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Vol. XI, No. 21 ~ EINet News Briefs ~ Oct 17, 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)
- USA: APIC seeks mandate for influenza shots in health workers
- USA: Seven states report sporadic influenza cases
- USA: Governors group identifies states' pandemic-preparedness gaps
2. Infectious Disease News
- Global: Wildlife group lists diseases that global warming may spur
- Global: Two firms win NIAID support for Ebola-Marburg vaccines
- Global: Polio vaccination may continue after wild virus fades
- Indonesia: Chikungunya virus epidemic continues to spread
- Russia (Stavropol): Increased incidence of Crimean-Congo hemorrhagic fever with six fatalities
- Russia (Perm): Tick-borne encephalitis diagnosed in 85 people
- Viet Nam: Foot-and-mouth disease outbreak continues
- Viet Nam: Woman diagnosed with hantavirus infection
- Canada: Death toll from listeriosis outbreak reaches 20
- Canada (Ontario): Streptococcal strain infects over 300 people and kills ten
- Canada (Ontario): E. coli O157:H7 outbreak sickens 50 and hospitalizes 19
- Canada (Saskatchewan): Nine babies infected in C. difficile outbreak in the regional NICU
- USA: Trial offers hope for shortening anthrax-shot series
- USA (Alaska): Adenovirus hospitalizes seven and kills one on Prince of Wales Island
- USA (Arizona): Man contracts bubonic plague
- USA (California): E. coli confirmed in the illness of 27 people
- USA (Michigan): E. coli outbreak linked to lettuce from California
- USA (Montana): 80 elementary school students exposed to dead rabid bat
- USA (Texas): Elderly man infected with rabies after bitten by kitten
- USA (New Jersey): Three die after contracting Legionnaires’ disease
- AVIAN/PANDEMIC INFLUENZA
- CHOLERA, DIARRHEA, AND DYSENTERY
- WEST NILE VIRUS
- Of Milk, Health, and Trade Security
- Rand report proposes standards for mass antibiotic dispensing
- Responses to Avian Influenza and State of Pandemic Readiness: Fourth Global Progress Report
- First World Congress of Vaccine conference
- Updated Recommendations for Isolation of Persons with Mumps
- Seventh International Bird Flu Summit
- Upcoming conferences on Asia-Pacific economics
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: 385 (243).
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 10.06.08): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 9.23.08): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html
USA: APIC seeks mandate for influenza shots in health workers
In the face of chronic low influenza vaccination rates among healthcare workers, the leading US society of infection control professionals says it's time to require medically eligible workers to either get the immunization or sign a form saying they understand the risks to patients if they skip it. "As part of a comprehensive strategy, we recommend that influenza vaccine be required annually for all healthcare personnel with direct patient care," the Association for Professionals in Infection Control and Epidemiology (APIC) said in a policy statement released 9 Oct 2008. APIC urges vaccination for all medical and nonmedical personnel in contact with patients or patient samples, including physicians, nurses, physical therapists, dieticians, religious workers, and cleaning, kitchen, and laboratory personnel.
Recent national survey data show that only 42% of healthcare workers receive an annual flu shot, and the rate has not risen significantly in the past decade, the APIC statement notes. Long-standing recommendations from APIC, the Centers for Disease Control and Prevention, and other national organizations have made little difference. "Voluntary efforts are clearly not effective—it's time for hospitals and other healthcare facilities to require influenza immunization," said Linda R. Greene, lead author of APIC's position statement. The policy statement notes that health workers can transmit the flu virus to others before they have any symptoms. Further, it says multiple studies show that 70% of health workers continue to work even when sick with the flu.
APIC has strongly advocated flu shots for healthcare workers for years, along with a variety of strategies to promote them, but this is the first time the organization has used the word "require," according to Greene. She said the declination form is the major new element in APIC's recommendation, but emphasized that it should be just part of a broad strategy for encouraging immunization. "This isn't just a declination that says, 'I don't want to get it and here's the reason.' It's an informed declination, where the employee really understands that by refusing to get the vaccine for other than medical reasons, they're not only putting their patients at risk, but also themselves and their family and the community as a whole," said Greene. But other measures must be linked with informed declination, she said. There is only limited evidence on how well declination forms work, she said. "But what we see is that declination alone, if you're not going to employ the other measures, has not necessarily been particularly effective," yielding only modest increases in immunization rates.
Greene hopes for much better results with a more comprehensive approach [in 2008]. Greene said a key part of promoting flu immunization is enlisting the support of a facility's administration and other departments, so "it's not just sitting in occupational health." Administrators can promote the effort by using the flu immunization rate as an important indicator of safety and quality for the facility, she said. In New York state, informed declination has been used successfully with hepatitis B vaccine for healthcare workers, Greene said. "We've found that we have a very, very high acceptance rate for the hepatitis vaccine." The vaccine is offered to direct-care workers when they are hired, and they see it as a benefit for protecting themselves, she added.
USA: Seven states report sporadic influenza cases
USA: Governors group identifies states' pandemic-preparedness gaps
2. Infectious Disease News
Global: Wildlife group lists diseases that global warming may spur
The Wildlife Conservation Society (WCS) has included avian influenza, Ebola fever, Rift Valley fever, and plague on a list of 12 diseases and pathogens that it believes may spread to new regions as a result of climate change. The report, titled "The Deadly Dozen: Wildlife Diseases in the Age of Climate Change," gives examples of diseases that may increase their ranges in response to changing temperatures and precipitation patterns, threatening wildlife and human health and causing economic damage.
More than melting ice caps
• Avian influenza: Currently the poultry business largely drives the geographic movement of H5N1 avian flu, "but changes in climate such as severe winter storms and droughts can disrupt normal movements of wild birds and can bring both wild and domestic bird populations into greater contact at remaining water sources."
Other diseases and pathogens on the WCS list are babesiosis, cholera, intestinal and external parasites, Lyme disease, harmful algal blooms called red tides, trypanosomiasis, tuberculosis, and yellow fever. The list does not include some other mosquito-borne diseases that have often been mentioned as candidates to increase their ranges in a warming world, such as dengue fever, malaria, and chikungunya fever.
Global: Two firms win NIAID support for Ebola-Marburg vaccines
Global: Polio vaccination may continue after wild virus fades
Writing in the New England Journal of Medicine, researchers from Imperial College London, the World Health Organization (WHO), and the National Primary Health Care Development Agency of Nigeria say that an oral vaccine containing a single strain of poliovirus produces four times greater immunity in children than the long-used three-strain vaccine does. Separately, a multinational team led by experts from the Egyptian government, two Egyptian universities, and a Cairo hospital say that the single-strain or monovalent oral vaccine not only produces superior immunity, but also reduces the likelihood that recipients will shed vaccine virus after being dosed.
Those two findings are good news for the WHO, which pushed for development of a monovalent vaccine and considers its deployment since 2005 a key element in the eradication struggle. But an accompanying editorial says these results represent only limited gains—because in order to finish the job of eradication and protect against its aftereffects, the campaign must abandon the oral vaccine and begin using the much more expensive injectable version. "Poliovirus will not go away after circulation of wild-type virus is halted, and a high level of immunity in the global population must be maintained—and not just in high-income countries that have already switched to the safer but more expensive" injectable vaccine, Ellie Ehrenfeld, of the National Institutes of Health, and Konstantin Chumakov, of the Food and Drug Administration stated.
Indonesia: Chikungunya virus epidemic continues to spread
Chikungunya virus has infected a total of 5200 villagers in Pangke, Kabupaten Tanjung Balai Karimun, of Kepulauan Riau province. The residents could not take medicine because they did not have the funds to cover the cost. The illness became epidemic in Pangke Village beginning in July2008, but many residents did not realize it. Moreover, their village was under the jurisdiction of a community health centre ten kilometers away, which made procuring medicine difficult.
The head of the Pangke Village, Bakhtiar, urged the government to help immediately. The residents have relied only on traditional medicine to cure this illness thus far. In addition, at least ten residents of Pangke Village, Kecamatan Meral, Karimun were attacked by chikungunya virus. "The illness began to spread, since a week ago, in the Meral Subdistrict. The data collected indicate that [people in] two villages have already been infected with the illness, first in the Pangke Village totaling ten people and in the Sidorejo Village totaling seven people," said the Head of the Meral Community Health Centre, Rusdi Hendra, in the Meral Community Health Centre, on 7 Oct 2008.
The incubation period is approximately two to four days. The virus that causes the spread of the disease is an alphavirus transmitted by bites of the Aedes aegypti species of mosquitoes. Symptoms typically resolve on their own and without intervention.
He explained that the 17 residents who are suffering from chikungunya disease are currently recuperating. Asked about the characteristics of the disease, he explained, the patient initially experiences high fever, followed by pain in muscles and joints, and lymph gland enlargement. Not infrequently, the symptoms of pain in the joints and muscles are very intense and enough to cause temporary paralysis. In addition, he said although the disease is not as dangerous as dengue fever, authorities still are taking preventative steps and are spraying and treating water catchments with abate in two of the villages.
Russia (Stavropol): Increased incidence of Crimean-Congo hemorrhagic fever with six fatalities
In five of the six fatal cases, the patients were admitted for medical treatment promptly (i.e. on the first or second day following the onset of symptoms). But unfortunately, diagnosis of CCHF was delayed, and appropriate treatment was not initiated early enough. In the Levokumsky district, the diagnosis of CCHF was not confirmed until one month after the death of one patient. Recently, CCHF has been diagnosed in two physicians in the same hospital. In 2006 and 2007, 41 and 64 cases of CCHF were recorded in the Stavropol Krai region respectively.
Russia (Perm): Tick-borne encephalitis diagnosed in 85 people
Viet Nam: Foot-and-mouth disease outbreak continues
Viet Nam: Woman diagnosed with hantavirus infection
The woman fell ill with a high fever on 20 Sep 2008 and was diagnosed with dengue fever by her doctor. Since the fever had not subsided three days later, she was hospitalized with viral fever. The patient then began having kidney problems, difficulty breathing, and blood showed in her urine, plus her stomach swelled and her lungs began to fill with fluid. She was moved to the cardiovascular department when her heartbeat slowed. She also had polyuria (excessive urination), fluid leakage in the outer cardiac membrane, and other lung problems.
On 3 Oct 2008, the patient was diagnosed with hantavirus infection at HCMC Pasteur Institute. The patient said she had seen mouse feces in her home. The institute has given her family eight mousetraps to catch mice in her house and also some nearby residences.
Hantavirus disease has an incubation time of nine to 35 days in humans before symptoms of infection occur, according to Nam. No specific medications for the disease are available now, although ribavirin, an anti-viral drug, is effective in the first stage of treatment in helping to decrease the likelihood of death, Nam said. He added that the most effective treatment is intensive care, respiratory support, and the timely treatment of cardiovascular problems. Hantavirus infection has historically killed more than half of those infected since its discovery in 1993.
Canada: Death toll from listeriosis outbreak reaches 20
The number of deaths from a listeriosis outbreak that have been linked to contaminated meat products has reached 20, Canadian health officials said on 1 Oct 2008. The latest death occurred in Ontario, where 15 of the deaths have been reported. Two deaths occurred in the western province of British Columbia, with one each in Alberta, Quebec, and New Brunswick. The health agency said six other deaths under investigation may also have resulted from the outbreak. The disease originated from the Toronto deli-meat processing branch of Maple Leaf Foods plant, Canada's biggest food company. The Listeria bacterium was found deep inside slicing equipment. The plant reopened 4 weeks after being closed on 20 Aug 2008. Several class-action suits are being planned as a result of the outbreak, which has led to one of the most serious food crises in recent Canadian history.
Canada (Ontario): Streptococcal strain infects over 300 people and kills ten
The city's officials also said they've treated another 75 people with invasive Group A streptococcal infections over the past year. Cases of Group A strep began surfacing in the Thunder Bay area in late summer 2007, which wasn't particularly unusual for an infectious disease that's known as the cause of strep throat. But cases continued to rise, growing beyond the normal six cases and one death per year. When the local health unit recognized an influx of more severe cases Feb 2008, officials began their probe and found about half of the cases belonged to a strain never seen before in the province, said health unit epidemiologist Lee Sieswerda. The strain, called emm-59, was already known in the western provinces.
Starting in 2006, a smattering of victims across the West became infected with the bug that's now linked to more than 300 cases in the region, said Greg Tyrrell, director of Edmonton's National Centre for Streptococcus. At its worse, the Group A streptococci bacterium causes life-threatening illnesses such as necrotizing fasciitis (commonly known as flesh-eating disease) and streptococcal toxic shock syndrome. In Thunder Bay, the infected group ranges in age from the mid-20s to the mid-50s and is comprised of about 60 percent men. About 38 percent are classified as intravenous drug users and another 15 percent are "underhoused," Sieswerda said. Although he didn't know the breakdown of the dead, he said they ranged in age from 39 to 77.
"The risk to the general public is very low," Sieswerda said, adding he stands by the health unit's decision to not notify the public until this week. Health officials have worked to contain the outbreak by providing intensive followups, tracing the closest contacts of the infected people and increasing street outreach, he said. But Sieswerda, Williams, and a prominent microbiologist all agree there's a strong possibility the infection will continue to spread. "We've seen it in Western Canada, we're seeing it move east," said Dr. Donald Low, chief microbiologist at Toronto's Mount Sinai Hospital. Low said he wouldn't be surprised if the infection migrated by the end of October or November 2008. "There's a lot of movement of individuals from city to city, so there may well be an opportunity for this thing to hitchhike along with somebody and be introduced into a new community of individuals that are susceptible," he said.
Canada (Ontario): E. coli O157:H7 outbreak sickens 50 and hospitalizes 19
A total of 19 people have been hospitalized since the outbreak began 11-12 Oct 2008. Nine remained in hospital as of 15 Oct 2008, but none have been admitted to the intensive care unit. The people affected range in age from 9 to 84. While all of the cases of illness have been linked to one restaurant, it is possible the outbreak is part of a larger problem that could affect people in other communities, said Doug Powell, associate professor of food safety at Kansas State University. For instance, a product such as lettuce, which is usually shipped to food retailers across a large area, could be the source of contamination.
Canada (Saskatchewan): Nine babies infected in C. difficile outbreak in the regional NICU
This strain of C. difficile is easily treated, he added, noting that none of the babies have been seriously ill or died from this bacterial infection. This outbreak is not the same strain of the bacterial infection identified as a factor in hundreds of deaths in immune-compromised patients in Ontario hospitals over the past two years. The particular strain of C. difficile in the Ontario outbreak did not respond well to antibiotics, Slater said
C. difficile, one of the most common infections found in hospitals and long-term care facilities, causes diarrhea, fever, loss of appetite, nausea, and cramps. The bacteria which cause the infection is found in feces and can be spread if people touch items or surfaces that are contaminated with the bacterium or its spores and then touch their mouths or noses. It can also be spread through hand contact as a result of improper hand washing technique.
USA: Trial offers hope for shortening anthrax-shot series
In the study, volunteers who received three or four intramuscular (IM), instead of subcutaneous, doses over six months had about the same antibody responses at seven months as did volunteers who received the standard regimen, involving four subcutaneous doses in the first six months. In addition, those who received four IM doses had fewer negative effects at the injection site than did those who received four subcutaneous doses. "Changing the injection route from SQ [subcutaneous] to IM may increase vaccine acceptability," stated the report, published in the 2008 Oct 1 Journal of the American Medical Association. "Reducing the number of doses in the AVA regimen would have the added benefit of increasing the number of doses available for prophylactic use."
USA (Alaska): Adenovirus hospitalizes seven and kills one on Prince of Wales Island
Indications are that the virus is responsible for causing pneumonia in at least 32 people on the island and sickening an untold number of others who did not go to a clinic seeking medical treatment, she said. Seven of the 32 cases were severe enough to warrant medivacs to hospitals in surrounding communities, including one patient who was taken to Alaska Native Medical Center in Anchorage to be put on a ventilator. One woman died, she said. "That individual also had fairly significant underlying lung disease -- chronic obstructive lung disease -- and it would have put that person at a higher risk for a bad outcome with any other infection on top of that," Funk said.
The virus spreads similarly to the common cold. It is transferred from person to person by coughing and sneezing, and it can also be contracted by touching an object, like a doorknob, that has the virus on it and then touching one's mouth, nose or eyes, according to the CDC. As with other viruses, there's no cure for adenovirus; it moves through a community and will eventually cycle itself out, Funk said. Because there is a fair amount of travel to and from the island, particularly to Ketchikan, there was some concern the illness could spread to other communities, she said. But there have been no reports of widespread illness off of the island.
"Nationally, it's been seen only rarely until the past year, where there have been a number of outbreaks," she said. "It seems like it may be what we call an emerging infection." In the past two years, there have been outbreaks of the virus in Oregon, Washington and Texas. Funk believes that the number of illnesses reported from the very ill is only capturing the "tip of the iceberg."
USA (Arizona): Man contracts bubonic plague
USA (California): E. coli confirmed in the illness of 27 people
Hundreds of people attended a barbecue on 6 Sep 2008 that raised money for the volunteer fire department in Forest Ranch. Afterward, a number of people became sick with severe stomach cramps and diarrhea. Four people got so ill they had to be hospitalized. Health officials learned that the sickness was caused by a dangerous strain called E. coli O157:H7. Interviews with people who attended the event led officials to conclude the tri-tip was contaminated and made people sick. However, they couldn't be sure until the link was proven by test results from the state lab, Lundberg said 6 Oct 2008. It's still not known how the cooked meat became contaminated, he said, and it may never be known.
Food preparers at the event had the right equipment and seemed to do everything right, he said, but obviously something went wrong. When large amounts of food are prepared there is the potential for
contamination, he said. It's possible the cooked meat came into contact with juices from the raw meat. Or possibly, he said, someone who helped prepare the food was sick and didn't wash his or her hands properly.
USA (Michigan): E. coli outbreak linked to lettuce from California
Holton said on 14 Oct 2008 that it remained unclear where in the supply chain the product was contaminated. Dominic Riggio, Aunt Mid's president, said the company resumed processing iceberg lettuce 9 Oct 2008. Holton said that Aunt Mid's will test each lot of the product for 30 days and report the findings to the state department of agriculture, which also will perform random tests during that period. There have been 38 reported illnesses in Michigan and 21 hospitalizations. There also have been nine illnesses reported in Illinois and three in Ontario. No deaths have been associated with the outbreak.
USA (Montana): 80 elementary school students exposed to dead rabid bat
When school officials were notified, they called county and state health officials, sent letters home with every student who may have been exposed and sent the bat to a laboratory for testing. The bat tested positive for rabies. Rabies is a fatal neurological virus that can be spread through saliva, usually through a bite. While the risk of contracting the disease from the dead bat is low, Kultgen said the 80 students who touched the bat are "strongly encouraged" to get the shots. Their parents must give permission.
The exposed students will receive six shots of anti-rabies vaccine. School officials say they will use liability insurance to pay up to USD 70 000 for the exposed children to be vaccinated. The overall cost could surpass USD 150 000.The school has since set a policy requiring that anyone visiting the school obtain a visitor pass.
USA (Texas): Elderly man infected with rabies after bitten by kitten
Texas health officials have been rationing access to rabies vaccine since the two worldwide manufacturers have seen their supplies dwindle. Problems began in the summer of 2007 when one of the manufacturers, Sanofi Pasteur, began renovating its plant in France to comply with Food and Drug Administration regulations. The Centers for Disease Control and Prevention (CDC) reports that the shortage is unlikely to be resolved until mid- to late 2009.
USA (New Jersey): Three die after contracting Legionnaires’ disease
Legionnaires' disease is a form of pneumonia that can be spread through plumbing and air conditioning systems. Hospital officials traced the outbreak to a decrease in chlorine levels in the hospital's water system. The cause of the decrease was under investigation.
- UN: http://www.undp.org/mdtf/influenza/overview.shtml UNDP recently launched a new 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 to governments, international agencies, NGOs, and scientific organizations.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html The Influenza Virus Tracking System is now live and can be accessed by the public at: www.who.int/fluvirus_tracker.
- UN FAO: http://www.fao.org/avianflu/en/maps.html. View the latest cumulative highly pathogenic avian influenza outbreak maps.
- 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: http://www.cdc.gov/flu/avian/index.htm. 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 government’s website for pandemic/avian flu: http://www.pandemicflu.gov/. View the factsheet "Control of Pandemic Flu Virus on Environmental Surfaces in Homes and Public Places" at: http://www.pandemicflu.gov/plan/individual/panfacts.html
- CIDRAP: http://www.cidrap.umn.edu/ See information on the upcoming “Big 7 Pandemic-Planning Mistakes” 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 Geological Survey, National Wildlife Health Center Avian Influenza Information: 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
The boy arrived from Nepal on 3 Oct 2008 and his travel companions have no symptoms. He is now in stable condition. According to the center, this is the fifth cholera case reported in 2008 in the city, and there were three in 2007.
According to Mawardi, for all of September 2008, the number of dengue cases in Batam reached 110. This figure was classified as high compared to previous months. "The number of dengue cases has been fluctuating, but this past September , it was moderately high. In October 2008, we also have made a high prediction.” Mawardi said that residents maintaining an environment free of mosquito breeding sites is the only effective method of addressing the increase in dengue cases in Batam.
Out of the 175 cases, more than half were dengue haemorrhagic fever, which can be fatal if not treated early. He said there have been a total of 35 227 dengue cases and 78 deaths nationwide so far in 2008. The government has been holding campaigns to educate the public as well as conduct checks for mosquito-breeding sites on residential and construction sites to try to stem dengue cases. Despite the efforts, the number of cases and deaths continues to rise each year.
Dengue, the world's most common mosquito-borne disease, is endemic in Singapore, where it has infected more than 4600 people in 2008. "Although screening is expensive, confidence in the blood supply could outweigh cost-effectiveness considerations,'' Tambyah and colleagues stated. Singapore doesn't screen blood donors for dengue because available tests would take 4 weeks, rendering blood platelets that must be used within five days useless, said Tan Hwee Huang, deputy division director of blood supply at the Health Sciences Authority.
Singapore's Health Sciences Authority rejects blood donors showing symptoms of dengue, and asks those who may have been exposed to defer giving blood. It also removes blood donations from people subsequently diagnosed with an infection or who show symptoms.
Of Milk, Health, and Trade Security
Bell, David M. Far Eastern Economic Review. Oct 2008.
The article is intended to raise awareness among trade and tourism stakeholders that they have an interest in the successful implementation of the revised International Health Regulations (IHR). The focus of the latest IHR shifted to prevention, detection, reporting and containment of public health emergencies that have an international impact while discouraging trade and travel restrictions disproportionate to the threat.
Rand report proposes standards for mass antibiotic dispensing
The Pandemic and All-Hazards Preparedness Act of 2006 requires HHS to develop performance standards for public health preparedness, and the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) asked Rand to develop the proposed standard. The standards are geared toward 72 cities that take part in the federal government's Cities Readiness Initiative (CRI), a program launched by the Centers for Disease Control and Prevention (CDC) in 2004 to prepare major cities and metropolitan areas to distribute antibiotics from the Strategic National Stockpile within 48 hours of a federal order to release them.
Though federal law mandates that the standards be evidence-based, the Rand authors pointed out that the rarity of large-scale public health disasters means there is little evidence to base the standards on. Instead, the authors developed the standards by talking to practitioners, reviewing existing literatures, using mathematical modeling, and seeking feedback from an expert panel. The standards are designed to allow communities to be flexible and innovative in how they meet the 48-hour dispensing goal, the report says. "Moreover, the standards are intended to provide minimal requirements and should not discourage CRI sites from exceeding them," it states.
The entire report is available http://www.rand.org/pubs/technical_reports/TR553/.
Responses to Avian Influenza and State of Pandemic Readiness: Fourth Global Progress Report
It is now nearly five years since H5N1 highly pathogenic avian influenza (HPAI) spread across Southeast Asia and then to the rest of Asia, Europe, and Africa. The rapid spread, significant economic losses, numerous human deaths, and the potential threat of a human pandemic influenza triggered concerted global action to control the disease and prepare for the next influenza pandemic.
First World Congress of Vaccine conference
Theme: Build an Olympian Meeting Platform for Future Vaccine World
Date: 1-5 Dec 2008
Venue: Fontainebleau Hotel, Foshan, China
More information available at http://www.bitlifesciences.com/WCV2008.
Updated Recommendations for Isolation of Persons with Mumps
Based on this review, CDC, AAP, and HICPAC now recom¬mend a 5-day period after onset of parotitis for 1) isolation of persons with mumps in either community or health-care settings and 2) use of standard precautions and droplet pre¬cautions. Postexposure recommendations remain unchanged. HCP with no evidence of mumps immunity who are exposed to patients with mumps should be excluded from duty from the 12th day after first exposure through the 26th day after last exposure.
This summit is designed to help you understand the threats of avian flu pandemic in your country, as well as meet your planning requirements on time, under budget, and with a minimum of disruption to your operations.
Confirmed speakers include:
An updated full agenda and additional information is available on the event website at: http://www.new-fields.com/birdflu7/index.php.
This conference, the fourth annual conference of the association to be hosted by the Central University of Finance and Economics (CUFE), will be held on the campus of the university. For a tentative list of participants and to keep abreast of conference developments, please visit http://apeaweb.org/confer/bei08/index.htm.
APEA conference, Santa Cruz, June 26-27, 2009
The fifth conference of APEA will be hosted by Department of Economics and Santa Cruz Center for International Economics (SSCIE), University of California, Santa Cruz, USA. The Federal Reserve Bank of San Francisco and the Bank of Korea are the sponsors of the conference.
Economics are invited to submit papers or extended abstracts for presentation considerable or to organize sessions of common themes. The deadline for submission is January 31, 2009. Additional information submitting papers or organizing a session can be found at http://www.apeaweb.org/confer/cruz09/index.htm.
Trade workshops in Beijing, November 22, 2008 and Hong Kong, February 28, 2009 The Research Center of International Economics at the University of Washington (RCIE @ UW), the Research Center of International Economics at the University of International Economics (RCIE @ UIBE), and the Department of Economics, Hong Kong Baptist University (HKBU) are jointly organizing a workshop series on international trade and related fields. The first one will be held on the campus of UIBE, Beijing, on November 22, 2008 and the second one on the campus of HKBU on February 28, 2009. Economists are welcome to come and present their previous work and current research. For more information, please visit http://www.rcie-cn.org.
KEBA-DGI conference in Daegu, Korea
The Korea Economics and Business Association (KEBA) and Daegu-Gyeongbuk Development Institute (DGI) are organizing an international conference on Knowledge Economy, Regional Development, and Free Economic Zones in Daegu, Korea on November 14-15, 2008. Economists are invited to submit papers. For more information, please visit. http://faculty.washington.edu/karyiu/confer/daegu08/index.htm