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Vol. XI No. 15 ~ EINet News Briefs ~ Jul 25, 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: HealthMap, the newest global infectious disease surveillance tool, values informal sources
- Indonesia (Jakarta): H5N1 avian influenza suspected in 38-year-old man's death
- Viet Nam (Long An): Hundreds of vaccinated chickens die of H5N1 avian influenza infection
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
2. Infectious Disease News
- Australia (Queensland): Anxious watch over veterinary staff in Hendra virus outbreak
- Indonesia (Bali): Officials report chikungunya outbreak
- Russia: Hemorrhagic fever with renal syndrome cases on the rise in 2008
- Russia (Moscow): First case of tularemia reported
- Russia (Krasnoyarsk): Two more young children diagnosed with Yersiniosis
- Russia (Rostov): Area seriously affected by Crimean-Congo hemorrhagic fever
- Russia (Buryatia): Number of suspected anthrax cases reaches 13, eight confirmed
- Viet Nam (Ha Giang): Contaminated meat suspected in anthrax cases
- USA (Florida): More cases of ciguatera poisoning from fish
- USA: Jalapeno pepper likely culprit in Salmonella outbreak
- USA (Georgia): E. coli outbreak continues, spreads to more states
- USA (Alabama): Eastern equine encephalitis virus infection confirmed in a baby
- USA: Measles outbreak has now reached 15 states
- USA (North Carolina): La Crosse encephalitis confirmed in two children
- AVIAN/PANDEMIC INFLUENZA
- WEST NILE VIRUS – New cases
- Deaths from Bacterial Pneumonia during 1918–19 Influenza Pandemic
- Protecting residential care facilities from pandemic influenza
- Bacterial Pneumonia and Pandemic Influenza Planning
- Promoting regional disaster preparedness among rural hospitals
- Phase I and II randomised trials of the safety and immunogenicity of a prototype adjuvanted inactivated split-virus influenza A (H5N1) vaccine in healthy adults.
- No Ordinary Flu: Preparedness comic book in multiple languages
- PHI2008--Envisioning Options for Integrated Public Health Information Systems for Low Resource Settings: Components, Connections, Partners, Strategies
- Guidance on Allocating and Targeting Pandemic Influenza Vaccine
1. Influenza News
Global: HealthMap, the newest global infectious disease surveillance tool, values informal sources
Dr. Larry Brilliant, one of the chiefs of the World Health Organization's (WHO's) smallpox-eradication effort and now executive director of the philanthropy Google.org said, "Is it possible, or even probable, that if we better understood the complexity and magnitude of the many factors that lead to the emergence of infectious disease, that we . . . might be able to get early warning signals from satellites or webcrawlers or phone banks?" Brilliant said in March in a keynote speech at the International Conference on Emerging Infectious Diseases. "Or even better, that we could identify hotspots where newly emerging communicable diseases would arise . . . ?"
The emerging surveillance systems seek very early warnings of outbreaks by analyzing data that originates outside the public health hierarchy. The most recent entry in the field is HealthMap, created by epidemiologist John Brownstein and software developer Clark Freifeld at the Children's Hospital Boston Informatics Program. It began as a pilot project in September 2006 and is described in the July issue of Public Library of Science Medicine (and is partially supported by a grant from Google.org). It joins older nonprofit tools including ProMED, a free Web and email-service of the International Society for Infectious Diseases (ISID); official surveillance efforts by public health agencies, such as the European Union's MedISys and the Global Public Health Intelligence Network (GPHIN), operated by the Public Health Agency of Canada for the WHO; and new grassroots efforts by epidemiologists and computer scientists such as the volunteer effort WhoIsSick.org. Collectively, the new surveillance efforts give teeth to the revised International Health Regulations, which took effect a year ago. The revision formally recognized "informal sources" of disease news as worthy of attention and capable of triggering an international outbreak alert.
What the new surveillance systems share is a refusal to depend on data from public health's established reporting systems, which rely on electronic or paper reports filed by physicians or local health departments and passed layer by layer through the public health hierarchy. Those reports may be exquisitely accurate, because they originate with medical professionals, but they are slow. The new systems balance the risk of sacrificing accuracy against the need for speed, which they get by harvesting and evaluating news stories, blog posts, listserv discussions, and whatever else can be spotted by eye or scraped by a Web-crawling program.
HealthMap, the newest entry, expands on the sources the other systems draw from: It performs fully automated Web-scraping from 14 aggregate sources that collect data from approximately 20,000 sites. It currently collects in English and machine-translates from four other languages, with three more under development. The reports it collects are automatically sifted for duplicates and mistakes, ranked by urgency, and sorted and posted by source, date, location, and disease. Its striking innovation is real-time mapping of the news it gathers. Reports are coded with latitude and longitude and "pinned" to a world map; clicking on the pins produces links to the reports that the system has gathered. The collective result—map plus links plus reports—is gathered into a single open-access Web page. The latest movement in novel reporting is the deployment of sophisticated but easy-to-use tools such as GIS-mapping for very local surveillance. It was the inspiration for WhoIsSick.org, a private project by California software engineer PT Lee that aggregates personal reports of illness into "crowdsourced" snapshots of local disease trends.
Developers of the new surveillance systems agree that incorporating local reports is the necessary next step in the systems' evolution. It may be the most challenging: Data gathered by amateurs is likely to include a higher percentage of inaccurate or irrelevant reports. But it may also be the only route by which areas with no official disease surveillance—or with tight political controls on disease reports—can share information with the rest of the world. In fact, representatives of the public health systems from 23 countries called for enhanced disease surveillance in a December 2007 "call for action," asking industrialized countries to help improve disease reporting especially in Africa and South Asia. Cell-phone text-messaging has already been used in India to report suspected cases of avian flu to provincial animal-health authorities. A new nonprofit named InSTEDD (Innovative Support to Emergencies, Diseases and Disasters) has received grants from the Rockefeller Foundation and Google.org's Predict and Prevent Initiative to bring rapid disease-reporting tools to Mekong Basin villages in Southeast Asia.
HealthMap's founders are working on a pilot project, using ProMED's volunteer moderators, that will test combining machine-harvested reports with human-evaluated ones. "The vision down the road is it would be a two-way line of communication, not just receiving or curating information [but] also inputting new data," Brownstein said. "That would be the concept that would open this up to the global community."
Indonesia (Jakarta): H5N1 avian influenza suspected in 38-year-old man's death
A 38-year-old Indonesian man from a town near Jakarta has reportedly died of H5N1 avian influenza. Indonesia has said it will no longer immediately report new H5N1 cases and will instead provide periodic updates. However, details about the man's death were reported by the AP, which cited the man's brother-in-law and anonymous health workers as its sources. The man was said to have died on 10 Jul 2008 after experiencing a high fever, coughing, and breathing difficulties. "The doctor told us he died of bird flu. The tests came back positive from Jakarta," the man's brother-in-law said. The 38 year old man was from Belendung, a village 24 miles west of Jakarta, the AP reported. Residents of the area said ducks and chickens roam the streets freely, but none were reported sick or dead.
Lily Sulistyowati, a health ministry spokeswoman, said she couldn't confirm the man's death. "But we'll let the public know when we release our report at the end of the month," she said. Under the International Health Regulations, countries are obligated to promptly report human H5N1 influenza cases and other diseases regarded as a potential global health threat to the World Health Organization (WHO), which posts announcements about them and keeps an official count of illnesses and deaths. It is not clear, however, if Indonesia's health ministry has informed WHO of the case. If WHO recognizes the man's infection, it will be listed as Indonesia's 136th H5N1 case and 111th death.
Viet Nam (Long An): Hundreds of vaccinated chickens die of H5N1 avian influenza infection
Since late June 2008, several hundred of the 3,000 chickens in the flock have died at the farm in Tan Lan commune in Long An province, 50 km [31 miles] west of Ho Chi Minh City. They were tested positive for the H5N1 avian-influenza virus, said Mr. Dinh Van The, head of the province's Animal Health Department. The farm owner reported to the department that all birds in the farm had been vaccinated against bird flu, he said. "We suspect that he was not honest in his report, or that the vaccine used at the farm was of bad quality," he added. "We are investigating the case."
***For data on human cases of avian influenza prior to 2008, go to: http://depts.washington.edu/einet/humanh5n1.html
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 7.14.08):
2. Infectious Disease News
Australia (Queensland): Anxious watch over veterinary staff in Hendra virus outbreak
The owner of a Brisbane veterinary clinic is anxiously waiting to see if more of his staff have contracted the potentially fatal Hendra virus. A nurse and a veterinarian at the Redlands Veterinary Clinic were diagnosed with the virus after treating several infected horses. Owner Dr. David Lovell said, "If we get through this weekend I get the feeling we will be on the road to recovery."
Lovell said staff had visited the nurse and veterinarian Ben Cunneen in the Princess Alexandra Hospital. "They are no way near being cured but it just means they are not deteriorating and that has to be some cause for optimism. But this is not detracting one bit from the seriousness of the condition." The veterinarian of 38 years has closed his horse practice during the crisis as eight other staff who worked closely with affected horses are monitored to see if they are incubating the bug. One of the horses was put down, another died and a third is recovering.
Cunneen and the nurse suffered flu-like symptoms from the virus, which claimed the life of trainer Vic Rail and 14 horses during the last outbreak in 1994. Brisbane Southside Population Health Unit medical officer Dr Brad McCall said the affected pair would have acquired the infection through close contact with the horses in the late stage of illness or at autopsy. There had been no evidence of person to person transmission of the virus and no risk to the wider community. Queensland Health continues to monitor seven people in Proserpine, north Queensland, who have undergone blood tests following a second outbreak of the virus. A virus-affected horse died late last week at a Cannonvale property.
Indonesia (Bali): Officials report chikungunya outbreak
Russia: Hemorrhagic fever with renal syndrome cases on the rise in 2008
The HFRS situation in Tatarstan has also worsened during 2008; 165 cases have been recorded so far this year, and one person had died. According to the Russian Epidemiological Surveillance System, last year 249 cases were reported with three deaths.
Russia (Moscow): First case of tularemia reported
Russia (Krasnoyarsk): Two more young children diagnosed with Yersiniosis
Russia (Rostov): Area seriously affected by Crimean-Congo hemorrhagic fever
Russia (Buryatia): Number of suspected anthrax cases reaches 13, eight confirmed
Viet Nam (Ha Giang): Contaminated meat suspected in anthrax cases
In late June 2008, some cattle died of an unknown disease, thought to be anthrax. Some people who ate meat from the sick cattle also got sick with symptoms of anthrax. The Preventive Health Agency has asked the Ha Giang Department of Health to take urgent measures to prevent the disease and warn locals not to eat meat of sick animals.
USA (Florida): More cases of ciguatera poisoning from fish
Numbers are increasing in Florida of people getting sick from toxic fish. The culprit is being narrowed down to grouper, as five more individuals have been diagnosed with ciguatera. This type of poisoning is caused by the consumption of certain subtropical and tropical marine fish.
In Palm Beach County, the health department has confirmed that five more people have become seriously ill from ciguatera in just one week. The health department usually only has a few cases in a year's time. In recent years, Florida has had outbreaks of ciguatera resulting from kingfish and amberjack. Other fish known to cause the illness include barracuda, snapper, jacks, mackerel and triggerfish. Even with the numbers of ciguatera rising in South Florida, the CDC has not issued any warnings against eating grouper at this time. A warning of this kind could hurt a wide range of businesses as grouper is one of the more popularly eaten fish in many restaurants.
USA: Jalapeno pepper likely culprit in Salmonella outbreak
It is also not clear whether the same packing plant, which has not been named by the FDA, also packs tomatoes. The FDA first suspected tomatoes as the cause of the salmonella outbreak and warned consumers on 7 Jun 2008 to avoid certain types of tomatoes. It lifted that warning during the week of 14-18 Jul 2008. Because people continued to get sick after the tomato warning, the FDA and the CDC shifted their investigation to jalapeno and serrano peppers, which sick people had also reported eating. For the FDA, which was under public and political pressure to find the cause of the salmonella outbreak, the discovery of a smoking pepper is a big breakthrough.
USA (Georgia): E. coli outbreak continues, spreads to more states
USA (Alabama): Eastern equine encephalitis virus infection confirmed in a baby
Health officials say it's important to limit your exposure to mosquitoes to avoid EEE virus infection. Environmentalist Rachel Beck recommends keeping repellant on hand when you are outdoors.
Mosquito-borne viruses like EEE and West Nile virus are transmitted from bird to mosquito to bird. When birds become scarce, sometimes mosquitoes will take blood from mammals like humans and horses. That's how humans and horses become ill. Although there are vaccines available for horses, there is no vaccine for West Nile or EEE viruses available to humans.
USA: Measles outbreak has now reached 15 states
Health officials are warning against the trend of parents not immunizing their children, saying that failing to do so could have devastating effects on the health of the country and world as a whole. According to experts, outbreaks and epidemics will continue throughout the developed world. In June 2008, British health officials said that measles had become an epidemic there for the first time since the mid-1990s due to parents not immunizing their children. Dr. Larry Pickering of the CDC said, "Until better global control is achieved, cases will continue to be imported into the United States and outbreaks will persist as long as there are communities of unvaccinated people."
This outbreak comes just eight years after the virus was declared virtually dead in the US, thanks to a vaccination program which began in the 1960s. According to the CDC, states with reported cases now include: Arizona, Arkansas, California, Georgia, Hawaii, Illinois, Louisiana, Michigan, Missouri, New York, New Mexico, Pennsylvania, Virginia, Wisconsin and Washington state, and Washington, D.C.
USA (North Carolina): La Crosse encephalitis confirmed in two children
States newly reporting WNV detected: Colorado, Connecticut, New Jersey, New York, North Carolina, Ohio, Virginia and Washington.
States newly reporting new human cases: Colorado, Louisiana and Utah.
Total human cases for 2008: 43 with no fatalities.
Thu Duc District has reported the highest number of dengue fever cases. Dang Hai Dang, deputy director of Ca Mau Province Preventive Health Department, said the number of patients with dengue fever in his province in June 2008 was nearly double the number reported in the first five months of this year 2008. Tran Van Thoi District has been hardest hit, with 600 cases reported so far in 2008, followed by the U Minh and Thoi Binh districts, and Ca Mau Town, he said. At the Children's Emergency Department of Ca Mau General Hospital, two or three patients share each bed.
The tropical disease, transmitted by the [Aedes aegypti] mosquito, has claimed four lives in Ca Mau Province in 2008. Soc Trang Province has the highest number of cases, with more than 1,900 cases reported so far in 2008. The provincial hospital's children department often struggles to cope with the influx of dengue patients. In Tien Giang Province, more than 1,400 cases of the disease have been reported in 2008. One death, a 7 year old boy, was also reported. Between 300 and 700 cases each of dengue fever have been reported in the Mekong Delta provinces of Dong Thap, Bac Lieu, Kien Giang, and Ben Tre.
Ho Chi Minh City's Pasteur Institute has run prevention and treatment training courses for health officials from Soc Trang, Ca Mau, Bac Lieu, and Hau Giang provinces. Ca Mau's health agency staff have been touring the province to advise residents on how to prevent the disease. The health departments of Soc Trang, Dong Thap, Kien Giang, and HCMC have launched mosquito eradication programs.
Deaths from Bacterial Pneumonia during 1918–19 Influenza Pandemic
Brundage JF, et al. Emerg Infect Dis. 2008 Aug; [Epub ahead of print].
Deaths during the 1918–19 influenza pandemic have been attributed to a hypervirulent influenza strain.
Hence, preparations for the next pandemic focus almost exclusively on vaccine prevention and antiviral
treatment for infections with a novel influenza strain. However, we hypothesize that infections with the
pandemic strain generally caused self-limited (rarely fatal) illnesses that enabled colonizing strains of
bacteria to produce highly lethal pneumonias. This sequential-infection hypothesis is consistent with
characteristics of the 1918–19 pandemic, contemporaneous expert opinion, and current knowledge
regarding the pathophysiologic effects of influenza viruses and their interactions with respiratory bacteria.
This hypothesis suggests opportunities for prevention and treatment during the next pandemic (e.g., with
bacterial vaccines and antimicrobial drugs), particularly if a pandemic strain–specific vaccine is
unavailable or inaccessible to isolated, crowded, or medically underserved populations.
Protecting residential care facilities from pandemic influenza
Bacterial Pneumonia and Pandemic Influenza Planning
Promoting regional disaster preparedness among rural hospitals
Context and Purpose
Phase I and II randomised trials of the safety and immunogenicity of a prototype adjuvanted inactivated split-virus influenza A (H5N1) vaccine in healthy adults.
No Ordinary Flu: Preparedness comic book in multiple languages
To promote pandemic flu preparedness, Public Health - Seattle & King County has developed a 12-page comic book on pandemic flu. Targeting readers of all ages, this story tells the tale of a family’s experience of the 1918 influenza pandemic. It also explains the threat of pandemic flu today, illustrates what to expect during a pandemic (such as school closures), and offers tips to help households prepare. You can order copies (or download) all 12 language versions of the comic (PDF format) at the above link.
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 U.S. Government is taking steps to minimize the need to make vaccine allocation decisions by supporting efforts to increase domestic influenza vaccine production capacity. Significant funding is being provided to develop new vaccine technologies that allow production of enough pandemic influenza vaccine for any person in the United States who wants to be vaccinated within six months of a pandemic declaration. Until this goal is met, Federal, State, local and tribal governments, communities, and the private sector will need guidance on who should be vaccinated earlier during the pandemic to best protect our people, communities, and country.
Issues to consider in drafting guidance on pandemic influenza vaccination are different and more complex than in developing recommendations for annual vaccination against seasonal influenza. In contrast with seasonal influenza, during a pandemic nobody in the population is likely to have immunity to the virus, many more people will become ill, and rates of severe illness, complications and death are likely to be much higher and more widely distributed throughout the population. The greater frequency and severity of disease will increase the burden on health care providers and institutions and may disrupt critical products and services in health care and other sectors. National and homeland security could be threatened if illness among military and other critical personnel reduces their capabilities. Because the needs that must be addressed by pandemic vaccination differ from seasonal influenza vaccination, the guidance on vaccination differs as well.
This guidance is intended to provide strong advice to support planning an effective and consistent pandemic response by States and communities. Nevertheless, it is important that plans are flexible as the guidance may be modified based on the status of vaccine technology, the characteristics of pandemic illness, and risk groups for severe disease – factors that will remain unknown until a pandemic actually occurs. Vaccination will be only one of several tools that can be used to fight the spread of influenza when a pandemic emerges. Additional approaches include non-pharmaceutical public health measures in communities, businesses, and households to reduce and slow the spread of infection; using antiviral medications for treatment and prevention; using facemasks and respirators in appropriate settings; and washing hands and covering coughs and sneezes. These strategies will be the initial mainstay of a pandemic response before vaccine is available and continue to have important effects throughout a pandemic. Guidance around vaccine use is meant to be applied in conjunction with and in the context of these other pandemic response efforts. More information about pandemic planning and response measures is provided at www.pandemicflu.gov.