Vol. XIII, No. 1 ~ EINet News Briefs ~ Jan 08, 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
- 2010 Cumulative number of human cases of avian influenza A/H5N1
- WHO situation update on pandemic influenza H1N1
- Global: WHO says demand for donated vaccine may drop
- Egypt: Avian influenza H5N1 outbreaks reported
- France: Government to sell 89 million influenza H1N1 vaccine doses
- China: 659 recorded pandemic H1N1 influenza deaths in 2009
- Hong Kong: H5N1 highly pathogenic avian influenza in a wild bird
- Indonesia: Mass chicken deaths confirmed avian influenza H5N1 positive
- Japan: Texas poultry banned after possible low-pathogenicity avian influenza found
- Viet Nam (Ca Mau): Avian influenza resurfaces
- USA / Mexico: Phase II trial of Fludase
- USA: CDC hopes to prevent repeat of 1958 flu mortality surge
- USA: Avian influenza H1N1 in California turkeys, Illinois pig
- USA: Rapid influenza H1N1 diagnostic test gets EUA

2. Infectious Disease News
- Indonesia (Lampung): Chikungunya reports increase
- Indonesia (Bali): Rabies deaths update
- Russia (Moscow): 41 people hospitalized due to rabies concerns
- Viet Nam (Ho Chi Minh City): Increase in pediatric meningitis
- Peru: Suspected rabies related deaths in children
- USA: Multistate Outbreak of E. coli O157:H7 Infections Associated with Beef
- USA (New Hampshire): Woman with GI anthrax improves

3. Updates

4. Articles
- Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina
- Severe 2009 H1N1 influenza in pregnant and postpartum women in California
- Evidence for an Effect of Fetal Growth on the Risk of Tuberculosis
- Streptococcus pneumoniae coinfection is correlated with the severity of H1N1 pandemic influenza
- The critically ill child with novel H1N1 influenza A: A case series
- Swine-origin pandemic H1N1 influenza virus-like particles produced in insect cells induce hemagglutination inhibiting antibodies in BALB/c mice

5. 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

2010 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Total/ 0(0)

***For data on human cases of avian influenza prior to 2010, go to: http://depts.washington.edu/einet/humanh5n1.html

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 467 (282)
(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


WHO situation update on pandemic influenza H1N1
As of 3 January 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 12,799 deaths. The most active areas of pandemic influenza transmission currently are in parts of central, eastern and southeastern Europe, North Africa, and South Asia.

In Europe, pandemic influenza transmission remains geographically widespread throughout the continent and there continues to be intense virus circulation in several countries of central, eastern, and southeastern Europe - particularly in Poland, Serbia, Ukraine, Georgia - where a high intensity of respiratory diseases activity has been recently reported. Among countries testing more than 20 clinical specimens from sentinel sites in the past week, the greatest proportions of samples testing positive for influenza were observed in Greece (72%), Georgia (54%), Switzerland (49%), Portugal (48%), Germany (48%), Luxembourg (40%), Romania (30%), Poland (25%), and Albania (23%). In most of western and northern Europe, rates of ILI/ARI continued to decline substantially, and in many places have returned to near seasonal baselines. Sporadic cases of seasonal H3N2 influenza have been identified in Western Europe but in very small numbers. Crude mortality rates among most European countries, measured as the cumulative number of pandemic H1N1 influenza associated deaths per million population, appear to be within the same range as rates observed elsewhere in northern and southern hemisphere, suggesting a relatively consistent global pattern of mortality.

In North Africa and West Asia, limited data suggest that influenza transmission remains active. Although west Asia may have already experienced a peak in influenza activity, parts of North Africa continue to report increasing respiratory diseases activity, particularly in Egypt. Elevated levels of ILI activity and increased influenza virus detections were observed during November and December in Algeria and Morocco, but activity has likely peaked in the later.

In South Asia, pandemic influenza transmission remains geographically widespread and active across the subcontinent - particularly in northern India, Nepal, and in Sri Lanka - where an increasing trend in respiratory diseases activity was reported. In Southeast Asia, influenza transmission remains geographically regional to widespread; however, overall influenza activity appears to be low but variable. Localized increases in ILI were reported in parts of Thailand over the past three weeks. In Viet Nam, after a period of substantial influenza transmission during September through November, activity declined significantly in December. In Laos and Cambodia, overall respiratory disease activity was reported to be decreasing during most of December.

In East Asia, influenza transmission remains widespread and 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. Pandemic H1N1 is clearly still the predominant circulating virus but seasonal H3N2 viruses continue to circulate in very small numbers in northern China. Slight increases in rates of ILI were again reported in Mongolia.

In central Asia, there is evidence of declining rates of ILI/ARI since respiratory disease activity recently peaked in late November and early December in Uzbekistan and Kyrgyzstan, respectively.

In the Americas, both in the tropical and northern temperate zones, overall pandemic influenza activity continued to decline or remain low. In North America, peak influenza activity occurred during early, mid, and late October in Mexico, the United States, and Canada, respectively. In all three countries, as expected, a substantially greater number of cases were recorded during the fall and winter transmission period as compared to spring and summer transmission period. In Canada, after experiencing substantial influenza activity unusually early during the fall and winter period, rates of ILI have now dropped below the historical seasonal baseline.

In temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission. This suggests that the level of population immunity in areas that experienced intense, high-level transmission during a winter season is high enough to prevent sustained transmission from recurring during the summer when the virus is less transmissible.
(WHO 01/08/2010)


Global: WHO says demand for donated vaccine may drop
Developing countries in line to receive donated H1N1 vaccine from the WHO may not want as much as the agency has been aiming to provide. The WHO hoped to provide enough for 10% of the population of countries that wanted the vaccine, but the agency's Dr. Marie-Paule Kieny said that with the pandemic waning, governments are "considering whether and how much vaccine they want to deploy."
(CIDRAP 01/06/2010)


Europe/Near East
Egypt: Avian influenza H5N1 outbreaks reported
Ducks and chickens infected with avian influenza H5N1 have been found in Egypt during the first week of 2010, according to the website of Strengthening Avian Influenza Detection and Response (SAIDR), a joint project of the UN Food and Agriculture Organization, the US Agency for International Development, and the Egyptian government.
(CIDRAP 01/06/2010)


France: Government to sell 89 million influenza H1N1 vaccine doses
The French government is offering a vast amount of unused H1N1 flu vaccine for sale to other countries and may have found buyers in the Middle East. Of the 94 million doses bought to inoculate each resident two times, only about five million were used. According to France's health ministry, potential buyers include Qatar, Egypt, Mexico and Ukraine.
(CIDRAP 01/04/2010)


China: 659 recorded pandemic H1N1 influenza deaths in 2009
China said 4 January 2010 it had recorded 659 influenza pandemic (H1N1) 2009 virus infection deaths in 2009, nearly all of them in the last two months of the year, and warned that the danger of mass outbreaks still existed in certain areas. The health ministry said the total number of A(H1N1) 2009 virus infections recorded since the virus was first detected last year stood at 120,940. At the end of October 2009, the reported death toll stood at just six. The number of recorded deaths then spiked, reaching about 180 at the start of December 2009 and 659 by the end of that month.
(ProMED 01/05/2010)


Hong Kong: H5N1 highly pathogenic avian influenza in a wild bird
A single Oriental Magpie Robin was found dead with a H5N1 highly pathogenic avian influenza virus infection on 29 December 2009. The infected wild bird was detected by the ongoing surveillance program on wild birds. While there is no evidence of the spread of the virus, an intensive surveillance system is in place on all poultry farms, poultry markets, pet bird shops, park birds, and wild birds in Hong Kong. H5N1 infection was confirmed through an immunohistochemical test, polymerase chain reaction (PCR) and virus isolation.
(ProMED 01/06/2010)


Indonesia: Mass chicken deaths confirmed avian influenza H5N1 positive
6,615 chickens died in seven sub-districts in the province of South Kalimantan between early December 2009 and 3 January 2010. H5N1 avian influenza was suspected and confirmed in specimens tested by the Veterinary Investigation and Diagnostic Center (BPPV) Regional V, Banjarbaru, South Kalimantan. To date, this outbreak has been limited to chickens. No bird to human virus transmission has been reported.
(ProMED 01/06/2010)


Japan: Texas poultry banned after possible low-pathogenicity avian influenza found
Japan has ceased accepting imports of poultry raised and slaughtered in Texas due to possible low-pathogenic avian flu virus in a live-bird market associated with a duck flock. The Texas Animal Health Commission restricted movement of about 1,000 birds following the identification of a "weak positive" at the market during routine surveillance. Subsequently, the Japanese government refused any imports of poultry or eggs from the state, dating back to a slaughter or collection date of Dec 1, 2009.
(CIDRAP 01/07/2010)


Viet Nam (Ca Mau): Avian influenza resurfaces
H5N1 avian influenza has broken out again in the southern-most province of Ca Mau, a local official confirmed on 5 Jan 2010. The outbreak was detected at a breeding farm belonging to Tran Van To in Khanh Hung commune, Tran Van Thoi district, on 31 Dec 2009. The farm was home to 95 chickens and most of the dead birds tested positive for the A (H5N1) virus. All remaining chickens have been culled to prevent the spread of the virus.
(ProMED 01/06/2010)


USA / Mexico: Phase II trial of Fludase
NexBio, Inc. announced 7 January 2009 the initiation of a double blind placebo controlled multi-center trial in the U.S. and Mexico of DAS181 (Fludase) for the treatment of laboratory confirmed influenza infection. DAS181 is an investigational host-targeted drug candidate that blocks entry of influenza virus into cells of the respiratory tract. The trial will assess the effect of DAS181 on influenza viral load as measured by the amount of viral shedding in the upper respiratory tract. In addition, the trial will assess the drug's safety and tolerability and will follow duration of clinical symptoms and global functionality. The study is being conducted at over 50 sites in the U.S. and Mexico. The trial is funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and is being monitored by an independent Data Safety Monitoring Board. More information about the study can be found at: http://www.das181flustudy.com/.
(PRNewswire 01/07/2010)


USA: CDC hopes to prevent repeat of 1958 flu mortality surge
Warning against complacency about H1N1 influenza, Dr. Anne Schuchat of the Centers for Disease Control and Prevention (CDC) said she doesn't want to see a repeat of what happened in 1957-58, when a perception that the pandemic was over was followed by a winter surge of flu- and pneumonia-related deaths. To prevent that, Schuchat, head of the CDC National Center for Immunization and Respiratory Diseases, urged the public to get the vaccine, now widely available.

Schuchat referred to a graph showing that deaths attributed to flu and pneumonia peaked in October of 1957, dropped back to a nearly normal level in December, but then surged again in the winter, peaking in late February. (Accounts of the pandemic say the second mortality peak, strangely, was not accompanied by widespread flu outbreaks.)
(CIDRAP 01/07/2010)


USA: Avian influenza H1N1 in California turkeys, Illinois pig
California officials announced that the pandemic H1N1 virus has been detected in a turkey breeding flock in the central part of the state, the American Veterinary Medical Association (AVMA) reported. The only sign of illness was a drop in egg production. Meanwhile, the US Department of Agriculture reported that its National Veterinary Services Laboratories have confirmed the virus in swine herd samples from Illinois that were collected Dec 16, 2009.
(CIDRAP 01/07/2010)


USA: Rapid influenza H1N1 diagnostic test gets EUA
Cepheid's Xpert Flu A Panel, which can identify pandemic H1N1 influenza in less than an hour, was given Emergency Use Authorization (EUA) status by the US Food and Drug Administration today. The test runs on the company's GeneXpert System, and the EUA will allow its use in laboratories certified to perform "moderate complexity" testing, which includes hospital labs.
(CIDRAP 01/04/2009)


2. Infectious Disease News

Indonesia (Lampung): Chikungunya reports increase
Over 12,000 people in Lampung province have reportedly contracted chikungunya virus since mid December 2009, the highest recorded number in the last 10 years, according to the provincial Health Agency.

To date, Tulangbawang and Mesuji have been reported as the worst hit regencies in the province, where the disease has affected between 3,000 and 4,000 people in both regions. In West Lampung, the regency health agency reported that 930 people were suffering from chikungunya virus disease.
(ProMED 01/01/2010)


Indonesia (Bali): Rabies deaths update
There have now been 27 rabies related human deaths since the present outbreak was identified in mid-2008. All of those previously listed as actual or suspected are now confirmed as rabies deaths. Thus far the afflicted have all been local Bali inhabitants, but tourists and other visitors to the island should be forewarned of the risk and take precautions accordingly.
(ProMED 12/29/2009)


Russia (Moscow): 41 people hospitalized due to rabies concerns
Fears of contact with a rabies-stricken dog have left 41 people hospitalized in Moscow. The patients, three of them children, are being treated for rabies, reported the Russian chief sanitary inspector Gennadi Onishchenko. Local media reported on 28 December 2009 that the dog had bitten numerous people in mid December 2009, while others had had contact with the dog's saliva. The animal later died of rabies. None of the victims have shown signs of rabies so far.
Onishchenko has said that about 10,000 feral dogs live in Moscow's streets, including fighting dogs. Sterilization and other methods have yet to bring the situation under control. There have been five human rabies cases in the last half year.
(ProMED 12/30/2009)


Viet Nam (Ho Chi Minh City): Increase in pediatric meningitis
The onset of cold weather in Ho Chi Minh City has seen more children admitted to hospitals with meningitis, health officials say. A total of 16 children have been treated for meningitis at the Children's Hospital No.2 in December 2009. There were only five cases during the same peak time in 2008.

Truong Huu Khanh, dean of the Infection and Mental Disease Department at Children's Hospital No.1, said 22 children were inpatients for meningitis at present, including five to six critical cases treated in ICUs (intensive care units).
(ProMED 12/28/2009)


Peru: Suspected rabies related deaths in children
Health Authorities in Amazonas reported 6 January 2010 that seven children have died in the district of Nieva, presumably of a bat-related rabies outbreak. The disease has been found in several specimens of bats that live in the area, and all the victims showed the typical symptoms of rabies. However, the doctors have not been able to perform any autopsy to confirm the cause of these deaths due to cultural issues.
(ProMED 01/07/2010)


USA: Multistate Outbreak of E. coli O157:H7 Infections Associated with Beef
Twenty-one people in 16 states have been sickened in the recent steak-related outbreak of Escherichia coli O157:H7, the Centers for Disease Control and Prevention (CDC) announced. Nine victims have been hospitalized, one with hemolytic uremic syndrome. The outbreak began in mid-October and was detected by CDC staff in foodborne-illness test results in mid-December. On Dec 24 the US Department of Agriculture announced that Oklahoma-based National Steak and Poultry was recalling 248,000 pounds of "blade tenderized" steak that had been made into 25 different products. Five national restaurant chains have indicated they had purchased meat that is now part of the recall or closely linked to it: Applebee's Neighborhood Grill & Bar, Darden Restaurants Inc.'s Olive Garden, Moe's Southwest Grill, Carino's Italian, and KRM Inc., operator of a chain called the 54th Street Grill & Bar. [For more information, refer to CDC outbreak notice http://www.cdc.gov/ecoli/2010/.]
(CIDRAP 01/07/2010)


USA (New Hampshire): Woman with GI anthrax improves
A young New Hampshire woman who was in critical condition with a gastrointestinal (GI) anthrax infection has improved enough to be taken out of intensive care, the Associated Press reported. Investigators believe the woman probably swallowed anthrax spores while attending a drum circle gathering in Durham, N.H., on 4 December 2009. Tests revealed anthrax spores on two of 64 animal-hide drums used at the gathering and in a sample from an electrical outlet in the building where it was held. CDC confirmed on 31 December 2009 that the anthrax strain in those samples matched the strain that infected the patient. Contaminated animal hides from Africa were implicated in two cases of cutaneous anthrax in Connecticut in 2007 and an inhalational anthrax case in a New York City man in 2006. GI anthrax, which is usually contracted by eating raw or undercooked contaminated meat, is nearly unknown in the United States.
(CIDRAP 01/07/2010)


3. Updates
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
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/


- 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.


Australia (Queensland)
Health authorities are nervous that an outbreak of dengue fever during the Christmas holiday season will be difficult to contain. Queensland Health has confirmed 12 dengue fever cases in Townsville, north Queensland. There are two strains of the mosquito-borne virus circulating in the city, with nine people diagnosed as having dengue virus type 1 and 3 as having virus type 3.

More than 1,000 people across north Queensland were infected with the virus during the previous outbreak, which began in November 2008, including an elderly woman who died due to complications in March 2009.
(ProMED 12/28/2009)

Indonesia (East Kalimantan)
Dengue fever hit West Kutai regency, East Kalimantan, infecting hundreds of Dayak tribespeople in December 2009 and killing two in the past week when the only doctor on duty was away for Christmas. Most of the dengue fever patients were children under the age of 12.

Dengue fever has also surfaced in Balikpapan. The Balikpapan Health Agency recorded 891 dengue fever cases since November 2009. 12 of the patients died, including 11 children and one adult. The agency predicted cases of dengue fever would still be high in December and January due to heavy rain.
(ProMED 12/28/2009)

Mexico (South)
A dengue fever red alert has been declared in the states of Tabasco, Veracruz, Yucatan, and Campeche. Jose del Carmen Hernandez Ferrer, head of the Sanitary Jurisdiction No. 3, said the red alert is not meant to alarm the public, rather it is a parameter by which health authorities intensify actions that allow reduction of the risks of infection.

The most recent weekly report, registers a total of 105 dengue cases, of which 22 are dengue hemorrhagic fever, and one death has now been reported. In the southeast, dengue cases are increasing at alarming levels as a result of the rains; in the case of the states of Campeche and Veracruz, 5,241 cases have been registered and in Yucatan 1,247 illnesses have been reported. Nationally, the Health agency has registered 105,000 probable dengue cases and some 55,000 confirmed cases.
(ProMED 12/28/2010)


Viet Nam
Samples of vegetables, dog meat and shrimp paste taken from restaurants and markets in Hanoi and the northern provinces of Hai Phong, Hai Duong, and Thanh Hoa had tested positive for the Vibrio cholera bacterium, said Tran Nhu Duong, deputy head of the Hanoi-based National Institute of Hygiene and Epidemiology.

Although cholera in Viet Nam has not been as prevalent in 2009 as in the past, 471 cases have been reported in 15 provinces nationwide, with one fatality in the northern province of Ninh Binh, according to the Department of Preventive Health and Environment.
(ProMED 12/24/2009)


4. Articles
Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina
Libster R, Bugna J, Coviello S, et al. N Engl J Med. 2010 Jan 7;362(1):45-55. Epub 2009 Dec 23.
Available at http://content.nejm.org/cgi/content/full/362/1/45.

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.


Severe 2009 H1N1 influenza in pregnant and postpartum women in California
Louie JK, Acosta M, Jamieson DJ, et al. N Engl J Med. 07 January 2010;362(1):27-35. Epub 2009 Dec 23.
Available at http://content.nejm.org/cgi/content/full/362/1/27.

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 < or = 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 < or = 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. 2010 Massachusetts Medical Society


Evidence for an Effect of Fetal Growth on the Risk of Tuberculosis
Villamor E, Iliadou A, Cnattingius S. J Infect Dis. 04 January 2010. [Epub ahead of print]
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/650313.

Abstract. We examined the risk of tuberculosis in relation to birth weight and ponderal index among 21,596 Swedish twins born from 1926 through 1958. Using a cohort design, tuberculosis risk was 11% lower for every 500 g of birth weight ([Formula: see text]) and 8% lower for every 0.2 of ponderal index, calculated as birth weight in grams multiplied by 100 and divided by the cube of birth length in centimeters ([Formula: see text]). The association between birth weight and tuberculosis was stronger in male individuals than in female individuals. In co-twin control analyses among disease-discordant monozygotic twins, tuberculosis risk was 46% lower for every 500 g of birth weight ([Formula: see text]). The association was stronger in male individuals (87% risk reduction; [Formula: see text]) than it was in female individuals (16% reduction; [Formula: see text]). A similarly stronger relation with male sex, compared with female sex, was found for ponderal index. Because associations among monozygotic twins are largely independent of shared genetic or environmental factors, we postulate that fetal growth may play a causal role in susceptibility to tuberculosis, possibly through early programming of immunity.


Streptococcus pneumoniae coinfection is correlated with the severity of H1N1 pandemic influenza
Palacios G, Hornig M, Cisterna D, et al. PLoS ONE. 31 December 2009;4(12): e8540. doi:10.1371/journal.pone.0008540
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0008540.

Background. Initial reports in May 2009 of the novel influenza strain H1N1pdm estimated a case fatality rate (CFR) of 0.6%, similar to that of seasonal influenza. In July 2009, however, Argentina reported 3056 cases with 137 deaths, representing a CFR of 4.5%. Potential explanations for increased CFR included virus reassortment or genetic drift, or infection of a more vulnerable population. Virus genomic sequencing of 26 Argentinian samples representing both severe and mild disease indicated no evidence of reassortment, mutations associated with resistance to antiviral drugs, or genetic drift that might contribute to virulence. Furthermore, no evidence was found for increased frequency of risk factors for H1N1pdm disease.

Methods/Principal Findings. We examined nasopharyngeal swab samples (NPS) from 199 cases of H1N1pdm infection from Argentina with MassTag PCR, testing for 33 additional microbial agents. The study population consisted of 199 H1N1pdm-infected subjects sampled between 23 June and 4 July 2009. Thirty-nine had severe disease defined as death (n = 20) or hospitalization (n = 19); 160 had mild disease. At least one additional agent of potential pathogenic importance was identified in 152 samples (76%), including Streptococcus pneumoniae (n = 62); Haemophilus influenzae (n = 104); human respiratory syncytial virus A (n = 11) and B (n = 1); human rhinovirus A (n = 1) and B (n = 4); human coronaviruses 229E (n = 1) and OC43 (n = 2); Klebsiella pneumoniae (n = 2); Acinetobacter baumannii (n = 2); Serratia marcescens (n = 1); and Staphylococcus aureus (n = 35) and methicillin-resistant S. aureus (MRSA, n = 6). The presence of S. pneumoniae was strongly correlated with severe disease. S. pneumoniae was present in 56.4% of severe cases versus 25% of mild cases; more than one-third of H1N1pdm NPS with S. pneumoniae were from subjects with severe disease (22 of 62 S. pneumoniae-positive NPS, p = 0.0004). In subjects 6 to 55 years of age, the adjusted odds ratio (OR) of severe disease in the presence of S. pneumoniae was 125.5 (95% confidence interval [CI], 16.95, 928.72; p<0.0001).

Conclusions/Significance. The association of S. pneumoniae with morbidity and mortality is established in the current and previous influenza pandemics. However, this study is the first to demonstrate the prognostic significance of non-invasive antemortem diagnosis of S. pneumoniae infection and may provide insights into clinical management.


The critically ill child with novel H1N1 influenza A: A case series
Lockman, J, Fischer, W, Perl, T, et al. Pediatr Crit Care Med. 31 December 2009. [Epub ahead of print]
Available at http://journals.lww.com/pccmjournal/Abstract/publishahead/The_critically_ill_child_with_novel_H1N1_influenza.99631.aspx.

Objective: To describe the presentation, course, and outcome of critically ill children with novel H1N1 influenza disease.

Design: Retrospective case series.

Setting: Pediatric intensive care unit in an urban tertiary academic center.

Patients: Thirteen consecutive patients admitted between June 2009 and August 2009 and known or subsequently found to be infected with novel H1N1 influenza A.

Interventions: None.

Measurements and Main Results: Clinical, laboratory, and radiographic data were reviewed. The patients were predominantly male (62%), aged 5 months to 21 yrs, and most (92%) had known risk factors for severe disease. Direct fluorescent antibody testing had a high false-negative rate (62%) and delayed treatment in some cases. The respiratory illness presented clinically with both bronchoconstriction and alveolar consolidation to varying degrees. Bacterial superinfection occurred frequently (23%). Forty-six percent of patients required mechanical ventilation and 23% required inotropic support for hypotension. None of the patients in this series required extracorporeal membrane oxygenation. Intensive care unit length of stay did not differ between an early (within 48 hrs) oseltamivir treatment group (length of stay, 4.2 +/- 4.4 days) vs. a late treatment group (length of stay, 6.8 +/- 8.8 days). All patients survived to hospital discharge.

Conclusions: Underlying chronic illness (especially respiratory illness) seems associated with critical novel H1N1 influenza disease in children. Respiratory manifestations are highly variable among patients and within a single patient involving both bronchoconstriction and alveolar disease. Therapies must be individualized and rapidly adjusted. The duration of critical illness was not different between early and late treatment groups. Whether this is reflective of sample size or indicative of the importance of therapeutic intervention at any time early during infection in critically ill patients is unclear. Bacterial superinfection was more common than previously reported for seasonal influenza A. Moderate novel H1N1 influenza disease, including respiratory failure and hypotension, had 100% survival in our series.


Swine-origin pandemic H1N1 influenza virus-like particles produced in insect cells induce hemagglutination inhibiting antibodies in BALB/c mice
Krammer F, Nakowitsch S, Messner P, et al. Biotechnol J. 29 Dec 2009. [Epub ahead of print]
Available at http://www3.interscience.wiley.com/journal/123227482/.

Abstract. Recent outbreaks of influenza A highlight the importance of rapid and sufficient supply for pandemic and inter-pandemic vaccines. Classical manufacturing methods for influenza vaccines fail to satisfy this demand. Alternatively, cell culture-based production systems and virus-like particle (VLP)-based technologies have been established. We developed swine-origin pandemic H1N1 influenza VLPs consisting of hemagglutinin (A/California/04/2009) and matrix protein. Hemagglutinin and matrix protein were co-expressed in insect cells by the baculovirus expression system. VLPs were harvested from infection supernatants, purified and used for intraperitoneal immunization of BALB/c mice. Immunization induced high serum antibody titers against A/California/04/2009 as well as hemagglutination inhibiting antibodies. Additionally, we compared VLP production in two different insect cell lines, Sf9 and BTI-TN5B1-4 (High FiveTM). Taken together VLPs represent a potential strategy for the fight against new pandemic influenza viruses.


5. Notifications
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/.


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/.


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


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/.


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.


Updated influenza guidance and information from the US CDC
Fact Sheet: Safety of Thimerosal in Vaccines Against 2009 H1N1 Flu
Released 04 January 2010
Available at http://www.cdc.gov/h1n1flu/vaccination/vaccine_factsheet.htm

Flu information for People with Diabetes and Caregivers of People with Diabetes
Released 06 January 2010
Available at http://www.cdc.gov/h1n1flu/diabetes/diabetes_factsheet.htm