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Vol. VIII, No. 6 ~ EINet News Briefs ~ Mar 18, 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:
- USA (New York): NYC Healt Dept. warns against consumption of some imported Mexican cheeses
- USA (Arizona): Group A streptococcus infects Two
- USA: Anthrax Alarm Uncovers Response Flaws
- 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: a brief summary of recent analyses of avian influenza H5N1 viruses from humans
- Viet Nam: Two Asymptomatic cases of avian influenza
- Viet Nam: Poultry vaccination planned; No New Outbreaks in 22 localities in 3 weeks
- Viet Nam: Nurse tested negative for bird flu
- Indonesia: Bird flu kills thousands of chickens in South Sulawesi
- Japan/North Korea: Bans North Korean Poultry in Bird Flu Scare
- Republic of Korea/North Korea: Probe into bird flu
- China: Launches first human trials of AIDS vaccine
- Japan: Blood Donation Ban May Have to be Reviewed
- Australia (Victoria): Mycobacterium ulcerans--mosquito-borne, suspected

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

2. Articles
- Isoloation and characterization of avian influenza viruses, including highly pathogenic H5N1...
- Characterization of a novel influenza A virus hemagglutinin subtype (H16) from black-headed gulls
- Diagnosis of human prion disease
- Burkholderia pseudomallei infections in Finnish tourists injured by the Dec 2004 tsunami in Thailand
- Inadvertent Use of Bicillin C-R to Treat Syphilis Infection--Los Angeles, California, 1999--2004
- Transmission of hepatitis B virus among persons undergoing blood glucose monitoring...
- Salmonellosis Associated with Pet Turtles--Wisconsin and Wyoming, 2004
- Trends in Tuberculosis --- United States, 2004
- Congenital pulmonary tuberculosis associated with maternal cerebral tuberculosis--Florida, 2002

3. Notifications
- World TB Day --- March 24, 2005
- World Water Day --- March 22, 2005
- The OIE Working Group for Wildlife Diseases: a continuous global monitoring
- Zoonoses and veterinary public health (VPH)
- APEC to Launch Virtual Task Force for Emergency Preparedness

4. APEC EINet activities
- New Features on the APEC EINet website

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
USA (New York): NYC Healt Dept. warns against consumption of some imported Mexican cheeses
Several types of cheese imported from Mexico may be contaminated with Mycobacterium bovis, which causes tuberculosis, according to the New York City Department of Health and Mental Hygiene (DOHMH). The types of cheese, including queso fresco, may be unpasteurized and may also be illegally imported from Mexico and sold without approval by the New York State Department of Agriculture and Markets. The Health Department has identified 35 cases of tuberculosis caused by M. bovis in city residents between 2001 and 2004. In one of those cases, a 15-month-old child who died in March 2004 was later determined to have died from complications due to M. bovis infection.

DOHMH Commissioner Thomas R. Frieden said, "Illegally imported food products may not be manufactured or packaged in compliance with the FDA's strict regulations; consuming these products may endanger your health. Some people are at higher risk than others, including pregnant women, newborn babies and children, seniors, and those with weakened immune systems..." The Health Department is currently working with the Food and Drug Administration (FDA), the U.S. Department of Agriculture, the New York State Department of Agriculture and Markets, and the CDC to determine the source of products associated with this illness in New York City – in particular, targeting stores that serve the city's Latin American communities. Consumers should avoid eating cheese that is not labeled or does not have the word "pasteurized" stated clearly on the label. People who have these products in their homes should not consume them and immediately dispose of them in the trash. DOHMH has also alerted physicians and medical institutions to consider the diagnosis of tuberculosis caused by M. bovis , and to report suspected cases to the Health Department's Bureau of TB Control.

M. bovis commonly causes disease in cattle and other animals but may cause illness in humans through eating unpasteurized milk products made from infected cattle. It is more likely than other TB-causing bacteria to cause tuberculosis in parts of the body other than the lungs. General symptoms of M. bovis tuberculosis may include fever, night sweats, and weight loss. Other symptoms may manifest themselves depending on the part of the body affected by the disease: e.g., infection of the lungs may be associated with coughing; lymph node infection may cause swelling in the neck; and gastrointestinal infection may cause abdominal pain and swelling, as well as diarrhea. In rare instances, a person may die if the disease is left untreated. Symptoms generally appear months to years after infection with M. bovis , but some people may never show signs of illness. See http://www.nyc.gov/html/doh/html/tb/tb-mbovis.html.

According to the FDA, some imported "soft" cheeses originating from Central American countries, including Mexico, Nicaragua and Honduras, are made from unpasteurized milk and can cause infectious diseases in addition to TB, including listeriosis, salmonella poisoning and brucellosis. These products may then be sold at stores, at flea markets, from the back of trucks, or by door-to-door salespersons. The FDA's advisory can be found at http://www.fda.gov/bbs/topics/news/2005/NEW01165.html.
(NYC Dept of Health and Mental Hygiene 3/15/05 http://www.nyc.gov/html/doh/html/public/press05/pr022-05.html; Promed 3/18/05)

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USA (Arizona): Group A streptococcus infects Two
A patient infected with flesh-eating bacteria spread the infection to a health care worker at Flagstaff Medical Center, leaving both people hospitalized in serious condition. The state Department of Health Services has asked doctors at the hospital to monitor other workers for symptoms, even though they don't think it has spread. The DHS said the Flagstaff case represents the first documented case in Arizona of invasive Group A streptococcus spreading from a patient to a health care worker. Officials at the medical center don't know how the disease was spread. Health experts say about 25 percent of the population has Group A strep in their throats or on their skin at any given time. "99 percent of the time, it's benign such as strep throat or impetigo like little kids get. There's just a rare instance where that organism can cause severe disease," said Dr. Mark Lacy, an infectious disease specialist at Flagstaff Medical Center.

In Arizona, there are about 300 cases of invasive Group A strep infections a year, state records show. Invasive Group A strep can manifest itself in many ways. In the case of the Flagstaff patients, it led to serious illness. The initial patient was admitted to the hospital 9 Feb 2005. The bacterial infection had developed into necrotizing fasciitis. The patient also developed streptococcal toxic shock syndrome (STSS) and bacteremia, a bacterial invasion of the bloodstream. The condition became so severe that doctors had to amputate the patient's left leg at the hip. 6 days later, 15 Feb 2005, the health care worker was hospitalized with pneumonia, bacteremia, and STSS. Necrotizing fasciitis, the so-called "flesh-eating disease," can be multibacterial or caused by a single organism, most commonly the Group A beta-hemolytic streptococcus. Many cases have an underlying disease. The posting does not state whether the health care worker had any underlying diseases. (Promed 3/8/05)

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USA: Anthrax Alarm Uncovers Response Flaws
The anthrax scare at the Pentagon exposed gaps between the military's procedures in handling biohazards and the rest of the federal government's that could have increased the threat to public health had the deadly bacteria actually been present, health experts and federal and Virginia officials said. Health officials inside government and out said the Pentagon's reliance on detection and response systems that are isolated from those at other federal agencies delayed Virginia health officials, the U.S. Postal Service and the CDC in moving to protect the public from a possible biohazard in the mail. "The takeaway for me is, the government hasn't learned too many lessons from the last few years," said Scott Becker, executive director of the Association of Public Health Laboratories. "The Department of Defense appears to be developing their own detection systems...The linkages to public health just didn't seem to be there..." In the muddle, local hazardous materials teams were confused by sensor equipment that differed from equipment used by the Postal Service and Department of Homeland Security, said Robert Stroube, Virginia's health commissioner. Also State and federal officials responsible for deciding public health actions said scientists had trouble interpreting the findings from a Pentagon contract lab, which is not part of the CDC's national network of labs that respond to bioterror.

Local officials and key members of Congress said they were kept out of the loop at the Pentagon and a subsequent alarm at a Defense Department office complex in Fairfax. Now that anthrax tests have come back negative, several officials are concerned about the differing testing guidelines. Since the 2001 anthrax attacks, the Postal Service has spent $1.4 billion to install a biohazard detection system at 283 mail facilities; the federal government has spent $370 million to boost public health labs, the backbone of the CDC's 140 bioterror Laboratory Response Network; and Homeland Security has launched a $60 million-plus BioWatch system to monitor air in more than 30 US cities. All rely on the same CDC protocols. But the Defense Department has not signed a federal memorandum of understanding that standardizes alerts, terminology, data sharing and response when biohazard systems at military sites within the US are triggered. The Pentagon is spending $1 billion to develop biohazard warning systems and procedures at 185 US and 15 overseas bases. "Why are they using a private facility to do environmental testing when we have invested billions of dollars to enhance public health and defense facilities to deal with 21st-century public health threats?" said George Foresman, homeland security adviser to the Virginia Governor. The BioWatch system has gone 2 years without a false positive; the Postal Service's system has reviewed 500 000 samples without a false positive.

The events began 10 Mar 2005 when one of 4 swab samples taken daily from sensor filters at the Pentagon delivery facility tested positive for anthrax at Commonwealth Biotechnologies Inc. in Richmond, a Pentagon subcontractor. The finding was confirmed by a highly accurate polymerase chain reaction test and forwarded 11 Mar 2005 to the prime contractor, said Robert B. Harris, president of the Richmond lab. Pentagon officials say they were notified 14 Mar 2005 morning of the finding. That afternoon--apparently by coincidence, military officials said--a machine on the 8th floor of the Fairfax complex that receives mail from the Pentagon sounded an airborne biohazard alarm.

Pentagon spokesman Glenn Flood defended the department's actions while acknowledging that "we're looking at all those issues. The contractor laboratory has worked well. We have protocols in place…Until we get all the information, I could not go beyond that," Flood said. Military officials said that although Army scientists at Fort Detrick confirmed the initial positive finding, quality control problems at the lab probably spoiled the sample. "We stand by our results, and the work is ongoing," said Harris, whose company has processed 2000 samples from the Pentagon over 2years. (Promed 3/17/05)

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Asia
WHO Latest Situation Reports on South and South-East Asia Tsunami
The focus has been on reviewing the current situation and planning for the longer-term rehabilitation of the health systems. Health staff and volunteers are being trained to better address the mental health needs of the tsunami-affected population. Hygiene promotion is being addressed with volunteers being trained, and education materials being developed. In Sri Lanka, the results of a survey to assess the water and sanitation situation in transition camps have been released, and facilities were found to be below national norms in some camps. More water storage facilities, toilets and bathing facilities are needed.

Indonesia: According to the Aceh Provincial health authorities, one person died of malaria (Plasmodium falciparum) from Teunom, in Aceh Jaya 4 Mar 2005. The patient became ill while traveling from Medan to the West coast with five others, who were also subsequently reported as having a febrile illness. He was transferred to Medan where he expired. One of the five people who traveled with the patient was also subsequently tested and diagnosed with P. falciparum malaria. A Ministry of Health vector survey conducted in Calang revealed that 59 malaria cases were reported in Teunom. 95 percent of these cases occurred in adults, and 75% were positive for P. falciparum, either as single or mixed infections with P. vivax (11 cases of mixed infections). There were no malaria cases in children under five. For the month of February there were 31 cases reported in Calang - no increase. Larvicide is on order from the Public Health Office. In Banda Aceh, nine teams sprayed the homes of more than 193 800 people. Teams also sprayed the relocation barracks housing 341 family units.

Two measles cases were confirmed from Lamgapang, in Aceh Besar, and Peniti, in Banda Aceh. Measles alerts from Aceh Jaya, Nagan Raya, Aceh Besar, Pidie, and Aceh Utara were investigated, but measles was determined to be unlikely. The third measles vaccination campaign has had a coverage rate at 79.4% in Banda Aceh, and the campaigns will continue in all other districts until 20 March.

Between 28 Feb and 6 Mar 2005, there have been 304 reported cases of acute watery diarrhoea, 21 reported cases of bloody diarrhoea, 23 confirmed cases of malaria, 2 reported cases of measles and 7 reported cases of acute jaundice syndrome in the 14 districts affected by the tsunami in Aceh province.

Sri Lanka: On 10 Mar 2005, WHO Sri Lanka reported sporadic outbreaks of dengue in Trincomalee and Kinniya ministry of health (MOH) areas. A malaria outbreak in Illupankulam in the Trincomalee MOH area was also reported. Various control measures have been initiated by local health authorities, such as periodic spraying of insecticides, re-treatment/distribution of insecticide-treated mosquito nets, and currently the number of cases shows a declining trend. WHO Sri Lanka also reported 32 cases of viral hepatitis in children aged 2-12 years, from Central Dispensary, Sampoor and Thileepan hospital, Pattalipuram. Only 4 of these cases were reported from Tsunami welfare centers. All the affected children had eaten illegally manufactured ice creams brought from MuthurTown. These products have been implicated as the source of an out break of viral hepatitis in MuthurTown in 2004. Sampoor and Pattalipuram area have since banned the sale of these products. Drinking water is being chlorinated systematically and health education programs have been intensified.

India, Myanmar, Thailand, and Maldives: No communicable disease outbreaks or unusual events have been reported. (WHO 3/11/05 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 compiles up-to-date unambiguous figures of avian influenza cases and deaths in East Asia. As of 18 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 71 with 47 deaths; whereas the official (WHO) figures are 69 cases and 46 deaths. The numbers of cases reported from mid-Dec 2004 to 18 Mar 2005 are:

Economy / Unofficial (Official) Cases / Unofficial (Official) Deaths
Cambodia / 1 (1) / 1 (1)
Thailand / 0 (0) / 0 (0)
Viet Nam / 25 (23) / 13 (12)
Total / 26 (24) / 14 (13)

***Readers may find relevant the article on CIDRAP, “Questions raised about Viet Nam's avian influenza reports and testing”, which highlights Viet Nam’s 2 potential problems with its data on human cases: transparency in reporting and accuracy in testing. To read the article, visit: http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/mar0405viet.html
(CIDRAP, 3/18/05 <http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html>)

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Viet Nam: a brief summary of recent analyses of avian influenza H5N1 viruses from humans
Since 31 Jan 2005, WHO has received more than 90 clinical specimens sampled between 24 Dec 2004 and 29 Jan 2005 from confirmed and suspected H5N1 human cases in Viet Nam. Antigenic and genetic analyses are being conducted in the WHO Collaborating Center for Reference and Research on Influenza and the WHO H5 Reference Laboratory in the National Institute of Infectious Diseases, Japan. So far, 9 viruses have been isolated from specimens collected from southern Viet Nam.

Results show that: 1) These viruses belong to group Z and are genetically highly similar to the viruses isolated in 2004, including A/Vietnam/1194/2004 and A/Vietnam/1203/2004, which are the prototype vaccine strains recommended by WHO for pandemic influenza vaccine production. 2) Except for one virus, all the rest are antigenically closely related to A/Vietnam/1194/2004 and A/Vietnam/1203/2004 3) At the receptor recognition site, there appears to be an avian receptor preference.

The conclusions so far: 1) Very little mutation has been observed since 2004. 2) There is no need to change the prototype pandemic vaccine strain selected by WHO in 2004 3) Genetically, the viruses continue to show resistance to amantadine. (Promed 3/9/05)

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Viet Nam: Two Asymptomatic cases of avian influenza
2 elderly Vietnamese have been documented as asymptomatic cases who have tested positive for avian influenza virus. The two, both from the northern province of Thai Binh, where a cluster of cases is causing great concern about the possibility of human-to-human transmission of the H5N1 virus, had relatives who had contracted the virus. "We certainly need to look into circumstances of how they might have got their infection, whether from poultry, a contaminated environment or from another infected person," said Hanoi-based WHO medical epidemiologist Peter Horby. What worries the experts most is the possibility of the virus mutating into a form which could pass easily between humans and set off a pandemic in a world without immunity to it and kill millions. So far, there has been no evidence that mutation has occurred, and the only previous probable case of human-to-human transmission occurred in Thailand, where a mother died after cradling her sick daughter in her arms for hours.

Vietnamese experts are investigating the Thai Binh cases to see if the 2 old people caught the virus from prolonged contact with other victims. The old man, the grandfather of a brother and sister who had contracted the disease, drank raw duck blood during the Tet Lunar New Year festivities last month, health officials in his village said. But the only contact established so far with the virus for the other case, a 61-year-old woman, was her husband, who died of bird flu in February 2005. "It could be that, and it could be from the contaminated environment," Horby said. "That's certainly a possibility that needs to be investigated." Health officials from the woman's village said she ate only pork, and all 4 chickens raised in her house had tested negative for avian influenza virus infection. There were cases of people contracting the H5N1 virus during its first appearance in Hong Kong in 1997, without showing symptoms but the elderly man and woman were the first known asymptomatic cases in Viet Nam, Horby said. (Promed 3/12/05)

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Viet Nam: Poultry vaccination planned; No New Outbreaks in 22 localities in 3 weeks
Duck flocks in the Mekong Delta will be vaccinated against bird flu April 2005, according to the Animal Health Department under the Ministry of Agriculture and Rural Development. The recent inoculation of chicken in the northern province of Ha Tay has shown "encouraging" results, the department announced. Animal health officials also planned to continue using bird flu vaccines made in China and the Netherlands. Applying AI vaccination in Viet Nam is a significant change in the country's official control policy. The last follow-up report of 28 Feb 2005 specified the following: control of arthropods; control of wildlife reservoirs; quarantine; movement control inside the country; stamping-out policy; screening. The recent FAO/OIE conference in Viet Nam concluded: "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". So far, only 2 Eastern-Asia countries, China and Indonesia, officially allow AI vaccination. Thailand indicated in Dec 2004 the planning of field vaccination trials.

No new bird flu outbreaks have been reported by 22 out of the 35 bird flu-infected provinces and cities across the country, for at least 3 consecutive weeks, the Veterinary Department announced 11 Mar 2005. The newest localities joining the list were the southernmost province of Ca Mau and the Mekong delta province of Soc Trang.

***An informative review on avian influenza poultry vaccines is available through Promed, 3/7/05 (http://www.promedmail.org/pls/askus/f?p=2400:1001:16720054481545971227::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:10001,28282) (Promed 3/12/05)

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Viet Nam: Nurse tested negative for bird flu
A female nurse suspected as having bird flu has tested negative for the disease, Vietnamese health officials have announced. Test results provided by the Center for Tropical Diseases in Hanoi showed the nurse was free of H5N1, said Viet Nam's Central Institution of Sanitation and Epidemiology 13 Mar 2005. The nurse, who worked in a hospital in the Red River Delta province of Thai Binh, was previously thought to be infected and was hospitalized for treatment. Another male nurse, infected with bird flu after having had direct contact with infected patients, has shown signs of improvement, doctors said. The institution is now carrying out an extensive search on how the virus gets circulated in the province of Thai Binh, where a number of people were found to be affected by the disease. (Promed 3/14/05)

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Indonesia: Bird flu kills thousands of chickens in South Sulawesi
The Central Government has decided to isolate South Sulawesi from chicken trading, as a fresh outbreak of bird flu has killed some 25 000 chickens during the second week of March 2005, an official said 16 Mar 2005. Deputy chief of the South Sulawesi office of the agriculture ministry's livestock department Arifin Daud said the government had also distributed some 200 000 doses of a locally produced vaccine to try and stop the disease from spreading. "There were indications of bird flu in the dead chickens. However, not all the chickens died because of bird flu," Arifin said in a hearing with the South Sulawesi Legislative Council. He said the bird flu hit the poultry business in the regencies of Maros, Sidrap, Wajo, Pinrang, Soppeng & Parepare. Indonesia has been hit by sporadic bouts of bird flu since 2003, but unlike in Viet Nam, Thailand and Cambodia, no cases have been reported in humans. (Promed 3/16/05)

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Japan/North Korea: Bans North Korean Poultry in Bird Flu Scare
Japan has banned poultry imports from North Korea following a reported bird flu outbreak in Pyongyang, officials said. South Korea's Yonhap news agency reported 15 Mar 2005 that thousands of chickens died from bird flu at a processing plant in the North's capital of Pyongyang last month and that the nation was believed to be preparing emergency measures. Japan imposed its ban as a preventative measure, although Japanese authorities so far have been unable to confirm the report, an official at the Ministry of Agriculture, Forestry and Fisheries said. Japan imported 5 tons of duck meat in 2002, the only poultry import from North Korea over the last 5 years, the ministry said. Tokyo currently bans poultry meat imports from more than a dozen nations where avian flu has struck. Bird flu hit Japan January 2004 for the first time in 79 years. The government confirmed in December the first case of human infection in the country but no death was reported. (Promed 3/17/05)

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Republic of Korea/North Korea: Probe into bird flu
South Korean officials are investigating a report of a massive bird flu outbreak in North Korea last month that killed several thousand chickens. Yonhap news agency said 15 Mar 2005 the chickens died at a poultry farm in Pyongyang, prompting an emergency response from North Korean authorities. Officials in Seoul said a South Korean food processing firm had asked Pyongyang to suspend the shipment of 40 tons of chicken due to arrive 17 Mar 2005. The shipment was to have been the first import of meat products in 5 decades from the North under a bilateral agreement signed earlier in 2005 providing for cross-border trade of some commodities. Kim Hong-jae, a spokesman for the South's Unification Ministry, said there was no evidence yet to confirm the bird flu outbreak, but the government was following up the report. WHO has said the agency had no first-hand information and that what was coming out of North Korea appeared to be based on reports by businessmen. Yonhap said it was not immediately clear if the outbreak was restricted to the farm, believed to be the largest in the country. It was also not clear if the strain of virus involved was H5N1. Yonhap said North Korean authorities had buried the dead chickens but that some residents had dug up the poultry. North Korea's state media did not say whether there had been an outbreak. "Veterinary and anti-epizootic work has been intensified at central and local chicken and poultry farms," the North's official KCNA news agency said 7 Mar 2005.

Health experts are hoping that reports of the outbreak prove unfounded, saying the disease would prove a nightmare to combat inside the isolated state. Information reaching the outside world from North Korea is notoriously hard to verify. "As soon as we heard the report, we put in a request with Pyongyang for more information. We have got nothing back yet," said Harsaran Pandey, WHO regional information officer. She said the world body had an acting representative in the North Korean capital. "Even so, it is a difficult country to get information out of." North Korea has for more than a decade relied on food aid from donor countries to meet the needs of its 23 million people. A confirmed outbreak of bird flu would necessarily trigger a vast cull of poultry, a main source of animal protein for North Koreans.

Since late 2003 WHO has registered a total of 69 human cases of the H5N1 strain of bird flu, of which 46 were fatal. South Korea confirmed in December 2004 an outbreak of a milder form of bird flu at a duck hatchery, although the virus type, identified as H5N2, was different from the highly contagious H5N1 strain. South Korea confirmed 19 cases of H5N1 infection at poultry farms between December 2003 and March 2004, resulting in a mass cull of poultry. No infection in humans have been reported in South Korea, but the outbreak halted the country's modest poultry exports to Japan, Hong Kong and China. (Promed 3/17/05)

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China: Launches first human trials of AIDS vaccine
China has begun its first human trials of a new AIDS vaccine, Xinhua news agency said. Some 49 volunteers aged between 18 and 50 would receive the tests in three phases, the first lasting 14 months. Experts have faulted China for being slow to recognize a growing AIDS problem, exacerbated by the cover-up of the blood-selling schemes in the central province of Henan that infected scores of people in the mid-1990s. The government estimates that China, with a 1.3 billion population, has 840,000 people with HIV. Activists and experts say a more accurate figure would be between 1 million and 1.5 million. The United Nations has said that the number of HIV/AIDS victims in China could rise to 10 million by 2010 unless serious steps are taken to fight the disease. On World AIDS Day in 2003, Premier Wen Jiabao shook hands with AIDS patients at a Beijing hospital in a symbolic display of commitment to fighting the disease. But efforts to step up AIDS prevention remain shackled by politics and conservative attitudes towards sex.

The AIDS virus has infected more than 43 million people worldwide and killed 25 million. The incurable virus spreads through sexual contact, blood products and mothers' milk but can be controlled to some degree with cocktails of drugs called highly active antiretroviral therapy. The International AIDS Vaccine Initiative has said dozens of potential vaccines are being tested and more than 70 human clinical trials have taken place although none has yet promised to conquer the virus. (SEA-AIDS eForum 2004: sea-aids@eforums.healthdev.org 3/15/05)

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Japan: Blood Donation Ban May Have to be Reviewed
Japan may review its new ban on blood donations from people who stayed in Britain or France--2 countries hit by mad-cow disease in the 1980s and 1990--for one day or longer between 1980 and 1996 if donated blood is in short supply, Health, Labor and Welfare Minister Hidehisa Otsuji said 8 Mar 2005. "We have to take the strictest possible measures to ensure the safety of the people in the country," he said at a press conference but added, "We will examine the situation and think about what to do next." Japan announced the ban 7 Mar 2005 when a health ministry panel concluded that a deceased Japanese man confirmed February 2005 to have been infected with variant Creutzfeldt-Jacob Disease was likely to have contracted the disease during a 24-day stay in Britain in 1990. The Ministry said the man also stayed in France for 3 days at around the same time that France was hit by an outbreak of mad cow disease. However, the Japanese Red Cross Society warned that the expanded ban would cut potential blood donors by several hundred thousand people per year. The new ban will be put into effect following sufficient notifications, the health ministry said. The previous ban covered those people who had stayed in Britain for at least one month and in France for at least 6 months between 1980 and now. (Promed 3/8/05)

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Australia (Victoria): Mycobacterium ulcerans--mosquito-borne, suspected
Scientists have linked an outbreak of a Mycobacterium ulcerans infection to mosquitoes in Point Lonsdale. Since it was detected in 2004, 18 Victorians have been infected with Mycobacterium ulcerans, also called Bairnsdale ulcer. The disease erodes skin and fat and can cause serious scarring. State Government-funded research, led by Associate Professor Paul Johnson of Austin Health, found the bacteria in mosquitoes from around Point Lonsdale. Victoria's chief health officer, Dr Robert Hall, warned people in Point Lonsdale to use insect repellent. "Residents and visitors to the Point Lonsdale area should be aware that a small risk of infection remains," he said.

Mycobacterium ulcerans infection (Buruli ulcer) is the third most common mycobacterial disease worldwide in immunocompetent humans after leprosy and tuberculosis. M. ulcerans is an environmental mycobacterium and has been recovered from water and soil in swampy areas. The disease is not known to be contagious between humans, and epidemiological studies have not yet established natural reservoirs or modes of transmission, though abrasions of the dermis and minor skin trauma after contact with contaminated water, soil, or vegetation could be likely routes of entry. Endemic foci exist throughout the world, predominantly in tropical rain forest areas. The peak incidence of the disease coincides with the rainfall pattern and farming season in endemic districts. This lends credence to speculation that disease onset is related to farming activities, which predispose to injury and pricks. Mycobacterium ulcerans has been found in fish and a few insects, but it has also been found in snails, spiders and crayfish.

Various clinical forms may develop after M. ulcerans enters through the skin: localized necrotizing skin ulcers; contiguous dissemination over extensive body surfaces; and metastatic spread of M. ulcerans to distant sites, usually skin and bone. Minor forms heal spontaneously, ordinarily in 3-6 months by a delayed-type hypersensitivity response, followed by scarring. Devastating sequelae (scarring or amputations) often ensue from tissue destruction and osteomyelitis. (Promed 3/11/05)

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1. Updates
Influlenza
Seasonal influenza activity for the Asia Pacific and APEC Economies 2005, 16 Mar 2005
Influenza activity continued to decline slightly in North America during week 9. In Europe, except for some north-eastern European countries where a gradual increase continued to be observed, activity declined and remained medium–low. In Asia and South America, influenza activity remained low. Influenza A(H3N2) viruses were responsible for the majority of epidemics during this week, while influenza B viruses predominated and caused outbreaks in some countries of eastern Europe.

Canada. Widespread influenza activity was reported in 3 provinces. Levels of activity remained similar to those of previous weeks in terms of 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 this week, 80% were influenza A and 20% were B viruses.

Hong Kong. A slight increase in influenza activity continued to be observed. Overall influenza activity remained low. Influenza A(H3N2) and B viruses co-circulated.

Russian Federation. Influenza activity remained widespread, when morbidity reached or exceeded epidemic thresholds in 77.8% of regions.

Other reports. During week 9, low influenza activity was detected in Japan (H3 and B). (WHO 3/16/05 http://www.who.int/csr/disease/influenza/update/en/print.html)

USA: Weekly Report: Influenza Summary Update (Week ending March 12, 2005-Week 10) Influenza activity in the United States appears to have peaked during February and continued to decline in most regions during week 10 (March 6-12, 2005). Seven hundred fifty-seven (19.6%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories were positive for influenza viruses. The proportion of patient visits to sentinel providers for influenza-like illness (ILI) remained above the national baseline but has declined during the last 3 weeks. The proportion of deaths attributed to pneumonia and influenza is above the epidemic threshold for the third consecutive week. There have been 18 influenza-associated pediatric deaths reported to CDC this season. Twelve states reported widespread influenza activity and 24 states reported regional influenza activity. Twelve states and New York City reported local activity; New Hampshire, the District of Columbia, and Puerto Rico reported sporadic activity. (CDC 3/18/05 http://www.cdc.gov/flu/weekly/) 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 are available at: http://www.oie.int/eng/en_index.htm

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Dengue/DHF
Australia (Torres Strait)
More cases of dengue fever have been discovered on Thursday Island in Torres Strait. The latest outbreak was identified last week and since then 8 cases of the disease had been confirmed. A Queensland Health spokeswoman said several more patients who had shown early signs of the disease were being tested. She said efforts were being made to control the outbreak of type 4 dengue--which has recently been active in Indonesia, East Timor and Papua New Guinea--as quickly as possible, because of the heightened risk to islanders following last year's type 2 dengue outbreak. People who contract 2 different types of dengue fever have a heightened risk of contracting dengue haemorrhagic fever, which can be fatal. Last wet season, 278 cases of type 2 dengue were reported in the Torres Strait area and one person died from it. The spokeswoman said health staff from Cairns and Townsville had been flown to Thursday Island to help control the outbreak. "They are going from house to house to identify and treat breeding sites of the mosquitoes, which carry the disease," she said. Symptoms of dengue fever include fever, headache, vomiting, diarrhoea, rash, exhaustion and a loss of appetite and residents have been warned to clear away anything that can contain water where mosquitoes can breed and to use insect repellents. (Promed 3/13/05)

Malaysia
2 people died of dengue in February 2005 making the total number of deaths due to the outbreak this year to 24 nationwide. Health Ministry's Disease Control Division Director Dr Ramlee Rahmat said a 21-year-old man died at Melaka Hospital 6 Feb 2005 while the other was a 54-year-old-man at Selayang Hospital on 16 Feb 2005. He said the number of dengue cases reported in the seventh week of this year rose by 124 to 1087 cases compared to 963 cases in the previous week. However, 4 states recorded lower dengue cases: Negeri Sembilan, Sabah, Pahang & Labuan. Selangor remained as the state with the highest number of dengue cases with 427, followed by Kuala Lumpur (172), Perak (125), Penang (63) and Johor (43). Dr Ramlee said to control the outbreak, Health Departments in the states had been directed to intensify continuous control and prevention efforts especially in the states which recorded an increase in the dengue cases. He also called on property developers to play a role in the efforts as the number of construction sites found breeding mosquitoes was still high. In Selangor alone, he said, out of 101 construction sites inspected in the seventh week of the year, 69 were found breeding mosquitoes while in Kuala Lumpur, 27 of 34 construction sites were found breeding mosquitoes. He said the Health Ministry had issued compound fines to 422 premises and ordered one premises to close down. (Promed 3/6/05) Singapore
There were 9459 cases of dengue fever in Singapore in 2004--the highest number recorded in a year. Senior Parliamentary Secretary Koo Tsai Kee said the situation was worrying. The "Mozzie Attack" programme will be rolled out to all constituencies by June 2005 to help spread the message of prevention. Mr Koo said the National Environment Agency [NEA] had stepped up its efforts to search and destroy mosquito breeding in homes and public areas. It is working with managing agents of condominiums and town councils to prevent mosquito breeding. There has been some success in public areas, with only 5 percent of schools found with breeding sites, down from 25 percent before 1999. But the rising trend of mosquito breeding in homes accounted for 60 percent of all breeding sites found. The NEA will continue to work with CDCs and grassroots organizations to include dengue control initiatives in their work plans. (Promed 3/13/05)

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Viral gastroenteritis
Russia (Hunty-Mansiyskiy Autonomous Area)
Rotavirus infection is increasing in Nyangan (Hunty-Mansiyskiy Autonomous Area). According to information from Olga Ezhova, the Head of the Epidemiology Department in the State Epidemiological Surveillance Center of Nyangan, 201 persons have been admitted to the central city hospital with this diagnosis. This is almost twice the usual number. High morbidity is apparent at all schools and kindergartens in the city. According to Ezhova, the peak of the outbreak has passed. During the final week of February 2005, there were 9 to 12 new cases of rotavirus infection registered each day, whereas now, the daily number of cases has fallen to 4 to 7 persons. Nevertheless, experts predict that the outbreak will be prolonged for 2 more weeks. (Promed 3/7/05)

Russia (Kazan, Tatarstan)
The infectious disease hospitals of Kazan are overflowing with patients who have been admitted with identical symptoms of high temperature, vomiting and diarrhea. Medical opinion is that the townspeople have been exposed to a viral disease. The route of transmission is unknown. Presumably, the infection can be transmitted through drinking water or dairy products. (Promed 3/7/05)

Russia (Ekaterinburg)
In Ekaterinburg, children's hospitals are working to capacity on account of an increase in gastroenteritis among children. As many as 15-20 children have been admitted to hospitals daily for several weeks. According to Andrey Jurovskih, the Head of the Department of Especially Dangerous Infections, of the Regional Epidemiological Surveillance Center, the growth of gastroenteritis morbidity is a seasonal effect. As a rule, it occurs in the winter-spring period. In 2005, morbidity has exceeded the level observed last year, and is persisting longer. In Ekaterinburg, the outbreaks of gastrointestinal infection are still on the increase. According to the City Public Health Department, rotavirus infection is the most common cause of hospitalization. The majority of sick children are in the 1-2 age group. A proportion of children is in serious condition, and is exhibiting conditions of exicosis and toxicosis. According to the Territorial Statistical Department, in the Sverdlovsk region in 2004, more than 874 000 persons have been ill with infectious and parasitic illnesses. The largest gastroenteritis outbreaks have occurred in Irbit, where more than 150 persons, 113 of whom were children, have fallen ill because of the consumption of poor-quality water. The same situation exists in Krasnoturyinsk, where patients also were measured in the hundreds. (Promed 3/7/05)

USA (Florida)
Nearly 100 passengers and crew members were sickened with a gastrointestinal illness on a 5-day Carnival Cruise Line voyage, the company said 1 Mar 2005. About 4 percent of passengers and crew were infected in what officials believe was a norovirus epidemic on a cruise from Jacksonville to Key West and the Bahamas aboard the Celebration. The cruise ended 26 Feb 2005. In total, 69 of 1647 passengers and 30 of 693 crew members were sick. Final test results were still pending. Noroviruses cause acute gastroenteritis in humans and last between 24 and 48 hours. Symptoms include vomiting and diarrhea. "Somebody brings it on board and then it spreads. So, what we do is a very rigorous cleaning and sanitation effort to remove the virus," said Jennifer de la Cruz, Carnival Cruise Lines spokeswoman. (Promed 3/7/05)

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2. Articles
Isoloation and characterization of avian influenza viruses, including highly pathogenic H5N1...
Doan C. Nguyen et al. Journal of Virology, April 2005, p. 4201-4212, Vol. 79, No. 7
Abstract: “Since 1997, outbreaks of highly pathogenic (HP) H5N1 and circulation of H9N2 viruses among domestic poultry in Asia have posed a threat to public health. To better understand the extent of transmission of avian influenza viruses (AIV) to humans in Asia, we conducted a cross-sectional virologic study in live bird markets (LBM) in Hanoi, Vietnam, in October 2001. Specimens from 189 birds and 18 environmental samples were collected at 10 LBM. Four influenza A viruses of the H4N6 (n = 1), H5N2 (n = 1), and H9N3 (n = 2) subtypes were isolated from healthy ducks for an isolation frequency of over 30% from this species. Two H5N1 viruses were isolated from healthy geese. The hemagglutinin (HA) genes of these H5N1 viruses possessed multiple basic amino acid motifs at the cleavage site, were HP for experimentally infected chickens, and were thus characterized as HP AIV. These HA genes shared high amino acid identities with genes of other H5N1 viruses isolated in Asia during this period, but they were genetically distinct from those of H5N1 viruses isolated from poultry and humans in Vietnam during the early 2004 outbreaks. These viruses were not highly virulent for experimentally infected ducks, mice, or ferrets. These results establish that HP H5N1 viruses with properties similar to viruses isolated in Hong Kong and mainland China circulated in Vietnam as early as 2001, suggest a common source for H5N1 viruses circulating in these Asian countries, and provide a framework to better understand the recent widespread emergence of HP H5N1 viruses in Asia.” (Promed 3/14/05; Journal of Virology http://jvi.asm.org/cgi/content/abstract/79/7/4201?etoc)

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Characterization of a novel influenza A virus hemagglutinin subtype (H16) from black-headed gulls
Ron A. M. Fouchier et al. Journal of Virology, March 2005, p. 2814-2822, Vol. 79, No. 5
Abstract: “In wild aquatic birds and poultry around the world, influenza A viruses carrying 15 antigenic subtypes of hemagglutinin (HA) and 9 antigenic subtypes of neuraminidase (NA) have been described. Here we describe a previously unidentified antigenic subtype of HA (H16), detected in viruses circulating in black-headed gulls in Sweden. In agreement with established criteria for the definition of antigenic subtypes, hemagglutination inhibition assays and immunodiffusion assays failed to detect specific reactivity between H16 and the previously described subtypes H1 to H15. Genetically, H16 HA was found to be distantly related to H13 HA, a subtype also detected exclusively in shorebirds, and the amino acid composition of the putative receptor-binding site of H13 and H16 HAs was found to be distinct from that in HA subtypes circulating in ducks and geese. The H16 viruses contained NA genes that were similar to those of other Eurasian shorebirds but genetically distinct from N3 genes detected in other birds and geographical locations. The European gull viruses were further distinguishable from other influenza A viruses based on their PB2, NP, and NS genes. Gaining information on the full spectrum of avian influenza A viruses and creating reagents for their detection and identification will remain an important task for influenza surveillance, outbreak control, and animal and public health. We propose that sequence analyses of HA and NA genes of influenza A viruses be used for the rapid identification of existing and novel HA and NA subtypes.” (Promed 3/9/05; Journal of Virology http://jvi.asm.org/cgi/content/abstract/79/5/2814)

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Diagnosis of human prion disease
Jiri G. Safar et al.
“With the discovery of the prion protein (PrP), immunodiagnostic procedures were applied to diagnose Creutzfeldt–Jakob disease (CJD). Before development of the conformation-dependent immunoassay (CDI), all immunoassays for the disease-causing PrP isoform (PrPSc) used limited proteolysis to digest the precursor cellular PrP (PrPC). Because the CDI is the only immunoassay that measures both the protease-resistant and protease-sensitive forms of PrPSc, we used the CDI to diagnose human prion disease. The CDI gave a positive signal for PrPSc in all 10–24 brain regions (100%) examined from 28 CJD patients. A subset of 18 brain regions from 8 patients with sporadic CJD (sCJD) was examined by histology, immunohistochemistry (IHC), and the CDI. Three of the 18 regions (17%) were consistently positive by histology and 4 of 18 (22%) by IHC for the 8 sCJD patients. In contrast, the CDI was positive in all 18 regions (100%) for all 8 sCJD patients. In both gray and white matter, 90% of the total PrPSc was protease-sensitive and, thus, would have been degraded by procedures using proteases to eliminate PrPC. Our findings argue that the CDI should be used to establish or rule out the diagnosis of prion disease when a small number of samples is available as is the case with brain biopsy. Moreover, IHC should not be used as the standard against which all other immunodiagnostic techniques are compared because an immunoassay, such as the CDI, is substantially more sensitive.” (PNAS 2005; 102: 3501-3506; Promed 3/8/05)

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Burkholderia pseudomallei infections in Finnish tourists injured by the Dec 2004 tsunami in Thailand
Tea Nieminen and Martti Vaara
“Burkholderia pseudomallei was isolated from three Finnish patients in January 2005. All three cases were in tourists who were visiting Khao Lak on the southwest coast of Thailand when the tsunami struck in December 2004. Two strains were isolated from wound swabs and one from a blood culture. B. pseudomallei is an environmental Gram negative bacterium, endemic in tropical climates, that can cause melioidosis, a potentially life-threatening disease, even in previously healthy individuals. Humans can be infected by soil contamination of skin abrasions. Most human cases are reported from South East Asia where B. pseudomallei is endemic. The infection is very rare in Europe, and the only case to have been previously reported in Finland was in a man who travelled to Thailand in 2000. The spectrum of infections caused by B. pseudomallei ranges from mild wound infections to septic disease or pneumonia. In the severe forms of the disease, the mortality is variable, ranging from about 20% to 40%. There has been increased awareness of melioidosis as a potential complication of the December 2004 tsunami in South East Asia , and a number of B. pseudomallei isolates from people who were injured in the natural disaster have been reported. Most of the isolates have been from wound swabs, and only a few cases of systemic disease have been reported. The three Finnish cases described here are a reminder for clinicians to consider melioidosis in patients who have returned from South East Asia after the tsunami with unexplained fevers, or unusual Gram negative isolates from wounds, blood, or respiratory samples…” (Promed 3/7/05; Eurosuveillance 3/9/05 http://www.eurosurveillance.org/ew/2005/050303.asp#5)

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Inadvertent Use of Bicillin C-R to Treat Syphilis Infection--Los Angeles, California, 1999--2004
“In March 2004, the Los Angeles County Department of Health Services (LACDHS) was notified that a large nonprofit clinic serving the gay and lesbian community in Los Angeles used a nonrecommended preparation of penicillin to treat syphilis patients during January 1999--March 2004. The clinic had inadvertently used Bicillin C-R, a mixture of 1.2 million units (MU) benzathine penicillin G (BPG) and 1.2 MU procaine penicillin G, rather than Bicillin L-A, a preparation that contains the 2.4 MU BPG per dose recommended by CDC. Bicillin L-A is recommended for treating syphilis and upper respiratory tract infections caused by susceptible streptococci. Bicillin C-R is indicated for streptococcal infections of the skin and respiratory tract; however, its efficacy in treating syphilis is unknown. The inadvertent use of Bicillin C-R, which contains only half the recommended dose of BPG for syphilis, was discovered after a patient treated for syphilis read the product insert, which stated that the medication was not indicated for treatment of syphilis. Review of clinic pharmacy records revealed that it received a shipment of Bicillin C-R in lieu of an unfilled order for Bicillin L-A in late 1998 and that the pharmacy subsequently ordered Bicillin C-R until March 2004. The clinic used Bicillin C-R as its exclusive formulation of injectable penicillin during January 1999--March 2004. This report summarizes the investigation of the misuse of Bicillin C-R at the Los Angeles clinic, which represents the largest occurrence of inadvertent treatment with Bicillin C-R to date. The investigation led to discussions among CDC, the Food and Drug Administration (FDA), and King Pharmaceuticals, Inc. (Bristol, Tennessee), whose Monarch Pharmaceuticals subsidiary markets Bicillin products. As a result, King Pharmaceuticals agreed to institute packaging and labeling changes to Bicillin products to prevent inadvertent treatment of syphilis with Bicillin C-R.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5409a1.htm (MMWR March 11, 2005 / 54(09);217-219)

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Transmission of hepatitis B virus among persons undergoing blood glucose monitoring...
in long temr care facilities--Mississippi, North Carolina, and Los Angeles County, California, 2003--2004
“Regular monitoring of blood glucose levels is an important component of routine diabetes care. Capillary blood is typically sampled with the use of a fingerstick device and tested with a portable glucometer. Because of outbreaks of hepatitis B virus (HBV) infections associated with glucose monitoring, CDC and the Food and Drug Administration (FDA) have recommended since 1990 that fingerstick devices be restricted to individual use. This report describes three recent outbreaks of HBV infection among residents in long-term--care (LTC) facilities that were attributed to shared devices and other breaks in infection-control practices related to blood glucose monitoring. Findings from these investigations and previous reports suggest that recommendations concerning standard precautions and the reuse of fingerstick devices have not been adhered to or enforced consistently in LTC settings. The findings underscore the need for education, training, adherence to standard precautions, and specific infection-control recommendations targeting diabetes-care procedures in LTC settings.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5409a2.htm (MMWR March 11, 2005 / 54(09);220-223)

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Salmonellosis Associated with Pet Turtles--Wisconsin and Wyoming, 2004
“Salmonellosis associated with small pet turtles in the United States was a major public health concern in the 1970s. In 1975, the Food and Drug Administration (FDA) banned commercial distribution of small turtles (i.e., those with a carapace of <4 inches). The FDA ban prevents an estimated 100,000 cases of salmonellosis among children each year. However, a recent resurgence in the sale of small turtles has generated concern. In Wisconsin and Wyoming, at least six human cases of salmonellosis have been linked to such turtles. This report describes the investigation into those cases. The findings underscore the need for health and environmental officials to prevent illegal distribution of small turtles and consider patient contact with turtles when investigating salmonellosis cases.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5409a3.htm (MMWR March 11, 2005 / 54(09);223-226)

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Trends in Tuberculosis --- United States, 2004
“During 2004, a total of 14,511 confirmed tuberculosis (TB) cases (4.9 cases per 100,000 population) were reported in the United States, representing a 3.3% decline in the rate from 2003. Slightly more than half (53.7%) of U.S. cases were in foreign-born persons. This report summarizes data from the national TB surveillance system for 2004 and describes trends since 1993. Findings indicate that although the 2004 TB rate was the lowest recorded in the United States since national reporting began in 1953, the declines in rates for 2003 (2.3%) and 2004 (3.3%) were the smallest since 1993. In addition, TB rates greater than the U.S. average continue to be reported in certain racial/ethnic populations; in 2004, Hispanics, blacks, and Asians had TB rates 7.5, 8.3, and 20.0 times higher than whites, respectively. Essential elements for controlling TB in the United States include sufficient local resources, interventions targeted to populations with the highest TB rates, and continued collaborative efforts with other nations to reduce TB globally.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5410a2.htm (MMWR March 18, 2005 / 54(10);245-249)

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Congenital pulmonary tuberculosis associated with maternal cerebral tuberculosis--Florida, 2002
“In 2002, congenital tuberculosis (TB), a rare disease with nonspecific signs and symptoms, was diagnosed in an infant in Florida. If untreated, congenital TB is fatal, which underscores the importance of suspecting congenital TB in newborns and infants who are at risk and who have unexplained febrile illnesses. This report summarizes the investigation of the case in Florida. Health-care practitioners should administer a tuberculin skin test to women who have risks for Mycobacterium tuberculosis infection and treat those who have latent TB infection (LTBI) to prevent maternal and congenital TB disease.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5410a3.htm (MMWR March 18, 2005 / 54(10);249-250)

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3. Notifications
World TB Day --- March 24, 2005
World TB Day commemorates the date in 1882 when Dr. Robert Koch announced his discovery of the tuberculosis (TB) bacillus. TB remains one of the leading causes of death from infectious disease worldwide. An estimated 2 billion persons (i.e., one third of the world's population) are infected with the bacteria that cause TB. Each year, approximately 9 million persons become ill from TB; of these, 2 million die. World TB Day provides an opportunity for TB programs, nongovernmental organizations, and other partners to describe TB-related problems and possible solutions and to support global TB-control efforts. During 1985--1992, after years of decline, the number of TB cases reported in the US increased 20%. A renewed emphasis on TB control and prevention during the 1990s reversed this trend. Provisional data indicate that the rate of TB in 2004 was the lowest recorded in the US since reporting began in 1953. However, the rate of decline has slowed in the past 2 years, and disparities persist for certain racial, ethnic, and foreign-born populations. CDC and its partners are committed to eliminating TB in the United States. Educational programs convened by local TB coalitions will be held in many states on World TB Day. Progress in international collaborative efforts to combat TB will be acknowledged at numerous events, including a meeting of the United States--Mexico Binational Health Card Project, a comprehensive TB-referral and case-management system for the United States and Mexico. Additional information about World TB Day and CDC TB-elimination activities is available at http://www.cdc.gov/nchstp/tb/worldtbday/2005/default.htm. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5410a1.htm (MMWR March 18, 2005 / 54(10);245)

Other TB links of interest: World TB Day 2005: http://www.stoptb.org/WTBD2005/ Stop TB Department: http://www.who.int/tb/en/ (WHO http://www.who.int/mediacentre/events/2005/tbday/en/index.html)

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World Water Day --- March 22, 2005
World Water Day, March 22, 2005, marks the start of the Water for Life Decade, 2005--2015, a new United Nations International Decade for Action. The decade-long effort will improve the chances of achieving international water-related goals, including that of the United Nations Millennium Declaration: by 2015, to reduce by 50% the proportion of persons without sustainable access to safe drinking water and basic sanitation. An estimated 1.1 billion persons lack access to an improved water source, and 2.6 billion persons lack access to adequate sanitation. Waterborne diseases account for approximately 4 billion episodes of illness and 2.2 million deaths every year, disproportionately affecting young children. Safe water, adequate sanitation, and hygiene education can substantially reduce morbidity and mortality from diarrheal diseases. The Safe Water System (SWS) program uses simple, inexpensive technologies to empower families to treat and safely store drinking water in their homes (http://www.cdc.gov/safewater). Promotion of hand washing with soap, an intervention proven to reduce diarrhea, is an integral component of SWS projects. SWS programs operate in 19 countries and were a critical tool in responding to contamination of water sources in Indonesia, India, and Myanmar after the December 2004 tsunamis. “Safe Water Systems for the Developing World: A Handbook for Implementing Household-Based Water Treatment and Safe Storage Projects” is a guide for program managers, technical staff, and other personnel in organizations involved in water and sanitation projects. The guide is available in English, French, Spanish, and Arabic. CDC, the WHO, the United Nations Children's Fund, and other public and private partners are members of the International Network to Promote Household Water Treatment and Safe Storage (http://www.who.int/household_water/en). Additional information about World Water Day is available at http://www.worldwaterday.org. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5410a6.htm (MMWR March 18, 2005 / 54(10);254)

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The OIE Working Group for Wildlife Diseases: a continuous global monitoring
“The OIE Working Group for Wildlife Diseases continually monitors infectious diseases in wild animals globally in order to keep OIE Member Countries informed of new developments. The Group met at the OIE headquarters in Paris from 14 to 16 February 2005 to report on the occurrence of wildlife diseases in the world during 2004…In the current epidemic of highly pathogenic avian influenza (HPAI) in Southeast Asia, there are occasional reports of wild birds having been infected with the H5N1 pathogenic strain of the virus. While wild birds are commonly infected with a wide range of mild strains of avian influenza (AI) virus that do not cause disease, there is little evidence as yet, that wild birds in Southeast Asia have been significantly affected by the HPAI virus strain(s). The potential involvement of migratory wild birds in spreading HPAI infection is currently being studied and analysed. The Working Group strongly recommended that surveillance for AI in wild birds be increased to better understand the epidemiology of AI in wild birds in SE Asia and worldwide…The increasing organizational cooperation between OIE, WHO and FAO in this regard was welcomed and encouraged by the Working Group.” (OIE http://www.oie.int/eng/press/en_050308.htm)

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Zoonoses and veterinary public health (VPH)
Any disease and/or infection which is naturally "transmissible from vertebrate animals to man" is classified as a zoonosis according to the PAHO publication "Zoonoses and communicable diseases common to man and animals". Over 200 zoonoses have been described and they are known since many centuries. They involve all types of agents: bacteria, parasites, viruses and unconventional agents. For more information, please visit: http://www.who.int/zoonoses/en/

*** FAO also offers zoonoses related sites for the Asia-Pacific: Animal Production and Health Commission for Asia and the Pacific: http://www.aphca.org/ FAO Regional Office for Asia and the Pacific: http://www.fao.or.th/ (WHO)

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APEC to Launch Virtual Task Force for Emergency Preparedness
As part of action in response to the Indian Ocean Tsunami, APEC will establish a virtual task force to unify resources and skills in the APEC community to deal with future emergencies and natural disasters. The decision to establish the Virtual Task Force for Emergency Preparedness was made at the First APEC Senior Officials' Meeting (SOM) for 2005 in Seoul, Korea. The Virtual Task Force will strengthen coordination efforts among APEC Member Economies and fora in relation to disaster relief, rehabilitation and reconstruction in disaster stricken areas. Core aims of the task force are to strengthen preventive measures and enhance preparedness for natural disasters. The task force will also undertake capacity building initiatives to improve regional emergency and natural disaster management capability. It is anticipated that once priorities have been identified the task force will seek to build capacity in order to deal with regional emergencies and disasters such a disease outbreaks, natural calamities and terrorist actions… The new task force will help to better prepare the APEC region for future natural disasters. This will include rejuvenating the Emergency Preparedness Website hosted by Australia in order to facilitate information sharing and best practice exchange. (APEC 3/4/05 http://www.apec.org/apec/news___media/media_releases/040305_kor_virtualtaskforceforemergencypreparedness.html)

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4. APEC EINet activities
New Features on the APEC EINet website
The EINet website development team has uploaded several new features on the EINet website: 1) A Search and Browse function which allows you to look for specific information from the EINet Newsbriefs and Alerts (currently only available for data from 2005 and Dec 2004 Tsunami Alerts) 2) Print option which allows you to print the specific article you are interested 3) Email option which allows you to email an article to yourself or to another person.

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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