Vol. XI, No. 16 ~ EINet News Briefs ~ Aug 08, 2008

2008
Bangladesh / 1 (0)
China / 3 (3)
Egypt / 7 (3)
Indonesia / 18 (15)
Viet Nam / 5 (5)
Total / 34 (26)

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

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Authorities’ efforts to cull poultry in West Bengal have been hampered by a lack of local cooperation, with villagers smuggling birds out of cull zones and selling them. The sudden glut of smuggled birds on the market has caused the price of chicken to fall. “Poor villagers are feasting on chicken. At normal times, they cannot afford to buy, as prices are so high. Now they are enjoying the meat,” said Sheikh Ali, a market vendor. Experts in neighboring Bangladesh warned that their government is suppressing news of the current outbreak. Previous reports of suspected human cases of avian (H5N1) influenza have failed to be confirmed. In the current situation, the signs and symptoms described in the above report are not sufficiently specific to exclude seasonal influenza or, indeed, any other febrile condition.
(Promed 8/3/08)

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Indonesia: Suspected human cases of avian influenza infection
Three people have died, and 13 have been admitted to hospital with symptoms of bird flu in Indonesia, a nurse treating the patients said 6 Aug 2008. Officials and residents in Asahan district of North Sumatra province said villagers began showing symptoms of avian flu after a large number of chickens died suddenly. The nurse at Asahan district's Kisaran hospital said three people had died after suffering bird flu-like symptoms in Air Batu village. Another 13 people had been admitted to the hospital with "high temperatures and respiratory problems," she said. Two of these -- a baby boy and a 7-year-old girl -- were transferred 6 Aug 2008 to a bird flu isolation unit at Adam Malik hospital in Medan. Adam Malik hospital spokesman Sinar Ginting confirmed that blood samples from the two children were sent to a health ministry laboratory for analysis. The two patients were reportedly in a "critical" condition, with a high fever, serious respiratory problems and a cough.

The ministry, which has stopped giving regular bird flu updates, announced earlier this week that the human toll from avian influenza in Indonesia had risen to 112. A 19-year-old Indonesian factory worker reportedly died of bird flu in a hospital just west of the capital, Jakarta, Nyoman Kandun, the director general of communicable disease control at the Health Ministry, said.
(Promed 8/3/08)

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USA: FDA approvals clear way for flu vaccine marketing
The six companies that make influenza vaccine for the US market have won federal approval for their version of this year's vaccine, in which all three flu strains used in last year's product have been replaced, the Food and Drug Administration (FDA) announced. The FDA announcement clears the way for marketing of the vaccines. At least three vaccine makers have begun shipping vaccine to distributors and providers. The six manufacturers and their vaccines are CSL Limited, Afluria; GlaoxSmithKline Biologicals, Fluarix; ID Biomedical Corp. (a unit of GlaxoSmithKline), FluLaval; MedImmune, FluMist; Novartis Vaccines and Diagnostics, Fluvirin; and Sanofi Pasteur, Fluzone.

In the wake of a relatively poor match between the vaccine and circulating flu strains last season, experts at the World Health Organization and the FDA recommended changing all three strains of virus used in the vaccine. In most years only one or two of the three strains are changed. "One of the biggest challenges in the fight against influenza is producing new vaccines every year," Jesse Goodman, MD, MPH, director of the FDA's Center for Biologics Evaluation and Research, said. "There is no other instance where new vaccines must be made every year." Two of the three strains in the 2008-09 vaccine are included in vaccines now being used in the Southern Hemisphere, where the flu season is under way, the FDA noted.

The decision to change all three strains in the vaccine had generated some concern about possible production delays or low yields of the viruses, which are grown in eggs. But Curtis Allen, a spokesman for the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), said today he hasn't heard of any problems growing the strains. Manufacturers have estimated they would produce a record total of 143 million to 146 million doses of flu vaccine for the US market this year. Allen said the estimates of vaccine production have not changed since then.

Sanofi announced Aug 1 that it had begun shipping the first 1.3 million doses of Fluzone. "Vaccine shipments to healthcare providers and to the [CDC] for distribution through the Vaccines for Children Program will continue through the fall and are planned to be completed in October," the company said. MedImmune announced yesterday that shipments of FluMist, a nasal-spray vaccine that uses a weakened form of live virus, had begun on Jul 31, 2008. The company affirmed that it plans to produce about 12 million doses, a record number. Novartis announced Aug 7, 2008 that it has begun shipping Fluvirin to US healthcare providers. The company said it expects to deliver 20 million doses by the end of September and aims to deliver the remaining 20 million by Oct 31, 2008.

This is the first year the CDC is formally recommending flu shots for school-age children, adding about 30 million people to the ranks of those targeted for vaccination. Allen said the total number of those targeted for vaccination—including people at risk for serious flu complications and their close contacts—is about 258 million, or roughly 84% of the population.
(CIDRAP 8/6/08)

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The natural reservoir for the Hendra virus is the fruit bat, which carries the virus without becoming sick, but it remains unclear how the virus "spills over" to horses. Hendra virus was first identified in 1994, when 14 horses and one person, a horse trainer, died in the Brisbane suburb of Hendra. A second person was infected, but recovered. Symptoms in humans have included a flu-like illness, which can progress to pneumonia; headache, high fever, and drowsiness, which can progress to convulsions or coma. The Hendra virus has not been identified outside of Australia.
(Promed 7/25/08)

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China (Shandong): Undiagnosed hemorrhagic disease; anaplasmosis
The WHO China Office has had ongoing communications with the Ministry of Health China regarding "Undiagnosed hemorrhagic disease. The Chinese experts have completed an investigation into the incident. Four cases of human granulocytic anaplasmosis were identified in Wanjiakou village in Shandong province. The diagnosis was laboratory confirmed by polymerase chain reaction and sequencing analysis. The first case was a 43-year-old male farmer hospitalized on 18 Jun 2008 (with fever, leucopenia, and thrombocytopenia) and died 23 Jun 2008 despite treatment. The father of this patient was also identified with the disease, had onset of symptoms on 1 Jul 2008, and died 10 Jul 2008. 2 other cases were found in the same village on 2 and 5 Jul 2008. They recovered after being treated and were discharged from hospital. Active case finding has not identified additional cases. Anaplasmosis is a tick-borne disease, not known to spread by human-to-human transmission. China has lately strengthened its prevention and control measures as well as improved diagnosis and treatment guidelines for tick-borne diseases. These are sporadic cases of anaplasmosis. The disease can be treated effectively [with] antibiotics. These cases of anaplasmosis do not pose an outbreak or epidemic threat.
(Promed 8/5/08)

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China (Jilin): Hand, foot and mouth disease on rise, causes three deaths
Cases of infectious intestinal disease were on the rise this summer in Jilin Province, northeast China, and three children were confirmed dead as a consequence of hand, foot and mouth disease (HFMD) in the period from 1 May to 23 Jul 2008. There were 6590 cases of infectious intestinal disease from 1 May to 23 Jul 2008, a rise of 170.2 percent from the same period last year, said the provincial health department 24 Jul 2008. The news briefing was organized to give a report of disease control in the province in the past 3 months. Of the total, HFMD cases made up 4141. And 3610 children who fell ill with the diseases were under the age of 5. Medical examinations found enterovirus 71 (EV71) was responsible. HFMD can be caused by a host of intestinal viruses, but EV71 and the coxsackievirus A16 (Cox A16) are the most common. It usually starts with a slight fever followed by blisters and ulcers in the mouth and rashes on the hands and feet. Those sickened by EV71 often show serious symptoms. It can also lead to meningitis, encephalitis, pulmonary edema and paralysis in some children. There is no vaccine.
(Promed 7/26/08)

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Malaysia: Malaria outbreak in Sarawak and Bario highlands
A strain of the malaria virus that multiplies rapidly has been discovered in Sarawak. Deputy Chief Minister Tan Sri Dr George Chan Hong Nam said teams of malaria experts from the State Health and Medical Services Department discovered this rapidly-spreading mosquito-borne disease when investigating the malaria outbreak in the Bario highlands deep in interior northern Sarawak. "The outbreak in Bario was caused by a fast-growing strain that multiplies rapidly within 24 hours instead of the usual 48 hours or 72 hours. This is something that we (state health authorities) are very worried about. Because it spreads very fast, it can attack the body organs rapidly, even the brain," said Dr Chan, who is also Sarawak Disaster Relief Committee chairman. Dr Chan said that this malaria strain was "not a normal thing in this state" and expressed worry that no one knew how many areas were infected by this strain. "The health teams deployed in Bario are now collecting as much data as possible on the latest situation in the affected regions. We want to accurately identify those places infected by this fast-spreading strain," he said.

The Star last week highlighted the malaria outbreak in the Bario highlands after 21 Penans were floored by high fever and had to be flown out to hospitals in Miri and Marudi. Initially, 2 Penan settlements -- Urur Dalan and Semirian -- were found to be infected. The outbreak then spread outside of Bario and hit Long Jikitan, a settlement located nearer to Miri. Dr Chan said he was hopeful that the same drugs used to treat previous malaria cases could deal with this fast-spreading strain. Authorities reminded the local community in the highlands to destroy mosquito breeding grounds such as in drains and containers and by cleaning their areas. They should also be always on the alert for those showing signs of malaria-infection.
(Promed 8/6/08, 8/3/08)

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Malaysia (Perak): Chikungunya outbreak expands
The Chikungunya disease [virus], which is believed to have infected the people of Kampung Rasau [in Slim River, Perak], has spread to at least 5 other nearby villages, Slim assemblyman Datuk Mohd Khusairi Abdul Talib said. Khusairi, said he was concerned. "From what I know, it started at Kampung Rasau near here," he said. "Now I am getting feedback that it has spread to nearby villages such as Ulu Slim, Slim Village, Bandar Baru Slim River, Kuala Slim, Kampung Bantang, and Trolak’" he added. Khusairi said whole families were reporting that they were down with prolonged fever, rashes, and joint pains. "This is worrying and villagers from nearby kampung (village) are now complaining of having the same symptoms," he added. Last week [21-27 Jul 2008], the polyclinic was treating between 25 and 30 patients with the same symptoms, he said, adding that this week, the number of patients was on the rise. He also advised the people to get rid of mosquito-breeding grounds. Khusairi said he had been informed that the health authorities had been fogging the area to rid the place of mosquitoes.
(Promed 7/29/08)

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Russia (Kemerovo): Update on tick-borne encephalitis
This year [2008], 32 100 people have applied for medical treatment for tick bite as of 25 Jul 2008 in Kemerovo Oblast. This is 18.5 percent more than the number of people who applied for treatment during the same period last year. Among those, there are 6148 children, whereas by comparison last year there were 5628 children in total. 99.4 percent of those who sought medical assistance received appropriate emergency treatment. 758 people have been admitted to hospital on suspicion of tick-borne encephalitis virus infection. This number is 30.7 percent greater than last year [2007]. 67 people have been registered with a confirmed diagnosis of tick-borne encephalitis virus infection. By comparison, during the whole course of 2007, only 64 cases were diagnosed. So far, there has been one fatality, an 8-year-old child. Altogether, 62 600 people have been vaccinated against tick-borne encephalitis. 25 800 ampules of immunoglobulin are available for urgent treatment. Tick-borne encephalitis, also known as Central European encephalitis or Russian spring-summer encephalitis, is a flavivirus infection of the central nervous system. Human infections are acquired through bites of infected ticks or, rarely, by ingesting unpasteurized dairy products primarily from infected goats, sheep, or cows.
(Promed 8/4/08)

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Russia (Siberia): Plague infects Siberian boy
A 13-year-old Siberian boy has been hospitalized after catching a plague-infected ground squirrel and bringing it home. The boy, living in a remote shepherds' community in south Siberia's Tuva Republic, brought the rodent home. His grandfather immediately killed the animal, and called a doctor. The teenager "came into immediate contact with a long-tailed ground squirrel [Spermophilus undulatus] infected with the plague. His state of health is satisfactory. He is undergoing prophylactic treatment," Gennady Onishchenko said. The area has been thoroughly disinfected, and medics from the regional plague prevention center are carrying out anti-epidemic measures in the area. Plague, caused by the Yersinia pestis bacterium, can be transmitted from rodents to humans via fleas. Bubonic plague is now extremely rare in industrialized countries, and can be treated with antibiotics. Rodents are the reservoir hosts. Many rodents suffer occasional epidemics or maintain the bacterium in natural cycles. In many cases, rodents may show mild illness or are asymptomatic. Plague is listed as a potential bioterror agent.
(Promed 7/30/08)

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Russia (Irkutsk): Botulism caused by preserved fish sickens nine
On 25 Jul 2008, nine residents of the village of Ivanovskoye were admitted to a hospital with a preliminary diagnosis of botulism. There are two children among them. A 22-year-old person died. Omul [fish] was bought privately and only the victims ate it. Fish dishes from omul (fried, salted, or smoked) are traditional Baikal delicacies. Omul is a salmonid from Lake Baikal in Russia, also known as Coregonus autumnalis migratorius. Type E botulism is the type frequently associated with fish products.
(Promed 7/28/08)

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Singapore: Chikungunya fever infects three more cases
Three more cases of chikungunya fever have been found in Singapore, Singapore's Ministry of Health (MOH) said 2 Aug 2008. It has found three new cases of chikungunya fever, bringing the total number of such cases to 48 for 2008. The 3 cases, involving two foreign workers and a local delivery driver, are likely to be local ones, as the three people have not traveled out of the country recently, said the ministry. The two foreign workers are now in hospital for treatment, but the Singaporean driver has returned to work after timely medical treatment. Currently, the ministry is carrying out active case detection at and around the site in Kranji Way, and blood samples are being sent to the country's environmental health institute for testing. Chikungunya fever is a mosquito-borne disease and the best way to prevent chikungunya fever is to take precautionary measures to prevent mosquito breeding. Chikungunya fever is characterized by sudden onset of fever, chills, headache, nausea, vomiting, joint pain with or without swelling, and low back pain.
(Promed 8/3/08)

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Viet Nam/Norway: Staphylococci toxin found in frozen fish from Viet Nam
A customer became acutely ill after eating a filet of fish, bought at a Rema 1000 store in Haugesund. The Norwegian Food Safety Authority [NSA] found dangerous bacteria and toxins from bacteria in frozen fish from the shop. When the customer became acutely ill for the second time after eating fish filet of the same type, the Norwegian Safety Authority was alerted. The NSA revealed that the fish from Viet Nam contained toxin from staphylococci bacteria, along with cholera vibrios which can cause cholera. The customer had bought frozen filets of the Asian fish type, pangasius, in a Rema 1000-store in Haugesund. The symptoms suggest that the person was infected with staphylococcal toxin.

The progression of the illness with a [staphylococcal] infection is very unpleasant. One is knocked out by intense vomiting and diarrhoea, which in turn leads to headaches and exhaustion. Concerning cholera vibrios, you need to get a lot in you before you get cholera," says Marit L. Manhenke, functioning overseer at the NSA's regional office in Rogaland and Agder. According to the NSA, the sickness occurs a few hours after infection with the staphylococcal toxin. The duration of the illness varies from between one and 8 hours. The bacteria are not deadly. Polar Seafood in Moss, which imports the filets from Viet Nam, has initiated the withdrawal and has halted sales of the fish filets from the consignment in question. The consignment was produced 28 and 29 Nov 2007. The withdrawn consignment may have been sold in Norwegian shops since January/February 2008, but only one person so far is know to have become sick from the fish toxin. ". . .The sickness is short-lived and not everyone would immediately link diarrhoea and vomiting with food poisoning," says Manhenke.
(Promed 7/27/08)

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An alert was triggered several weeks ago, when an unusual number of cases of salmonellosis was confirmed in stool samples taken from people who came to their doctors with high fevers, vomiting, and diarrhea. Since the end of June 2008, experts from the BC Centre for Disease Control and several other health agencies have been investigating the cause. "It's called Salmonella [enterica serotype] Enteritidis," said Dr Galanis, naming the strain identified in the 64 confirmed patients.
(Promed 7/30/08)

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Canada (Alberta): First reporting of Canadian human granulocytic anaplasmosis
Investigations conducted in Calgary, Alberta, Canada have identified the first Canadian reported case of human granulocytic anaplasmosis (HGA) that is thought to have been acquired locally. An 82-year-old man was admitted to a local hospital with fever and progressive confusion. He was initially treated as having had community acquired pneumonia and pulmonary edema. A fully engorged Ixodes tick was identified on the patient during his second day of hospitalization. Laboratory findings revealed leukopenia/lymphopenia, progressive thrombocytopenia, and increased liver enzymes and creatinine kinase. Peripheral blood smears revealed intracytoplasmic inclusions within granulocytes consistent with morulae. Cerebral spinal fluid showed increased protein but no lymphocytic pleiocytosis. A whole blood PCR [polymerase chain reaction] confirmed the presence of Anaplasma phagocytophilum. With the addition of doxycycline to his treatment regimen the patient made a full recovery. He had not traveled outside of the city of Calgary in many years. His tick(s) were thought to have been acquired during repeated forays into local wooded recreational areas. While Ixodes ticks are present in many parts of Canada, HGA has not previously been described. However, there have been multiple occasions in which anaplasmosis has been described in animals. HGA is not a reportable illness in Canada.
(Promed 7/31/08)

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USA (Massachusetts, Virginia): E. coli O157:H7 outbreaks
Massachusetts officials announced 4 Aug 2008 that they were investigating six E. coli O157:H7 illnesses that are linked to a multistate outbreak, while Virginia officials report that E. coli has sickened as many as 73 Boy Scouts at a camp. The Massachusetts Department of Public Health (MDPH) said that it has not yet identified the source of the patients' infections but suspects contaminated ground beef. The cases were linked to a multistate outbreak through PulseNet, an electronic network for sharing molecular fingerprinting (pulsed-field gel electrophoresis) data. "These cases may be linked to 20 other cases in several states and Quebec that were caused by the same strain of E. coli," MDPH states. The US Department of Agriculture (USDA) is working with state officials to determine the cause of the Massachusetts cases, and authorities collected several ground beef samples from stores and will conduct tests this week. The MDPH said patients range in age from 3 to 60 years old. They reported becoming ill between 10-16 Jul 2008 and at least five patients were hospitalized. No deaths have been reported.

Meanwhile, the Virginia Department of Health (VDH) reported on 31 Jul 2008 that it was investigating an E. coli outbreak in one of the nation's largest Boy Scout camps, located in Goshen. The Goshen Scout Reservation hosted several thousand scouts and adult leaders and staff starting late July 2008. In an update on 5 Aug 2008, the VDH said that 73 Scouts have reported illness since attending the camp, and E. coli O157:H7 infections have been confirmed in 21; eight Scouts have been hospitalized. Public health officials who visited the camp examined its food handling and storage practices and recommended changes, said Robert Hicks, director of the Office of Environmental Health Services.
(Promed 8/6/08, 8/4/08)

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USA: FDA finds tainted jalapenos at supermarket warehouse; update on Salmonella outbreak
A grocery chain based in Arizona removed Mexican-grown jalapeno peppers from its produce departments after some of the peppers from one of its distributors tested positive for the Salmonella outbreak strain, as the number of sick linked to the outbreak today climbed to 1,330. Bashas' supermarkets, based in Chandler, Ariz., said Aug 1, 2008 the jalapenos were purchased from one of its local distributors. The peppers came from either a distributor in Arizona or one in California, according to the Associated Press (AP). Samples of Salmonella enterica Saintpaul that match the nationwide outbreak that has hit 43 states, the District of Columbia, and Canada, had previously been found at a McAllen, Tex., produce distributor, a farm in Mexico, and at the home of a patient from Colorado, according to previous reports.

"As a precaution, we have removed all jalapenos from our stores, sanitized our shelves, and restocked our shelves with jalapenos grown in the United States," the company said. Bashas' operates more than 160 stores in Arizona, California, and New Mexico. Bashas' spokeswoman Kathy Neid said the US Food and Drug Administration (FDA) notified the company on Aug 1, 2008 about the positive tests on peppers from the company's warehouse. On Aug 1, the FDA asked retailers and food service operators to remove and securely dispose of all fresh jalapeno and Serrano peppers that are grown, harvested, or packed in Mexico, according to a statement from the agency.

In the latest report, CDC reports that the epidemiological studies conducted indicate that more than one food vehicle is involved in this outbreak. No one food item can explain the entire outbreak. By themselves, tomatoes cannot explain the entire outbreak, nor do jalapeño peppers explain all the clusters. At present, information indicates that jalapeño peppers and serrano peppers grown, harvested, or packed in Mexico are the cause of some clusters and are major food vehicles for the outbreak. Although tomatoes currently on the market are safe, raw tomatoes consumed early in the outbreak are still under investigation. The outbreak strain Salmonella Saintpaul has been isolated twice from jalapeño peppers and once from serrano peppers.

Since April 2008, 1348 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 43 states, the District of Columbia, and Canada. Among the 1311 persons with information available, illnesses began between April 10 and July 19, 2008, including 59 who became ill on July 1 or later. These numbers include those with estimated onset dates as well as those with reported onset dates. The latest reported onset date is July 19. The latest estimated onset date is July 19. Patients range in age from <1 to 99 years; 50% are female. The rate of illness is highest among persons 20 to 29 years old; the rate of illness is lowest in children 10 to 19 years old and in persons 80 or more years old. At least 262 persons were hospitalized. A man in his eighties who died in Texas from cardiopulmonary failure had an infection with the outbreak strain at the time of his death; the infection may have contributed to his death. A man in his sixties who died in Texas from cancer had an infection with the outbreak strain of at the time of his death; the infection may have contributed to his death. (CIDRAP 8/4/08; CDC 8/6/08 http://cdc.gov/salmonella/saintpaul/ )

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USA (Colorado): Six residents treated for rabies; five rabid bats found
Six Larimer County, Colorado, residents are being treated for rabies, and five bats in the county have been confirmed to have the disease, according to the Larimer County Department of Health and Environment. Also, two dogs and a cat have been quarantined in Fort Collins after possible exposure to rabid bats. Last year, two bats were confirmed to be rabid in Larimer County. No other wildlife has been found with the disease in Larimer County for years. Jane Viste, public information officer for the county health office, said July into September is the peak rabies season because it coincides with bat migration and people being outdoors. Studies in Colorado have found about 15 percent of bats are carriers of the disease. Viste said, "Rabies is endemic to the bat population, so we see rabies every year. We might be seeing it now because it's hot and people are leaving their doors and windows open, and people are outside more. It's not that the bats are doing anything differently." There has not been a human rabies fatality in Colorado since 1931.
(Promed 7/27/08)

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USA (Mississippi, Virginia): Four cases of La Crosse encephalitis
State health officials say [there are] now a total of three cases of La Crosse encephalitis in Mississippi. This week two cases are reported. The Central Shenandoah Health District reported 24 Jul 2008 the first confirmed human case of La Crosse encephalitis in the district this season [2008] in Virginia. La Crosse encephalitis is caused by a virus that is spread through the bite of a particular species of mosquito. Although most La Crosse virus (LACV) infections [result in] subclinical or mild febrile illnesses, frank encephalitis progressing to seizures and coma can occur [but] the case fatality rate is less than one per cent. In the USA, particularly in the upper Midwestern states, an average of 70 clinical cases is reported annually. Children under 16 years of age tend to be at risk for developing serious illness. No vaccine against LACV is available. A brief fact sheet for LACV can be accessed at <http://www.cdc.gov/ncidod/dvbid/arbor/lacfact.htm>.
(Promed 7/26/08)

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SEASONAL INFLUENZA
Influenza Virus Vaccine 2008/2009 season
The Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee (VRBPAC) met 21 Feb 2008 to select the influenza virus strains for the composition of the influenza vaccine for use in the 2008-2009 U.S. influenza season. During this meeting, the advisory panel reviewed and evaluated the surveillance data related to epidemiology and antigenic characteristics, serological responses to 2007/2008 vaccines, and the availability of candidate strains and reagents.

The panel recommended that vaccines to be used in the 2008-2009 influenza season in the U.S. contain the following: an A/Brisbane/59/2007 (H1N1)-like virus; an A/Brisbane/10/2007 (H3N2)-like virus; a B/Florida/4/2006-like virus. The influenza vaccine composition to be used in the 2008-2009 influenza season in the U.S. is identical to that recommended by the World Health Organization on 14 Feb 2008, for the Northern Hemisphere's 2008-2009.
(Promed 8/5/08)

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CHOLERA, DIARRHEA, AND DYSENTERY
Indonesia (West Papua)
At least 172 villagers have died in a cholera outbreak that has triggered unrest in Indonesia's remote eastern Papua province, church authorities said 29 Jul 2008. Church aid workers in the Kamuu valley [West Papua] reportedly confirmed the victims had died from severe diarrhea and vomiting caused by cholera. The source of the outbreak, which began in April 2008, was still unknown, but the disease appeared to be spreading via drinking water from a river and products in markets in the highland region.
(Promed 7/30/08)

Viet Nam
The Health Ministry on 28 Jul 2008 reported to the government that there were 441 acute diarrhea patients in 18 provinces and cities in July, including 67 [documented] cholera patients, but no deaths. Nguyen Thanh Cong, Director of the Health Department of the northern province of Hai Duong, announced that an acute diarrhea epidemic had broken out in Tan Viet commune, Thanh Ha district, Hai Duong, with 3 people positive for Vibrio cholerae. These people ate food that contained the bacterium at a funeral in Tan Viet. Well water taken from the home of 1 patient is also positive for Vibrio cholerae.
(Promed 7/30/08)

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DENGUE
Philippines (Negros Oriental)
The Department of Health (DoH) reported that 3 people died from dengue virus this year [2008] in Negros Oriental province. DoH investigation shows that the deaths were a result of late referral to doctors. With this, Dr Socrates Villamor, Provincial Epidemiology Surveillance Unit, advised relatives of possible dengue victims to seek early consultation. The DoH top official here warned of an abrupt increase of dengue cases in August 2008 due to the rainy season. Villamor also noted that cases of dengue in the months of June and July 2008 increased. Villamor said that there are 486 cases recorded as of 26 Jul [2008] this year compared to 897 cases of the same period last year. He clarified, however, that although the cases are alarming, there is no epidemic status in the province. He said proper sanitation is the most important and effective tool to prevent dengue-carrying mosquitoes.
(Promed 8/6/08)

Taipei/Myanmar
Ten members of a Taipei religious group have been infected with dengue fever [virus] while taking part in volunteer relief efforts in Myanmar in the aftermath of Cyclone Nargis, marking the first case of mass overseas dengue fever infections to be recorded in Taipei in recent years, a Centres for Disease Control (CDC) official said 29 Jul 2008. The cases were discovered after one of the patients, a 48-year-old Taipei County woman, sought treatment earlier this month [July 2008] at the Far Eastern Memorial Hospital and was diagnosed on 18 Jul 2008 with dengue fever, according to CDC Deputy Director-General Shih Wen-yi. A subsequent investigation found that she and 10 other members of her group had visited Myanmar to help with the aftermath of the disaster and that 10 of the 11-member mission had already fallen ill while in Myanmar, Shih said. The patients were aged between 48 and 87 years, Shih said. Shih said the CDC had also notified local health authorities to check other people who might have had contact with the 10 patients after their return to Taiwan to make sure they are not infected with the disease [virus], which is contracted through the bite of the mosquito.
(Promed 8/6/08)

Thailand
Dengue fever has spread across the country, killing 48 people and infecting more than 40 000 so far this year [2008], Public Health Minister Wicharn Meenchainant said 31 Jul 2008. Up to 26 Jul 2008, 41 307 patients have been diagnosed nationwide with dengue haemorrhagic fever [DHF], and Bangkok was the hardest hit with 3763 patients, according to the Disease Control Department's Bureau of Epidemiology. Ratchaburi suffered the second worst outbreak with 1710 victims, followed by Nakhon Sawan with 1582, Phetchabun with 1304, and Rayong with 1291. The risk of catching dengue fever from mosquitoes this year [2008] was running high compared to 2007, which saw 29 fatalities out of 60 000 cases. This year's [2008] seasonal epidemic was blamed on [dengue virus] type 2, while last year [2007], type 1 [virus] was virulent. Authorities have ordered provincial public health offices to strictly control and monitor the transmission of dengue fever among people in the local area. Local authorities should spray insecticide to eradicate the adult Aedes aegypti mosquito. Residents should drain off any stagnant water to prevent mosquitoes from breeding and use pesticide to destroy their larvae.
(Promed 8/6/08)

Viet Nam
As of late July 2008, 21 000 cases of dengue fever have been reported. Although the outbreak of the disease can happen any time, people's awareness of prevention against it has not been much raised. In the southern provinces, stagnant rainwater has been seen everywhere in and around houses. Some houses even have tens or hundreds of earthenware jars of rainwater. As far as the southern provinces are concerned, dengue fever occurred earlier than expected in 2008. Children under age 15 years have suffered most. However, the number of adults suffering from the disease shows signs of gradual increase.
(Promed 8/6/08)

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WEST NILE VIRUS
Canada
Date: 20-26 Jul 2008: no WNV human cases

USA
Date: 30 Jul-5 Aug 2008
States newly reporting new human WNV cases: Nebraska, Nevada, Ohio There have been a total of 114 human cases and 2 fatalities to date in 2008.
(Promed 8/7/08)

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Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case-control study
Lancet. 2008 Aug 2;372(9636):398-405. Jackson ML, Nelson JC, Weiss NS, et al. http://www.thelancet.com/journals/lancet/article/PIIS0140673608611605/abstract

Summary: Background. Pneumonia is a common complication of influenza infection in elderly individuals and could therefore potentially be prevented by influenza vaccination. In studies with data from administrative sources, vaccinated elderly people had a reduced risk of admission for pneumonia compared with unvaccinated seniors; however, these findings could have been biased by underlying differences in health between the groups. Furthermore, since most individuals with pneumonia are not treated in hospital, such studies should include both outpatient and inpatient events. We therefore assessed whether influenza vaccination is associated with a reduced risk of community-acquired pneumonia in immunocompetent elderly people after controlling for health status indicators. Methods. We did a population-based, nested case-control study in immunocompetent elderly people aged 65–94 years (cases and controls) enrolled in Group Health (a health maintenance organisation) during the 2000, 2001, and 2002 preinfluenza periods and influenza seasons. Cases were individuals with an episode of outpatient or inpatient community-acquired pneumonia (validated by review of medical records or chest radiograph reports). We randomly selected two age-matched and sex-matched controls for each case. The exposure of interest was influenza vaccination. We reviewed medical records to define potential confounders, including smoking history, presence and severity of lung and heart disease, and frailty indicators. Findings. 1173 cases and 2346 controls were included in the study. After we adjusted for the presence and severity of comorbidities, as defined by chart review, influenza vaccination was not associated with a reduced risk of community-acquired pneumonia (odds ratio 0.92, 95% CI 0.77–1.10) during the influenza season. Interpretation. The effect of influenza vaccination on the risk of pneumonia in elderly people during influenza seasons might be less than previously estimated.

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Crystal structures of oseltamivir-resistant influenza virus neuraminidase mutants
Nature 2008 Jun 26;453(7199):1258-61 http://www.nature.com/nature/journal/v453/n7199/abs/nature06956.html (references removed)

Abstract: The potential impact of pandemic influenza makes effective measures to limit the spread and morbidity of virus infection a public health priority. Antiviral drugs are seen as essential requirements for control of initial influenza outbreaks caused by a new virus, and in pre-pandemic plans there is a heavy reliance on drug stockpiles. The principal target for these drugs is a virus surface glycoprotein, neuraminidase, which facilitates the release of nascent virus and thus the spread of infection. Oseltamivir (Tamiflu) and zanamivir (Relenza) are two currently used neuraminidase inhibitors that were developed using knowledge of the enzyme structure. It has been proposed that the closer such inhibitors resemble the natural substrate, the less likely they are to select drug-resistant mutant viruses that retain viability. However, there have been reports of drug-resistant mutant selection in vitro and from infected humans. We report here the enzymatic properties and crystal structures of neuraminidase mutants from H5N1-infected patients that explain the molecular basis of resistance. Our results show that these mutants are resistant to oseltamivir but still strongly inhibited by zanamivir owing to an altered hydrophobic pocket in the active site of the enzyme required for oseltamivir binding. Together with recent reports of the viability and pathogenesis of H5N1 and H1N1 viruses with neuraminidases carrying these mutations, our results indicate that it would be prudent for pandemic stockpiles of oseltamivir to be augmented by additional antiviral drugs, including zanamivir.

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Lymphocytic Choriomeningitis Virus Transmitted Through Solid Organ Transplantation--Massachusetts, 2008
“Lymphocytic choriomeningitis virus (LCMV) is a rodent-borne arenavirus found worldwide. House mice (Mus musculus) are the natural reservoir, but LCMV also can infect other wild, pet, and laboratory rodents (e.g., rats, mice, guinea pigs, and hamsters). Humans can be infected through exposure to rodent excreta. Person-to-person transmission has occurred only through maternal-fetal transmission and solid organ transplantation. LCMV infection in humans can be asymptomatic or cause a spectrum of illness ranging from isolated fever to meningitis and encephalitis. . . Transmission of LCMV and an LCMV-like arenavirus via organ transplantation has been documented in three previous clusters. Of 11 recipients described in those clusters, 10 died of multisystem organ failure, with LCMV-associated hepatitis as a prominent feature. The surviving patient was treated with ribavirin (an antiviral with in vitro activity against LCMV) and reduction of immunosuppressive therapy. On April 15, 2008, an organ procurement organization (OPO) notified CDC of severe illness in two kidney transplant recipients from a common donor. . .one of the recipients had died. Samples from the donor and both recipients were tested at CDC; on April 22, test results revealed evidence of acute LCMV infection in the donor and both recipients. This report summarizes the results of the subsequent public health investigation. . .”
(MMWR July 25, 2008 / 57(29);799-801; references removed)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5729a3.htm?s_cid=mm5729a3_e

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Use of Mass Tdap Vaccination to Control an Outbreak of Pertussis in a High School--Cook County, Illinois, September 2006--January 2007
“On September 6, 2006, the Cook County Department of Public Health was notified that a local high school student aged 17 years had pertussis. During September 2006--January 2007, 36 pertussis cases directly linked to the high school were identified. Because Bordetella pertussis immunity from childhood vaccinations wanes over time, outbreaks of pertussis can periodically occur among students and staff at middle and high schools. . .A pertussis booster vaccine suitable for adolescents and adults became available in the United States in 2005, when two new tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines were licensed for persons aged 10--18 years and 11--64 years, respectively. . .This report summarizes strategies used to control the pertussis outbreak in Cook County, Illinois, including efforts to increase Tdap vaccination coverage. Despite multiple communications recommending Tdap vaccination and implementation of a cough exclusion policy during the pertussis outbreak, student vaccination rates did not increase substantially until a school-based Tdap vaccination clinic was implemented. Because persons at risk for pertussis might not seek vaccination from their usual health-care provider, even during an outbreak, local health departments might consider early implementation of a cough exclusion policy and on-site Tdap vaccination clinic as control measures. . .”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5729a2.htm
(MMWR July 25, 2008 / 57(29);796-799; references removed)

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Persons Tested for HIV--United States, 2006
“Early diagnosis of human immunodeficiency virus (HIV) infection enables infected persons to obtain medical care that can improve the quality and length of their lives and adopt behaviors to prevent further HIV transmission. . .To reduce the number of persons with undiagnosed HIV infection, CDC issued recommendations in September 2006 to implement HIV screening as part of routine medical care for all persons aged 13--64 years. To establish a baseline for evaluating the effects of these recommendations and other strategies to increase HIV testing, CDC analyzed data from the National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which indicated that testing rates remained nearly flat during 2001--2006. In 2006, 40.4% (an estimated 71.5 million persons) of U.S. adults aged 18--64 years reported ever being tested for HIV infection. In addition, 10.4% (an estimated 17.8 million persons) reported being tested in the preceding 12 months, and 23% of persons who acknowledged having HIV risk factors reported being tested in the preceding 12 months. These findings indicate that many persons in the United States have never been tested for HIV infection. Health-care providers should routinely screen all patients aged 13--64 years for HIV in accordance with CDC recommendations. New strategies are warranted to increase HIV testing, particularly among persons who are disproportionately affected by HIV infection. . .”
(MMWR August 8, 2008 / 57(31);845-849; references removed)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5731a1.htm

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Trends in HIV- and STD-Related Risk Behaviors Among High School students--United States, 1991--2007
“Persons who engage in unprotected sexual intercourse or use injection drugs are at increased risk for human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs). . .CDC analyzed data from nine biennial national Youth Risk Behavior Surveys (YRBS). This report summarizes the results of that analysis, which indicated that, during 1991--2007, the percentage of U.S. high school students who ever had sexual intercourse decreased 12%, the percentage who had sexual intercourse with four or more persons during their lifetime decreased 20%, and the percentage who were currently sexually active decreased 7%. Among students who were currently sexually active, the prevalence of condom use increased 33%. However, these changes in risk behaviors were not observed in some subgroups. In addition, no changes were detected in the prevalence of sexual risk behaviors from 2005 to 2007, and many students still engaged in behaviors that place them at risk for HIV infection and STDs. Additional efforts to reduce sexual risk behaviors, particularly among black, Hispanic, and male students, must be implemented to meet the Healthy People 2010 national health objective for adolescent sexual behaviors and to decrease rates of HIV infection and STDs. . .”
(MMWR August 1, 2008 / 57(30);817-822; references removed)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5730a1.htm

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Newborn Hepatitis B Vaccination Coverage Among Children Born January 2003--June 2005 --- United States
“Hepatitis B vaccine was first recommended for administration to all infants in 1991 by the Advisory Committee on Immunization Practices (ACIP) as the primary focus of a strategy to eliminate hepatitis B virus (HBV) transmission in the United States. The recommended timing of administration of the first dose of hepatitis B vaccine to infants has evolved since then to optimize prevention of perinatal and early childhood HBV infections. . .In December 2005, ACIP issued revised recommendations specifying that all medically stable newborns who weigh >2,000 g (4.4 lbs) receive their first dose of hepatitis B vaccine before hospital discharge. To measure hepatitis B vaccination coverage during the neonatal period, CDC analyzed data from the 2006 National Immunization Survey (NIS). This report summarizes the results of this analysis and provides national, state, and local data on vaccination coverage for infants who received the hepatitis B vaccine during the first days of life. The findings reveal that, during January 2003--June 2005, before implementation of the 2005 ACIP hepatitis B vaccine recommendation, the national newborn hepatitis B vaccination coverage estimate was 42.8% at age 1 day and 50.1% at age 3 days, with substantial variation by states and local areas. To comply with ACIP recommendations and increase coverage, delivery hospitals should provide hepatitis B vaccination of newborns as a standard of care. . .”
(MMWR August 1, 2008 / 57(30);825-828; references removed)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5730a3.htm

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Prions Not Degraded By Conventional Sewage Treatment Processes
Scientists in Wisconsin are reporting that typical wastewater treatment processes do not degrade prions. Prions, rogue proteins that cause incurable brain infections such as Mad Cow Disease and its human equivalent, variant Creutzfeldt-Jakob Disease, are difficult to inactivate, resisting extreme heat, chemical disinfectants, and irradiation. Until now, scientists did not know whether prions entering sewers and septic tanks from slaughterhouses, meatpacking facilities, or private game dressing, could survive and pass through conventional sewage treatment plants. Joel Pedersen and colleagues used laboratory experiments with simulated wastewater treatment to show that prions can be recovered from wastewater sludge after 20 days, remaining in the "biosolids," a byproduct of sewage treatment sometimes used to fertilize farm fields. Although emphasizing that prions have never been reported in wastewater treatment plant water or biosolids, the researchers note that existing tests are not sufficiently sensitive to detect the extremely low levels of prions possible in those materials.
(Promed 8/5/08)

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Dates: 18-19 September 2008
Location: Seattle, USA

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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The 7th International Bird Flu Summit
November 13-14, 2008 in Las Vegas, Nevada. The two-day event will draw on first-hand best practices to create solid business continuity plans that companies and organizations need to prepare for, respond to, and survive a pandemic. Public Health Officials, Top leaders and key decision-makers of major companies representing a broad range of industries will meet with distinguished scientists, law enforcers, first responders, and other experts to discuss pandemic prevention, preparedness, response and recovery at the two day summit.

Discussions topics:
* Surveillance and Data Management
* Preparing Communities Strategies; Local Partnership and Participation
* Delivery of Vaccine and Antiviral Medication
* National Pandemic Influenza Medical Countermeasure
* Socio Economic Impact on Poultry Industry
* Benefit-risk Assessment: Public Health, Industry and Regulatory Perspectives
* Prevention Education Efforts and Risk Communication
* Command, Control and Management
* Emergency Response Management
* Business-Based Planning
* School-Based Planning
* Community-Based Planning and more!

New Fields
1001 Pennsylvania Avenue, NW 6th Floor South
Washington, DC 20004
Tel: (202) 536-5000; Fax: 202.280.1239; email: sharon.villalon@new-fields.com
(Bird Flu Summit 8/6/06)

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Epidemic Intelligence Service Online-Only Application Deadline --- September 15, 2008
Applications for CDC's July 2009--June 2011 Epidemic Intelligence Service (EIS) program are now being accepted. This year, applications are only being accepted via the new EIS online application system. EIS is a 2-year, postgraduate program of service and on-the-job training for health professionals interested in the practice of epidemiology. Each year, EIS provides approximately 90 persons, selected from applicants around the world, opportunities to gain hands-on experience in epidemiology at CDC or at state or local health departments.

Persons with a strong interest in applied epidemiology who meet at least one of the following qualifications may apply to EIS: physicians with >1 year of clinical training; persons with a PhD, DrPH, or other doctoral degree in epidemiology, biostatistics, social or behavioral sciences, natural sciences, or nutrition sciences; dentists, physician assistants, and nurses with an MPH or equivalent degree; or veterinarians with an MPH or equivalent degree or relevant public health experience.

For more information: http://www.cdc.gov/eis/applyeis/toapply.htm ; by telephone (404-498-6110); or by e-mail (eisepo@cdc.gov).
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5730a4.htm

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Webcast: Immunization Update 2008
CDC and the Public Health Training Network will present a webcast, Immunization Update 2008, on August 28, 2008. The 2-hour broadcast will occur during 12:00pm--2:00 p.m. EDT. Anticipated topics include influenza and zoster vaccines, recently approved vaccines, and updates on vaccine supplies and vaccine safety. For more information: http://www2d.cdc.gov/phtn/immupdate2008/default.asp. No registration is necessary to access the webcast via an Internet connection. The link to the webcast is available at http://www2a.cdc.gov/phtn/webcast/immupdate2008/default.asp. The program will become available as a self-study DVD and Internet-based program in October 2008.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5730a5.htm

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