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EINet Alert ~ Dec 04, 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
- Global: Repeated anaphylactic reactions to influenza vaccines may be due to antibiotics
- Global: Promising results reported for VLP H1N1 vaccine
- Global: WHO investigates oseltamivir-resistant influenza clusters
- Global: WHO clears Glaxo H1N1 vaccine for developing countries
- Italy: Oseltamivir resistant pandemic H1N1 influenza virus found
- Australia: Seasonal vaccine delayed by H1N1
- China: Increase in pandemic H1N1 related deaths
- China: Pandemic H1N1 found in dogs
- Indonesia: Duck farmer suspected of contracting H5N1 avian influenza
- Japan: Abnormal behavior possibly related to influenza infection
- Vietnam (Dien Bien): H5N1 avian influenza death reported
- Canada: H1N1 taking toll on much younger group than seasonal flu
- Canada: Decision to be made regarding excess pandemic H1N1 vaccine
- USA (New Mexico): Native Americans at higher risk of pandemic H1N1 related death
- USA (Alaska): Alaska Natives have highest rates of hospitalization for pandemic H1N1 infection
- USA: Approval of second Novartis seasonal influenza vaccine
- USA: CDC sees opportunity as flu wanes, vaccine supply grows
- USA: US CDC estimates pandemic H1N1 case-fatality rate at 0.018%

2. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA

3. Articles
- A Serine12Stop mutation in PB1-F2 of the 2009 pandemic (H1N1) influenza A: a possible reason for its enhanced transmission and pathogenicity to humans
- Influenza Morbidity and Mortality in Elderly Patients Receiving Statins: A Cohort Study
- Viral load in patients infected with pandemic H1N1 2009 influenza A virus

4. Notifications
- HealthMap "Outbreaks Near Me" Android App
- Northwest Center for Public Health Practice Hot Topics Preparedness forum
- 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/ 38 (4)
Viet Nam/ 5 (5)
Total/ 50 (13)

***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: 444 (262)
(WHO 11/27/09 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_11_27/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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WHO situation update on pandemic influenza H1N1
As of 22 November 2009, worldwide more than 207 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 7820 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 the United States and Canada, influenza transmission remains very active and geographically widespread. In the United States, disease activity appears to have peaked in all areas of the country. In Canada, influenza activity remains similar but number of hospitalizations and deaths is increasing. Most countries in the Caribbean have ILI and SARI levels coming down.

In Europe, widespread and increasing transmission of pandemic influenza virus was observed across much of the continent and most countries that were not yet experiencing elevated ILI activity in the last few weeks, have seen a rapid increase in ILI. Very high activity is seen in Sweden, Norway, Moldova and Italy. Over 99% of subtyped influenza A viruses in Europe were pandemic H1N1 2009. Impact on health care services is severe in Albania and Moldova. Some countries seem to have peaked already: Belgium, Bulgaria, Belarus, Ireland, Luxemburg, Norway, Serbia, Ukraine and Iceland.

In East Asia, influenza transmission remains active. Intense influenza activity continues to be observed in Mongolia but has peaked already. In Japan, influenza activity remains stably elevated, but may be decreasing slightly in populated urban areas.

ILI activity in India and Nepal and Sri Lanka has increased.

In the tropical zone of the Americas and Asia, influenza transmission remains variable but low in many countries. In the tropical areas of Central and South America, most countries continue to report declining influenza activity, with the exception of Ecuador and Venezuela.

In the temperate region of the southern hemisphere, little pandemic influenza activity has been reported.
(WHO 11/27/2009)

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Global: Repeated anaphylactic reactions to influenza vaccines may be due to antibiotics
In general influenza vaccines, including the pandemic (H1N1) 2009 virus vaccine, are cultured in eggs, and in very rare cases there may be an anaphylactic reaction to egg protein. A portion of the people who have repeated anaphylactic reactions to influenza vaccines may be reacting to antibiotics, which are sometimes used to suppress bacterial growth in the culture, rather than reacting to the egg protein. Many, but not all, data sheets for influenza vaccines list the antibiotic as an ingredient. For those with severe allergy to tetracycline and penicillin, an influenza vaccination can be a very risky affair.
(ProMED 12/03/2009)

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Global: Promising results reported for VLP H1N1 vaccine
Novavax Inc. reported good initial results in the first stage of a phase 2 trial of its virus-like-particle (VLP) vaccine for pandemic H1N1 flu. One thousand healthy adults received two doses of 5, 15, or 45 micrograms. A review of findings in 500 participants 14 days after the first dose showed that the vaccine was well tolerated and that antibody responses to the two higher doses met the criteria of regulatory agencies. Novavax plans to pursue registration of the vaccine in Mexico.
(CIDRAP 12/02/2009)

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Global: WHO investigates oseltamivir-resistant influenza clusters
WHO has been informed of two recent clusters of patients infected with oseltamivir-resistant H1N1 viruses. Both clusters, detected in Wales, UK and North Carolina, USA, occurred in a single ward in a hospital, and both involved patients whose immune systems were severely compromised or suppressed. Transmission of resistant virus from one patient to another is suspected in both outbreaks.

The outbreaks are being further investigated to determine the mode of transmission within the wards and to ensure that resistant viruses have not spread to staff, other patients in the hospitals, or into the wider community. Results to date are reassuring. No illness in staff caring for these patients has been detected, suggesting that the resistant virus does not spread easily to otherwise healthy people, especially when good measures for infection control are in place. Moreover, intensified surveillance has found no spread to other wards within the two hospitals or into the wider community.

Modified treatment recommendations
The experts agreed that severely immunocompromised patients need to be regarded as an especially vulnerable group. These patients are highly susceptible to infection, particularly difficult to treat, and especially likely to develop resistance. As early signs of influenza may be masked by symptoms associated with underlying disorders or their treatment, the experts further agreed that doctors treating such patients should operate with a high level of suspicion for influenza virus infection and be especially vigilant for the rapid development of oseltamivir resistance.

In these patients, standard treatment doses and duration for treatment with oseltamivir are unlikely to be sufficient. Though clinical judgment is important, doses may need to be increased and continued, without interruption, for the duration of acute illness. Zanamivir should be considered as the treatment of choice for patients who develop prolonged influenza illness despite treatment with oseltamivir. In addition, once oseltamivir resistant virus has been detected in a ward treating severely immunocompromised patients, doctors should consider switching to zanamivir as the antiviral drug of first choice for treatment and when considering post exposure prophylactic treatment of other patients on the ward.

The experts were emphatic in their recommendation that health care staff, carers and family contacts of patients be vaccinated against pandemic influenza.

Vigilant monitoring needed
WHO recommends vigilant monitoring for the development of oseltamivir-resistant viruses and for any changes in the transmissibility or pathogenicity of these viruses. Experience with seasonal influenza viruses shows that resistant viruses can quickly spread within the general population and become established, rendering one or more antiviral drugs ineffective.

Within the past two weeks, the number of documented cases of oseltamivir resistance in H1N1 viruses has risen from 57 to 96. Around one third of these cases occurred in patients whose immune systems were severely suppressed by hematological malignancy, aggressive chemotherapy for cancer, or post-transplant treatment. The clusters in the two hospital wards should be viewed in the context of these overall trends. Although all incidents of oseltamivir resistance merit investigation, no evidence suggests that events to date constitute a public health threat.
(WHO 12/02/2009)

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Global: WHO clears Glaxo H1N1 vaccine for developing countries
GlaxoSmithKline announced that the WHO has prequalified its adjuvanted pandemic H1N1 vaccine made in Canada, a key step that will allow it to be distributed to developing countries. Prequalification signifies that the vaccine meets quality and safety standards. Glaxo's pandemic vaccine is the first to get the WHO endorsement. In November Glaxo promised to donate 50 million doses to the WHO.
(CIDRAP 12/01/2009)

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Europe/Near East
Italy: Oseltamivir resistant pandemic H1N1 influenza virus found
On 18 Nov 2009, the first case of oseltamivir resistant influenza A (H1N1) 2009 virus in Italy was reported by the Virology Unit of Policlinico San Matteo in Pavia, one of the laboratories belonging to the National Influenza Centre Italian virological network. The resistant virus strain was identified in the nasal swab of a 2-year-old female, hospitalized for acute lymphoblastic leukemia at the Pediatric Oncohematology Unit of the same Hospital.
(ProMED 11/03/2009)

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Asia
Australia: Seasonal vaccine delayed by H1N1
Production of pandemic H1N1 vaccine may delay the arrival of Australia's seasonal flu vaccine by about three weeks, according to a spokeswoman from CSL Ltd, which makes most of the vaccine for the Australian market. The company expects the seasonal flu vaccine, which will contain the pandemic strain, to arrive in April instead of March. CSL is one of the companies making pandemic vaccine for the United States and is the only vaccine producer in the Southern Hemisphere.
(CIDRAP 12/01/2009)

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China: Increase in pandemic H1N1 related deaths
The Chinese mainland saw an increase in deaths from pandemic 2009 A/H1N1 influenza in recent weeks. A total of 74 deaths were reported during 23-29 Nov 2009, according to a notice on the Ministry of Health's website on 2 Dec 2009. Reported deaths in the previous two weeks were 28 and 51, respectively.

As of 30 Nov 2009, more than 27 million people nationwide had been inoculated with Chinese produced A/H1N1 vaccine. Four deaths had been reported after vaccination. Three of these have been confirmed as unrelated to the vaccine, while the cause of the other is not yet clear, the Ministry said.
(ProMED 12/03/2009)

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China: Pandemic H1N1 found in dogs
China's Ministry of Agriculture has called for intensified monitoring and investigation of A/H1N1 flu in animals after two samples from sick dogs were tested positive for the virus. The veterinary clinic of College of Veterinary Medicine at the China Agricultural University reported on 25 Nov 2009 that two out of 52 samples from sick dogs were tested positive for A/H1N1 flu virus. Analysis of genetic composition found the virus detected in the samples and those found on human A/H1N1 flu cases were 99 percent homologous, it said. The ministry urged local authorities to further enhance prevention and control, intensify monitoring and investigation in animal cases of A/H1N1 flu, and closely watch the virus mutation situation in animals.
(ProMED 11/28/2009)

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Indonesia: Duck farmer suspected of contracting H5N1 avian influenza
A 37-year old duck farmer from Tanjuang Durian, suspected to have contracted A/(H5N1) avian influenza virus, has been admitted to a hospital. The farmer reportedly buried his ducks after nearly all of them died suddenly. He developed high fever at noon the same day and consumed an antipyretic drug. His fever increased during the afternoon and his family took him to Pasa Baru Public Health Center. The Public Health Center then referred the patient to a local hospital, where he was diagnosed as a suspected avian influenza case.
(ProMED 11/30/2009)

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Japan: Abnormal behavior possibly related to influenza infection
The Health Ministry has reported that 151 flu patients up to age 17 demonstrated abnormal behavior between late September and mid-November 2009, including acting violently or uttering gibberish. Most of the cases are believed to have involved patients with pandemic H1N1 2009 influenza virus infection. The strange behavior is thought to have occurred regardless of whether the patients were given Tamiflu, according to one report submitted to a research group at the Ministry of Health, Labor and Welfare.

The number of cases, coming in a period of less than two months, is already close to the total of 179 seen in all of last 2008's seasonal flu season. A Ministry official said cases this year have been on the rise in line with the spread of the new pandemic H1N1 flu, and young patients should be watched carefully for at least two days after developing a fever.

Of the 151 patients, it is known that Tamiflu was used in 26 cases, Relenza in 36, and neither of them in 16. Tamiflu has been banned for use among teenagers out of fear it may cause abnormal behavior, though it can still be used in some situations.
(ProMED 12/03/2009)

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Vietnam (Dien Bien): H5N1 avian influenza death reported
A 23-year-old man from the northern province of Dien Bien died from H5N1 avian influenza on 28 Nov 2009, a health official said. His death brings the nationwide death toll to five since the beginning of 2009, announced the chief of the Preventive Medicine and Environment Department, Nguyen Huy Nga on 30 Nov 2009.

The man experienced symptoms of high fever, cough, and breathing problems on 18 Nov 2009. The victim's condition did not improve and was taken to the province's General Hospital with serious lung damage eight days later. Doctors' efforts to save him were futile and he died two days later. Tests results from the Institute of Hygiene and Epidemiology have confirmed he was infected with H5N1 avian influenza virus.
(ProMED 12/01/2009)

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Americas
Canada: H1N1 taking toll on much younger group than seasonal flu
Details of hospitalized and fatal cases of H1N1 demonstrate how different this influenza virus is from seasonal influenza, said the head of the Public Health of Canada. Dr. David Butler-Jones said that where seasonal flu mainly kills the elderly, the pandemic virus is taking its worst toll on those far down the age spectrum. "Those most seriously affected by H1N1 are 23 to 45 years younger than what we see with seasonal flu," Butler-Jones said.
(ProMED 12/03/2009)

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Canada: Decision to be made regarding excess pandemic H1N1 vaccine
The federal government will make a decision in the next couple of weeks about what to do with up to 30 million unused doses of H1N1 vaccine. The admission came on 28 November 2009, after Health Minister Leona Aglukkaq revealed the Public Health Agency of Canada will provide 5.7 million doses of pandemic vaccine to the provinces next week [29 November - 05 December 2009]. When that shipment is in place, more than 21.5 million doses of vaccine will have been made available across the country. This is considerably more than the number of Canadians who have indicated a willingness to be immunized up until now.

Canada ordered 50.4 million doses of H1N1 vaccine, enough to give 75 percent of Canadians two doses apiece if two were required for protection. Studies completed after the order was placed revealed that one dose is sufficient to protect all but the youngest of children. Some of this excess vaccine could be donated to the WHO to help supply vaccine to developing countries. At one point, however, Chief Public Health Officer Dr. David Butler-Jones said the Public Health Agency would talk with manufacturer GlaxoSmithKline about turning back unneeded vaccine so the company could start filling orders from other countries sooner.
(Canadian Press 11/27/2009)

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USA (New Mexico): Native Americans at higher risk of pandemic H1N1 related death
Pandemic (H1N1) 2009 influenza virus infection is killing Native Americans in New Mexico at a higher rate than other ethnic groups, and a top state Department of Health official says chronic disease and the distance many Native Americans have to travel to medical care could be part of the reason.

Native Americans make up 10 percent of New Mexico's population but 20 percent of the state's pandemic H1N1 influenza deaths. Mike Landen, deputy state epidemiologist, said a number of factors may explain the incongruity. "We know American Indians have higher rates of diabetes in New Mexico, and that may partly contribute to what we're seeing," he said. "We also know American Indians have higher poverty rates as a group than other population groups. We also know that in the West, American Indians may be living in relatively remote places with longer distances to medical care. All of these may be possible explanations."

New Mexico health officials plan to target Native Americans in the state with school-based vaccination clinics once the state accumulates enough vaccine for such clinics, Landen said. The Health Department has ordered 334,860 doses, which have been arriving in small amounts and are being distributed to public health offices statewide.
(ProMED 12/03/2009)

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USA (Alaska): Alaska Natives have highest rates of hospitalization for pandemic H1N1 infection
A review by state officials of people hospitalized with pandemic flu in Anchorage, Alaska, between Sep 1 and Oct 21, 2009 found that rates were highest in Alaska Natives and American Indians, followed by Asians and Pacific Islanders, the Anchorage Daily News reported. Most hospitalized patients had underlying conditions. The state epidemiologist said past studies have shown Alaska Natives have the highest rates of respiratory illnesses.
(CIDRAP 11/30/2009)

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USA: Approval of second Novartis seasonal influenza vaccine
A second seasonal influenza vaccine made by Novartis was approved recently by the US Food and Drug Administration (FDA), and the company said some doses may reach the market this flu season. The FDA on 27 Nov 2009 announced its approval of the injectable vaccine, called AgriFlu, for use in patients age 18 and older. It is made in Siena, Italy, and comes in single-dose, pre-filled syringes with no preservative, the agency said. The vaccine is not intended to provide protection against the pandemic H1N1 virus.

More than 97 million doses of the vaccine have been distributed in other countries over the past 20 years, including some in Europe, where the vaccine goes by the name Agrippal. A company spokesman said the vaccine was tested only in adults in connection with the application for US licensing, but a development program for children and adolescents is under way. The European version of the vaccine is used in children from the age of six months, he reported.
(CIDRAP 12/02/2009)

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USA: CDC sees opportunity as flu wanes, vaccine supply grows
Decreasing pandemic flu activity and growing supplies of vaccine offer a window of opportunity for people to protect themselves from the virus, especially if the nation experiences a third wave of infections, Thomas Frieden, director of the US CDC said 01 Dec 2009. At a press briefing Frieden said the number of pandemic vaccine doses available to states for ordering has grown to about 70 million, nearly nine million more than the CDC's last vaccine supply report on 25 Nov 2009.
(CIDRAP 12/01/2009)

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USA: US CDC estimates pandemic H1N1 case-fatality rate at 0.018%
The estimated case-fatality rate (CFR) for pandemic H1N1 flu so far is 0.018%-about 100-fold lower than the 2% CFR in the pandemic of 1918-19, Dr. Martin Cetron of the US CDC said. Cetron, director of the CDC Division of Global Migration and Quarantine, gave the estimate in a webcast, presented by Public Health Reports, on lessons of the 1918 pandemic.
(CIDRAP 11/30/2009)

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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
A Serine12Stop mutation in PB1-F2 of the 2009 pandemic (H1N1) influenza A: a possible reason for its enhanced transmission and pathogenicity to humans
Ramakrishnan MA, Gramer MR, Goyal SM, et al. J Vet Sci. Dec 2009;10(4):349-51.
Available at http://www.vetsci.org/2009/pdf/349.pdf.

Abstract. As the scientific community scrambles to define the ancestry and lineages of the eight segments of new pandemic H1N1 strain, we looked for unique genetic events in this virus's genome to explain the newly found enhanced virulence and transmissibility among humans. Genome annotations of this virus identified a stop mutation replacing serine at codon 12 (S12Stop) of the PB1-F2 protein, a virulence factor in influenza A viruses. Here, we discuss the significance of this finding and how it may contribute to host specialization, explaining the virtual absence of the H1N1 influenza A virus strain in pig populations. This finding is expected to lead to a better understanding of the transmission and pathogenesis of the 2009 pandemic strain.

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Influenza Morbidity and Mortality in Elderly Patients Receiving Statins: A Cohort Study
Kwong JC, Li P, Redelmeier DA. PLoS ONE. 30 November 2009; 4(11): e8087. doi:10.1371/journal.pone.0008087
Available at http://www.plosone.org/article/info:doi/10.1371/journal.pone.0008087

Background. Statins possess immunomodulatory properties and have been proposed for reducing morbidity during an influenza pandemic. We sought to evaluate the effect of statins on hospitalizations and deaths related to seasonal influenza outbreaks.

Methodology/Principal Findings. We conducted a population-based cohort study over 10 influenza seasons (1996 to 2006) using linked administrative databases in Ontario, Canada. We identified all adults older than 65 years who had received an influenza vaccination prior to the start of influenza season and distinguished those also prescribed statins (23%) from those not also prescribed statins (77%). Propensity-based matching, which accounted for each individual's likelihood of receiving a statin, yielded a final cohort of 2,240,638 patients, exactly half of whom received statins. Statins were associated with small protective effects against pneumonia hospitalization (odds ratio [OR] 0.92; 95% CI 0.89-0.95), 30-day pneumonia mortality (0.84; 95% CI 0.77-0.91), and all-cause mortality (0.87; 95% CI 0.84-0.89). These protective effects attenuated substantially after multivariate adjustment and when we excluded multiple observations for each individual, declined over time, differed across propensity score quintiles and risk groups, and were unchanged during post-influenza season periods. The main limitations of this study were the observational study design, the non-specific outcomes, and the lack of information on medications while hospitalized.

Conclusions/Significance. Statin use is associated with a statistically significant but minimal protective effect against influenza morbidity that can easily be attributed to residual confounding. Public health officials and clinicians should focus on other measures to reduce morbidity and mortality from the next influenza pandemic.

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Viral load in patients infected with pandemic H1N1 2009 influenza A virus
To KK, Chan KH, Li IW, et al. J Med Virol. 30 Nov 2009;82(1):1-7.
Available at http://www3.interscience.wiley.com/journal/123194646/abstract?CRETRY=1&SRETRY=0.

Abstract. Viral shedding profile of infections caused by the pandemic H1N1 2009 influenza A virus has not been reported. The aim of this study was to determine the viral load in different body sites. Viral loads of pandemic H1N1 virus in respiratory specimens, stool, urine, and serum were determined by quantitative reverse transcriptase-polymerase chain reaction (RT-PCR). Respiratory specimens from patients with seasonal influenza were used as historical controls. Initial pre-treatment viral load were compared between these two groups. Serial respiratory specimens from patients with pandemic H1N1 virus infection were obtained for analysis of viral dynamics. Twenty-two pandemic H1N1 cases and 44 seasonal influenza historical controls were included. The mean initial viral load before oseltamivir therapy was 1.84 x 10(8) copies/ml for pandemic H1N1 virus compared with 3.28 x 10(8) copies/ml in seasonal influenza historical controls (P = 0.085). Among patients with pandemic H1N1 virus infection, peak viral load occurred on the day of onset of symptoms, and declined gradually afterwards, with no virus being detectable in respiratory specimens by RT-PCR 8 days and by culture 5 days after the onset of symptoms respectively, except in one patient. Pandemic H1N1 virus was detected in stool and in urine from 4/9 and 1/14 patients, respectively. Viral culture was also positive from the stool sample with the highest viral load. Younger age was associated with prolonged shedding in the respiratory tract and higher viral load in the stool. Data from this quantitative analysis of viral shedding may have implications for formulating infection control measures.

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4. Notifications
HealthMap "Outbreaks Near Me" Android App
"Outbreaks Near Me," an up-to-the-minute disease-tracking system released as an iPhone application in September, is now available free of charge for use on Android mobile phones. It utilizes GPS technology to show health alerts and ongoing outbreak news in the vicinity of the user. The application also allows users to submit disease reports, and to search for outbreaks in specific locations worldwide. These reports are screened and will be used to alert ProMED moderators about new disease events.
For more information and screenshots see: http://www.healthmap.org/outbreaksnearme/#droid.

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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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14th International Congress on Infectious Diseases (ICID)
Miami, Florida, Mar 9-12, 2010
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://www.colloquium.eu/site/IMG/pdf/ISHEID10_preliminaire.pdf

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
Update: H1N1 Flu (Swine Flu): Preparedness Tools for Professionals
Released 03 December 2009
Available at http://www.cdc.gov/h1n1flu/tools/.

2009 H1N1 Information for Parents who have Children with High-Risk Medical Conditions
Released 03 December 2009
Available at http://www2c.cdc.gov/podcasts/player.asp?f=393367.

Alert: Fraudulent emails referencing CDC-sponsored State Vaccination Program
Released 01 December 2009
Available at http://www.cdc.gov/hoaxes_rumors.html.

Preparing for the Flu: Communication Toolkit for Schools (Grades K-12)
Released 01 December 2009
Available at http://www.cdc.gov/h1n1flu/schools/toolkit/.

Update: Interim Guidance for Management of Influenza-Like Illness aboard Commercial Aircraft during the 2009-10 Influenza Season
Released 30 November 2009
Available at http://www.cdc.gov/h1n1flu/guidance/air-crew-dom-intl.htm.

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 apecein@u.washington.edu