennsylvania (5), Rhode Island (2), Tennessee (5), Texas (293), Utah (2), Virginia (21), Vermont (1), Washington (1), Wisconsin (5), and the District of Columbia (1).
Among the 325 persons with information available, illnesses began between 10 Apr 2008 and 13 Jun 2008. Patients range in age from less than 1 to 99 years; 50 percent are female. At least 71 persons were hospitalized. No deaths have been officially attributed to this outbreak. Only three persons infected with this strain of S. Saintpaul were identified in the country during the same period in 2007.
USA (Ohio & Michigan): Multistate outbreak of E. coli infection may be linked to ground beef
Glynn said Ohio and Michigan health authorities have not identified the supplier or the specific type of ground beef that caused the illnesses. “We purchase our ground beef from major suppliers in the industry and we are working with federal, state, and local agencies to identify the supplier,” she said. As of 23 Jun 2008, the CDC said it had confirmed 24 cases of E. coli that shared the same genetic fingerprint and characteristics, indicating they were related. Of those 24, the CDC said 11 cases were reported in Michigan and 13 in Ohio; 14 people have been hospitalized, and one has developed a type of kidney failure called hemolytic-uremic syndrome, the CDC said. No deaths have been reported.
USA (Newly reported for the period 9-24 Jun 2008) States reporting WNV detected: Arkansas, Connecticut, Missouri, North Dakota, Puerto Rico, and Utah
States reporting new human cases: California and North Dakota. Total human cases for 2008: 13 with no fatalities.
Influenza Activity — United States and Worldwide, 2007–08 Season
MMWR Weekly, 2008;57(25):692-697
Virus transfer from personal protective equipment to healthcare employees’ skin and clothing
A key aspect of patient isolation is proper use of personal protective equipment (PPE) to protect HCWs from pathogen exposure during patient care. PPE includes use of barriers (gowns, gloves, eye shields) and respiratory protection (masks, respirators) to protect mucous membranes, airways, skin, and clothing from contact with infectious agents. The importance of PPE was underscored in the recent outbreak of severe acute respiratory syndrome (SARS). HCWs accounted for ≈20% of cases; failure to properly use PPE was a risk factor for HCW infection.
This outbreak raised concern that HCWs could contaminate their skin or clothes with pathogens during PPE removal, resulting in accidental self-inoculation and virus spread to patients, other HCWs, or fomites. The Centers for Disease Control and Prevention (CDC) addressed this concern by designing a protocol to minimize contamination to the wearer during PPE removal (Figure 1). However, the effectiveness of this protocol in preventing self-contamination has not been validated. To determine if removing PPE according to the CDC protocol prevents viral contamination of the wearer, a human challenge study was undertaken using a nonpathogenic virus.
An adjuvanted, low-dose, pandemic influenza A (H5N1) vaccine candidate is safe, immunogenic, and induces cross-reactive immune responses in healthy adults
Immune responses of healthy subjects to a single dose of intramuscular inactivated influenza A/Vietnam/1203/2004 (H5N1) vaccine after priming with an antigenic variant
Clinical review: Influenza pandemic — physicians and their obligations
Tackle the problem when it gets here: pandemic preparedness among small and medium businesses
Mitigating pandemic influenza: ethics of implementing a school closure policy
Primary care physicians and pandemic influenza: an appraisal of the 1918 experience and an assessment of contemporary planning
Pharmacokinetics and tolerability of Oseltamivir (Tamiflu®) combined with probenecid
PHI2008: Envisioning options for integrated public health information systems for low resource settings: components, connections, partners, strategies
PHI2008 will be hosted by Global Partners in Public Health Informatics (GPPHI) at the Center for Public Health Informatics (CPHI) at the University of Washington, Seattle, WA, USA. The idea of creating a partnership of governmental and non-governmental organizations, academic institutions and companies to define and develop a vision for addressing health challenges in low-resource settings through information and communications technologies was first articulated at PHI2007: Building a Global Partnership in Public Health Informatics. PHI2007 brought together nearly 200 individuals from across the globe, who created the impetus for the Global Partners in PHI.
The Rockefeller Foundation recently funded the UW Center for Public Health Informatics to begin the planning process for the Global Partners organization. That process will take place over the coming year through an invitational meeting on Public Health Informatics at the Rockefeller Foundation conference center in Bellagio, Italy as well as at the second annual GPPHI meeting — PHI2008 — to be held in September 18-19, 2008 at the Bell Harbor Conference Center, Seattle, Washington, USA. The theme for the PHI2008 meeting is “Envisioning Options for Integrated Public Health Information Systems for Low Resource Settings: Components, Connections, Partners, Strategies.”
The first Oxford avian influenza conference, BirdFlu2008, will address most aspects of basic and applied research on avian influenza viruses and their potential health and socio-economic impact on humans. The conference is aimed at bringing together leading experts from academia and industry, veterinarians, postdoctoral researchers, graduate research students, physicians and doctors, research managers and policy makers. Thus this event will provide an international forum to discover the latest research directions and thinking in this field in academic and commercial settings, to exchange data and ideas and to develop new collaborative links.