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Vol. VIII, No. 5 ~ EINet News Briefs ~ Mar 04, 2005


*****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:
- Chile: Thousands sick from seafood bacteria outbreak
- Dominican Republic/USA/Canada/Europe: One new case of Plasmodium falciparum malaria
- WHO Latest Situation Reports on South and South-East Asia Tsunami
- East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
- Viet Nam: Two new suspected human cases of avian influenza
- Viet Nam: WHO concerned lack of avian flu reports from Vietnam impedes risk assessment
- Viet Nam: FAO/OIE regional meeting on avian influenza control in animals in Asia: conclusions
- China (Guangxi): Taking steps to ward off bird flu
- Philippines: Nine new cases of meningococcemia noted with two deaths
- Malaysia: hand, foot & mouth disease alert in Penang
- Australia (New South Wales): New legionnaires' disease case confirmed
- New Zealand: More Maori succumb to meningococcal epidemic
- Botulism in the Samara region of Russia
- Russia: measles in Novosibirsk may have been introduced from Kazakhstan

1. Updates
- Influenza
- Dengue/DHF
- Viral gastroenteritis

2. Articles
- CDC EID Journal, Volume 11, Number 3-March 2005
- Fatal Avian Influenza A (H5N1) in a Child Presenting with Diarrhea Followed by Coma
- Interventions to Increase Influenza Vaccination of Health-Care Workers--California and Minnesota
- Vaccination coverage among callers to a state influenza hotline...
- USA (Ohio): Gastroenteritis, multiple causes, Summer 2004
- Legionnaires disease associated with potable water in a hotel--Ocean City, Maryland, Oct 03--Feb 04
- Fatal Bacterial Infections Associated with Platelet Transfusions --- United States, 2004
- Tularemia Transmitted by Insect Bites --- Wyoming, 2001--2003
- Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other...
- Cryptosporidiosis Surveillance --- United States 1999—2002
- Giardiasis Surveillance --- United States, 1998--2002
- Progress in Reducing Measles Mortality --- Worldwide, 1999--2003

3. Notifications
- FDA Statement: British Lift Suspension of Flu Manufacturer's License
- Creation of a new OIE/FAO worldwide mechanism to fight against Avian Influenza
- Satellite Broadcast: Partner Counseling and Referral Services for HIV Prevention
- Pacific island health ministers meet on "Healthy Islands"
- International zoonoses conference announcement and call for posters
- First Panamerican Congress on Zoonoses
- Sixth International Conference on the Pathogenesis of Mycobacterial Infections
- Fourth International Conference on Mycobacterium bovis
- SSI/ISID Infectious Diseases Research Fellowship Program
- ISID Small Grants Program

4. APEC EINet activities
- EINet to focus on three main activities

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Chile: Thousands sick from seafood bacteria outbreak
More than 6000 people in Chile have fallen ill after eating raw or under cooked shellfish infected with a virulent bacteria related to cholera. Climate change and rising sea temperatures are being blamed for the outbreak. Chile has never seen anything like it, as 6300 people have fallen sick since the start of January 2005 after eating seafood such as oysters and clams. The normal symptoms of those infected are severe stomach cramps and fever, but it could have killed at least one person. The Government is warning people to cook shellfish for at least five minutes to kill off the bacteria. Consumers can still buy shellfish, but sales have plunged an estimated 80 per cent. An article regarding outbreaks of V. parahaemolyticus in Chile, from Emerging Infectious Diseases is available at http://www.cdc.gov/ncidod/eid/vol11no01/04-0762.htm (Gonzalez-Escalona N, Cachicas V, Acevedo, C. Vibrio parahaemolyticus diarrhea, Chile, 1998 and 2004. Emerg Infect Dis 2005; 11: 129-31). (Promed 2/23/05)

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Dominican Republic/USA/Canada/Europe: One new case of Plasmodium falciparum malaria
As of 18 Feb 2005, the CDC has received reports of 21 cases of malaria in travelers to resort areas of the Dominican Republic. Plasmodium falciparum malaria has been confirmed in five patients from the US, six from Canada, and 10 from European countries, all of whom had recently traveled to areas of the Dominican Republic where malaria had not previously been reported. All returned home between 3 Nov 2004 and 10 Jan 2005. CDC continues to recommend that all travelers to La Altagracia Province, including the Punta Cana resort area, should take an antimalarial drug (prophylaxis). In addition, an antimalarial drug is recommended for travelers to rural areas throughout the country. Chloroquine is the recommended drug for the Dominican Republic. Antimalarial drugs taken correctly and consistently, along with other measures to prevent mosquito bites, have been shown to be effective in preventing malaria. However, CDC has rescinded recommendations for malaria prophylaxis for Duarte Province because no new cases have been reported from the area in the last two months, the epidemiologic investigation by the Ministry of Health of the Dominican Republic did not reveal any new cases, and their surveillance system did not detect any cases of malaria in the province in recent years. The Ministry of Health in the Dominican Republic has implemented malaria control measures, including intensified surveillance, prompt case management, and intensive mosquito control activities. (Promed 2/28/05)

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Asia
WHO Latest Situation Reports on South and South-East Asia Tsunami
As most tsunami-affected regions enter the second phase of the post-disaster health program, they are focusing on rebuilding their infrastructure, increasing capacity and assessing and rehabilitating their health systems. Medical supplies, their storage and tracking systems are being strengthened in these countries. In India, the National Institute of Communicable Diseases, Delhi, has established a comprehensive network for epidemiological surveillance in the tsunami-affected areas of the Andaman and Nicobar islands. In Indonesia, a repeat measles vaccination campaign has been launched in Banda Aceh. In the Maldives, WHO experts, along with a government team, are assessing the surveillance systems at health centre and regional hospital levels. In Calang, in Indonesia’s Aceh Jaya district, health authorities, in consultation with WHO, announced that their priorities will be the areas of communicable disease control, primary health care, maternal and child health and nutrition, in three puskema (health center) sites.

India: The National Institute of Communicable Diseases, Delhi, has established a comprehensive network for epidemiological surveillance in the Andaman and Nicobar islands. There is a Central Unit at Port Blair and six mobile peripheral teams, to monitor water-borne and vector-borne diseases. The laboratory at the GB Pant Hospital has been strengthened to provide rapid laboratory surveillance. Oral Rehydration Salt (ORS) depots have been established at various camps, and ORS is being distributed to diarrhea cases to prevent dehydration.

Indonesia: A measles vaccination campaign is being repeated in Banda Aceh from 28 February – 5 March 2005, due to the low coverage attained during the initial campaign. 3066 children were vaccinated in the first morning. Seven cases of clinically diagnosed measles were reported from Samalamga in Bireuen district, and case investigations are currently underway. A new case of acute jaundice syndrome was reported in Meulaboh. The onset was two weeks ago, and hepatitis testing is currently pending. An intensive campaign along the west coast of Aceh has ensured the delivery of thousands of bednets to protect from vector-borne diseases. In Bakornas, indoor residual spraying has been done in 47 barracks.

Myanmar, Sri Lanka, Maldives, Thailand: No communicable disease outbreaks or unusual events have been reported. (WHO 2/15/05 http://www.who.int/hac/crises/international/asia_tsunami/en/)

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East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
The Center for Infectious Disease Research and Policy (CIDAR) at the University of Minnesota is compiling up-to-date unambiguous figures of avian influenza cases and deaths in East Asia. As of 4 Mar 2005 the number of unofficial cases (i.e., the aggregated WHO, press and governmental figures) in East Asia from Jan 2004 to the present is 66 with 46 deaths; whereas the official (WHO) figures are 55 cases and 42 deaths. The numbers of cases reported from mid-Dec 2004 to 28 Feb 2005 are:

Economy / Unofficial (Official) Cases / Unofficial (Official) Deaths
Cambodia / 1 (1) / 1 (1)
Thailand / 0 (0) / 0 (0)
Viet Nam / 21 (10) / 13 (9)
Total / 22 (11) / 14 (10)
(Promed 3/1/05, <http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html>)

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Viet Nam: Two new suspected human cases of avian influenza
Two people from Viet Nam's northern region have just been hospitalized on suspicion of having contracted avian influenza A (H5N1) virus infection. The Two patients, one from Hai Duong province and the other from Nam Dinh province, were admitted to the Tropical Disease Institute in Hanoi 1 Mar 2005 after suffering fever and breathing difficulty, the local newspaper Pioneer reported 2 Mar 2005. The institute is treating three confirmed cases of H5N1 infection: a 35-year-old woman named from Hanoi, a 21-year-old man from northern Thai Binh province, and the man's 14-year-old sister (this patient was reported previously to have tested H5N1-negative).

Besides the two new suspected cases, it is treating a 36-year-old man from Thai Binh who is waiting for the final result of virus testing. Samples from the man were tested positive to the virus on the first testing, but negative on the second. Admitted to the Institute 22 Feb 2005, the man is in a poor condition, but two other avian influenza patients are showing signs of recovery. Two of these patients ate goose meat, while the third has frequently been present in live poultry markets in the city, working as a rubbish collector.

In the most recent outbreak starting in late December 2004, Vietnam has identified 21 local people (with confirmed avian influenza H5N1 virus infection), of whom 13 have died, according to local media. The country's Health Ministry, however, has confirmed only 12 fatalities. Avian influenza, which has killed and led to the forced culling of more than 1.5 million fowls in 35 cities and provinces in Viet Nam, is subsiding. 14 out of the 35 localities have detected no new bird flu-affected spots for at least three weeks, according to the Viet Nam Department of Animal Health. (Promed 3/2/05)

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Viet Nam: WHO concerned lack of avian flu reports from Vietnam impedes risk assessment
A top WHO official expressed concern over Vietnam's lack of official reporting on recent human cases of the dangerous H5N1 avian flu strain. Dr. Klaus Stohr suggested the absence of timely information from the country is impeding the WHO's ability to do risk assessment on a potential pandemic. The Vietnamese government has not reported a new human case to the agency since 2 Feb 2005, Stohr revealed. A number of cases have been reported though a variety of unofficial channels in the month since Vietnam last updated WHO. WHO only uses government reports to tally its official case counts for diseases such as SARS or avian influenza. "It's something that we are certainly not satisfied with," Stohr, director of the WHO's global influenza program, said of the lack of official information on the reported new cases. "The situation is that WHO has a request by its member states to provide proper risk assessment, to help other member states of WHO . . . in assessing what's going on in Asia and provide advice to other member states. And without this information, this is very difficult." Stohr said WHO officials have issued several requests, in writing and in person, to Vietnam's Ministry of Health for more up-to-date information. "…for the last 30 days . . . we haven't had any official letter from the Ministry of Health..."

Vietnamese and international Media reports would suggest WHO's case count is falling seriously behind what is happening on the ground. In the past week alone, four human cases have been reported. WHO's most recent case count--dated 2 Feb 2005--sets the number of human cases of H5N1 infection since January 2004 at 55, with 42 deaths. But tallies kept by the Center for Infectious Disease Research and Policy at the University of Minnesota tell another story. Staff there have taken to combing a variety of official and unofficial sources to compile what they believe to be a more accurate count of the known human cases of the disease so far. Their sources include ProMED, and mainstream Media reports that cite government officials. The centre, known as CIDRAP, suggests there have been 65 human cases since January 2004 and 46 of those people have died (see above, “East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)”).

"I think it has become so confusing to try to understand the reporting of cases in Southeast Asia by both official and unofficial sources that we felt it would be helpful for our readers to do it," said Dr. Michael Osterholm, director of the centre. Osterholm said centre staff keep a meticulous list of information on each case. WHO has stockpiles of anti-viral drugs in various locations in Southeast Asia. Should it become apparent H5N1 is spreading from person to person--the remaining prerequisite for the strain to trigger a pandemic--the agency hopes to use the drugs to slow the virus's emergence from the region to give the world more time to prepare. But if the WHO isn't receiving prompt information about cases, that plan might be impossible to put in place. "One of the issues we have to really come to grips with is how would you blanket an area once the cow's out of the barn door?" Osterholm said. (Promed 3/2/05)

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Viet Nam: FAO/OIE regional meeting on avian influenza control in animals in Asia: conclusions
The 3 day meeting was organized by the FAO and the OIE in collaboration with the WHO and the Vietnamese government. Over 140 delegates from 28 countries and regions as well as international organizations attended the meeting. The delegates reached a number of conclusions:

- prevention and controlling of avian influenza are now at a critical time and further joint efforts are needed in the battle.
- progress has been made in the early detection of and rapid response to the disease a year after the avian influenza crisis.
- the virus is still circulating among poultry, ducks and wildlife in Asia and continues to pose a serious threat to human health and animals.
- waterfowl: they agreed that one of the new features of current waves of avian influenza in several Asian countries compared with previous ones is the role of ducks, which are a reservoir of infection.
- live poultry markets: The breeding of poultry and other animals on the same small plot of land, the long-time existence of live fowl markets and the poor biosecurity in poultry production and slaughter are also contributing to the disease's spread.
- management: the link between farming systems and the spread of the virus, especially the proximity between farmed chickens and ducks in many backyard households as well as the movement and marketing of live animals, also contribute to the spread of the disease.
- transmission: several strategies recommended by the meeting to minimize the risk of virus transmission between species, and to therefore protect humans, include segregation in farm settings of chickens, ducks, and other animals, such as pigs, and a reduction in contact between these animals and humans.
- vaccination: with the success of vaccination in preventing and controlling the disease in the past year in several countries and regions, the meeting agreed that vaccines can be a strong weapon in the fight against the disease in poultry, and the possibility of vaccinating ducks should be explored. But further study is needed on the conditions in which vaccines can be delivered with minimum risk to human health.
- financial support: realizing that the battle against bird flu needs joint efforts among the world community, the meeting called for international cooperation and financial support to urgently strengthen animal health services and laboratories to improve virus detection and its ultimate eradication.
- international organizations: FAO, OIE and the WHO agreed to further coordinate their activities and programs in leading the world to fight against the disease. (Promed 2/26/05)

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China (Guangxi): Taking steps to ward off bird flu
South China's Guangxi Zhuang Autonomous Region is taking measures to ward off bird flu, as the epidemic expands to the border between China and Viet Nam, the Ministry of Agriculture said. Bilateral trade along the 1020 km border between Guangxi and Viet Nam has grown in recent years. Half of Viet Nam's provinces and cities have reported bird flu cases during February 2005, and more than 1.2 million poultry have been slaughtered, according to the ministry. Although there have been no reported outbreaks in Guangxi, the regional government has spared no effort to prevent them, the report quoted provincial animal epidemic official Ren Biqiang as saying. The autonomous region suspended poultry imports from Viet Nam 6 Jan 2005 and has closed the market for poultry trade in the border area, said the report.

Strict quarantine and disinfection measures for people, vehicles and materials crossing the border are being carried out. Meanwhile, at the 3 day Second FAO/OIE Regional Meeting on Avian Influenza Control, held in Ho Chi Minh City, experts concluded that the H5N1 bird flu virus will not be eliminated in the near future, and the risk of human infection will continue, according to Xinhua News Agency. At the closed-door meeting, experts warned that the "risk of the virus acquiring characteristics for effective human to human transmission and further global spread is likely to increase." Therefore, they said, it is essential to control the disease at the source to prevent the occurrence of H5N1 infections in humans.

The Li Ka Shing Foundation of Hong Kong announced 25 Feb 2005 in Hong Kong that it would donate EUR 3 million (USD 3.96 million) to support the fight against avian flu. (Promed 2/26/05)

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Philippines: Nine new cases of meningococcemia noted with two deaths
Barely a month after lowering the meningococcemia alert in Baguio, health officials disclosed that the bacterial disease continues to hound the city. In 22 Feb 2005 press briefing, officials from the Baguio Health Department and the Department of Health reported nine confirmed meningococcemia patients in Baguio from 24 Jan to 21 Feb 2005. Of these, two patients, a 6 year old and a 67 year old male, already died. Dr Ramoncito Navarro of the National Epidemiology Center explained the lowering of the meningococcemia alert in Jan 2005 did not mean the disease has been totally contained. "We have to understand that the alert was lowered because the level of the occurrences during that time declined. But it does not mean that we should be relaxed…" Navarro stressed. Navarro also advised the public to remain vigilant and practice good personal hygiene. Meanwhile, Mayor Braulio Yaranon is confident that this development will not threaten the influx of visitors expected to arrive this weekend for the Panagbenga festival. "We don't see it as a threat. As we said, this disease also occurs in other places." (Promed 2/25/05)

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Malaysia: hand, foot & mouth disease alert in Penang
All 334 Sentinel Centers nationwide have been reminded to be on alert for any outbreak of hand, foot and mouth disease (HFMD), Health Ministry Communicable Disease Control Division director Dr Ramlee Rahmat said 22 Feb 2005. The Centers include 106 private and 119 government health clinics, and 109 treatment centers. Since HFMD is an endemic disease in Malaysia, he said, they had been told always to be on the alert for an outbreak, especially among children aged under 10 years. Some 352 children were hospitalized for HFMD within the first 50 days in 2005. No deaths have been reported. Penang recorded 309 cases, followed by Pahang (30), Selangor (8), and Johor (5). Dr Ramlee said reports had yet to be obtained from other states.

A statewide alert in Pahang was issued following the hospitalization over the third week of February 2005 of 15 children from Jengka and Jerantut. The children, all below age five, were admitted to the Jengka Hospital with symptoms of the disease, which include high fever, cough, mouth ulcers, a rash on the palms and soles of the feet, sore throat, running nose, vomiting and diarrhea. Deputy Menteri Besar Datuk Tan Mohd Aminuddin Ishak has instructed the State Health Department to check the cleanliness of places frequented by young children, as children were the most prone to the viral disease. Dr Ramlee said all HFMD cases reported so far in 2005 were isolated cases and had been brought under control. (Promed 2/23/05)

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Australia (New South Wales): New legionnaires' disease case confirmed
Health authorities on the New South Wales south coast have confirmed another case of legionnaires' disease, bringing the total number of patients to nine. A further six cases are under investigation, a spokeswoman for the South Eastern Sydney and Illawarra Health Service (SESIHS) said. The ninth case, a 68-year-old man, was in a stable condition in Wollongong Hospital. The SESIHS announced the outbreak 11 Feb 2005, with four initial cases involving men ranging in ages from the mid-30s to 84 years. The men contracted the disease between 30 Dec 2004 and 11 Feb 2005. The health service began an in-depth epidemiology study to track the movements of patients, who all visited Wollongong's Central Business District. "These movements will then be plotted on a map and we will be examining all of the maps to look for any common areas," director of the Illawarra Public Health Unit, Sarah Thackway said. (Promed 2/18/05)

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New Zealand: More Maori succumb to meningococcal epidemic
Maori children are more than four times likely to contract meningococcal B than paheka (New Zealanders of non-Maori and non-Polynesian heritage) counterparts. Western Bay of Plenty iwi Ngaiterangi and Ngati Ranginui have joined forces to raise awareness about the killer disease meningococcal B and its new vaccine, MeNZB. Project manager Kim Skinner of Ngati Ranginui says it's important for Maori families to immunize their children because the risk against them is so much higher. "Statistics show us one in 100 Maori children under the age of five will contract meningococcal B as opposed to one in 438 paheka children. Because our (children) are so much at risk it's crucial for them to get their first MeNZB immunization immediately." More than half a million vaccinations have now been administered throughout the top half of the North Island. Not a single incident or serious side effect has been reported from any of those immunized. "We are encouraged to hear from some local practices that Maori families are enthusiastic and pro-active about getting the free MeNZB immunization..." Skinner said. (Promed 2/25/05)

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Botulism in the Samara region of Russia
16 persons have been hospitalized with botulism in Tolyatti, including five children. According to information from Vladimir Drobyshev, the main health officer of the city, three patients are on artificial respirators due to paralysis of the diaphragm. Their condition is stable, however, the physician noted. The poisoning took place in a school in the Avtozavodskoy district of the city. Analysis has shown that people were poisoned by a salad prepared from home-canned food (tinned cucumbers, according to http://www.rian.ru/incidents/20050225/39461567.html). According to Drobyshev, this salad had been eaten by 27 additional persons, who are under daily supervision of physicians. (Promed 2/28/05)

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Russia: measles in Novosibirsk may have been introduced from Kazakhstan
Seventeen cases of measles have been recorded in Novosibirsk, 13 of which have been confirmed by serological analysis. Local physicians believe that cases of measles are coming from Kazakhstan where there is currently a measles outbreak. Last week about 420 cases of measles were registered in Kazakhstan. According to the Novosibirsk Public Health department, they are currently conducting additional immunization against measles. People who are at occupational or social risk are being given priority for vaccination; these are 4810 medical providers and 5190 students. According to epidemiologists, currently in Novosibirsk and in the Russia Federation as a whole, the disease situation is unstable. Analysis of records for the past 15 years has revealed relatively low rates of measles: in 1993 there were 1177 cases, in 2003 there were three cases, and in 2004 none. Epidemiologists predict a rise in measles every 4-5 years, which would explain the current rise. In Novosibirsk all children are vaccinated. The Public Health Department plans to eradicate measles by the year 2010. The plan anticipates vaccinating everyone under the age of 35. The Novosibirsk Public Health Department considers that the 10 000 doses of vaccine available today will be sufficient to prevent epidemics of measles in the city. (Promed 2/24/05)

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies 2005, 3 Mar 2005
Overall levels remained medium–low in most parts of the world. Influenza A(H3N2) viruses were responsible for the majority of epidemics during this period.

Canada. Widespread influenza activity was reported in 4 provinces. Compared with the previous week, a decline was observed in the number of regions reporting widespread or localized activity, the overall ILI consultation rate, the number of outbreaks in long-term care facilities, the number of detections of influenza viruses and the percentage of positive influenza tests. Of the influenza viruses detected during week 7, 91% were influenza A and 9% were B viruses.

Japan. Influenza activity continued to decline. The majority of the viruses detected were influenza B viruses.

Russian Federation. Influenza activity has continued to increase since week 4 and was reported as widespread in week 7, when morbidity reached or exceeded epidemic thresholds in 63.2% of regions. Influenza A(H3N2) and B viruses co-circulated in the country.

United States. Influenza activity continued to increase, with an increasing overall ILI consultation rate and number of states reporting widespread activity of influenza. However, the number of influenza viruses isolated weekly declined in weeks 6 and 7. During week 7, 3 additional influenza-associated paediatric deaths were reported. The proportion of influenza A and B viruses detected in week 7 remained the same as the previous week.

Other reports. During week 7, low influenza activity was detected in Chile (A) and Hong Kong (H1, H3 and B), Mexico reported no influenza activity. (WHO 3/3/05 http://www.who.int/csr/disease/influenza/update/en/print.html)

Influenza Activity United States, 2004--05 Season
Influenza activity has increased steadily in the United States since late December and, as of February 19, might not have peaked. Laboratory-confirmed influenza infections have been reported from all 50 states. This report summarizes influenza activity during October 3, 2004--February 19, 2005. During October 3--February 19, World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories in the United States tested 83,753 respiratory specimens for influenza viruses; 11,547 (13.8%) were positive.

Of the 11,547 influenza viruses identified since October 3, a total of 9,773 (84.6%) were influenza A viruses, and 1,774 (15.4%) were influenza B viruses. Among the influenza A viruses, 3,001 (30.7%) were subtyped; 2,990 (99.6%) were influenza A (H3N2), and 11 (0.4%) were influenza A (H1). Using hemagglutination-inhibition tests with post-infection ferret serum, CDC has antigenically characterized 320 influenza viruses collected by U.S. laboratories since October 1, 2004. Of these, 228 (71.3%) were influenza A (H3N2) viruses, two (<1%) were influenza A (H1N1) viruses, and 90 (28.1%) were influenza B viruses. Of the 228 influenza A (H3N2) isolates, 125 (54.8%) were A/Fujian/411/2002-like (H3N2), the influenza A (H3N2) strain recommended for the 200405 influenza vaccine, and 103 (45.2%) were antigenically similar to A/California/7/2004 (H3N2), a recently characterized drift variant of A/Fujian/411/2002-like (H3N2) viruses. Current influenza B viruses fall into one of two antigenically and genetically distinct lineages represented by B/Yamagata/16/88 and B/Victoria/2/87 viruses. Of the 90 influenza B viruses, 66 (73.3%) were similar to B/Shanghai/361/2002-like viruses (from the B/Yamagata/16/88 lineage), the influenza B strain recommended for the 200405 influenza vaccine, five (5.6%) had reduced titers to B/Shanghai/361/2002 using ferret antisera, and 19 (21.1%) belonged to the B/Victoria/2/87 lineage.

During the week ending February 19, a total of 8.5% of deaths reported through the 122 Cities Mortality Reporting System were attributed to pneumonia and influenza (P&I), which is above the epidemic threshold of 8.2% for that week. The percentage of P&I deaths exceeded the epidemic threshold for 3 nonconsecutive weeks during October 3--February 19 but otherwise has remained below threshold. As of February 19, nine states had reported nine pediatric deaths to CDC; all deaths occurred during January and February. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5408a1.htm

The latest US influenza weekly report is available from CDC at: http://www.cdc.gov/flu/weekly/ (MMWR March 4, 2005 / 54(08);193-196).

OIE Avian Influenza Update: “Update on avian influenza in animals in Asia” and the latest follow-up reports on highly pathogenic avian influenza from Thailand and Viet Nam are available at: http://www.oie.int/eng/en_index.htm

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Dengue/DHF
Dengue haemorrhagic fever in Timor-Leste
As of 28 February, WHO has received reports of 336 hospitalized cases of dengue infection and 22 deaths. Two hundred and sixty-three of the 336 cases had clinical features compatible with dengue haemorrhagic fever (DHF) and the remaining 73 cases were diagnosed as suspected dengue fever (DF) using WHO standard case definitions. Districts reporting DF/DHF cases are Baucau, Dili, Ermera, Liquica, Maliana, Manatuto and Viqueque, with 76% of the cases reported from Dili. Preliminary laboratory results have identified Dengue three as the main circulating strain in this outbreak. The virologist from the National Institute of Infectious Diseases (NIID), Japan, is working with the Central Laboratory and the National Hospital, Dili, for further laboratory investigations.

WHO and the WHO Collaborating Centre for Case Management of Dengue/DHF, Thailand, Queen Sirikit National Institute of Child Health provided on site support to the Ministry of Health (MOH) and the National Hospital, Dili for the clinical management of dengue patients. In addition, WHO and the MOH conducted practical training seminars on early diagnosis, referral procedures and clinical management to doctors and nurses from Dili and other provinces. The case fatality rate at the National Hospital, Dili, has dropped from 16.3% during the period of 5-21 January 2005 to 3.6% during the period of 12-24 February 2005.

The MOH, with support from WHO, NIID, and USAID are carrying out vector control activities. Insecticide spraying has covered more than 2000 households in high-risk areas, and additional spraying and larval control are underway in Dili and Baucau. Health education activities are also being carried out to raise awareness of the disease and the need for appropriate prevention and control measures. The MOH has established an Emergency Action Task Force for Dengue to coordinate all activities aimed at reducing the transmission and fatalities from dengue infection. WHO is working with the Ministry of Health on the long- and short-term strategy for dengue control in Timor-Leste. Other partners in the Task Force are UN agencies, donors, international and national nongovernmental organizations. (WHO 3/1/05 ttp://www.who.int/csr/don/2005_03_01a/en/)

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Viral gastroenteritis
Indonesia
Since early February 2005, at least 19 people in Morowali Regency here have died due to diarrhea, making the ailment a major cause of concern in the region. The 19 people were among 149 people affected by diarrhea in the regency since the start of Feb 2005, said Natsir Borman, the head of the Central Sulawesi Provincial Health Office. According to Natsir, the 19 died due to a lack of medical treatment; instead of seeking medical attention, they consulted shamans. The office had sent medicine and a team of medical personnel to the worst affected areas to help combat the outbreak. The cause of the outbreak is unknown. The high proportion of deaths suggests a bacterial rather than a viral gastroenteritis. (Promed 2/27/05)

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2. Articles
CDC EID Journal, Volume 11, Number 3-March 2005
CDC Emerging Infectious Diseases Journal, Volume 11, Number 3-March 2005 issue now available at: http://www.cdc.gov/ncidod/eid/index.htm.

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Fatal Avian Influenza A (H5N1) in a Child Presenting with Diarrhea Followed by Coma
New England Journal of Medicine brief report, Menno D. de Jong and 12 others.
Abstract: In southern Viet Nam, a 4-year-old boy presented with severe diarrhea, followed by seizures, coma, and death. The cerebrospinal fluid contained 1 white cell per cubic millimeter, normal glucose levels, and increased levels of protein (0.81 g per liter). The diagnosis of avian influenza A (H5N1) was established by isolation of the virus from cerebrospinal fluid, fecal, throat, and serum specimens. The patient's 9-year-old sister had died from a similar syndrome 2 weeks earlier. In both siblings, the clinical diagnosis was acute encephalitis. Neither patient had respiratory symptoms at presentation. These cases suggest that the spectrum of influenza H5N1 is wider than previously thought. We report an additional fatal case of influenza H5N1, diagnosed by isolating the virus from cerebrospinal fluid, fecal, throat, and serum specimens, in a boy who presented with severe diarrhea but no apparent respiratory illness, followed by rapidly progressive coma, leading to a clinical diagnosis of acute encephalitis. 2 weeks earlier, his sister had died of a similar illness. These cases suggest that the clinical spectrum of influenza H5N1 is wider than previously thought, and therefore they have important implications for the clinical and public health responses to avian influenza. (Promed 2/19/05)

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Interventions to Increase Influenza Vaccination of Health-Care Workers--California and Minnesota
“Vaccination of health-care workers (HCWs) has been shown to reduce influenza infection and absenteeism among HCWs, prevent mortality in their patients, and result in financial savings to sponsoring health institutions. However, influenza vaccination coverage among HCWs in the United States remains low; in 2003, coverage among HCWs was 40.1% (CDC, unpublished data, 2005). This report describes strategies implemented in three clinical settings that increased the proportion of HCWs who received influenza vaccination. The results demonstrate the value of making influenza vaccination convenient and available at no cost to HCWs.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5408a2.htm (MMWR March 4, 2005 / 54(08);196-199)

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Vaccination coverage among callers to a state influenza hotline...
Connecticut, 04--05 Influenza Season
“In response to the influenza vaccine shortage in the United States, the Connecticut Department of Public Health (DPH) operated a telephone hotline during October 22, 2004--January 15, 2005. The purpose of the hotline was to address questions from the public regarding the availability of influenza vaccine, reduce the number of telephone inquiries to physicians and local health departments (LHDs), and advise callers regarding which groups were most at risk and in need of influenza vaccination. Caller information was collected and shared daily with LHDs, which were encouraged to follow up with callers as their resources allowed. This report summarizes results of a retrospective survey of callers to the DPH influenza vaccine hotline during November 2004. The results indicated that vaccination coverage varied by age group and that persons receiving follow-up calls from LHDs were more likely to receive vaccination. State health departments might consider a hotline as a method for educating the public regarding influenza vaccination and a follow-up system as a means to improve vaccination coverage, especially among those at greatest risk.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5408a3.htm (MMWR March 4, 2005 / 54(08);199-200)

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USA (Ohio): Gastroenteritis, multiple causes, Summer 2004
The Ohio Department of Health (ODH), working along with partners at the Ottawa County Health Department, the CDC, the Ohio EPA, Ohio Department of Agriculture, and the Ohio Department of Natural Resources, issued a preliminary report as to the cause of a gastrointestinal illness outbreak in summer 2004. The findings have identified widespread ground water contamination as the mostly likely source of the illnesses. This came about through exhaustive study of ill people who fit the case definition; extensive testing of many water systems on the island; a study of the groundwater or aquifer on the island; a review of past hydrological studies of the island and the aquifers; and a case control study comparing sick people with their well traveling companions. The preliminary report identified 1450 cases of gastrointestinal illness in residents and visitors to South Bass Island from 23 Jul to 12 Sep 2004. Infections included cases of campylobacteriosis, giardiasis, and norovirus infection. A case control study found that cases were more likely than controls to drink tap water on the island (matched odds ratio = 4.3, CI 2.2-9.3, p=0.000005) with a significant dose-response effect to tap water consumption. Cases were also more likely than controls to have had any drink on the island that contained ice (matched odds ratio = 7.1, CI 2.2-25.5, p=0.0002). No clear association of illness was found with any lake or swimming pool exposure. The complete report can be found at http://www.odh.ohio.gov/features/invstg/invstg1.asp. (Promed 2/25/05)

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Legionnaires disease associated with potable water in a hotel--Ocean City, Maryland, Oct 03--Feb 04
“During October 2003--February 2004, eight cases (seven confirmed cases and one possible) of Legionnaires disease (LD) were identified among guests at a hotel in Ocean City, Maryland. This report summarizes the subsequent investigation conducted by the Worcester County Health Department (WCHD), Maryland Department of Health and Mental Hygiene (DHMH), and CDC, which implicated the potable hot water system of the hotel as the most likely source of infection. The detection of this outbreak underscores the importance of enhanced, state-based surveillance for timely detection of travel-associated LD and implementation of control measures.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5407a1.htm (MMWR February 25, 2005 / 54(07);165-168)

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Fatal Bacterial Infections Associated with Platelet Transfusions --- United States, 2004
“Each year, approximately 9 million platelet-unit concentrates are transfused in the United States; an estimated one in 1,000--3,000 platelet units are contaminated with bacteria, resulting in transfusion-associated sepsis in many recipients. To reduce this risk, AABB (formerly the American Association of Blood Banks) adopted a new standard on March 1, 2004, that requires member blood banks and transfusion services to implement measures to detect and limit bacterial contamination in all platelet components. This report summarizes two fatal cases of transfusion-associated sepsis in platelet recipients in 2004 and describes results of a 2004 survey of infectious-disease consultants regarding their knowledge of transfusion-associated bacterial infections and the new AABB standard. Health-care providers should be aware of the new standard and the need for bacterial testing of platelets to improve transfusion safety. However, health-care providers also should be able to diagnose transfusion-associated infections, because even when testing complies with the new standard, false negatives can occur and fatal bacterial sepsis can result.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5407a2.htm (MMWR February 25, 2005 / 54(07);168-170)

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Tularemia Transmitted by Insect Bites --- Wyoming, 2001--2003
“Tularemia is a zoonotic disease caused by Francisella tularensis, a fastidious, gram-negative coccobacillus that infects vertebrates, especially rabbits and rodents. In humans, tularemia is classified into six major syndromes: ulceroglandular (the most common form), glandular, typhoidal, oculoglandular, oropharyngeal, and pneumonic. The case-fatality rate among humans can reach 30%--60% in untreated typhoidal cases. Although bites from ticks and handling infected animals are considered the most common modes of tularemia transmission in the United States, the disease also is spread through ingestion of contaminated food or water, inhalation, and insect bites. During 2001--2003, Wyoming experienced an increase in reported human cases of tularemia. This report describes the subsequent investigation by the Wyoming Department of Health (WDH), which indicated that 1) insect bites (particularly from deerflies and other horseflies) were the most commonly reported likely mode of transmission, and 2) the increase in cases was geographically and temporally associated with an outbreak of tularemia among rabbits in southwestern Wyoming. To obtain a timely diagnosis and provide information on appropriate preventive measures, health-care providers and public health officials should have knowledge of the local epidemiology of tularemia, particularly regarding modes of transmission and resultant clinical syndromes.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5407a3.htm (MMWR February 25, 2005 / 54(07);170-173)

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Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other...
Nonoccupational Exposure to HIV in the United States
“The most effective means of preventing human immunodeficiency virus (HIV) infection is preventing exposure. The provision of antiretroviral drugs to prevent HIV infection after unanticipated sexual or injection-drug--use exposure might be beneficial. The U.S. Department of Health and Human Services (DHHS) Working Group on Nonoccupational Postexposure Prophylaxis (nPEP) made the following recommendations for the United States. For persons seeking care <72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person known to be HIV infected, when that exposure represents a substantial risk for transmission, a 28-day course of highly active antiretroviral therapy (HAART) is recommended. Antiretroviral medications should be initiated as soon as possible after exposure. For persons seeking care <72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person of unknown HIV status, when such exposure would represent a substantial risk for transmission if the source were HIV infected, no recommendations are made for the use of nPEP. Clinicians should evaluate risks and benefits of nPEP on a case-by-case basis. For persons with exposure histories that represent no substantial risk for HIV transmission or who seek care >72 hours after exposure, DHHS does not recommend the use of nPEP. Clinicians might consider prescribing nPEP for exposures conferring a serious risk for transmission, even if the person seeks care >72 hours after exposure if, in their judgment, the diminished potential benefit of nPEP outweighs the risks for transmission and adverse events. For all exposures, other health risks resulting from the exposure should be considered and prophylaxis administered when indicated. Risk-reduction counseling and indicated intervention services should be provided to reduce the risk for recurrent exposures.” http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm (MMWR January 21, 2005 / 54(RR02);1-20)

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Cryptosporidiosis Surveillance --- United States 1999—2002
“Problem/Condition: Cryptosporidiosis, a gastrointestinal illness, is caused by protozoa of the genus Cryptosporidium. Reporting Period: 1999--2002. System Description: State and two metropolitan health departments voluntarily reported cases of cryptosporidiosis through CDC's National Electronic Telecommunications System for Surveillance. Results: During 1999--2002, the total number of reported cases of cryptosporidiosis increased from 2,769 for 1999 to 3,787 for 2001 and then decreased to 3,016 for 2002. The number of states reporting cryptosporidiosis cases increased from 46 to 50, and the number of states reporting more than four cases per 100,000 population increased from two to five. A greater number of case reports were received for children aged 1--9 years and for adults aged 30--39 years compared with other age groups. Incidence of cryptosporidiosis was particularly high in the upper Midwest and Vermont. Peak onset of illness occurred annually during early summer through early fall. Interpretation: Transmission of cryptosporidiosis occurs throughout the United States, with increased diagnosis or reporting occurring in northern states. However, state incidence figures should be compared with caution because individual state surveillance systems have varying capabilities to detect cases. The seasonal peak in age-specific case reports coincides with the summer recreational water season and might reflect increased use of communal swimming venues (e.g., lakes, rivers, swimming pools, and water parks) by young children. Public Health Action: Cryptosporidiosis surveillance provides data to educate public health practitioners and health-care providers about the epidemiologic characteristics and the disease burden of cryptosporidiosis in the United States. These data are used to improve reporting of cases, plan prevention efforts, and establish research priorities.” http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5401a1.htm (MMWR January 28, 2005 / 54(SS01);1-8)

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Giardiasis Surveillance --- United States, 1998--2002
“Problem/Condition: Giardiasis, a gastrointestinal illness, is caused by the protozoan parasite Giardia intestinalis. Reporting Period: 1998--2002. System Description: State, commonwealth, territorial, and two metropolitan health departments voluntarily reported cases of giardiasis through CDC's National Electronic Telecommunications System for Surveillance. Results: During 1998--2002, the total number of reported cases of giardiasis decreased from 24,226 for 1998 to 19,708 for 2001 and then increased to 21,300 for 2002. The number of states reporting giardiasis cases increased from 42 to 46; however, the number of states reporting more than 15 cases per 100,000 population decreased from 10 to five. A greater number of case reports were received for children aged 1--9 years and for adults aged 30--39 years compared with other age groups. Incidence of giardiasis was highest in northern states. Peak onset of illness occurred annually during early summer through early fall. Interpretation: The increase observed for 2002 might reflect increased reporting after reporting of giardiasis as a nationally notifiable disease began in 2002. Transmission of giardiasis occurs throughout the United States, with increased diagnosis or reporting occurring in northern states. However, state incidence figures should be compared with caution because individual state surveillance systems have varying capabilities to detect cases. The seasonal peak in age-specific case reports coincides with the summer recreational water season and might reflect increased use of communal swimming venues (e.g., lakes, rivers, swimming pools, and water parks) by young children. Public Health Action: Giardiasis surveillance provides data to educate public health practitioners and health-care providers about the epidemiologic characteristics and the disease burden of giardiasis in the United States. These data are used to improve reporting of cases, plan prevention efforts, and establish research priorities.” http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5401a2.htm (MMWR January 28, 2005 / 54(SS01);9-16)

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Progress in Reducing Measles Mortality --- Worldwide, 1999--2003
“Measles remains an important cause of childhood mortality, especially in developing countries. In the joint Strategic Plan for Measles Mortality Reduction, 2001--2005, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) targeted 45 priority countries* with high measles burden for implementation of a comprehensive strategy for accelerated and sustained measles mortality reduction. Components of this strategy include achieving high routine vaccination coverage (>90%) in every district and ensuring that all children receive a second opportunity for measles immunization. In May 2003, the World Health Assembly endorsed a resolution urging member countries to reduce deaths attributed to measles by half (compared with 1999 estimates) by the end of 2005. This report updates progress toward this goal and summarizes recent recommendations on methods to estimate global measles mortality.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5408a4.htm (MMWR March 4, 2005 / 54(08);200-203)
Measles news report also available from WHO: http://www.who.int/mediacentre/news/releases/2005/pr11/en/index.html

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3. Notifications
FDA Statement: British Lift Suspension of Flu Manufacturer's License
Statement from Dr. Jesse Goodman, Director, Center for Biologics Evaluation and Research, Regarding the MHRA Action
“The British Medicines and Healthcare products Regulatory Agency (MHRA) lifted their October 5, 2004 suspension of Chiron’s license to manufacture influenza vaccine. FDA has been working closely with MHRA, including during inspections, as the agency evaluates Chiron’s progress in correcting their manufacturing problems. FDA considers MHRA's action an extremely important milestone in Chiron's efforts to supply influenza vaccine for the U.S. market for the coming flu season, but work remains. FDA and MHRA will continue to closely monitor Chiron’s progress as manufacturing proceeds. When all critical stages of manufacturing are in full swing, and needed corrective actions can be fully evaluated, FDA plans to conduct a comprehensive inspection of Chiron's Liverpool facility to assure that Chiron can produce a safe and effective vaccine.” (FDA 3/2/05)

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Creation of a new OIE/FAO worldwide mechanism to fight against Avian Influenza
During the OIE/FAO 3-day regional conference on Avian Influenza control in Ho Chi Minh City, Chief Veterinary Officers from 28 countries called upon governments in the region and the international community to make the fight against the lethal virus a top priority and to commit more financial resources to national and regional anti-bird flu campaigns carried out by Veterinary Services. The conference recommended several strategies to reduce the circulation of the virus in animals. The meeting agreed that vaccines used appropriately can be a strong weapon in the fight against the disease in poultry in the countries currently infected. Regional cooperation has also been indicated as being a crucial factor in the fight against the disease. In this respect, the OIE recalls the importance of the New worldwide Avian Influenza Network which will be officially launched during the OIE/FAO International Scientific Conference on Avian Influenza to be held at the OIE Headquarters in Paris, (France), 7-8 April 2005 and which aims at:
- collaborating with the WHO human Influenza Network on issues relating to the animal-human interface
- developing the research on avian influenza
- offering veterinary expertise and new skills to Member Countries to assist in the control and eradication of AI.

Through an active and permanent cooperation, the Network will develop and harmonise synergistic research projects in different parts of the world. Sharing permanently updated scientific information and efficient control methods of the animal disease will provide a pro-active approach in helping infected countries to eradicate the disease and free countries to protect themselves. While reminding that eradicating the disease at the source is the most effective way to avoid a human pandemic, the OIE also believes that it is crucial for human medical research to have a timely access to the animal strains of the virus in order to prepare the most efficient vaccines for humans. The OIE/FAO Network will also gather information on national and regional epidemiological activities and will be instrumental in the collection and despatch of virus strains to OIE/FAO Reference Laboratories. Wherever required, virus strains will be shared with the WHO Network of Influenza Reference laboratories. For comprehensive information about the OIE/FAO Scientific International Conference on Avian Influenza (in collaboration with WHO), please visit: http://www.oie.int/eng/Avian_Inf_2005/home.htm (OIE 2/25/05)

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Satellite Broadcast: Partner Counseling and Referral Services for HIV Prevention
CDC and the Public Health Training Network will present a satellite broadcast and webcast, "Partner Counseling and Referral Services for HIV Prevention," April 21, 2005, beginning at 1 p.m. EDT. The 2-hour forum will cover the goals of HIV Partner Counseling and Referral Services (PCRS) and the process, techniques, and skills for delivering PCRS. A panel of experts will answer viewers' questions, which can be sent via fax during the broadcast or by e-mail after the broadcast. Additional information is available at http://www.cdcnpin-broadcast.org and through the CDC Fax Information System, telephone 888-232-3299, by entering document number 130039 and a return fax number. Organizations are responsible for setting up their own viewing sites and are encouraged to register their sites as soon as possible so that persons who wish to view the broadcast can access information online. Directions for establishing and registering a viewing site are available on the broadcast website. The broadcast also can be viewed live or later on computers with Internet and Real Player capability at http://www.cdcnpin-broadcast.org. Videotapes and CD-ROMs of the broadcast can be ordered by telephone, 866-366-7502. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5407a7.htm (MMWR February 25, 2005 / 54(07);180)
Other major HIV/AIDS-related conferences can be found at http://www.cdc.gov/hiv/conferen.htm. (CDC http://www.cdcnpin-broadcast.org/scripts/start.htm)

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Pacific island health ministers meet on "Healthy Islands"
Ministers of health from the Pacific island countries and areas are to meet next month to discuss approaches designed to sustain and strengthen the "Healthy Islands" concept and explore ways to further improve collaboration. The gathering, in Apia, Samoa from 14 to 17 March 2005, will be the sixth time health ministers of Pacific island countries and areas have met in line with commitments made in Fiji in 1995. The Fiji meeting of health ministers resulted in the Yanuca Declaration, which advanced the concept of Healthy Islands as a unifying theme for health promotion and health protection in the Pacific. High on the agenda in Apia will be an assessment of the progress so far in implementing the Tonga Commitment to Promote Healthy Lifestyles and Supportive Environments. Also up for discussion will be HIV/AIDS and sexually transmitted infections, migration of health personnel, surveillance and outbreak response capacity building, dengue, the Pacific Open Learning Health Network and the expanded programme on immunization in Pacific island countries and areas. (WHO/WPRO http://www.wpro.who.int/pic/mtg2005.asp)

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International zoonoses conference announcement and call for posters
Liverpool, UK; 15-17 Jun 2005
From Caroline Harcourt harcourt@liverpool.ac.uk:
The Prevention and Control of Zoonoses: from Science to Policy, organized by the Health Protection Agency with other UK based partners, is being held 15-17 Jun 2005 at the Crowne Plaza Hotel, Princes Dock, Liverpool, UK. The aim of the conference is to bring together leading national practitioners and policy makers in both human and veterinary medicine with their counterparts from Europe and other areas of the world to discuss zoonotic diseases…The themes of this conference will be: policy setting; surveillance and modeling of zoonoses; foodborne zoonoses; new and emerging zoonoses; and globalization and zoonoses. The deadline for poster abstract submission is 1 Apr 2005. Reduced rate registration is available until 31 Mar 2005. For further information on the program visit: <http://www.hpazoonosesconference.org.uk>.

For more information, contact: Dr C Harcourt, Information Officer NW Zoonoses Group, Dept of Veterinary Clinical Science. Leahurst, Chester High Road, Neston, Wirral CH64 7TE. http://www.northwest-zoonoses.info (Promed 2/23/05)

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First Panamerican Congress on Zoonoses
La Plata, BA, Argentina; 10-12 May 2006
From Oscar Larghi:
We very cordially invite you to attend the First PanAmerican Congress on Zoonoses, Fifth Argentine Congress on Zoonoses, and Second Zoonoses Congress of the Province of Buenos Aires. For 2006, the Argentine Congress and the First PanAmerican Congress will be combined to allow for the participation of a larger number of professionals from the region dedicated to research, prevention, and control of these diseases. The Scientific Committee invites you and colleagues to submit abstracts. The deadline for their submission is 15 Nov 2005, with complete presentations submitted by 15 Mar 2006.

Please visit: http://www.zoonosis2006.com. For more information, contact: Dr Oscar P Larghi, Fray Lamas 248, 1706 Haedo, BA, ARGENTINA
tel: 54 11 4460 2089; fax: 54 11 4443 2971; oplarghi@speedy.com.ar. (Promed 2/21/05)

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Sixth International Conference on the Pathogenesis of Mycobacterial Infections
Stockholm, Sweden, 30 Jun - 3 Jul 2005
From Stefan B. Svenson:
The Organizing Committee is pleased to invite you to attend the Sixth tri-annual International Conference on the Pathogenesis of Mycobacterial Infections…These conferences, which started in 1990, are devoted to basic frontier research on the pathogenesis of mycobacterial infections, and we hope that the sixth meeting will again attract the world's top researchers in this field…We cordially invite you and your colleagues to submit abstracts. The deadline for abstract submission is 11 Apr 2005. Online submission is accessible at <http://www.congrex.com/mycobact>. The Preliminary Programme and further details are to be found on the official homepage for the conference, which will continuously be updated: http://www.congrex.com/mycobact It is our hope that the conference will provide you with a scientifically stimulating environment and an updated review of the frontiers in the field of mycobacterial infections and their pathogenesis.

For more information, contact: mycobact.abstract@congrex.se Stefan B. Svenson, Professor, PhD, Dr.Med. Sci., SLU, Uppsala & SMI, Solna, Sweden
+ 46 705322471; (Promed 2/19/05)

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Fourth International Conference on Mycobacterium bovis
Dublin, Ireland; 22-26 Aug 2005
Despite ongoing advances, infection with Mycobacterium bovis remains a significant animal and public health challenge in many countries. This conference seeks to facilitate the sharing of knowledge and ideas among policy-makers, stakeholders and research scientists with the aim of addressing current constraints to the control and eradication of tuberculosis in livestock. The themes of the sessions will include:
- M. bovis infection at its most complex--in a diverse wildlife community with potential for zoonotic spill-over
- Recent developments in the basic sciences: what policy-makers need to know
- Farm-level perspectives. Advances in our understanding of disease epidemiology, and implications for control and eradication
- Farm-level perspectives. Maximising the effectiveness of control and eradication options: a role for critical evaluation of local programmes (case studies)
- Addressing TB at the national level (a series of national case studies)
- Varying strategies to address the wildlife reservoir

The Conference is organised by the Centre for Veterinary Epidemiology and Risk Analysis (CVERA) at University College Dublin. For more information, including registration, visit: <http://www.4icmb.org>. The call for abstracts will close 30 Apr 2005. (Promed 3/3/05)

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SSI/ISID Infectious Diseases Research Fellowship Program
ISID and the Swiss Society for Infectious Diseases (SSI) jointly sponsor the SSI/ISID Infectious Diseases Research Fellowship Program.
The purpose of this Fellowship Program is to support infectious disease physicians and scientists from developing and middle income countries through multidisciplinary clinical and laboratory training at select biomedical institutions in Switzerland. The objectives of the Fellowship Program are:
• to train promising young physicians and scientists from developing and middle income countries for clinical and research positions in infectious diseases,
• to foster partnerships between Fellows and infectious disease leaders in Switzerland, and
• to increase scientific research capacity in low income/high disease burden countries.
Opportunities for training and research in a variety of areas ranging from basic studies of the mechanism of disease to studies in public health, epidemiology, diagnostics, therapeutics or vaccine development, are available through this program. The term of the Fellowship is for one year. A financial stipend of up to 36,000 SF per year (approximately $21,000 USD) will be given to Fellows to cover travel costs and living expenses. The program intends to award two fellowships every year. Language skills of French or German are necessary according to the institution chosen. (ISID http://www.isid.org/programs/ssi_isid_fellowship.shtml)

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ISID Small Grants Program
The Small Grants Program is designed to fund pilot research projects by young investigators in developing countries. The goal is to support and foster the professional development of young individuals in the field of infectious diseases research by helping them to acquire additional skills and data to apply for other grants. Areas of interest include, but are not limited to investigations of the epidemiology, pathophysiology, diagnosis or treatment of infectious diseases, the epidemiology and control of hospital-acquired infections, and modeling of cost effective interventions. Upon completion of the project, a written report of the project must be sent to the Society. The Society encourages recipients of grants to present their results at scientific meetings and to submit them for publication in peer-reviewed journals. Up to five grants of up to US $6,000 each will be awarded annually. Deadlines for submission of proposals are April 1 (notification after June 1) and October 1 (notification after December 1). (ISID http://www.isid.org/programs/prog_smgrants.shtml)

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4. APEC EINet activities
EINet to focus on three main activities
APEC EINet's Dr. Louis Fox presented his talk on the EINet initiative at the APEC Health Task Force meeting in Seoul, Korea, 28 Feb 2005. Currently EINet is focusing on three main activities: 1) news briefs and alerts 2) a certificate program through the University of Washington and 3) advanced networks effort. Another multipoint videoconference with several East Asian countries is now underway. The EINet website development team is currently working on a search capacity for the news briefs, which will allow searches to be conducted by date, economy/country, text, etc.

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5. To Receive EINet Newsbriefs
APEC EINet email list
The APEC EINet email list was established to enhance collaboration among academicians and public health professionals in the area of emerging infections surveillance and control. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe (or unsubscribe), contact apec-ein@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://depts.washington.edu/einet/.

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 apecein@u.washington.edu