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Vol. VIII, No. 10 ~ EINet News Briefs ~ May 13, 2005


*****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:
- Global: Destruction of influenza A (H2N2) proficiency testing samples
- East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
- Cambodia: Fourth avian influenza case and death confirmed
- Thailand: Declares avian flu battle is over
- East Asia: Doubts about sensitivity of avian influenza diagnostic testing in humans
- Indonesia: Polio cases spread; 4 cases confirmed
- China: Beijing to establish animal epidemic disease prevention center
- Russia: 3 People hospitalized with CCHF in Stavropol
- USA (multi-state): Salmonella outbreak linked to poultry
- USA: Combination vaccine approved to protect adolescents against whooping cough
- USA: Over 70 cases in Cyclospora outbreak in Florida
- Canada: 40 cases of Cyclospora in Toronto, Ontario
- Canada: Milkshakes linked to E. coli illness
- Canada: Rubella cases probably from Netherlands

1. Updates
- Influenza
- Cholera, diarrhea & dysentery
- Dengue/DHF
- Typhoid

2. Articles
- WHO/WPRO: "Nature" magazine article on bird flu misleading
- Trade related infections: farther, faster, quieter
- Outbreak of Multidrug-Resistant Salmonella Typhimurium Associated with Rodents Purchased at Retail Pet Stores--United States, December 2003--October 2004
- Positive Test Results for Acute Hepatitis A Virus Infection Among Persons With No Recent History of Acute Hepatitis--United States, 2002--2004
- Assessment of Epidemiologic Capacity in State and Territorial Health Departments--USA, 2004
- Terrorism and emergency preparedness in state and territorial public health depts., US, 2004

3. Notifications
- First APEC Emergency Preparedness Task Force Meeting in Bali, Indonesia
- Control of Communicable Diseases Manual 18th Ed
- Publication of Guidance on Public Reporting of Healthcare-Associated Infections
- Fourth Annual Conference on Public Health Law--June 13--15, 2005
- National Nursing Home Week --- May 8--14, 2005
- Hepatitis Awareness Month --- May 2005
- 2005 National HIV Prevention Conference
- Fred Hutchinson Cancer Research Center to co-sponsor global health-care summit June 8-11, 2005
- 60th Annual Meeting of the International Conference on Diseases in Nature Communicable to Man (INCDNCM)

4. APEC EINet activities
- EINet article on trade related infections

5. To Receive EINet Newsbriefs
- To Receive EINet Newsbriefs


Global
Global: Destruction of influenza A (H2N2) proficiency testing samples
All influenza A (H2N2) samples that were prepared by a private contractor laboratory and distributed to more than 6000 laboratories and health care facilities in 18 countries as part of influenza proficiency testing panels have been accounted for and are reported by the proficiency testing organizations that sent out the panels as being destroyed. Most of the labs were in the U.S. The virus has not circulated since 1968, which means that most people now would have little or no immunity to it. The organizations received written confirmations of destruction from their client laboratories that received these samples. The U.S. Department of Health and Human Services (HHS), the CDC, and the WHO are continuing follow up investigations to evaluate the cause of the incident and determine how best to prevent similar incidents from occurring in the future.

As of May 3, 2005, there have been no confirmed reports of H2N2-related illness associated with possible exposure to the proficiency testing samples. CDC and other public health agencies will continue to follow up reports of possible cases of influenza-like illness among laboratory workers occurring after working with the samples that contained H2N2. See the Health Alert Network (HAN) notice of April 15 (http://www.cdc.gov/flu/h2n2situation.htm) for more information about these follow-up procedures. CDC and HHS are also in touch with foreign governments and WHO regarding investigations of any reports of possible H2N2-related influenza-like illness worldwide.

The influenza A (H2N2) samples were included in laboratory proficiency testing panels distributed to U.S. and international laboratories from October 2004 through March 2005. Following full characterization of the influenza A isolate submitted to Canadian public health authorities, investigators recognized the virus in the proficiency testing kits as an influenza A (H2N2) virus that closely resembled the viruses circulating in 1957 and 1958; influenza A (H2N2) is a virus that has not circulated among humans since 1968. Because of the potential public health risk associated with this virus, public health agencies, including WHO, HHS, and CDC, recommended immediate destruction of all the proficiency test samples to prevent reintroduction of the strain.

CDC has formed a multi-agency task force that will conduct an extensive investigation into the circumstances that led to the H2N2 samples being included in the proficiency testing kits. It is expected that the findings of the task force will be used to help improve the proficiency testing system and prevent an occurrence of a similar event in the future.Additionally, CDC is working with the National Institutes of Health (NIH) to raise the recommended Biosafety Level for laboratory work involving some human influenza A (H2N2) viruses. CDC and NIH recommend that wild-type non-contemporary human influenza A (H2N2) strains should be handled by using Biosafety Level 3 and Animal Biosafety Level 3 practices, procedures, and facilities, with rigorous adherence to additional respiratory protection and clothing change protocols. Negative pressure, HEPA-filtered respirators or positive air-purifying respirators (PAPRs) are being recommended for use. Important considerations in working with these strains are the number of years since an antigenically related virus last circulated and the potential for presence of a susceptible population. For additional information about this interim laboratory guidance, please see: http://www.cdc.gov/flu/h2n2bsl3.htm. For additional information about the influenza A (H2N2) situation, please refer to CDC's website at http://www.cdc.gov/flu/h2n2situation.htm.

The Biosafety Recommendations are part of a new edition of guidelines for biomedical labs that will be published in full this fall. With regard to the 1918 pandemic virus, the recommendations state, "Any research involving reverse genetics of the 1918 influenza strain should proceed with extreme caution. The risk to laboratory workers is unknown at the present time, but the pandemic potential is thought to be significant." In recent studies, researchers have engineered viruses similar to the 1918 pandemic strain, H1N1, and exposed mice to them in an effort to learn what made the virus so deadly. The 1918 pandemic is estimated to have killed between 50 million and 100 million people around the world. (CDC 5/3/05; Promed 5/4/05)

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Asia
East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) compiles up-to-date figures of avian influenza cases and deaths in East Asia. As of 4 May 2005 the number of unofficial cases in East Asia from Jan 2004 to the present is 90 with 53 deaths; the official WHO figures are 89 cases and 52 deaths. Numbers of cases reported mid-Dec 2004 to present are:

Economy / Unofficial (Official) Cases / Unofficial (Official) Deaths
Cambodia / 4 (4) / 4 (4)
Thailand / 0 (0) / 0 (0)
Viet Nam / 41 (41) / 16 (16)
Total / 45 (45) / 20 (20)
(CIDRAP, 5/4/05 http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html)

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Cambodia: Fourth avian influenza case and death confirmed
The Ministry of Health in Cambodia confirmed today that a 20-year-old woman from Kampot province who died 19 Apr 2005 in a hospital in Viet Nam, was the country's fourth reported case of avian influenza. The woman, a secondary school student, was from Kompong Trach district in Kampot province, the same district as the first case reported from Cambodia in February. Samples taken from the woman tested positive for avian influenza A/H5 virus by the Pasteur Institute in Ho Chi Minh City. Staff from the Ministry of Health, Cambodia conducted active case finding in the village where the woman attended school and also provided education sessions to the students at the school. The Ministry of Agriculture is conducting an investigation into poultry deaths in the area of the school. (WHO 5/4/05)

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Thailand: Declares avian flu battle is over
After an arduous 10-month battle against the H5N1 avian influenza virus, Thailand has declared itself free of the disease, the Bangkok Post reported. The country hasn't identified a human case of H5N1 infection since the death in Oct 2004 of a 14-year-old girl, but poultry outbreaks had continued. 5 May 2005 marked the end of a 3-week surveillance period at a farm in Lop Buri, the last place to have reported an H5N1 outbreak, the newspaper said. This is the first time Thailand has been free of avian flu since the disease re-emerged Jul 2004. Officials will continue to conduct bi-weekly checks for avian flu. In addition, the ministry has recruited more than 600 temporary workers to watch for avian flu. They will work in 9 northern and central provinces where H5N1 kept reappearing. Along with the surveillance, officials will seek closed-system poultry-raising methods for small-scale farms.

The end of the outbreaks is good news for Thailand's poultry industry. Chicken exports are expected to reach a target of 300 000 tons in 2005, Anan Sirimongkolkasem, president of the Thai Broiler Processing Exporters Association, told the Post. That is nearly a 40 percent increase over 2004. Thailand is chiefly shipping cooked products because raw poultry remains banned in major export markets, he said. Since the first emergency report from Thailand on the diagnosis of Highly Pathogenic Avian Influenza on 23 Jan 2004, the country has meticulously sent follow-up reports to the OIE. The last report pertaining to 3 new outbreaks, follow-up report No 51, was sent 12 Apr 2005. The later reports, 52 and 53 (29 Apr and 6 May 2005, respectively), announced the absence of new cases.

OIE's last update (6 May 2005) of the HPAI H5N1 panzootic, includes the number of accumulated outbreaks in each country: Cambodia (15), China (50), Hong Kong (4), Indonesia (207), Japan (5), South Korea (19), Laos (1), Malaysia (10), Thailand (1092) and Viet Nam (1837). Of these, 3 countries have sent their final reports in which they notified their regained freedom from HPAI: Japan (13 Jul 2004), S. Korea (24 Sep 2004) and Malaysia (4 Jan 2005). According to the said article, a country may be considered free from HPAI when it has been shown that HPAI has not been present for at least the past 3 years; or 6 months after the slaughter of the last affected animal for countries in which a stamping-out policy is practiced with or without vaccination against HPAI. The above 3 countries applied stamping-out and refrained from vaccinating. Thailand has adopted the same policy. (Promed 5/6/05)

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East Asia: Doubts about sensitivity of avian influenza diagnostic testing in humans
A diagnostic test designed by Canadian researchers and used in Viet Nam to detect avian influenza A (H5N1) virus infection is out of date, scientists from the National Microbiology Laboratory admit, raising the possibility that some human cases may have been dismissed in error. The test was designed at the Winnipeg lab using genetic sequencing information from samples of the virus that circulated in the early 2004. But the virus has changed enough since then that questions have surfaced about the test's sensitivity. Tracking the virus's forays into and among humans is critical, given fears that the H5N1 virus may acquire the ability to transmit easily from person to person, sparking an influenza pandemic.

Earlier this year 2005, Japanese scientists retested a number of specimens that technicians at a lab in Ho Chi Minh City had determined were negative. The re-analysis found several of the rejected cases were actually positive. A scientist from the Winnipeg lab says at least part of the problem behind the out-of-date test stems from the fact that Vietnamese laboratories have had limited success in isolating and growing stocks of the circulating viruses in 2005. For reasons that are not clear, the virus is not growing well in the cell culture medium that was used in the past, says Darwyn Kobasa, a respiratory virus researcher. "There have been enough changes in the viruses between last year [2004] and this year that we found some of our PCR primers did not work that well," says Kobasa. "With our own testing, we found there were some issues with sensitivity…"

The National Institute for Hygiene and Epidemiology has been using the Canadian test as a screening tool. All specimens from suspected H5N1 cases were tested using the Canadian assay. Samples that tested positive were then re-tested using primers designed at the U.S. CDC. If the second test came back positive as well, the case was considered confirmed. But samples that tested negative during the screening were not subjected to the second test. The Winnipeg lab will now try to design more sensitive primers. (Promed 5/9/05)

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Indonesia: Polio cases spread; 4 cases confirmed
4 young children in Indonesia are now confirmed to have polio, in the country's first outbreak in a decade. Officials said other suspected cases, all of which have been recorded in the same area of West Java province, were still being investigated. WHO has called on Indonesia – which has generally good vaccination coverage -- to step up its campaign. Officials are confident they could prevent a major outbreak. The WHO said 5 May 2005 that 2 more infants were confirmed to have contracted the disease, after Indonesian authorities announced earlier this week that 2 other children were infected.

Polio is a waterborne disease which usually infects young children by attacking the nervous system. It causes paralysis and muscular atrophy, and there is no cure. Polio vaccination rates across Indonesia stand at about 90 percent, but in western Java the rate has been around 55 percent. Authorities have now launched a drive to immunize 5 million children in the area. DNA tests done on a viral sample from one of the infected children has determined that the polio arrived in Indonesia from Nigeria, via Saudi Arabia. Experts suspect the strain could have been carried by migrant workers or pilgrims visiting Muslim holy sites in Saudi Arabia. The disease has all but disappeared in the developed world, but it is still endemic in Nigeria, a problem that was made worse in 2003 when Muslim clerics there spread rumors that the polio vaccine had been contaminated to make Muslims infertile.Until the middle of the 20th century, when a vaccine was discovered, polio was endemic across the globe, and the international campaign for universal vaccination has been one of the great successes in the fight against disease of recent years. (Promed 5/5/05)

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China: Beijing to establish animal epidemic disease prevention center
Beijing will establish an animal epidemic disease prevention and control center together with an animal disease information management and early-warning system, sources with the municipal agriculture bureau said 1 May 2005. The move is to strengthen the supervision over animal epidemics and improve emergency handling abilities for any exotic animal epidemic diseases. According to an official, Beijing will enhance the management for animal epidemic prevention, improve the animal epidemic prevention and supervision system, and integrate the veterinary technical resources. The city also plans to establish an animal quarantine farm and 2 isolation and disposal stations for sick animals or contaminated animal products, while promoting experiments in chain distribution or pesticides, improving the archive management for the use of pesticides and animal remedies in plantations, and fish-breeding and poultry-raising bases. The general structure of the competent authorities dealing with animal health issues in the People's Republic of China (PRC) are as follows:

1. On the central level, there are 2 main entities:

a. The Ministry of Agriculture (MOA), comprising 4 principal bodies:
i. The Bureau of Animal Husbandry and Health
ii. The National General Station of Animal Husbandry and Health
iii. The Animal Disease Monitoring Centre
iv. The National Institute for Veterinary Pharmaceutics Supervision

b. The State General Administration of the PRC for Quality Supervision and Inspection and Quarantine (AQSIQ).

2. On the regional and local levels, both of the above central structures have their provincial, municipal and other branches.

There are 31 provincial, 374 regional (prefecture level), and 1990 county level animal husbandry and health bureaus in the country. Under their respective authority, 31 provincial, 407 prefecture, 3117 county animal husbandry and veterinary stations have been established. The stations are equipped for diagnosis and surveillance, animal health research, diagnostic and inspection services, and are responsible for the prevention and quarantine of animal disease and zoonoses, as well as the promotion and application of veterinary diagnostic techniques. (Promed 5/6/05)

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Russia: 3 People hospitalized with CCHF in Stavropol
3 people have been hospitalized in Stavropol with Crimean-Congo hemorrhagic fever (CCHF). 7 more people who had been bitten by ticks are under medical observation. According to the Stavropol State Epidemiological Surveillance Center, the first case of tick-bite this season was reported 21 Apr 2005. Up to the present, about 400 people have been treated for tick bites. Most of these people look after domestic animals. They usually remove ticks from an animal's skin by hand, and the ticks may be crushed in the process. CCHF virus infection could be transmitted via cuts or abrasions. A blood donor day has been organized in Stavropol as a way of combating infection. Most of the donors were students. Over the past 5 years, about 15 people have died from CCHF and about 100 people in Stavropol have been treated for the disease. Presumably, the blood donations by students were intended for treatment of hemorrhage, as blood donations from adult rural workers might transmit CCHF virus infection. (Promed 5/1/05)

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Americas
USA (multi-state): Salmonella outbreak linked to poultry
9 people from New Mexico and 4 other states (Colorado, Kansas, Oklahoma and Texas) have been reported with salmonella infections in the past 2 months, and 6 of those cases are linked to young poultry from a New Mexico hatchery. 7 of the 9 cases in Mar and Apr 2005 were in children age 1 year or younger, the New Mexico agency said. 3 of those with infections live in Taos, Roosevelt, and Curry counties. Symptoms of salmonella, which begin 12 to 72 hours after exposure, include diarrhea, fever, and abdominal cramps that usually last 4 days to a week. The Health Department said most people recover without medication or treatment, but that young children can suffer from more severe symptoms.

Also, 5 Oregon cases of Salmonella have been identified, with the source of the outbreak being traced to baby chicks from a Washington hatchery. Residents in Washington and Idaho have also been affected. Some people who were infected reported that they did not handle chicks directly, but hadworked or passed through rooms where chicks were kept. Baby chicks, usually sold by mail order or in feed stores, have been repeatedly identified as the source of salmonellosis outbreaks.

Human salmonella infections occur when contaminated food, hands, or other objects are placed in the mouth. Health officials recommend that young children avoid contact with poultry and that people who handle baby chicks, ducks, or other poultry thoroughly wash their hands with soap and water afterward. Poultry also should be kept outdoors in an area separate from young children or sources of food. (Promed 5/6/05)

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USA: Combination vaccine approved to protect adolescents against whooping cough
The US Food and Drug Administration (FDA) approved on 3 May 2005 the first combination vaccine that provides a booster immunization against pertussis (whooping cough) in combination with tetanus and diphtheria for adolescents. The vaccine will be marketed as Boostrix by GlaxoSmithKline (GSK). Pertussis is a highly communicable disease of the respiratory tract that can be especially serious for infants under 1 year old, and may even be fatal. Pertussis can cause spells of coughing and choking that make breathing difficult. The disease is generally less severe in adolescents, but it is thought that they might transmit the disease to susceptible infants and other family members. In the last 20 years, rates of pertussis infection have been increasing in very young infants who have not received all their immunizations and in adolescents and adults.

Boostrix is a tetanus toxoid (T), reduced diphtheria toxoid (d) and acellular pertussis vaccine (ap), adsorbed. Although booster vaccines for adolescents containing T and d are currently licensed and marketed for use in this age group, none contains a pertussis component. Boostrix has the same components as Infanrix, a DTaP vaccine for infants and young children, but in reduced quantities. Boostrix is indicated for use as a single booster dose to adolescents age 10-18 years. The efficacy of the vaccine was measured by looking at the immune response to the vaccine. The response to the T and d components was at least as good as the response to a licensed Td vaccine. Boostrix also induced an antibody response to the pertussis component of the vaccine. It is not known how long immunity to pertussis will last. Adolescents who received Boostrix experienced pain, redness, and swelling at the injection site. The frequency of redness and swelling after Boostrix was similar to what is expected following the administration of a Td vaccine. However, pain reactions at the injection site were more frequent with those who received Boostrix. Other side effects included headaches, fever and fatigue for a short period of time after the injection. (Promed 5/11/05)

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USA: Over 70 cases in Cyclospora outbreak in Florida
In Florida, there are now more than 70 cases of a parasitic illness that spreads through contaminated food or water. Cyclospora are microscopic organisms that contaminate fresh produce and burrow into the small intestine. Symptoms of cyclospora infection include rapid weight loss, severe diarrhea, loss of appetite, bloating, stomach cramps, muscle aches and low-grade fever. The last outbreak in Florida was in Palm Beach County in the late 1990's. What makes this recent outbreak unusual is that the cases have been reported in 20 counties in all regions of the state. Florida health officials usually see only a couple of cases of cyclosporiasis each year. This recent outbreak suggests a shared source, but health officials have not tracked it down. Cyclospora infections are not fatal and can be cured with antibiotics. The usual sources of infection are imported lettuce and berries. (Promed 5/6/05)

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Canada: 40 cases of Cyclospora in Toronto, Ontario
A cluster of 40 cases of cyclosporiasis (14 confirmed, 27 suspected) has been detected among a group of 63 persons (55 students and 8 teachers/chaperones) who attended a school retreat West of Toronto. Epidemiologic analysis has revealed a significant association with a pasta salad dish which contained fresh basil. The source of the basil has not been confirmed, but is believed to have originated in a Latin American country. Toronto Public Health continues to investigate the source of the outbreak in cooperation with the Canadian Food Inspection Agency, the Ontario Ministry of Health and Long Term Care, Health Canada, and the Public Health Agency of Canada. Outbreaks of cyclosporiasis occur regularly in Canada and the U.S., estimated at 1600-1700 cases in the U.S. and Canada annually. (Promed 5/6/05)

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Canada: Milkshakes linked to E. coli illness
The Calgary Health Region (CHR) is reporting another 2 cases of Escherichia coli infection. A total of 15 people have contracted the bacterium after drinking marshmallow milkshakes at Peters' Drive-In. The drinks were consumed during a 3-day period starting 23 Apr 2005. Health officials say the incubation period for E. coli is 10 days. Because many people don't go to the doctor right away, the CHR says more cases are possible. A teenage girl remains in hospital in fair to serious condition after drinking one of the shakes. The restaurant closed for a day to sanitize and disinfect equipment. The illness has been traced back to a Peters' employee who prepared the marshmallow mix. Presumably, he or she was infected and through inadequate hand washing contaminated the milkshake material. Asymptomatic infection with E. coli O157:H7 does occur but is thought to be uncommon. (Promed 5/10/05)

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Canada: Rubella cases probably from Netherlands
The rubella outbreak galloping through a cluster of religious communities in south western Ontario probably originated in a outbreak in the Netherlands, Ontario's chief medical officer of health said 9 May 2005. Dr Sheela Basrur confirmed that a third pregnant woman has tested positive for the disease, which can trigger a miscarriage or cause birth defects in the fetus when contracted in the early stages of pregnancy. "We are speculating that it was introduced from the Netherlands, given the cross-border traffic that exists between this community and a similar community in the Netherlands," Basrur said. "They've had an outbreak going on for 8 months now in what they call the Bible Belt." Basrur said to date there is no evidence that the virus has moved into other nearby religious groups that also shun vaccination. But health officials are investigating whether there are any links between the communities and whether additional measures are needed to reduce the chance of it spreading.

Basrur said she'll be pressing members of all the religious groups to have their children vaccinated if they are currently unprotected. As of Monday the case count in the outbreak was 121, including the 3 pregnant women. 7 other pregnant women who may have been exposed to the highly contagious virus are under observation. The case count also includes a 32 year old man who was vaccinated against rubella in 1974. Basrur said it's suspected that this case of vaccine failure was probably caused by a break in what's called the cold chain--the requirement to ensure vaccines are stored at temperatures no higher than 8 degrees Celsius. It is believed the man became infected after coming in contact with fellow students who are older siblings of children attending the religious school that has been at the heart of the outbreak -- Rehoboth Christian School in Norwich. The school draws its students from 4 closely aligned religious denominations. The bulk of the school's 651 students come from this last church, which is officially neutral on the issue of vaccination. But about 60 per cent of the students attending Rehoboth Christian School are unvaccinated. Public health authorities have issued an indefinite school exclusion order for unvaccinated children who have never had rubella. Rubella is a viral illness spread through coughing or sneezing. Symptoms include rash, fever, swollen glands, joint pain, muscle pain and runny nose. (Promed 5/10/05)

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies 2005, 11 May 2005
Influenza activity declined further and remained low in most parts of the northern hemisphere in weeks 15–16, except in Hong Kong, where medium-to-high levels of influenza activity are remaining. Influenza activity remained low in the southern hemisphere.

Canada. Overall influenza activity continued to decline, with widespread activity reported in 1 province in weeks 15–16. Of the influenza viruses detected during week 16, 24% were influenza A viruses and 76% were B viruses.

Hong Kong. The activity of influenza A(H3N2) virus remained high in weeks 15–16. Influenza A(H1N1) and B viruses were also detected.

Japan. Influenza activity was reported as regional in week 14, but declined rapidly. In week 16, localized activity was reported.

Russia. A decline in influenza activity continued to be observed. In week 15, the epidemic threshold was exceeded in 1 city. Overall activity was reported as regional.

USA. Influenza activity continued to decline in weeks 15–16, when the overall ILI consultation rate remained below the national baseline and the proportion of deaths attributable to pneumonia and influenza remained at the epidemic threshold. Of the influenza viruses detected in week 16, 42% were influenza A viruses and 58% were B viruses. For week 18 USA influenza surveillance, visit CDC: http://www.cdc.gov/flu/weekly/

Other reports. During weeks 15–16, low influenza activity was detected in Australia (A), Chile (H3 and A), Mexico (H3, A and B), and Thailand (H3 and B). The Philippines reported no influenza activity.
(WHO 5/11/05 http://www.who.int/csr/disease/influenza/update/en/; CDC 5/12/05)

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Cholera, diarrhea & dysentery
Malaysia
Health officials hope to narrow down the possible causes of 150 children in Sabah's Kota Belud district being struck with diarrhea and fever. Sabah Health Department deputy director Dr Mohd Yusof Ibrahim said although officials initially ruled out cholera and typhoid, they would carry out tests on all samples for the diseases to cover all bases. The affected children were from 20 villages in the district. On 30 Apr 2005, 40 were admitted to the Kota Belud Hospital for diarrhea while the others received outpatient treatment. Health officers have collected more samples of piped water from the affected areas. Herbert Timbun Lagadan, the state assemblyman for Kedamaian, where most of the cases were reported, said a possible factor was low chlorine content in the water. (Promed 5/7/05)

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Dengue/DHF
Philippines
Health officials are bracing themselves for a surge in the number of dengue cases as the disease claimed 9 children in the region from Jan-Apr 2005. The dengue virus has affected more than 540 residents so far, an increase from 2004's 303 cases, 2 of which resulted in death. The Regional Epidemiology and Surveillance Unit [RESU] said 2005's fatalities were children ages 1 to 9 years. Reynan Cimafranca, Nurse-2 of RESU, said that because of water scarcity, especially in the mountain barangays, some people tend to store water in lidless containers that could be breeding sites for mosquitoes. "We are anticipating the number of cases will continue to increase because of the dry spells…" Cimafranca said. If there is a need to store water, he urged the public to cover their containers so as not to create a breeding site for the mosquitoes. The Philippines has experienced a dramatic increase (78 per cent) in dengue fever infections from Jan to Apr 2005 compared with the same period of 2004. According to the local authorities, children aged 1 to 9 years are predicted to suffer most from this surge of dengue fever and DHF. (Promed 5/10/05)

Viet Nam
Dengue fever has now spread to 20 provinces in southern Vietnam with a total of 6290 cases so far, including 3 deaths, reported the Ho Chi Minh City Pasteur Institute. Ho Chi Minh City has the most patients infected with the disease followed by An Giang province with 714 cases. The disease is also present in Tien Giang province with 664 cases, Dong Thap province with 577 cases, Soc Trang province with 537 cases, Can Tho city with 411 cases and Hau Giang province with 203 cases including one death. Although the number of victims is smaller than in 2004, the tropical fever transmitted by mosquitoes is now on the rise. Within a week from April 11 to 17, there were 70 new patients in Soc Trang and 52 new patients in Dong Thap. At the same time, An Giang reported 46 more patients and Ben Tre received 33 new patients. No data were available on the percentage of mosquitoes infected with dengue virus. (Promed 5/10/05)

Thailand
The Thai Red Cross Society appealed for urgent donations of Group B blood to cope with the emergence of a new strain of dengue haemorrhagic fever. The Thai Red Cross Society said that dengue fever patients in Ramathibodi Hospital required 40 units of blood each day, equivalent to the blood from 40 donors. However, with no Group B blood in its reserves, the hospital is in desperate need of new donors. The hospital is also said to be facing shortages of blood from other groups. Donors are being urged to contact the Thai Red Cross Society and can arrange for donations. No detailed information is available on the incidence of outbreaks of dengue fever and DHF pertaining to Ramathibodi Hospital. (Promed 5/10/05)

Hong Kong
The Centre for Health Protection has confirmed an imported case of Dengue fever involving a 27 year old woman who developed fever, bone pain and headache 9 Feb 2005. It brings 2005's total number of Dengue fever cases to 6, all imported. The woman had been in Indonesia 3-17 Feb 2005. She was admitted to hospital 19 Feb for 6 days and has recovered. The patient's family contacts have no symptoms of the disease. The centre has reminded the public and travelers to take preventive measures. (Promed 5/10/05)

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Typhoid
Malaysia
About 200 stalls in Jelawat were ordered to be closed for a day 4 May 2005 and their operators instructed to clean their premises to prevent the spread of typhoid in the district, which has already recorded 53 cases. The directive came from the health authorities following complaints that many people had been infected by the fever after eating cakes from the stalls. The District Health Officer, Dr Hanuzah Mohd Sultan, said 12 operators were ordered to close their stalls for 2 weeks for breaching the rules on hygiene, and 100 operators were given anti-typhoid injections. About 300 people, including the state assemblyman for Jelawat, Datuk Dr Ilias Hussin, and the president of the Bachok District Council, Mohd Faudzi Che Mamat, participated in the gotong-royong. Typhoid fever cases in Kelantan have dropped sharply since late April 2005, an indication that the worst of the outbreak may be over. The State Health Department said that, as of 7 May 2005, in Kota Baru, a total of 105 cases were in hospitals. 27 were confirmed to have the disease, and 78 were suspects. (Promed 5/9/05)

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2. Articles
WHO/WPRO: "Nature" magazine article on bird flu misleading
An article published this week in the journal Nature has created certain misimpressions. The article, entitled "Refusal to Share' leaves agency struggling to monitor bird flu," states that "affected countries are failing, or refusing, to share their human H5N1 samples with WHO's influenza program…" In the opening paragraph, the story states that "…from dozens of patients who caught the deadly H5N1 strain this year, the WHO has managed to obtain just six samples." That is not correct. This year, Viet Nam, which has had 44 human avian influenza cases since Dec 2004, has provided well over 100 human clinical samples. What influenza experts have expressed concern about is the limited number of viruses derived from those samples. The yield of viruses has been very low for reasons yet to be elucidated. There is no refusal to share human samples by Viet Nam or any country with avian influenza cases. Further, in the Nature story, the Food and Agriculture Organization (FAO) is criticized for not sharing animal samples with WHO. Such criticism is not appropriate as FAO does not receive any animal virus samples; instead, FAO, in collaboration with the World Organisation for Animal Health (OIE), relies on the joint FAO/OIE network of national and international reference laboratories for the handling of such samples. FAO and OIE continue to encourage this network to provide virus strain samples to WHO. We regret the misimpressions caused by this story, some of which WHO staff contributed to. (WHO/WPRO 5/13/05 http://www.wpro.who.int/)

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Trade related infections: farther, faster, quieter
Kimball AM et al.
“Modern global trading traffics large volumes of diverse products rapidly to a broad geographic area of the world. When emergent infections enter this system in traded products their transmission is amplified. With truly novel emergent infections with long incubation periods, such as Human Immunodeficiency Virus (HIV) or variant Creutzfeld Jacob Disease (vCJD), this transmission may silently disseminate infection to far distant populations prior to detection. We describe the chronology of two such "stealth infections," vCJD and HIV, and the production, processing, and distribution changes that coincided with their emergence. The concept of "vector products" is introduced. A brief case study of HIV incursion in Japan is presented in illustration. Careful "multisectoral" analysis of such events can suggest ecologically critical pathways of emergence for further research. Such analyses emphasize the urgency of implementing safety measures when pathogens enter globally traded products.” (Globalization and Health 22 Apr 2005. http://www.globalizationandhealth.com/content/1/1/3)

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Outbreak of Multidrug-Resistant Salmonella Typhimurium Associated with Rodents Purchased at Retail Pet Stores--United States, December 2003--October 2004
“During 2004, the Minnesota Department of Health (MDH) Public Health Laboratory notified CDC about the isolation of multidrug-resistant Salmonella enterica serotype Typhimurium from ill hamsters from a Minnesota pet distributor. This report describes two of the first identified human cases associated with this outbreak, summarizes the multistate investigation of human S. Typhimurium infections associated with exposure to rodents (e.g., hamsters, mice, and rats) purchased at pet stores, and highlights methods for reducing Salmonella transmission from pet rodents to their owners. This is the first documented salmonellosis outbreak associated with pet rodents. Findings demonstrate that the handling of pet rodents is a potential health risk, especially for children. Public health practitioners should consider pet rodents a potential source of salmonellosis…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5417a3.htm (MMWR May 6, 2005 / 54(17);429-433)

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Positive Test Results for Acute Hepatitis A Virus Infection Among Persons With No Recent History of Acute Hepatitis--United States, 2002--2004
“Hepatitis A is a nationally reportable condition, and the surveillance case definition includes both clinical criteria and serologic confirmation. State health departments and CDC have investigated persons with positive serologic tests for acute hepatitis A virus (HAV) infection (i.e., IgM anti-HAV) whose illness was not consistent with the clinical criteria of the hepatitis A case definition. Test results indicating acute HAV infection among persons who do not have clinical or epidemiologic features consistent with hepatitis A are a concern for state and local health departments because of the need to assess whether contacts need postexposure immunoprophylaxis. This report summarizes results of three such investigations, which suggested that most of the positive tests did not represent recent acute HAV infections. To improve the predictive value of a positive IgM anti-HAV test, clinicians should limit laboratory testing for acute HAV infection to persons with clinical findings typical of hepatitis A or to persons who have been exposed to settings where HAV transmission is suspected.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5418a1.htm (MMWR May 13, 2005 / 54(18);453-456)

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Assessment of Epidemiologic Capacity in State and Territorial Health Departments--USA, 2004
“In November 2001, the Council of State and Territorial Epidemiologists (CSTE) conducted a survey of state and territorial health departments to assess their core epidemiologic capacity. The survey was completed just before distribution of approximately $1 billion in terrorism preparedness and emergency response funds in fiscal year 2002, intended to improve the U.S. public health infrastructure. Results of the 2001 survey, published in 2003, indicated inadequate capacity in six of eight key epidemiology program areas (all except infectious disease and chronic disease) to fully perform the essential public health services most dependent on epidemiology. In 2004, CSTE conducted a follow-up survey that assessed epidemiologic capacity in the United States and its territories in the same eight program areas, estimated the number of additional epidemiologists needed for full performance, and identified education and training needs. This report summarizes the results of that 2004 follow-up survey, which indicated a 26.9% increase from 2001 in the overall number of epidemiologists working in state and territorial health departments, increased capacity in two program areas (i.e., terrorism preparedness and emergency response; maternal and child health) and decreased capacity in six other program areas (i.e., infectious disease, chronic disease, environmental health, injury, occupational health, and oral health). Results also revealed that 28.5% of epidemiologists lacked any formal training or academic coursework in epidemiology. Creation of a strong public health infrastructure fully capable of performing essential services will require additional trained epidemiologists in state and territorial health departments.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5418a2.htm (MMWR May 13, 2005 / 54(18);457-459)

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Terrorism and emergency preparedness in state and territorial public health depts., US, 2004
“After the events of September 11, 2001, federal funding for state public health preparedness programs increased from $67 million in fiscal year (FY) 2001 to approximately $1 billion in FY 2002. These funds were intended to support preparedness for and response to terrorism, infectious disease outbreaks, and other public health threats and emergencies. The Council of State and Territorial Epidemiologists (CSTE) assessed the impact of funding on epidemiologic capacity, including terrorism preparedness and response, in state health departments in November 2001 and again in May 2004, after distribution of an additional $1 billion in FY 2003. This report describes the results of those assessments, which indicated that increased funding for terrorism preparedness and emergency response has rapidly increased the number of epidemiologists and increased capacity for preparedness at the state level. However, despite the increase in epidemiologists, state public health officials estimate that 192 additional epidemiologists, an increase of 45.3%, are needed nationwide to fully staff terrorism preparedness programs.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5418a3.htm (MMWR May 13, 2005 / 54(18);459-460)

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3. Notifications
First APEC Emergency Preparedness Task Force Meeting in Bali, Indonesia
The foundations for greater regional emergency readiness were laid at the first face-to-face meeting of the APEC Virtual Task Force on Emergency Preparedness in Bali, May 2-3, 2005. One of the main priorities for the task force was to identify gaps in activities and capacity so as to enable APEC member economies to be better prepared to deal with regional disasters. APEC Senior Officials agreed to establish the virtual task force, jointly chaired by Australia and Indonesia on an interim basis, to unify resources and skills in the APEC community to deal with future emergencies and natural disasters. Executive Director of the APEC Secretariat, Ambassador Choi Seok Young said the first meeting of the task force was an important step forward in enhancing the regions' capacity to deal with potential threats to life and property. APEC's collective fight against those nature disasters will be a long-term task. The Ambassador said,

"The Boxing Day Tsunami was a tragic event that reminded us of the importance of the people of our region working together to overcome crises…This not only means working together after a disaster has occurred but cooperating beforehand to combine our intellectual and material resources. The core aims of the task force are to strengthen preventive measures and enhance preparedness for natural disasters. The first meeting of the APEC Virtual Task Force on Emergency Preparedness is establishing the areas in which APEC is best suited to be proactive and complement other forums. It is important that our work does not duplicate the efforts of other forums and relief organizations…APEC is a forum that covers a range of critical infrastructure sectors such as telecommunications, energy and transport. The task for us is to ensure these sectors have the capacity to deal with a crisis when it occurs to ensure the immediate safety of local populations. Other areas such as tourism and small business have different preparation needs before a crisis. These are the sectors that will be called on to provide jobs and income to ensure the long term recovery following disasters."

The task force is expected to strengthen coordination efforts among APEC Member Economies and fora in relation to disaster relief, rehabilitation and reconstruction in disaster stricken areas. To avoid duplication with work conducted by other regional and international organizations, the APEC virtual task force will focus on undertaking long-term capacity building initiatives to improve regional emergency and natural disaster management capability. (APEC 5/5/2005 http://www.apecsec.org.sg/apec.html)

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Control of Communicable Diseases Manual 18th Ed
Author: Edited by David L. Heymann, MD
The Control of Communicable Diseases Manual is the most widely recognized sourcebook on infectious diseases. The new 18th edition, available June 2005, addresses concerns about the impact of communicable diseases around the globe as communicable diseases, new and unknown, continue to thrive, kill, maim and surprise the masses. Among the diseases addressed in the new edition is a chapter on Severe Acute Respiratory Syndrome (SARS). The emergence of this disease so clearly demonstrates that every country is vulnerable and that the impact of this communicable disease has been felt worldwide. Provided in detail is accurate, informative text for public health workers in official and voluntary health agencies, including those serving in the armed forces and other governmental agencies, and for all students of medicine. Each listing in this easy to understand manual includes identification, infectious agent, occurrence, mode of transmission, incubation period, susceptibility and resistance, and methods of control that are not limited to but include prevention and epidemic control measures. The 18th edition will be available online. Translations into several languages currently Spanish, Portuguese, Korean, Serbian, Indonesian and Italian make this text a global treasure. Dr. David Heymann who, along with his team from the WHO, compiled an impressive group of experts from around the world to serve as reviewers, authors and editors. (American Public Health Association http://www.apha.org/)

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Publication of Guidance on Public Reporting of Healthcare-Associated Infections
In U.S. hospitals alone, health-care--associated infections (HAIs) account for an estimated 2 million infections, 88,000 deaths, and $4.5 billion dollars in excess health-care costs annually. Increasingly, consumers are requesting public release of information such as HAI rates to enable them to make more informed health-care choices. Several states have initiated legislative efforts that will mandate hospitals and other health-care organizations to publicly report HAI rates. The Healthcare Infection Control Practices Advisory Committee (HICPAC) has developed a guidance document on public reporting of HAIs to assist policymakers, program planners, consumer advocacy organizations, and others who will be tasked with designing and implementing such reporting systems. The document, “Guidance on Public Reporting of Healthcare-Associated Infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee”, provides a framework for an HAI reporting system and recommendations for process and outcome measures to be included in the system; the document does not provide model legislation. These recommendations have been endorsed by the Association for Professionals in Infection Control and Epidemiology, the Council of State and Territorial Epidemiologists, and the Society for Healthcare Epidemiology of America. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5418a6.htm (MMWR May 13, 2005 / 54(18);464)

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Fourth Annual Conference on Public Health Law--June 13--15, 2005
The CDC Public Health Law Program and the American Society of Law, Medicine and Ethics, along with collaborating organizations, are sponsoring the fourth annual conference on "The Public's Health and the Law in the 21st Century," June 13--15, 2005, in Atlanta, Georgia, USA. The conference will focus on innovative legal tools for improved public health, with emphasis on information participants can use in day-to-day practice. Participants and faculty include public health practitioners and medical professionals, attorneys, judges, elected officials, emergency management and law enforcement professionals, and researchers. Sessions will cover legal and policy issues, including the following: public health emergencies, hospital infection control, quarantine, migration, vaccine safety, and use of international trade agreements for public health purposes. Continuing education credits will be offered.

Final day for early registration is May 10. Additional information is available at http://www.phppo.cdc.gov/od/phlp/conference/con2005_overview.asp or by e-mail: KMcCarthy2@cdc.gov. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5417a6.htm (MMWR May 6, 2005 / 54(17);437)

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National Nursing Home Week --- May 8--14, 2005
“National Nursing Home Week, established by the American Health Care Association, honors those who promote quality of care at nursing home facilities, including residents, family members, volunteers, community, and staff. A Nursing Home Survey conducted by CDC indicated that approximately 18,000 nursing homes in the US provide care for 1.6 million residents; 1.4 million (90%) of these residents are aged >65 years…Infections, particularly respiratory and urinary tract infections, are a major cause of morbidity, mortality, and excess health-care costs among nursing home residents. To address the burden of infections among nursing homes residents, CDC launched a national educational campaign targeting clinicians who provide care to persons in long-term--care facilities. The campaign promotes 12 evidence-based practices that can reduce infections and antimicrobial resistance in nursing homes. For more information: http://www.cdc.gov/drugresistance/healthcare/ltc/12steps_ltc.htm. Information about National Nursing Home Week: http://www.nnhw.org. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5417a7.htm (MMWR May 6, 2005 / 54(17);438)

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Hepatitis Awareness Month --- May 2005
May is Hepatitis Awareness Month. In 2003, in the USA, an estimated 61,000 new infections occurred with hepatitis A virus, 73,000 with hepatitis B virus, and 30,000 with hepatitis C virus. Effective interventions, such as hepatitis A and hepatitis B immunization and counseling and testing for hepatitis C, can help prevent and control viral hepatitis and protect personal and community health. Additional information regarding Hepatitis Awareness Month, activities associated with this month, prevention and control of viral hepatitis, and free educational materials is available at http://www.cdc.gov/hepatitis. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5418a7.htm (MMWR May 13, 2005 / 54(18);464)

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2005 National HIV Prevention Conference
(June 12-15) Atlanta, Georgia, USA

The 2005 National HIV Prevention Conference (NHPC) targets governmental and non-governmental organizations, health departments, community, and academic partners in HIV prevention whose interaction, cooperation, and coordination is crucial to successful efforts to prevent HIV and AIDS in the USA. The National Prevention Conference is meant to highlight breaking information and important scientific advances relating to domestic HIV prevention efforts. NHPC provides a forum for discussing the science base for HIV prevention, strengthens collaborations between program practitioners and researchers and promotes cross-field collaboration to share effective prevention approaches and research findings in areas including behavioral interventions, vaccine development, monitoring the epidemic, implementing rapid and reliable tests for early HIV diagnosis, and improving access to early treatment and prevention services for persons with HIV. The HIV Prevention Leadership Summit (HPLS) is primarily intended for CDC grantees and has a major focus on CDC's funded HIV prevention efforts. HPLS offers practical opportunities for prevention workers to build skills and to apply that science to their programs. The HPLS targets staff from community-based organizations and health departments, community planning group members, capacity-building and technical assistance providers, national partners, and CDC and other federal agencies. (CDC http://www.2005hivprevconf.org/index.asp)

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Fred Hutchinson Cancer Research Center to co-sponsor global health-care summit June 8-11, 2005
Fred Hutchinson and The National Bureau of Asian Research will launch next summer a series of annual meetings that draw together experts in science, policy, medical practice, research and public health from countries around the Pacific Rim. The inaugural Pacific Health Summit will take place June 8-11 at the Bell Harbor International Conference Center in Seattle. The theme for the 2005 summit is "Science Innovation and the Future of Health: Building Partnerships to Transform Healthcare." Similar summits will take place in 2006, 2007 and beyond. The 2008 event will be held in Beijing in conjunction with the Olympic Games. "Our goal is to launch a collaborative dialogue on health-care policy that emphasizes international teamwork on research, technology and treatment," said Dr. Lee Hartwell, center president and director and co-chair of the summit steering committee. The Bill & Melinda Gates Foundation and the Russell Family Foundation provided seed funding. APEC supports the event. The summit is also coordinated with the U. S. Olympic Committee's Pacific Rim Sports Summit — a major athletic and cultural festival directed by the Seattle Organizing Committee. For more information, visit www.pacifichealthsummit.org. (FHCRC 1/6/2005 http://www.fhcrc.org/pubs/center_news/2005/jan6/br1.html)

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60th Annual Meeting of the International Conference on Diseases in Nature Communicable to Man (INCDNCM)
The University of Calgary, Calgary, Alberta, Canada

Abstracts as oral presentations or posters are invited for the 60th meeting of INCDNCM. The conference is multidisciplinary in scope and covers infectious agents such as viral, bacterial, parasitic, prion-related diseases acquired by humans from natural sources, including animals (wild or domestic), contaminated water or food supplies, arthropod vectors and other sources. Invited speakers will open a symposium followed by presentations related to that theme. Conference themes include: Avian influenza; West Nile virus; BSE; Zoonotic bacterial, viral and parasitic diseases Conference, registration and abstract information is available at http://secure.provlab.ab.ca/bugs/incdncm or by contacting:
Kevin Fonseca or Reeta Padamsey
Provincial Laboratory for Public Health (Microbiology)
3030 Hospital Drive NW, Calgary, Alberta, Canada. T2N 4W4
k.fonseca@provlab.ab.ca or r.padamsey@provlab.ab.ca (Promed 5/3/05)

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4. APEC EINet activities
EINet article on trade related infections
The APEC EINet website now allows for automatic subscription at: http://depts.washington.edu/einet/?a=subscribe. The EINet team’s latest study is available in the newly launched journal, “Globalization and Health”. The article, “Trade related infections: farther, faster, quieter”, by Kimball et al., is available at http://www.globalizationandhealth.com/content/1/1/3.

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5. To Receive EINet Newsbriefs
To Receive EINet Newsbriefs
The APEC EINet email list was established to enhance collaboration among health, commerce, and policy professionals concerned with emerging infections in APEC member economies. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe, go to: http://depts.washington.edu/einet/?a=subscribe or contact apecein@u.washington.edu. Further information about APEC EINet is available at http://depts.washington.edu/einet/.

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 apecein@u.washington.edu