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Vol. XII, No. 3 ~ EINet News Briefs ~ Feb 06, 2009


*****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
- Cumulative number of human cases of avian influenza A/(H5N1)
- Global: Experts weigh new avian influenza H5N1 vaccine strategies
- France: Low pathogenic avian influenza reported on a duck farm
- Bangladesh: Avian influenza H5N1 outbreak on commercial farm
- China (Hong Kong): H5N1 avian influenza confirmed in two dead ducks
- China (Hunan): WHO confirms human case of avian influenza H5N1
- India (West Bengal): Thousands of poultry to be culled in latest H5N1 avian influenza outbreak
- Indonesia: Suspected avian influenza H5N1 case now declared negative
- Viet Nam: New avian influenza H5N1 outbreak among ducks at a commune farm
- Canada (British Columbia): Avian influenza outbreak on poultry farm determined to be H5N2 virus
- Egypt: Confirms 54th human case of avian influenza H5N1

2. Infectious Disease News
- Australia (Victoria): Largest measles outbreak in a decade, 11 cases so far
- Chinese Taipei: Unknown illness ails four children; encephalitis suspected
- Indonesia (Bali): Rabies outbreak threatens tourist industry
- Japan: Malaysian resident in Kobe diagnosed with chikungunya virus
- Philippines: Exposure to Ebola Reston virus confirmed in five humans
- USA: Salmonella outbreak linked to peanut butter continues

3. Updates
- AVIAN/PANDEMIC INFLUENZA
- DENGUE
- CHOLERA, DIARRHEA, & DYSENTERY

4. Articles
- Meeting the Challenge of Influenza Pandemic Preparedness in Developing Countries
- Evaluation of the filtration performance of 21 N95 filtering face piece respirators after prolonged storage
- Multistate Outbreak of Salmonella Infections Associated with Peanut Butter and Peanut Butter--Containing Products-- United States, 2008-2009
- For the Good of Us All: Ethically Rationing Health Resources in Minnesota in a Severe Influenza Pandemic

5. Notifications
- 2009 International Molecular Methods in Food Microbiology Symposium and Workshop Series
- Staphylococcus Symposium 2009
- XI International Symposium on Respiratory Viral Infections


1. Influenza News

Global
Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)

2009
China/ 7 (4)
Egypt/ 3 (0)
Total/ 10 (4)

***For data on human cases of avian influenza prior to 2009, go to:
http://depts.washington.edu/einet/humanh5n1.html

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 405 (254).
(WHO 2/5/09 http://www.who.int/csr/disease/avian_influenza/en/index.html )

Avian influenza age distribution data from WHO/WPRO:
http://www.wpro.who.int/sites/csr/data/data_Graphs.htm (WHO/WPRO 1/27/09)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 1/27/09): http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 1/22/09):
http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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Global: Experts weigh new avian influenza H5N1 vaccine strategies
At an Infectious Diseases Society of America (IDSA) symposium in Washington, DC, on 3 Feb 2009 regarding seasonal and pandemic influenza, a group of experts answered questions on some new trends and emerging issues, including prepandemic strategies for H5N1 avian influenza vaccines, now that some countries are stockpiling them.

Keiji Fukuda, coordinator of the World Health Organization's (WHO's) global influenza program, said that experts don't really know what virus will spark the next global pandemic, but given the persistent and lethal nature of the H5N1 virus, the WHO has received pledges from pharmaceutical manufacturers to develop a 150 million dose international vaccine stockpile. He said the stockpile is intended to stop or slow a pandemic if the outbreak is detected early enough.

The existence of individual-country H5N1 vaccine stockpiles and plans for a WHO global stockpile have raised complex questions about potential uses for the vaccine during the prepandemic period, Fukuda said. Some countries are weighing what to do with the vaccines, especially since some doses are set to expire. Global health officials are considering other options, such as vaccinating people in high-risk countries such as China, Indonesia, or Vietnam or perhaps adding the antigen to seasonal flu vaccines as a priming strategy.

The United States, for example, has so far stockpiled about 26 million H5N1 vaccine doses, though some has already expired or is about to expire, according to a Sep 2008 report on US pandemic vaccine policy from the Congressional Budget Office (CBO). The United Kingdom has stockpiled three million doses of H5N1 vaccine. Several countries have announced stockpiling plans, including France, Ireland, Italy, and Austria, according to the CBO report. Other countries such as Japan are in the midst of clinical trials to produce their own H5N1 vaccines.

In November 2008, the WHO established a SAGE working group to focus on H5N1 vaccine issues. According to the Jan 9 issue of the WHO Weekly Epidemiological Record, the working group said it would address:
• Use of the H5N1 vaccine during the prepandemic period to protect people in high-risk jobs, such as cullers, essential workers, and the public
• Priming and immunization strategies for essential workers and the general public
• Recommendations to the WHO and other groups on what to do with H5N1 doses that are about to expire
• Possible changes to the projected size of the WHO's H5N1 vaccine stockpile

"It's likely that different countries will look at this issue differently. This is quite an important pivotal discussion," Fukuda said. Though the WHO's stockpile is still in a virtual state, made up of pledges from pharmaceutical companies, Fukuda said countries that have real stockpiles are facing imminent issues about what to do with expiring H5N1 vaccine. "This will be a country-by-country decision," he said.

Arnold Monto, an influenza epidemiologist at the University of Michigan, said that some experts began discussing the possibility of adding H5N1 antigen to the seasonal flu vaccine a few years ago, but he said some elements of the vaccine have changed since then. Though Monto predicted that discussions will continue on the appropriate use of the H5N1 vaccine, he said new uses for the vaccine won't happen anytime soon.

Among other possibilities for the H5N1 vaccine, pharmaceutical companies might someday market the product to the public, Monto said, adding that if the H5N1 virus ever turns up in North American birds, Americans might demand the vaccine.

At the press conference on 3 Feb 2009, influenza experts also provided updates on other influenza topics:
• The US flu season has been relatively mild, said Nancy Cox, director of the influenza division at the Centers for Disease Control and Prevention (CDC). She said she expects flu activity to increase over the coming weeks as the season peaks.
• Among several suggestions to improve the seasonal flu vaccine, experts are considering adding a second influenza B strain to the vaccine to help solve the problem of deciding which strain to add, said Monto. Early returns this season suggest that Victoria strains are more common, though this season's vaccine contains the Yamagata strain.
• Much more work is needed on bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), that cause influenza complications, said Andrew Pavia, chair of the IDSA National and Global Public Health Committee. Pavia also said more work is needed to develop better treatments and determine who is at increased risk of dying from the complications.
• A road map for influenza research is being fleshed out by the Wellcome Trust, an independent medical research funding charity based in London, said Frederick Hayden, an influenza expert at the University of Virginia School of Medicine in Charlottesville. He said the process will help identify research gaps.
(CIDRAP 2/3/09)

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Europe/Near East
France: Low pathogenic avian influenza reported on a duck farm
The French authorities have recently reported an outbreak of low pathogenic avian influenza (LPAI) on a duck breeding farm in Vendee region. The birds were 12 months old and at the end of their moult. Preliminary testing confirmed the virus was not the H5N1 type and it was later identified as the H5N3 serotype. Disease control measures have been put in place, including a 1 km restriction zone.

Sporadic findings of LPAI are not uncommon across the European Union (EU). The H5N3 strain in France appeared to have caused about one percent mortality in the affected flock. Infection with LPAI in ducks and geese is generally asymptomatic. However, in this specific case, the ducks may have been more susceptible to infection due to stress associated with moulting.
(ProMED 2/5/09)

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Asia
Bangladesh: Avian influenza H5N1 outbreak on commercial farm
Livestock officials in Bangladesh recently reported another H5N1 outbreak in Chittagong division, in the southernmost part of the country, according to a 29 Jan 2009 report from the World Organization for Animal Health (OIE). The outbreak, which began on 26 Jan 2009, struck 80 birds at a commercial farm. Authorities culled the remaining 1,165 birds to control the disease's spread. Bangladesh has reported several outbreaks since October 2008, when the virus reemerged after a four-month lull.
(CIDRAP 2/2/09)

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China (Hong Kong): H5N1 avian influenza confirmed in two dead ducks
A spokesman for Hong Kong's Agriculture, Fisheries and Conservation Department (AFCD) said on 4 Feb 2009 that laboratory tests on a dead goose and two dead ducks found in Sha Lo Wan, Lantau Island, Hong Kong have confirmed H5N1 avian influenza infection.

The carcasses of a goose and duck were collected on 29 Jan 2009 on a beach near the Sha Lo Wan football pitch. Department staff have collected another dead duck at the same location. There are no poultry farms within 3 km of the area. On 1 Feb 2009, department staff inspected the beach and the nearby villages of Sha Lo Wan Tsuen and Sha Lo Wan San Tsuen. There was no evidence of any backyard poultry being kept there. The department is looking into why the carcasses were found at the beach, including whether they had been washed ashore or dumped.

The 26-year-old driver who had participated in collecting the dead birds on 29 Jan 2009 has developed fever and symptoms of upper respiratory infection since 27 Jan 2009. As he developed symptoms two days before the operation, the chance of him being infected with avian flu is low. However, as a precautionary measure, he has been admitted to the Princess Margaret Hospital for observation and further investigation.
(ProMED 2/1/09, 2/5/09)

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China (Hunan): WHO confirms human case of avian influenza H5N1
According to China's Ministry of Health, the Hunan Province Bureau of Health reported on 31 Jan 2009 that a human case of highly pathogenic avian influenza had been confirmed in the province. The patient's condition is now stable and symptoms are improving. She is being actively treated.

The patient is a 21-year-old female. She is a farmer who resides in Xupu County of Hunan Province and fell ill on 23 Jan 2009. After her condition worsened, she was admitted to Xupu County People's Hospital on 26 Jan 2009. On 29 Jan 2009, she was transferred to Xiangya Hospital of Central South University in Changsha City.

On 29 Jan 2009, the Hunan CDC ran tests on samples taken from the patient. The results were positive for avian influenza H5 virus RNA. On 30 Jan 2009, China CDC ran confirmatory tests on samples taken from the patient. The results were positive for avian influenza H5N1 virus RNA. Epidemiological investigations found that the patient had contact with diseased poultry carcasses prior to her illness.

WHO confirmed the case on 2 Feb 2009. Of the 38 cases confirmed to date in China, 25 have been fatal.
(ProMED 1/31/09, 2/3/09)

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India (West Bengal): Thousands of poultry to be culled in latest H5N1 avian influenza outbreak
Officials in India recently said they would cull thousands of chickens and ducks after dead birds in two villages in West Bengal state tested positive for the H5N1 virus. The villages are in Cooch Behar district, which borders Bangladesh.

Rajesh Sinha, a senior government official, said that 30 culling teams are slated to target 45,000 chickens and ducks in the region. West Bengal, Assam, and Sikkim states, all in eastern India, have battled recent H5N1 outbreaks. India has battled sporadic H5N1 outbreaks since 2006.
(CIDRAP 2/2/09)

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Indonesia: Suspected avian influenza H5N1 case now declared negative
A suspected avian H5N1 influenza patient who was treated for eight days in the regional Public Hospital Gunung Jati, Cirebon City, has now been declared bird flu negative. The patient was allowed to return home after receiving results from the laboratory of the Penelitian Dan Pengembangan Kesehatan Hall of the Department of the Health.

Chairman of the the RS Gunung Jati Bird Flu Laboratory, Dr Ali Hanafiah stated on 30 Jan 2009 that results of samples of blood, nasal, and throat fluids from a suspected bird flu patient had tested negative. Subsequently the patient was allowed to return home. During the patient's stay in the hospital her clinical condition improved. Her initially low leucocyte counts and her low body temperature returned to normal.

The patient was initially considered to be a suspected bird flu patient because of contact with poultry that suddenly died. The patient is eight months pregnant and on admission was suffering from respiratory tract inflammation and bronchial pneumonia. There was no indication of bird flu infection. All test results from the laboratory of Balitbangkes Department of Health were negative for avian influenza virus infection.
(ProMED 1/30/09)

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Viet Nam: New avian influenza H5N1 outbreak among ducks at a commune farm
Animal health officials in Vietnam reported a new H5N1 avian influenza outbreak in a duck flock in the southern part of the country. In southern Vietnam, the virus hit 460 ducks at a commune farm in Ca Mau province. Though the virus has struck birds in the province before, the outbreak was the first in Tran Van Thoi district, said Su Van Minh, head of the district's avian flu committee. Officials have culled infected ducks and disinfected the surrounding area to stop the outbreak, Su stated. Lam Minh Tuan, the commune's chairman, said that dozens of unvaccinated ducks started dying on 19 Jan 2009, but the farmer did not report the outbreak until 29 Jan 2009.
(CIDRAP 2/2/09)

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Americas
Canada (British Columbia): Avian influenza outbreak on poultry farm determined to be H5N2 virus
The Canadian Food Inspection Agency [CFIA] says the virus responsible for an outbreak of avian influenza in British Columbia's Fraser Valley is an H5N2 virus. The agency says testing at the National Centre for Foreign Animal Diseases in Winnipeg determined the neuraminidase type or the N in the virus's name. The agency says preliminary tests suggest the virus was a low pathogenic type of avian flu.

Approximately 60,000 turkeys on the affected farm were euthanized during the week of 26 Jan 2009 and they are being composted in the barn at temperatures that should ensure any viruses are destroyed.

The H5N2 virus is not related to the H5N1 avian flu virus that has been decimating poultry flocks and killing people in Asia, the Middle East, Africa, and parts of Eastern Europe for the last five years. It is, however, the same type of virus that caused an outbreak in the Fraser Valley in late 2005. More than 62,000 poultry had to be destroyed in that outbreak.

A total of 36 premises in the surrounding area remain under quarantine, either because they are located within 3 km of the affect farm or because they were known contact with the farm when the virus might have been present. They are being quarantined as a precautionary measure, the agency says. To date there have been no signs of any human infections with the virus.
(ProMED 2/5/09)

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Africa
Egypt: Confirms 54th human case of avian influenza H5N1
On 4 Feb 2009, the Egyptian Health Ministry confirmed that a two-year-old baby has been infected with bird flu virus, which brings the total number of human cases of bird flu to 54 in the populous country. The baby from the Suez governorate, some 120 km east of Cairo, was admitted to hospital with a high temperature. It is believed that the baby contracted the virus after being in contact with infected birds.

This is the third case of human bird flu in Egypt in 2009. On 25 Jan 2009, a 2-year-old baby from the Delta governorate of Al-Minufiyah, about 65 km north of Cairo, was hit by the deadly disease. On 12 Jan 2009, a 21-month-old baby girl from Kerdasa, 6th of October governorate, was infected with the virus.

In addition, authorities in Egypt reported an H5N1 outbreak in backyard birds in the country's Sharkiya governorate, according to a 3 Feb 2009 report posted on the Website of Egypt-based Strengthening Avian Influenza Detection and Response (SAIDR).

The outbreak involved 150 chickens, 15 ducks, and 12 geese in El Kenayat district. Vaccination status of the birds was not known. Sharkiya governorate is in northern Egypt and is located about 50 miles northeast of Cairo. Egypt reported its first H5N1 virus in dead poultry in February 2006 and the first human case in March of the same year.
(ProMED 2/5/09, CIDRAP 2/5/09)

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2. Infectious Disease News

Asia
Australia (Victoria): Largest measles outbreak in a decade, 11 cases so far
Victoria is currently experiencing its largest measles outbreak in years. There have already been 11 cases in January 2009; there were only two in all of 2008. Health officials have warned all Victorians, especially young adults, to be alert to the symptoms. They say there is a chance more people may be infected.

The outbreak began in January 2009, with three adults and a baby girl catching the disease. On 4 Feb 2009, the Department of Human Services revealed there have been seven more cases: three girls aged up to 14, a 36-year-old woman, and three young men. There did not appear to be a common thread to the cluster of cases, with patients dotted around the suburbs and as far as Gippsland. Six of the 2009 cases have required hospital treatment. If left untreated, the disease can cause serious illness and lead to pneumonia or other complications.

Victoria's last big measles year was 1999, when there were several large clusters of cases in the western and eastern suburbs. The childhood MMR vaccine has made the disease a rare occurrence. Those most at risk are unvaccinated children over the age of six months and unvaccinated adults aged 26 to 42.
(ProMED 2/4/09)

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Chinese Taipei: Unknown illness ails four children; encephalitis suspected
Taiwanese media reports that four primary students with symptoms of a mild cold deteriorated within one day after seeking treatment. They are suspected to be infected with an unknown pathogen. One has died.

Reports say that the four sick children first had mild colds, but sharply deteriorated within one day. One girl could not be saved and another child is in critical condition. The hospital has ruled out influenza and gastrointestinal pathogens. Acute encephalitis caused by an unknown pathogen is suspected. The remains of the deceased have been sent to Taiwan CDC for analysis.

The hospital stated that the patient's brain, liver, heart and hematopoietic function were affected by the pathogen. Encephalitis was determined to be the cause of death. But exactly what pathogen caused this illness will not be announced for at least two weeks.

Vice Director of Taiwan CDC, Zhou Zhihao, said that these are isolated cases and whether they are caused by a microorganism or pathogen cannot be quickly determined.
(ProMED 1/26/09)

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Indonesia (Bali): Rabies outbreak threatens tourist industry
The authorities in Bali are battling a rabies outbreak that has spread across the island and is threatening its tourism industry. The first cases were reported in Denpasar and Badung districts in November 2008, but this month it spread to Kuta, which is one of the main tourist resorts.

Since the beginning of January 2009, the number of infected people has increased from a "handful" a week to at least 10 a day, hospital staff members have said. A total of six deaths have been reported. More than 24,000 pet dogs have been vaccinated, while more than 1000 strays have been culled.

"It could be that in the past few months there were a number of cases that weren't reported," said Ken Wirasandhi, the director of services at Sanglah, Bali's largest hospital. "We've received calls from tourists asking about the rabies situation, but we haven't received reports of any tourists being bitten by dogs," said Gede Nurjaya, the head of the Bali Tourism Authority.

Tour operators report that the outbreak has not yet led to cancellations, but admit it is vital that the spread of the disease is contained quickly. A spokesman for the tour operator Kuoni, which reported this week that Indonesia had moved up from 20th in 2007 to 16th in its annual list of popular long-haul destinations, said it was making passengers aware of the risks, but that no one had cancelled.

Since the onset of the financial downturn, Bali has struggled to attract visitors. The number of tourists has failed to reach the levels experienced before the bombings in October 2002, which killed 202 people. A further setback has been the banning of Indonesia's main carrier, Garuda, from European territory, because of safety concerns.

The Foreign Office has joined the United States and Australia in issuing a warning to travelers about rabies in Bali. Rabies has been reported on the Indonesian islands of Java and Flores, but this is the first time it has been recorded on Bali.
(ProMED 1/31/09)

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Japan: Malaysian resident in Kobe diagnosed with chikungunya virus
An adult female Malaysian, a resident of Kobe in Japan for three years, visited the Kobe Kaisei Hospital to be evaluated for dengue fever-like symptoms including high fever, malaise and arthritis on 6 Jan 2009. She visited Kuala Lumpur, Malaysia from 19 Dec 2008-3 Jan 2009.

She developed a high fever and polyarthritis, predominately in her hands, feet, and ankles on 5 Jan 2009. Large joints were less severely affected. Laboratory tests on 6 Jan 2009 showed negative results for IgM antibody for dengue fever (PanBio Dengue), rapid influenza antigen test, and malaria smear and blood culture for salmonella typhi but positive IgG-dengue fever. The serum was submitted for PCR assay to the National Institute of Infectious Diseases in Tokyo, where it was determined to be positive for chikungunya virus (CHKV) RNA.

Chikungunya fever is not a reportable infectious disease in Japan. Since diagnostic tests for chikungunya are not available commercially, diagnosis using PCR assay is made by arranged submission of specimens to the limited institutes by clinicians. Recently, several reports have warned that increased travel associated with globalization may have led to the introduction of chikungunya fever into non-endemic areas by travelers with viremia, because of resident populations of Aedes species that are chukungunya virus vectors.
(ProMED 2/4/09)

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Philippines: Exposure to Ebola Reston virus confirmed in five humans
Four more pig farm workers have tested positive for the Ebola Reston Virus (ERV), health officials revealed 30 Jan 2009. Health Secretary Francisco Duque III said the four were found positive out of 77 individuals suspected of being exposed to the virus. "The four new cases bring the total number of ERV antibody-positive humans to five as of 30 Jan 2009," Duque stated.

Duque, however, assured the public there is no cause for alarm since the ERV poses no threat to human health. Duque said the total of five individuals found positive for the virus were workers of pig farms in Bulacan, Pangasinan and Valenzuela City. Another worker was traced to a slaughterhouse in Pangasinan.

He said all of the patients are males and have not been sick for the past 12 months. Based on initial findings, the five individuals got exposed by directly handling infected pigs. Duque said they did not wear any personal protective gear when handling the infected pigs. He said the presence of ERV antibodies in the individuals showed they have effectively mounted a protective defense against the virus.

A World Health Organization (WHO)-led UN team said all the men – who are aged between 22 and 52 -- are well and no longer carry the virus after being able to expel it from their systems.

Health authorities traced the first case of ERV to a backyard farmer who had direct contact with sick pigs. Duque said the possibility of pig-to-human transmission could not be ruled out at this time. However, he maintained the risk of the virus spreading from hogs to humans is still low. International health experts supported the report of the Philippine government that an outbreak of ERV in the country is unlikely.
(ProMED 1/31/09)

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Americas
USA: Salmonella outbreak linked to peanut butter continues
The case count in the US nationwide Salmonella outbreak tied to peanut butter climbed to 550 as of 2 Feb 2009, as federal officials announced an effort to use "social media" such as podcasts and YouTube videos to keep consumers abreast of product recalls and other developments in the outbreak.

In its latest update, the Centers for Disease Control and Prevention (CDC) said 550 people infected with the outbreak strain of Salmonella Typhimurium have been reported from 43 states, along with one in Canada, an increase of 21 since the previous update on 30 Jan 2009. The number of deaths possibly related to the outbreak remains at eight. It is too early to say the outbreak is over, but it apparently peaked in December and is now in decline, the CDC said.

Meanwhile, the Food and Drug Administration (FDA) said on its online database of recalls related to the outbreak that 887 products have been recalled. More than 100 companies have issued recalls, an FDA official said.

The outbreak has been tied to a peanut processing plant operated by Peanut Corp. of America (PCA) in Blakely, GA. After an FDA investigation at the plant, the company recalled all products made there since the beginning of 2007. The FDA said it found a dozen cases in which the company sold peanut products that had initially tested positive for Salmonella, along with other problems such as a leaky roof, mold, roaches, and improper storage practices. The agency launched a criminal investigation of the facility last week.

The Blakely plant does not make peanut butter or other products for direct retail sale, and no national peanut butter brands have been linked to the outbreak, according to the FDA. But items included in the recall are processed by other companies into hundreds of consumer products. Products from the plant include dry-roasted and oil-roasted peanuts, granulated peanuts, peanut meal, peanut butter, and peanut paste.

In other developments, the Department of Health and Human Services (HHS) announced an effort to use "the power of social media" to spread important information about the recall of peanut butter and peanut-containing products linked with the Salmonella outbreak. The "heart of the outreach effort" is the FDA's online, searchable list of recalled products, HHS said. "A widget has been created so news, parenting, health care and other concerned parties can access the database information directly from their Web sites," the agency said.

The outreach effort also includes such tools as podcasts, YouTube videos, Twitter, and a blog, the agency said. Links are available on a new HHS, FDA, and CDC social media Web page. As part of the initiative, the CDC held a webinar and teleconference designed for bloggers who write about the outbreak. CDC and FDA officials gave an update on the outbreak, described the investigation, and explained the various agency roles in investigating outbreaks. They also pointed out online tools the agencies provide to help keep the public informed.

Jack Guzewich of the FDA's Center for Food Safety and Applied Nutrition said it's important to keep the outbreak and recall information in front of the public for safety reasons. "We're concerned that people will begin to lose interest in this recall," he said. "In terms of prevention or public health protection, what's important is to realize is that this recall is ongoing," Guzewich said. He added that more products with potential contamination are likely to be identified, and people might still have some of them on their shelves long after the outbreak has faded from the headlines.

Guzewich said Salmonella could have been on raw peanuts when they were delivered to the PCA plant or could have been brought into the plant by workers or animals. Since peanuts grow in the ground, they are exposed to various bacteria, including Salmonella, he said. "So it's very possible that those bacteria could be present on the peanuts" when delivered to the plant, he said. But employees could bring in the pathogen inadvertently on their feet or hands, and vermin or rodents could also spread it, he added.

In other developments, a PCA plant in Plainview, Tex., operated for several years without a license and without government health inspections. The facility in the Texas panhandle was never inspected until after the outbreak prompted the FDA to investigate the company. After inspectors learned about the plant, they checked it and found no Salmonella there.
(CIDRAP 2/3/09)

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3. Updates
AVIAN/PANDEMIC INFLUENZA
- UN: http://www.undp.org/mdtf/influenza/overview.shtml UNDP’s web site for information on fund management and administrative services and includes the website of the Central Fund for Influenza Action. This site also includes a list of useful links.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html The (interim) Influenza Virus Tracking System can be accessed at: www.who.int/fluvirus_tracker.
- UN FAO: http://www.fao.org/avianflu/en/index.html. View the latest avian influenza outbreak maps, upcoming events, and key documents on avian influenza.
- OIE: http://www.oie.int/eng/info_ev/en_AI_avianinfluenza.htm. Link to the Communication Portal gives latest facts, updates, timeline, and more.
- US CDC: Visit "Pandemic Influenza Preparedness Tools for Professionals" at: http://www.cdc.gov/flu/pandemic/preparednesstools.htm. This site contains resources to help hospital administrators and state and local health officials prepare for the next influenza pandemic.
- The US government’s website for pandemic/avian flu: http://www.pandemicflu.gov/. View archived Webcasts on influenza pandemic planning.
- CIDRAP: http://www.cidrap.umn.edu/ Find their new report: Pandemic Influenza, Electricity, and the Coal Supply Chain.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm Link to the Avian Influenza Portal at: http://influenza.bvsalud.org/php/index.php?lang=en. The Virtual Health Library’s Portal is a developing project for the operation of product networks and information services related to avian influenza.
- US National Wildlife Health Center: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp Read about the latest news on H5N1 in wild birds and poultry.
(UN; WHO; FAO, OIE; CDC; CIDRAP; PAHO; USGS)

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DENGUE
Australia
The number of dengue fever cases in north Queensland climbed above 200 on 22 Jan 2009 amid fears the disease carrying mosquitoes may be resistant to pesticides.

Cairns-based insect expert Scott Ritchie said Queensland Health was looking at alternative pesticides to address what has been described as the state's worst dengue outbreak since before World War II. "We are concerned that a minority of residents do not perceive the public health risk associated with neglecting mozzie [mosquito] breeding on their property," Dr Ritchie said.

In Cairns, where 13 suburbs have been affected, 190 dengue fever cases have been confirmed, while in Townsville, 20 people have been infected.

Despite scientists expressing concern that the dengue mosquito could easily reestablish itself in the state's southeast region, Lord Mayor Campbell Newman said studies had revealed no sign of them in Brisbane.
(ProMED 1/26/09)

Malaysia
The government of Malaysia confronts the worst dengue epidemic in the history of the country that has already caused 14 deaths and close to 5000 infected people in 2009. The director general of the Health Ministry, Ismail Merican, said that the number of victims represents almost three times those registered in 2008 when five deaths and 2223 infected individuals were reported.

Merican called on the citizens to avoid combating the disease with pesticides that only kill adult mosquitoes but not larvae.

The Setapak zone in Kuala Lumpur has the highest number of dengue cases with 45. According to the Kuala Lumpur City Hall Health Department vector control unit, so far 163 cases had been reported in January 2009. The numbers of cases in the other areas are City Centre (25), Kepong (30), Old Klang (30), Cheras (28), and Damansara (5). The health department said in Kuala Lumpur, places with high density like Setapak, had a higher number of cases compared with the rest. Kuala Lumpur warned that the epidemic threatens the economy of the country.
(ProMED 2/4/09)

Singapore
Singapore registered more dengue cases in the first three weeks of January 2009 than over the same period in 2008. Singapore's National Environment Agency (NEA) said that 509 people caught dengue fever in the first three weeks of January 2009, compared to 341 during the same period in 2008.

The NEA said it was monitoring whether the increase in cases was simply due to short-term fluctuations, adding that a surge in the number of cases in neighboring Malaysia may have an impact on Singapore.
(ProMED 2/4/09)

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CHOLERA, DIARRHEA, & DYSENTERY
China (Yunnan)
All 47 people struck down during a cholera epidemic in January 2009 in Yuxi city of southwestern China's Yunnan Province have fully recovered, a provincial official said 2 Feb 2009. The outbreak in Tonghai, Huaning, and Jiangchuan counties on 18 Jan 2009 led to 20 confirmed cases of cholera, with 27 people also found to be carrying the cholera bacterium, Chen Juemin, director of the provincial health department.

"No deaths were reported," Chen stated. Chen said all 47 patients had been among the 585 villagers who attended a funeral feast in Tonghai from 15 to 17 Jan 2009. Around 3 am on 18 Jan 2009, the first patient, aged 73, was admitted to a local hospital suffering diarrhea, and was followed by two other patients later that day, the director said.

On the morning of 21 Jan 2009, the Yuxi center for disease control initially diagnosed Vibrio cholera O139 type, confirming the infection the following day, Chen said. After the reported outbreak, all 585 persons who attended the feast, along with those who had come into immediate contact with them, were isolated. Local police also closed infected areas, while the local health department checked the health of 8561 villagers, the government said.

Investigators found that 26 of the 585 people at the feast had traveled abroad and visited high-risk cholera areas, with one of those identified as carrying the disease having done the cooking for the feast.
(ProMED 2/4/09)

Philippines
According to the City Health Office (CHO), six persons died, including a nine-year-old boy and three senior citizens, while more than half of the population of a remote village in Bukidnon province fell ill with amoebiasis from December 2008 through January 2009. Dr Dennis Sangalang, CHO chief, said the incidence of diarrhea cases over this period in Sitio Candiisan, Barangay Canayan was blamed on contaminated drinking water or water from an unsanitary source. The CHO reported that residents fetch water from a spring with an unprotected source that is untreated with chlorine.

Sangalang said the number of cases is the biggest in almost a decade in the city. He said 90 percent of the city's villages have access to safe potable water. But the remaining 10 percent have "doubtful sources of water, including that in Candiisan," he said.
(ProMED 2/4/09)

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4. Articles
Meeting the Challenge of Influenza Pandemic Preparedness in Developing Countries
Fedson DS. Emerg Infect Dis. March 2009 (early online publication). Available at http://www.cdc.gov/eid/content/15/3/pdfs/08-0857.pdf.

Abstract
Developing countries face unique difficulties in preparing for an influenza pandemic. Our current top-down approach will not provide these countries with adequate supplies of vaccines and antiviral agents. Consequently, they will have to use a bottom-up approach based on inexpensive generic agents that either modify the host response to influenza virus or act as antiviral agents. Several of these agents have shown promise and many are currently produced in developing countries. Investigators must primarily identify agents for managing infection in populations, and not simply seek explanations for how they work. They must determine in which countries these agents are produced and define patterns of distribution and costs. Because prepandemic research cannot establish whether these agents will be effective in a pandemic, randomized controlled trials must begin immediately after a new pandemic virus has emerged. Without this research, industrialized and developing countries could face an unprecedented health crisis.

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Evaluation of the filtration performance of 21 N95 filtering face piece respirators after prolonged storage
Viscusi DJ et al. American Journal of Infection Control. 2 February 2009. Available at http://www.ajicjournal.org/article/S0196-6553(08)00853-5/abstract.

Background. Organizations are stockpiling respirators to prepare for an influenza pandemic. To understand better the effects of prolonged storage, this investigation evaluated the filtration efficiency of 21 different models of National Institute for Occupational Safety and Health (NIOSH)-certified disposable N95 filtering face piece respirators. These respirators had been stored in their original packaging for a period of at least 6 years in research laboratories and dry warehouse facilities, ranging in temperature between 15°C and 32°C and relative humidity between 20% and 80%.

Methods. Filter penetration was measured using an abbreviated version of the NIOSH respirator certification test incorporating a polydisperse sodium chloride aerosol at 85 L/min.

Results. Of the 21 respirator models tested, 19 models had both average penetration results of less than 5%. Mean initial penetration values ranged from 0.39% to 5.83%, whereas mean maximum penetration values ranged from 0.95% to 5.83%. There did not appear to be any correlation between the length of storage and failure to pass the filtration test.

Conclusion. Results indicate that most N95 filtering face piece respirators stored for up to 10 years at warehouse conditions will likely have expected levels of filtration performance and that the degree of filtration efficiency degradation is likely model specific.

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Multistate Outbreak of Salmonella Infections Associated with Peanut Butter and Peanut Butter--Containing Products-- United States, 2008-2009
US Centers for Disease Control and Prevention. MMWR. 29 January 2009; 58 (early release): 1-6. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0129a1.htm.

On November 25, 2008, an epidemiologic assessment began of a growing cluster of Salmonella serotype Typhimurium isolates that shared the same pulsed-field gel electrophoresis (PFGE) pattern in PulseNet. As of January 28, 2009, 529 persons from 43 states and one person from Canada had been reported infected with the outbreak strain. This report is an interim summary of results from ongoing epidemiologic studies and recall and control activities by CDC, the Food and Drug Administration (FDA), and state and local public health agencies. Confirmed, reported onset of illness dates have ranged from September 1, 2008, to January 16, 2009. A total of 116 patients were reported hospitalized, and the infection might have contributed to eight deaths. Sequential case-control studies have indicated significant associations between illness and consumption of any peanut butter (matched odds ratio [mOR] = 2.53), and specific brands of prepackaged peanut butter crackers (mOR = 12.25), but no association with national brand jarred peanut butter sold in grocery stores. Epidemiologic and laboratory findings indicate that peanut butter and peanut paste produced at one plant are the source of the outbreak. These products also are ingredients in many foods produced and distributed by other companies. This outbreak highlights the complexities of "ingredient-driven" outbreaks and the importance of rapid outbreak detection and investigation. Consumers are advised to discard and not eat products that have been recalled.

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For the Good of Us All: Ethically Rationing Health Resources in Minnesota in a Severe Influenza Pandemic
Vawter DE et al. Minnesota Pandemic Ethics Project. 30 January 2009. Available at http://www.ahc.umn.edu/mnpanflu/prod/groups/ahc/@pub/@ahc/@ethicsmpep/documents/content/ahc_content_090503.pdf.

In response to experts’ warnings that a worldwide outbreak of a respiratory virus is inevitable, pandemic influenza preparedness plans are being developed around the globe. Another pandemic will certainly occur, though no one knows when or whether it will be mild, moderate or severe. Severe pandemics raise unique and particularly difficult challenges, so it is prudent to prepare and plan for one.

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5. Notifications
2009 International Molecular Methods in Food Microbiology Symposium and Workshop Series
Location: Bangkok, Thailand
Dates: 30 Mar-3 Apr 2009

Colorado State University, Cornell University, the Silliker Food Science Center, and Mahidol University have partnered to offer the first international workshop entitled "Molecular Methods in Food Microbiology." The workshop will exclusively cover nucleic acid-based approaches; other rapid methods, such as antibody-based technologies (such as, ELISA or enzyme-linked immunosorbent assay, etc.) will not be covered.

The overall goal of this workshop is to provide in-depth training on nucleic acid-based detection and characterization methods for food borne pathogens and spoilage organisms, including PCR (polymerase chain reaction), multiplex PCR assays, real-time PCR, and quantitative reverse transcriptase-based PCR assays along with DNA sequencing of PCR products. Attendees will become familiar with commercial DNA-based detection methods (including troubleshooting and interpretation of results) as well as approaches to design custom PCR-based assays and protocols for food borne pathogens and spoilage microorganisms. The workshop will consist of a two-day symposium (30-31Mar 2009) followed by a three-day hands-on laboratory session (1-3 Apr 2009) with limited registration.

For more information, including a detailed workshop schedule and registration instructions, please visit the workshop website at http://ansci.colostate.edu/content/view/701/105/.

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Staphylococcus Symposium 2009
Location: Honolulu, HI
Dates: 11-14 Mar 2009

This meeting will assemble an outstanding group of leaders, practitioners, and investigators to share understanding, insight, and management advice regarding the evolving epidemic of MRSA.

You can view the program and register on the website at http://www.staph2009.com.

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XI International Symposium on Respiratory Viral Infections
Dates: 19-22 February 2009
Location: Bangkok, Thailand

World opinion leaders will address key topics including epidemiology, pathogenesis, clinical, vaccinology and prevention, antivirals and therapeutics, as well as a minisymposium on avian influenza H5N1 animal-human interface.

Additional information available at www.themacraegroup.com.

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 apecein@u.washington.edu