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Vol. XII, No. 25 ~ EINet News Briefs ~ Dec 11, 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
- Germany: States request sell off of excess vaccine
- Italy (Lombardy): Outbreak of pandemic A/H1N1 virus among swine
- UK: Sixth case of pandemic H1N1 among swine
- China: WHO finds no vaccine link in three Chinese deaths
- China: Pandemic H1N1 influenza outbreaks hit army
- China (Shanghai): Blood donations solicited from vaccinated citizens
- North Korea: North Korea to accept antivirals from South
- Viet Nam: Cluster of seven oseltamivir-resistant infections found
- Canada (Ontario): Some pandemic H1N1 patients hospitalized for three months
- USA: Autopsies show damage to entire airway
- Kenya & Togo: First African nations to receive pandemic H1N1 vaccine
2. Infectious Disease News
- WHO reports good news in global TB battle
- Australia: Aedes albopictus found in Queensland
- Malaysia: Chikungunya cases drop 14 percent
- Philippines (Isabela): Anthrax hospitalizes 50 villagers
- USA: 198 cases of prion disease in 2009
- USA: Norovirus illnesses linked to oysters
- INFLUENZA A/H1N1
- AVIAN INFLUENZA
- CHOLERA, DIARRHEA, and DYSENTARY
- Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study
- Prolonged shedding of influenza A(H1N1)v virus: two case reports from France 2009
- Persistent Infection with West Nile Virus Years after Initial Infection
- Clinical Features of the Initial Cases of 2009 Pandemic Influenza A (H1N1) Virus Infection in China
- The Severity of Pandemic H1N1 Influenza in the United States, from April to July 2009: A Bayesian Analysis
- Vaccination with ALVAC and AIDSVAX to Prevent HIV-1 Infection in Thailand
- Post-exposure prophylaxis during pandemic outbreaks
- Northwest Center for Public Health Practice Hot Topics Preparedness forum
- International Symposium on Neglected Influenza Viruses
- 14th International Congress on Infectious Diseases (ICID)
- ISHEID Symposium on HIV and Emerging Infectious Diseases
- CDC 7th International Conference on Emerging Infectious Diseases
- Options for the Control of Influenza VII
- Promising Practices adds tools for H1N1 response
- Updated influenza guidance and information from the US CDC
1. Influenza News
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
WHO situation update on pandemic influenza H1N1
As of 29 November 2009, worldwide more than 207 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 8,768 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 both Canada and the United States, influenza virus circulation remains active and geographically widespread, however, disease activity appears to have peaked in past three to four weeks. In the United States, deaths due to pneumonia and influenza (P&I mortality) continued to increase past the epidemic threshold for the past eight weeks and cumulative rates of hospitalizations for the current influenza season have exceeded rates seen in recent seasons among all age groups except those aged 65 or older.
In Europe, widespread and intense transmission of pandemic influenza virus continued to be observed across most of the continent. In western and northern Europe the peak of disease activity has passed in Belgium, Iceland, Ireland, Netherlands, Norway, Northern Ireland, and Wales; activity may be peaking or plateauing in Spain, Portugal, Italy, Sweden and Denmark. Influenza activity continues to increase in much of Central Europe and from Germany to Romania. In Eastern Europe, recent peaks or plateaus in disease activity have also been observed in Ukraine, Belarus, Bulgaria and the Republic of Moldova. In the Russian Federation, influenza activity remains active and intense in some regions, with an overall increasing trend. A moderate impact on the healthcare system has been reported in parts of Northern and Eastern Europe. Over 99% of subtyped influenza A viruses in Europe were pandemic H1N1 2009.
In Western and Central Asia, influenza transmission remains active. Disease activity continues to increase in Kazakhstan, Kyrgyzstan, Uzbekistan, Iran and Iraq, while activity may have peaked in Israel, Jordan, and Afghanistan.
In East Asia, increasing ILI or respiratory disease activity has been reported in Southern China and Japan. A recent decline in activity has been observed in Northern China. In South and Southeast Asia, influenza activity continues to increase in the north-western parts of India, Nepal, Sri Lanka, and Cambodia, while activity in the rest of region remains low.
In the tropical zone of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining except for focal areas of increasing activity in Jamaica, Venezuela, and Ecuador.
In Africa, pandemic H1N1 2009 virus continues to be isolated from all parts of the continent, and there is evidence of continued co-circulation of pandemic (H1N1) 2009 and seasonal H3N2 viruses. In the temperate region of the southern hemisphere, little pandemic influenza activity has been reported.
Germany: States request sell off of excess vaccine
Germany's health minister said 07 December 2009 that states have asked the federal government to sell 2.2 million doses of H1N1 vaccine to other nations. Another possibility would be to donate the vaccine, which is available because of low demand. The country has ordered 20 million doses to arrive by the end of December and 50 million by the end of March. So far about four million Germans, or five percent of the population, have received the vaccine.
Italy (Lombardy): Outbreak of pandemic A/H1N1 virus among swine
There was an outbreak of pandemic H1N1 virus among swine in northern Italy from 23 November to 4 December 2009. Of 1,250 susceptible swine, there were 375 cases of influenza, giving an apparent morbidity rate of 30%. There were not associated deaths and all sows recovered fully within a few days.
UK: Sixth case of pandemic H1N1 among swine
On 2 December 2009 a sixth case of pandemic H1N1 2009 influenza virus in pigs was confirmed in the UK. Routine scanning surveillance has confirmed that the strain of the virus found is virtually identical to strains currently circulating in humans.
China: WHO finds no vaccine link in three Chinese deaths
The WHO office in China said three of four deaths of patients from the mainland who received the pandemic vaccine were not related to immunization. The WHO said the fourth case is still under investigation. A WHO spokeswoman said the findings show that the vaccine surveillance system is working. Hong Kong plans to start its vaccine campaign for high-risk groups on Dec 21, 2009, using a different vaccine from the one used on the mainland.
China: Pandemic H1N1 influenza outbreaks hit army
China's defense ministry said it has totaled 51 large pandemic H1N1 outbreaks among army soldiers. The report didn't list the number of cases. A health official with the Chinese Army said outbreaks involving hundreds of soldiers are difficult to manage. On Dec 2, 2009, the Army held a influenza drill in Beijing.
China (Shanghai): Blood donations solicited from vaccinated citizens
Shanghai health authorities have launched their latest drive in the fight against influenza pandemic (H1N1) 2009 virus infection, calling on people who have been vaccinated against the virus to donate blood for emergency-treatment storage. First in the queue will be 34 inoculated medical staff at the Shanghai Public Health Clinical Center.
Since antibodies are produced two weeks after vaccination, blood from vaccinated donors can be used to treat patients seriously affected by pandemic H1N1 virus. "Using serum from vaccinated staff to treat serious cases is mentioned in a treatment guide issued by the Ministry of Health," said Dr Lu Hongzhou, a member of city's expert panel on pandemic H1N1 influenza treatment -- and one of the 34 expected donors.
"The technology is safe and we have used it on our patients with good results," Lu said. Since carrying out vaccinations on the most at-risk groups of the population, such as medical staff, public servants and students and teachers at schools, Shanghai has inoculated more than 800,000 people. A total of 2.1 million people will be included in the vaccination plan, which has been expanded to include university students and people aged 60 and over with local residency.
By 30 November 2009, Shanghai had reported 2,074 incidents of pandemic influenza, including 26 serious cases, since the first one was detected in May 2009.
North Korea: North Korea to accept antivirals from South
A South Korean cabinet minister said 10 December 2009 that North Korea has agreed to accept aid in the form of oseltamivir to fight an H1N1 outbreak. North Korean state media reported 09 December 2009 that the country had nine H1N1 cases. A spokesman for the South Korean minister said Seoul would send enough oseltamivir to treat 500,000 people. South Korea's oseltamivir offer was its first offer of humanitarian aid since President Lee Myung-bak took office in early 2008.
Viet Nam: Cluster of seven oseltamivir-resistant infections found
Physicians from Vietnam, writing in the New England Journal of Medicine, reported a cluster of seven cases of oseltamivir-resistant H1N1 infections. Six cases occurred in a group of 10 students who traveled together on a train, and the seventh case involved a traveler in another carriage. The students were well during the trip and were not taking the drug, but fell ill afterward. All recovered. The resistance mutation was found in specimens taken before any oseltamivir treatment. [Complete report available at http://content.nejm.org/cgi/content/full/NEJMc0910448/]
Canada (Ontario): Some pandemic H1N1 patients hospitalized for three months
Some of the 1,541 seriously ill patients have spent more than three months in hospitals, the Canadian Ministry of Health reported in a weekly bulletin. Ontario also says the case volume for pandemic (H1N1) 2009 virus infection in the second wave was up to six times higher than the case load reached in the worst of the past five influenza seasons going back all the way to 2004. The highest confirmed cases of influenza in the past five flu seasons peaked at 500 cases in mid-February of 2005 for the 2004-2005 seasonal flu outbreak. The peak of the second wave of pandemic H1N1 reached some 2,150 confirmed cases during week 43.
Of the 1,158 admitted to hospital between 1 Sep and 25 Nov 2009 -- the second wave -- 222 remained hospitalized when the report was compiled; and patients had a mean stay of four days but the range was between 0 to 94 days in hospital. 70 people died during the second wave which is not over yet and 25 died during the first wave which started in April 2009, the report said.
USA: Autopsies show damage to entire airway
In patients who died from novel H1N1 flu, the virus damaged cells throughout the respiratory tract, much as in the 1918 and 1957 pandemics, according to a study released 07 December 2009 by researchers from the National Institutes of Health (NIH) and the office of New York's medical examiner. Of the 34 fatal cases studied, evidence of secondary bacterial infection was seen in more than half. Also, 62% of deaths were among those 25 to 49 years old, 91% had underlying conditions, and 72% were obese. [Complete press release available at http://www3.niaid.nih.gov/news/newsreleases/2009/FluAutopsy.htm.]
Kenya & Togo: First African nations to receive pandemic H1N1 vaccine
A WHO official said Kenya and Togo will be the first African countries to receive donations of pandemic H1N1 vaccine, Capital News reported 4 December 2009. He said the first shipments, expected in January 2010, will target high-risk groups such as healthcare workers. The countries will receive enough to vaccinate about 10% of their populations by March 2010.
2. Infectious Disease News
WHO reports good news in global TB battle
Over the past 15 years a rigorous approach to tuberculosis (TB) treatment has cured 36 million people and saved approximately eight million lives, the WHO stated in its latest TB report. In 1994 the WHO incorporated the DOTS strategy into its TB program, which added five elements: political commitment with sustained financing, case detection through quality bacteriology, standardized treatment with supervision and patient support, an effective drug supply system, monitoring and evaluation protocols, and impact measurement. In the past year, 87% of treated patients were cured, marking the first time the global target of 85% has been met since it was set in 1991, the WHO said. Progress is being made on addressing TB and HIV coinfections, but not all patients are receiving the treatment they should. Multidrug-resistant TB and extensively drug-resistant TB are still a persistent challenge in many parts of the world, the agency reported.
Australia: Aedes albopictus found in Queensland
An aggressive species of dengue virus-carrying mosquito has been found in Queensland, with concerns it could bring the disease to southern parts of the state. Larvae of the Asian tiger mosquito, Aedes albopictus were discovered in the tiny Cape York town of New Mapoon. Health authorities say the mosquito has the ability to transmit dengue and the yellow fever virus.
Queensland's Chief Health Officer Jeannette Young said more concerning was its ability to survive in cooler climates and the potential for it to establish itself in the state's south-east. Until now, dengue fever has been confined to only tropical regions in the north. "The Asian tiger mosquito has the potential to transmit dengue [virus], but is not as effective a carrier as the Aedes aegypti mosquito, which is already established in northern and central Queensland," Dr Young said. "However, we do have some concerns about its spread as it survives at cooler temperatures than Ae. aegypti, so it could become established further south."
Earlier this year, Queensland experienced its worst dengue outbreak in 50 years, with more than 1,000 people infected and one woman killed. The spread throughout regional cities including Cairns and Townsville was so rampant, experts held a dengue summit, summoning experts from all over the world.
Malaysia: Chikungunya cases drop 14 percent
According to Health Director-General Tan Sri Dr Mohd Ismail Merican, the number of cases of chikungunya dropped by 14 percent to 140 cases during the week of 29 Nov 2009. There have been 5,044 cases thus far in 2009, with Sarawak registering 98 percent of them.
Philippines (Isabela): Anthrax hospitalizes 50 villagers
At least 50 people from a remote Isabela village in the Philippines have been hospitalized for the last four weeks after partaking of anthrax-contaminated carabao [water buffalo] meat. The victims, all residents of Dicamay 2 in Jones, Isabela, exhibited signs of anthrax infection after consuming meat of carabaos believed to have been downed by the dreaded disease. In addition to the number of villagers affected, reports also indicated that at least six carabaos have already died due to anthrax since 16 Oct 2009, prompting the Isabela veterinary office to declare an outbreak of anthrax in the entire village.
USA: 198 cases of prion disease in 2009
During 1 Jan 2009 to 7 Nov 2009, the US National Prion Disease Pathology Surveillance Center received 341 referrals, of which 198 were classified as prion disease. The cases included 133 cases of sporadic Creutzfeldt-Jakob disease (CJD), 33 of familial CJD, and no cases of iatrogenic CJD or vCJD.
USA: Norovirus illnesses linked to oysters
The US Food and Drug Administration is advising consumers to avoid eating oysters harvested from the San Antonio Bay on or after 16 Nov 2009 due to reports of norovirus-associated illnesses in some people who had consumed oysters harvested from this area, which is located on the Gulf of Texas.
The FDA, along with the Centers for Disease Control and Prevention (CDC) and the states of North Carolina, South Carolina, and Texas, are investigating about a dozen reports of norovirus-related illnesses from South Carolina and North Carolina consumers who ate oysters recently harvested from the San Antonio Bay. Consumers who purchased oysters on or after 16 Nov 2009 that have a label showing they came from San Antonio Bay are advised to dispose of the oysters and not eat them. Restaurant operators and retailers should not serve or offer for sale oysters subject to this advisory. No other seafood is affected by this advisory. The Texas Department of State Health Services has ordered a recall of all oysters harvested from the San Antonio Bay between 16 and 25 Nov 2009.
The following websites provide the most current information, surveillance, and guidance.
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
Eastern Mediterranean: http://www.emro.who.int/csr/h1n1/
Western Pacific: http://www.wpro.who.int/health_topics/h1n1/
- North America
US CDC: http://www.cdc.gov/h1n1flu/update.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
- 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.
Two new cases of dengue fever have been confirmed in north Queensland. Authorities launched a warning two weeks ago after three cases of imported dengue fever were confirmed in Cairns and one case was detected in Townsville.
Queensland Health says it is on the alert for more cases of dengue fever in the state's north. Dr Steven Donohue, from the Department's Tropical Population Health, says two more locally acquired cases have been found in the Townsville suburb of Heatley. "They haven't travelled anywhere, which is a worry because we've been concerned that this could be the start of another big dengue outbreak," he said.
Warm winters thus far in southern Taiwan have brought a dengue fever epidemic, according to a Chinese Taipei Health Department report. An official command center was set up for the dengue fever epidemic. So far in 2009, there have been 648 local cases with two deaths. The epidemic is expected to pose a severe test in 2010.
According to the Deputy Secretary for Disease Control, Zhou Zhihao, in 2009 dengue fever has been concentrated in Kaohsiung City (438 cases), Kaohsiung County (81 cases) and Pingtung County (64 cases). Health director Chih-Liang Yaung predicted that this wave of dengue fever will continue into 2010, forming the acid test for the eradication of the vector mosquito. Spraying alone will lead to emergence of mosquitoes resistant to disease prevention measures so control must be accomplished with other measures.
The Health Ministry announces a nationwide dengue alert with 819 cases and three deaths, two in Malacca and one in Penang. Health deputy director-general Datuk Dr Hasan Abdul Rahman said an additional 99 cases were reported the week ending 21 November 2009, bringing the total to 819 cases. He also warned that, if the public does not take the necessary precautions, the number of cases could increase to 1,600 during December 2009.
University of Florida mosquito researchers are watching with a wary eye as dengue virus returns to the state after more than 50 years. By late November 2009, 20 cases of locally transmitted dengue had been confirmed in Key West. Monroe County officials have issued a health alert and launched an education campaign urging residents to eliminate water sources in and around their homes where mosquitoes can breed. "We haven't seen dengue in Florida in a long time, but this does give us evidence that we can have it again," said Roxanne Connelly, an associate professor of medical entomology with University of Florida's Institute of Food and Agricultural Sciences.
Researchers don't expect this outbreak to reach beyond Monroe County, but it's a strong reminder for Floridians to be on guard. The last large dengue epidemic in Florida was in 1934 and left more than 25,000 Floridians ill, according to Jonathan Day, a medical entomology professor at the Florida Medical Entomology Laboratory.
CHOLERA, DIARRHEA, and DYSENTARY
Papua New Guinea
At least eight people have died from cholera in Papua New Guinea's East Sepik Province, and it is estimated another 200 people in rural areas have the disease. Cholera has been affecting the PNG northern coast provinces since August with several dozen people dying. It has been in East Sepik now for a month but the provincial health advisor, Albert Bunat, says it is spreading and reached the main town, Wewak.
(Radio New Zealand International 12/08/2009)
Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study
Donaldson LJ, Rutter PD, Ellis BM, et al. BMJ. 10 December 2009;339:b5213.
Available at http://www.bmj.com/cgi/content/short/339/dec10_1/b5213.
Objective. To establish mortality from pandemic A/H1N1 2009 influenza up to 8 November 2009.
Design. Investigation of all reported deaths related to pandemic A/H1N1 in England.
Setting. Mandatory reporting systems established in acute hospitals and primary care.
Participants. Physicians responsible for the patient.
Main outcome measures. Numbers of deaths from influenza combined with mid-range estimates of numbers of cases of influenza to calculate age specific case fatality rates. Underlying conditions, time course of illness, and antiviral treatment.
Results. With the official mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000. It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged ?65 (980 (range 300-3200) per 100 000). In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57). Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England. Fifty (36%) had no, or only mild, pre-existing illness. Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive them within the first 48 hours of illness.
Conclusions. Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction. Our data support the priority vaccination of high risk groups. We observed delayed antiviral use in most fatal cases, which suggests an opportunity to reduce deaths by making timely antiviral treatment available, although the lack of a control group limits the ability to extrapolate from this observation. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme and for continuing to make early antiviral treatment widely available.
Prolonged shedding of influenza A(H1N1)v virus: two case reports from France 2009
Fleury H, Burrel1 S, Weber CB, et al. Eurosurveillance. 10 December 2009;14(10)
Available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19434.
Abstract. We observed a prolonged shedding of virus 14 and 28 days after symptom onset in two patients with pandemic H1N1 influenza, who did not have immunodepression and were treated with neuraminidase inhibitor. This prolonged shedding was not associated with the emergence of resistance mutation H275Y in the viral neuraminidase gene.
Persistent Infection with West Nile Virus Years after Initial Infection
Murray K, Walker C, Herrington E, et al. J Infect Dis. 10 December 2010;201(1):1.
Available at http://www.journals.uchicago.edu/doi/full/10.1086/648731.
Abstract. West Nile virus (WNV) RNA was demonstrated in 5 (20%) of 25 urine samples collected from convalescent patients 573-2452 days (1.6-6.7 years) after WNV infection. Four of the 5 amplicons sequenced showed >99% homology to the WNV NY99 strain. These findings show that individuals with chronic symptoms after WNV infection may have persistent renal infection over several years.
Clinical Features of the Initial Cases of 2009 Pandemic Influenza A (H1N1) Virus Infection in China
Cao B, Li XW, Mao Yu, et al. N Engl J Med. 09 December 2009; 10.1056/NEJMoa0906612.
Available at http://content.nejm.org/cgi/content/full/NEJMoa0906612?query=TOC.
Background. The first case of 2009 pandemic influenza A (H1N1) virus infection in China was documented on May 10. Subsequently, persons with suspected cases of infection and contacts of those with suspected infection were tested. Persons in whom infection was confirmed were hospitalized and quarantined, and some of them were closely observed for the purpose of investigating the nature and duration of the disease.
Methods. During May and June 2009, we observed 426 persons infected with the 2009 pandemic influenza A (H1N1) virus who were quarantined in 61 hospitals in 20 provinces. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection, the clinical features of the disease were closely monitored, and 254 patients were treated with oseltamivir within 48 hours after the onset of disease.
Results. The mean age of the 426 patients was 23.4 years, and 53.8% were male. The diagnosis was made at ports of entry (in 32.9% of the patients), during quarantine (20.2%), and in the hospital (46.9%). The median incubation period of the virus was 2 days (range, 1 to 7). The most common symptoms were fever (in 67.4% of the patients) and cough (69.5%). The incidence of diarrhea was 2.8%, and the incidence of nausea and vomiting was 1.9%. Lymphopenia, which was common in both adults (68.1%) and children (92.3%), typically occurred on day 2 (range, 1 to 3) and resolved by day 7 (range, 6 to 9). Hypokalemia was observed in 25.4% of the patients. Duration of fever was typically 3 days (range, 1 to 11). The median length of time during which patients had positive real-time RT-PCR test results was 6 days (range, 1 to 17). Independent risk factors for prolonged real-time RT-PCR positivity included an age of less than 14 years, male sex, and a delay from the onset of symptoms to treatment with oseltamivir of more than 48 hours.
Conclusions. Surveillance of the 2009 H1N1 virus in China shows that the majority of those infected have a mild illness. The typical period during which the virus can be detected with the use of real-time RT-PCR is 6 days (whether or not fever is present). The duration of infection may be shortened if oseltamivir is administered.
The Severity of Pandemic H1N1 Influenza in the United States, from April to July 2009: A Bayesian Analysis
Presanis AM, De Angelis D, Hagy A, et al: PLoS Med. 08 December 2009;6(12): e1000207.
Available at http://www.plosmedicine.org/article/info:doi%2F10.1371%2Fjournal.pmed.1000207.
Background. Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources.
Methods and Findings. We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data-medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York-were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%-0.096%), sCIR of 0.239% (0.134%-0.458%), and sCHR of 1.44% (0.83%-2.64%). Using self-reported ILI, we obtained estimates approximately 7-9× lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest.
Conclusions. These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.
Vaccination with ALVAC and AIDSVAX to Prevent HIV-1 Infection in Thailand
Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S, et al. NEJM. 03 December 2009; 361(23):2209-2220.
Available at http://content.nejm.org/cgi/reprint/361/23/2209.pdf.
Background. The development of a safe and effective vaccine against the human immunodeficiency virus type 1 (HIV-1) is critical to pandemic control.
Methods. In a community-based, randomized, multicenter, double-blind, placebo-controlled efficacy trial, we evaluated four priming injections of a recombinant canarypox vector vaccine (ALVAC-HIV [vCP1521]) plus two booster injections of a recombinant glycoprotein 120 subunit vaccine (AIDSVAX B/E). The vaccine and placebo injections were administered to 16,402 healthy men and women between the ages of 18 and 30 years in Rayong and Chon Buri provinces in Thailand. The volunteers, primarily at heterosexual risk for HIV infection, were monitored for the coprimary end points: HIV-1 infection and early HIV-1 viremia, at the end of the 6-month vaccination series and every 6 months thereafter for 3 years.
Results. In the intention-to-treat analysis involving 16,402 subjects, there was a trend toward the prevention of HIV-1 infection among the vaccine recipients, with a vaccine efficacy of 26.4% (95% confidence interval [CI], ?4.0 to 47.9; P = 0.08). In the perprotocol analysis involving 12,542 subjects, the vaccine efficacy was 26.2% (95% CI, ?13.3 to 51.9; P = 0.16). In the modified intention-to-treat analysis involving 16,395 subjects (with the exclusion of 7 subjects who were found to have had HIV-1 infection at baseline), the vaccine efficacy was 31.2% (95% CI, 1.1 to 52.1; P = 0.04). Vaccination did not affect the degree of viremia or the CD4+ T-cell count in subjects in whom HIV-1 infection was subsequently diagnosed.
Conclusions. This ALVAC-HIV and AIDSVAX B/E vaccine regimen may reduce the risk of HIV infection in a community-based population with largely heterosexual risk. Vaccination did not affect the viral load or CD4+ count in subjects with HIV infection. Although the results show only a modest benefit, they offer insight for future research. (ClinicalTrials.gov number, NCT00223080.)
Post-exposure prophylaxis during pandemic outbreaks
Moghadas SM, Bowman CS, Rost G, et al. BMC Medicine. 02 December 2009;7:73
Available at http://www.biomedcentral.com/1741-7015/7/73/abstract
Background. With the rise of the second pandemic wave of the novel influenza A (H1N1) virus in the current season in the Northern Hemisphere, pandemic plans are being carefully re-evaluated, particularly for the strategic use of antiviral drugs. The recent emergence of oseltamivir-resistant in treated H1N1 patients has raised concerns about the prudent use of neuraminidase inhibitors for both treatment of ill individuals and post-exposure prophylaxis of close contacts.
Methods. We extended an established population dynamical model of pandemic influenza with treatment to include post-exposure prophylaxis of close contacts. Using parameter estimates published in the literature, we simulated the model to evaluate the combined effect of treatment and prophylaxis in minimizing morbidity and mortality of pandemic infections in the context of transmissible drug resistance.
Results. We demonstrated that, when transmissible resistant strains are present, post-exposure prophylaxis can promote the spread of resistance, especially when combined with aggressive treatment. For a given treatment level, there is an optimal coverage of prophylaxis that minimizes the total number of infections (final size) and this coverage decreases as a higher proportion of infected individuals are treated. We found that, when treatment is maintained at intermediate levels, limited post-exposure prophylaxis provides an optimal strategy for reducing the final size of the pandemic while minimizing the total number of deaths. We tested our results by performing a sensitivity analysis over a range of key model parameters and observed that the incidence of infection depends strongly on the transmission fitness of resistant strains.
Conclusions. Our findings suggest that, in the presence of transmissible drug resistance, strategies that prioritize the treatment of only ill individuals, rather than the prophylaxis of those suspected of being exposed, are most effective in reducing the morbidity and mortality of the pandemic. The impact of post-exposure prophylaxis depends critically on the treatment level and the transmissibility of resistant strains and, therefore, enhanced surveillance and clinical monitoring for resistant mutants constitutes a key component of any comprehensive plan for antiviral drug use during an influenza pandemic.
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.
International Symposium on Neglected Influenza Viruses
Amelia Island, Florida, 3-5 Feb 2010
The International Symposium on Neglected Influenza Viruses will bring together international scientists whose work focuses on mammalian influenza viruses from nonhuman/nonavian sources. This highly scientific conference will examine an extensive body of swine and equine influenza data and also consider what roles, if any, canine influenza and marine mammal influenza might play in new epidemics and epizootics. You are invited to submit an abstract of original research in all areas related to nonhuman/nonavian influenza research for oral or poster presentation.
For a complete conference program, registration, and abstract submission information visit https://www.isirv.org/events/neglected-influenza/overview.
14th International Congress on Infectious Diseases (ICID)
Miami, Florida, 9-12 Mar 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/.
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: email@example.com; Ph. : +33 1 44 64 15 15 - Fax : +33 1 44 64 15 16
CDC 7th International Conference on Emerging Infectious Diseases
Atlanta, Georgia, 11-14 Jul 2010
The 2010 International Conference on Emerging Infectious Diseases (ICEID) is the principal meeting for emerging infectious diseases organized by CDC. This conference includes plenary and panel sessions, as well as oral and poster presentations, and covers a broad spectrum of infectious diseases of public health relevance. ICEID 2010 will also focus on the impact of various intervention and preventive strategies that have been implemented to address emerging infectious disease threats.
Additional information is available at http://www.iceid.org/.
Options for the Control of Influenza VII
Hong Kong , 3-7 Sep 2010
Options for the Control of Influenza VII is the largest forum devoted to all aspects of the prevention, control, and treatment of influenza. As it has for over 20 years, Options VII will highlight the most recent advances in the science of influenza. The scientific program committee invites authors to submit original research in all areas related to influenza for abstract presentation. Accepted abstracts will be assigned for oral or poster presentation.
Additional information is available at http://www.controlinfluenza.com.
Promising Practices adds tools for H1N1 response
A peer-reviewed Web database of pandemic preparedness practices, established by CIDRAP in 2007, has launched a set of public health practices specific to pandemic H1N1 response. For example, it includes tools for managing vaccine clinics and delivering flu information to hard-to-reach groups. It is seeking additional promising practice submissions related to the pandemic.
Available at http://www.cidrappractices.org/.
Updated influenza guidance and information from the US CDC
In The News Question & Answer on The Estimated Number of U.S. 2009 H1N1 Cases, Hospitalizations and Deaths
Released 10 December 2009
Available at http://www.cdc.gov/h1n1flu/in_the_news/updated_cdc_estimates.htm.
Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season
Released 07 December 2009
Available at http://www.cdc.gov/h1n1flu/recommendations.htm.
Caring for Someone Sick at Home
Released 05 December 2009
Available at http://www.cdc.gov/h1n1flu/homecare/.