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Vol. XIII, No. 2 ~ EINet News Briefs ~ Jan 22, 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 director-general says lack of H1N1 vaccine demand surprising
- Egypt: 91st human case of H5N1 avian influenza
- Belgium, Greece, Italy, Norway: Pandemic H1N1 vaccine orders scaled back
- Switzerland: Concern raised over pandemic H1N1 vaccine and autoimmune disease
- Asia: H5N1 avian influenza forgotten (almost), but not gone
- Australia: Nation braces for possible back-to-school H1N1 influenza wave
- Bangladesh: H5N1 influenza strikes poultry farm
- China: Influenza B up in China
- China: Health Ministry urges H1N1 influenza vaccine for holiday travelers
- India (West Bengal): H5N1 influenza hits villages
- Indonesia: Economy's H5N1 influenza status debated as outbreak reported
- Japan: First imported pandemic H1N1 vaccines approved
- Mexico (Mexico City): Pandemic H1N1 vaccine offered for subway riders
- USA: Pediatric flu deaths triple past three season average
- USA (Massachusetts): Minorities hit harder by flu than whites
- USA (California): Los Angeles airport makes flu vaccines available
- USA (Iowa): Novel influenza A (H3N2) virus found in child
- Nigeria: Progress in securing pandemic H1N1 vaccine

2. Infectious Disease News
- Australia (Northern Territories): Notification to protect against melioidosis
- Russia (Yaroslavl): Increased cases of hemorrhagic fever with renal syndrome
- Viet Nam: Kawasaki disease on the rise
- Chile: Hantavirus infection
- USA (New Hampshire): Anthrax remains at contamination site
- USA (Washington): Botulism among heroin users
- USA: CDC reorganization creating emerging and zoonotic disease center

3. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA
- DENGUE
- CHOLERA, DIARRHEA, and DYSENTARY

4. Articles
- Evolution of MRSA during hospital transmission and intercontinental spread
- Incidence of 2009 pandemic influenza A H1N1 infection in England: a cross-sectional serological study
- Treatment with Monoclonal Antibodies against Clostridium difficile Toxins
- Acyclovir and Transmission of HIV-1 from Persons Infected with HIV-1 and HSV-2
- Evolutionary Dynamics of Complex Networks of HIV Drug-Resistant Strains: The Case of San Francisco
- Public health management of pandemic (H1N1) 2009 infection in Australia: A failure!

5. Notifications
- International Symposium on Neglected Influenza Viruses
- 14th International Congress on Infectious Diseases (ICID)
- International Swine Flu Conference (ISFC)
- ISHEID Symposium on HIV and Emerging Infectious Diseases
- CDC 7th International Conference on Emerging Infectious Diseases
- Options for the Control of Influenza VII
- Updated influenza guidance and information from the US CDC


1. Influenza News

Global
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 12/30/09): 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 9/24/09): http://gamapserver.who.int/mapLibrary/Files/Maps/Global_H5N1Human_2009_FIMS_20090924.png.

WHO's timeline of important H5N1-related events (last updated 1/4/10): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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WHO situation update on pandemic influenza H1N1
As of 17 January 2010, worldwide more than 209 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 14,142 deaths.

The overall situation is largely unchanged since last week. The most intense transmission of pandemic influenza virus continues to occur in North Africa, South Asia, and in limited areas of Eastern Europe. Overall pandemic influenza activity in the temperate northern hemisphere peaked between late October and late November 2009 and has continued to decline since.

In North Africa, limited data suggest that transmission of pandemic influenza virus remains geographically widespread and active throughout the region, but has likely recently peaked in most places. During early January 2010 only the Libyan Arab Jamahiriya reported an increasing trend in respiratory diseases activity. Egypt is now reporting a declining trend after increases in respiratory diseases activity throughout December 2009, suggesting a recent peak in activity during early January 2010. In West Asia, limited data suggests pandemic influenza virus transmission remains geographically widespread however overall activity has been declining in most places during December and January.

In South Asia, active transmission of pandemic influenza virus persists in the northern and western parts of the subcontinent, however overall activity has recently peaked. In India, influenza activity has been largely confined to the northern and western states; activity in the northern states peaked during mid December 2009 and in the western states during early January 2010. In Nepal, active transmission of virus persists, and the trend in respiratory diseases activity remains unchanged since the previous week after reporting continuous increases in activity since late October 2009.

In Europe, pandemic influenza virus transmission remains geographically widespread across parts of western, central, and southeastern Europe, however overall influenza activity continued to decline or remain low in most countries The areas of most intense transmission currently include Poland, Austria, Estonia, Romania, Hungary, and Moldova; however, in all but Romania, ILI activity has declined significantly since peaking in November. The overall rate of specimens testing positive for influenza fell to 20% in Europe after reaching a peak of 45% during early November 2009. Pandemic H1N1 2009 virus continues to be predominant circulating influenza virus in the European region with only sporadic detections of seasonal influenza viruses.

In East Asia, pandemic influenza activity remains widespread but continues to decline in most places. Mongolia reported a very high intensity of respiratory diseases during early January 2010; rates of ILI have been elevated above expected seasonal levels since late October 2009 but are well below a significant peak of activity observed during November 2009. In Japan, overall influenza activity continued to decline since peaking at the end of November 2009, however regional increases in activity were observed during late December on the southern island of Okinawa. In China, Hong Kong, and Chinese Taipei pandemic influenza activity remains widespread but continues to decline or remain stable. Pandemic H1N1 continues to be the predominant circulating virus in the region but seasonal H3N2 viruses continue to circulate in very small numbers in northern China.

In the Americas, both in the tropical and northern temperate zones, overall pandemic influenza activity continued to decline or remain low in most places.

In temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.
(WHO 01/22/2010)

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Global: WHO director-general says lack of H1N1 vaccine demand surprising
The H1N1 influenza pandemic brought no "devastating surprises," but what has surprised public health agencies is the public's lack of interest in getting vaccinated, Margaret Chan, director-general of the WHO, said 18 January 2010. Chan, speaking at the opening of the WHO Executive Board's meeting in Geneva, made the comment in the wake of moves by a number of European countries to reduce their vaccine orders in response to falling public demand for the vaccine.

"People make their own decisions about what information to trust, and base their actions on those decisions," she said. "The days when health officials could issue advice, based on the very best medical and scientific data, and expect populations to comply, may be fading. It may no longer be sufficient to say that a vaccine is safe, or testing complied with all regulatory standards, or a risk is real."

Chan said part of the problem is the sharp contrast between expectations based on the H5N1 avian flu threat and the pandemic that so far has occurred: "An event similar to the 1918 pandemic was feared, when what actually happened is probably closer to the 1957 or 1958 pandemics."

As for where the pandemic will go from here, Chan said the critical question is whether there are "enough susceptible people left to sustain further waves of community-wide transmission. At present, we simply do not have enough data to answer this question with certainty. Studies are, however, under way."

The CDC has said it is doing serologic studies to assess what share of the population has antibodies to the virus as a result of either vaccination or infection, with or without symptoms. But no results have been reported so far.
(CIDRAP 1/19/2010)

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Europe/Near East
Egypt: 91st human case of H5N1 avian influenza
A 20 year old woman began experiencing symptoms of avian influenza (H5N1) virus infection on 6 January 2010. Her family reported she had contact with sick and dead poultry. She was reported to be in a stable condition on 13 Jan 2010. The MOH Ministry of Health reported that this was the 91st case of highly pathogenic avian influenza H5N1 virus infection in Egypt. The event took place in Beni Suef Governorate, Beba District.
(ProMED 1/20/2010)

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Belgium, Greece, Italy, Norway: Pandemic H1N1 vaccine orders scaled back
Greece and Norway have both cut back on pandemic vaccine deliveries. The Greek health ministry said it would pay for only the 3.6 million doses it has already received and wants companies to refund advances made for future shipments. Meanwhile, Norway's health ministry said it reached an agreement with Glaxo Smith Kline (GSK) to trim its order by 30%. It has received about 4.3 million doses so far and has vaccinated about 60% of its population. Belgium has cut back its pandemic vaccine order with GSK by a third because of falling demand. The country's health ministry said the cut would save the government about $47.6 million. Meanwhile, Italy cancelled 24 million doses it had ordered from Sanofi. The Italian media has reported that only 900,000 people were immunized against pandemic flu. Italy had also bought 24 million doses from Novartis.
(CIDRAP 1/15/2010, 1/19/2010)

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Switzerland: Concern raised over pandemic H1N1 vaccine and autoimmune disease
Switzerland's medical regulatory agency, Swissmedic, recommends that people who have serious autoimmune diseases not receive Novartis's H1N1 vaccine because it has not been tested in such patients. The agency said it could not exclude the risk that the vaccine antigen or adjuvant could exacerbate disease.
(CIDRAP 1/20/2010)

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Asia
Asia: H5N1 avian influenza forgotten (almost), but not gone
While the world concentrates on countering the pandemic H1N1 virus, avian influenza H5N1 has quietly continued to take its toll on both poultry and humans. In 2009, 17 countries, stretching from Cote d'Ivoire and Germany to China and Japan, reported outbreaks of H5N1 in domestic poultry and wild birds; and the WHO, which says H5N1 remains a pandemic threat, recorded 72 human cases, 32 of them fatal. In the year 2009, Indonesia accounted for 19 of the 32 H5N1 human deaths; Viet Nam, for five and China for four. But there are glimmers of progress.

The number of human deaths has been dropping since peaking at 79 in 2006. And fewer countries reported human outbreaks in 2009 than in 2008. Countries are refining responses to outbreaks, as was in evidence at the Asian Partnership on Emerging Infectious Diseases Research meeting in Kunming, China, from 13 to 16 Jan 2010. At the meeting, researchers from Cambodia, China, Indonesia, Laos, Thailand, and Viet Nam compared notes on the effectiveness of control measures. Scientists reported that carefully targeted culling can be just as effective as widespread culling, and less disruptive. Others reported that reducing risk among those keeping backyard poultry has to be a community-wide effort, since changing the practices of individual farmers has proven difficult. Other discussion focused on the role of wild birds in spreading the virus.
(ProMED 1/17/2010)

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Australia: Nation braces for possible back-to-school H1N1 influenza wave
The Australian Medical Association (AMA) has said it is likely swine flu will strike the country again, possibly as a second wave after school resumes in a couple weeks and as people return from overseas holiday travel. AMA vice-president Steven Hambleton said, "We're expecting to reimport the virus and to see people getting sick again." Officials are encouraging vaccination.
(CIDRAP 1/15/2010)

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Bangladesh: H5N1 influenza strikes poultry farm
Livestock officials in Bangladesh reported that the H5N1 avian influenza virus struck a poultry farm in the western part of the country, according to a report from the World Organization for Animal Health (OIE). The outbreak began on 4 January 2010 and killed 250 poultry; the remaining 932 birds were culled. Investigators have not found the source of the outbreak, which is Bangladesh's first since September. Authorities disinfected the farm and have limited poultry transport in the area. On 19 January 2010 India reported an H5N1 outbreak in backyard birds in West Bengal state, not far from the border with Bangladesh.
(CIDRAP 1/20/2010)

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China: Influenza B up in China
Though the pandemic H1N1 virus is still the dominant flu strain, China has found influenza B in 12.6% of specimens, the WHO reported 15 January 2010. Some countries are sporadically detecting seasonal H1N1 and H3N2 viruses.
(CIDRAP 1/15/2010)

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China: Health Ministry urges H1N1 influenza vaccine for holiday travelers
China's Health Ministry has urged vulnerable groups to get influenza pandemic (H1N1) 2009 virus vaccinations or limit travel during the upcoming Chinese Lunar New Year holiday due to the spread of the virus. "Pregnant women, children, the elderly, obese people, and those with chronic diseases should avoid public travel during the peak period of Spring Festival travel," the Ministry said in a statement posted on its website 13 Jan 2010. Such vulnerable groups should also get pandemic H1N1 vaccinations and steer clear of crowded public places and people showing obvious flu symptoms, it said. The Ministry also urged for prevention measures to be stepped up, including wearing face masks, frequently washing hands and getting early medical checkups for coughs and other flu symptoms.

Tens of millions of people are expected to pack into trains, planes, and buses during the upcoming Lunar New Year travel period when Chinese return to their hometowns and villages for annual family reunions. This year's travel period extends from 30 Jan 2010 to 10 Mar 2010. Lunar New Year's Day, or the start of the traditional Spring Festival, falls on 14 Feb 2010.
(ProMED 1/15/2010)

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India (West Bengal): H5N1 influenza hits villages
Animal health officials in India confirmed an H5N1 avian influenza outbreak in backyard birds in three villages in the country's West Bengal state, according to a Jan 15 report from the World Organization for Animal Health (OIE). The outbreak, India's first since October 2009, killed 1,000 of about 80,000 susceptible birds in the three Murshidabad district villages. The remaining birds and those in a 3-kilometer radius around the area were culled to prevent the spread of the virus. Veterinary authorities are conducting intensive surveillance in areas within 10 kilometers of the outbreak site. They have also closed poultry markets in the area and have prohibited the sale and transport of birds. Investigators haven't yet determined the source of the virus.
(CIDRAP 1/19/2010)

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Indonesia: Economy's H5N1 influenza status debated as outbreak reported
Health and agriculture officials in Indonesia say fewer H5N1 outbreaks in poultry may have decreased the number of infections in humans, but other experts say the risk has not changed and that the country's poultry surveillance system is weak, the United Nations Integrated Regional Information Networks (IRIN) reported 18 January 2010.

Indonesian Health Minister Endang Rahayu Sedyaningsih said there have been no human illnesses since November 2009, and Agus Wiyono, the agriculture ministry's director of animal health, said no major poultry outbreaks have occurred in three years. But Dr Chairil Nidom, a microbiologist at Airlangga University, said some poultry outbreaks have probably gone unreported and that the surveillance system is weak. A World Health Organization (WHO) spokesman told IRIN that the group's assessment of Indonesia's risk has not changed. The country leads the world in human H5N1 infections and deaths.

The mixed assessments of Indonesia's risk came as veterinary officials in East Java reported that the virus recently struck chickens in a village, which led to the culling of 270 birds. Rapid-test results on 100 birds were positive, an official from Pamekasan regency's veterinary health office said.
(CIDRAP 1/19/2010)

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Japan: First imported pandemic H1N1 vaccines approved
Japan has approved domestic use of H1N1 flu vaccines made by GlaxoSmithKline (GSK) and Novartis, paving the way for their use within a month. Japan has finalized deals for enough GSK vaccine for 7.4 million healthy adults and Novartis vaccine for 2.5 million. The approval marks Japan's first agreement to accept imported vaccine.
(CIDRAP 1/20/2010)

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Americas
Mexico (Mexico City): Pandemic H1N1 vaccine offered for subway riders
Health officials in Mexico City have begun offering pandemic H1N1 vaccine at 26 of the city's busiest subway stations. On 18 Jan 2010, about 10,200 of Mexico City's 300,000 vaccine doses were distributed at the subway stops. City officials said they will extend the immunization effort to markets by the end of the week. Mexico City was at the center of the novel H1N1 outbreak in the spring. The country hopes to vaccinate 24 million people by March.
(CIDRAP 1/20/2010)

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USA: Pediatric flu deaths triple past three season average
In an overview of flu activity during the 2009-10 flu season that started Aug 30, the US CDC said pediatric deaths from the pandemic virus are three times higher than the average for the past three seasons. Flu activity peaked on Oct 24, much earlier than the February peaks of the most recent flu seasons. The CDC pointed out that multiple waves were seen during the three most recent pandemics, emphasizing the importance of vaccination. [MMWR article available here: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5902a3.htm?s_cid=mm5902a3_x.]
(CIDRAP 1/21/2010)

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USA (Massachusetts): Minorities hit harder by flu than whites
Massachusetts is the latest jurisdiction to find higher rates of flu illness and death in its non-white residents, the Boston Globe reported in its blog White Coat Notes. Asians were hospitalized 1.5 times as often as whites and were four times as likely to die from flu; Hispanics were hospitalized three times as often and were six times as likely to die; and blacks were hospitalized more than four times as often, and had death rates more than three times higher than whites.
(CIDRAP 1/19/2010)

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USA (California): Los Angeles airport makes flu vaccines available
The Los Angeles international airport recently began offering flu shots, including the pandemic vaccine, in most of its terminals. A spokeswoman said the airport's goal is to help curb flu spread and put the shots within convenient reach of travelers. Vaccination stations are staffed by nurses from FluEase, a company that specializes in immunization services for organizations. The shots cost $30, and vaccination will continue throughout flu season.
(CIDRAP 1/19/2010)

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USA (Iowa): Novel influenza A (H3N2) virus found in child
One case of human infection with a novel influenza A virus was reported by the Iowa Department of Public Health. The case patient had onset of symptoms in September 2009, but did not require hospitalization and has fully recovered. The virus was identified as swine influenza A (H3N2) and investigated in November 2009. No clear exposure to swine was identified, but no evidence of sustained human-to-human transmission with this virus was found. Early identification and investigation of novel influenza A cases is critical to evaluate the extent of the outbreak and possible human-to-human transmission. Surveillance for human infections with novel influenza A viruses is conducted year-round.

There are a variety of influenza viruses circulating among pigs. According to the CDC, the four main types currently found are H1N1, H1N2, H3N1 and H3N2 viruses. Prior to the pandemic, a human case of swine flu in the United States was discovered every year or two. But in the three years or so before the H1N1 pandemic, 12 cases were found.
(ProMED 1/16/2010)

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Africa
Nigeria: Progress in securing pandemic H1N1 vaccine
Following the first deaths and illnesses from pandemic H1N1 flu, Nigeria's health ministry said that it is in advanced talks with the WHO to receive the vaccine. The ministry said Nigeria wasn't previously on the WHO's priority list because it had not detected any illnesses but now said the country could receive vaccine doses by February. Nigeria has confirmed two H1N1 deaths and eight illnesses.
(CIDRAP 1/21/2010)

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2. Infectious Disease News

Asia
Australia (Northern Territories): Notification to protect against melioidosis
Top End residents have been reminded to protect themselves against the potentially life-threatening, soil-borne disease melioidosis after nine new cases were reported in the past month. The disease, commonly known in Australia as Nightcliff gardener's disease, is an illness that presents after heavy rain. Health Department Centre for Disease Control director Vicki Krause said melioidosis could cause pneumonia and blood infection.

"The bacterium lives below the soil's surface during the dry season and, after heavy rain, is found in surface water and mud and may even become airborne," she said. The bacteria then enter the body through cuts or sores, and occasionally through ingestion or inhalation. Dr. Krause said, "An increase in cases has been seen in past years following cyclones, heavy rains and floods." There have been 13 reported cases of melioidosis so far this wet season, with nine cases in the past four weeks.
(ProMED 1/13/2010)

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Russia (Yaroslavl): Increased cases of hemorrhagic fever with renal syndrome
The number of cases of hemorrhagic fever with renal syndrome (HFRS) in the Yaroslavl oblast increased by a third in 2009 in comparison with 2008. There were 118 cases in 2009, and the high rate of infection has continued into this year.

During the first week of 2010, seven new cases of HFRS have been detected. The reason for the high morbidity is thought to be a consequence of the mild winter weather and the abundance of rodents. The public health authorities have stated that the incidence of infection is expected to decline throughout December 2009 and January 2010. However, the epidemic situation is serious, and rodent control measures have been inadequate in recent times.
(ProMED 1/21/2010)

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Viet Nam: Kawasaki disease on the rise
The number of children suffering from Kawasaki disease -- an illness that causes high fever, diarrhea, affects the lymph nodes and seriously damages children's hearts -- has recently been on the rise, head of the Children Hospital No1's Heart Department Vu Minh Phuc has warned. Typically there are approximately 20 hospitalized cases per year. However, in 2009, there were more than 100 cases, most of whom were children under the age of five. So far in 2010, five additional children have been tested for the disease.

According to health experts, Kawasaki disease was discovered in 1967 by a Japanese doctor. The disease mostly occurs in children under five, especially those aged between one and two years old. Up to 25 percent of the patients were found to have inflamed blood vessels within several days of contracting the disease.
(ProMED 1/19/2010)

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Americas
Chile: Hantavirus infection
The Regional Secretary of the Ministry of Health of the Araucania region, Loreto Uribe, has confirmed a new case of a hantavirus infection in the area. The case is a 24 year-old resident of the Lumaco area, who several months ago moved from the Biobio region to Araucania to work in this rural area. An investigation has been initiated to determine where exactly the infection had been acquired.

According to the Epidemiology Department of the Chilean Health Ministry, there were 31 cases of hantavirus infections in 2009 with nine of them being fatal.
(ProMED 1/19/2010)

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USA (New Hampshire): Anthrax remains at contamination site
A total of four additional samples containing low-levels of anthrax were found inside the building where a Strafford County woman was exposed to it in December 2009. State Public Health Director Dr. Jose Montero said a total of 73 samples were collected last week and only four tested positive for a low-level of anthrax. In addition to the four samples, there are 10 samples that were inconclusive and are being sent to the Centers for Disease Control and Prevention (CDC) for more specialized testing. Montero said the fact some of the samples are inconclusive might indicate the level of contamination is so low it's hard to detect.
(ProMED 1/16/2010)

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USA (Washington): Botulism among heroin users
Health officials said 8 January 2010 there is a confirmed case of wound botulism in a heroin user in Yakima County. A second case is suspected. Both individuals, a man and a woman, are hospitalized and on ventilators. Patnode, communicable disease services coordinator for the Yakima Health District said Yakima sees sporadic cases of botulism among intravenous drug users who cut their heroin with a substance, often dirt or honey, which contains the spores of Clostridium botulinum.
(ProMED 1/13/2010)

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USA: CDC reorganization creating emerging and zoonotic disease center
A new division of the Centers for Disease Control and Prevention is expected to improve resource allocation, scientific collaboration, and partnership in addressing emerging and zoonotic diseases, a spokesman said.

The CDC planned at press time to begin operations of the proposed National Center for Emerging and Zoonotic Infectious Diseases in January, but agency spokesman David Daigle said in a message that it could be longer until the change becomes official. The new division includes parts of the National Center for Zoonotic, Vector-Borne, and Enteric Diseases and the National Center for Preparedness, Detection, and Control of Infectious Diseases. Daigle said other parts of the two older centers will be merged into the Center for Global Health, which was also recently created, and other parts of the CDC.

He said the change is also expected to create a "clear and compelling vision and mission for addressing emerging and zoonotic infections," increase coordination of funding, improve the development and allocation of resources, improve scientific collaboration and communication regarding emerging infectious disease, and help the CDC work with partners on addressing microbial threats to animal and human health.
(American Veterinary Medical Association, 2/1/2010)

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

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

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

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

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

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DENGUE
Malaysia (Sarawak)
More people in the state were afflicted with dengue fever between last year [2009] and 2 Jan 2010. According to a statement from the state health department on 10 Jan 2010, 4,579 cases of dengue fever were reported during the period, compared with 1,527 cases in 2008. The Miri District had the highest at 990, followed by, among others, Kuching District (838), Sibu (516), Sri Aman (265), and Sarikei (264).
(ProMED 1/19/2010)

Indonesia (East Kalimantan) Since December 2009, two people have died, and 176 others have been treated in hospital in Balikpapan, East Kalimantan after being infected with dengue fever virus. Balikpapan mayoralty health agency head Diyah Muryani said on 12 Jan 2010 that the dengue outbreak was already out of control. Hospitals were obliged to give free treatment to dengue fever patients, she added.
(ProMED 1/19/2010)

Indonesia (East Java)
The local administration in Jember regency, East Java, has recorded a total of 141 cases of dengue fever in the first 11 days of 2010 and say the number may increase in the coming weeks. "Usually, the number peaks between January and February at the height of the wet season," Yumarlis, spokesman of the local health agency said 12 Jan 2010. In 2009, 962 people in the regency contracted the fever; 5 of them died.
(ProMED 1/19/2010)

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CHOLERA, DIARRHEA, and DYSENTARY
Viet Nam
Many children in HCM City are falling victim to acute diarrhea caused by rotavirus, according to doctors. Tang Chi Thuong, head of the city's Paediatric Hospital No. 1, said the number of kids being hospitalized had increased by one third. According to hospital figures, 720 children were admitted in December 2009. In the digestive ward, there were four or five patients to every bed, he said.
(ProMED 1/11/2010)

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4. Articles
Evolution of MRSA during hospital transmission and intercontinental spread
Harris SR, Feil EJ, Holden MTG, et al. Science. 22 January 2010;327(5964):469-74.
Available at http://www.sciencemag.org/cgi/content/abstract/327/5964/469.

Abstract. Current methods for differentiating isolates of predominant lineages of pathogenic bacteria often do not provide sufficient resolution to define precise relationships. Here, we describe a high-throughput genomics approach that provides a high-resolution view of the epidemiology and microevolution of a dominant strain of methicillin-resistant Staphylococcus aureus (MRSA). This approach reveals the global geographic structure within the lineage, its intercontinental transmission through four decades, and the potential to trace person-to-person transmission within a hospital environment. The ability to interrogate and resolve bacterial populations is applicable to a range of infectious diseases, as well as microbial ecology.

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Incidence of 2009 pandemic influenza A H1N1 infection in England: a cross-sectional serological study
Miller E, Hoschler K, Hardelid P, et al. Lancet. 21 January 2010; doi:10.1016/S0140-6736(09)62126-7.
Available at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)62126-7/fulltext#.

Background. Knowledge of the age-specific prevalence of immunity from, and incidence of infection with, 2009 pandemic influenza A H1N1 virus is essential for modelling the future burden of disease and the effectiveness of interventions such as vaccination.

Methods. In this cross-sectional serological survey, we obtained 1403 serum samples taken in 2008 (before the first wave of H1N1 infection) and 1954 serum samples taken in August and September, 2009 (after the first wave of infection) as part of the annual collection for the Health Protection Agency seroepidemiology programme from patients accessing health care in England. Antibody titres were measured by use of haemagglutination inhibition and microneutralisation assays. We calculated the proportion of samples with antibodies to pandemic H1N1 virus in 2008 by age group and compared the proportion of samples with haemagglutination inhibition titre 1:32 or more (deemed a protective response) before the first wave of infection with the proportion after the first wave. Findings. In the baseline serum samples from 2008, haemagglutination inhibition and microneutralisation antibody titres increased significantly with age (F test p<0.0001). The proportion of samples with haemagglutination inhibition titre 1:32 or more ranged from 1.8% (three of 171; 95% CI 0.6-5.0) in children aged 0-4 years to 31.3% (52 of 166; 24.8-38.7) in adults aged 80 years or older. In London and the West Midlands, the difference in the proportion of samples with haemagglutination inhibition titre equal to or above 1:32 between baseline and September, 2009, was 21.3% (95% CI 8.8-40.3) for children younger than 5 years of age, 42.0% (26.3-58.2) for 5-14-year-olds, and 20·6% (1.6-42.4) for 15-24-year-olds, with no difference between baseline and September in older age groups. In other regions, only children younger than 15 years showed a significant increase from baseline (6.3%, 1.8-12.9).

Interpretation. Around one child in every three was infected with 2009 pandemic H1N1 in the first wave of infection in regions with a high incidence, ten times more than estimated from clinical surveillance. Pre-existing antibody in older age groups protects against infection. Children have an important role in transmission of influenza and would be a key target group for vaccination both for their protection and for the protection of others through herd immunity.

Funding. National Institute for Health Research Health Technology Assessment Programme.

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Treatment with Monoclonal Antibodies against Clostridium difficile Toxins
Lowy I, Molrine D, Leav B, et al. N Engl J Med. 21 January 2010;363(1);197-205.
Available at http://content.nejm.org/cgi/content/short/362/3/197.

Background. New therapies are needed to manage the increasing incidence, severity, and high rate of recurrence of Clostridium difficile infection.

Methods. We performed a randomized, double-blind, placebo-controlled study of two neutralizing, fully human monoclonal antibodies against C. difficile toxins A (CDA1) and B (CDB1). The antibodies were administered together as a single infusion, each at a dose of 10 mg per kilogram of body weight, in patients with symptomatic C. difficile infection who were receiving either metronidazole or vancomycin. The primary outcome was laboratory-documented recurrence of infection during the 84 days after the administration of monoclonal antibodies or placebo.

Results. Among the 200 patients who were enrolled (101 in the antibody group and 99 in the placebo group), the rate of recurrence of C. difficile infection was lower among patients treated with monoclonal antibodies (7% vs. 25%; 95% confidence interval, 7 to 29; P<0.001). The recurrence rates among patients with the epidemic BI/NAP1/027 strain were 8% for the antibody group and 32% for the placebo group (P=0.06); among patients with more than one previous episode of C. difficile infection, recurrence rates were 7% and 38%, respectively (P=0.006). The mean duration of the initial hospitalization for inpatients did not differ significantly between the antibody and placebo groups (9.5 and 9.4 days, respectively). At least one serious adverse event was reported by 18 patients in the antibody group and by 28 patients in the placebo group (P=0.09).

Conclusions. The addition of monoclonal antibodies against C. difficile toxins to antibiotic agents significantly reduced the recurrence of C. difficile infection. (ClinicalTrials.gov number, NCT00350298 [ClinicalTrials.gov] .)

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Acyclovir and Transmission of HIV-1 from Persons Infected with HIV-1 and HSV-2
Celum C, Wald A, Lingappa J, et al. N Engl J Med. 20 January 2010; 10.1056/NEJMoa0904849.
Available at http://content.nejm.org/cgi/reprint/NEJMoa0904849v1.pdf.

Background. Most persons who are infected with human immunodeficiency virus type 1 (HIV-1) are also infected with herpes simplex virus type 2 (HSV-2), which is frequently reactivated and is associated with increased plasma and genital levels of HIV-1. Therapy to suppress HSV-2 reduces the frequency of reactivation of HSV-2 as well as HIV-1 levels, suggesting that suppression of HSV-2 may reduce the risk of transmission of HIV-1.

Methods. We conducted a randomized, placebo-controlled trial of suppressive therapy for HSV-2 (acyclovir at a dose of 400 mg orally twice daily) in couples in which only one of the partners was seropositive for HIV-1 (CD4 count, ?250 cells per cubic millimeter) and that partner was also infected with HSV-2 and was not taking antiretroviral therapy at the time of enrollment. The primary end point was transmission of HIV-1 to the partner who was not initially infected with HIV-1; linkage of transmissions was assessed by means of genetic sequencing of viruses.

Results. A total of 3408 couples were enrolled at 14 sites in Africa. Of the partners who were infected with HIV-1, 68% were women, and the baseline median CD4 count was 462 cells per cubic millimeter. Of 132 HIV-1 seroconversions that occurred after randomization (an incidence of 2.7 per 100 person-years), 84 were linked within couples by viral sequencing: 41 in the acyclovir group and 43 in the placebo group (hazard ratio with acyclovir, 0.92, 95% confidence interval [CI], 0.60 to 1.41; P=0.69). Suppression with acyclovir reduced the mean plasma concentration of HIV-1 by 0.25 log10 copies per milliliter (95% CI, 0.22 to 0.29; P<0.001) and the occurrence of HSV-2-positive genital ulcers by 73% (risk ratio, 0.27; 95% CI, 0.20 to 0.36; P<0.001). A total of 92% of the partners infected with HIV-1 and 84% of the partners not infected with HIV-1 remained in the study for 24 months. The level of adherence to the dispensed study drug was 96%. No serious adverse events related to acyclovir were observed.

Conclusions. Daily acyclovir therapy did not reduce the risk of transmission of HIV-1, despite a reduction in plasma HIV-1 RNA of 0.25 log10 copies per milliliter and a 73% reduction in the occurrence of genital ulcers due to HSV-2. (ClinicalTrials.gov number, NCT00194519 [ClinicalTrials.gov] .)

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Evolutionary Dynamics of Complex Networks of HIV Drug-Resistant Strains: The Case of San Francisco
Smith R, Okano J, Kahn J, et al. Science. 2010 January 14. [Epub ahead of print]
Available at http://www.sciencemag.org/cgi/content/abstract/science.1180556.

Abstract. Over the past two decades, HIV resistance to antiretrovirals (ARVs) has risen to high levels in the wealthier countries of the world able to afford widespread treatment. We have gained insights into the evolution and transmission dynamics of ARV resistance by designing a biologically complex multistrain network model. Using this model, we traced the evolutionary history of ARV resistance in San Francisco and predict the future dynamics. Using classification and regression trees, we have identified the key immunologic, virologic, and treatment factors that increase ARV resistance. Our modeling shows that 60% of the currently circulating ARV-resistant strains in San Francisco are capable of causing self-sustaining epidemics, as each individual infected with one of these strains can cause on average more than one new resistant infection. It is possible that a new wave of ARV-resistant strains that pose a significant threat to global public health is emerging.

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Public health management of pandemic (H1N1) 2009 infection in Australia: A failure!
Waterer G, Hui D, Jenkins C. Respirology. 2009 December 27;15(1):51-56.
Available at http://www3.interscience.wiley.com/cgi-bin/fulltext/123226687/PDFSTART.

Abstract. In April 2009, severe cases of pneumonia preceded by influenza-like illness were noted to occur in Mexico and North America. A novel influenza A (H1N1) virus was identified as the cause and it rapidly evolved into a pandemic, leading to a large number of cases in Australia despite implementation of public health control measures. In this paper, two senior academics discuss the management of pandemic (H1N1) 2009 infection in Australia from the public health perspective.

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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/.

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14th International Congress on Infectious Diseases (ICID)
Miami, Florida, USA, 9-12 Mar 2010
Additional information and registration available at http://www.isid.org/14th_icid/.

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International Swine Flu Conference (ISFC)
London, United Kingdom, 10-12 Mar 2010
Reflecting their strong agreement about the importance of the International Swine Flu Conference (ISFC), renowned medical experts have agreed to share end-to-end H1N1 prevention, preparedness, and response and recovery strategies at the event. It is sponsored by New-Fields, the same company that brought to us the ISFC in Washington, United States and Toronto, Canada.
Additional information and registration available at http://www.new-fields.com/isfc_uk/.

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ISHEID Symposium on HIV and Emerging Infectious Diseases
Marseille, France, 24-26 Mar 2010
Tackling each topic from basic science to clinical applications, this meeting will deal with issues of HIV/AIDS, Viral Hepatitis, Emerging Infectious Diseases, and welcome many Key Opinion Leaders.
Additional information and registration available at http://www.isheid.com/.

The ISHEID 2010 congress organizing office...
E-mail: isheid@clq-group.com; Ph. : +33 1 44 64 15 15 - Fax : +33 1 44 64 15 16

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CDC 7th International Conference on Emerging Infectious Diseases
Atlanta, Georgia, USA 11-14 Jul 2010
The 2010 International Conference on Emerging Infectious Diseases (ICEID) is the principal meeting for emerging infectious diseases organized by CDC. This conference includes plenary and panel sessions, as well as oral and poster presentations, and covers a broad spectrum of infectious diseases of public health relevance. ICEID 2010 will also focus on the impact of various intervention and preventive strategies that have been implemented to address emerging infectious disease threats.
Additional information is available at http://www.iceid.org/.

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Options for the Control of Influenza VII
Hong Kong, 3-7 Sep 2010
Options for the Control of Influenza VII is the largest forum devoted to all aspects of the prevention, control, and treatment of influenza. As it has for over 20 years, Options VII will highlight the most recent advances in the science of influenza. The scientific program committee invites authors to submit original research in all areas related to influenza for abstract presentation. Accepted abstracts will be assigned for oral or poster presentation.
Additional information is available at http://www.controlinfluenza.com.

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Updated influenza guidance and information from the US CDC
Open Letter to the American People about the H1N1 Flu Vaccine
Released 21 January 2010
Available at http://www.cdc.gov/h1n1flu/open_letter_h1n1_vaccine.htm.

Summary of 2009 Monovalent H1N1 Influenza Vaccine Data - Vaccine Adverse Event Reporting System: Data through January 8, 2010
Released 14 January 2010
Available at http://vaers.hhs.gov/resources/2010H1N1Summary_Jan14.pdf.

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 apecein@u.washington.edu