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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

3. Updates
- AVIAN/PANDEMIC INFLUENZA
- HAND, FOOT & MOUTH DISEASE
- DENGUE FEVER
- CHOLERA, DIARRHEA & DYSENTERY

4. Articles
- 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

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

2008
Bangladesh / 1 (0)
China / 3 (3)
Egypt / 7 (3)

Indonesia / 18 (15)
Viet Nam / 5 (5)
Total / 34 (26)

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: 385 (243).
(WHO 6.19.08 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 6.19.08)

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):
http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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Global: Identification of host characteristics may provide insight into H5N1 avian influenza control
Scientists have identified around 100 genes that the H5N1 bird flu virus needs in a host in order to replicate, and this finding may help in the hunt for ways to block its proliferation.

"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.
(Reuters 7.9.08)

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Asia
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.
(LA Times 7.5.08)

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Americas
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.
(ProMED 7.10.08)

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USA: Study reveals long list of problems hampering pandemic influenza planning
A study from Indiana reveals a long list of problems hampering county-level planning for pandemic influenza, ranging from misunderstanding of the threat and lack of coordination and resources to rivalry between hospital systems. Interviews with health officials in 11 Indiana counties showed recent progress in pandemic planning, but also pointed out many difficulties, according to the report in the Journal of Homeland Security and Emergency Management. Among misunderstandings, some planners thought a pandemic would involve such high rates of illness and death that planning would be useless, and many officials had unrealistic expectations about getting help from outside sources such as the National Guard or the state governor. In addition, planning and coordination were hindered by blurry agency roles and mismatches between political boundaries and local healthcare market boundaries. The study also showed that most hospitals were hoping to deal with the influx of pandemic flu patients largely by reducing demand for services, mainly through triage systems.

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."
(CIDRAP 7.9.08)

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2. Infectious Disease News

Asia
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.
(ProMED 7.10.08)

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Malaysia: Chikungunya virus sickens 34 plantation workers
A total of 34 plantation workers from a rubber estate here in Segamat are suspected to be sick with chikungunya fever. While many received outpatient treatment for the mosquito-transmitted fever, at least 14 have been warded at the Segamat Hospital since the outbreak was detected about 12 days ago in Bukit Datuk Estate. Many of the workers have been suffering from fever, rashes and joint pains. This is the second major outbreak in the state over the past three months. In April 2008, several villagers in Kampung Ulu Choh and Kampung Paya Mengkuang near Gelang Patah had contracted chikungunya [virus infection]. On the latest outbreak in Segamat, state Health department director Dr. Mohd Khairi Yakub said, "14 were admitted, but as of now we have two or three people still warded for observation. We have also taken at least 12 samples and have sent it for further tests to confirm whether it was chikungunya fever," he said. He urged the public not to panic. "The situation is under control," he said, adding that the fever was not life threatening.
(ProMED 6.28.08)

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Russia (Tatarstan): Botulism linked to domestically prepared foods
So far in 2008, botulism has been confirmed in six of seven cases of disease recorded in Tatarstan. In all cases the disease was associated with smoked or dried fish of domestic preparation or purchased by individuals in (unlicensed stalls) near markets, shops, or public transportation stops. So far this year the number of cases equal the entire number of cases in 2007. Those cases were connected with pickled mushrooms, canned vegetables, and canned and dried fish of domestic preparation.
(ProMED 7.10.08)

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Russia (Buryatia): 11 people hospitalized with anthrax infection
Two more people have been hospitalized with suspected anthrax in East Siberia's Republic of Buryatia, bringing the total number to 11, the republic's emergencies ministry said on 7 Jul 2008. Seven people have been officially diagnosed with skin or intestinal anthrax. They are currently receiving medical treatment for the disease. In the previous week, nine people were hospitalized in the republic's Barguzinsky Region with the suspected disease after coming into contact with sick cattle.

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.
(ProMED 7.9.08)

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Russia (Tomsk): Number of trichinellosis cases rise
The number of people affected with trichinellosis in Tomsk has now increased to 40, including two children under the age of 14. The total number of people that ate bear meat is 114. The outbreak has become so large partly because of the volume of bear meat involved, and since more than 100 people consumed the meat, we can expect more cases. In 2007, there were 171 cases of trichinellosis registered in 34 places, and in 2006, 201 cases were registered. The majority of the cases are registered in the Siberian federal district of Russia.
(ProMED 7.6.08)

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Viet Nam (Ha Giang): Anthrax infects 420 people, kills two
Some 420 people have been poisoned, two fatally, in Ha Giang Province after eating anthrax-infected beef in June 2008, according to a local health center. The provinces' Preventive Health Center said the infected people belonged to nearly 90 families in Po Qua Hamlet of Meo Vac District.

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.
(ProMED 7.9.08)

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Americas
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.
(ProMED 7.9.08)

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USA (Michigan & Ohio): Hundreds of tons of ground beef recalled due to E. coli outbreak
Nebraska Beef, Ltd, an Omaha, Nebraska, establishment is recalling approximately 531,707 pounds (241.2 tons) of ground beef components that may be contaminated with E. coli O157:H7, the USA Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS) announced 30 Jun 2008. Kroger brand ground beef samples were collected by the Michigan and Ohio Departments of Agriculture and Health from patients in Michigan and Ohio. Nebraska Beef, Ltd, was identified as a common supplier to those stores in addition to two federally inspected establishments where FSIS obtained a positive ground beef sample that was matched to the outbreak strain identified in Michigan and Ohio.

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.
(ProMED 7.1.08)

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

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HAND, FOOT & MOUTH DISEASE
Since March 2008, a growing number of cases of hand-foot-mouth disease (HFMD) have been reported in parts of Asia, mainly affecting children. HFMD is common among infants and children. It is very contagious and is spread through direct contact with the nose and throat secretions, saliva, blister fluid, or stool of an infected person. A large number of cases in the current outbreaks of HFMD in Asia are reportedly caused by enterovirus 71 (EV71). However, other strains of enterovirus can also cause HFMD. In addition to the countries listed below, other countries in the Western Pacific have also increased surveillance for HFMD. (The available statistics as of 3 Jul 2008 are listed below).

China
On 16 Jun 2008, the Chinese Center for Disease Control and Prevention (China CDC) posted a notice confirming that the HFMD outbreak peaked on 14 May 2008, and is now in decline. According to Ministry of Health spokesman Mao Qun'an, although over 176,000 cases were reported in June 2008, the number of daily reported cases decreased from 11,501 during the outbreak's peak to 3,922 by 5 Jun 2008. The provinces which have been most affected by this outbreak are Guangdong, Zhejiang, Hebei, Shandong, and Hunan. A joint report from China CDC and the Office of the World Health Organization (WHO) in China, released 19 May 2008, states that cases have also occurred in other provinces, including Anhui, Hebei, Hubei, Henan, Jiangsu, Jiangxi, Shaanxi, Sichuan, and Yunnan, and in the municipalities of Beijing and Chongqing. As of 16 Jun 2008, over 370 cases have also been reported in Macau, according to China CDC.

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.

Hong Kong
As of 2 Jul 2008, a total of 100 cases of HFMD have been reported in Hong Kong, with 66 (66 percent) of the cases caused by EV71.

Singapore
As of 2 Jul 2008, the Ministry of Health in Singapore has reported a total of 15,776 cases. Since the end of May 2008 the number of cases reported each week has been decreasing. Of these, none had serious complications and none were fatal. As of 3 Jun 2008, 32 percent of cases tested this year in the Ministry's sentinel surveillance system were positive for EV71. The Ministry is working closely with preschools and child-care centers to help limit the spread of HFMD and stresses the importance of good personal and environmental hygiene, especially for children.

Chinese Taipei
On 30 Jun 2008, the Central News Agency reported that the Taiwan Centers for Disease Control (Taiwan CDC) had confirmed a total of 272 cases in 2008, including nine deaths. Due to the decreasing numbers of cases reported each week, Taiwan CDC is reporting that the outbreak is waning. The importance of good hygiene and prompt medical attention for children showing severe symptoms has been encouraged.

Prevention measures for travelers
No vaccine is available to prevent HFMD. There is no specific treatment for people who are sick with this disease other than treating symptoms, such as fever. Travelers can take steps to prevent getting HFMD by practicing good personal hygiene and following safe food and water practices. Adults should help child travelers to follow these recommendations. Infants, children, and adolescents are more susceptible to infection and illness because they are less likely than adults to have cells that fight infection from previous exposures to the enteroviruses that cause HFMD. Infection results in immunity to the specific virus that caused HFMD. A second episode of HFMD may occur following infection with a different member of the enterovirus group.

Additional information
HFMD is an illness caused by certain strains of enterovirus, including EV71, which are common worldwide. Outbreaks of HFMD caused by EV71 are not uncommon and have been reported by countries throughout the Asia-Pacific region in recent years. EV71 can be spread from person to person by direct contact with nose and throat secretions (such as, by coughing or sneezing), saliva, fluid from blisters, or the stool of infected persons. People sick with HFMD often experience symptoms such as fever, sores in the mouth, and a rash, occasionally with blisters. HFMD caused by EV71 may sometimes lead to serious complications, including swelling of the brain (encephalitis). Most cases of HFMD occur in children under 10 years of age, but adults can also become infected.
(ProMED 7.4.08)

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DENGUE FEVER
Indonesia
In Jakarta Timur, 46 of 65 districts, including all the Duren Sawit Subdistrict districts and Cakung, were designated "red" for cases of dengue fever. According to Sudin Kesmas (Health Service) Jakarta East, Duren Sawit was still in first place in the number of the dengue fever sufferers followed by the Cakung Subdistrict. He provided details indicating that dengue sufferers in Duren Sawit numbered 1,610 cases, whereas in Cakung there were 1,358 cases. Following were Jatinegara (765 cases), Pulogadung (748 cases), Kramatjati (651 cases), Matraman (490 cases), Makasar (437 cases), Ciracas (366 cases), Cipayung (364 cases), and Pasar Rebo 237 cases. The total of dengue sufferers in Jakarta East at this time reached 7,026 cases.

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.
(ProMED 7.1.08 & 7.7.08)

Malaysia
Three deaths due to dengue were reported among 911 cases diagnosed with the disease nationwide between 15-21 Jun 2008. A statement issued by the Health Ministry's Disease Control Director, Datuk Dr Hasan Abdul Rahman, said although there was a drop in the number of cases from the previous week, it was still 27 percent higher than the targeted figure of 717 cases. He said Selangor reported the highest number of cases at 412, followed by Kuala Lumpur (98 cases), Kelantan (60 cases) and Johor (57 cases).

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.
(ProMED 7.1.08)

Viet Nam
The Ministry of Health on 24 Jun 2008 continued warning of the spread of dengue fever in southern provinces. The past week witnessed a report of over 1,400 dengue fever patients in 27 locations, four of whom died, raising the total number of cases to 19,859 so far in 2008, including 20 deaths. Provinces with the highest numbers of patients are Ho Chi Minh City 3,754 cases/two dead, Soc Trang 1,717 cases/one dead, Tien Giang 1,489 cases/one dead, and Ca Mau 1,123 cases/three dead. Hanoi has had nearly 100 cases.

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.
(ProMED 7.1.08)

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CHOLERA, DIARRHEA & DYSENTERY
Indonesia
New reports from Human Rights and Church sources in West Papua state that 85 people have died in a cholera outbreak from April-June 2008 in the adjacent Nabire and Paniai regencies of West Papua. Previous reports by Indonesian authorities in early June 2008 stated 17 people had died. At that time health authorities disputed figures from West Papuan Human Rights workers that there had actually been 34 fatalities if cases in the villages were counted. The Papua Health Office reported an "Ogawa-type Vibrio cholerae infection" following tests in Jayapura.

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.
(ProMED 7.2.08)

Viet Nam
Three northern provinces of Ninh Binh, Bac Ninh and Hai Phong reported many cases of acute diarrhea in June 2008, announced the Preventive Health Department on 24 Jun 2008. Among them, several cases of the cholera bacterium were found, 30 of which were discovered in Bac Ninh Province. According to Bac Ninh Province's health department, 49 patients were admitted in hospitals suffering from acute diarrhea including 27 cases inflicted with cholera. Most of the patients were residents of Chan Lac Village, whose lake tested positive for the bacterium.

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.
(ProMED 6.27.08)

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4. Articles
Global Spread and Persistence of Dengue
Kyle JL, et al. Annual Review of Microbiology. 2008;62 (final online publication date: 8 Sep 2008)
http://arjournals.annualreviews.org/doi/abs/10.1146/annurev.micro.62.081307.163005

Abstract
Dengue is a spectrum of disease caused by four serotypes of the most prevalent arthropod-borne virus affecting humans today, and its incidence has increased dramatically in the past 50 years. Due in part to population growth and uncontrolled urbanization in tropical and subtropical countries, breeding sites for the mosquitoes that transmit dengue virus have proliferated, and successful vector control has proven problematic. Dengue viruses have evolved rapidly as they have spread worldwide, and genotypes associated with increased virulence have expanded from South and Southeast Asia into the Pacific and the Americas. This review explores the human, mosquito, and viral factors that contribute to the global spread and persistence of dengue, as well as the interaction between the three spheres, in the context of ecological and climate changes. What is known, as well as gaps in knowledge, is emphasized in light of future prospects for control and prevention of this pandemic disease.
(Annual Reviews 4.22.08)

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Ready for avian flu?
Yamada T, Dautry A, Wallport M. Nature. 2008;454:162
http://www.nature.com/nature/journal/v454/n7201/full/454162a.html

Introduction
Several chilling considerations highlight the seriousness of an impending pandemic of the H5N1 'avian' influenza virus. The highly contagious nature of influenza, the limited ability to restrict its transmission and the efficiency of modern international transport all conspire to reduce the time from the first infection to a potential global crisis. Recent models built on data from the 1918 flu pandemic predict that 50 million–80 million people could die. Perhaps not surprisingly, 95% of these deaths are likely to occur in the developing world, where higher population density, poor health status and limited access to public-health interventions prevail. Prevention through vaccination would be optimal, but vaccines against a pandemic strain might take six months to manufacture and deliver, even in developed countries. Moreover, total global capacity for flu vaccine manufacture in the first 12 months is estimated at only 500 million doses, and no global financing-vehicle exists.

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.
(CIDRAP 7.10.08)

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The contents of the syringe
Salzberg S. Nature. 2008;454:160-161
http://www.nature.com/nature/journal/v454/n7201/full/454160a.html

Introduction
During the past 50 years, the scientific community has studied the influenza virus in great detail, and has developed an effective vaccine that is administered widely each year. The vaccine contains isolates from each of the three strains commonly circulating in humans: H3N2, H1N1 and influenza B. H3N2 has been the dominant strain of influenza A in most years, since it first emerged in 1968, and it is responsible for the most serious infections. The milder H1N1 has been co-circulating since it reappeared in Russia in 1977, and influenza B is milder yet. Because the virus mutates rapidly, the vaccine strains — especially H3N2 — need to be changed almost every year in order to remain effective. In some respects, the influenza-vaccine programme is a remarkable success: every year a new vaccine is developed and distributed, and most of the time it works.

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.
(CIDRAP 7.10.08)

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Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population
van der Sande M, et al. PLoS ONE. 2008;3(7):e2618.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0002618

Background
Governments are preparing for a potential influenza pandemic. Therefore they need data to assess the possible impact of interventions. Face-masks worn by the general population could be an accessible and affordable intervention, if effective when worn under routine circumstances.

Methodology
We assessed transmission reduction potential provided by personal respirators, surgical masks and home-made masks when worn during a variety of activities by healthy volunteers and a simulated patient.

Principal Findings
All types of masks reduced aerosol exposure, relatively stable over time, unaffected by duration of wear or type of activity, but with a high degree of individual variation. Personal respirators were more efficient than surgical masks, which were more efficient than homemade masks. Regardless of mask type, children were less well protected. Outward protection (mask wearing by a mechanical head) was less effective than inward protection (mask wearing by healthy volunteers).

Conclusions/Significance
Any type of general mask use is likely to decrease viral exposure and infection risk on a population level, in spite of imperfect fit and imperfect adherence, personal respirators providing most protection. Masks worn by patients may not offer as great a degree of protection against aerosol transmission.
(CIDRAP 7.8.08)

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Science into policy: preparing for pandemic influenza
Harper DR, et al. Journal of Public Health. Published online on 4 July 2008.
http://jpubhealth.oxfordjournals.org/cgi/content/full/fdn049v1

Abstract
Authoritative government pandemic preparedness requires an evidence-based approach. The scientific advisory process that has informed the current UK pandemic preparedness plans is described. The final endorsed scientific papers are now publicly available.
(CIDRAP 7.4.08)

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West Nile virus activity in Latin America and the Caribbean
Komar N, Clark GG. Rev Panam Salud Publica. 2006;19(2):112-7.
http://journal.paho.org/?a_ID=307

Objectives
West Nile virus (Flavivirus: Flaviviridae; WNV) has spread rapidly throughout the Caribbean Basin since its initial detection there in 2001. This report summarizes our current knowledge of WNV transmission in tropical America.

Methods
We reviewed the published literature and consulted with key public health officials to obtain unpublished data.

Results
West Nile virus infections first appeared in human residents of the Cayman Islands and the Florida Keys in 2001, and in apparently healthy Jamaican birds sampled early in 2002. Serologic evidence of WNV infection in 2002 was detected in horses, chickens, and resident free-ranging birds in Guadeloupe, the Dominican Republic, and eastern Mexico. In 2003, WNV spread in Mexico and northern Central America, and serologic evidence was detected in the Bahamas, Puerto Rico, and Cuba. In 2004, the 1st serologic evidence of WNV activity in South American ecosystems surfaced in September-October in Colombia and Trinidad, where domestic animals circulated WNV-neutralizing antibodies.

Conclusions
The sparse reports of equine, human, and avian disease in Latin America and the Caribbean are puzzling. Isolates are needed to evaluate viral attenuation or other possible explanations for reduced disease burden in tropical ecosystems.
(ProMED 7.7.08)

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5. Notifications
PHI2008--Envisioning Options for Integrated Public Health Information Systems for Low Resource Settings: Components, Connections, Partners, Strategies
http://www.gpphi.org/conferences


Dates: 18-19 September 2008
Location: Seattle, WA, USA
Venue: Bell Harbor International Conference Center

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."

Program:

  • Keynote addresses by leading international experts
  • Plenary presentations:
    • National approaches from countries leading the development of integrated public health information systems
    • Creative approaches to collecting and linking data and systems to improve public health practice
    • Strategies for compiling and delivering contextually relevant information for decision support
  • Poster sessions presenting research and applied methodologies and results from public health informatics interventions in low-resource settings throughout the world
  • Panelist discussions of funding opportunities for research and applications development
  • Information exchange and networking opportunities

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Nipah Virus Colloquium 2008
http://nipah.um.edu.my

Dates: 20-21 Oct 2008
Location: Kuala Lumpur, Malaysia
Venue: University Malaya

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.
(ProMED 7.10.08)

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 apecein@u.washington.edu