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EINet Alert ~ Nov 20, 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
- WHO situation update on pandemic influenza H1N1
- Safety profiles of pandemic H1N1 vaccines
- Tamiflu resistant cases detailed
- WHO notes pandemic-related TB challenges
- Egypt: Eighty-eighth case of human HPAI avian influenza [H5N1]
- Hungary: Spike in influenza cases prompts Hungary to declare epidemic
- Ukraine: Pandemic (H1N1) 2009 investigation results
- China: Effectiveness of Chinese control measures debated
- China: Beijing influenza research center planned
- North Korea: Pandemic flu detected in North Korea
- Russia (Moscow): Influenza and acute respiratory viral infections morbidity
- South Korea (Gangwon): Resurgence of low pathogenicity avian influenza
- Thailand: Thai official says second wave of pandemic H1N1 influenza is starting
- Thailand: Economy is free of H5N1 avian influenza
- USA: CDC campaigns for flu precautions for travelers
- USA: House committees probe pandemic vaccine decisions
- USA: CDC airs flu guidelines for labor and delivery settings
- USA: Most flu-stricken health workers not infected at work

2. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA

3. Articles
- Differentiation of two distinct clusters among currently circulating influenza A(H1N1)v viruses, March-September 2009
- Pre-existing immunity against swine-origin H1N1 influenza viruses in the general human population
- Hospitalised adult patients with pandemic (H1N1) 2009 influenza in Melbourne, Australia
- Measures against transmission of pandemic H1N1 influenza in Japan in 2009: simulation model
- Rhinoviruses, A(H1N1)v, RVS: The race for hivernal pandemics, France 2009-2010

4. Notifications
- WHO interim planning considerations for mass gatherings in the context of pandemic (H1N1) 2009 influenza
- Northwest Center for Public Health Practice Hot Topics Preparedness forum
- EPIDEMICS˛: Second International Conference on Infectious Diseases Dynamics
- 14th International Congress on Infectious Diseases (ICID)
- ISHEID Symposium on HIV and Emerging Infectious Diseases
- 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/ 37 (4)
Viet Nam/ 4 (4)
Total/ 48 (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: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm (last updated 9/10/09)

WHO's map showing world's areas affected by H5N1 avian influenza (last updated 11/06/09): http://gamapserver.who.int/mapLibrary/

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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WHO situation update on pandemic influenza H1N1
As of 8 Nov 2009, worldwide more than 206 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 6,250 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.

In North America, Canada reported sharp increases in rates of influenza-like-illness (ILI), detections of pandemic H1N1 virus, and school outbreaks over the past three weeks as pandemic activity continues to spread west to east. In the United States, influenza transmission remains geographically widespread and intense but largely unchanged since the previous reporting week; rates of hospitalizations among persons aged 0-4 years, 5-17 years, and 18-49 years have now exceeded those seen during recent previous influenza seasons. Disease activity may have peaked in the earlier affected southern and south eastern parts of the United States. In Mexico, influenza activity remains geographically widespread with a significant wave of cases reported since early September, most notably from central and southern Mexico.

In Europe and Central Asia, overall influenza transmission continues to intensify throughout the continent as pandemic activity spreads eastward. At least 10 countries of Western Europe (Iceland, Poland, Romania, Belgium, Germany, the Netherlands, Norway, Spain, Sweden and the United Kingdom) now report that the proportion of sentinel samples testing positive for influenza exceeded 20% consistent with active circulation of pandemic influenza viruses. High to very high intensity of respiratory diseases with concurrent circulation of pandemic H1N1 2009 was also reported in the Netherlands, Italy, much of Northern Europe, Belarus, Bulgaria, and in the Russian Federation (particularly in the Urals). Disease activity may be peaking in a few countries, notably Iceland, Ireland, and parts of the UK (Northern Ireland) that experienced intense transmission during early autumn. The initial analysis of data from the Ukraine indicates that the numbers of severe cases do not appear to be excessive when compared to the experience of other countries and do not represent any change in the transmission or virulence of the virus. Over 99% of subtyped influenza A viruses in Europe were pandemic H1N1 2009 with the exception of the Russian Federation where <10% of viruses subtyped were seasonal influenza subtypes, H3N2 and seasonal H1N1.

In Western Asia, increasing activity has been observed in several countries. In Israel, sharp increases in rates of ILI and pandemic virus detections have been observed over the past three weeks. In Afghanistan, the proportion of sentinel visits for acute respiratory infections (ARI) has increased over the past 3-4 weeks, but more dramatically in the last 1-2 weeks.

In East Asia, very intense and increasing influenza activity continues to be reported in Mongolia with a severe impact on the healthcare system. In China, the proportion of sentinel hospital visits for ILI and the proportions of respiratory samples testing positive for influenza, continued to increase over the past 3-4 weeks. More than 80% of influenza viruses isolated in China were pandemic H1N1 2009. In Hong Kong SAR, rates of ILI have returned baseline after a recent wave of predominantly pandemic H1N1 influenza in September and October. In Japan, sharp increases in influenza activity continue to be reported nationally. On northern island of Hokkaido, which to date has been the most heavily affected, disease activity may have recently peaked.

Although active, predominantly pandemic influenza transmission persists in the Caribbean region, disease activity may have recently peaked in some places as evidenced by recently declining rates of ARI and severe acute respiratory infections (SARI) in the 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 and Sri Lanka, overall transmission continues to decline in most parts of South and Southeast Asia. In the temperate region of the southern hemisphere, little pandemic influenza activity has been reported in recent weeks. Of note, a cluster of pandemic influenza cases been reported in Argentina in the capital area.
(WHO 11/13/2009)

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Safety profiles of pandemic H1N1 vaccines
To date, WHO has received vaccination information from 16 of approximately 40 countries conducting national H1N1 pandemic vaccine campaigns. Based on information in these 16 countries, WHO estimates that around 80 million doses of pandemic vaccine have been distributed and around 65 million people have been vaccinated. Vaccination campaigns currently under way to protect populations from pandemic influenza are among the largest in the history of several countries, and numbers are growing daily. Given this scale of vaccine administration, at least some rare adverse reactions, not detectable during even large clinical trials, could occur, underscoring the need for rigorous monitoring of safety. Results to date are encouraging.

Common side effects. Mild side effects and allergic reactions have been observed and are well within the expected range.

Guillain-Barré syndrome. To date, fewer than ten suspected cases of Guillain-Barré syndrome have been reported in people who have received vaccine. These numbers are in line with normal background rates of this illness, as reported in a recent study. WHO has received no reports of fatal outcomes among suspected or confirmed cases of Guillain-Barré syndrome detected since vaccination campaigns began. All cases have recovered. WHO recommends continued active monitoring for Guillain-Barré syndrome.

Vaccine Comparisons. Campaigns are using nonadjuvanted inactivated vaccines, adjuvanted inactivated vaccines, and live attenuated vaccines. No differences in the safety profile of severe adverse events among different vaccines have been detected to date.

Although intense monitoring of vaccine safety continues, all data compiled to date indicate that pandemic vaccines match the excellent safety profile of seasonal influenza vaccines, which have been used for more than 60 years.
(WHO 11/19/2009)

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Tamiflu resistant cases detailed
In a review of the global cases of oseltamivir (Tamiflu) resistant H1N1 reported thus far, the European Centre for Disease Prevention and Control (ECDC) said the patients have been geographically dispersed and not linked and the viruses were all susceptible to the other common antiviral, zanamivir (Relenza). Of the 32 cases detailed, two factors may have played a role in development of resistance: reduced immunity and preventive antiviral therapy (prophylaxis). Three cases had no known history of exposure to oseltamivir.
(CIDRAP 11/18/2009)

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WHO notes pandemic-related TB challenges
Because many H1N1 related deaths have involved people with chronic respiratory conditions, the WHO recently issued a statement to alert tuberculosis (TB) program managers to possible "challenges and synergies" in the effort to control the two diseases. The statement stresses the importance of maintaining TB treatment during a pandemic and notes that lab services developed for TB control can be useful for pandemic H1N1 diagnostics and surveillance.
(CIDRAP 11/16/2009)

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Europe/Near East
Egypt: Eighty-eighth case of human HPAI avian influenza [H5N1]
The Egyptian Ministry of Health reported the 88th case of highly pathogenic avian influenza [H5N1] in Egypt. The patient, a 21 year-old university student, reported close contact with sick poultry. This case occurred in Sedy Baher District of Alexandria Governorate.
(ProMED 11/18/2009)

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Hungary: Spike in influenza cases prompts Hungary to declare epidemic
Hungarian officials declared a flu epidemic 17 Nov 2009 after illness reports rose more than 30% in a week, putting cases above the country's epidemic threshold. The number of flu hospitalizations rose to 172. Hungary launched a pandemic vaccine campaign in October using its own vaccine, which is based on a mock-up produced for the H5N1 virus. Children younger than 18 and people in high-risk jobs receive it for free.
(CIDRAP 11/19/2009)

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Ukraine: Pandemic (H1N1) 2009 investigation results
Preliminary tests reveal no significant changes in the pandemic (H1N1) 2009 virus based on investigations of samples taken from patients in Ukraine. Analyses are being performed by two WHO influenza collaborating centers as part of the global influenza surveillance network. Preliminary genetic sequencing shows that the virus is similar to the virus used for production of the pandemic influenza vaccine, reconfirming the vaccine's efficacy at this time. Additional questions about the pandemic virus circulating in Ukraine will be answered as more data is available.

A total of 34 samples were analyzed independently by the WHO Collaborating Centre for Reference and Research on Influenza, in London, UK, and the WHO Collaborating Centre for the Surveillance, Epidemiology and Control of Influenza in Atlanta, USA.
(WHO 11/17/2009)

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Asia
China: Effectiveness of Chinese control measures debated
H1N1 cases in China have risen sharply, despite aggressive quarantine measures, according to Dr. Michael O'Leary, the World Health Organization's top official in China. He said the 70,000 cases and 53 deaths cited by the government are only "minimum numbers." But China's health minister said the control measures helped buy time to develop a vaccine, which is now being given to 1.5 million people a day in an effort to cover 90 million--7% of the population--by the end of the year.
(CIDRAP 11/19/2009)

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China: Beijing influenza research center planned
The WHO and China have agreed to open an influenza research center in Beijing to identify and share knowledge about new strains, officials announced. Approval to open the center was given when Chinese health officials met with WHO assistant director-general Keiji Fukuda. If the laboratory is designated a WHO collaborating center as planned, it would join a group of such labs in Atlanta, London, Tokyo, and Melbourne.
(CIDRAP 11/17/2009)

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North Korea: Pandemic flu detected in North Korea
In what may be the first pandemic H1N1 virus detection in North Korea, a South Korean man got sick with the flu while working across the border at an industrial complex. The man was diagnosed in South Korea, where the country's unification ministry announced the case. South Korea reported the case to North Korea and advised it to check all North Korean workers at the industrial complex.
(CIDRAP 11/16/2009)

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Russia (Moscow): Influenza and acute respiratory viral infections morbidity
Tatyana Golikova, the Minister of Health of the Russian Federation, has stated that the mortality indicators for influenza do not exceed the level of 2008. She also rejected recent news concerning three [pandemic] H1N1 related deaths in Moscow and added that the official statistics indicate that, in Russia, there have been about 4,563 cases of swine flu and 19 fatalities. Most of these deaths have been due to pneumonia as a complication of influenza.
(ProMED 11/14/2009)

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South Korea (Gangwon): Resurgence of low pathogenicity avian influenza
The resurgence of bird flu in Chuncheon, Gangwon Province is causing concerns to health authorities. A low pathogenic bird-flu virus was found in excrement of migratory birds in a reservoir in Chuncheon. Despite the low infectivity, health authorities claim they cannot rule out danger to humans or mutation and pledged to stay alert. On 10 Nov 2009, disease prevention headquarters said it will vaccinate some 40,000 fowl breeders beginning the third week of November 2009 instead of December [2009] as originally planned.
(ProMED 11/13/2009)

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Thailand: Thai official says second wave of pandemic H1N1 influenza is starting
The second round of the H1N1 epidemic has begun in Thailand, Public Health Minister Witthaya Kaewparadai said on 19 Nov 2009. He said 30% of 200 students tested in the northeastern province of Nakhon Ratchasima were infected. An estimated 8.4 million Thais were infected in the first wave of the outbreak, and the death toll reached 185 yesterday. Kaewparadai said the government purchased two million doses of vaccine from France and is considering buying 800,000 more.
(CIDRAP 11/19/2009)

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Thailand: Economy is free of H5N1 avian influenza
Thailand is now free of H5N1 avian influenza, but precautionary measures have been implemented to prevent another outbreak, Preecha Somboonprasert, director-general of the Livestock Development Department said on 16 Nov 2009. Though the northern province of Nan recently reported an outbreak of H5N1 virus, Preecha said the poultry had in fact died from inability to adapt to seasonal weather change. Authorities nationwide have been asked to closely monitor the situation, including migratory birds, the director-general said.
(ProMED 11/16/2009)

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Americas
USA: CDC campaigns for flu precautions for travelers
The US CDC launched what it called its largest-ever public awareness campaign about avoiding illness while traveling, with a focus on H1N1. The agency will urge people to stay home if they are sick, get vaccinated against seasonal flu and against H1N1 if they are in a target group, and to use hygiene measures. The campaign will continue through the holidays and involve a wide range of media, with themes such as "Prevention can be travel-sized."
(CIDRAP 11/19/2009)

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USA: House committees probe pandemic vaccine decisions
Federal officials, along with representatives from four vaccine companies, appeared before two US House of Representatives committees to answer questions about why the nation has not stretched scarce pandemic vaccine supply with adjuvants and if a more federally directed distribution system might help the vaccine get to more high-risk patients. Members of the House subcommittees on health and oversight and investigations also grilled health officials and company executives about reasons for vaccine delays and when they first became aware that shipments in October would fall dramatically below summer projections. They also expressed concerns that the nation will face similar vaccine shortfalls if another emergency strikes unless new technologies such as cell- or DNA-based production systems come online.

Representative Bart Stupak, from Michigan, asked why federal officials haven't approved an adjuvanted vaccine, especially because the United States has stockpiled adjuvant and has limited vaccine supplies. Nicole Lurie, MD, assistant secretary for preparedness and response at the US Department of Health and Human Services, responded by saying that the nation has never had an adjuvanted seasonal flu vaccine and that adding one to the pandemic vaccine might undermine public confidence in the vaccine, which is already very fragile. Some Americans have voiced worries over Guillain-Barré syndrome, the paralytic condition that ultimately derailed the nationwide swine flu vaccination campaign in 1976. In addition, concerns about thimerosal and autism remain, despite a lack of scientific evidence showing an association.
(CIDRAP 11/18/2009)

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USA: CDC airs flu guidelines for labor and delivery settings
After input from professional groups, the US CDC recently updated its guidance for managing pandemic flu in labor and delivery settings, relaxing some restrictions on keeping sick moms from their babies. Previous guidance recommended that the ill mother avoid close contact with her baby until she had been on antiviral medication for 48 hours, was fever-free, and could control coughs and secretions. They stipulated that until these conditions were met, the newborn receive care in a separate room from a healthy caregiver. The revised version recommends only a temporary separation and says newborns can stay in the mother's room in an isolette or a bassinette placed more than six feet from the sick mother and with a curtain or plexiglass barrier. The CDC said newborns can be kept in the nursery with standard precautions unless they have suspected H1N1 infection.

Babies of ill mothers who are febrile, have been on antivirals for less than 48 hours, or can't control their coughs or secretions are to be fed by healthy caregivers who encourage breast-feeding and help the mothers express milk. The CDC's subject matter experts said expressed breast milk from sick mothers is safe for babies, even if the mother is on antiviral treatment, and is not thought to contain the virus. Mothers should wear a face mask for at least seven days after symptom onset and until they have been symptom-free for 24 hours.

The CDC continues to strongly urge early antiviral treatment for pregnant women with suspected H1N1 infection, without waiting for testing or test results, and they have placed this high-risk group at the front of the line to receive the first pandemic H1N1 vaccine doses.
(CIDRAP 11/17/2009)

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USA: Most flu-stricken health workers not infected at work
Most healthcare workers who have contracted H1N1 influenza were exposed to the flu in their households and community, not in their healthcare institutions, according to testimony before the National Biodefense Science Board (NBSB). The board, chartered by the Department of Health and Human Services, was meeting to discuss mental health, healthcare strain and vaccine supply in the H1N1 pandemic, including how much personal protective equipment health workers require.
(CIDRAP 11/13/2009)

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2. 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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3. Articles
Differentiation of two distinct clusters among currently circulating influenza A(H1N1)v viruses, March-September 2009
Fereidouni SR, Beer M, Vahlenkamp T, Starick E. Euro Surveill. 19 November 2009; 14(46):pii=19409. Available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19409.

Abstract. Analysis of all complete genome sequences of the pandemic influenza A(H1N1)v virus available as of 10 September 2009 revealed that two closely related but distinct clusters were circulating in most of the affected countries at the same time. The characteristic differences are located in genes encoding the two surface proteins - haemagglutinin and neuraminidase - and four internal proteins - the polymerase PB2 subunit, nucleoprotein, matrix protein M1 and the non-structural protein NS1. Phylogenetic inference was demonstrated by neighbour joining, maximum likelihood and Bayesian trees analyses of the involved genes and by tree construction of concatenated sequences.

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Pre-existing immunity against swine-origin H1N1 influenza viruses in the general human population
Greenbauma JA, Kotturia MF, Kima Y, et al. PNAS. 16 November 2009; doi: 10.1073/pnas.0911580106. Available at http://www.pnas.org/content/early/2009/11/13/0911580106.full.pdf+html?sid=0008dd3f-c3bb-4b8d-bb41-57335204c166.

Abstract. A major concern about the ongoing swine-origin H1N1 influenza virus (S-OIV) outbreak is that the virus may be so different from seasonal H1N1 that little immune protection exists in the human population. In this study, we examined the molecular basis for pre-existing immunity against S-OIV, namely the recognition of viral immune epitopes by T cells or B cells/antibodies that have been previously primed by circulating influenza strains. Using data from the Immune Epitope Database, we found that only 31% (8/26) of B-cell epitopes present in recently circulating H1N1 strains are conserved in the S-OIV, with only 17% (1/6) conserved in the hemagglutinin (HA) and neuraminidase (NA) surface proteins. In contrast, 69% (54/78) of the epitopes recognized by CD8_ T cells are completely invariant. We further demonstrate experimentally that some memory T-cell immunity against S-OIV is present in the adult population and that such memory is of similar magnitude as the pre-existing memory against seasonal H1N1 influenza. Because protection from infection is antibody mediated, a new vaccine based on the specific S-OIV HA and NA proteins is likely to be required to prevent infection. However, T cells are known to blunt disease severity. Therefore, the conservation of a large fraction of T-cell epitopes suggests that the severity of an S-OIV infection, as far as it is determined by susceptibility of the virus to immune attack, would not differ much from that of seasonal flu. These results are consistent with reports about disease incidence, severity, and mortality rates associated with human S-OIV.

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Hospitalised adult patients with pandemic (H1N1) 2009 influenza in Melbourne, Australia
Denholm JT, Gordon CL, Johnson PD, et al. MJA. 16 November 2009. Available at http://www.mja.com.au/public/issues/192_02_180110/den10902_fm.pdf.

Objective. To describe the case characteristics and outcomes of patients hospitalised with pandemic (H1N1) 2009 influenza infection during the first two months of the epidemic.

Design, participants and setting. Prospective case series of 112 patients admitted to seven hospitals in Melbourne with laboratory-confirmed pandemic (H1N1) 2009 influenza between 1 May and 17 July 2009.

Main outcome measures. Details of case characteristics, risk factors for severe disease, treatment and clinical course.

Results. Of 112 hospitalised patients, most presented with cough (88%) and/or fever (82%), but several (4%) had neither symptom. A quarter of female patients (15) were pregnant or in the post-partum period. Patients presenting with multifocal changes on chest x-ray had significantly longer hospital lengths of stay, and were more likely to require intensive care unit admission. Thirty patients required admission to an intensive care unit, and three died during their acute illness. The median length of intensive care admission was 10.5 days (interquartile range, 5-16 days).

Conclusions. This study highlights risk factors for severe disease, particularly pregnancy. Clinical and public health planning for upcoming influenza seasons should take into account the spectrum and severity of clinical infection demonstrated in this report, and the need to concentrate resources effectively in high-risk patient groups.

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Measures against transmission of pandemic H1N1 influenza in Japan in 2009: simulation model
Yasuda1 H, Suzuki K. Euro Surveill. 05 November 2009; 14(44):pii=19385. Available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19385.

Abstract. The first outbreak of pandemic H1N1 influenza in Japan was contained in the Kansai region in May 2009 by social distancing measures. Modelling methods are needed to estimate the validity of these measures before their implementation on a large scale. We estimated the transmission coefficient from outbreaks of pandemic H1N1 influenza among school children in Japan in summer 2009; using this transmission coefficient, we simulated the spread of pandemic H1N1 influenza in a virtual community called the virtual Chuo Line which models an area to the west of metropolitan Tokyo. Measures evaluated in our simulation included: isolation at home, school closure, post-exposure prophylaxis and mass vaccinations of school children. We showed that post-exposure prophylaxis combined with isolation at home and school closure significantly decreases the total number of cases in the community and can mitigate the spread of pandemic H1N1 influenza, even when there is a delay in the availability of vaccine.

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Rhinoviruses, A(H1N1)v, RVS: The race for hivernal pandemics, France 2009-2010
Casalegno JS, Bouscambert-Duchamp M, Morfin F, et al. Euro Surveill. 05 November 2009; 14(44):pii=19390. Available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19390.

To the editor: The A(H1N1)v circulation in France, like in other European countries (Sweden), is still reported as sporadic. The incidence of A(H1N1)v infections monitored in the community by the French National Influenza Centre has remained stable for six weeks from week 37 to week 42 (159 cases per 100,000 inhabitants). This is right above the epidemic cut-off of 114 cases per 100,000 inhabitants two months after the start of the new school year. This delay in the A(H1N1)v outbreak expansion is puzzling. At the same time, we report a high rhinovirus activity (34.5 % of samples positive for rhinovirus) in the community and in the hospital (unpublished data).

It has been postulated by A. Linde et al. that the viral interaction between the A(H1N1)v and the rhinoviruses may explain partly this delay. This is an interesting hypothesis, indeed it is well known that during winter, rhinovirus, respiratory syncytial virus (RSV) and influenza viruses epidemic peaks happen one after the other and occasionally overlap. The seasonal epidemiology of influenza is surely dependent on weather conditions such as low relative humidity and cold temperature. These features were observed in our laboratory last winter.

Indeed, during the 2008-2009 winter, our laboratory analysed samples from the paediatric hospital of Lyon. The laboratory diagnosis was based on cellular culture for RSV and influenza viruses detection and on specific RT-PCR technique for the influenza and the rhinoviruses detection. Between week 31 of 2008 and week 9 of 2009, 6516 respiratory samples (nasal swabs or nasopharyngeal aspirates) were analysed (culture and PCR) in our laboratory. The number of confirmed rhinoviruses, RSV and Influenza A viruses is reported week by week in the Figure.

This year, rhinovirus detection started on week 37, peaked on week 40 and decreased on week 43. At that moment, we can report the first detection of RSV and an increasing activity of A(H1N1)v. Regarding what was observed during last winter on the circulation of rhinovirus, RSV and A(H3N2) virus, it will be of much interest to follow the impact of the A(H1N1)v pandemic on the coming RSV peak. In other words, which respiratory virus between RSV or A(H1N1)v, will win the race for second place?

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4. Notifications
WHO interim planning considerations for mass gatherings in the context of pandemic (H1N1) 2009 influenza
Planners of mass gatherings face special challenges during a global influenza pandemic. The purpose of this document is to outline key planning considerations for organizers of mass gatherings in the context of pandemic (H1N1) 2009 influenza. It should be used in conjunction with WHO's Communicable disease alert and response for mass gatherings.
Available at http://www.who.int/csr/resources/publications/swineflu/cp002_2009-0511_planning_considerations_for_mass_gatherings.pdf.

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Northwest Center for Public Health Practice Hot Topics Preparedness forum
Noon-1:00 pm (PST), Dec 15, 2009

A live web seminar entitled "Pandemic Influenza H1N1 - How Prepared Were We?" will be given by Jeffrey Duchin, MD, FACP, FIDSA, Chief, Communicable Disease Epidemiology & Immunization Section, Public Health - Seattle & King County. Computer connections to the event are limited, so we encourage you to login as a group in a meeting room.
Registration information available at http://www.nwcphp.org/htip.

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EPIDEMICS˛: 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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Updated influenza guidance and information from the US CDC
Updated Guidance for the Use of CSL 2009 H1N1 Monovalent Vaccine
Released 19 November2009
Available at http://www.cdc.gov/H1N1flu/vaccination/csl_guidance.html.

FDA Questions and Answers for Health Care Providers: Renal Dosing and Administration Recommendations for Peramivir IV
Released 13 November 2009
Available at http://www.cdc.gov/h1n1flu/eua/peramivir.htm.

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 apecein@u.washington.edu