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Vol. XII, No. 23 ~ EINet News Briefs ~ Nov 13, 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
- 2009 Cumulative number of human cases of avian influenza A/H5N1
- Global: WHO situation update on pandemic influenza H1N1
- Global: WHO stresses antiviral use in high-risk H1N1 patients
- Global: Agreement for donation of pandemic H1N1 vaccine signed
- Global: WHO counters homeopathic vaccine advice in pregnancy
- Europe: Seasonal flu may hit Europe after H1N1
- Bulgaria: School closures and social distancing measures take effect
- UAE: Pilgrims must be immunized before hajj
- Ukraine: Cases top one million
- Cambodia: WHO to provide H1N1 vaccines by end of 2009
- China: H1N1 spread spurs boost in vaccine efforts
- China: Entire Beijing population to receive H1N1 vaccine
- Russia: Epidemic situation for acute respiratory infections and influenza
- Russia: Highly pathogenic avian influenza (H5N1) found in a pigeon
- Thailand: No new H1N1 related deaths reported, first time in four months
- Viet Nam: H1N1 and dengue co-infection
- Viet Nam: 40th death by A (H1N1) reported in Viet Nam
- Mexico: Researchers detail lung damage in fatal cases
- USA: CDC's new estimation method raises H1N1 numbers
- USA: CDC study finds no protective effect of seasonal flu shot
- USA: CDC urges pneumococcal vaccine for risk groups
- USA: Guillain-Barre syndrome reported in boy who received H1N1 vaccine
- USA: Sanofi vows to finish making H1N1 vaccine by year's end
- H1N1 reported in 29 African countries

2. Infectious Disease News
- Australia (South Australia): Pertussis outbreak
- Australia (Victoria): Hepatitis A virus in Semi-dried tomatoes
- Indonesia: Rabies immunoglobulin not available in Bali
- Philippines (Western Visayas): Measles outbreak
- CDC Outbreak Notice: Chikungunya Fever in Asia and the Indian Ocean
- Peru (Loreto): Health brigades sent to Loreto for possible rabies outbreak
- USA (New York): Mumps Outbreak
- USA: E. coli O157 contaminated ground beef

3. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA
- DENGUE
- CHOLERA, DIARRHEA, and DYSENTARY

4. Articles
- Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis
- A Business Plan To Help The 'Global South' In Its Fight Against Neglected Diseases

5. Notifications
- Pandemic guide for HR professionals released
- EPIDEMICS²: Second International Conference on Infectious Diseases Dynamics
- 14th International Congress on Infectious Diseases (ICID)
- ISHEID Symposium on HIV and Emerging Infectious Diseases
- Online tool to locate influenza vaccines
- Updated influenza guidance and information from the US CDC


1. Influenza News

Global
2009 Cumulative number of human cases of avian influenza A/H5N1

Economy / Cases (Deaths)
China/ 7 (4)
Egypt/ 36 (4)
Viet Nam/ 4 (4)
Total/ 47 (12)

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

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 442 (262)
(WHO 9/24/09 http://www.who.int/csr/disease/avian_influenza/en/index.html )

Avian influenza age distribution data from WHO/WPRO (last updated 9/10/09): http://www.wpro.who.int/sites/csr/data/data_Graphs.htm

WHO's map showing world's areas affected by H5N1 avian influenza (status as of 09/24/09): http://gamapserver.who.int/mapLibrary/Files/Maps/Global_H5N1Human_2009_FIMS_20090924.png.

WHO's timeline of important H5N1-related events (last updated 7/27/09): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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Global: WHO situation update on pandemic influenza H1N1

As of 1 November 2009, worldwide more than 199 countries and overseas territories/communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 6,000 deaths. As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred.

Intense and persistent influenza transmission continues to be reported in North America without evidence of a peak in activity. The proportion of sentinel physician visits due to influenza-like-illness (ILI) (8%) has exceeded levels seen over the past six influenza seasons; 42% of respiratory samples tested were positive for influenza and 100% of subtyped influenza A viruses were pandemic H1N1 2009. Rates of ILI, proportions of respiratory samples testing positive for influenza, and numbers of outbreaks in educational settings continues to increase sharply in Canada as activity spreads eastward. Significantly more cases of pandemic H1N1 have been recorded in Mexico since September than were observed during the initial springtime epidemic.

In Europe and Central and Western Asia, pandemic influenza activity continues to increase across many countries, signaling an unusually early start to the winter influenza season. Active circulation of virus marked by high proportions of sentinel respiratory samples testing positive for influenza has been reported in Belgium (69%), Ireland (55%), Netherlands (51%), Norway (66%), Spain (46%), Sweden (33%), the United Kingdom (Northern Ireland:81%), and Germany (27%). In addition, there is evidence of increasing and active transmission of pandemic influenza virus across Northern and Eastern Europe (including Ukraine and Belarus), and eastern Russia. In Western Asia and the Eastern Mediterranean Region, increasing activity has been reported in Oman and Afghanistan.

In East Asia, intense and increasing influenza activity continues to be reported in Mongolia. In China, after an earlier wave of mixed influenza activity (seasonal H3N2 and pandemic H1N1), pandemic H1N1 influenza activity now predominates and is increasing. Sharp increases in pandemic influenza activity continue to be reported throughout Japan with highest rates of illness being reported on the northern island.

Active influenza transmission and increasing levels of respiratory diseases continues to be reported in parts of the Caribbean, including in Cuba, Haiti, and other Caribbean Epidemiology Centre (CAREC) countries. Most other countries in the tropical region of Central and South America continue to report declining influenza activity. With the exception of Nepal, Sri Lanka, and Cambodia, overall transmission continues to decline in most but not all parts of tropical South and Southeast Asia. Influenza virus isolates from sub-Saharan Africa are predominantly pandemic H1N1 virus but some seasonal H3N2 has been detected even in recent weeks. Unconfirmed media reports from the area indicate that disease activity has increased in recent weeks.

Since the new pandemic H1N1 2009 virus emerged, infections in different species of susceptible animals (pig, turkey, ferret, and cat) have been reported. Limited evidence suggests that these infections occurred following direct transmission of the virus from infected humans. These isolated events have had no impact on the dynamics of the pandemic, which is spreading readily via human-to-human transmission. As human infections become increasingly widespread, transmission of the virus from humans to other animals is likely to occur with greater frequency. Unless the epidemiology of the pandemic changes, these will continue to pose no special risks to human health.
(WHO 11/06/2009)

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Global: WHO stresses antiviral use in high-risk H1N1 patients

Citing reports that hospitals and clinics in some countries are being overwhelmed by pandemic influenza cases, the World Health Organization (WHO) put an exclamation on its advice about the importance of prompt antiviral treatment for high-risk patients. The WHO made three specific recommendations:

  • People in high-risk groups, especially pregnant women, children less than 2 years old, and those with chronic medical conditions, should receive antiviral treatment as soon as possible if they have flu symptoms.

  • People who are not in those groups but have persistent or rapidly worsening symptoms also should get antiviral medication. Particular danger signs include difficult breathing and high fever lasting longer than three days.

  • Those who already have pneumonia should be given both antiviral and antibiotic treatment.
(CIDRAP 11/12/2009)

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Global: Agreement for donation of pandemic H1N1 vaccine signed

GlaxoSmithKline (GSK) is to donate 50 million doses of pandemic H1N1 vaccine to the World Health Organization (WHO) under an agreement signed at WHO headquarters in Geneva by the WHO Director-General, Dr Margaret Chan, and the Chief Executive Officer of GlaxoSmithKline, Mr. Andrew Witty. GSK expects to prepare the first shipments of vaccine to the WHO by the end of November 2009. The WHO has a list of 95 developing countries that are eligible to receive donated vaccines, and aims to secure enough vaccines to cover 10 percent of the population of these countries.
(WHO 11/10/2009)

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Global: WHO counters homeopathic vaccine advice in pregnancy

A WHO official criticized the Swiss Society of Homeopathic Physicians for advising pregnant women to avoid getting vaccinated against H1N1. Marie-Paule Kieny, director of the WHO's Initiative for Vaccine Research, said the advice could put pregnant women and their babies at risk for severe consequences. The WHO's vaccine advisory group has said the two adjuvanted vaccines licensed in Switzerland are safe for use in pregnant women.
(CIDRAP 11/09/2009)

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Europe/Near East
Europe: Seasonal flu may hit Europe after H1N1

The pandemic (H1N1) 2009 influenza virus could kill up to 40,000 people across Europe and be followed by seasonal flu waves that could kill the same number, European health experts said on 6 Nov 2009. The Sweden-based European Center for Disease Prevention and Control [ECDC] said epidemics of pandemic (H1N1) 2009 virus infection were now affecting almost all countries in the European Union but it could not predict how intense the peaks would be. What was certain, it said, was that the pandemic would continue to kill thousands and put many patients into intensive care as the northern hemisphere's winter sets in.

ECDC's latest daily update said all 27 EU and four EFTA countries have cases of H1N1 pandemic flu and there have been 389 deaths linked to pandemic H1N1 in the region since April 2009, including 154 in Britain, 73 in Spain, 25 in Italy, and 22 in France.
(ProMED 11/07/2009)

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Bulgaria: School closures and social distancing measures take effect

Bulgaria's health ministry on Nov 6 declared a flu epidemic, which triggered a one-week school closure and other social distancing measures. The country also suspended hospital visits and prescheduled surgeries. Though the ministry didn't close theaters or other public venues, it urged citizens to avoid crowds. Flu epidemics had already been declared in 16 of the country's 28 regions, including the capital, Sofia.
(CIDRAP 11/09/2009)

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UAE: Pilgrims must be immunized before hajj

A newspaper in the United Arab Emirates (UAE) has reported that everyone going on the annual Muslim pilgrimage (hajj) to Mecca must be vaccinated against H1N1 influenza before leaving. Pilgrims can be vaccinated at four centers in Dubai and 30 elsewhere in the country. The hajj will take place in the last week of November.
(CIDRAP 11/10/2009)

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Ukraine: Cases top one million

Ukraine's deputy health minister said the nation's epidemic of flu and other acute respiratory illnesses has now affected more than a million people. Vasyl Lazoryshynets said the death toll from the epidemic had risen to 174. Nearly 53,000 Ukrainians have been hospitalized, he said, but the number in intensive care has fallen by nearly a quarter to about 330. Sixty-seven confirmed H1N1 cases have been reported, 14 of them fatal, he said.
(CIDRAP 11/10/2009)

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Asia
Cambodia: WHO to provide H1N1 vaccines by end of 2009

The World Health Organization will give Cambodia stocks of the A (H1N1) influenza vaccine sometime late in 2009, though with supply levels still uncertain, the organization plans on prioritizing access to the vaccine for high-risk groups. Ly Sovann, deputy director of the Communicable Diseases Control Department at the Ministry of Health, announced the WHO commitment on 6 Nov 2009. He also said that, as of 4 Nov 2009, in-country infections of the A (H1N1) virus had risen to 313.
(CIDRAP 11/11/2009)

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China: H1N1 spread spurs boost in vaccine efforts

China is stepping up its H1N1 vaccination drive after cases increased by about 5,000 and the death toll rose from 16 to 30 over the past three days. The health ministry numbered confirmed cases at 59,478 and said 240 people were in critical condition. Calling the increase in cases "alarming," health ministry spokesman Mao Qunan said the government has ordered increased vaccine production and immunizations. As of yesterday, 8.7 million Chinese had been vaccinated.
(CIDRAP 11/10/2009)

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China: Entire Beijing population to receive H1N1 vaccine

Beijing health officials said that they would extend H1N1 vaccine from high-risk citizens to all of the city's 16 million residents as the H1N1 death toll in the country rises. The city will offer free vaccine to all people older than three years. A public health official said Beijing now has 3.63 million doses but will receive more.
(CIDRAP 11/6/2009)

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Russia: Epidemic situation for acute respiratory infections and influenza

During the week 26 Oct to 1 Nov 2009 the epidemic threshold was exceeded in 25 cities and 11 administrative divisions. The threshold was crossed across all age groups in several regions, including Moscow, Pskov, Yuzhno-Sakhalinsk, Chelyabinsk, and Krasnoyarsk. According to Rospotrebnadzor, the public health service, schools and other educational institutions are being closed as an anti-epidemic measure across the country. As of 2 Nov 2009, 3,122 cases of pandemic A/H1N1 influenza have been confirmed. There were 19 fatalities, of whom 14 were confirmed as influenza cases. As of 9 Nov 2009, the immunization coverage was 22,717,527 doses or 16 percent of the total population.
(CIDRAP 11/10/2009)

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Russia: Highly pathogenic avian influenza (H5N1) found in a pigeon

A rock dove (Columba livia) was found sick with highly pathogenic avian influenza (H5N1) in Pushchino, Serpukhov, Moskovskaya Oblast, according to Dr. Nicolay Vlasov, CVO, Veterinary services, Ministry of Agriculture and Food. The infection was diagnosed clinically and by laboratory methods (nucleotide sequencing, PCR, and virus isolation).
(ProMED 11/07/2009)

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Thailand: No new H1N1 related deaths reported, first time in four months

Thailand's Ministry of Public Health confirmed that the country had no fatalities related to influenza A (H1N1) when it made its report on 11 Nov 2009. This marked the first week in four months without an H1N1 related death, according to Witthaya Kaewparadai, public health minister. Mr. Witthaya said that the zero fatalities report for the past week may be caused in part by the improved awareness of the public at large, as well as quick access to effective treatment. The ministry remains on high alert to respond to any outbreak as the second wave of flu is expected to impact the kingdom in December 2009, when winter begins, Mr. Witthaya said.
(CIDRAP 11/11/2009)

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Viet Nam: H1N1 and dengue co-infection

Two patients infected with both influenza pandemic (H1N1) 2009 virus and dengue fever have died in Hanoi, Nguyen Hong Ha, deputy head of the National Institute of Tropical and Infectious Diseases, said on 11 Nov 2009. The nation's first two patients with the combination of pandemic (H1N1) 2009 virus infection and dengue fever virus detected early in November 2009 had also been treated at the institute. They were discharged after full recovery.
(ProMED 11/12/2009)

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Viet Nam: 40th death by A (H1N1) reported in Viet Nam

On 10 Nov 2009, the Health Ministry announced an additional fatal case of A (H1N1) flu, bringing the total deaths to 40. The victim was a 17-year-old girl from Dong Anh district, Hanoi. By 10 Nov 2009, Viet Nam reported 10,791 H1N1 patients with 10,549 of them recovered.
(CIDRAP 11/11/2009)

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Americas
Mexico: Researchers detail lung damage in fatal cases

Autopsies of 15 Mexican patients who died of suspected novel H1N1 infections found the virus in 5 of them, of which 4 were young adults, doctors reported in a New England Journal of Medicine letter. Lung tissue was heavier than normal and solid. Four had upper-airway hallmarks seen in seasonal flu cases, but all five had pulmonary damage and interstitial lesions typically seen with H5N1 infections. Two patients showed evidence of other organ involvement seen in lethal H5N1 cases.
(CIDRAP 11/12/2009)

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USA: CDC's new estimation method raises H1N1 numbers

On 12 Nov 2009, the US CDC unveiled a new counting method that significantly increases the estimated numbers of pandemic HIN1 cases, hospitalizations, and deaths. At a media briefing, Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, said the CDC's new method of calculating pandemic cases and deaths is designed to provide a better big-picture view. Though the new numbers are significantly larger than the CDC's previous counts, they don't suggest that the disease situation has changed, she said.

The new estimates combine information from the CDC's Emerging Infection Program Network, which tracks flu cases in 10 states and 62 counties, with aggregate state reports of lab-confirmed hospitalizations and deaths. Previous hospitalization and death counts were based on individual lab-confirmed cases. "We've tried this a few different ways, and really the estimates converge," Schuchat said. "We're feeling comfortable we'll be giving you appropriate estimates today."

The CDC numbers for April through Oct 17 give a single number for each category, plus lower and upper estimates around each number. She said the CDC estimates that 22 million people in the United States have become ill with the pandemic flu virus. The number of hospitalizations is estimated to be 98,000, with range between 63,000 and 153,000. For comparison, the CDC's most recent hospitalization count using the previous tracking method is 17,838. Deaths through Oct 17 likely totaled 3,900, with a range of 2,500 to 6,100. For comparison, the CDC's most recent fatality count using its previous tracking method is 672. Pediatric deaths calculated with the new system total 540, with a range of 300 to 800. For comparison, the CDC's most recent pediatric death tally using its previous method was 129 lab-confirmed pandemic H1N1 fatalities.

Age-based breakdowns using the new method are available on the CDC's Web site (http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm ) and all the numbers will be updated every 3 to 4 weeks. Schuchat said the new estimation method confirms that younger people are bearing the brunt of pandemic illnesses and supports the prioritization recommendations set by the CDC's vaccine advisory committee.
(CIDRAP 11/12/2009)

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USA: CDC study finds no protective effect of seasonal flu shot

A study by the CDC (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a5.htm?s_cid=mm5844a5_e ) found no evidence that seasonal flu vaccine was protective against the H1N1 virus. The CDC compared the vaccination coverage among 356 H1N1 case-patients in eight states with the estimated population coverage in those states. Overall vaccine effectiveness was found to be minus 10% but varied widely by age-group. The results, combined with others, suggest that seasonal flu vaccine neither raises nor lowers the risk of H1N1 infection.
(CIDRAP 11/12/2009)

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USA: CDC urges pneumococcal vaccine for risk groups

The US CDC sent a letter to healthcare providers warning that pneumococcal infections have been seen in some fatal pandemic H1N1 cases and reminding them to offer the pneumonia vaccine to those who are currently recommended to receive them. It urged special emphasis on vaccinating those under age 65 who have high-risk conditions, because coverage rates are especially low and they may be more likely to develop secondary bacterial infections.
(CIDRAP 11/11/2009)

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USA: Guillain-Barre syndrome reported in boy who received H1N1 vaccine

A 14-year-old Virginia boy developed symptoms of Guillain-Barre syndrome (GBS) within 18 hours of getting a pandemic vaccine. His mother had taken him to the health department to receive the seasonal shot, where they also offered the H1N1 vaccine. It's not clear if the boy received both. The CDC said five GBS cases have been reported so far, not including the boy's. It said the rate is less than expected; 80 to 120 cases are reported in the general population each week.
(CIDRAP 11/11/2009)

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USA: Sanofi vows to finish making H1N1 vaccine by year's end

After a slow start in producing H1N1 flu vaccine, Sanofi Pasteur has improved yields threefold and expects to fulfill its government order for 75 million doses by the end of the year, company officials said on 11 Nov 2009. Wayne Pisano, Sanofi Pasteur president and CEO, said "In three weeks we'll be ahead of schedule."

The 75 million doses expected from Sanofi make up about 30% of the 251 million doses the Department of Health and Human Services has ordered from five companies. As of 6 Nov 2009, about 38 million doses had been produced by all the suppliers.
(CIDRAP 11/11/2009)

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Africa
H1N1 reported in 29 African countries

Twenty-nine countries in Africa have reported confirmed pandemic H1N1 flu cases so far, totaling 14,868 illnesses, with 103 deaths, the WHO Regional Office for Africa reported. The vast majority of the confirmed cases were reported by South Africa, with 12,619 cases. The numbers show an increase from the 14,109 cases and 76 deaths previously reported through Nov 1. The number of confirmed cases greatly underestimates actual cases.
(CIDRAP 11/10/2009)

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2. Infectious Disease News

Asia
Australia (South Australia): Pertussis outbreak

South Australia (SA) is experiencing its worst whooping cough [pertussis] outbreak on record and babies are the main victims of the potentially fatal and highly infectious disease. SA Health Communicable Disease Control branch director Dr Ann Koehler said SA had the highest rate in the nation, although it was not clear why. She said SA had recorded the highest number of notifications since records started being kept in 1991, and warned that people needed to be vigilant about vaccinations to protect vulnerable children. About 95 percent of SA children are immunized, but Dr Koehler said SA Health was concerned about some people's resistance to or complacency about vaccinating children. She warned homeopathic "vaccines" did not work. "That's wasting your money. . .you're putting yourself, your children and other people's children at risk," she said.

SA Health has received almost 3,500 reports in 2009, compared with 859 at the same time in 2008 and 318 in 2007. National statistics show the rate in South Australia is twice as high as the national average.
(ProMED 11/07/2009)

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Australia (Victoria): Hepatitis A virus in Semi-dried tomatoes

Victorian health authorities have renewed their warnings over links between semi-dried tomatoes and an outbreak of hepatitis A following a further 23 cases of the infectious disease diagnosed in the past week. Victoria's chief health officer Dr John Carnie said that so far in 2009, there have been 200 notifications of hepatitis A, compared to 74 at the same time last in 2008. A study into the increase of cases indicates that more than two thirds of people that have become ill recalled eating semi-dried tomatoes, he said. Local producers had promised the Department of Human Services they were doing their best to reduce the risk, while importers of the tomatoes had also been instructed to ensure appropriate quality control measures were in place, he said.
(ProMED 11/04/2009)

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Indonesia: Rabies immunoglobulin not available in Bali

Human or equine rabies immunoglobulin is, for all practical purposes, not presently available in Bali. The supply of WHO-approved tissue culture rabies vaccines also cannot be assured. Travelers likely to be engaged in high risk activities for potential exposure should consider receiving pre-exposure rabies vaccine prior to their departure. If a traveler does incur a rabies exposure in Bali, the nearest facilities that are able to provide reliable post-exposure treatment are in Singapore, Bangkok and Australia. All of these can be reached by direct daily flights.

***Post exposure prophylaxis (treatment) is an emergency and should be undertaken as soon as possible after exposure.***
(ProMED 11/01/2009)

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Philippines (Western Visayas): Measles outbreak

The Department of Health (DOH) Center for Health Development 6 noted an increase in measles cases in Western Visayas, with Iloilo top of the list registering 33 out of the 41 confirmed measles laboratory results. Dr. Renilyn P. Reyes, CHD regional coordinator for the Expanded Program for Immunization (EPI), said there is a resurgence of measles cases in the region, although there are no recorded deaths. Of the 33 confirmed measles cases in Iloilo, Iloilo City has 15 confirmed measles cases, and 18 are registered in the 10 municipalities in the province and the component city of Passi. In 2008, there were no recorded measles cases in Iloilo and Panay.

In a press conference on 10 Nov 2009, Reyes attributed the resurgence of measles cases in Western Visayas to the "accumulation of susceptibles." The poor vaccination coverage contributes to the recurrence of the disease. From 2005 until 2007, there were no confirmed measles cases in Western Visayas. In 2007, the government launched a mass immunization program to prevent its resurgence.
(ProMED 11/12/2009)

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CDC Outbreak Notice: Chikungunya Fever in Asia and the Indian Ocean

Since 2006, parts of Asia and the Indian Ocean have reported chikungunya fever activity. Several countries have increased surveillance for this disease, and cases continue to be reported throughout this region. Chikungunya fever is a disease caused by a virus that is spread to people through the bite of infected mosquitoes. Symptoms can include sudden fever, joint pain with or without swelling, chills, headache, nausea, vomiting, lower back pain, and a rash. Chikungunya mainly occurs in areas of Africa and Asia.

As of September, 29, 2009, a large outbreak of chikungunya fever has affected Thailand, particularly the southern region including some tourist destinations, such as Phuket. According to the Ministry of Public Health in Thailand, over 42,300 cases have been documented this year in 50 provinces. Reports from Thailand show that chikungunya virus continues to circulate throughout the country.

As of September 26, 2009, the Ministry of Health in Malaysia has reported over 3,185 cases of chikungunya fever. The most affected areas are the northern provinces of Kedah, followed by Kelantan, Selangor, Perak, and Sarawak.
(US CDC 11/12/2009)

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Americas
Peru (Loreto): Health brigades sent to Loreto for possible rabies outbreak

The Ministry of Health, through the Regional Health Authority (Diresa) Loreto, sent crews with specialized personnel to the Morona District of Loreto, to investigate a possible outbreak of rabies transmitted by the bite of bats that have caused the deaths of five people from the Huambisa ethnic group. The group consists of infectious disease physicians, epidemiologists, veterinarians, laboratory staff and environmental health staff and immunizations, aimed at determining the existence of a rabies outbreak as well as investigating the epidemiological situation in the area, in addition to vaccinating those people in the communities that had been exposed to bat bites.
(ProMED 11/06/2009)

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USA (New York): Mumps Outbreak

At least 45 children in Rockland have been diagnosed with mumps, a highly infectious disease that is also being reported in communities in Brooklyn and Orange County, New York, according to the state Department of Health (DOH). The State DOH is also tracking 62 cases reported in the Borough Park section of Brooklyn, as well as seven confirmed cases in Kiryas Joel in Orange County. Other cases connected to the outbreak have also been reported in Lakewood, New Jersey, and in Quebec, Canada according to health officials.

The outbreak apparently started in August 2009 in a summer camp in Sullivan County, New York, attended primarily by children from Borough Park, according to the State [Department of Health].
(ProMED 11/06/2009)

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USA: E. coli O157 contaminated ground beef

The US CDC said 28 people in 12 states from California to Maine are now infected with matching strains of Escherichia coli O157 after an outbreak in ground beef. Of those people, 16 are in hospitals and three have developed kidney failure as a result of the contamination, CDC said late on 2 Nov 2009, adding that two people have died after becoming infected.
The US Department of Agriculture announced the week of 26 Oct 2009 that Fairbank Farms in Ashville, New York, was recalling more than half a million pounds [about 250,000 kg] of fresh ground beef products that may be contaminated with a strain of E. coli. The products subject to recall were sent to retailers including Trader Joe's, Price Chopper, Lancaster, and Wild Harvest, Shaw's, BJ's, Ford Brothers, and Giant Food Stores. The exact products affected are listed on the USDA's website.

The recall was for distribution centers in eight states, but Fairbank Farms said some retailers may have sent the affected beef to other states. Each package is printed with "EST. 492" inside the USDA mark of inspection or on the nutrition label. They were packaged on 15 and 16 Sep 2009 and may have been labeled at the retail stores with a sell-by date from 19 to 28 Sep 2009 through 28, the USDA said.
(ProMED 11/03/2009)

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3. Updates
INFLUENZA A/H1N1

The following websites provide the most current information, surveillance, and guidance.

- WHO
Influenza A/H1N1: http://www.who.int/csr/disease/swineflu/en/index.html
Influenza A/H1N1 frequently asked questions: http://www.who.int/csr/disease/swineflu/frequently_asked_questions/en/index.html
Pandemic Influenza Preparedness and Response - A WHO Guidance Document
http://www.who.int/csr/disease/influenza/pipguidance2009/en/index.html
International Health Regulations (IHR) at http://www.who.int/ihr/en/index.html.

- WHO regional offices
Africa: http://www.afro.who.int/
Americas: http://new.paho.org/hq/index.php?option=com_content&task=blogcategory&id=805&Itemid=569
Eastern Mediterranean: http://www.emro.who.int/csr/h1n1/
Europe: http://www.euro.who.int/influenza/ah1n1
South-East: http://www.searo.who.int/EN/Section10/Section2562.htm
Western Pacific: http://www.wpro.who.int/health_topics/h1n1/

- North America
US CDC: http://www.cdc.gov/flu/swine/investigation.htm
US pandemic emergency plan: http://www.flu.gov
MOH Mexico: http://portal.salud.gob.mx/index_eng.html
PHA of Canada: http://fightflu.ca

- Other useful sources
CIDRAP: Influenza A/H1N1 page: http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/biofacts/swinefluoverview.html
ProMED: http://www.promedmail.org/

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AVIAN INFLUENZA

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

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DENGUE

Indonesia (Jakarta)
The Jakarta city administration warned that the number of dengue fever cases might rise in the coming months. "Observing data from the last two years, dengue fever began to increase in December and reached its peak in March," Dien Emawati, Jakarta Health Agency head, said at a conference on dengue fever prevention. Dien explained the Aedes aegypti mosquito population rose when the wet season reached its peak. "Areas covered with stagnant water increase and become breeding grounds for mosquitoes," she said. Dien added that the agency was preparing a massive fogging campaign this month.

The agency recorded that, as of October 2009, more than 26,500 Jakarta residents were suspected of having contracted dengue fever. The fever claimed 33 lives.
(ProMED 11/10/2009)

Mexico
Health authorities reported that dengue fever has increased 40 percent in 2009 compared to 2008. The Secretariat of Health reported that, in 2009, dengue spread to 27 states of the country, even among those which were previously declared free of the disease, such as Queretaro, Zacatecas and Guanajuato. The Secretariat reported that during October 2009 there were approximately 10,000 new cases which brought the total number of dengue cases to roughly 35,000.
(ProMED 11/10/2009)

Philippines (Cebu)
Even with a rise in dengue cases, the Department of Health in Central Visayas (DOH-7) said that there is no evidence of a dengue outbreak. "We are not conducting an entomological survey, we have not seen the need for one. There is no outbreak," said Dr. Expedito Medalla, DOH-7's Health Emergency Management Services coordinator. He said the survey, which entails counting larvae and adult Aedes aegypti, is only done when there is evidence of a large concentration of the dengue-carrying vectors in an area. According to the latest DOH-7 surveillance report, dengue cases went up by 42 percent between 1 Jan - 24 Oct 2009 compared with the same period in 2008.
(ProMED 11/10/2009)

Philippines (Kalinga)
The Cordillera office of the Center for Health Development (CHD-CAR) in Kalinga recently rescinded the dengue outbreak and heightened alert in this province following a significant reduction in the number of cases in the previous monitoring period over the past several weeks. For the past week, dengue fever cases in the province have dropped to only 7, which is an indication that people in the different critical areas have already been properly informed on how to prevent the worsening of the outbreak that could prove to be deadlier once it is not controlled.
(ProMED 11/02/2009)

USA (Florida)
A state health official urged Floridians on 22 Sep 2009 to take precautions against dengue fever after three people were found to be infected. It has been 40 years since officials have seen locally acquired dengue fever. It is however possible that dengue has been in the community but was not properly diagnosed.
(ProMED 11/10/2009)

Viet Nam (national)
The Ministry of Health said on 24 Oct 2009 that, within the last month, 55 out of 63 provinces in Viet Nam recorded 17,140 cases of dengue fever with 14 deaths. Since the beginning of 2009, Viet Nam has seen over 74,242 dengue cases, an increase of 16.8 per cent over the same period in 2008. Of the total, 58 have died, six less compared to 2008. Hanoi has seen the highest increase of people infected in the country, with 8,000 patients so far in 2009, 15 times higher than in 2008. It is also the capital city's worst dengue outbreak in the past 10 years.
(ProMED 11/02/2009)

Viet Nam (Delta)
On 29 Oct 2009, Dong Thap Province reported a dramatic increase in the number of dengue fever patients in 2009 to 2,452 so far, 111.6 per cent more year-on-year, according to the provincial preventive health center. Meanwhile, Soc Trang Province also reported high dengue rates, with over 5,000 people hit by the mosquito borne disease since the beginning of 2009.
(ProMED 11/02/2009)

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CHOLERA, DIARRHEA, and DYSENTARY

Papua New Guinea (Madang)
The cholera outbreak in Papua New Guinea's Madang is still worsening with more than 300 people now being treated for the illness. An epidemiologist with the World Health Organization, Alexander Rosewell, says local authorities are still considering whether to declare a public health emergency as has been done in neighboring Morobe province. Rosewell says most affected people come from a settlement just outside of Madang city. They hope to establish a longer-term special cholera treatment facility in the next few days.
(ProMED 11/11/2009)

Thailand
ProMED-mail for Mekong Basin Disease Surveillance (PRO/MBDS) has learned from a very reliable source that there is an outbreak of cholera following heavy flooding in the southern part of Thailand, near the border with Malaysia.
(ProMED 11/11/2009)

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4. Articles
Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis

Echevarría-Zuno S, Mejía-Aranguré JM, and Mar-Obeso AJ. The Lancet. 12 November 2009; doi:10.1016/S0140-6736(09)61638-X. Available at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961638-X/fulltext.

Background. In April, 2009, the first cases of influenza A H1N1 were registered in Mexico and associated with an unexpected number of deaths. We report the timing and spread of H1N1 in cases, and explore protective and risk factors for infection, severe disease, and death.

Methods. We analyzed information gathered by the influenza surveillance system from April 28 to July 31, 2009, for patients with influenza-like illness who attended clinics that were part of the Mexican Institute for Social Security network. We calculated odds ratios (ORs) to compare risks of testing positive for H1N1 in those with influenza-like illness at clinic visits, the risk of admission for laboratory-confirmed cases of H1N1, and of death for inpatients according to demographic characteristics, clinical symptoms, seasonal influenza vaccine status, and elapsed time from symptom onset to admission.

Findings. By July 31, 63 479 cases of influenza-like illness were reported; 6945 (11%) cases of H1N1 were confirmed, 6407 (92%) were outpatients, 475 (7%) were admitted and survived, and 63 (<1%) died. Those aged 10-39 years were most affected (3922 [56%]). Mortality rates showed a J-shaped curve, with greatest risk in those aged 70 years and older (10.3%). Risk of infection was lowered in those who had been vaccinated for seasonal influenza (OR 0.65 [95% CI 0.55-0.77]). Delayed admission (1.19 [1.11-1.28] per day) and presence of chronic diseases (6.1 [2.37-15.99]) were associated with increased risk of dying.

Interpretation. Risk communication and hospital preparedness are key factors to reduce mortality from H1N1 infection. Protective effects of seasonal influenza vaccination for the virus need to be investigated.

Funding. None.

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A Business Plan To Help The 'Global South' In Its Fight Against Neglected Diseases

Frew SE, Liu VY, and Singer PA. Health Affairs. 2009; 28(6):1760-1773. Available at http://content.healthaffairs.org/cgi/content/full/28/6/1760?ijkey=Gxaby.UeeO/zA&keytype=ref&siteid=healthaff.

Abstract. Although neglected tropical diseases (NTDs) threaten the health of those living in the developing world, innovation directed toward addressing NTDs is comparatively meager. Health biotechnology firms in rapidly growing economies in the global South are developing and selling vaccines, diagnostics, and therapeutics for these diseases to local markets. In this paper we identify a pipeline of sixty-two NTD products from seventy-eight "Southern" companies. We also propose creation of a Global Health Accelerator-a new nonprofit organization whose mission would be to support and help grow this Southern source of affordable innovation for NTDs.

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5. Notifications
Pandemic guide for HR professionals released

A guide for human resource (HR) managers looking for ways to quickly plan for and respond to the H1N1 pandemic has been issued by the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News, and the Society for Human Resource Management. The free 42-page guide was prepared with support from the Centers for Disease Control and Prevention. It includes lessons learned by HR professionals whose response skills were tested in the early days of the pandemic.
Available at http://www.cidrap.umn.edu/cidrap/files/33/cidrap-shrm-hr-pandemic-toolkit.pdf.

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EPIDEMICS²: Second International Conference on Infectious Diseases Dynamics
Athens, Greece, 2-4 Dec 2009

Following the highly successful inaugural Epidemics Conference in Asilomar, USA in 2008, the organizers are pleased to announce a second conference in the series to be held in Athens, Greece.
Additional information and registration available at http://www.epidemics.elsevier.com/.

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14th International Congress on Infectious Diseases (ICID)
Miami, Florida, Mar 9-12, 2010

The deadline for abstract submissions to the 14th ICID has been extended to November 30th. Take advantage of reduced registration fees by registering on or before January 15, 2010.
Additional information and registration available at http://www.isid.org/14th_icid/.

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ISHEID Symposium on HIV and Emerging Infectious Diseases
Marseille, France, 24-26 Mar 2010

Tackling each topic from basic science to clinical applications, this meeting will deal with issues of HIV/AIDS, Viral Hepatitis, Emerging Infectious Diseases, and welcome many Key Opinion Leaders.

Preliminary program: http://ems6.net/r/?F=t52gxqgrsuxuaj8rzw4tzbgnstb7z348677srxae9269mghaltvxj72-1224022

Registration and hotel booking are open on-line, we recommend you to secure your participation.

The ISHEID 2010 congress organizing office...
E-mail: isheid@clq-group.com; Ph. : +33 1 44 64 15 15 - Fax : +33 1 44 64 15 16

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Online tool to locate influenza vaccines

Collaboration among Google, the American Lung Association, and the US Department of Health and Human Services has produced a searchable interactive map that displays government and private offices where seasonal and H1N1 vaccines are available, including location and contact details. The tool currently covers chain pharmacies in 50 states and health agencies in 20 states, with more data being added.
Available at http://www.google.com/flushot.

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Updated influenza guidance and information from the US CDC

Interim Guidance: Considerations Regarding 2009 H1N1 Influenza in Intrapartum and Postpartum Hospital Settings
Released 10 November 2009
Available at http://www.cdc.gov/h1n1flu/guidance/obstetric.htm.

Frequently asked questions on use of influenza A(H1N1) 2009 monovalent vaccines (2009 H1N1 monovalent influenza vaccines): Practical considerations for immunization programs and providers
Released 10 November 2009
Available at http://www.cdc.gov/H1N1flu/vaccination/top10_faq.htm.

Letter to Providers Promoting PPSV for Adults
Released 10 November 2009
Available at http://www.cdc.gov/h1n1flu/vaccination/provider/lettertoprovider.htm.

CDC Health Alert Network (HAN) Info Service Message: Key Issues for Clinicians Concerning Antiviral Treatments for 2009 H1N1
Released 06 November 2009
Available at http://www.cdc.gov/H1N1flu/HAN/110609.htm.

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 apecein@u.washington.edu