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Vol. VIII, No. 9 ~ EINet News Briefs ~ Apr 29, 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:
- Global: Veterinary Scientists Shore Up Defenses Against Bird Flu
- East Asia: Progress on the destruction of an inadvertently distributed influenza virus
- East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
- Cambodia: New suspected avian influenza case in Kampot province
- Viet Nam: Intensification of avian influenza prevention
- Viet Nam: Bans waterfowl egg hatching
- North Korea/E.U.: North Korean feathers, pet birds barred from E.U.
- North Korea: Avian influenza outbreak contained
- Indonesia: H5N1 avian influenza identified in Indonesian pigs
- Indonesia: Chikungunya spreads in West Lombok
- Malaysia: 300 new typhoid cases in Kelantan
- Russia (Siberia): Three Yersiniosis outbreaks
- USA: Bush administration considering easing "downer cattle" ban
- USA: GAO faults FDA handling of BSE-linked feed ban
- USA (Minnesota): Salmonella cases linked to frozen chicken entrees
- USA (Colorado): First Case of Hantavirus Infection in La Plata County since 1993

1. Updates
- Influenza
- Cholera, diarrhea & dysentery
- Dengue/DHF

2. Articles
- CDC EID Journal, Volume 11, Number 5-May 2005
- Congenital Malaria--Nassau County, New York, 2004

3. Notifications
- APHA Book of the Month: Behind the Mask: How the World Survived SARS, the First Epidemic of the Twenty-First Century
- National Infant Immunization Week: Working together with Vaccination Week in the Americas
- National STD Awareness Month--April 2005
- CDC Announces Landmark Reorganization
- The 28th World Veterinary Congress/142nd AVMA Annual Convention
- IEEE Third International Workshop on Technology for Education in Developing Countries
- Bio-era "Thinking Ahead" Service: Web Teleconferences and Reports

4. APEC EINet activities
- Planning for an online Virtual Symposium, Fall 2005

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Global: Veterinary Scientists Shore Up Defenses Against Bird Flu
At a recent meeting in Paris, more than 200 bird flu scientists called for more aggressive research and control efforts--from improved surveillance to finding more humane ways of killing birds. They also launched a new international lab network to coordinate research and share virus strains.

There have been 15 known outbreaks of highly pathogenic avian influenza (HPAI) between 2000 and 2004, which killed or led to the culling of some 200 million birds, Ilaria Capua of the Istituto Zooprofilattico Sperimentale della Venezie in Italy said at the meeting. In the 40 years before, she said, there were just 18 outbreaks, affecting 23 million birds. Several strains other than Asia’s lethal H5N1--including H9N2 in China and Hong Kong, H7N2 in the US, H7N3 in Canada, and H7N7 in the Netherlands--have also caused human infection, disease, or even death.

Researchers aren't exactly sure what triggered the change or how big a threat it poses to humans. That is why meeting participants called for more funding to study the panoply of strains. The meeting organizers, the World Organization for Animal Health (OIE) and the UN’s Food and Agricultural Organization [FAO] proposed a new network. Mirroring a similar network for human influenza, the new structure, dubbed OFFLU, would pool veterinary expertise, stimulate closer collaboration with human flu researchers, and facilitate the exchange of samples--often a thorny issue because of intellectual property concerns. OIE has also proposed that countries be required to search for and report outbreaks of low-pathogenicity avian influenza (LPAI) as well as HPAI. LPAI outbreaks cause little mortality and are easy to miss, says OIE's Alejandro Thiermann--but they can evolve to become HPAI.

At the same time, OIE plans to introduce a new strategy called "compartmentalization" that could help protect international trade during an outbreak. Currently, entire regions or countries are shut off from the international market when they have bird flu. In the future, parts of the poultry industry could keep their disease-free status if they can show that their entire operation--including, for instance, feed supply, farm workers, and vets--operate within a biosafe "compartment" out of reach from the virus. Thiermann hopes the measure, which will be formally discussed by OIE's 167 member countries in May, will spur investment in flu-proof poultry facilities.

The 73rd General (annual) Session of the OIE is due in Paris 22-27 May 2005. The 167 member countries will be represented in the assembly, defined as "The International Committee", by their permanent delegates, in most cases being the countries' Chief Veterinary Officers. The assembly will discuss significant modifications in OIE's International Terrestrial Animal Health Code; the basic change relates to the definition of the HPAI; notifiable avian influenza (NAI) will be defined as an infection of poultry caused by any influenza A virus of the H5 or H7 subtypes or by any AI virus with an intravenous pathogenicity index (IVPI) greater than 1.2 (or as an alternative at least 75 percent mortality in 4-to 8-week-old chickens infected intravenously).

NAI viruses can be divided into highly pathogenic notifiable avian influenza (HPNAI) and low-pathogenicity notifiable avian influenza (LPNAI). Both will be notifiable to the OIE, whereas until now only HPAI, caused by any AI subtype, was notifiable. The new, proposed code which also address the new definition of "compartment" and all relevant requirements for international trade in avians and their products, have been included last year in the Code as "under study"; they can be seen at <http://oie.int/eng/normes/mcode/en_chapitre_2.7.12.htm>. For the full report of the OIE/FAO International Scientific Conference on Avian Influenza, held in Paris (France), 7-8 April 2005, see: http://www.oie.int/eng/avian_influenza/OIE_FAO_Recom_05.pdf (Promed 4/15/05; OIE http://www.oie.int/eng/avian_influenza/guidelines.htm)

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Asia
East Asia: Progress on the destruction of an inadvertently distributed influenza virus
An international effort is underway to ensure the destruction of an influenza A(H2N2) virus that was inadvertently distributed to 3747 laboratories worldwide. Considerable progress has been made, and the WHO believes the task of destroying all the virus panels will be completed very soon. The five countries or areas in the Western Pacific to have received the samples – Hong Kong, Japan, the Republic of Korea, Singapore and Taiwan – have all destroyed the virus. There have been no reports of any acute respiratory disease or outbreaks connected to the laboratories that received the virus and no cases of human infection have been reported. (WHO/WPRO 4/18/05 http://www.wpro.who.int/)

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East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) compiles up-to-date figures of avian influenza cases and deaths in East Asia. As of 22 Apr 2005 the number of unofficial cases in East Asia from Jan 2004 to the present is 90 with 53 deaths; the official WHO figures are 80 cases and 50 deaths. Numbers of cases reported mid-Dec 2004 to present are:

Economy / Unofficial (Official) Cases / Unofficial (Official) Deaths
Cambodia / 4 (3) / 4 (3)
Thailand / 0 (0) / 0 (0)
Viet Nam / 41 (33) / 16 (15)
Total / 45 (36) / 20 (18)
(CIDRAP, 4/28/05 http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html)

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Cambodia: New suspected avian influenza case in Kampot province
A Cambodian woman suspected of having contracted avian influenza in Kampot province has died in a hospital in southern Viet Nam, a doctor said 20 Apr 2005. The 20 year old woman was admitted 19 Apr 2005 to the hospital in Kien Giang province of Viet Nam, bordering Cambodia, with a serious lung infection. She was connected to a respirator but died later in the day, said hospital director Pham Van Dom. Swab samples taken from the woman are being tested. The woman's relatives said there were dead chickens in her neighborhood and that she ate chicken 8 days before falling ill, Tuoi Tre newspaper reported. In Jan 2005, a 25 year old Cambodian woman, also from Kampot province, died of avian influenza in the same hospital. Dom said Cambodians often crossed the border to seek medical care at the hospital, which provides better treatment than hospitals in their country.

Health authorities said they had no independent information on the case, but were investigating. "The first thing we're going to do is to try and verify the rumor and get our network to find out if she does actually test positive for avian influenza," said Megge Miller, an epidemiologist working with the WHO in Cambodia. Thailand, and other countries in the region where bird flu is now under control, must help their poorer neighbors, together with the rest of the world, urged Robert Webster, an influenza expert from St Jude Children's Research Hospital in Tennessee. "If one of these viruses does transmit human to human, it's a global problem, so it has to be a global effort that helps these countries, not just the local countries," he said speaking 20 Apr 2005 at a meeting of the Association of South East Asian Nations in Bangkok.

If the death of this young woman is confirmed as a case of avian influenza infection, it will be the fourth case of human H5N1 influenza virus infection to have been contracted in Cambodia in 2005. All the cases have been contracted in Kampot province close to the Vietnamese border. There is no evidence of human-to-human transmission associated with this suspected case. Contact with and/or consumption of diseased birds is the suggested route of infection. (Promed 4/20/05)

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Viet Nam: Intensification of avian influenza prevention
Viet Nam will take more drastic measures on bird flu prevention to bring the disease under control by 2006 or 2007, and eliminate it by 2010, Viet Nam News reported 19 Apr 2005. The country will ban raising poultry in some inner cities and urban areas, including Ho Chi Minh city, and isolate fowl production establishments from residential areas, Vietnamese deputy minister of agriculture and rural development Bui Ba Bong said at a conference reviewing bird flu prevention on 18 Apr 2005. In addition, the country will use bird flu vaccines on chicken flocks and waterfowl in southern Tien Giang province and northern Nam Dinh province on the trial basis in 2005.

At the conference, the Health Ministry asked the government to invest in building 2 more bird flu testing laboratories, which cost some VND 80 billion (USD 5.1 million). The UN Food and Agriculture Organization (FAO) has pledged to fund Viet Nam USD 4 million to build the laboratories and USD 2.5 million to redevelop its poultry sector. Bird flu has killed or led to the forced culling of some 46 million fowl, causing a total loss of some VND 3.5 trillion (USD 222.9 million).

Also, experts are zeroing in on the role that wild and domestic ducks play as silent carriers, spreading the disease in backyard open-air farms. "In my opinion, the ducks should be culled. I can't see an alternative way," said Robert Webster of St Jude Children's Research Hospital in Tennessee, US. Compounding the problem are age-old methods of farming in Asia, where free-range ducks waddle in rice paddies and farmyards, mixing with geese and chickens and spreading the disease. Webster cited a Vietnamese study which showed an H5N1 prevalence rate of 70 per cent when ducks and chickens were raised together, compared to 8 per cent for chickens raised separately. Malik Peiris, a leading microbiologist at the University of Hong Kong, also backed a wider cull, but said it should be followed by a complete overhaul of duck farming in Viet Nam. That meant putting a stop to ducks wandering freely through rice fields and shutting them up in closed pens. These and other biosecurity measures would be costly, and some farmers may lose their livelihoods, he said. (Promed 4/21/05)

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Viet Nam: Bans waterfowl egg hatching
Vietnam has ordered a ban on the hatching of all water fowl eggs as it tries to stamp out the bird flu virus, which has killed about 50 people in Asia since late 2003, state media reported 27 Apr 2005. The ban, effective immediately, would last until Feb 2006, the Lao Dong newspaper quoted the Anti-Bird Flu Committee as saying. The committee also ordered a mass cull of all 1.5 million water fowl carrying the H5 component of the H5N1 bird flu virus in the Mekong Delta city of Can Tho. The committee has requested the government to provide compensation to poultry farmers affected by the cull.

Viet Nam decided earlier in 2005 to ban the breeding of ducks until 30 Jun 2005, and in February Ho Chi Minh City ordered a cull of all ducks. The current decision, extending the policy for almost a year, is in line with the recent FAO/OIE conclusions, namely that "control of highly pathogenic avian influenza (HPAI) should be carried out at source, managing transmission of the virus where the disease occurs in poultry, specifically free-range chickens and in wetland dwelling ducks". The feasibility of such a far-reaching decision remains to be seen. According to agriculture figures, in Viet Nam there are an estimated 59 million ducks, geese and other waterfowl, most raised in open-air backyard farms. (Promed 4/28/05)

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North Korea/E.U.: North Korean feathers, pet birds barred from E.U.
Import of feathers and pet birds from North Korea to the European Union has been banned following confirmation of an outbreak of deadly bird flu, the EU said 14 Apr 2005. EU animal health experts added North Korea to its list of 8 Asian nations (Cambodia, China, Indonesia, Laos, Malaysia, Pakistan, Thailand and Vietnam) whose poultry exports to the EU are banned until the end of Sep 2005 due to uncertainty that avian flu is under control in the region. (In addition, HPAI was recorded in 2004 in Japan and Sout Korea, but both succeeded in eradicating the disease by stamping out, allowing them to officially declare freedom of the disease; consequently, the ban upon them has been removed and they are allowed exporting live poultry and poultry products to the EU). Although the value of imports of North Korean feathers and pet birds to the EU is very limited, the ban was adopted so there is no chance contaminated products can enter the EU, a Commission spokesman said. (Promed 4/15/05)

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North Korea: Avian influenza outbreak contained
The recent outbreak of avian influenza in North Korea (DPRK) has been successfully contained, UN Food and Agriculture Organization (FAO) said 25 Apr 2005, urging the country to continue surveillance on the affected farms and elsewhere to ensure that no residual infection remains. An H7 strain of the bird flu virus had been detected recently on 3 poultry farms near the capital Pyongyang. Although this virus caused severe disease in chickens, it is not directly related to the H5N1 avian influenza virus.

"The virus appears to have been eliminated from the 3 infected farms by combining culling of around 218 000 infected chickens, vaccination of unaffected birds in unaffected poultry houses and strict biosecurity measures," said FAO consultant Les Sims, who traveled to Pyongyang to advise the North Korean veterinary authorities. According to World Organization for Animal Health’s (OIE) Code, the eradication of a notifiable disease is to be officially confirmed in a final report of the affected member-country. North Korea has acted promptly and appropriately and has provided essential information in a timely manner, Sims said, and the official declaration was done in due time. FAO sent 3 experts to the country to assist national authorities in diagnosis and disease management. This was done through the East Asian Regional Network on Avian Influenza set up by FAO.

Also, South Korean officials traveled to the North Korean city of Kaesong 22 Apr 2005 for talks on helping North Korea combat a bird flu outbreak, Unification Ministry officials said. The talks are the first contact between the authorities of the South and North since July 2004, an official said. South Korea was also sending the first shipment of medications and equipment, to be used in combating the outbreak, another official said. The talks were being attended by agricultural, unification and veterinary officials.

"Reagents and laboratory tools provided by FAO will assist in continuing the battle against the virus, but additional strengthening of veterinary diagnostic and surveillance capacity is seen as a priority to ensure that this work is completed," said Joseph Domenech, FAO's Chief Veterinary Officer. China has tightened quarantine controls at its border with North Korea and barred the entry of poultry. (Promed 4/25/05, 4/22/05)

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Indonesia: H5N1 avian influenza identified in Indonesian pigs
Indonesian scientists have found the H5N1 bird flu virus in a pig. Scientists fear pigs could act as a "mixing vessel" in which a human pandemic strain could evolve, because the animals can harbor both human and avian flu viruses. But while suspected, such hybridisation has never been proven. Java was the worst-affected part of Indonesia during 2004's H5N1 bird flu outbreak. But by slaughtering and vaccinating poultry, Indonesia stopped the outbreak in October. But in Apr 2005, bird flu struck poultry throughout Java once again, mainly in village-based backyard flocks. Indonesia offers free vaccination for such flocks. But vaccinated birds can still harbor and spread the virus unless they are strictly monitored for infection. Amin Soebandrio, a microbiologist and Indonesia's assistant deputy minister for health sciences, said that while larger farms do such monitoring, smallholders cannot.

Now C A Nidom, of Airlangga University in Surabaya, has found the H5N1 virus in throat swabs and blood samples from a pig in Surabaya. The isolated virus's gene for a crucial surface protein, haemagglutinin, was more than 98 percent identical to samples taken from infected Indonesian chickens and quail. Traces of H5N1 infection had been reported in 1 pig in Vietnam and 2 in China. But this is the first time that a virus isolated from a natural infection in pigs has been genetically sequenced. Pigs are of concern because they can be infected by both bird flu viruses and flu viruses from mammals. A hybrid bird-human virus could have a haemagglutinin from birds that human immune systems will not recognize, and genes from human-adapted flu that will make the hybrid highly contagious in people. The pandemics of 1957 and 1968, which killed millions, did seem to result from the mixing of bird flu strains with mammalian flu, although where this occurred is not known.

Robert Webster, an influenza expert from St Jude Children's Research Hospital in the US, told a meeting on biosecurity in Mar 2005 that his lab has found that H5N1 grows well in pigs, making hybridisation theoretically possible. But it might not get far -- infected pigs, Webster told New Scientist, do not pass H5N1 to each other. This means relatively few pigs will catch it. [see <http://www.upmc-biosecurity.org/pages/events/biosafety/speakers/webster/webster.html>] Poultry may be more important for the virus's evolution. (Promed 4/14/05)

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Indonesia: Chikungunya spreads in West Lombok
Chikungunya epidemic has struck at least 2 subdistricts in West Lombok regency in the past week, infecting and paralyzing dozens of residents in the area. Thamrin Hijaz, a senior official at the West Lombok Health Office, said that 48 people in Gunung Sari subdistrict and 55 others in the neighboring subdistrict of Belencong had been infected with the virus. Since 1954, the virus has been implicated as the cause of epidemics in Asian countries including the Philippines, Thailand, Cambodia, Vietnam, India, Burma, and Sri Lanka. Chikungunya virus has been isolated from humans and mosquitoes in south eastern Asia, where it has been responsible for hundreds to thousands of cases of illness.

Chikungunya was first recognized in epidemic form in East Africa in 1952, while in Indonesia, the disease was first reported in 1973. Chikungunya is similar yet basically distinct from dengue fever in terms of the causal agents. Both are mosquitoborne viral infections with high febrile reactions and joint pains. Human infections of chikungunya are acquired through the bite of infected Stegomyia aegypti (formerly known as Aedes aegypti) mosquitoes, and epidemics are sustained by human-mosquito-human transmission. The epidemic cycle is similar to those of dengue and urban yellow fever.

Chikungunya fever is characterized by sudden onset of chills and fever, headache, nausea, vomiting, arthralgia, and rash. Compared with dengue, chikungunya is distinguished by a briefer incubation period and febrile episode, by persistent arthralgia in some cases, and by the absence of fatalities. However, similarities between clinical appearances of the 2 diseases probably account for misclassification and some underreporting of chikungunya fever in areas with endemic dengue; therefore, laboratory confirmation of reported cases is important. (Promed 4/22/05)

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Malaysia: 300 new typhoid cases in Kelantan
Some 300 new typhoid cases have been registered in Kelantan in the past 24 hours, 26-27 Apr 2005, bringing the total number of cases to 589. State Health authorities are now focusing on screening children below age 15 years. Most of them are students who have the tendency to consume food sold outside, Deputy State Health director (Public Health) Dr Lila P. Mohamed Meeran said. Investigations since the outbreak was detected 2 weeks ago also revealed poor sanitation and water supply systems as among the causes for the spread of the disease. This was made worse by people living close together in most semi-urban and rural areas in Kelantan. As of 26 Apr 2005, there were 226 confirmed and 363 suspected cases. The Kota Baru hospital had the highest number with 150 patients, Tumpat (24), Pasir Putih (21), Pasir Mas (14), Machang (10), Tanah Merah (1), Jeli (2) and Universiti Sains Malaysia Hospital HUSM (80). The rest were treated in private hospitals. (Promed 4/28/05)

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Russia (Siberia): Three Yersiniosis outbreaks
3 new outbreaks of yersiniosis (Yersinia pseudotuberculosis) have been reported in the Novosibirsk region of Siberia, March-April 2005. Epidemiologists are conducting an investigation in the village Suzun among children at a school where 42 cases of yersiniosis were found 18-21 Apr 2005, according to preliminary data. All the children had eaten food from the school canteen. Another outbreak was reported in Novosibirsk at Navy College, where 18 students that were living in hostel were infected. A third outbreak was reported among the students of an agricultural college in Kolivan, where the infection affected 9 students that were living in a hostel. The cause of all 3 outbreaks is thought to be related to the sanitary conditions in the canteens of the facilities. The disease was thought to be spread via vegetables (cabbage, onions, carrots) that were stored improperly. In all of the storage facilities, experts discovered a lot of mouse excrement. In 2004, the yersiniosis rate was 29.35 infected per 100 000 of the population, that is 7.4 times higher that national Russian average (3.96 per 100 000).

Infection with Y. pseudotuberculosis is a zoonosis, with reservoirs in many animals. Most individuals affected are children or young adults. The most common presentation of this infection is mesenteric lymphadenitis presenting with fever and right lower quadrant abdominal pain which can be confused with acute appendicitis. The diagnosis of infection with this bacterium can be made by isolation of the organism from lymph node or stool. Serological tests can be helpful, but cross-reactions are found between Yersinia and other enteric organisms, including some salmonellae. (Promed 4/27/05)

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Americas
USA: Bush administration considering easing "downer cattle" ban
The Bush administration said it may allow some injured cattle to be slaughtered for human food, easing a regulation that the Agriculture Department (USDA) adopted 15 months ago after the nation's first case of mad cow disease. Consumer groups said they oppose any changes in regulations aimed at keeping the deadly disease out of the food supply. The USDA prohibited all so-called downer cattle from being slaughtered for human food, soon after a Washington State dairy cow was diagnosed with bovine spongiform encephalopathy (BSE) in Dec 2003. The ban was part of a package of tighter USDA regulations to prevent mad cow disease, whose symptoms can include an inability to walk. Agriculture Secretary Mike Johanns suggested that the ban on downer cattle may be eased after the USDA completes an enhanced surveillance program of US cattle later in 2005. "…If you've got an animal that's clearly under 30 months that broke a leg in transit, there is no threat of BSE whatsoever," he said. No other cases of BSE have been found in the US cattle herd, despite expanded testing since Jun 2004. As of 10 Apr 2005, the USDA tested 314 394 animals in its expanded program. That will be completed in the next few months, opening the door for USDA to propose changes based on its findings.

Scientists believe that mad cow disease is spread through contaminated livestock feed. The ban on downer cattle being slaughtered for human food represents a sizable financial loss to cattle ranchers. For example, a 1110 pound steer is worth around USD 1000 if slaughtered for steaks and ground beef, but brings less than USD 200 if condemned as a downer and used for pet food. About 195 000 cattle are downers out of more than 30 million slaughtered annually, according to industry estimates.

The package of mad cow prevention measures adopted by the USDA 15 months ago included a ban on using brains and small intestines from older cattle for human food and a ban on stunning cattle with a powerful air injection to the skull. The Food and Drug Administration (FDA) is still considering whether to ban the use of cattle blood as a protein supplement for calves and the use of chicken litter as cattle feed. A question that remains is whether an infected, as yet asymptomatic animal is not a risk for disease transmission across species (to humans eating products from that infected yet asymptomatic animal). Withholding testing for BSE by pre-supposing absolutely no risk of BSE under age 30 months is guaranteeing that one will not identify BSE in the under 30 months age group. (Promed 4/18/05)

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USA: GAO faults FDA handling of BSE-linked feed ban
Despite some improvements since 2002, the Food and Drug Administration's (FDA) enforcement of rules to keep bovine spongiform encephalopathy (BSE) from spreading through cattle feed still has serious gaps, the Government Accountability Office (GAO) reported Mar 2005. BSE spreads when cattle eat feed containing the remains of infected animals. To prevent this, in 1997 the FDA banned the use of most proteins from mammals in feed for cattle and other ruminants. (However, cattle blood, milk, restaurant plate waste, and gelatin can still be used in cattle feed.) The sole US case of BSE so far was discovered in Dec 2003 in a Canadian-born cow in Washington. The discovery promoted the US Department of Agriculture (USDA) to add some new rules to keep infective material out of the food supply and to greatly increase testing of cattle for the disease. The USDA and FDA banned the use of specified-risk materials--high-risk cattle parts such as the brain, spinal cord, and tonsils--in human food, but they can still be used in feed for nonruminant animals and pets. Under the FDA feed ban, firms must clearly label feed and feed ingredients that may contain banned proteins with the statement "Do not feed to cattle or other ruminants." Firms also must have methods for preventing mixing if they handle feed for both nonruminants (whose feed is still allowed to contain cattle protein) and ruminants.

The report says the FDA has remedied some problems that the GAO had described in a report in 2002. The agency now has uniform methods for inspecting feed facilities and training both FDA and state inspectors, plus better methods for tracking inspection results. However, the GAO finds that the enforcement program still has serious weaknesses:

- About 14 800 feed manufacturers and other feed-industry businesses have been inspected so far, but the FDA knows there are others that have not been inspected.
- The FDA has not reinspected about 2800 feed businesses in the past 5 years.
- The FDA's inspection guidelines do not call for routine testing of cattle feed for banned material.
- The FDA has not always alerted the USDA and states when it learned that cattle might have been given feed containing banned material, even though it is required under FDA's guidelines.
- The FDA has given incomplete information about feed-ban compliance to Congress/public.

The report says that the FDA said it believed "that the weaknesses we identified are not sufficiently material to place U.S. cattle at risk for BSE and that its risk-based inspection approach assures adequate oversight of the feed-ban rule." The report includes 9 recommendations to correct the various problems. The FDA disagreed with 4 of the recommendations, including the advice that the FDA should test feed samples when it inspects feed businesses.

For more information see: GAO report "Mad cow disease: FDA's management of the feed ban has improved, but oversight weaknesses continue to limit program effectiveness" http://www.gao.gov/new.items/d05101.pdf and CIDRAP News story "GAO says US barriers to mad cow disease are full of holes" (28 Feb 2002) http://www.cidrap.umn.edu/cidrap/content/other/bse/news/gaorept.html.

The continued use of ruminant-derived MBMs for the feeding of non-ruminants was regarded, in Europe, as one of the factors allowing cross-contamination and spillover of BSE-infected material into ruminant feed. OIE's Terrestrial Animal Health Code specifies the following requirements related to the BSE exposure assessment in a country, as follows: "Exposure assessment consists of assessing the likelihood of exposure of the BSE agent to cattle, through a consideration of the following:

1. epidemiological situation concerning all animal TSE agents in the country or zone;
2. recycling and amplification of the BSE agent through consumption by cattle of meat & bone meal or greaves [crackling, a by-product of fat rendering] of ruminant origin, or other feed or feed ingredients contaminated with these;
3. the origin and use of ruminant carcasses (including fallen stock), by-products and slaughterhouse waste, the parameters of the rendering processes and the methods of animal feed manufacture;
4. implementation and enforcement of feed bans, including measures to prevent cross-contamination of animal feed". (Promed 4/28/05)

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USA (Minnesota): Salmonella cases linked to frozen chicken entrees
Health officials have warned consumers to make sure they fully cook frozen meat and poultry products, in the wake of several Salmonella infections linked to frozen chicken entrees sold in Minnesota and Michigan. 4 cases of salmonellosis have been linked with frozen, prebrowned stuffed chicken entrees in Minnesota, the Minnesota Department of Health (MDH) reported 21 Apr 2005. About 9 salmonellosis cases associated with similar products have been reported recently in Michigan, according to the US Department of Agriculture's (USDA's) Food Safety and Inspection Service (FSIS).

The entrees implicated in Minnesota were sold at Cub Foods stores under the Cub name. Products from the same plant may have been sold by other store chains, officials said. An FSIS statement said consumers heated the products in microwave ovens and might not have realized they contained raw chicken. Such products should be cooked to an internal temperature of at least 165 F. Minnesota investigators determined that at least 4 cases of salmonellosis from Jan through Mar 2005 involved Salmonella enterica serotype Heidelberg, the MDH said. At least one package of frozen chicken with broccoli and cheese from a Cub store was found to contain serotype Heidelberg that matched the strain identified in the 4 illness cases. Cub voluntarily pulled the implicated product lots from store shelves.

USDA testing has shown that, on average, about 13 percent of raw broiler chickens contain Salmonella. FSIS plans to look at how frozen chicken entrees are marketed and consider whether the package labeling should be changed to make it clearer that the products are raw. Products labeled with phrases such as "Cook and Serve," "Ready to Cook," and "Oven Ready" are intended to convey to the consumer that the product is not ready-to-eat and must be fully cooked for safety. Although products may appear to be pre-cooked or browned, such products should be handled and prepared no differently than raw product.

Consumers must follow the microwave instructions completely. If using a microwave to cook meat and poultry products, be sure to take multiple temperature readings at different locations throughout the product due to the non-uniformity of the heating process. Because a microwave oven typically cooks product at non-uniform rates, it is important to ensure that the product is covered sufficiently for steam to build in the product, and that the product is set aside for a sufficient time for the heat to uniformly spread throughout the product at the completion of the microwave cycle. (Promed 4/25/05)

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USA (Colorado): First Case of Hantavirus Infection in La Plata County since 1993
A La Plata County man has contracted hantavirus infection. Hantavirus Pulmonary Syndrome (HPS), the potentially fatal disease caused by hantavirus infection, has not been seen in the county since the virus was isolated in 1993, according to the Colorado Department of Public Health and Environment. Hantavirus infection is contracted from the saliva, urine and feces of an infected deer mouse. Human exposure to hantavirus tends to be highest in the spring, when people are more active--such as when cleaning out sheds where deer mice and their waste can be found, said Joe Fowler, regional epidemiologist for southwest Colorado with the San Juan Basin Health Department. Hikers and campers are also vulnerable. Hantavirus has an incubation period of 1-6 weeks in the body. Early symptoms include: Fever and body aches, nausea, vomiting and headaches, coughing and shortness of breath. A sore throat, runny nose and sneezing are not symptoms of hantavirus infection, Fowler said. Hantavirus infection can eventually develop into HPS, which can cause a deadly accumulation of fluid in the lungs.

Though it can be serious, Fowler says no one should panic. But people should remain aware of its presence where mice may roam. Person-to-person transmission has not been reported in the US. Hantavirus was isolated in 1993 after several healthy young adults in Utah, New Mexico, Arizona, Colorado suddenly developed acute respiratory symptoms. Half of them died. From 1993 to 2003, 34 HPS cases were reported in Colorado, with 15 deaths, according to state health department statistics.

The CDC offers information on hantaviruses: http://www.cdc.gov/ncidod/diseases/hanta/hps/ (Promed 4/28/05)

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies 2005, 20 Apr 2005
Overall influenza activity continued to decline in weeks 13–14, 2005 Influenza activity declined further in most parts of the northern hemisphere in weeks 13–14 except in Hong Kong. In the southern hemisphere, influenza activity was low.

Canada. Overall influenza activity continued to decline, with widespread activity reported in 1 province in week 14. An increase in influenza B activity was noted during the past 3 weeks. Of the influenza viruses detected during week 14, 32% were influenza A and 68% were B viruses.

Hong Kong. The activity of influenza A(H3N2) virus remained high in weeks 13–14. Influenza A(H1N1) and B viruses were also detected.

Japan. Influenza activity continued to decline and remained sporadic in weeks 13–14. Around 50% of isolates were influenza B viruses.

Russia. Decline in influenza activity continued in week 13, with regional activity remaining.

Mexico. During weeks 13–14, low influenza activity was detected (H3 and A).

USA. Influenza activity continued to decline in weeks 13–14. The overall ILI consultation rate was below the national baseline for the first time in 12 weeks. The proportion of deaths attributable to pneumonia and influenza remained above the epidemic threshold. During weeks 13–14, 4 additional influenza-associated pediatric deaths were reported. There have been 30 influenza-associated pediatric deaths reported to CDC this season. Of the influenza viruses detected in week 14, 46% were influenza A viruses and 54% were B viruses. There were no reports of widespread influenza activity. Two states reported regional influenza activity, 6 states reported local activity, and 35 states, New York City, and Puerto Rico reported sporadic activity. 6 states and the District of Columbia reported no influenza activity. (WHO 4/20/05 http://www.who.int/csr/disease/influenza/update/en/print.html; CDC 4/23/05 http://www.cdc.gov/flu/weekly/)

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Cholera, diarrhea & dysentery
Brunei Darussalam
43 primary school pupils were rushed to the RIPAS Hospital 19 Apr 2005, after suffering from alleged food poisoning. According to the headmistress of the school, the pupils from primary 2, 3and 4 of Dato Marsal Primary School in Kg. Perpindahan Lambak Kanan experienced vomiting and diarrhea. "However, 33 pupils were later discharged while the other 10 were hospitalised…" she said. The headmistress added that the food and drink supplied to the school on that day included packet drinks and cake rolls. The school canteen also sells food and drinks that are permitted by the Ministry of Education. There are also vendors selling food outside the school compound.

The headmistress also said packet drinks supplied to the school had valid expiration dates on them. The Public Relations Unit of the Ministry of Education said that all parents were notified immediately by the school authorities and an immediate investigation is currently being carried out by the Ministry of Education with the cooperation of the Health Division of the Ministry of Health. Samples of food consumed by the pupils have been sent to the RIPAS Hospital to ascertain the cause of food poisoning. (Promed 4/22/05)

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Dengue/DHF
Mexico (Sonora)
3 women living in the Cajeme and Etchojoa communities have been infected with the dengue virus in their own homes. Aedes aegypti mosquitoes were found in the backyards of the homes of these women. This vector is responsible for human-to-human transmission of the dengue virus. One of the women developed the hemorrhagic form of the disease after being stricken by the infection for a second time. Fortunately, she recovered. The 2 other women also recovered uneventfully and only developed the so-called classic symptoms, such as intense bone pain, eye pain, headache and joint pain, sudden onset of fever, malaise, and a mild rash.

In addition to these 3 women, there are now 7 confirmed dengue cases in Sonora in 2005, 3 of them having had the hemorrhagic form. Out of these 3 last cases, 2 recovered uneventfully, but one from the Cobachi community died from the disease. There are also another 2 new dengue cases. The 2 cases of hemorrhagic and classic dengue were detected in the Villa Bonita and Libertad communities, and the health Secretariat decreed an alert for these places. Mr Valente Parra-Dominguez, chief of Sanitary Authority No. 4, stated that, as a result of the alert, no other positive case has been detected. One woman affected in Villa Bonita is age 35, and the one from Libertad is age 58. Enforcement of rubbish elimination has already been taking place in these communities and it will continue. Abate spraying and fumigation will be performed in the communities where dengue has been detected or suspected. Out of 37 suspected cases analyzed until now, 3 cases have reported positive, the first one in Tobarito precinct, an 11-year-old child. For the past 10 days, the results of tests performed for 10 suspected cases revealed that 8 of them were negative for dengue.

Dengue, a disease that originated in Africa, appeared in Mexico in 1981. Since then, many people have acquired the infection, and there are more complications for the population. Health Secretary Raymundo Lopez stated that the cause of the epidemics is the reluctance of the people of Sonora to maintain clean backyards. In the central, coastal and southern Sonora regions, the Health Secretariat performed entomological studies, which have reported the presence of Aedes aegypti.

With warmer weather approaching the northern hemisphere, dengue infections are increasingly reported in endemic areas. The campaign of eliminating the breeding grounds of the arthropod vector St. aegypti [formerly known as Ae. aegypti] by local authorities is timely and effective. Other measures, such as avoiding mosquito bites by wearing protective clothing and/or using insect repellents between dusk and dawn when the mosquitoes are most active, should be taken. Public education programs to increase public awareness should be imposed in Sonora before and during the dengue season. (Promed 4/23/05)

Hong Kong
The Centre for Health Protection has confirmed an imported case of Dengue fever involving a 31 year old man, bringing 2005’s total to 5, all imported. The patient traveled to Indonesia March 12 – 27, 2005 and developed fever, shivering, muscle pain and bone pain on Mar 27. He was admitted to a private hospital on Mar 28 and was discharged Apr 4. His family members have not developed any symptoms. The latest information on dengue fever in other places can be found under "Outbreak News" on the department's Hong Kong Travellers' Health Service website. Travel agents, tour guides and travellers can visit the website for news and advice on preventive measures. <http://news.gov.hk/en/category/healthandcommunity/050421/html/050421en05001.htm> (Promed 4/23/05)

Peru (Lima)
The General Office of Epidemiology announced 34 cases of dengue fever in patients coming from district of Comas, city of Lima. The National Health Institute confirmed cases by serology. The strain was typified as dengue virus type III by polymerase chain reaction. The health authorities have begun the spraying of 8000 houses in the outbreak area, along with active surveillance of cases. (Promed 4/23/05)

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2. Articles
CDC EID Journal, Volume 11, Number 5-May 2005
CDC Emerging Infectious Diseases Journal, Volume 11, Number 5-May 2005 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. The following conference summary is available online: Symposium on Infectious Diseases of Animals and Quarantine, M. Kayima et al.

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Congenital Malaria--Nassau County, New York, 2004
“Human malaria is a parasitic disease caused by four distinct species of intraerythrocytic protozoa of the genus Plasmodium. The parasites are transmitted to persons by the bite of an infective female Anopheles mosquito and rarely through blood transfusion and congenital transmission. The majority of malarial infections reported in the United States are acquired abroad by recent immigrants or persons returning from areas where malaria is endemic. This report describes the first documented case of congenital malaria acquired in Nassau County, New York, which is the fifth case of congenital malaria reported in the United States since 2000. Health-care providers should consider malaria as a diagnosis in neonates and young infants, particularly those with fever, whose mothers emigrated from areas where malaria is endemic…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5415a3.htm (MMWR April 22, 2005 / 54(15);383-384)

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3. Notifications
APHA Book of the Month: Behind the Mask: How the World Survived SARS, the First Epidemic of the Twenty-First Century
By: Timothy J. Brookes, in collaboratoin with Omar A. Khan, MD, MHS Forward by David L. Heymann, MD, World Health Organization

This exciting new book tells the story of SARS - Severe Acute Respiratory Syndrome, the first true epidemic of the 21st century. It follows the beginnings of this epidemic from the point of view of the virus-hunters as well as of those most affected. Follow the SARS trail from rural China as it spreads to various places in the world. See how seemingly casual contacts help the disease spread like wildfire. Work alongside the many infectious disease specialist from health organizations around the world as they painstakingly trace the disease to its origins and simultaneously work on treatments - all the time knowing that each hour of delay allows the disease to spread even further. Tim Brookes' extensive research and travels - from the World Health Organization in Geneva, to health officials in China and in Canada, to the Centers for Disease Control and Prevention in Atlanta - give him a unique insight into the story behind SARS - the beginnings, the detective work to identify the virus, the world's efforts to contain the spread and restore order, and the public health repercussions.

To order, visit the American Public Health Association website: http://www.apha.org/

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National Infant Immunization Week: Working together with Vaccination Week in the Americas
April 24-30, 2005
National Infant Immunization Week (NIIW) is an annual observance to promote the benefits of immunizations and to focus on the importance of immunizing infants against 12 vaccine-preventable diseases by age two. This year NIIW will again be held in conjunction with the Pan American Health Organization’s Vaccination Week in the Americas (VWA), April 23-30, 2005. The U.S. will join together with 35 countries in the Western Hemisphere to concurrently promote the need for routine vaccinations for infants and children during the last week in April. For more information, visit: (CDC http://www.cdc.gov/nip/events/niiw/2005/05default.htm)

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National STD Awareness Month--April 2005
“April is National Sexually Transmitted Diseases (STDs) Awareness Month, a health observance created to increase awareness about STDs, including their transmission, prevention, and treatment. STDs continue to be a major health threat in the United States, especially among adolescents and young adults. CDC estimates that 19 million new STD infections occur annually, nearly half of them among persons aged 15--24 years. Untreated STDs can lead to potentially severe and costly health consequences. Annual direct medical costs of STDs among persons aged 15--24 years are estimated at $6.5 billion..." (MMWR April 22, 2005 / 54(15);387 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5415a7.htm)

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CDC Announces Landmark Reorganization
“As the world copes with 21st-century health threats such as terrorism, avian influenza, and the unrelenting stresses of modern life, CDC has taken a landmark step in its readiness to confront these challenges. After notification by the U.S. Department of Health and Human Services on April 5, 2005, the U.S. Congress officially accepted CDC's plans for internal restructuring, making it official on April 21. These proposed changes will enable CDC to pursue its mission in preparing for new and unpredictable health threats and protecting the health and quality of life of all U.S. residents throughout their lives.

CDC is also changing to keep up with more complex health concerns such as childhood asthma, AIDS, catastrophic natural disasters, and a barrage of global health threats. During its most recent major transformation nearly 20 years ago, CDC had approximately 4,000 employees and a budget of $411 million. Today, its combined workforce of employees and contractors totals nearly 14,000, with a budget of approximately $8 billion. The agency is changing to meet 21st-century challenges such as new technology, complex information flow, and rising health-care costs. Change also includes modernizing its management and accountability to realize tangible savings that can go directly to science and programs that affect public health.

This modernization involves a new organizational structure, including a framework for four new coordinating centers that will help CDC scientists combine their expertise to solve public health problems, streamline the flow of information for leadership decision-making, and better leverage the expertise of CDC partners. CDC has also added two new centers to focus on health informatics and health marketing, which are vital in translating scientific data into usable information and health messages that help U.S. residents make sound health decisions. Additional information about the reorganization of CDC is available at http://www.cdc.gov/od/oc/media.” (MMWR April 22, 2005 / 54(15);387 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5415a8.htm)

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The 28th World Veterinary Congress/142nd AVMA Annual Convention
Minneapolis, Minnesota, USA; 16-20 Jul 2005
From Rupa Patadia:
Register today for the World Veterinary Congress. It will feature over 1000 scientific sessions held in 35 concurrent tracks. Great new online tools help you organize your time during the convention. The interactive Educational Planner allows you to search out the sessions that are of interest to you…you can search and view all educational program details and create a personal schedule to help balance your time.

Some session topics are:
Advances in Veterinary Medicine, Translational Research in Veterinary Pain Management, Cell Signaling and Analgesic Drug Development, Pharmacogenetics and Analgesia, Vallinois Receptors and Analgesia, Liposome Encapsulation of Analgesic Drugs, Current Topics, Exotic Diseases of Alimentary Tract and Endemic Differential Diagnosis, BRM for Fecal/Oral Transmissions, Exotic Respiratory Disease and Endemic Differentials, BRM for Direct Contact, Food Safety, Antimicrobial Resistance and Companion Animals, Using Sensitivity Results and Antibiograms to Make Treatment Decisions, The Impact of Sensitivity Testing for Mastitis Therapy, Introduction to Codex Alimentarius, Introductions to the World Health Organization, Agroterrorism and Food Animal Diseases, Quest for Microbial Annihilation, Pork, Poultry, Beef: Food Safety and Trade, International and Domestic Efforts in Foodborne Disease Surveillance and Attribution, International Pavilion, Research and Regulation to Improve the Welfare of Animals Transported by Land and Sea, Integration of Animal Welfare Strategies and Australian Livestock Exports, Isolation of Mycoplasma From Sheep by PCR in Iran, Bioterrorism, Role of the Veterinary in TB Control.

Contact: <http://www.wvc2005.org>
Rupa Patadia, Marketing Manager, American Veterinary Medical Association
1931 N. Meacham Rd. Suite 100, Schaumburg, IL 60173-4360
tel: (847) 285-6663; fax: (847) 925-1329; rpatadia@avma.org
(Promed 4/19/05)

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IEEE Third International Workshop on Technology for Education in Developing Countries
July 6, 2005; Kaohsiung, Taiwan
In Conjunction with IEEE International Conference on Advanced Learning Technologies (ICALT 2005) TEDC 2005 is pleased to announce its Student Travel Grant Program. The purpose of the program is to encourage graduate student participation at the workshop by partially or fully funding the travel costs of students who would otherwise be unable to attend.

Applications are accepted from graduate students at degree granting institutionsthroughout the world. Priority will be given to students in developing countries. Deadline for submission of grant application: June 5, 2005. Details are available at: http://ifets.massey.ac.nz/tedc2005/ For any queries, please contact Dr Daby Sow at sowdaby@us.ibm.com

Kinshuk, kinshuk@ieee.org
Information Systems Dept., Massey Univ., Private Bag 11-222, Palmerston North, New Zealand
Tel: +64 6 3505799 ext. 2090 Fax: +64 6 355 4334
http://infosys.massey.ac.nz/~kinshuk
(TEDC 2005 4/20/05)

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Bio-era "Thinking Ahead" Service: Web Teleconferences and Reports
Web Teleconferences:
1. The Economic and Business Significance of an Avian Influenza Pandemic--a one-hour inaugural web teleconference on March 9, 2005 featuring a 40 minute presentation by bio-era Managing Director, James Newcomb, with invited comments from outside experts, Prof. PaulEwald, Dr. William Karesh, and Prof. Richard Matthew--followed by group discussion. All participants also receive a fully illustrated, edited transcript via email.
2. Using Scenarios for Pandemic Planning and Preparedness – a second one-hour teleconference on April 8, 2005, feauturing a 40 minute presentation by bio-era -- followed by Q&A. The teleconference has once again been transcribed, and will be sent to all participants shortly.

Bio-era Reports:
1. Thinking Ahead: The Business Significance of Avian Influenza—a 32-page in-depth bio-era report, examining the global business significance of avian influenza, including bio-era's independent assessment of the risk by country of AI pandemic emergence, and country economic risk exposure. The report also provides in-depth background on the current situation, and assesses the possible business implications of a pandemic, drawing on lessons learned from SARS and other disease outbreaks.
2. Thinking Ahead: Using Scenarios to Understand the Risks of an Influenza Pandemic--another in-depth bio-era report presenting a wide range of scenarios for pandemic avian influenza emergence, including signposts to watch and the implications of each scenario.

To learn more about the service, please visit http://www.bio-era.net. To enroll, visit: http://bio-era.net/research/avianflu_multiclient_service_form.html.
Stephen C. Aldrich, President
saldrich@bio-era.net, 617 956-3034
Bio Economic Research Associates
(Bio Economic Research Associates, 4/20/05)

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4. APEC EINet activities
Planning for an online Virtual Symposium, Fall 2005
The APEC EINet website now allows for automatic subscription at: http://depts.washington.edu/einet/?a=subscribe. The EINet team met with a representative from AARNet (Australia’s Academic and Research Network) to discuss ongoing collaboration activities and the planning for a virtual symposium (using Access Grid node technology) on biopreparedness for fall 2005.

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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), go to: http://depts.washington.edu/einet/?a=subscribe or 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