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Vol. XI No. 14 ~EINet News Brief ~ 11 July 2008 ~ EINet News Briefs ~ Jul 11, 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: Identification of host characteristics may provide insight into H5N1 avian influenza control
- Indonesia: Officials threaten to close U.S. Navy lab, virus-sharing conflict continues
- Viet Nam (Tra Vinh): H5N1 avian influenza outbreak on duck farm
- USA: Study reveals long list of problems hampering pandemic influenza planning
2. Infectious Disease News
- Australia: Measles cases 'spike' in two states
- Malaysia: Chikungunya virus sickens 34 plantation workers
- Russia (Tatarstan): Botulism linked to domestically prepared foods
- Russia (Buryatia): 11 people hospitalized with anthrax infection
- Russia (Tomsk): Number of trichinellosis cases rise
- Viet Nam (Ha Giang): Anthrax infects 420 people, kills two
- USA: Multistate outbreak of Salmonella continues, Canada also affected
- USA (Michigan & Ohio): Hundreds of tons of ground beef recalled due to E. coli outbreak
- AVIAN/PANDEMIC INFLUENZA
- HAND, FOOT & MOUTH DISEASE
- DENGUE FEVER
- CHOLERA, DIARRHEA & DYSENTERY
- Global Spread and Persistence of Dengue
- Ready for avian flu?
- The contents of the syringe
- Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population
- Science into policy: preparing for pandemic influenza
- West Nile virus activity in Latin America and the Caribbean
- PHI2008--Envisioning Options for Integrated Public Health Information Systems for Low Resource Settings: Components, Connections, Partners, Strategies
- Nipah Virus Colloquium 2008
1. Influenza News
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 385 (243).
Avian influenza age distribution data from WHO/WPRO:
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 6.19.08): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 6.17.08):
Global: Identification of host characteristics may provide insight into H5N1 avian influenza control
"All viruses rely on host cell proteins and their associated mechanisms to complete the viral life cycle. Identifying the host molecules that participate in each step of virus replication could provide valuable new targets for antiviral therapy," scientists wrote in the latest edition of Nature magazine. In their study, the experts from Japan, Indonesia and the United States infected fruit fly cells with genetically altered H5N1 virus. The H5N1 virus needed slight modifications because fruit flies are normally not susceptible to influenza. The experts also chose the fruit fly because it has a relatively small number of genes — 14,000 — making it easier for scientists to study.
"We found genes (proteins) that are important for influenza virus replication. We identified about 100 genes," said Yoshihiro Kawaoka, a leading virologist and bird flu expert at the University of Tokyo in Japan. Of these, at least three existed in human cells. "We took three and tested them and they were important for flu virus replication (in humans)," he said. "I presume that many of the other genes we identified are also important for influenza virus replication in humans."
Next, the team wants to zero in on host proteins that the H5N1 needs to bind to in order to replicate. "If you could inhibit (block) the interaction between those (host) proteins and influenza virus proteins, you can inhibit virus replication. This can be a target for development of new drugs," Kawaoka said.
Indonesia: Officials threaten to close U.S. Navy lab, virus-sharing conflict continues
Threats to shut down a U.S. Navy medical research lab here may undermine the hunt for mutating viruses that could set off the next flu pandemic, Western scientists warn. Indonesia suspended negotiations with the United States over the fate of Naval Medical Research Unit No. 2 last month after senior politicians said it didn't benefit Indonesia and could be a cover for spying. The U.S. Embassy firmly denied that the facility is used to gather intelligence, and said most of the lab's staff members are Indonesians helping with research carried out in cooperation with local health officials. The biomedical research lab opened in Jakarta in 1970 and is used to study tropical diseases, including malaria, dengue fever and avian flu, according to an embassy fact sheet. It has a staff of about 175 scientists, doctors, veterinarians and technologists; only 19 are Americans and the rest are Indonesians. The Navy also has research labs in Egypt, Kenya, Peru and Thailand.
Defense Minister Juwono Sudarsono said last month that his ministry recommended that the lab be closed because its operations were too secretive and were incompatible with Indonesia's security interests. Health Minister Siti Fadilah Supari also said she had recommended to President Susilo Bambang Yudhoyono that it be closed.
"I've told the president the lab's useless, the cooperation degrades our sovereignty and it should be shut down," Supari told members of parliament. Negotiations would resume as early as this month, the Foreign Ministry said, once the country had a "unified stand" on the issue. But U.S. Embassy spokesman Tristram Perry said he was not aware of any date for talks.
U.S. officials say privately that the dispute is part of a bigger argument over sharing virus samples, including strains of the avian flu, which the World Health Organization warns could set off a pandemic. Before Indonesia announced in January 2007 that it would no longer share samples with other countries, the U.S. naval lab did research on normal flu viruses from seasonal outbreaks as well as bird flu cases treated in Indonesian hospitals.
"Sometimes you test a virus and you don't know if it's avian influenza, or normal flu or something completely different," said a Western scientist who spoke on condition of anonymity. Now those viruses appear not to be going anywhere for testing, the scientist said, adding that Indonesian labs cannot do the sophisticated research the Americans can do. "Nobody knows what they are," she added. "Maybe there could be a pandemic from a different, new strain."
After announcing the ban on virus sharing, the health minister, who is a cardiologist, published a book in which she warned that any viruses shared with other countries could be turned into biological weapons. She also recounted a meeting in Geneva with John E. Lange, the U.S. special representative for pandemic flu, in which she told him, "It is not impossible that there will be a group of people in developed countries insane enough to reengineer the viruses to create an outbreak in the Third World."
Her book, widely sold in English and Bahasa Indonesia editions, also said the pressure to share viruses was an example of exploitation of developing countries' natural resources.
"They also exploited part of the human body from the people of the powerless countries," the health minister wrote. "They took our blood. They took our cells. They took our antibodies. And perhaps it would be more dangerous when, in the end they would take our brain cells as well, to be reengineered to create a new generation of slaves."
Early this year, she insisted that the move to stop virus-sharing was necessary to protect poor nations from profiteering drug companies. Indonesia says it fears that vaccines developed from local viruses will go to foreigners first, leaving Indonesians without protection or profit. In March 2008, Supari pledged to resume sharing, but only with WHO researchers. Supari said she won assurances that no vaccine would be developed from the Indonesian samples without the country's consent. The organization said it would work out details of an agreement in negotiations.
Since virus-sharing was stopped, Indonesia has confirmed that 52 more people have come down with bird flu. The Health Ministry gave foreign researchers virus samples from only six of those cases, the first Western scientist said. Indonesia's hard line against cooperation also affects research on regular flu strains, which kill 250,000 to 500,000 people worldwide annually. Most of those outbreaks start in Southeast Asia, British scientists Derek Smith and Colin Russell reported in a study published this year. That makes it crucial for U.S. researchers to keep working here, the Western scientists said.
Viet Nam (Tra Vinh): H5N1 avian influenza outbreak on duck farm
Bird flu has occurred in Tra Vinh province, announced the Veterinary Department. The department said that ducks died in Phuong Thach commune, Cang Long district, Tra Vinh province, from 24 Jun 2008. By 4 Jul 2008, around 1,000 unvaccinated ducks had died. Their samples tested positive to H5N1 virus. The local veterinary service culled the ducks.
USA: Study reveals long list of problems hampering pandemic influenza planning
The study was part of an effort by researchers at Purdue University to develop a planning template for ways to provide surge capacity to care for a flood of patients during a pandemic. The researchers interviewed public health, emergency preparedness, and hospital officials in 11 representative Indiana counties between November 2006 and August 2007; questionnaires were tested in two other counties. The researchers, with George H. Avery as first author, found that planners generally had made progress but had a long way to go.
"While planners, for the most part, were committing a significant effort in trying to develop a pandemic influenza plan, and in fact had made large strides over the previous year, the plans developed were still crude and required much more work," the report says.
Among lessons drawn from their findings, the authors say that legal and institutional barriers may limit planning in ways that are not obvious and that planners may not have the authority to address such problems.
"Issues such as insurance reimbursement, malpractice and liability insurance, and scope of practice rules constrain the solution set for local planners, and require policy action at a state or federal level to solve," they state. They also note other researchers' observation that the idea of using alternative sites to provide surge capacity in a pandemic is widespread, but it is not clear just how these sites would work or even if they would be feasible. They write, "Significant barriers exist to the use of alternative care sites for building hospital surge capacity, and any attempt to develop such capacity should focus on how alternative care arrangements fit into the overall local emergency management and healthcare systems. More important than the alternative care site is the strategy for an alternative care system."
2. Infectious Disease News
Australia: Measles cases 'spike' in two states
Measles cases have spiked in two states, with national statistics showing babies and young people having been hardest hit. The latest report from the federal health department shows 58 official notifications of the highly contagious disease in the first half of 2008, compared to just seven during the same time in 2007. "This is due to several localized clusters and outbreaks in New South Wales (NSW) and Queensland (QLD), and secondary cases associated with cases who acquired measles outside of Australia," a department spokeswoman said.
NSW has been most severely affected, with 38 cases, including a few babies less than one year old. Nationwide, 10 children under the age of four have been affected, while 17 involve adolescents and teenagers and most of the remaining cases affect people in their 20s. Both federal and state authorities have warned that a significant proportion of those affected had not been immunized, or had only received one dose of the two-dose vaccine. The measles vaccine is provided at age 12 months and 18 months, with a catch-up at four years for those who have missed out earlier, leaving babies under one at particular risk, the spokeswoman said.
Malaysia: Chikungunya virus sickens 34 plantation workers
Russia (Tatarstan): Botulism linked to domestically prepared foods
Russia (Buryatia): 11 people hospitalized with anthrax infection
Medics were placed on high alert and meat supplies from several villages, close to the potential source of infection, have been suspended. A total of 210 people, who may have had contacted with the infection, are currently being treated with antibiotics. Anthrax most commonly infects wild mammals and domestic cattle and sheep, which ingest or inhale the spores while grazing. Humans can be affected when exposed to blood and other tissues from infected animals. Anthrax can be highly lethal, but in some forms it responds well to antibiotic treatment and effective vaccines are available against the disease.
Russia (Tomsk): Number of trichinellosis cases rise
Viet Nam (Ha Giang): Anthrax infects 420 people, kills two
On 21 Jun 2008, two families in the hamlet shared beef with the affected families from their two cows, which died of unknown causes. Those eating the meat started vomiting, complained of stomachache, and suffered from swollen legs. Two died on 29 Jun 2008 after being hospitalized in a coma. Three others in critical condition are undergoing treatment at Meo Vac Hospital. Local health authorities said anthrax has broken out in the district and they are mobilizing resources to contain the disease. The number of affected animals is not known. They also warned residents against eating meat from infected animals.
USA: Multistate outbreak of Salmonella continues, Canada also affected
CDC is collaborating with public health officials in many states, the Indian Health Service, and the US Food and Drug Administration (FDA) to investigate an ongoing multi-state outbreak of human Salmonella (enterica) serotype Saintpaul infections. An initial epidemiologic investigation comparing foods eaten by ill and well persons identified consumption of raw tomatoes as strongly linked to illness. Recently, many clusters of illnesses have been identified in several states among persons who ate at restaurants. These clusters led us to broaden the investigation to be sure that it encompasses food items that are commonly consumed with tomatoes. Fresh tomatoes, fresh hot chili peppers such as jalapenos, and fresh cilantro are the lead hypotheses. However, at this point in the investigation, we can neither directly implicate any of these ingredients as the single source, nor discard any as a possible source.
The FDA said it is going to test some foods from Mexico for salmonella before they enter the US market as part of the agency's investigation into the outbreak. A former director of the FDA’s import operations said the expanded search raises a number of questions about the salmonella investigation.
"Where's the contaminated product?" asked Carl Nielsen. "How would you know? And where along the supply chain did it happen? Was it at the retail level? Is somebody doing something to expose the product at the retailer? Is it at the wholesale? Is it at the grower? Is it at the processor? Is it in transport? Where is it? They don't know."
In Canada health officials have confirmed that four people have been infected with the same strain of salmonella identified in the USA outbreak. Public health officials said on 8 Jul 2008, three of the people became ill after returning from a trip to the United States.
"Cross-border cases are expected given the size of the outbreak in the United States, and travel by Canadians to the United States," the Canadian Food Inspection Agency and the Public Health Agency of Canada said. Canadian officials confirmed the first case, which involved an Ontarian who had traveled to the S United States on 3 Jul 2008.
Since April 2008, 991 persons infected with S. Saintpaul with the same genetic fingerprint have been identified in 41 states, the District of Columbia, and Canada. At least 194 persons were hospitalized.
USA (Michigan & Ohio): Hundreds of tons of ground beef recalled due to E. coli outbreak
The epidemiological investigations and a case control study conducted by the Michigan and Ohio Departments of Agriculture and Health and the US Centers for Disease Control and Prevention (CDC) determined that there is an association between the ground beef products and 35 illnesses reported in Michigan (17) and Ohio (18). As a result of the investigation, on 25 Jun 2008 FSIS announced a recall of ground beef products sold at Kroger retail establishments in Michigan and Central and Northwestern Ohio.
HAND, FOOT & MOUTH DISEASE
Of the HFMD cases reported in China, most were in children five years of age and younger, and of those tested in laboratories, the majority were caused by EV71. The Chinese government has enhanced its surveillance, prevention, and control activities, including implementing a public awareness campaign and monitoring water quality.
Prevention measures for travelers
Also cause for concern, dengue fever in the lower parts of Central Java is endemic, and the number of patients is increasing. There was a doubling of the number of dengue patients in Central Java in 2007 compared to 2006. In 2006, deaths resulting from dengue reached 220, and the figure increased in 2007 to 329 people. According to Dr. Dwi Heri of the Health Authority, the disease is spreading in various areas. The dangerous illness increased not only in the number of sufferers but also in the number of deaths. The number of sufferers also increased from 10,924 in 2006 to 20,565 sufferers in 2007.
The Health Ministry and the local authorities, he said, had distributed 78,919 pamphlets and 2,849 posters on dengue, especially in high-risk areas, and had conducted 413 dialogue sessions, 19,146 demonstrations and 12,809 discussions to enlighten the public on the disease. "However, cooperation from the public is still low, with 67 percent of the premises -- comprising residential buildings and shops that are checked by the Health Ministry and the local authorities -- found to be breeding grounds for Aedes mosquitoes," he added.
The Health Ministry noted that though the total number of patients is less than in 2007, the disease could spread even more widely as the rainy season has come.
CHOLERA, DIARRHEA & DYSENTERY
This cholera epidemic was first reported in Paniai in early April 2008 at Ekemanida village. It has spread to nearby villages at Kamuu and North Kamuu Districts. The villages where the disease was reported are Ekemanida, Idakotu, Dogimani/Idadagi, Makidimi/Egebutu, Ekimani/Nuwa, Denemani/Apagogi, Kimupugi, Dikiyouwo, Duntek, Boduda, Deiyai, Goodide, Idakebo, Mogou, and Dogimani. In March and April 2006, in the highland regencies of Jayawijaya and Yahukimo, 178 and 33 indigenous West Papuans respectively died reportedly from cholera.
The department disinfected the lake and has warned the locals not to use the water there. Nguyen Van Luyen, director of infectious disease control and vaccine bio-products department from the department of health said they spent considerable efforts in educating people on the importance of maintaining safe and hygienic living standards to prevent diseases. After the ministry declared that the epidemic of acute diarrhea was over at the end of 2007, it re-appeared in January 2008 and then again in March 2008, said Nguyen Huy Nga, director of the Department for Preventive Health and Environment. While the number of patients has decreased, patients afflicted by the disease are still streaming into hospitals. In May 2008, the Ministry of Health recorded 1,400 cases of acute diarrhea including 170 cases positive for cholera. Since the beginning of 2008, Viet Nam has recorded nearly 500 cholera cases.
Global Spread and Persistence of Dengue
Kyle JL, et al. Annual Review of Microbiology. 2008;62 (final online publication date: 8 Sep 2008)
Ready for avian flu?
There is some good news. The World Health Organization (WHO) has announced plans to stockpile H5 influenza vaccine and several manufacturers have already offered to contribute. Other manufacturers are supportive but await details before committing. Efforts have been initiated by the WHO to create a policy framework for vaccine allocation and recommendations for its use. An ethics framework, and financing, regulatory and distribution systems will also have to be developed with member states.
The contents of the syringe
This year, however, the vaccine was a failure: the strain of H3N2 that was used provided very little protection from infection. After a mild start dominated by H1N1 a new type of H3N2 emerged in mid-winter and quickly dominated, soaring to 71% of cases in the first 8 weeks of 2008 and overwhelming medical clinics in many places. A study in Wisconsin found the vaccine to be only 44% effective compared with the 70–90% effectiveness expected, and a Harris Poll of more than 2,500 people revealed that for the first time in at least four winters, people who were vaccinated seemed no less likely to become infected. The harm was thus twofold; people fell ill and their trust in the vaccine system was undermined. This failure could have been predicted, if not prevented, through a more open system of vaccine design, a stronger culture of sharing in the influenza research community and a serious commitment to new technologies for production. The habits of the vaccine community must change for the sake of public health.
Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population
Science into policy: preparing for pandemic influenza
West Nile virus activity in Latin America and the Caribbean
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."
Dates: 20-21 Oct 2008
In conjunction with the 10th anniversary of the discovery of Nipah virus and in remembrance of the outbreak, a colloquium will be held at University Malaya in Kuala Lumpur, Malaysia on 20-21 Oct 2008. Renowned Nipah virus experts have been invited to describe their latest research, offer an historical perspective of the outbreak and share their personal experiences during the outbreaks. It is hoped that the meeting will help foster closer research collaboration between Nipah virus researchers and generate consensus views on areas concerning Nipah virus that need greater research efforts.