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EINet Alert ~ Jan 01, 2010


*****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
- Cambodia: Avian influenza H5N1 strikes poultry farm
- China: Nationwide A/H1N1 epidemiological investigation to be launched in 2010
- Hong Kong: Avian Influenza A/H9N2 infection in 35-month-old girl
- Indonesia: 20 Avian influenza H5N1 cases reported--19 fatal since January
- North Korea: Aid group claims government issued a flu alert
- Chile: Three H1N1 reinfections reported
- USA: Company says DNA flu vaccine formulated quickly
- USA: High-dose seasonal influenza vaccine approved for seniors

2. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA

3. Articles
- Household Transmission of 2009 Pandemic Influenza A (H1N1) Virus in the United States
- Outbreak of 2009 Pandemic Influenza A (H1N1) at a New York City School
- Household responses to pandemic (H1N1) 2009-related school closures, Perth, Western Australia
- Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina
- Improving the Clinical Diagnosis of Influenza-a Comparative Analysis of New Influenza A (H1N1) Cases
- Development of a Rapid Automated Influenza A, Influenza B, and Respiratory Syncytial Virus A/B Multiplex Real-Time RT-PCR Assay and Its Use during the 2009 H1N1 Swine-Origin Influenza Virus Epidemic in Milwaukee, Wisconsin

4. Notifications
- 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)
Indonesia/ 20(19)
Viet Nam/ 5 (5)
Total/ 72(32)

***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 12/30/09 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_12_30/)

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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WHO situation update on pandemic influenza H1N1
As of 27 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 12,220 deaths.

The most active areas of pandemic influenza transmission currently are in central and eastern Europe. Focal increases in rates of ILI/ARI during recent weeks were reported in at least three eastern European countries, Georgia, Montenegro, and Ukraine. A high intensity of respiratory diseases activity with concurrent circulation of pandemic influenza persists in parts of southern and eastern Europe, particularly in Greece, Poland, Bulgaria, Serbia, Ukraine, and the Urals Region of the Russian Federation. In Western Europe, influenza transmission remains active and widespread, but overall disease activity has peaked. At least 13 of 21 countries (testing more than 20 sentinel samples) reported that 30% or more of sentinel specimens were positive for influenza, down from a peak of over 70%. All influenza viruses detected in Western Europe were pandemic H1N1 2009; however, very small numbers of seasonal influenza viruses, making up less than 1% of all influenza viruses detected, were reported in Russia. In addition, limited available data indicates that active, high intensity transmission is occurring in Northern African countries along the Mediterranean coast (Algeria, Tunisia, and Egypt).

In Central Asia, limited data suggest that influenza virus circulation remains active, but transmission may have recently peaked in some places. In West Asia, Israel, Iran, Iraq, Oman, and Afghanistan also appear to have passed their peak period of transmission within the past month, though both areas continue to have some active transmission and levels of respiratory disease activity have not yet returned to baseline levels.

In East Asia, influenza transmission remains active but appears to be declining overall. Influenza/ILI activity continued to decline in Japan, in northern and southern China, Chinese Taipei, and Hong Kong. Slight increases in ILI were reported in Mongolia after weeks of declining activity following a large peak of activity over one month ago. In southern Asia, influenza activity continues to be intense, particularly in northern India, Nepal, and, Sri Lanka. Seasonal influenza A (H3N2) viruses are still being detected in very small numbers in China making up about 2.5% of the influenza A viruses detected there.

In North America, influenza transmission remains widespread but has declined substantially in all countries. In the US, sentinel outpatient ILI activity has returned to the seasonal baseline, and indicators of severity, including hospitalizations, pediatric mortality, and P&I mortality have declined substantially since peaking during late October. Rates of hospitalization among cases aged 5-17 years and 18-49 year far exceeded rates observed during recent influenza seasons, while rates of hospitalizations among cases aged >65 years were far lower than those observed during recent influenza seasons.

In the tropical regions 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 focal increases in respiratory disease activity in a few countries.

In the temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.
(WHO 12/30/2009)

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Asia
Cambodia: Avian influenza H5N1 strikes poultry farm
Cambodian officials have reported an H5N1 avian influenza outbreak at a poultry farm in Kampong Cham province, in the southeastern part of the country, according to a report from the World Organization for Animal Health (OIE). The virus killed 143 birds in a backyard poultry area of Ponhea Kreak district that contained 1,216 chickens and ducks. Authorities culled the remaining birds to control the spread of the virus. The outbreak started on 16 December 2009, and investigators have not yet determined the source of the virus. Veterinary authorities ordered the backyard poultry operation to be disinfected, and they restricted poultry movements in the area. The outbreak is Cambodia's first reported outbreak since December 2008. The country's health ministry recently reported an H5N1 infection in a 57-year-old man who was from the same district, but an 18 December 2009 report from the WHO said the ministry was conducting an investigation into the source of the man's infection.
(CIDRAP 12/31/2009)

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China: Nationwide A/H1N1 epidemiological investigation to be launched in 2010
China will launch a nationwide epidemiological investigation of A/H1N1 influenza next year in a bid to provide more scientific data for further prevention and control measures. According to a circular released by the Ministry of Health on 30 December 2009, the research will be focused on 12 provinces, municipalities and autonomous regions including Beijing, Shandong and Henan. A total of 54,000 people -- 4,500 for each province -- will be surveyed. The research will be carried out in three time periods: January, March-April and August-September. Experts with the ministry said that currently a large number of patients only have slight flu symptoms and many potential infection cases exist, which means the official number of flu cases can no longer reflect the actual epidemic situation in the country.

A nationwide serum epidemiological investigation will also be launched next year, sampling 400 people from each of the 31 provinces, municipalities, autonomous regions and the Xinjiang Production and Construction Corps.

Statistics from the ministry show that, from Dec. 21 to 27, a total of 4,448 new flu cases were reported across the country.
(Xinhua News 12/30/2009)

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Hong Kong: Avian Influenza A/H9N2 infection in 35-month-old girl
The Centre for Health Protection (CHP) of the Department of Health is investigating a case of influenza A/H9N2 infection -- a mild form of avian influenza -- involving a 35-month-old girl. A CHP spokesman said 23 December 2009 that the girl, living in Sha Tin, developed symptoms of cough, fever, and runny nose in late November 2009. She was admitted to the Prince of Wales Hospital and was discharged on 11 December 2009. She has now recovered.

Influenza A/H9N2 was detected in the patient's respiratory specimen. Investigation is ongoing, and the department will inform the World Health Organization. This is the seventh time that H9 viruses were found in humans in Hong Kong. Five females and a male were confirmed to have suffered from H9 infection in 1999, 2003, 2007, 2008 and 2009.

Influenza A/H9 is an avian influenza virus which has been isolated from ducks and chickens for many years. Infection in humans is rare and appears to present as a mild disease.
(ProMED 12/24/2009)

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Indonesia: 20 Avian influenza H5N1 cases reported--19 fatal since January
Indonesia's Ministry of Health, updating information on H5N1 avian influenza for the first time since 22 January 2009, has quietly reported that the country has had 20 human cases so far in 2009, with 19 of them fatal-a 95% case-fatality rate (CFR). A brief notice from the Ministry of Health on 28 December 2009 listed the figures and said the latest reported case was identified in South Jakarta on 23 September 2009. Indonesia's cumulative H5N1 toll since 2005 is now 161 cases with 134 deaths, for a CFR of 83%.

Indonesia's then-health minister, Siti Supari, announced in June 2008 that the government would stop issuing prompt reports of new H5N1 cases and instead offer only periodic updates. The announcement raised concern about the world's ability to track the virus's evolution and impact. Supari also stirred controversy in 2007 by clamping down on sending samples from H5N1 patients to the WHO, saying viruses from the samples are used to make vaccines that enrich pharmaceutical companies but are too expensive for Indonesia and other developing countries.
(CIDRAP 12/30/2009)

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North Korea: Aid group claims government issued a flu alert
A humanitarian agency said North Korea recently issued a nationwide alert about its apparently worsening outbreak of pandemic flu. The Seoul-based Buddhist aid group Good Friends said that North Korean officials declared that novel H1N1 patients should be given priority. The group said the statement was of a type issued only twice before, for war-related casualties in the 1950s and in 2002. South Korea has shipped 500,000 doses of antivirals to the North.
(CIDRAP 12/30/2009)

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Americas
Chile: Three H1N1 reinfections reported
In a letter in Emerging Infectious Diseases, Chilean physicians describe pandemic flu reinfection in three patients, ages 14, 38, and 62 years. Both initial and repeat infections were confirmed via polymerase chain reaction (PCR) test. The authors attributed the reinfections, which occurred two to three weeks after recovery from the initial illness, to incomplete immunity after the first infection and said one or two may have resulted from exposure in the hospital. [Complete article letter available at http://www.cdc.gov/eid/content/16/1/pdfs/156.pdf.]
(CIDRAP 12/29/2009)

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USA: Company says DNA flu vaccine formulated quickly
The pharmaceutical company Vical formulated an adjuvanted DNA-based vaccine against H1N1 influenza more rapidly than any of the companies relying on chicken eggs or cell-culture techniques, and demonstrated its immunogenicity in mice and rabbits, according to an article in Gene Therapy and Regulation. Vical, based in San Diego, has a $1.25 million contract with the US Navy for a phase 1 trial of a DNA-based vaccine against H1N1 flu. [Abstract available at http://www.worldscinet.com/gtr/04/0401/S1568558609000084.html.]
(CIDRAP 12/29/2009)

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USA: High-dose seasonal influenza vaccine approved for seniors
The US Food and Drug Administration (FDA) has approved a high-dose seasonal influenza vaccine for elderly people, whose aging immune systems may not respond effectively to flu vaccines intended for younger people. The vaccine, Fluzone High-Dose, made by Sanofi Pasteur, contains four times as much antigen as standard seasonal flu vaccines. The FDA and the company announced its approval 23 December 2009. It is intended for people aged 65 years and older and will be available in time for the 2010-11 flu season. It apparently is the first flu vaccine licensed in the United States specifically for older people.

In a phase 3 trial conducted during the 2006-07 flu season, involving 3,856 elderly people, the vaccine induced significantly stronger immune responses than standard-dose vaccine did. Non-serious side effects were more common with the high-dose vaccine, but the overall safety profile was similar to that of the standard vaccine, the company said. The study, which was published in the Journal of Infectious Diseases (JID) in July, did not assess actual protection from flu. Sanofi will be required to conduct further studies to determine whether the vaccine decreases flu in recipients.

Each dose of Fluzone High-Dose will contain 180 micrograms (mcg) of antigen-60 mcg for each of the three flu strains normally targeted in seasonal vaccines, the FDA said. Standard seasonal flu vaccines contain 15 mcg for each strain, for a total of 45 mcg.
(CIDRAP 12/28/2009)

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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 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. 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 H5N1.
- 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 health officials prepare for an influenza pandemic.
- The US government's website for pandemic/avian flu: http://www.flu.gov/. "Flu Essentials" are available in multiple languages.
- CIDRAP: http://www.cidrap.umn.edu/. Center for Infectious Disease Research and Policy based at the University of Minnesota.
- 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 avian influenza H5N1 in wild birds and poultry.

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3. Articles
Household Transmission of 2009 Pandemic Influenza A (H1N1) Virus in the United States
Cauchemez S, Donnelly CA, Reed C, et al. N Engl J Med. 31 December 2009; 361(27): 2619-2627.
Available at http://content.nejm.org/cgi/content/full/361/27/2619.

Background. As of June 11, 2009, a total of 17,855 probable or confirmed cases of 2009 pandemic influenza A (H1N1) had been reported in the United States. Risk factors for transmission remain largely uncharacterized. We characterize the risk factors and describe the transmission of the virus within households.

Methods. Probable and confirmed cases of infection with the 2009 H1N1 virus in the United States were reported to the Centers for Disease Control and Prevention with the use of a standardized case form. We investigated transmission of infection in 216 households - including 216 index patients and their 600 household contacts - in which the index patient was the first case patient and complete information on symptoms and age was available for all household members.

Results. An acute respiratory illness developed in 78 of 600 household contacts (13%). In 156 households (72% of the 216 households), an acute respiratory illness developed in none of the household contacts; in 46 households (21%), illness developed in one contact; and in 14 households (6%), illness developed in more than one contact. The proportion of household contacts in whom acute respiratory illness developed decreased with the size of the household, from 28% in two-member households to 9% in six-member households. Household contacts 18 years of age or younger were twice as susceptible as those 19 to 50 years of age (relative susceptibility, 1.96; Bayesian 95% credible interval, 1.05 to 3.78; P=0.005), and household contacts older than 50 years of age were less susceptible than those who were 19 to 50 years of age (relative susceptibility, 0.17; 95% credible interval, 0.02 to 0.92; P=0.03). Infectivity did not vary with age. The mean time between the onset of symptoms in a case patient and the onset of symptoms in the household contacts infected by that patient was 2.6 days (95% credible interval, 2.2 to 3.5).

Conclusions. The transmissibility of the 2009 H1N1 influenza virus in households is lower than that seen in past pandemics. Most transmissions occur soon before or after the onset of symptoms in a case patient.

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Outbreak of 2009 Pandemic Influenza A (H1N1) at a New York City School
Lessler J, Reich NG, Cummings DAT, et al. N Engl J Med. 31 December 2009; 361(27):2628-2636.
Available at http://content.nejm.org/cgi/content/full/361/27/2628.

Background. In April 2009, an outbreak of novel swine-origin influenza A (2009 H1N1 influenza) occurred at a high school in Queens, New York. We describe the outbreak and characterize the clinical and epidemiologic aspects of this novel virus.

Methods. The New York City Department of Health and Mental Hygiene characterized the outbreak through laboratory confirmation of the presence of the 2009 H1N1 virus in nasopharyngeal and oropharyngeal specimens and through information obtained from an online survey. Detailed information on exposure and the onset of symptoms was used to estimate the incubation period, generation time, and within-school reproductive number associated with 2009 H1N1 influenza, with the use of established techniques.

Results. From April 24 through May 8, infection with the 2009 H1N1 virus was confirmed in 124 high-school students and employees. In responses to the online questionnaire, more than 800 students and employees (35% of student respondents and 10% of employee respondents) reported having an influenza-like illness during this period. No persons with confirmed 2009 H1N1 influenza or with influenza-like illness had severe symptoms. A linkage with travel to Mexico was identified. The estimated median incubation period for confirmed 2009 H1N1 influenza was 1.4 days (95% confidence interval [CI], 1.0 to 1.8), with symptoms developing in 95% of cases by 2.2 days (95% CI, 1.7 to 2.6). The estimated median generation time was 2.7 days (95% CI, 2.0 to 3.5). We estimate that the within-school reproductive number was 3.3.

Conclusions. The findings from this investigation suggest that 2009 H1N1 influenza in the high school was widespread but did not cause severe illness. The reasons for the rapid and extensive spread of influenza-like illnesses are unknown. The natural history and transmission of the 2009 H1N1 influenza virus appear to be similar to those of previously observed circulating pandemic and interpandemic influenza viruses.

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Household responses to pandemic (H1N1) 2009-related school closures, Perth, Western Australia
Effler PV, Carcione D, GieleEmerg C, et al. Emerg Infect Dis. February 2010; [Epub ahead of print].
Available at http://www.cdc.gov/eid/content/16/2/pdfs/09-1372.pdf.

Abstract. School closure is often purported to reduce influenza transmission, but little is known about its effect on families. We surveyed families affected by pandemic (H1N1) 2009-related school closures in Perth, Western Australia, Australia. Surveys were returned for 233 (58%) of 402 students. School closure was deemed appropriate by 110 parents (47%); however, 91 (45%) parents of 202 asymptomatic students reported taking >1 day off work to care for their child, and 71 (35%) had to make childcare arrangements because of the class closures. During the week, 172 (74%) students participated in activities outside the home on >1 occasion, resulting in an average of 3.7 out-of-home activities for each student. In our survey, activities outside the home were commonly reported by students affected by school closure, the effect on families was substantial, and parental opinion regarding school closures as a means to mitigate the outbreak of pandemic (H1N1) 2009 was divided.

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Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina
Libster R, Bugna J, Coviello S, Hijano DR, et al. N Engl J Med. 23 December 2009. [Epub ahead of print]

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 1 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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Improving the Clinical Diagnosis of Influenza-a Comparative Analysis of New Influenza A (H1N1) Cases
Ong AK, Chen MI, Lin L, et al. PLoS ONE. 29 December 2009;4(12): e8453. doi:10.1371/journal.pone.0008453.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0008453?utm_source.

Background. The presentation of new influenza A(H1N1) is broad and evolving as it continues to affect different geographic locations and populations. To improve the accuracy of predicting influenza infection in an outpatient setting, we undertook a comparative analysis of H1N1(2009), seasonal influenza, and persons with acute respiratory illness (ARI) in an outpatient setting.

Methodology/Principal Findings. Comparative analyses of one hundred non-matched cases each of PCR confirmed H1N1(2009), seasonal influenza, and ARI cases. Multivariate analysis was performed to look for predictors of influenza infection. Receiver operating characteristic curves were constructed for various combinations of clinical and laboratory case definitions. The initial clinical and laboratory features of H1N1(2009) and seasonal influenza were similar. Among ARI cases, fever, cough, headache, rhinorrhea, the absence of leukocytosis, and a normal chest radiograph positively predict for both PCR-confirmed H1N1-2009 and seasonal influenza infection. The sensitivity and specificity of current WHO and CDC influenza-like illness (ILI) criteria were modest in predicting influenza infection. However, the combination of WHO ILI criteria with the absence of leukocytosis greatly improved the accuracy of diagnosing H1N1(2009) and seasonal influenza (positive LR of 7.8 (95%CI 3.5-17.5) and 9.2 (95%CI 4.1-20.3) respectively).

Conclusions/Significance. The clinical presentation of H1N1(2009) infection is largely indistinguishable from that of seasonal influenza. Among patients with acute respiratory illness, features such as a temperature greater than 38°C, rhinorrhea, a normal chest radiograph, and the absence of leukocytosis or significant gastrointestinal symptoms were all positively associated with H1N1(2009) and seasonal influenza infection. An enhanced ILI criteria that combines both a symptom complex with the absence of leukocytosis on testing can improve the accuracy of predicting both seasonal and H1N1-2009 influenza infection.

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Development of a Rapid Automated Influenza A, Influenza B, and Respiratory Syncytial Virus A/B Multiplex Real-Time RT-PCR Assay and Its Use during the 2009 H1N1 Swine-Origin Influenza Virus Epidemic in Milwaukee, Wisconsin
Beck ET, Jurgens LA, Kehl SC, et al. J Mol Diagn. January 2010;12(1):74-81. Epub 2009 Dec 3.
Available at http://jmd.amjpathol.org/cgi/reprint/12/1/74.

Abstract. Rapid, semiautomated, and fully automated multiplex real-time RT-PCR assays were developed and validated for the detection of influenza (Flu) A, Flu B, and respiratory syncytial virus (RSV) from nasopharyngeal specimens. The assays can detect human H1N1, H3N2, and swine-origin (S-OIV) H1N1 Flu A viruses and were effectively used to distinguish Flu A infections (of all subtypes) from Flu B and RSV infections during the current S-OIV outbreak in Milwaukee, WI. The analytical limits of detection were 10(-2) to 10(1) TCID(50)/ml depending on the platform and analyte and showed only one minor cross-reaction among 23 common respiratory pathogens (intermittent cross-reaction to adenovirus at >10(7) TCID(50)/ml). A total of 100 clinical samples were tested by tissue culture, both automated assays, and the US Food and Drug Administration-approved ProFlu+ assay. Both the semiautomated and fully automated assays exhibited greater overall (Flu A, Flu B, and RSV combined) clinical sensitivities (93 and 96%, respectively) and individual Flu A sensitivities (100%) than the Food and Drug Administration-approved test (89% overall sensitivity and 93% Flu A sensitivity). All assays were 99% specific. During the S-OIV outbreak in Milwaukee, WI, the fully automated assay was used to test 1232 samples in 2 weeks. Flu A was detected in 134 clinical samples (126 H1N1 S-OIV, 5 H1N1 [human], and 1 untyped) with 100% positive agreement compared with other "in-house" validated molecular assays, with only 2 false-positive results. Such accurate testing using automated high-throughput molecule systems should allow clinicians and public health officials to react quickly and effectively during viral outbreaks.

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4. Notifications
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. 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
Antiviral Drugs for the 2009-2010 Influenza Season [Podcast]
Released 23 December 2009
Available at http://www2c.cdc.gov/podcasts/player.asp?f=175219#.

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 apecein@u.washington.edu