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Vol. VIII, No. 7 ~ EINet News Briefs ~ Apr 01, 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: Biohazard procedures to change, officials acknowledge anthrax scare missteps
- USA (Florida): Hemolytic uremic syndrome, petting zoo
- USA (Florida): Red Tide's toxins trouble lungs ashore
- 28 Mar 2005 Asia Earthquake: Damage Assessment Underway
- East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
- Viet Nam: WHO update, 3 additional human cases of avian influenza
- Cambodia: WHO update, second human case of avian influenza
- North Korea: Avian Influenza in 3 chicken farms
- North Korea: Avian Influenza outbreak, FAO sends experts to North Korea
- Thailand: Thousands of health volunteers to monitor bird flu
- Myanmar: UN gives Myanmar funds to fight bird flu
- Indonesia: Bird flu kills quail in Indonesia's Central Java
- Indonesia: Rabies outbreak leaves one dead
- China: Guangdong Province Battles Rabies Outbreak
- Viet Nam: German measles casts shadow over Ho Chi Minh City
- Australia (Queensland): Soldiers battle Scrub Typhus
- Australia (Queensland): 3 dead as melioidosis strikes
- Russia (Stavropol): 9 Tularemia cases
- Russia (Tatarstan): More Children Diagnosed with HFRS in the Visokogorskiy District

1. Updates
- Influenza
- Cholera, Diarrhea, and Dysentery
- Viral gastroenteritis

2. Articles
- CDC EID Journal, Volume 11, Number 4-April 2005
- Pseudomonas bloodstream infections associated with heparin/saline Flush, 2004-2005
- Varicella-Related Deaths --- United States, January 2003--June 2004
- Varicella Surveillance in Public Elementary Schools --- Multnomah County, Oregon, 2002--2004
- Achievements in public health: elimination of rubella and congenital rubella syndrome—US, 1969--2004
- Inadvertent Laboratory Exposure to Bacillus anthracis --- California, 2004
- Estimated influenza vaccination coverage among adults and children--U.S., Sep 1, 2004--Jan 31, 2005
- Influenza Vaccine Prebooking and Distribution Strategies for the 2005--06 Influenza Season
- Damage to ecosystems poses growing threat to human health
- Infection with multidrug resistant, dual-tropic HIV-1 and rapid progression to AIDS: a case report.
- Prevalence of norovirus among visitors from the US to Mexico and Guatemala...

3. Notifications
- CDC Update: Guidelines and Recommendations, Avian Influenza
- Teleconference: Avian Influenza: Using Scenarios for Pandemic Planning and Preparedness
- First meeting of the OIE/FAO regional steering committee of GF-TADS for Asia and the Pacific
- New APEC Molecular Biology Laboratory Network to be Established
- Introduction to Public Health Surveillance Course
- Vaccination Week in the Americas, 23–30 April 2005
- FDA Issues Nationwide Alert on ONE lot of Pharmedium Services magnesium sulfate solution

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

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
USA: Biohazard procedures to change, officials acknowledge anthrax scare missteps
The Defense Department is changing how it handles biohazard threats, acknowledging that internal breakdowns delayed its response to an anthrax scare at the Pentagon and nearby office buildings, confused the rest of the federal government, and alarmed state and local public health workers, officials said. Under fire for gaps with civilian bioterrorism detection and response systems, military officials said they will quicken reporting of test results from biological sensors around their headquarters to no more than 24 hours, and, shift away from using contract laboratories. It took 3 days to get results from a contractor after the 14 Mar 2005 incident. Pentagon representatives discussed the steps 25 Mar 2005 during a review chaired by Thomas J. Lockwood, national capital region coordinator for the Department of Homeland Security. Representatives from the White House, FBI, the Health and Human Services Department, and the U.S. Postal Service, as well as state and local officials, were present. Homeland Security Secretary Michael Chertoff ordered the review, after alerts in 2 military mailrooms shut the main delivery center at the Pentagon, disrupted mail delivery to U.S. government offices, and put 900 workers in several buildings on antibiotics for 3 days.

Although the presence of anthrax bacteria in one of 4 samples taken on 10 Mar 2005 from the Pentagon's Remote Delivery Facility was confirmed by 3 laboratories, subsequent testing found no trace of the pathogen. Senior military officials said the most plausible explanation was contamination by the original contractor laboratory, Commonwealth Biotechnologies Inc., which has said a subsequent review produced no evidence of contamination. Another 14 Mar 2005 airborne alert at a mailroom in the Skyline office building complex in Baileys Crossroads -- whose defense contractor employees receive mail from the Pentagon facility -- turned out not to signal the presence of any hazardous substance and apparently was a coincidence. About 800 workers were locked down for 6 hours. Timing is critical, because scientists believe that healthy people exposed to anthrax bacteria can die in 7 days.

Overall, national bioterrorism experts inside and outside of government say the episode revealed lingering problems in achieving a coordinated emergency response since the area's anthrax attacks through the mail in 2001. Virginia and District leaders have said they were kept out of the loop early in the recent incident, potentially endangering the public. The review group also reached preliminary agreement that government agencies should rely on the CDC's bioterrorism Laboratory Response Network, which includes 140 specially certified labs, to test for such incidents instead of contract facilities, 2 officials said. The review group also agreed that federal agencies should coordinate with state and local public health agencies before ordering antibiotic treatment solely for federal employees. (Promed 3/28/05)

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USA (Florida): Hemolytic uremic syndrome, petting zoo
The number for people infected with a bacterial illness after visiting central Florida petting zoos continues to grow. 5 new cases have been confirmed in children, bringing the total number to 22. The latest results include 3 in Volusia County and 1 each in Charlotte and Collier counties. 24 other infections are suspected. Some victims have tested positive for the E. coli O157:H7 bacterium, and others have developed a related kidney disease, potentially life-threatening hemolytic uremic syndrome. In one bit of good news, a suspected link between the outbreak and the death of a 12-year-old Pasco County girl has been ruled out. Tests came back negative for the E. coli strain at the center of the probe. Investigators are leaning more toward petting zoo animals than food vendors as the source of the problem, Lindsay Hodges, a spokeswoman for the state Health Department, said. All of the victims visited the Central Florida Fair in Orange County or the Florida Strawberry Festival in Plant City early Mar 2005. Since the incubation period from exposure to the petting zoos is over, newly reported cases are either just being recognized after presenting earlier or are secondarily spread infections. A petting zoo planned this weekend at the Springtime Tallahassee festival has been canceled. The Lake County Fair, starting Apr 7 2005 in Eustis, has ruled out a petting zoo from the same company used by the 2 central Florida events. (Promed 3/31/05)

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USA (Florida): Red Tide's toxins trouble lungs ashore
A massive red tide off the beaches of southwest Florida is causing an outbreak of wheezing and coughing among beachgoers, and new evidence suggests that the effects of an airborne neurotoxin the tide produces may be more harmful than health officials previously thought. Since Jan 2005, a large algae bloom has been releasing into the air odorless toxins that waft onto beaches with every onshore wind. Red tide occurs nearly every year, but this year's bloom is unusually persistent.

Florida tourism officials have long downplayed the human respiratory effects of red tide, in part because exposure depends on shifting winds and the toxins affect some people differently than others. But some results from a 5-year series of studies by scientists show for the first time that the events may be causing significant health problems. During a 3-month 2001 red tide event examined in the study, Sarasota Memorial Hospital's emergency room admissions for respiratory problems were 54 percent higher for people living along or visiting the coast than during the same time period the next year, when there was no red tide. There was no similar spike inland. The study also documents that beachgoers with chronic respiratory problems have reduced lung capacity after even a short exposure to red tide, although it's unclear how long the problems last. The study will be published in a series of 7 papers in Environmental Health Perspectives. Barbara Kirkpatrick, staff scientist at Mote Marine Laboratory in Sarasota and one of the lead researchers of the study, wants state and local officials to develop a visible warning system to alert beach visitors to red tides. Still, healthy people appear to be affected only temporarily; watery eyes and scratchy throats can be cured by simply going inside an air-conditioned room or leaving the beach.

Florida's red tide is caused by a naturally occurring single-celled organism, Karenia brevis. The organism multiplies and accumulates in the Gulf of Mexico almost every year; the neurotoxin is released when the fragile cells die. People who eat seafood contaminated by the neurotoxin can become ill. Still, swimming is allowed and most people report few adverse reactions. How best to warn the public about red tide's respiratory effects is a delicate subject in southwest Florida, where so many people's livelihoods rely on tourism. Because Florida does not close beaches during red tide events, lifeguards often educate beach-goers. Kirkpatrick said there are still many unknowns about red tide, such as how long symptoms can last and the potential for exposure to cause chronic and immune system problems. (Promed 3/29/05)

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Asia
28 Mar 2005 Asia Earthquake: Damage Assessment Underway
WHO is continuing to work with the Ministry of Health to assess the health needs of people in the areas of Indonesia affected by the earthquake. Emergency medical supplies are being sent to the affected areas and WHO is supporting emergency relief services. WHO has also strengthened its office in Medan, North Sumatra Province and is closely monitoring the situation in cooperation with Provincial and District Health Offices. Immediate needs are:

• Mobile medical service for affected victims, injuries and trauma care.
• Shelter, water, food, including infant and supplementary food for children, clothes, blankets, sanitary measures and emergency lights.
• Large heavy earth moving equipment.
• Operational funding supports for health staff to be mobilized and provide health services to affected areas.
• Special transportation services to reach affected areas and evacuate critically injured.
• Satellite telecommunication support.
• Infrastructure recovery including electricity and telecommunications

The following persons can be contacted if more information is needed:

Dr. Doti Indrasanto, Acting Head of Department, Center for Emergency preparedness and response (PPMK) MOH
Tel: 811173712
Fax: 021-5271111
Crisis@Depkes.go.id

Dr Anshu Banerjee, Field Operations Manager, WHO
Tel: 8121064878
Fax: +47-241- 37387
banerjeea@aceh.who.int

Dr. Kyaw Win (Vijay Nath), Medical Officer, EHA, WHO
Tel: 021-5204349, 811933821, 86811020053 (satellite phone)
Fax: 021-5201164
wink@who.or.id

WHO Latest Situation Reports on South and South-East Asia Tsunami: There has been no update since 11 Mar 2005 (see APEC EINet News Brief 18 Mar 2005). (WHO 3/31/05 http://www.who.int/hac/crises/idn/sitreps/2005/earthquake_03/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 (CIDRAP) at the University of Minnesota compiles up-to-date unambiguous figures of avian influenza cases and deaths in East Asia. As of 29 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 79 with 49 deaths; whereas the official (WHO) figures are 70 cases and 47 deaths. The numbers of cases reported from mid-Dec 2004 to present are:

Economy / Unofficial (Official) Cases / Unofficial (Official) Deaths
Cambodia / 2 (1) / 2 (1)
Thailand / 0 (0) / 0 (0)
Viet Nam / 32 (24) / 14 (13)
Total / 34 (25) / 16 (14) (CIDRAP, 3/29/05 http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html)

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Viet Nam: WHO update, 3 additional human cases of avian influenza
The Ministry of Health in Viet Nam has confirmed three additional cases of human infection with H5N1 avian influenza. The cases concern a 5-year-old boy from the central province of Quang Binh, a 17-year-old girl from the northern province of Nam Dinh, and a 40-year-old woman from the northern province of Quang Ninh. The 17-year-old girl has died. An earlier case has also been confirmed. These recently confirmed cases bring the total in Viet Nam since mid-December to 28. WHO is aware of reports of suspected H5 avian influenza infection in five members of a family who are presently hospitalized in the northern port city of Haiphong. These cases, which include the parents and their three young daughters, are undergoing further investigation following initial tests indicating infection with the H5 subtype of avian influenza. Reports indicate outbreaks of avian influenza in poultry in the vicinity. Field investigation of this family cluster is under way.

The current outbreak of human cases in Viet Nam has included several clusters, mostly in family members, of cases closely related in time and place. Thorough investigation of all such clusters is essential to determine possible changes in the behavior of the virus and thus assess the risk of an influenza pandemic. There is currently no evidence that the H5N1 virus is spreading easily from person to person. Rapid sharing with WHO of viruses from recent clusters of cases has become increasingly important. Analysis can determine whether any significant changes in the virus have taken place and provide further support for risk assessment. Several media reports have recently covered rumours of a large outbreak of influenza-like illness in Quang Binh Province. The outbreak is presently under investigation by provincial and central health authorities. Samples have been taken for testing, and WHO is awaiting the results. The number of cases with influenza-like illness appears much smaller than initially reported by the media. (Promed 3/30/05; WHO 3/29/05)

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Cambodia: WHO update, second human case of avian influenza
The 28-year-old man, from Kampot Province, developed symptoms 17 March 2005 and was hospitalized in Phnom Penh 21 March. He died 22 March. The same day, laboratory tests by the Pasteur Institute in Phnom Penh confirmed that the man was infected with H5 avian influenza virus. The Cambodian government immediately launched an investigation to search for possible additional cases and identify possible sources of exposure to the virus. The investigation team, which is continuing its work in Kampot Province, includes Cambodian Ministry of Health and Ministry of Agricultural officials joined by staff from the WHO country office and the Pasteur Institute in Phnom Penh. FAO is assisting the investigation of animal disease. Numerous deaths among chickens in the area have been reported and samples taken from sick chickens have tested positive for avian influenza. The results from the investigation indicate the deceased man had contact with sick poultry. An 18 year-old boy initially identified as an additional suspected case has tested negative for the avian influenza virus. Samples taken from twenty seven other people, including family contacts of the confirmed case and Phnom Penh medical staff involved in his care, have all tested negative for H5 avian influenza infection. Results from a further six people from Kampot Province have also tested negative for H5 influenza virus. The majority of poultry in Cambodia are raised in small backyard flocks in rural areas, making surveillance for outbreaks especially challenging. A campaign to educate rural populations about the dangers of contact with dead or diseased poultry is being undertaken by the government, with support from WHO. (Promed 3/30/05; WHO 3/29/05)

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North Korea: Avian Influenza in 3 chicken farms
North Korea has culled 219 000 birds at 3 chicken farms following what is believed to be its first outbreak of bird flu, an official at the FAO said 31 Mar 2005. North Korean authorities also told an FAO expert that areas near the chicken farms have been vaccinated, and surveillance measures for the disease have been expanded to the entire country. The official said although FAO suspects avian influenza, a final confirmation has yet to be made. It is unknown whether the virus involved is the H5N1 strain of the bird flu virus. Hans Wagner, a senior official with the FAO, said, "There are indications that it is avian influenza, but they lack the diagnostic tools to do a proper diagnosis of which type and sub-type…So far there are no indications that we have human flu cases…They are very well aware of the general threat of avian influenza on a global scale". But Pyongyang's neighbours are taking no chances. China has tightened quarantine controls on its border with North Korea, and stepped up the fight against poultry smuggling. South Korea, which has also stepped up quarantine measures at border points and at poultry farms near the border, believes the outbreaks in North Korea are extensive. South Korea is also examining wild and domestic birds near the DMZ for signs of the illness. South Korea and China have offered North Korea equipment and chemicals for culling.

The source of the outbreaks was not known, but the fact the 3 farms are owned by the same company probably contributed to the spread of the disease. "Admittedly we are a little bit surprised to have an outbreak in large farms because generally large farms have higher biosecurity standards than smaller farms," Wagner said. Most of North Korea's annual 25 million birds are produced on larger farms. Bird flu has become entrenched in several other Asian countries because the virus can circulate among small, backyard farms where chickens often mix with wild ducks, believed to be silent carriers of the disease.

Hospitals in North Korea are known to lack sanitary facilities, antibiotics and equipment considered basic in the West. The WHO advises people to cook fowl completely and wash their hands thoroughly after handling, "but we're talking about a country where there isn't even enough soap," said one official. Even if the flu is confined to the bird population, the economic consequences are likely to be severe. North Korea's people suffer from a chronic lack of protein, and the nation's sparse economy generates few legal exports. "Their loss defies comparison," said Lee Suk Doo, president of Porky Trading Korea, the Seoul-based firm that has suspended plans to import 2000 tons of chicken from North Korea this year. The deal had been in the works since 2000, when then-South Korean President Kim Dae Jung met with Kim Jong Il to set the stage for economic cooperation. Lee believes that North Korean chicken would sell well in the South because it is "almost 100 percent organic", raised without added hormones or antibiotics. (Promed 4/1/05, WHO 3/29/05)

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North Korea: Avian Influenza outbreak, FAO sends experts to North Korea
FAO has sent a veterinary expert to Pyongyang/North Korea to obtain further information on the extent of the current avian influenza outbreak and to offer assistance to control the bird flu virus. Two additional FAO avian influenza experts from China and Australia will arrive soon. North Korea has informed FAO about bird flu outbreaks on two or three farms. In response, FAO has sent diagnostic kits for avian influenza to support national control efforts. Poultry production is one of the few growing sectors in the country. The number of poultry is estimated at some 25.5 million in 2004, about two times higher than in 1997. North Korea is one of the poorest countries in the world, with around 8 million chronically undernourished in 2000-2002.

The spread of the disease into North Korea underlines the need for close regional cooperation, FAO said. North Korea is already benefiting from a regional FAO project on avian influenza, shared with China, Mongolia and the Republic of Korea. The project assists in improving and upgrading veterinary laboratories as well as creating a network for the sharing of epidemiological information, and provision of equipment to control and prevent avian flu. A national workshop on bird flu will be held soon in North Korea to improve awareness of the disease, and provide information on control methods, laboratory diagnosis and good farming practices. The workshop will be jointly organised by the government and FAO. It is essential to fight the bird flu virus in poultry, free-range chickens and ducks, in order to reduce the risk of a human flu pandemic, FAO said.

Also, the WHO country office in Pyongyang has offered direct assistance to the Ministry of Public Health in strengthening surveillance and diagnostic capacity for the detection of possible human cases. WHO has offered to send oseltamivir, an antiviral drug that can be used prophylactically, to reduce the risk of human infection and disease, as well as therapeutically. The WHO country office has further offered to supply personal protective equipment for poultry cullers. WHO is this week despatching test kits to support laboratory diagnosis of H5-subtype avian influenza in humans. (FAO 3/30/05; WHO 3/30/05)

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Thailand: Thousands of health volunteers to monitor bird flu
The Thai government has organised more than 850 000 health-care volunteers to closely monitor for local outbreaks of bird flu in order to contain the disease. Organised by the Ministry of Public Health, the scheme is intended to prevent human's catching the infection, the newly appointed Public Health Minister, Dr.Suchai Charoenrattanakul, said. Volunteers will monitor the death rate of chickens in every village and report regularly to the districts' health-care chiefs who will report to the Ministry of Public Health. Officials in Thailand's upper central and lower northern regions have been told to beef up their monitoring system because these areas have had repeated outbreaks of the disease in the past 2 years. Since the system was introduced several months ago, no new cases of bird flu patients have been found. But local public health workers have been told not to lower their guard, the public health minister said. (Promed 3/22/05)

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Myanmar: UN gives Myanmar funds to fight bird flu
The UN has provided funds to help Myanmar fight bird flu, although no case of the disease has been confirmed in the country yet, a semi-official newspaper said 21 Mar 2005. The funds from the UN FAO will be used for administrative support, veterinarian training and equipment for disease diagnosis, the Myanmar Times said. The money, totaling USD 350 000, will be shared with 9 other Asian countries. Myanmar banned poultry imports in January 2004 from countries where bird flu has been detected, and officials are monitoring poultry farms in the country. Also, officials in Myanmar have denied recent reports of a possible outbreak of bird flu, but are on alert against it. The FAO had asked Rangoon to check a report on an opposition web site that thousands of chickens had died in southern Myanmar. (Promed 3/22/05, Promed 3/24/05)

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Indonesia: Bird flu kills quail in Indonesia's Central Java
The bird flu virus has killed thousands of quail on Indonesia's main island of Java since February 2005, the Agriculture Ministry said 28 Mar 2005. H.R. Wasito, director-general of animal husbandry at the ministry, said some 60 000 quail had either died from the disease or had been culled at farms in Central Java province. The province's farmed quail population was around 130 000. New cases of the H5N1 virus on a small scale have re-emerged in some parts of Indonesia since it was first found in late 2003. The authorities have insisted that, overall, the deadly disease is under control. Wasito said that in the Jan-Mar 2005 period, bird flu had killed a total of 281 730 fowl in 3 provinces of South Sulawesi, West Java and Central Java. The Indonesian government has said bird flu is endemic and that it would take years to fully stamp out the disease. So far, there have been no reports of the H5N1 strain infecting people in Indonesia. (Promed 3/28/05)

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Indonesia: Rabies outbreak leaves one dead
54 people have been exposed to rabid animals in Ende regency, East Nusa Tenggara, over the past several weeks, with one death. To stop the spread of the virus, government officials are vaccinating thousands of dogs and monkeys, and killing those animals suspected of carrying the virus, said M. Littik, the head of the provincial animal husbandry office. There was an outbreak of rabies in Lembata regency in January that also killed one person, M. Littik said. Rabies has killed 128 people in the past 8 years in 8 regencies in the province. The rabies situation in Indonesia is defined as "urban", characterised by the virus reservoir being found mainly within the (unvaccinated and uncontrolled) stray dog population. Besides the activities related to the animal reservoir, such as a significant reduction of the feral dog population and vaccination of domestic dogs, public education is an essential component of rabies control. Obviously, this might be effective only if backed by adequate public-health infrastructure, especially in remote areas. (Promed 3/19/05)

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China: Guangdong Province Battles Rabies Outbreak
A southern Chinese province's worst rabies epidemic in a decade has prompted authorities to kill unvaccinated dogs and limit the animals' movement between counties, the government said. Guangdong province reported 244 cases of the disease during 2004 -- an increase of 41 percent from 2003 -- the official Xinhua News Agency said. Rabies has been reported in 8 cities in the populous province. The provincial health bureau has ordered the killing of all dogs that have not been vaccinated within a 1.5-mile radius of villages where rabies was reported, and in counties where 2 or more cases have been reported, Xinhua said. Affected counties have also been banned from selling or transferring the dogs that have been killed, and are not allowed to import dogs for one year, Xinhua reported. The report did not say whether there were reports of people affected by the disease. During 2004, Guangdong had more than 5 times the average annual number of cases reported in 1995-2002, Xinhua said. An increase in the number of unregistered dogs and fewer vaccinations have contributed to the spread of the disease, Xinhua said. (Promed 3/18/05)

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Viet Nam: German measles casts shadow over Ho Chi Minh City
Up to 798 people, mostly female workers, in Viet Nam's southern Ho Chi Minh City have suffered from rubella, a contagious viral infection with mild symptoms associated with a rash, since Nov 2004. Most of the patients are from Cu Chi District, and they work in industrial parks in the city, the local newspaper Labor reported 18 Mar 2005. To deal with the situation, local health agencies are strengthening vaccination among residents, especially young women at universities and factories, and children aged 12-24 months. They are also urging people to improve hygiene in their living and working environments. German measles, also known as rubella, or 3-day measles, is caused by a virus that is spread through the air or by close contact. It can also be transmitted to a fetus by a mother with an active infection, causing severe disease in the fetus. The current outbreak in Ho Chi Minh City attracts attention because of its extent and the age groups affected, which suggest either a breakdown in vaccine coverage or an inadequacy of the vaccine employed. It is generally benign in children and adults. In view of the involvement in Ho Chi Minh City of a large number of young adult women, it will be advisable for the local health-care authorities to undertake surveillance for congenital rubella syndrome. (Promed 3/21/05)

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Australia (Queensland): Soldiers battle Scrub Typhus
A group of North Queensland soldiers thought to have contracted leptospirosis have been cleared of the disease. The group fell ill while involved in a regular military exercise in Innisfail. Leptospirosis is a bacterial disease that can lead to kidney damage, meningitis, liver failure, and respiratory distress. Captain Andrew Bird, from Third Brigade headquarters, says a third round of blood tests on 14 Townsville-based soldiers has come back negative. He says medical advice is that the soldiers suffered from the effects of a bacterial disease called scrub typhus, which cause symptoms similar to dengue fever. "From what I've been briefed scrub typhus is caused by a mite, which is normally picked up off the ground, and our soldiers spend a lot of time on the ground," he said.

This change in diagnosis illustrates the relatively nonspecific nature of many infections. Scrub typhus is spread to humans by the bite of the larval stage of trombiculid mites (chiggers). The term scrub comes from the type of local vegetation--scrub--between forests and cleared areas, where the vector is found. The disease is also referred to as tsutsugamushi fever. The organism, Rickettsia tsutsugamushi, or Orientia tsutsugamushi, causes natural disease in eastern Asia and in the western Pacific. In any area, because of high rates of transovarian transmission in the mite, highly focal areas of high risk exist. Symptoms are often nonspecific, but severe headache and myalgias (common in rickettsioses), and an eschar with regional lymphadenopathy, can be helpful in diagnosis in endemic areas. The diagnosis can be made serologically, although early treatment (doxycycline) may blunt the antibody response. (Promed 3/29/05, Promed 3/22/05)

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Australia (Queensland): 3 dead as melioidosis strikes
3 people died and 7 others were in hospital after acquiring melioidosis, a tropical soil-borne disease in north Queensland. Queensland Health's Tropical Public Health Unit warned north Queenslanders 24 Mar 2005--especially those with poor health or chronic conditions--to take precautions against melioidosis following 10 recent cases. Public health physician Jeffrey Hanna said 4 people from Cape York, 2 from Townsville, 1 from Bowen, 2 from Cairns, and a visitor from interstate had all been affected by the disease. A patient from Cairns, 1 from Cape York and the interstate visitor all died from the illness, he said. All were elderly and had underlying medical conditions; deaths were not unexpected in people with underlying disease. Dr Hanna encouraged north Queenslanders to wear gloves and footwear while gardening or working outdoors, to cover wounds with waterproof dressings to prevent exposure to contaminated soil or water, and to wash skin thoroughly after contact with soil.

The melioidosis bacillus, Burkholderia pseudomallei, exists as an environmental saprophyte living in soil and surface water in endemic areas (southeast Asia and northern tropical Australia), particularly in rice paddies. In endemic countries, the organism exists primarily in focal areas and is not equally distributed throughout the landscape. Sporadic cases have been reported to have been acquired in parts of Africa and the Americas. 2 outbreaks in Australia have implicated potable water supplies rather than surface water as a potential source of the infection. Melioidosis is a disease of the rainy season in the endemic areas. It mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (commonest risk factor), renal disease, cirrhosis, thalassemia, alcohol dependence, immunosuppressive therapy, chronic obstructive lung disease, cystic fibrosis, and excess kava consumption. Melioidosis may present at any age, but peaks in the 4th and 5th decades of life, affecting men more than women. In addition, although severe fulminating infection can and does occur in healthy individuals, severe disease and fatalities are much less common in those without risk factors.

The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, chest pain and, although the cough can be nonproductive, respiratory secretions can be purulent, significant in quantity, and associated with on-and-off bright red blood. The lung infection can be rapidly fatal or somewhat more indolent. The melioidosis bacillus is intrinsically insensitive to many antimicrobials. Bioterrorism strains may be engineered to be even more resistant. (Promed 3/24/05)

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Russia (Stavropol): 9 Tularemia cases
Since the beginning of 2005, 9 inhabitants of the Stavropol region have developed tularemia, including 8 adults and a 13-year-old, based on reports from the Regional Epidemiological Surveillance Center. All infected persons were inhabitants of the Petrovskiy, Shpakovskiy and Ipatovskiy districts of the Stavropol region and the city of Stavropol. They were all hunters or members of a hunter's family and were thought to have acquired the bacterial infection from exposure to the carcasses of animals (hares). In the Stavropol region annual outbreaks of tularemia have been reported since 2003. (Promed 3/22/05)

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Russia (Tatarstan): More Children Diagnosed with HFRS in the Visokogorskiy District
An outbreak of hemorrhagic fever with renal syndrome (HFRS) has been documented among schoolchildren in the village of Dachniy in the Visokogorskiy district of the republic of Tatarstan. The chief infectious diseases specialist, Diraya Nagimova, stated this should be a warning alerting officials in other districts to clean rubbish from their streets. She added that Tatarstan is an endemic zone for HFRS and that the last serious outbreak occurred in 1997, with more than 1000 infected people. Every year about 600-700 cases are recorded in Tatarstan, and the incidence rate is 4-fold greater than the average for Russia. The vector of the disease is the bank vole.

By 24 Mar 2005, 12 children had been hospitalized with a preliminary diagnosis of HFRS. The diagnosis has been confirmed now for 6 of them. The first case, which was registered 22 Feb 2005, has also been confirmed as HFRS, so in total 13 children are ill (with confirmed or presumptive HFRS). Almost all of the others are schoolchildren with an age range of 8 to 15 years. 89 schoolchildren in the village of Dachniy are considered to be at risk of developing HFRS, since the incubation period for this disease is 45 days. Physicians are carrying out regular house visits. It has not been determined yet how the children were exposed to HFRS infection. According to Nagimova, rodent control measures have already been undertaken twice in 2005. Infection requires inhalation of dust contaminated with vole excrement. The village school, a kindergarten, and a local shop have been temporarily closed. An area around the village has been subjected to rodent disinfestation measures. (Promed 3/26/05)

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies 2005, 22 Mar 2005

Medium–low levels of influenza activity continued in week 10, 2005 During week 10, influenza activity continued to decline in North America. In central Europe, influenza activity remained widespread, and a gradual increase continued to be observed in some north-eastern European countries. In other parts of world, activity remained medium to low.

Canada. Overall influenza activity declined in week 10, with widespread activity reported in 2 provinces. Of the influenza viruses detected during week 10, 72% were influenza A viruses and 28% were B viruses.

Hong Kong. The number of influenza viruses isolated continued to increase in week 10, although overall influenza activity remained low. Influenza A(H3N2) and B viruses co-circulated.

Russian Federation. Influenza activity remained widespread. Influenza A and B viruses co-circulated.

United States. Influenza activity appears to have peaked during February and has declined since then. The overall ILI consultation rate was still above the national baseline, although it declined during the previous 3 weeks. The proportion of deaths attributed to pneumonia and influenza remained above the epidemic threshold. During week 10, 3 additional influenza-associated pediatric deaths were reported. Of the influenza viruses detected in week 10, 70% were influenza A viruses and 30% were B viruses.

Other reports. During week 10, low influenza activity was detected in Chile (A), Japan (B), and Mexico (H3 and A). (WHO 3/16/05 http://www.who.int/csr/disease/influenza/update/en/print.html)

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Cholera, Diarrhea, and Dysentery
Philippines (Samar)
4 people were killed and 50 others were hospitalized during a cholera outbreak in Northern Samar at the height of typhoon Auring, Health Undersecretary Ethelyn Nieto said 22 Mar 2005. The victims, mostly children, are residents of 2 barangays, including Nambutak, in Palapag town. "The patients have been re-hydrated and given antibiotics. The water has been chlorinated, and those who were not given (chlorine solution) have been advised to boil their drinking water," Nieto said. She said the victims started falling ill 15 Mar 2005, but the cases peaked 3 days later. The residents source their water from deep wells. Lab tests on water samples showed they were contaminated with Vibrio cholerae. (Promed 3/28/05)

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Viral gastroenteritis
Mexico, Antigua, and Guatemala
Few studies have investigated the prevalence of norovirus infection among civilians traveling from industrialized to developing countries, said researcher Kellogg J. Schwab, reporting in the March issue of the Journal of Clinical Microbiology (see our Articles section below), His team.analyzed stool samples from 34 people who suffered traveler's diarrhea during trips to Antigua, Guatemala or Cuernavaca, Mexico. Nearly 2/3 of them had at least one stool sample that tested positive for the presence of noroviruses,. The finding is relatively new, since molecular detection methods for these viruses have only recently been introduced into labs in the US or other countries. The authors noted that 11 of the norovirus-positive stool samples also tested positive for E. coli. This suggests that dual infections among people with traveler's diarrhea may also be more common than previously thought. The researchers said their findings indicate a need for further research into the role of noroviruses in traveler's diarrhea. (Promed 3/30/05)

USA (Pennsylvania)
A local hospital was forced to take precautions, after several children contracted rotavirus infection. Patients at Children's Hospital contracted the virus, which leads to vomiting and diarrhea. Hospital officials say 10-12 children caught the virus. 4 of those came down with it while at the hospital. One newborn had the virus 3 days after having surgery at Children's Hospital. He then passed it on to his mother. Rotavirus infection generally lasts 3 to 8 days. The best way to prevent getting the virus is to wash your hands often. Rotavirus is the most common cause of diarrhea in children and infants. It is transmitted from fecal matter through contaminated water, food or contact. It is treated by re-hydration. (Promed 3//30/05)

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2. Articles
CDC EID Journal, Volume 11, Number 4-April 2005
CDC Emerging Infectious Diseases Journal, Volume 11, Number 4-April 2005 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. The following expedited article is available online: “Highly Pathogenic H5N1 Influenza Virus in Smuggled Thai Eagles, Belgium”, S.V. Borm. The following conference summaries are also of interest:
- “Workshop on Carbohydrate Moieties as Vaccine Candidates”, C. Taylor
- “Third Congress for the European Society for Emerging Infections”, M. Mavris and L. Halos
- “SARS Coronaviruses and Highly Pathogenic Influenza Viruses: Safety and Occupational Health for Laboratory Workers”, J. Taylor et al.
- “Emergence and Control of Viral Respiratory Diseases”, R. Webster et al.

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Pseudomonas bloodstream infections associated with heparin/saline Flush, 2004-2005
“On January 26, 2005, CDC was notified of four cases of Pseudomonas fluorescens bloodstream infection among patients at an oncology clinic in Missouri. All patients had received a heparin/saline flush to prevent clotting of indwelling, central venous catheters. The flushes were preloaded in syringes by IV Flush and distributed by Pinnacle Medical Supply (Rowlett, Texas). On January 31, a nationwide alert against use of all heparin or saline flushes preloaded in syringes by IV Flush was issued by the Food and Drug Administration; the company recalled these products. As of February 15, state and local health departments and CDC had identified a total of 36 Psuedomonas species infections in patients in four states who were administered the heparin/saline flushes from multiple lots. This report describes the ongoing investigation and provides recommendations for investigation and management of potential cases…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5411a1.htm (MMWR March 25, 2005 / 54(11);269-272)

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Varicella-Related Deaths --- United States, January 2003--June 2004
“During 2003 and the first half of 2004, CDC received reports of eight varicella-related deaths. The age of the decedents ranged from 1 to 40 years. Six of the eight deaths occurred among children and adolescents aged <20 years. The cases were reported from Arizona (two), Maryland (two), Arkansas (one), New Hampshire (one), Ohio (one), and New York City (one). Six deaths occurred in unvaccinated persons. Vaccination status of the remaining two persons could not be determined. This report describes clinical data for three of the fatal varicella cases in children, reported from Arizona, Arkansas, and New York City; all three patients were susceptible and unvaccinated, but otherwise healthy. The three other children and adolescents, not described in detail in this report, were immunocompromised as a result of at least one preexisting condition. The findings in this report underscore 1) the importance of timely routine vaccination of children aged 12--18 months and catch-up vaccination of older susceptible children and adolescents according to current recommendations and 2) the need for timely and complete national varicella death surveillance…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5411a2.htm (MMWR March 25, 2005 / 54(11);272-274)

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Varicella Surveillance in Public Elementary Schools --- Multnomah County, Oregon, 2002--2004
“Varicella vaccination of school-aged children reduces the number of varicella cases and lost days of school. In 1996, the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination of all children aged 12--18 months, catch-up vaccination of all susceptible children before age 13 years, and vaccination of susceptible persons who have close contact with persons at high risk for serious complications and susceptible persons at high risk for exposure. In 1999, ACIP updated these recommendations to include vaccination requirements for child care and school entry. Since 2000, in accordance with ACIP recommendations, varicella vaccination requirements have been phased in for Oregon children who have not had varicella before starting out-of-home child care, kindergarten, or seventh grade; elementary school children will be fully covered by school year (SY) 2006--07. To monitor changes in varicella incidence, Oregon Health Services (OHS) and Multnomah Education Service District (MESD) started routine, individual, case-based varicella surveillance in Multnomah County public elementary schools (kindergarten through 5th grade) beginning SY 2002--03. This report describes the surveillance system, the incidence of varicella during SY 2002--03 and SY 2003--04, and the results of active surveillance for unidentified cases during SY 2002--03. The findings indicate that the number of varicella cases has decreased in Oregon and that establishing public elementary school--based varicella surveillance is feasible and useful…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5411a3.htm (MMWR March 25, 2005 / 54(11);274-276)

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Achievements in public health: elimination of rubella and congenital rubella syndrome—US, 1969--2004
“In October 2004, CDC convened an independent panel of internationally recognized authorities on public health, infectious disease, and immunization to assess progress toward elimination of rubella and congenital rubella syndrome (CRS) in the United States, a national health objective for 2010. Since rubella vaccine licensure in 1969, substantial declines in rubella and CRS have occurred, and the absence of endemic transmission in the United States is supported by recent data: 1) fewer than 25 reported rubella cases each year since 2001, 2) at least 95% vaccination coverage among school-aged children, 3) estimated 91% population immunity, 4) adequate surveillance to detect rubella outbreaks, and 5) a pattern of virus genotypes consistent with virus originating in other parts of the world. Given the available data, panel members concluded unanimously that rubella is no longer endemic in the United States. This report summarizes the history and accomplishments of the rubella vaccination program in the United States and the Western Hemisphere and the challenges posed by rubella for the future...” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5411a5.htm (MMWR March 25, 2005 / 54(11);279-282)

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Inadvertent Laboratory Exposure to Bacillus anthracis --- California, 2004
“On June 9, 2004, the California Department of Health Services (CDHS) was notified of possible inadvertent exposure to Bacillus anthracis spores at Children's Hospital Oakland Research Institute (CHORI), where workers were evaluating the immune response of mice to B. anthracis. This report summarizes the subsequent investigation by CDHS and CDC, including assessment of exposures, administration of postexposure chemoprophylaxis, and serologic testing of potentially exposed workers. The findings underscore the importance of using appropriate biosafety practices and performing adequate sterility testing when working with material believed to contain inactivated B. anthracis organisms…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5412a2.htm (MMWR April 1, 2005 / 54(12);301-304)

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Estimated influenza vaccination coverage among adults and children--U.S., Sep 1, 2004--Jan 31, 2005
“In response to the unexpected shortfall in the 2004--05 influenza vaccine supply, CDC recommended in October 2004 that vaccine be reserved for persons in certain priority groups, including persons aged >65 years and 6--23 months, persons aged 2--64 years with conditions that increased their risk for influenza complications, residents of chronic-care facilities, close contacts of infants aged <6 months, and health-care workers with direct patient contact. In late December 2004, based on declining demand among these groups, two additional groups (i.e., healthy persons aged 50--64 years and household contacts of all persons at high risk) were added to the list of vaccination priority groups. To monitor influenza vaccination coverage during the 2004--05 season, the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing, state-based, telephone survey of civilian, noninstitutionalized persons, added new questions to collect information on priority status and the month and year of vaccination for adults and children. This report is based on analysis of data collected during February 1--27, 2005, regarding respondent-reported receipt of influenza vaccination during September 1, 2004--January 31, 2005. The results of this analysis indicated that influenza vaccination coverage levels through January 2005 among adults in priority groups nearly reached those in recent years, whereas coverage levels among adults not in priority groups were approximately half of levels in 2003, in part because 9.3% of those unvaccinated persons in nonpriority groups declined vaccination this season. The results further suggested that designation of the priority groups successfully directed the nation's influenza vaccine supply to those at highest risk. In addition, vaccination coverage among children aged 6--23 months was notable (48.4%), given that 2004--05 was the first year this group was recommended for influenza vaccination…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5412a3.htm (MMWR April 1, 2005 / 54(12);304-307)

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Influenza Vaccine Prebooking and Distribution Strategies for the 2005--06 Influenza Season
“For the 2004--05 influenza season, CDC, in coordination with the Advisory Committee on Immunization Practices (ACIP), issued interim influenza vaccine use recommendations after Chiron Corporation announced that none of its inactivated influenza vaccine (Fluvirin®) would be available in the United States. To plan for the upcoming 2005--06 influenza season, CDC has met with influenza vaccine manufacturers, including those intending to apply for approval to sell in the United States, to develop supply projections and distribution strategies, including prebooking (i.e., advance ordering of vaccine) and partial shipment of orders to those customers who prebook. As of March 25, 2005, the supply of inactivated influenza vaccine projected for the 2005--06 season appeared adequate to meet the historical demand from persons in the priority groups established by ACIP during the 2004--05 season. If more vaccine becomes available, additional groups can also be targeted for vaccination…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5412a4.htm (MMWR April 1, 2005 / 54(12);307-308)

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Damage to ecosystems poses growing threat to human health
A new report shows that some 60% of the benefits that the global ecosystem provides to support life on Earth (such as fresh water, clean air and a relatively stable climate) are being degraded or used unsustainably. In the report, scientists working on the Millennium Ecosystem Assessment (MA) warn that harmful consequences of this degradation to human health are already being felt and could grow significantly worse over the next 50 years. The Millennium Ecosystem Assessment (MA) synthesis report warns that the erosion of ecosystems could lead to an increase in existing diseases such as malaria and cholera, as well as a rising risk of new diseases emerging. (WHO 3/30/05 http://www.who.int/mediacentre/news/releases/2005/pr15/en/index.html)

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Infection with multidrug resistant, dual-tropic HIV-1 and rapid progression to AIDS: a case report.
Markowitz M, Mohri H, Mehandru S, Shet A, Berry L, Kalyanaraman R, Kim A, Chung C, Jean-Pierre P, Horowitz A, La Mar M, Wrin T, Parkin N, Poles M, Petropoulos C, Mullen M, Boden D, Ho DD.

Abstract: “BACKGROUND: Rapid progression to AIDS after acute HIV-1 infection, though uncommon, has been noted, as has the transmission of multidrug resistant viruses. Here, we describe a patient in whom these two factors arose concomitantly and assess the effects. METHODS: We did a case study of a patient with HIV-1 seroconversion. We genotyped the virus and host genetic markers by PCR and nucleotide sequencing. To ascertain the drug susceptibility of our patient's HIV-1 we did phenotypic studies with the PhenoSense assay. We assessed viral coreceptor use via syncytium formation in vitro and with a modified PhenoSense assay. FINDINGS: Our patient seems to have been recently infected by a viral variant of HIV-1 resistant to multiple classes of antiretroviral drugs. Furthermore, his virus population is dual tropic for cells that express CCR5 or CXCR4 coreceptor. The infection has resulted in progression to symptomatic AIDS in 4-20 months. INTERPRETATION: The intersection of multidrug resistance and rapid development of AIDS in this patient is of concern, especially in view of his case history, which includes high-risk sexual contacts and use of metamfetamine. The public health ramifications of such a case are great.” (Lancet. 2005 Mar 16;365(9464):1031-8. See also comment on Promed 3/26/05)

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Prevalence of norovirus among visitors from the US to Mexico and Guatemala...
Chapin AR, Carpenter CM, Dudley WC, Gibson LC, Pratdesaba R, Torres O, Sanchez D, Belkind-Gerson J, Nyquist I, Karnell A, Gustafsson B, Halpern JL, Bourgeois AL, Schwab KJ.

Abstract: “Traveler's diarrhea (TD) is the most common infectious illness acquired by visitors to developing nations. The purpose of this study was to utilize molecular diagnostic techniques to determine the prevalence of norovirus (NoV) in TD occurring among visitors from the United States to Guatemala and Mexico. Stool samples (n = 54) were collected from 34 TD cases and analyzed for NoV by reverse transcription-PCR and oligoprobe confirmation. The overall prevalence of NoV was 65%. Interestingly, all NoV-positive stool samples were identified as genogroup I NoVs, and time spent at travel destinations was found to be an important factor in determining the frequency of infection (P = 0.003). Eleven NoV-positive stool samples also tested positive for enterotoxigenic Escherichia coli, indicating that dual infections with this leading bacterial cause of TD were very common. Results of this study suggest that NoV infection is a frequent occurrence among travelers to Mexico and Guatemala who experience episodes of TD. In addition, the simple molecular detection method utilized here will serve to facilitate more in-depth epidemiological studies of this emergent viral pathogen in travelers and other at-risk populations.” (J Clin Microbiol. 2005 Mar;43(3):1112-7)

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3. Notifications
CDC Update: Guidelines and Recommendations, Avian Influenza
“Interim Guidance about Avian Influenza A (H5N1) for U.S. Citizens Living Abroad”, updated 24 Mar 2005 is available at: http://www.cdc.gov/travel/other/avian_flu_ig_americans_abroad_032405.htm.

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Teleconference: Avian Influenza: Using Scenarios for Pandemic Planning and Preparedness
From Stephen C. Aldrich, Bio Economic Research Associates, saldrich@bio-era.net: This special web-based teleconference will take place on Thursday, 7 Apr 2005, at 11:00 AM e.s.t. and will feature a web-based presentation by James Newcomb, Managing Director for Research at bio-era [Bio Economic Research Associates], on the logic behind 6 bio-era scenarios for the possible emergence of an avian influenza pandemic in SE Asia; their economic and business consequences; and how they can by used by medical directors, corporate planners, security managers, and public health and other government officials to improve planning and preparedness. The call will include comments from invited experts and group discussion. This is the 2nd in a series of monthly web teleconferences and accompanying reports being offered by bio-era as a service to track and analyze the economic and business significance of avian influenza. The call is free to participants in the service, and open to others on a sliding scale fee (public health officials pay less). To learn more about the teleconference, please go to: http://www.uptilt.com/ct.html?s=6fb,bww6,11b6,h1wv,9u2n,kcz5,d9d3 (Promed 4/1/05)

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First meeting of the OIE/FAO regional steering committee of GF-TADS for Asia and the Pacific
The first regional steering committee of the Global Framework for the Progressive Control of Transboundary Animal Diseases (GF-TADs) in Asia and the Pacific was held in Tokyo, Japan 7-9 Mar 2005. The GF-TADs is a joint initiative of the FAO and of the OIE which combines the strengths of both organisations in the fight against transboundary animal diseases (TADs) world wide. The ultimate aim of the Programme is to control and eradicate the most significant animal diseases including those transmissible to humans. The GF-TADs will endeavor to empower regional alliances in the fight against TADs, to provide for capacity building, to assist in establishing programmes for the specific control of certain TADs based on regional priorities and to convince donors to support these activities.

This initiative is also being supported by the WHO. The specific aim for GF-TADs is to establish sub-Regional Support Units (RSUs)), integrated in Regional Specialised Organisations (RSOs). In the region, OIE and FAO Headquarters, Regional Commissions and Representations will support the Regional Specialised Organisations and sub-Regional Support Units for the design and the implementation of regional and national programmes. The GF-TADs Programme is developed along three main thrusts:

- A regionally led mechanism to operationally address and implement action against priority diseases
- The development of Global and Regional Early Warning Systems for major animal diseases, selected for each Sub Regional Unit
- The enabling and application of Research on TADs for more efficient disease control and eradication

By recognising country and regional specificities as regards animal diseases prevalence and control, a major objective of the GF-TADs is to try to adapt policies and programmes to regions, sub-regions and countries. Taking part at the meeting, the Director General of the OIE, Dr Bernard Vallat said that especially with diseases such as avian influenza posing a potential threat to humans, it is vital to ensure early detection and a rapid response. "A part of the investment to be done will be to help developing countries to develop early detection, early response and notification systems. The new global and regional mechanism GF-TADs represents a promising tool for reaching these goals worldwide", Dr Vallat added. The creation of trust funds has been decided, aimed at financing programmes for the control of the most significant animal diseases in the region and at strengthening existing programmes as the South-East Asia Foot and Mouth Disease Campaign and the regional programme for the Avian Influenza control. (OIE 3/22/05)

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New APEC Molecular Biology Laboratory Network to be Established
Life Sciences research in the Asia-Pacific has been given a boost with plans for APEC to establish an innovative molecular biology laboratory network to link together leading scientists, institutions, policy-makers and entrepreneurs. The APEC Electronic International Molecular Biology Laboratory (eIMBL) will enable participating laboratories to share research equipment, materials, know-how and research findings. Scientists will also be able to engage in real-time peer discussion and analysis of results among laboratories participating in the "Unit Lab".

The decision to establish the eIMBL was made at the recent meeting of the APEC Industrial Science & Technology Working Group in Gwangju, Korea, 15-16 Mar 2005. Chair of the meeting, Dr. Paul Cheung, said the eIMBL will enable the APEC region to better prepare to deal with potential threats such as SARS or Avian Influenza as well as increasing the competitiveness of the regional biotechnology sector. "The increasing need for regional cooperation and information sharing to deal with trans-border biomedical and agricultural as well as environmental concerns has been evident in recent years. "The APEC eIMBL will enable greater collaboration to be carried out in leading centers of scientific excellence and we will all enjoy the benefits of the resulting information sharing." The eIMBL will be officially launched at the APEC Economic Leaders' Meeting that will take place in Busan, Korea, in November. The ISTWG's objective is to increase the capacity of the industrial science and technology sector in the APEC Region to improve quality of life while safeguarding the natural environment. (APEC 3/22/05)

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Introduction to Public Health Surveillance Course
CDC and Emory University's Rollins School of Public Health will cosponsor "Introduction to Public Health Surveillance," May 9--13, 2005, in Atlanta, Georgia. The course is designed for state and local public health professionals. The course will provide practicing public health professionals with the theoretical and practical tools necessary to design, implement, and evaluate effective surveillance programs. Topics include overview and history of surveillance systems; planning considerations; sources and collection of data; analysis, interpretation, and communication of data; surveillance systems technology; ethics and legalities; state and local concerns; and future considerations. Additional information and applications are available from Emory University, Global Health Dept., 1518 Clifton Road, N.E., Room 746, Atlanta, GA 30322; telephone, 404-727-3485; fax, 404-727-4590; at http://www.sph.emory.edu/epicourse; or by email, pvaleri@sph.emory.edu. http://www.cdc.gov/mmwr/mmwr_wk.html (MMWR March 25, 2005 / 54(11);284)

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Vaccination Week in the Americas, 23–30 April 2005
Coordinated by WHO's Regional Office for the Americas (PAHO), "Vaccination Week in the Americas" is the largest immunization drive in the Americas held every year. This year's vaccination campaign aims to reach children who live in hard to reach rural regions, as well as indigenous people and vulnerable groups such as women of childbearing age and the elderly. They will be immunized against diseases such as measles, polio and rubella. For more information, visit the PAHO site: http://www.paho.org/English/DD/PIN/vw_2005.htm. (WHO http://www.who.int/mediacentre/events/2005/vaccinationweek/en/index.html)

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FDA Issues Nationwide Alert on ONE lot of Pharmedium Services magnesium sulfate solution
FDA is issuing a nationwide alert against the use of PharMEDium Services Magnesium Sulfate 1 gram in 50mL D5W (piggyback) IV solution, lot number 100504900049 and expiration date 4/4/05. This product is manufactured by PharMEDium Services of Houston, Texas and may be contaminated with Serratia marcescens bacteria that can cause serious, life-threatening illness in patients with compromised immune systems. This product is frequently administered intravenously to patients undergoing cardiac surgery and was apparently distributed to several hospitals around the country. To date it has been associated with at least 5 recent cases of Serratia marcescens infection in a hospital in New Jersey. All patients have responded to treatment with antibiotics and are reportedly recovering well. The firm has notified FDA that it is in the process of withdrawing this lot from hospitals. FDA, the CDC, and other public health authorities are investigating this problem to determine if other lots of this product may be affected.

Serratia marcescens can cause a wide variety of hospital-acquired infections and has been associated with infections in injecting drug users, particularly endocarditis and osteomyelitis. Immunologically normal individuals can acquire S. marcescens infection especially in the hospital setting. The organism is widespread in the environment but not a common component of the human fecal flora. (FDA http://www.fda.gov/bbs/topics/news/2005/NEW01166.html; Promed 3/20/05)

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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