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Vol. XII, No. 25 ~ EINet News Briefs ~ Dec 25, 2009


*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:

1. Influenza News
- 2009 Cumulative number of human cases of avian influenza A/H5N1
- Global: WHO situation update on pandemic influenza H1N1
- Global: WHO clears Novartis vaccines for developing world
- Global: Difficulty of comparing deaths due to pandemic H1N1 and seasonal influenza
- Egypt: Ministry of Health reports 90th H5N1 case
- Europe: Some countries eye returning surplus pandemic vaccine
- Thailand: First case of pandemic H1N1 in swine
- South Korea: Pandemic H1N1 found at 15 pig farms
- Cambodia: Confirmed case of H5N1 Avian influenza
- USA: CDC sets sights on getting pandemic vaccine to adults
- USA: Slight loss of potency prompts recall of nasal H1N1 vaccine

2. Infectious Disease News
- Australia (South Australia): Hepatitis A public health warning
- Indonesia: Update of Bali rabies fatalities
- New Zealand: 84 people at risk after measles exposure
- USA (New York): Largest mumps outbreak in years

3. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA
- DENGUE

4. Articles
- Hantavirus Pulmonary Syndrome in Five Pediatric Patients--Four States, 2009
- Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina
- Severe 2009 H1N1 Influenza in Pregnant and Postpartum Women in California
- Immunogenicity of a monovalent 2009 influenza A(H1N1) vaccine in infants and children: a randomized trial
- Epidemiological characteristics and low case fatality rate of pandemic (H1N1) 2009 in Japan
- Rotavirus vaccines: an update
- Is a Mass Immunization Program for Pandemic (H1N1) 2009 Good Value for Money? Early Evidence from the Canadian Experience

5. Notifications
- APEC EINet Hot Topics Video Summary
- 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
- 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)
Cambodia/ 1 (0)
China/ 7 (4)
Egypt/ 39 (4)
Viet Nam/ 5 (5)
Total/ 52 (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: 447 (263) (WHO 12/21/09 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_12_21/en/)

Avian influenza age distribution data from WHO/WPRO (last updated 11/27/09): http://www.wpro.who.int/sites/csr/data/data_Graphs.htm

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

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

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Global: WHO situation update on pandemic influenza H1N1
As of 20 December 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 11,516 deaths.

In United States and Canada, influenza activity continues to be geographically widespread but overall levels of influenza-like illnesses (ILI) have declined substantially to near the national baseline level in the US and below the seasonal baseline in Canada. Although numbers of hospitalizations and death in US have declined steadily since their peak over six weeks ago, the proportional mortality due to pneumonia and influenza (P&I mortality) remains elevated above the epidemic threshold for the 11th consecutive week. In Canada, rates of ILI, numbers of outbreaks, and proportions of samples testing positive for influenza have declined substantially since peaking six weeks ago. Approximately 53% of hospitalized cases in Canada had an underlying medical condition; cases with underlying medical conditions tended to be older (compared to those without), and were at increased risk of hospitalization and death. Also from Canada, a smaller proportion of hospitalized cases during the winter transmission season compared with those hospitalized cases during the summer transmission season, were persons of aboriginal origin (3.9% vs. 20.3%).

In Europe, geographically widespread and active transmission of pandemic influenza virus continued to be observed throughout the continent, however, overall pandemic influenza activity appears to have recently peaked across a majority of countries. At least ten countries reported that 30% or more of their sentinel respiratory specimens had tested positive for influenza. Greater than 98% of subtyped influenza A viruses detected in Europe were pandemic H1N1 2009, however, seasonal influenza viruses (H1N1, H3N2, and type B) continue to be detected at low levels. Of note, a few countries are experiencing increasing disease activity and have yet to peak (Hungary and Montenegro ), while several others are experiencing a resurgence in activity (Serbia, Ukraine, Georgia, and Turkey). Rates of ILI have returned to near seasonal baselines in the earlier affected areas of western Europe (Belgium, the Netherlands, Ireland, and Iceland) and a substantial decline in activity has been observed in much of northern Europe over the past month. In central and southern Europe, where influenza virus transmission has been most active recently, disease activity in most places has either plateaued (Albania, Czech Republic, Estonia) or begun to decline (Austria, Germany, Poland, Latvia, Croatia, Slovakia, and Greece). Further east, influenza activity appears to be variable, with the Russian Federation reporting a steady decline in rates of ARI after a recent peak three weeks ago; while several other countries are reporting increases in rates of ILI/ARI (Ukraine and Georgia). In Europe, the highest rates of ILI have been recorded among children 0-4 years of age (in 15 countries) and among older children 5-14 years of age (in 18 countries). Detections of RSV in Europe continued to increase over the past six weeks, partially accounting for elevated ILI activity among young children in some countries.

In Western and Central Asia, limited data suggest that influenza virus circulation remains active throughout the region, however disease trends remain variable. Increasing respiratory diseases activity continued to be reported in Kazakhstan and in Egypt; while several others countries, Israel and Oman, have been reporting declining trends of respiratory diseases activity after recording a peak of activity approximately one month ago.

In East Asia, the situation remains similar to last week; influenza transmission remains active but appears to be declining overall. Influenza/ILI activity has recently peaked and continues to decline in Japan, in northern and southern China, Chinese Taipei and in Mongolia. In southern Asia, influenza activity continues to increase in the northern India, Nepal, and, Sri Lanka.

In the tropical region of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining or remains unchanged in most parts, except for in Barbados and Ecuador, were recent increases in respiratory diseases activity have been reported.

In the temperate region of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.
(WHO 12/23/2009)

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Global: WHO clears Novartis vaccines for developing world
The WHO has prequalified all three H1N1 vaccines made by Novartis to be supplied to United Nations agencies for use in the developing world, the company announced. The vaccines are Celtura and Focetria, both of which contain the MF59 adjuvant, and a nonadjuvanted vaccine based on the Fluvirin seasonal vaccine. The WHO previously prequalified an adjuvanted H1N1 vaccine made by GlaxoSmithKline.
(CIDRAP 12/22/2009)

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Global: Difficulty of comparing deaths due to pandemic H1N1 and seasonal influenza
The World Health Organization (WHO) addressed the difficulty of assessing the severity of the H1N1 pandemic by comparing H1N1 fatality counts with seasonal flu counts. In a briefing note, the agency said that such comparisons can be misleading because death tolls from seasonal flu are estimates, whereas death numbers for the pandemic usually represent confirmed fatal cases. Such comparisons can also mislead because H1N1 has a greater impact on young people than seasonal flu does. [Original briefing available at http://www.who.int/csr/disease/swineflu/notes/briefing_20091222/en/index.html/.]
(CIDRAP 12/22/2009)

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Europe/Near East
Egypt: Ministry of Health reports 90th H5N1 case
The Ministry of Health of Egypt has reported a new laboratory confirmed human case of avian influenza A(H5N1) on 19 December 2009. The case is a 21 year old female from the El Tanta District of Gharbia Governorate. She developed symptoms of fever and cough on 15 December 2009.

The case was confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network (GISN). Of the 90 laboratory confirmed cases of Avian influenza A(H5N1) reported in Egypt, 27 have been fatal.
(WHO 12/21/2009)

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Europe: Some countries eye returning surplus pandemic vaccine
Swiss officials said today they plan to donate or sell 4.5 million surplus doses of pandemic vaccine, because uptake among the public has been low. Germany and Spain have also said they want to return excess vaccine to manufacturers. Meanwhile, the Greek media reported that government officials hope to cancel an order for eight million vaccine doses. Immunization began in Greece a month ago, but the health ministry said citizens are skeptical and uptake has been low.
(CIDRAP 12/18/2009)

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Asia
Thailand: First case of pandemic H1N1 in swine
Thailand confirmed 17 Nov 2009 its first case of a pig infected with influenza pandemic (H1N1) 2009 virus spread from humans. Agriculture minister, Thira Wongsamut, said that one of 80 pigs in a sample group tested for the virus at Kasetsart University farm in the central province of Saraburi had contracted A (H1N1) influenza. The ministry has quarantined a 5 km-radius around the farm, where university research is carried out, as a precautionary measure, he said, adding that new health checks would be conducted at the farm every three days. The ministry's permanent secretary, Yukol Limlamthong, said that none of the 132 workers at the university farm had contracted the virus.

Since the swine flu outbreak began in April 2009, the ministry said it has tested more than 26,000 pigs for the virus. Of the 29,741 confirmed human cases of the flu, 190 have been fatal.
(ProMED 12/23/2009)

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South Korea: Pandemic H1N1 found at 15 pig farms
South Korean veterinary officials said they isolated the pandemic H1N1 virus at 15 pig farms during surveillance conducted since May 2009. Their report to the World Organization for Animal Health (OIE) said the source of the virus wasn't known. The outbreaks were detected in December, mostly in the south. Response included movement restriction and farm disinfection. So far 241 of about 24,000 pigs tested positive.
(CIDRAP 12/23/2009)

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Cambodia: Confirmed case of H5N1 Avian influenza
The Ministry of Health of Cambodia has announced a new confirmed case of human infection with the H5N1 avian influenza virus. The 57-year-old male, from Ponhea Kreak District, Kampong Cham Province, developed symptoms on 11 December 2009. The case was admitted to Kampong Cham Provincial Hospital on 16 December 2009, where he received treatment. He is in a stable condition. The presence of the H5N1 virus was confirmed by the National Influenza Centre, the Institut Pasteur du Cambodge. A team led by the Ministry of Health is conducting field investigations into the source of his infection.

Of the nine cases confirmed to date in Cambodia, seven have been fatal. This is the first diagnosed case in Cambodia during 2009.
(WHO 12/18/2009)

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Americas
USA: CDC sets sights on getting pandemic vaccine to adults
The nation's supply of pandemic vaccine has grown to 111 million doses, enough so that the US CDC is turning part of its attention toward boosting the percentage of adults who get vaccinated. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, told reporters that though the virus seems to be retreating in many states, nearly all of what's circulating is the pandemic H1N1 strain, and it's clear that the virus isn't going away.

Over the next several weeks, the nation can expect to see more efforts to urge more people to get the vaccine, Schuchat said. She said National Influenza Vaccination Week, a national observance used over the past few years to foster greater use of flu vaccine after the holiday season and past January, will start Jan 10. It was originally scheduled for the week of 6 December 2009 but was postponed because both pandemic and seasonal flu vaccines were in short supply at the time.
(CIDRAP 12/22/2009)

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USA: Slight loss of potency prompts recall of nasal H1N1 vaccine
MedImmune Inc. today announced a recall of leftover doses from 13 lots of its nasal-spray H1N1 vaccine because of a slight loss of potency, but the company said those who received doses from the affected lots don't need to be revaccinated. The company and the US Food and Drug Administration (FDA) said there are no safety problems with the recalled doses.

MedImmune's announcement said, "These doses were well within potency specifications at the time they were distributed, and in fact, some of the doses being recalled are actually still within required potency limits. In exercising the most conservative approach, MedImmune is recommending that all lots marked with an expiration date of between January 19 and January 26, 2010, not be used." [The recall notice can be found at http://www.medimmune.com/pdf/H1N1_Recall_letter_122209.pdf.]
(CIDRAP 12/22/2009)

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2. Infectious Disease News

Asia
Australia (South Australia): Hepatitis A public health warning
South Australia Health has issued a public health warning after a supermarket employee was diagnosed with hepatitis A. He was working at the butcher’s counter while infectious. 55 cases of hepatitis A have been reported in South Australia in 2009 while 19 cases were reported in South Australia in 2008.
(ProMED 12/21/2009)

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Indonesia: Update of Bali rabies fatalities
According to the Jakarta Post, there have been 19 officially recognized rabies fatalities. Other local media report up to six additional fatalities. To date, all infected persons have been local inhabitants.
(ProMED 12/17/2009)

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New Zealand: 84 people at risk after measles exposure
Health authorities are now trying to contact 84 people exposed to measles by a baby who flew from London to Christchurch via Auckland. The baby arrived in Auckland on Air New Zealand flight NZ1 on Mon 7 December 2009, before travelling to Christchurch on flight NZ509. Auckland and Canterbury health authorities are trying to contact people sitting near the baby on both flights; for the international leg, 56 people sitting in rows 56-60 were at risk while 28 people sitting in rows 13-17 were exposed on the domestic flight.
(ProMED 12/17/2009)

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Americas
USA (New York): Largest mumps outbreak in years
The number of people in Rockland County who have come down with mumps has jumped to 152 as part of what state and federal health officials are calling the largest outbreak of the disease nationwide in years. Nearly all local cases of the highly infectious disease are among Orthodox Jewish and Hasidic residents of Monsey and New Square, according to the Rockland Department of Health. At least 60 per cent of the people in Rockland who have contracted mumps during the current outbreak had not been fully immunized. So far, there is no indication that people outside those communities are coming down with mumps.

"The outbreak has spread and gradually increased in size and is now the largest US mumps outbreak since 2006," the CDC said. It's also the largest outbreak in New York since 2005, according to Tom Allocco, a spokesman for the state Department of Health. More than 300 cases have been reported statewide outside of New York City, with half in Rockland and half in Orange County, according to health officials.
(ProMED 12/20/2009)

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3. Updates
INFLUENZA A/H1N1
The following websites provide the most current information, surveillance, and guidance.

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

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

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

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

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

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DENGUE
Australia (Queensland)
The north Queensland city of Townsville now has two separate dengue fever outbreaks, with the wet season yet to start in earnest. Queensland Health said it had confirmed nine locally-acquired dengue virus type 1 cases and two type 3 cases, in the suburbs of Garbutt, Heatley and Wulguru. Results on four other cases are expected later on 18 Dec 2009.

The north Queensland dengue epidemic during the last wet season was the worst in 50 years. More than 1,000 people were infected with the virus during the outbreak, which began in November 2008, including an elderly woman who died due to complications in March 2009.
(ProMED 12/21/2009)

Malaysia (Sarawak)
Sarawak's State Ministry of Environment and Public Health has sounded an alarm following an explosion of dengue cases, with about 10 new hospital admissions in Miri City alone every day. The number of infected people has reached the 4,000 mark, with 873 patients in Miri City. Five people have died throughout the state, four of them in Miri City and one in Kuching.
(ProMED 12/21/2009)

Mexico (Jalisco)
The number of dengue cases in Jalisco now totals 4,635, of which 690 are the dengue hemorrhagic fever (DHF) form of the disease, according to the latest report of the National Center of Epidemiological Surveillance and Disease Control, which places the state in fourth place nationally for the greatest number of persons affected by dengue virus.

In the last report issued by the federal agency for epidemiological week 47, 22-28 November 2009, there were 220 confirmed cases, of which 169 were classical dengue and 51 DHF, which indicates that the outbreak in the state continues to be present. According to information from the Jalisco State Secretariat of Health, the municipalities in the latest batch of data most affected by dengue are Puerto Vallarta, Cihuatlan, and Tomatlan as a result of rains registered in the Jalisco Pacific coast for the past two weeks, which might generate an upturn in cases that would show up in later epidemiological data.
(ProMED 12/15/2009)

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4. Articles
Hantavirus Pulmonary Syndrome in Five Pediatric Patients--Four States, 2009
MMWR. 25 December 2009; 58(50): 1409-1412.
Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5850a3.htm?s_cid=mm5850a3_e.

Introduction. Hantavirus pulmonary syndrome (HPS) is a reportable infectious disease with a high case-fatality rate, transmitted to humans by exposure to rodents. Each year, 20-40 cases of HPS occur in the United States; cases in persons aged less than 17 years make up fewer than 7 percent of those cases, and cases in children aged less than 10 years are exceptionally rare. CDC received reports of 5 pediatric cases of HPS occurring during 16 May- 25 Nov 2009, among children aged 6-14 years from Arizona, California, Colorado, and Washington. 3 of the children were aged less than 10 years, and all 5 had exposure to rodents. This report summarizes the 5 cases, including the clinical findings and likely means of transmission of a hantavirus. Thrombocytopenia, elevated white blood cell (WBC) count, and pulmonary infiltrates were observed in all 5 children; elevated hematocrit was observed in 3. One child died, and 3 of the 4 children who recovered required mechanical ventilation during hospitalization. Clinicians should consider HPS in the differential diagnosis for children with unexplained acute respiratory distress, especially if recent rodent exposure is noted. Public health agencies should promote preventive measures, including rodent control in housing and play areas, and children should be advised to avoid contact with rodents and areas of infestation.

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Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina
Libster R, Bugna J, Coviello S, et al. N Engl J Med. 23 December 2009; 0: NEJMoa0907673.
Available at http://content.nejm.org/cgi/content/full/NEJMoa0907673.

Background. While the Northern Hemisphere experiences the effects of the 2009 pandemic influenza A (H1N1) virus, data from the recent influenza season in the Southern Hemisphere can provide important information on the burden of disease in children.

Methods. We conducted a retrospective case series involving children with acute infection of the lower respiratory tract or fever in whom 2009 H1N1 influenza was diagnosed on reverse-transcriptase polymerase-chain-reaction assay and who were admitted to one of six pediatric hospitals serving a catchment area of 1.2 million children. We compared rates of admission and death with those among age-matched children who had been infected with seasonal influenza strains in previous years.

Results. Between May and July 2009, a total of 251 children were hospitalized with 2009 H1N1 influenza. Rates of hospitalization were double those for seasonal influenza in 2008. Of the children who were hospitalized, 47 (19%) were admitted to an intensive care unit, 42 (17%) required mechanical ventilation, and 13 (5%) died. The overall rate of death was 1.1 per 100,000 children, as compared with 0.1 per 100,000 children for seasonal influenza in 2007. (No pediatric deaths associated with seasonal influenza were reported in 2008.) Most deaths were caused by refractory hypoxemia in infants under one year of age (death rate, 7.6 per 100,000).

Conclusions. Pandemic 2009 H1N1 influenza was associated with pediatric death rates that were 10 times the rates for seasonal influenza in previous years.

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Severe 2009 H1N1 Influenza in Pregnant and Postpartum Women in California
Louie JK, Acosta M, Jamieson DJ, et al. N Engl J Med. 23 December 2009; 0: NEJMoa0910444.
Available at http://content.nejm.org/cgi/content/full/NEJMoa0910444.

Background. Like previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women.

Methods. Statewide surveillance for patients who were hospitalized with or died from 2009 H1N1 influenza was initiated by the California Department of Public Health. We reviewed demographic and clinical data reported from April 23 through August 11, 2009, for all H1N1-infected, reproductive-age women who were hospitalized or died — nonpregnant women, pregnant women, and postpartum women (those who had delivered ≤2 weeks previously).

Results. Data were reported for 94 pregnant women, 8 postpartum women, and 137 nonpregnant women of reproductive age who were hospitalized with 2009 H1N1 influenza. Rapid antigen tests were falsely negative in 38% of the patients tested (58 of 153). Most pregnant patients (89 of 94 [95%]) were in the second or third trimester, and approximately one third (32 of 93 [34%]) had established risk factors for complications from influenza other than pregnancy. As compared with early antiviral treatment (administered ≤2 days after symptom onset) in pregnant women, later treatment was associated with admission to an intensive care unit (ICU) or death (relative risk, 4.3). In all, 18 pregnant women and 4 postpartum women (total, 22 of 102 [22%]) required intensive care, and 8 (8%) died. Six deliveries occurred in the ICU, including four emergency cesarean deliveries. The 2009 H1N1 influenza–specific maternal mortality ratio (the number of maternal deaths per 100,000 live births) was 4.3.

Conclusions. 2009 H1N1 influenza can cause severe illness and death in pregnant and postpartum women; regardless of the results of rapid antigen testing, prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women. The high cause-specific maternal mortality rate suggests that 2009 H1N1 influenza may increase the 2009 maternal mortality ratio in the United States.

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Immunogenicity of a monovalent 2009 influenza A(H1N1) vaccine in infants and children: a randomized trial
Nolan T, McVernon J, Skeljo M, et al. JAMA. 21 December 2009; 0: 20091911-10.
Available at http://jama.ama-assn.org/cgi/content/full/2009.1911.

Context. In the ongoing influenza pandemic, a safe and effective vaccine against 2009 influenza A(H1N1) is needed for infants and children.

Objective. To assess the immunogenicity and safety of a 2009 influenza A(H1N1) vaccine in children.

Design, setting, and participants. Randomized, observer-blind, age-stratified, parallel group study assessing two doses of an inactivated, split-virus 2009 influenza A(H1N1) vaccine in 370 healthy infants and children aged 6 months to less than 9 years living in Australia.

Intervention. Intramuscular injection of 15 mug or 30 mug of hemagglutinin antigen dose of monovalent, unadjuvanted 2009 influenza A(H1N1) vaccine in a 2-dose regimen, administered 21 days apart.

Main outcome measures. Hemagglutination inhibition assay to estimate the proportion of participants with antibody titers of 1:40 or greater, seroconversion, or a significant antibody titer increase, and factor increase in geometric mean titer. Assessments of solicited adverse events during 7 days and unsolicited adverse events for 21 days after each vaccination.

Results. Following the first dose of vaccine, antibody titers of 1:40 or greater were observed in 161 of 174 infants and children in the 15-mug group (92.5%; 95% confidence interval [CI], 87.6%-95.6%) and in 168 of 172 infants and children in the 30-mug group (97.7%; 95% CI, 94.2%-99.1%). Corresponding seroconversion rates were 86.8% (95% CI, 80.9%-91.0%) and 94.2% (95% CI, 89.6%-96.8%), and factor increases in geometric mean titer were 13.6 (95% CI, 11.8-15.6) and 18.3 (95% CI, 15.7-21.4). All participants demonstrated antibody titers of 1:40 or greater after the second vaccine dose. Immune responses were robust regardless of age, baseline serostatus, or seasonal influenza vaccination status. The majority of adverse events were mild to moderate in severity.

Conclusion. One 15-mug dose of vaccine was immunogenic in infants and children starting at 6 months of age and vaccine-associated reactions were mild to moderate in severity. Trial Registration clinicaltrials.gov Identifier: NCT00940108

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Epidemiological characteristics and low case fatality rate of pandemic (H1N1) 2009 in Japan
Kamigaki T, Oshitani H. PLoS Currents: Influenza. 2009 December 21; Version 14.
Available at http://knol.google.com/k/taro-kamigaki/epidemiological-characteristics-and-low/38epug6fmizmk/1.

Abstract. Pandemic (H1N1) 2009 has been causing large outbreaks in Japan. Yet, the case fatality rate (CFR) remains low and only 85 deaths have been confirmed as of December 17, 2009. Surveillance data was analyzed to define epidemiological characteristics of pandemic (H1N1) 2009 in Japan. It was shown that most of the reported influenza-like illness cases and hospitalizations have occurred in those aged 5–9 years and 10–14 years, in whom CFR is extremely low. However, CFRs are higher in small children (<5 years) and adults. The transmission to these age groups may possibly have been minimized through aggressive suspension of classes in schools.

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Rotavirus vaccines: an update
WHO. Weekly Epidemiological Record Bulletin. 18 December 2009; 84(51-52): 533–540.
Available at http://www.who.int/wer/2009/wer8451_52.pdf.

Introduction. Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. According to 2004 estimates by WHO, 527,000 children aged <5 years die each year from vaccine preventable rotavirus infections; most of these children live in low-income countries. Two oral, live, attenuated rotavirus vaccines, Rotarix (GlaxoSmithKline Biologicals, Rixensart, Belgium) and RotaTeq (Merck & Co. Inc., West Point, PA, USA), are available internationally; and both vaccines are considered safe and effective in preventing gastrointestinal disease caused by rotaviruses. In the position paper on rotavirus vaccines published in 2007, WHO recommended the inclusion of rotavirus vaccination into national immunization programmes in regions where efficacy data suggested there would be a significant public health impact – that is, mainly in the Americas and Europe. However, until effectiveness and safety had been confirmed in all regions, in particular in Asia and Africa, WHO was not prepared to recommend that rotavirus vaccines be included in all national immunization programmes.

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Is a Mass Immunization Program for Pandemic (H1N1) 2009 Good Value for Money? Early Evidence from the Canadian Experience
Sander B, Bauch C, Fisman DN, et al. PLoS Currents: Influenza. 17 December 2009. RRN1137.
Available at http://knol.google.com/k/beate-sander/is-a-mass-immunization-program-for/39gzqilkz43g8/1.

Abstract. This work contributes informed estimates to the current debate about the pandemic (H1N1) 2009 mass immunization program’s economic merits. We performed a cost-utility analysis of the (H1N1) 2009 mass immunization program in Ontario, Canada’s most populous province. The analysis is based on a simulation model of a pandemic (H1N1) 2009 outbreak, surveillance data, and administrative data. We consider no immunization versus mass immunization reaching 30% of the population. Immunization program costs are expected to be $118 million in Ontario. Our analysis indicates this program will reduce influenza cases by 50%, preventing 35 deaths, and cutting treatment costs in half. A pandemic (H1N1) 2009 immunization program is likely to be highly cost-effective.

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5. Notifications
APEC EINet Hot Topics Video Summary
A video summary of the 5 November 2009 Hot Topics videoconference, "Pandemic H1N1 preparedness: lessons learned & preparing for the second wave", is available at http://depts.washington.edu/einet/symposium.html. Singapore, Australia, and the Philippines shared case studies regarding how preparedness plans affected the response to pandemic influenza, what worked, did not work, and what could be changed for a more effective response in the future.

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International Symposium on Neglected Influenza Viruses
Amelia Island, Florida, USA; 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. 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/.

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14th International Congress on Infectious Diseases (ICID)
Miami, Florida, USA; 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/.

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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.
Additional information and registration available at http://www.isheid.com/.

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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CDC 7th International Conference on Emerging Infectious Diseases
Atlanta, Georgia, USA; 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/.

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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.

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Updated influenza guidance and information from the US CDC
UPDATED: What You Should Know and Do this Flu Season If You Are 65 Years and Older
Released 22 December 2009
Available at http://www.cdc.gov/h1n1flu/65andolder.htm.

2009 H1N1 Influenza Vaccination Coverage
Released 22 December 2009
Available at http://www.cdc.gov/h1n1flu/in_the_news/influenza_vaccination.htm.

Updated: Vaccine Information for Clinicians and Health Care Professionals
Released 21 December 2009
Available at http://www.cdc.gov/h1n1flu/vaccination/professional.htm.

Update: FDA-Issued rRT-PCR Swine Flu Panel (also referred to as Swine Flu Test Kit) Fact Sheet for Health Care Providers (PDF)
Released 21 December 2009
Available at http://www.cdc.gov/h1n1flu/eua/pdf/eua_amendment_swine_healthcare.pdf.

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 apecein@u.washington.edu