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Vol. XI, No. 19 ~ EINet News Briefs ~ Sep 19, 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)
- Indonesia: Retrospective announcement of two confirmed human avian influenza H5N1 deaths
- New Zealand: Low-pathogenic avian influenza H5N1 found in ducks
- Togo: Recent bird flu outbreak confirmed as H5N1 avian influenza
2. Infectious Disease News
- Russia (Bashkortostan): Anthrax infection confirmed in 11 persons
- Russia (Magadan): Trichinellosis outbreak hospitalizes 12
- Russia (Voronezhska): Two die of rabies virus infection
- Russia (Pskov): Three more cases of tick-born encephalitis in Pskov region
- Singapore: Chikungunya fever outbreaks continue
- Taipei (Changhua): 11 deaths attributed to hand, foot, and mouth disease in 2008
- Canada (Quebec): Shellfish harvesting sites close due to red tide
- USA: CDC reports on results for new public health gno flyh list
- USA (New York): Dialysis center shut down after patient tests positive for hepatitis C
- USA (Utah): Man dies of hantavirus pulmonary syndrome
- USA (Oklahoma): E. coli O111 outbreak continues with 291 cases, one killed
- USA (Pennsylvania): Two human salmonella cases lead to pet food recall
- AVIAN/PANDEMIC INFLUENZA
- CHOLERA, DIARRHEA, AND DYSENTERY
- WEST NILE VIRUS
- Influenza vaccines: research, development and public health challenges
- Effects of school closures during the 2008 winter influenza season, Hong Kong
- Effectiveness of maternal influenza immunization in mothers and infants
- Preparing for the Real Storm during the Calm: A Comparison of the Crisis Preparation Strategies for Pandemic Influenza in China and the U.S.
- Pandemic influenza in Australia: Using telephone surveys to measure perceptions of threat and willingness to comply
- Identification of cardioviruses related to Theiler's murine encephalomyelitis virus in human infections
- Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection
- Surveillance for Waterborne Disease and Outbreaks Associated with Recreational Water Use and Other Aquatic Facility-Associated Health Events--United States, 2005--2006
- Surveillance for Waterborne Disease and Outbreaks Associated with Drinking Water and Water not Intended for Drinking--United States, 2005--2006
- Public Health Informatics Fellowship Application Deadline--November 14, 2008
- International Symposium on Viral Hepatitis and Liver Disease
- Ethics and Severe Pandemic Influenza: Maintaining Essential Functions through a Fair and Considered Response
- US policy regarding pandemic influenza vaccines
- Practical Management Strategies for Avian Influenza and Emerging Infectious Diseases--The Implementation Toolkit
1. Influenza News
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
***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: 387 (245).
Avian influenza age distribution data from WHO/WPRO (last updated 6/19/08): http://www.wpro.who.int/sites/csr/data/data_Graphs.htm
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 9/15/08): http://gamapserver.who.int/mapLibrary/
WHOfs timeline of important H5N1-related events (last updated 9/8/08): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html
Indonesia: Retrospective announcement of two confirmed human avian influenza H5N1 deaths
The Ministry of Health of Indonesia has retrospectively announced two confirmed cases of human infection with the H5N1 avian influenza virus. The first case, a 38-year-old male from Tangerang Municipality, Banten Province developed symptoms on 4 Jul 2008, was hospitalized on 9 Jul and died on 10 Jul 2008. There were free-roaming poultry throughout his neighborhood, including a commercial poultry pen owned by a neighbor. The second case, a 20-year-old male from Tangerang District, Banten Province developed symptoms on 20 Jul, was hospitalized on 29 Jul, and died on 31 Jul 2008. Reports indicate that chickens from the case's household had died in the week preceding the onset of his symptoms and that he had slaughtered and consumed some of his stock during this period. Of the 137 cases confirmed to date in Indonesia, 112 have been fatal.
New Zealand: Low-pathogenic avian influenza H5N1 found in ducks
Findings in New Zealand's wild birds are similar to those in the United States. A 17 Sep 2008 update from the Highly Pathogenic Avian Influenza Early Detection Data System (HEDDS), representing wild-bird surveillance by US federal and state agencies, says 27,231 birds have been sampled this year. Eight samples tested positive for presumed low-pathogenic avian influenza.
Togo: Recent bird flu outbreak confirmed as H5N1 avian influenza
Togo state television says lab tests performed after a recent outbreak of bird flu have confirmed the presence of the H5N1 strain of the virus, which has the potential to infect humans. However, no human cases have been detected so far in Togo. State media reported 15 Sep 2008 that the lab tests were carried out by experts in Ghana and Italy after the outbreak was discovered among several thousand birds in Agbata outside the capital of Lome during the week of 8 Sep 2008. The health ministry says, "Precautionary measures have been taken to contain the situation." Togo's eastern neighbor, Benin, notified the World Organization for Animal Health of an H5N1 outbreak, reportedly starting 29 Jul 2008, on its southern border with Togo. Togo reported three H5N1 outbreaks in 2007.
(ProMED 9/17/08; CIDRAP 9/17/08)
2. Infectious Disease News
Russia (Bashkortostan): Anthrax infection confirmed in 11 persons
The Management of Rospotrebnadzor in Bashkortostan reports that anthrax cases have been confirmed and that as of 1 Sep 2008, the number of registered cases of anthrax are 11 persons. All of them are in the hospital. Since August 2008, 30 specialists have been investigating samples of soil and water collected in Yanaul and the Yanaulsky district. Work will continue up to 10 Sep 2008. Analyses are being carried out in the Centre of Hygiene & Epidemiology of Bashkortostan. 172.5 kg of meat has been removed from the population and destroyed. Anti-epidemic, preventive, and treatment measures have been employed.
Russia (Magadan): Trichinellosis outbreak hospitalizes 12
Russia (Voronezhska): Two die of rabies virus infection
Russia (Pskov): Three more cases of tick-born encephalitis in Pskov region
Singapore: Chikungunya fever outbreaks continue
Taipei (Changhua): 11 deaths attributed to hand, foot, and mouth disease in 2008
The latest victim came down with a fever, vomiting, and vesicular eruptions in the mouth on 26 Aug 2008 and was hospitalized on 29 Aug 2008 when he developed a skin rash. The boy was discharged from hospital two days later, according to a report from the Changhua health authorities. However, on 1 Sep 2008, the boy was hospitalized again after he took a sudden turn for the worse and died on 4 Sep 2008.
CDC statistics showed that from the beginning of 2008 to 8 Sep 2008, a total of 352 severe enterovirus infections were recorded in the country, 11 of which were fatal and 93 percent of which were caused by enterovirus type 71 (EV71). Of these 352 cases, 63 were in children under the age of one, 97 involved one-year olds, and 96 were two-year-olds. According to the CDC, the largest number of cases occurred in the central and southern parts of Taiwan, with 49 cases in Tainan County and 48 in Changhua County.
While the 2008 enterovirus outbreak slowed down noticeably following the start of the summer vacation in July 2008, a new peak was expected after school reopened in September 2008. Shih, however, said no suspected cases of severe enterovirus infection have been reported since 1 Sep 2008, which indicates that the expected peak has not occurred. Shih reminded the public that sporadic enterovirus infections can occur in Taiwan even when the virus is not in season, and he advised people to maintain good hygiene to prevent infection and avoid passing the virus to young children in their families.
Canada (Quebec): Shellfish harvesting sites close due to red tide
A toxic algal bloom, also known as red tide, some 600 square kilometers in size, developed in early August 2008 in the St. Lawrence Estuary (SLE), Quebec, Canada, and resulted in an unprecedented faunal mortality event in the SLE. Alexandrium tamarense, a toxic dinoflagellate, naturally present in the SLE and Gulf of St. Lawrence can bloom when the temperature rises and salinity decreases in surface waters as a result of increased freshwater runoff in the St. Lawrence River and coastal tributaries. Alexandrium tamarense produces saxitoxin that affects the nervous system and can cause paralytic shellfish poisoning (PSP) following consumption of toxin-contaminated organisms.
At the end of July and in early August 2008 heavy precipitation, warm temperatures, and calm surface waters favored the blooming of the dinoflagellate. On 8 Aug 2008 about 100 dead birds (8 different species) were first observed by Parks Canada staff near Tadoussac at the confluence of the Saquenay River and St. Lawrence Estuary. Numerous dead fish, birds, whales and seals were observed floating dead or stranded dead on shore. The bloom dissipated due to strong winds during the week of 18 Aug 2008 as it reached the Gulf of St. Lawrence.
During the toxic algal bloom the Canadian Department of Fisheries and Oceans (DFO) closed all the shellfish harvesting areas in the affected zone to protect public health. The Canadian Food Inspection Agency (CFIA) monitors various shellfish sites in the SLE and advises closure when levels of toxin in shellfish exceed the accepted norm. As a precaution the CFIA and Health Canada advised the public against eating the liver and viscera of fish and invertebrates caught in the SLE during the red tide event and advised against eating the viscera of waterfowl hunted this fall. Saxitoxin accumulates in the digestive system of affected organisms but not in the flesh.
USA: CDC reports on results for new public health gno flyh list
The list is managed by the CDC and the US Department of Homeland Security (DHS), though it said the DHS defers public health decisions and actions to the CDC. According to the provisions of the DNB list, state and local health officials must contact their local CDC quarantine station to place a person on the DNB list. Then the CDC determines if the person is: likely contagious with a communicable disease that presents a serious public health threat; unaware of or likely to not comply with public health recommendations and medical treatment; likely to try boarding a commercial aircraft. The CDC said it has several criteria for deciding when to add or remove people from the DNB list. Once public health officials determine a patient is not contagious, the CDC and DHS remove the person from the list, usually within 24 hours. The CDC also said it reviews the list each month to determine if anyone on the list is eligible for removal.
According to the MMWR report, the CDC received 42 requests to add persons to the DNB list, all of whom had suspected or confirmed pulmonary tuberculosis (TB). The agency approved 33 (79%) of the requests. Of the 9 people who were not added to the list, 4 were subject to other local public health actions such as isolation orders, 3 agreed not to fly, and 2 were determined to be noncontagious.
Of the 33 people who were added to the list, 28 were placed by public health departments in the US. Fourteen of the 33 were placed on the list while they were outside of the country. Two of the 33 people who were placed on the DNB list attempted to evade the air travel restriction, and both were detained by border officials and were taken to local hospitals for evaluation and treatment of TB. CDC said judicious use of the DNB list could help avoid the human and economic burdens of contact investigations that result when people with communicable diseases fly.
USA (New York): Dialysis center shut down after patient tests positive for hepatitis C
USA (Utah): Man dies of hantavirus pulmonary syndrome
Health officials are investigating the death but suspect the man was exposed to a hantavirus while cleaning up rodent droppings. Hantaviruses are shed in the urine and fecal droppings of rodents. Humans can become infected by inhaling dust that contains dried contaminated rodent urine or feces. The health department said extreme care should be taken when cleaning up rodent droppings. Clean up rodent droppings using a wet method such as spraying disinfectant, such as diluted bleach, prior to cleaning. Then use a wet mop or towel moistened with disinfectant to clean, the agency said. Do not clean up rodent droppings using a dry method, such as sweeping and vacuuming.
USA (Oklahoma): E. coli O111 outbreak continues with 291 cases, one killed
The Oklahoma State Department of Health (OSDH) reported on 4 Sep 2008 that laboratory analysis of water samples taken from a private well on the property of the Economy Cottage restaurant in Locust Grove, OK has found no disease-causing bacteria. "The well water is not the source of this outbreak," said State Epidemiologist Dr. Kristy Bradley. "We are continuing our efforts to conduct microbiological testing of food preparation and serving surfaces in the restaurant, and we continue to interview cases, as we try to establish an association with those who became ill and a potential source."
"This appears to be the largest E. coli O111 outbreak ever reported in the USA," Bradley stated. "The complexity of this outbreak and the necessity to be extremely thorough in our investigation means we still have more questions than answers." OSDH investigators, along with staff from the Tulsa Health Department and area local county health departments have interviewed more than 500 persons in an effort to identify the source of the outbreak. The restaurant is closed while the investigation continues. Not all persons who ate at the restaurant have become ill. No other restaurant or food service outlet in the area has been linked to the outbreak.
Health officials say E. coli O111 is a rare type not normally associated with an outbreak this large. Although much attention has been paid to O157:H7 strains of E. coli that cause enterohemorrhagic disease with or without hemolytic-uremic syndrome (HUS), other serotypes of E. coli, as seen in this outbreak, have been associated with this illness.
USA (Pennsylvania): Two human salmonella cases lead to pet food recall
The same serotype of S. Schwarzengrund and the same manufacturer were involved in another situation in 2007. It is not clear whether the same plant was involved or whether the bacterial strains are genetically linked. The relationship between the two human cases and the dog food is also unclear.
- UN: http://www.undp.org/mdtf/influenza/overview.shtml UNDPfs web site for information on fund management and administrative services and includes the website of the Central Fund for Influenza Action. This site also includes a list of useful links.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html The Influenza Virus Tracking System can be accessed at: www.who.int/fluvirus_tracker.
- UN FAO: http://www.fao.org/avianflu/en/index.html. View the latest avian influenza outbreak maps, upcoming events, and key documents on avian influenza.
- OIE: http://www.oie.int/eng/info_ev/en_AI_avianinfluenza.htm. Link to the Communication Portal gives latest facts, updates, timeline, and more.
- US CDC: Visit "Pandemic Influenza Preparedness Tools for Professionals" at: http://www.cdc.gov/flu/pandemic/preparednesstools.htm. This site contains resources to help hospital administrators and state and local health officials prepare for the next influenza pandemic.
- The US governmentfs website for pandemic/avian flu: http://www.pandemicflu.gov/. View archived Webcasts on influenza pandemic planning.
- CIDRAP: http://www.cidrap.umn.edu/ See information on the upcoming gAvoiding the Big 7 Pandemic-Planning Mistakesh Webinar (October 9, 2008).
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm Link to the Avian Influenza Portal at: http://influenza.bvsalud.org/php/level.php?lang=en&component=19&item=1. The Portal is a developing project for the operation of product networks and information services, for specialists, authorities and the general public.
- US National Wildlife Health Center: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp Read about the latest news on H5N1 in wild birds and poultry.
(UN; WHO; FAO, OIE; CDC; CIDRAP; PAHO; USGS)
CHOLERA, DIARRHEA, AND DYSENTERY
Unofficial records show that there are already 6000 cases of acute gastroenteritis in the province. The provincial health office is now providing chlorine solution to barangays with contaminated shallow tube wells to alleviate the number of cholera cases.
Norma Jacobo Hernandez, Chief of the Department of Vectors and Zoonoses of the state Secretariat of Health (SSJ) recognized that, in concentrating their efforts in coastal communities, preventive actions in Metropolitan Guadalajara have been relaxed. "In coastal areas, in contrast to Zapopan, there have been frequent and continuous efforts to eliminate mosquito breeding sites within houses and we have not carried out this activity with such frequency in Metropolitan Guadalajara," said Jacobo Hernandez. She indicated that the factor which most favors the presence of the mosquito vector of dengue disease virus is the presence in homes of containers where clean water is stored, which is an ideal site for mosquito breeding. Up until now, the actions and operations have not been sufficient to eliminate all of the mosquito breeding sites. For this reason, community participation is necessary so that every person does their part in the elimination of breeding sites in their homes. "The idea that simply applying insecticides can control dengue outbreaks is false, but it is simply not that way, it requires the participation of the community, because I could apply insecticides that would give me results for a week, but if people don't eliminate breeding sites, we will have problems with dengue again a week later," she emphasized.
The mosquitoes have great reproductive capacity. Vector mosquitoes located in Zapopan increases the possibility that the outbreak might extend to other municipalities in the metropolitan area. The mosquito can fly up to 200 meters, but it is also possible that they can travel greater distances. For example, people can transport them in their cars to other places by accident. The collective municipalities within metropolitan Guadalajara essentially present one large populated area and there would be few barriers to inhibit the spread of the vectors or the viruses within it.
Vietnam (Ho Chi Minh City)
However, there is no data to suggest that dengue virus infections caused by different members of the Aedes species of mosquitoes are more severe than others. The A. albopictus mosquito has been a rural and suburban mosquito, whereas the A. aegypti mosquito is an urban mosquito.
Influenza vaccines: research, development and public health challenges
Osterhaus ADME & Poland G, Eds. Vaccine. 12 Sep 2008; 26(4): D1-D74. http://www.sciencedirect.com/science/journal/0264410X
A special issue of the journal Vaccine addressing the research, development, and public health challenges of influenza vaccines.
Effects of school closures during the 2008 winter influenza season, Hong Kong
On 12 Mar 2008 after three children died, apparently from seasonal flu, Hong Kong's government announced that all primary schools, special schools, kindergartens, and day nurseries would close for two weeks, the authors reported. The closure, which came a week before the start of the annual week-long Easter break, occurred during the peak of the area's winter flu season. The closure was Hong Kong's first since the SARS (severe acute respiratory syndrome) epidemic of 2003, and it affected nearly 560,000 children.
According to the research group's review of the surveillance data, the flu season was already waning when officials decided to close the schools. Their review of outpatient consultation data revealed that the 2008 winter flu season was moderately severe compared with the previous nine years. The authors found that routine surveillance did not show a large effect from the school closures. They concluded that epidemic curves based on the surveillance data showed that a decline in flu cases after the school closure might have occurred even without any intervention, though they warned that changes in an epidemic curve may lag behind changes in transmission dynamics, as had been shown for SARS.
Their results should be interpreted cautiously, the researchers wrote. "In particular, influenza might have continued to circulate for a longer period had the school closures not been implemented." The authors also acknowledged that other studies suggest school closures can mitigate flu epidemics. Public officials who decided to close the Hong Kong schools might not have known from the data they had that the flu season was moderate and might have already been declining naturally, the report says. Surveillance system improvements, particularly real-time or near real-time reporting, could help officials make more informed decisions, it adds.
Jeffrey Duchin, chief of communicable disease control for Seattle King County Public Health in Washington, told CIDRAP News that it isn't surprising that the study didn't detect a benefit from school closure late in a flu season. "After all, most persons in the community would have already been infected," he said. Given the relative mildness of the season, indirect indicators of flu activity would have been less sensitive, he said, adding that it's difficult to study the impact of school closures on transmission retrospectively, because schools typically close late in the flu season. gThe cost-benefit of closing schools in seasonal epidemics that are not at the high end of the severity scale is probably low, and few if any close early [in the season]," Duchin said. Real-time surveillance might be especially important in more severe flu epidemics, in which officials would need to gauge the impact of school closure, he said.
Effectiveness of maternal influenza immunization in mothers and infants
Abstract: Background Young infants and pregnant women are at increased risk for serious consequences of influenza infection. Inactivated influenza vaccine is recommended for pregnant women but is not licensed for infants younger than 6 months of age. We assessed the clinical effectiveness of inactivated influenza vaccine administered during pregnancy in Bangladesh. Methods In this randomized study, we assigned 340 mothers to receive either inactivated influenza vaccine (influenza-vaccine group) or the 23-valent pneumococcal polysaccharide vaccine (control group). Mothers were interviewed weekly to assess illnesses until 24 weeks after birth. Subjects with febrile respiratory illness were assessed clinically, and ill infants were tested for influenza antigens. We estimated the incidence of illness, incidence rate ratios, and vaccine effectiveness. Results Mothers and infants were observed from August 2004 through December 2005. Among infants of mothers who received influenza vaccine, there were fewer cases of laboratory-confirmed influenza than among infants in the control group (6 cases and 16 cases, respectively), with a vaccine effectiveness of 63% (95% confidence interval [CI], 5 to 85). Respiratory illness with fever occurred in 110 infants in the influenza-vaccine group and 153 infants in the control group, with a vaccine effectiveness of 29% (95% CI, 7 to 46). Among the mothers, there was a reduction in the rate of respiratory illness with fever of 36% (95% CI, 4 to 57). Conclusions Inactivated influenza vaccine reduced proven influenza illness by 63% in infants up to 6 months of age and averted approximately a third of all febrile respiratory illnesses in mothers and young infants. Maternal influenza immunization is a strategy with substantial benefits for both mothers and infants.
Preparing for the Real Storm during the Calm: A Comparison of the Crisis Preparation Strategies for Pandemic Influenza in China and the U.S.
Abstract: Humanity is facing the rapid spread of avian flu and the potential severe threat of a future global pandemic flu. The World Health Organization (WHO) and the governments of various countries and regions have proposed plans for managing a pandemic flu. China and the U.S. also issued their own preparation plans in September and November, 2005, respectively. This article asks whether there are vulnerabilities or shortcomings inherent in either preparation plan, and if so, what measures should be taken to improve them. The article first provides a theoretical analysis of the issues of crisis preparation, chiefly from the perspective of a real crisis. Second, it does some crisis analysis of a pandemic flu and proposes preliminary preparation strategies to deal with it. More importantly, it compares the United States and China concerning their crisis preparation strategies, including the process of forming strategies, cognition of risks, choices of goals, basic principles, framework, and implementation. Finally, it concludes by making some suggestions for crisis policy formulation regarding a pandemic flu.
Pandemic influenza in Australia: Using telephone surveys to measure perceptions of threat and willingness to comply
Abstract: Background: Baseline data is necessary for monitoring how a population perceives the threat of pandemic influenza, and perceives how it would behave in the event of pandemic influenza. Our aim was to develop a module of questions for use in telephone health surveys on perceptions of threat of pandemic influenza, and on preparedness to comply with specific public health behaviors in the event of pandemic influenza. Methods: A module of questions was developed and field tested on 192 adults using the New South Wales Department of Health's in-house Computer Assisted Telephone Interviewing (CATI) facility. The questions were then modified and re field tested on 202 adults. The module was then incorporated into the New South Wales Population Health Survey in the first quarter of 2007. A representative sample of 2,081 adults completed the module. Their responses were weighted against the state population. Results: The reliability of the questions was acceptable with Kappa ranging between 0.25 and 0.51. Overall 14.9% of the state population thought pandemic influenza was very or extremely likely to occur; 45.5% were very or extremely concerned that they or their family would be affected by pandemic influenza if it occurred; and 23.8% had made some level of change to the way they live their life because of the possibility of pandemic influenza. In the event of pandemic influenza, the majority of the population were willing to: be vaccinated (75.4%), be isolated (70.2%), and wear a face mask (59.9%). People with higher levels of threat perception are significantly more likely to be willing to comply with specific public health behaviors. Conclusion: While only 14.9% of the state population thought pandemic influenza was very or extremely likely to occur, a significantly higher proportion were concerned for self and family should a pandemic actually occur. The baseline data collected in this survey will be useful for monitoring changes over time in the population's perceptions of threat, and preparedness to comply with specific public health behaviors.
Identification of cardioviruses related to Theiler's murine encephalomyelitis virus in human infections
Abstract: Cardioviruses comprise a genus of picornaviruses that cause severe illnesses in rodents, but little is known about the prevalence, diversity, or spectrum of disease of such agents among humans. A single cardiovirus isolate, Saffold virus, was cultured in 1981 in stool from an infant with fever. Here, we describe the identification of a group of human cardioviruses that have been cloned directly from patient specimens, the 1st of which was detected using a pan-viral microarray in respiratory secretions from a child with influenza-like illness. Phylogenetic analysis of the nearly complete viral genome (7961 bp) revealed that this virus belongs to the Theiler's murine encephalomyelitis virus (TMEV) subgroup of cardioviruses and is most closely related to Saffold virus. Subsequent screening by RT-PCR [reverse transcriptase polymerase chain reaction] of 719 additional respiratory specimens [637 (89 percent) from patients with acute respiratory illness] and 400 cerebrospinal fluid specimens from patients with neurological disease (aseptic meningitis, encephalitis, and multiple sclerosis) revealed no evidence of cardiovirus infection. However, screening of 751 stool specimens from 498 individuals in a gastroenteritis cohort resulted in the detection of 6 additional cardioviruses (1.2 percent). Although all 8 human cardioviruses (including Saffold virus) clustered together by phylogenetic analysis, significant sequence diversity was observed in the VP1 gene (66.9 percent-100 percent pairwise amino acid identities). These findings suggest that there exists a diverse group of novel human Theiler's murine encephalomyelitis virus-like cardioviruses that hitherto have gone largely undetected, are found primarily in the gastrointestinal tract, can be shed asymptomatically, and have potential links to enteric and extra intestinal disease.
Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection
Surveillance for Waterborne Disease and Outbreaks Associated with Recreational Water Use and Other Aquatic Facility-Associated Health Events--United States, 2005--2006
Surveillance for Waterborne Disease and Outbreaks Associated with Drinking Water and Water not Intended for Drinking--United States, 2005--2006
Public Health Informatics Fellowship Application Deadline--November 14, 2008
CDC offers a two-year postgraduate fellowship in public health informatics, the systematic application of information technology to public health practice, research, and learning. Fellows receive training in both informatics and public health, are assigned to teams involved in research and development of CDC information systems, and are given the opportunity to lead one or more major projects during their fellowships. The deadline to apply for the fellowship period beginning Jul 2009 is Nov 14, 2008. Additional information regarding the application process: http://www.cdc.gov/epo/phifp/appinfo.htm. Additional information regarding the program: http://www.cdc.gov/epo/phifp, by telephone, 404-498-6219, or by e-mail, email@example.com (subject line: request info).
http://cdc.gov/mmwr/preview/mmwrhtml/mm5735a4.htm (MMWR September 5, 2008 / 57(35);970-971)
International Symposium on Viral Hepatitis and Liver Disease
Ethics and Severe Pandemic Influenza: Maintaining Essential Functions through a Fair and Considered Response
This article provides ethics guidance for pandemic planning, response, and resource allocationthat is, what ethical considerations determine which public health responses are implemented, who will be restricted and who will be helped, what will be communicated to the public, and how will the public be included in decisions and responses?
The response to severe pandemic influenza will be managed by experts in public health and infectious disease and by government officials to whom the public will turn for information and direction. Nonetheless, there remain important ethical considerations that can shape what goals are given priority, how scarce resources are distributed, how the public is included, and how we treat the most vulnerable in our response to a pandemic. This article assumes that the secondary consequences of severe pandemic influenza could be greater than deaths and illness from influenza itself. Response plans then, must consider threats to societal as well as medical infrastructures. While some have suggested that scarce medical countermeasures be allocated primarily to first responders and then to the sickest, we suggest that an ethical public health response should set priorities based on essential functions. An ethical response also will engage the public, will coordinate interdependent sectors as a core preparedness priority, and will address how plans affect and can be understood by the least well off.
US policy regarding pandemic influenza vaccines
This paper from the Congressional Budget Office (CBO) focuses on the governmentfs role, under the U.S. Department of Health and Human Servicefs (HHS) plan to prepare for and combat an influenza pandemic, in the development of new vaccines and the capacity to manufacture them. It provides information on progress and on the potential cost of achieving HHSfs vaccine-related goals, the continuing expenditures that are likely to be needed to maintain preparedness, and the experience of other countries in preparing for a possible pandemic. It also presents options for modifying HHSfs 2005 plan. The work is based on a review of the academic literature, on industry data, and on interviews with government and industry experts who are working to improve the response of vaccine producers to a potential influenza pandemic.
Practical Management Strategies for Avian Influenza and Emerging Infectious Diseases--The Implementation Toolkit
Participants identified specific materials and examples to be included in the toolkit. The toolkit is designed to be a one stop shopEfor sharing experiences and accessing materials used by other countries. There was consensus that the value of the website would be enhanced by an interactive forum that allowed information and resource sharing and discussion. Participants also agreed that it was extremely important that work continue to collect and document country experiences to develop case studies for the website, as very little of this information has been documented or shared in other places. The toolkit launch will take place at the next global Ministerial Conference for Avian and Pandemic Influenza scheduled for 24-26 October in Sharm El-Sheikh, Egypt.