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Vol. XII, No. 12 ~ EINet News Briefs ~ Jun 12, 2009
*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
1. Influenza News
- Cumulative number of human cases of influenza A/(H1N1)
- Cumulative number of human cases of avian influenza A/(H5N1)
- Global: WHO declares global influenza pandemic
- UK (Scotland): Considering vaccinating all children
- Australia: Laboratory test to diagnose influenza A/H1N1 said to be 90 percent accurate
- China (Hong Kong): Influeanza A/H1N1 vaccination plan approved
- India: May ask countries to screen departing passengers for influenza A/H1N1
- Canada: PHA update on influenza A/H1N1
- Canada: Serious cases of influenza A/H1N1 among First Nations people raise concern
- USA: CDC update on influenza A/H1N1
- USA: CDC says pandemic declaration will not change its response
- Egypt: Influenza A/H1N1 outbreak at university results in quarantine
- Egypt: Reports 80th human avian influenza H5N1 case
2. Infectious Disease News
- China (Shaanxi): Reports 11 rabies deaths since March 2009
- Chinese Taipei: Reports imported case of valley fever, first in 4 years
- Russia (Khakassia): Tick bites and tick-borne infections up from 2008
- Russia (Sverdlovskaya): Increase in tick bites results in 2 deaths
- Thailand: Chikungunya infection continues to spread, kills newborn
- USA (California): Tick-borne relapsing fever case in San Luis Obispo County
- USA (Missouri): Elderly man dies of tick-borne disease ehrlichiosis
- USA (New Mexico): Boy dies and sister hospitalized due to bubonic plague infections
- USA (Tennessee): Typhoid cluster in Chattanooga, source unknown
- INFLUENZA A/H1N1
- AVIAN INFLUENZA
- HAND, FOOT, and MOUTH DISEASE
- Origins and evolutionary genomics of the 2009 swine-origin H1N1 influenza A epidemic
- Origins of the new influenza A(H1N1) virus: time to take action
- Influenza A(H1N1) and Pandemic Preparedness Under the Rule of International Law
- Use of Revised International Health Regulations during Influenza A (H1N1) Epidemic, 2009
- Preliminary analysis of influenza A(H1N1) individual and aggregated case reports from EU and EFTA countries
- Environmental transmission of low pathogenicity avian influenza viruses and its implications for pathogen invasion
- Weekly Epidemiological Record Bulletin
- International Swine Flu Conference
- Influenza H1N1 planning conferences in US
1. Influenza News
Cumulative number of human cases of influenza A/(H1N1)
74 countries have officially reported 29,669 of influenza A/H1N1 infection, including 145 deaths.
Economy / Cases (Deaths)
APEC updates: US and Canada report increased risk for pregnant women related to novel H1N1 with two deaths in the US and six Canadian women on respirators. Influenza A/H1N1 has spread to every Australian state and territory.
***For data on human cases of avian influenza prior to 2009, go to:
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 433 (262).
Avian influenza age distribution data from WHO/WPRO:
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 5/10/09): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 3/23/09):
Global: WHO declares global influenza pandemic
WHO Director-General Dr. Margaret Chan announced the long-expected move to pandemic alert phase 6, meaning that the virus has caused sustained community outbreaks in more than one global region. The move comes amid growing signs of community transmission in Australia, Chile, and the United Kingdom—far from the epidemic's birthplace in Mexico and the United States.
"The scientific criteria for a pandemic have been met," Chan said. "I have therefore decided to raise the level of influenza pandemic alert from phase 5 to phase 6. The world is now at the start of the 2009 influenza pandemic."
The announcement came as the WHO's global H1N1 count rose to 28,774 confirmed cases in 74 countries. The United States, Mexico, and Canada account for the vast majority of those, but cases have been mounting in Australia (with 1,307), Chile (1,694), and the United Kingdom (822), among others. "Spread in several countries can no longer be traced to clearly defined chains of human-to-human transmission," Chan said. "Further spread is considered inevitable."
She said there was unanimous agreement among WHO member countries and the agency's emergency committee that "we have indisputable evidence that we are at the beginning of a pandemic caused by a new H1N1 virus."
In making the announcement to a world conditioned by the H5N1 avian influenza virus to think that a pandemic means the global spread of an often-lethal virus, Chan explained that the virus causes mild illness in the vast majority of patients. But she also noted that it differs from seasonal flu in significant ways. In areas with large outbreaks, most cases have occurred in people younger than 25, and in some of these areas, about 2% of cases have been severe, Chan said. She added that most of the severe and fatal infections have involved people between 30 and 50, and about a third to half of those people were previously healthy.
"Although the pandemic appears to have moderate severity in comparatively well-off countries, it is prudent to anticipate a bleaker picture as the virus spreads to areas with limited resources, poor health care, and a high prevalence of underlying medical problems," Chan stated.
Seven weeks since emergence
The pandemic is the first since the worldwide spread of an H3N2 flu virus in 1968-69, when the tools for tracking and identifying influenza viruses were far less sophisticated than today. Yet the H1N1 virus surprised the world by emerging in North America instead of Asia and causing mild illness in most people, instead of the severe disease associated with the H5N1 virus. But experts warn that it could evolve into a more threatening form.
The WHO had hesitated to move to phase 6 out of concern that it would cause undue alarm and lead to unnecessary and harmful measures such as trade embargoes, travel restrictions, and a flood of worried but healthy people into hospitals. Last week the agency promised to couple its pandemic announcement with an assessment of the severity of the threat in an effort to prevent overreactions.
Chan repeated the WHO's recommendations against travel restrictions and border closures. In a question period, she seemed to downplay the concern that the pandemic declaration would lead to new travel and trade restrictions. Noting that some countries did impose various restrictions in the early weeks of the epidemic, she said they have been lifting them since then. "We must recognize that with a new disease . . . it's not unusual to have a degree of overreaction. I think this is understandable," she said.
The meaning of 'moderate'
As for what the world should do now that the pandemic has officially arrived, the general answer from Chan and Fukuda was essentially, "Stay vigilant." "Countries should prepare to see cases, or the further spread of cases, in the near future," Chan said. "Countries where outbreaks appear to have peaked should prepare for a second wave of infection." She added that the WHO has sent guidance on specific measures to all health ministries.
Chan said the epidemic in Mexico "is coming to a steady state," with sporadic cases and outbreaks. "In the event that Mexico is coming out of the first wave, it doesn't mean that Mexico should let down its guard. Mexico should prepare to continue and keep up its vigilance because the virus can come back in a second wave."
Chan also reminded reporters that the H5N1 virus is still lurking. "We should never forget it as we're talking about H1N1, we still have H5N1 in [pandemic alert] phase 3, and this is the first time we have two new viruses coexisting at the same time in pandemic alert," she said.
Antivirals distributed Concerning antiviral drugs, the WHO has sent doses of oseltamivir (Tamiflu) to 121 countries, disbursing all 5 million doses initially donated by Roche. Chan said the agency has received a second donation of 5.6 million doses, some of which are the pediatric formulation, and those will be sent to other countries.
As for a vaccine, Dr. Marie-Paule Kieny of the WHO said all vaccine manufactures have received the vaccine virus. She said a few have already started making a vaccine, and others will begin in the next week or two. Kieny predicted that the first doses will become available sometime in September 2009, depending on how production goes and how long it takes to get regulatory approval. Chan said the WHO will urge regulatory agencies to "fast track" the vaccines. As for who will get the first doses, Kieny said, "When enough is available in the coming weeks, we'll make a policy recommendation on which groups, which populations should be prioritized for the first vaccine doses."
In recent interviews in anticipation of the pandemic declaration, public health experts said they would welcome the move and downplayed the risk of panic and overreactions. "It'll potentially raise awareness again in the country," said Dr. Paul Jarris, executive director of the (US) Association of State and Territorial Health Officials (ASTHO). "There seems to be a sentiment among some policymakers that this thing is gone and the response was an overreaction. It's still in the US, it's still spreading, it's not just another seasonal flu. Seasonal flu doesn’t put 23-year-olds in intensive care. . . . It's still here, and we need to plan for a resurgence in the fall."
Jarris said he doesn't expect panic in the wake of the announcement. "If we let them know that it means that a new virus has traveled around the world, people will understand it," Jarris added. "We need to reinforce the hygiene and hand washing, but also reinforce that this is the time for planning."
At the same time, Jarris voiced concern about science's capability to accurately assess the threat posed by the new virus. "Right now I think we still are unable to accurately portray the transmissibility or severity of this virus," he said. "We don't really know how many have been ill, how many have been exposed. We don't have the lab capacity to test everyone."
UK (Scotland): Considering vaccinating all children
As the number of confirmed novel H1N1 cases in Scotland soared to 232 as of 9 Jun 2009, officials discussed the idea of vaccinating all of the country's children. Though no final decisions on vaccine prioritization have been made, a government spokesperson said children and healthcare workers will likely be in the top tier and that the goal is to vaccinate all Scottish citizens by the middle of 2010.
Australia: Laboratory test to diagnose influenza A/H1N1 said to be 90 percent accurate
Some Australians may have been falsely diagnosed with influenza A/H1N1 while others with the disease may have been sent home with a negative result because the laboratory test used to identify the virus is only about 90 percent accurate.
As of 10 June 2009, more than 1200 Australians have tested positive to H1N1. New South Wales (NSW) Health is among those departments using polymerase chain reaction testing (PCR) to identify the H1N1 strain of influenza. The latest information from the World Health Organization (WHO), supported by the US Food and Drug Administration (FDA), suggests the newly developed rRT-PCR "rapid" testing method gives only a "presumptive positive" rather than a "definitive positive" result for H1N1 influenza. According to reports from both organizations, the test can also provide a "false negative" result in cases where the patient actually has the virus.
In April 2009, the FDA issued an emergency use authorization to allow a "rapid" form of the method to be rushed to laboratories across the US to combat a potential swine flu epidemic, even though the method had not been fully developed or obtained approval. A document released by the FDA on 28 Apr 2009 states only that rRT-PCR novel H1N1 testing "may be effective" in testing for influenza A/H1N1. The FDA report states that "a positive result indicates that the patient is presumptively infected with [influenza A/H1N1 virus, but not the stage of infection", and that "a negative result does not, by itself, exclude the possibility of [influenza A/H1N1] virus infection."
The WHO has issued its protocols for using the new test method to laboratories around the world. That document states tests can provide only a "presumptive positive" result for H1N1. The WHO document also said "a false negative result may occur if inadequate numbers of organisms are present in the specimen due to improper collection, transport, or handling".
The rRT-PCR testing method was developed by the global pharmaceutical Roche -- the company that also owns the rights to Tamiflu, one of just two anti-viral drugs used to treat the virus. George Koumantakis, the Scientific and Regulatory Affairs manager for Roche Diagnostics Australia, said the PCR testing method was "about 90 percent accurate." During the week of 1 Jun 2009, Roche reported that stocks of Tamiflu had sold out in Australia due to unprecedented demand. The health minister, Nicola Roxon, said the virus was mild in Australia, and only about 10 people had been hospitalized.
China (Hong Kong): Influeanza A/H1N1 vaccination plan approved
India: May ask countries to screen departing passengers for influenza A/H1N1
Canada: PHA update on influenza A/H1N1
The PHA has confirmed 2878 human cases of influenza A/H1N1 in 12 provinces/territories. Four fatalities have been reported. The provinces most heavily burdened are Ontario (1562) and Quebec (611). Two deaths have been reported in Ontario and one death in both Alberta and Quebec. Only Newfoundland has not reported any cases.
Canada: Serious cases of influenza A/H1N1 among First Nations people raise concern
An official from the World Health Organization (WHO) said 9 Jun 2009, that health experts are closely monitoring novel H1N1 influenza infections in Canada's Inuit populations, following reports that the communities are seeing more than their share of severe cases.
The WHO’s Keiji Fukuda stated, "We can say now that we know a larger number than expected of young Inuit people developed serious illnesses and had to get hospitalized." He added that the WHO doesn't know if the trend is linked to socioeconomic factors, genetic factors, or chronic underlying diseases, and commented that Inuit groups were hit hard in some earlier pandemics. Fukuda is assistant director-general for health security and the environment. On 8 Jun 2009, Joel Kettner, Manitoba's chief medical officer, said that 26 people were being treated in intensive care units for suspected novel influenza infections, which is unusual for an influenza outbreak. He said more than half of the patients are of aboriginal descent, with an average age of 35.
Further, Manitoba's health department said that 15 extra ventilators have arrived at the province's ICUs and that the Winnipeg Regional Health Authority is helping the departments prioritize patients and was considering deferring non-urgent surgical procedures that would normally require use of the units.
As of 8 Jun 2009, Manitoba said it had confirmed 40 novel flu cases in six of its 11 health regions. Meanwhile, health officials in Canada's Nunavut territory said on 9 Jun 2009 that the number of confirmed novel flu cases has jumped from 25 to 53, with six patients in the hospital. Nunavut's population is primarily Inuit.
Donald R. Olson, research director for the International Society for Disease Surveillance, said that the severe cases in Canada's Inuit populations are puzzling. However, he added that among remote populations, the 1918 pandemic influenza was more severe and didn't follow the age patterns seen in the rest of the world. "Inuit groups didn't show the same apparent sparing of the elderly, so possibly the older proportion of the population had not been exposed" to previous viruses related to the pandemic strain, he said. The medical literature tells of "flu orphans" from remote Alaskan villages who survived the 1918-19 pandemic, though their parents and grandparents died, presumably because they had not been exposed to earlier H1-like viruses.
In 2006 at a state summit in Alaska, former US Health and Human Services Secretary Mike Leavitt described the impact of the 1918 pandemic virus on Alaska's native populations. "The Alaska native population in Nome was decimated—176 of the 300 Alaska Natives in the region died," he said in comments posted on the HHS pandemic flu Web site. "The pandemic swept through communities, killing whole villages." Preexisting health conditions may also have contributed to the severity of the 1918 pandemic in Inuit populations, which also had high tuberculosis rates in the early 20th century.
Officials don't know if higher rates of chronic illnesses in today's Inuit populations are playing a role in the high number of severe cases. However, Health Canada reports that when compared to the rest of the nation, First Nations and Inuit people have 1.5 times the rate of heart disease, 3 to 5 times the rate of type 2 diabetes, and 8 to 10 times the rate of tuberculosis infection.
On 8 Jun 2009, an Australian health expert from Darwin warned that the country's indigenous populations might be at greater risk for novel H1N1 infections. Besides citing lack of exposure to similar virus and underlying conditions as possible risk factors, experts have also theorized that remote populations might have a genetic predisposition that makes them more susceptible to the virus, Olson said. But he expressed doubt that the factor is playing a role in Canada's current outbreak. The signals coming out of Canada are worrying, he said. "The less developed world may have a terrible experience with this, though there is a lot of coughing and sneezing in the rest of the world," Olson said.
Danuta Skowronski, a physician and epidemiologist at the University of British Columbia, said that over the past few years, circulation of seasonal H1N1 viruses in North America has been patchy, and people in remote communities are likely to have had less exposure to the viruses than have people living in urban settings. There's still much that researchers don't know about possible cross-protection against the novel H1N1 virus from exposure to previous H1N1 strains, she said. Though researchers have identified antibody markers and determined that seasonal vaccination offers little protection, they still haven't gauged the cell-mediated response—which can offer protection during severe infections—afforded by exposure to previous H1N1 strains, Skowronski added.
Public health officials will also be looking for environmental factors that might be contributing to the infections in the First Nations and Inuit groups, she said. For example, large numbers of people living in one household may have greater exposure to the virus. "This all needs to be assessed, because we're picking up possible signals of concern," Skowronski said.
USA: CDC update on influenza A/H1N1
USA: CDC says pandemic declaration will not change its response
Thomas Frieden, who as the CDC's new director spoke on 11 Jun 2009 at his first press conference on the novel H1N1 virus, said US officials expected the declaration. He added that the decision fits with the scientific data supporting continued human-to-human transmission in more than one WHO region. "For all intents and purposes, the US government has been in phase 6 of the pandemic for some time now," he said. "This, however, is important, because it does send the strong message that the virus is here, and, in all likelihood, it's going to stay." He emphasized the pandemic level change doesn't signify a change in the severity level or behavior of the new virus. Moving forward, the CDC's goals are to identify where the virus is spreading and blunt its impact, particularly on vulnerable populations, such as those with chronic health conditions and infants, he said.
Preparing for a second wave
Napolitano said, "We are reaching out to our partners in state and local government, in school districts and the private sector to urge them to modify and update their pandemic plans." She added that the government is working with scientists to test and prepare a possible vaccine and comparing notes on the virus with experts in other countries.
Virus acting much like seasonal H1N1
The novel H1N1 virus is behaving like its seasonal H1N1 counterpart, which typically has a bigger impact on younger people, Schuchat said. Of people who were hospitalized with novel flu infections, 71% had underlying conditions such as asthma, chronic obstructive pulmonary disease, immune deficiency, or pregnancy, she said.
CDC officials said people should contact a healthcare provider right away if they or a loved one has a measured fever of 100.4°F or higher with a cough or a sore throat, along with an underlying health condition such as asthma or pregnancy. Though the CDC sees ongoing transmission in all states, two regions are above the influenza-like illness baseline for this time of year—New England and the New York and New Jersey area.
So far, there's no evidence to suggest that circulating novel H1N1 strains won't be a good match for the seed strains used in the vaccines, Schuchat said. Testing of isolates from different countries and states so far shows no changes. "But with influenza, we need to keep looking," she added.
Egypt: Influenza A/H1N1 outbreak at university results in quarantine
The influenza A/H1N1 virus was detected in seven foreign students of the American University of Cairo (AUC) while another 140 students have been placed in quarantine, according to the medical services and the establishment. The dormitory's 110 students from 10 nationalities, as well as 124 workers and lecturers who use the building, were tested following the outbreak and the university announced it would suspend classes until 14 Jun 2009.
All of the new cases are Americans. The first two AUC cases were a woman who arrived from New Jersey via New York and London, and a man from Florida who came via New York. The five more recent cases had been in contact with the original two infections, Nasser Al Sayyed, assistant minister for preventive medicine, stated.
"The dormitory will remain under quarantine for a week until no more cases are detected. We will provide all facilities they need including food and communication around the clock," Sayyed said. A ministry official has taken up residence in the dorm to monitor possible infections around the clock.
The first Egyptian case of influenza A was detected on 2 Jun 2009. It is a 12-year-old American girl who arrived on holiday in Cairo. It was also the first case detected in Africa.
Egypt: Reports 80th human avian influenza H5N1 case
2. Infectious Disease News
China (Shaanxi): Reports 11 rabies deaths since March 2009
In Hanzhong city of northwest China's Shaanxi Province, two more people have died of rabies bringing the rabies death toll in the city since March 2009 to 11. The two fatalities were both women, one aged 58 and the other 56, said a local government official. The first death was reported on 21 Mar 2009 and the number of people injured by dog bites in the city has since reached 6256. So far, approximately 335,900 pet dogs have been vaccinated in the city. The city, with more than 370,000 registered dogs, reported 35 total deaths from rabies from 1985 to 1992.
Human deaths indicate the rabies virus is very active and poses a great public health threat, Shi Ruihua, local agricultural bureau chief, said early June 2009. The city carried out a rabies prevention campaign from 23 May-1 Jun 2009, implementing door-to-door compulsory vaccinations of dogs and urging dog owners to put their pets on a leash or keep them off the streets.
Chinese Taipei: Reports imported case of valley fever, first in 4 years
This was the third valley fever case ever recorded in Taipei. The previous two cases, also imported, were recorded in 2005 and 1991, respectively, according to the CDC. The latest case was a 30-year-old woman who was in the US between 1 Jul 2008 and 1 May 2009. The infection was diagnosed on 3 Jun 2009 through blood tests, the CDC said.
Valley fever is caused by Coccidioides immitis, a fungus commonly found in the soil of desert regions in the United States, Mexico, and Central and South America, the CDC said. People can be infected after
inhaling the fungus spores in the air. The disease is not spread person to person. While many infected persons display no symptoms, some may develop fever, cough, chills, night sweats, headache, joint aches, chest pain, and a red spotty rash. Rarely, the infection can lead to pneumonia, meningitis, and even death.
Russia (Khakassia): Tick bites and tick-borne infections up from 2008
The highest rate of tick attacks have been observed in nearby Sayanogorsk. Epidemiologists indicated that among tick bite victims who came for medical assistance not more than 20 percent are vaccinated against tick-borne encephalitis virus. As result the majority of tick bite victims are at risk of infection. Tick-borne encephalitis has been confirmed in 17 inhabitants of the republic. Also, 18 persons, including two children, contracted Lyme disease; in 2008 it was just 10 persons.
Russia (Sverdlovskaya): Increase in tick bites results in 2 deaths
The vice head of Sverdlovski oblast Rospotrebnadzor administration Andrey Yurovskickh said elderly people and small children are not getting vaccines properly. The plan for vaccination has been completed by 21 percent. Acaricidal (anti-tick) treatments in parks have been completed by 60 percent. Specialists forecast that ticks will be more abundant in 2009, compared with 2008.
Thailand: Chikungunya infection continues to spread, kills newborn
On 30 May 2009, Trang Hospital chief Somneuk Cheuthong announced that the mosquito-borne chikungunya disease is believed to have killed for the first time in Thailand, claiming a 6-day-old baby boy. Trang doctors performed emergency surgery on a 28-year-old pregnant chikungunya patient on 23 May 2009 to save her baby. However, the baby had died from respiratory complications. The infant had contracted the virus from his mother's blood and that it had penetrated 40 percent of his body. The hospital has put 10 other pregnant women with chikungunya virus infection under close observation.
USA (California): Tick-borne relapsing fever case in San Luis Obispo County
A case of tick-borne relapsing fever (TBRF) has been diagnosed in a San Luis Obispo County resident. TBRF is a relatively rare disease, with approximately 25 cases diagnosed in the USA each year from states where TBRF is a reportable disease. The case was diagnosed in a North County resident, which is consistent with the epidemiology of TBRF, with cases found between 1500-8000 feet of elevation.
Cases of TBRF are characterized by fever, generalized body aches, headaches, chills, and sweats. Relapsing fever gets its name from the fact that the patient experiences a fever, which resolves and then returns. Most cases of TBRF are self-resolving, although some cases can have long-term symptoms. The tick associated with TBRF is a night feeding tick that is generally found in rodent nests and burrows. The rodents most generally associated with the ticks are ground or tree squirrels and chipmunks.
USA (Missouri): Elderly man dies of tick-borne disease ehrlichiosis
In 2008, there were a record number of tick-borne diseases at 668 in the state. Health officials are urging people to wear insect repellent and check their skin for ticks after being outdoors.
USA (New Mexico): Boy dies and sister hospitalized due to bubonic plague infections
Plague is generally transmitted to humans through the bites of infected fleas, but also can be transmitted by direct contact with infected animals. Fleas collected from the area are being sent to the CDC for testing. Health workers also canvassed the neighborhood to tell other residents that plague had been confirmed in the area.
The CDC says an average of 10 to 15 persons contract the plague each year in the USA. Modern antibiotics are an effective treatment.
USA (Tennessee): Typhoid cluster in Chattanooga, source unknown
The following websites provide the most current information and advice.
- North America
- Other useful sources
The health department disease surveillance report showed that from January to 9 May 2009, there were a total of 6537 cases of dengue with 62 deaths as compared to 15,334 cases and 163 deaths over the same period in 2008. The figures reveal a 57.4 percent decrease in the number of dengue cases compared to 2008. Clustering of dengue cases was seen in three or more barangays during the past four weeks in the following areas: Metro Manila; Calabarzon; Negros Occidental; Cebu and Davao City, among others.
The Ho Chi Minh City (HCMC) Pediatrics Hospital No. 1 received between 66 and 84 patients a day during the week of 26 May 2009, double that of the last week of April 2009. HCMC has led the country in dengue fever cases so far in 2009, with 3600 cases and four fatalities reported. Dengue fever cases are also surging in the Cuu Long (Mekong) Delta provinces of Kien Giang and Soc Trang and the central province of Khanh Hoa.
The number of dengue fever cases nationwide has risen to 16,600 since the beginning of 2009, up 20 percent from the same period in 2008. Seventeen people have died in 2009 compared with 11 people during the same period of 2008.
HAND, FOOT, and MOUTH DISEASE
Origins and evolutionary genomics of the 2009 swine-origin H1N1 influenza A epidemic
Smith GJD et al. Nature. 4 June 2009. Available at http://www.nature.com/nature/journal/vnfv/ncurrent/abs/nature08182.html.
Origins of the new influenza A(H1N1) virus: time to take action
To gain insight into the possible origins of the 2009 outbreak of new influenza A(H1N1), we performed two independent analyses of genetic evolution of the new influenza A(H1N1) virus. Firstly, protein homology analyses of more than 400 sequences revealed that this virus most likely evolved from recent swine viruses. Secondly, phylogenetic analyses of 5,214 protein sequences of influenza A(H1N1) viruses (avian, swine and human) circulating in North America for the last two decades (from 1989 to 2009) indicated that the new influenza A(H1N1) virus possesses a distinctive evolutionary trait (genetic distinctness). This appears to be a particular characteristic in pig-human interspecies transmission of influenza A. Thus these analyses contribute to the evidence of the role of pig populations as “mixing vessels” for influenza A(H1N1) viruses.
Influenza A(H1N1) and Pandemic Preparedness Under the Rule of International Law
The international outbreak of severe acute respiratory syndrome (SARS) in 2003 and the more recent influenza A(H5N1) among birds with limited transmission to humans helped prepare the world for the current pandemic threat. SARS galvanized WHO to revise the antiquated International Health Regulations in 2005, which took effect June 15, 2007. Governments instituted preparedness plans in response to avian influenza. (Excerpt with references removed.)
Use of Revised International Health Regulations during Influenza A (H1N1) Epidemic, 2009
Strong international health agreements and good planning created a structure and common procedure for nations involved in detection and evaluation of the emergence of influenza A (H1N1). This report describes a timeline of events that led to the determination of the epidemic as a public health emergency of international concern, following the agreed upon procedures of the International Health Regulations. These events illustrate the need for sound international health agreements and should be a call to action for all nations to implement these agreements to the best of their abilities.
Preliminary analysis of influenza A(H1N1) individual and aggregated case reports from EU and EFTA countries
Since the first importation of influenza A(H1N1)v virus to Europe in late April of this year, surveillance data have been collected in the Member States of the European Union and European Free Trade Association. This is the first preliminary analysis of aggregated and individual data available as of 8 June 2009 at European level.
Environmental transmission of low pathogenicity avian influenza viruses and its implications for pathogen invasion
Understanding the transmission dynamics and persistence of avian influenza viruses (AIVs) in the wild is an important scientific and public health challenge because this system represents both a reservoir for recombination and a source of novel, potentially human pathogenic strains. The current paradigm locates all important transmission events on the nearly direct fecal/oral bird-to-bird pathway. In this article, on the basis of overlooked evidence, we propose that an environmental virus reservoir gives rise to indirect transmission. This transmission mode could play an important epidemiological role. Using a stochastic model, we demonstrate how neglecting environmentally generated transmission chains could underestimate the explosiveness and duration of AIV epidemics. We show the important pathogen invasion implications of this phenomenon: the non-negligible probability of outbreak even when direct transmission is absent, the long-term infectivity of locations of prior outbreaks, and the role of environmental heterogeneity in risk.
Weekly Epidemiological Record Bulletin
WHO. 12 June 2009; 84(24): 227-248. Available at http://www.who.int/wer.
Learning objectives for the conference:
Influenza H1N1 planning conferences in US
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