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EINet Alert ~ Jan 29, 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
- Global: WHO situation update on pandemic influenza H1N1
- Global: WHO statement on allegations of conflict of interest and 'fake' pandemic
- Global: Physicians' views on influenza H1N1 vary by country
- Egypt: Four new human cases of avian influenza H5N1 infection
- Israel: Avian influenza H5N1 outbreak among poultry
- Switzerland: Novartis profits rise as it issues warning to nations
- ASEAN: Southeast Asian officials confer on vaccine, antivirals
- Bangladesh: H5N1 avian influenza outbreak on poultry farm
- Hong Kong: No plans to sell or donate H1N1 influenza vaccine
- Hong Kong: Centre for Health Protection finds H1N1 influenza vaccine safe for fetuses
- Indonesia: Poultry slaughterhouses to be relocated due to H5N1 influenza threat
- Vietnam: Multiple Avian influenza outbreaks reported
- Bahamas: First pandemic H1N1 vaccines received
- Canada: Five million H1N1 vaccine doses given to WHO
- USA (Florida): Tampa health agencies vaccinating homeless people with H1N1 vaccine
- USA (Kentucky): State shuts down its pandemic H1N1 hotline

2. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA

3. Articles
- Mask Use, Hand Hygiene, and Seasonal Influenza-Like Illness among Young Adults: A Randomized Intervention
- 2009 H1N1 Influenza A and Pregnancy Outcomes in Victoria, Australia
- Distribution of Airborne Influenza Virus and Respiratory Syncytial Virus in an Urgent Care Medical Clinic
- Face masks to prevent transmission of influenza virus: a systematic review
- Correlates of severe disease in patients with 2009 pandemic influenza (H1N1) virus infection
- Influenza pandemic preparedness and severity assessment of pandemic (H1N1) 2009 in South-east Asia
- Research and development of universal influenza vaccines
- Community-acquired pneumonia due to pandemic A(H1N1)2009 influenza virus and methicillin resistant Staphylococcus aureus co-infection
- Outside the Box and Into Thick Air: Implementation of an Exterior Mobile Pediatric Emergency Response Team for North American H1N1 (Swine) Influenza Virus in Houston, Texas

4. 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)
Egypt / 4 (0)
Total / 4(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: 471 (282)
(WHO 1/28/10 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_01_28/ )

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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Global: WHO situation update on pandemic influenza H1N1
As of 24 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 14,711 deaths.

Although much of the temperate northern hemisphere passed a peak of fall and wintertime pandemic influenza activity between late October and late November 2009, virus transmission remains active in several later affected areas, particularly in North Africa, limited areas of eastern and southeastern Europe, and in parts of South and East Asia.

In North Africa, limited data suggests that pandemic influenza virus transmission remains active and geographically widespread, particularly in Morocco, Algeria, Libyan Arab Jamahiriya, and in Egypt, although most countries in the region appeared to have recently passed a peak of activity during December 2009 or January 2010. In west Asia, pandemic influenza activity continues be geographically regional to widespread, however activity levels have continued to decline or remain low since December 2009.

In South Asia, pandemic influenza activity remains active but geographically variable. Recent peaks in activity were noted during late December and early January 2010 in northern India, Nepal, and Sri Lanka. Influenza activity remained stable but elevated in western India, continued to decline substantially in northern India, and remained low overall in southern and eastern India. In Bangladesh, regional influenza activity and a low intensity of respiratory diseases activity was reported.

In East Asia, transmission of pandemic influenza virus remains active, however, overall activity continued to decline in most countries. An increasing trend in respiratory diseases with localized spread was reported for North Korea. In the Republic of Korea, transmission of pandemic influenza virus remains active (>20% respiratory specimens tested positive for pandemic H1N1), however, overall activity continue to decline since peaking during November 2009. In Japan, influenza activity continues to decline, however high levels of transmission persist on the southern island of Okinawa. In northern and southern China, pandemic virus isolations have declined substantially since peaking early to mid November 2009, however, in recent weeks detections of influenza type B viruses have increased.

In southeast Asia, transmission of pandemic influenza virus persists, but current activity levels are low. In Vietnam, influenza activity has declined substantially since peaking during October and November 2009. In Thailand, focal outbreaks of influenza were reported from a few provinces in northern and central parts of the country, however, overall ILI activity remains low.

In Europe, transmission of pandemic influenza virus remains geographically regional to widespread in the central, eastern, and southeastern parts of the continent, however, overall activity continues to decline in most places. Several countries (Austria, Albania, Bulgaria, Slovakia, and the Russian Federation) reported slight increases in the levels of ARI or ILI activity, however in most, levels remain well below recent peaks in activity. The overall rate of respiratory specimens testing positive for influenza (16%) continued to fall since peaking (45%) during early November 2009.

In the Americas, both in the tropical and northern temperate zones, overall pandemic influenza activity continued to decline or remain low in most places. Of note, detections of RSV have increased in a few countries in the Americas, which may partially account for elevated ILI activity in those areas, particularly among young children. In the US and Canada, pandemic influenza virus detections and the numbers of severe and fatal cases have decline substantially as rates of ILI have fallen below seasonal baselines. In Central America and the Caribbean, pandemic influenza virus transmission persists but overall activity remains low or unchanged 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. Pandemic influenza (H1N1) 2009 virus continues to be the predominant virus circulating worldwide. Seasonal H3N2 and type B viruses are circulating at low levels in parts of Africa, east and Southeast Asia and are being detected only sporadically on other continents.
(WHO 1/29/2010)

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Global: WHO statement on allegations of conflict of interest and 'fake' pandemic
Providing independent advice to Member States is a very important function of the World Health Organization (WHO). We take this work seriously and guard against the influence of any improper interests. The WHO influenza pandemic policies and response have not been improperly influenced by the pharmaceutical industry.

WHO recognizes that global cooperation with a range of partners, including the private sector, is essential to pursue public health objectives today and in the future. Numerous safeguards are in place to manage conflicts of interest or perceived conflicts of interest among members of WHO advisory groups and expert committees. Expert advisers provide a signed declaration of interests to WHO detailing any professional or financial interest that could affect the impartiality of their advice. WHO takes allegations of conflict of interest seriously and is confident of its decision-making independence regarding the pandemic influenza.

Additional allegations that WHO created a 'fake' pandemic to bring economic benefit to industry are scientifically wrong and historically incorrect.

  • Lab analyses showed that this influenza virus was genetically and antigenically very different from other influenza viruses circulating among people
  • Epidemiological information provided by Mexico, the US and Canada demonstrated person-to-person transmission.
  • Clinical information, especially from Mexico, indicated this virus also could cause severe disease and death. At the time, those reports did not indicate a pandemic situation, but taken together sent a very strong warning to WHO and other public health authorities to be ready for one.
  • As the pandemic evolved, clinicians identified a very severe form of primary viral pneumonia, which was rapidly progressive and frequently fatal, that is not part of the disease pattern seen during seasonal influenza. While these cases were relatively rare, they imposed a heavy burden on intensive care units.
  • Geographical spread was exceptionally rapid.
    • On 29 April 2009, WHO reported lab confirmed cases in nine countries.
    • About six weeks later, on 11 June, WHO reported cases in 74 countries and territories in more than two WHO regions. It is this global spread which led WHO to call for increasing phases and finally, to announce that a pandemic was underway.
    • By 1 July, infections had been confirmed in 120 countries and territories.
The world is going through a real pandemic. The description of it as a fake is wrong and irresponsible. We welcome any legitimate review process that can improve our work.

An explanation of how WHO uses advisory bodies in responding to the influenza pandemic was made publicly available on the WHO web site on 3 December 2009.
(WHO 1/22/2010)

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Global: Physicians' views on influenza H1N1 vary by country
A seven-country survey by the market research firm Synovate found wide differences in physicians' views about the H1N1 pandemic. Only 20% of Chinese doctors agreed that pregnant women should be vaccinated, versus 90% of US doctors. Overall, 51% of the doctors said they had been vaccinated, with a range from 21% in Spain to 76% in Chinese Taipei. Sixty-two percent believed that the vaccine is effective, while 27% were uncertain. The survey focused on Synovate's proprietary physician panel.
(CIDRAP 1/25/2010)

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Europe/Near East
Egypt: Four new human cases of avian influenza H5N1 infection
Egypt's health ministry has confirmed four new H5N1 avian influenza cases, which aren't related although all had contact with sick and dead poultry and are recovering in stable condition, the WHO reported. The new cases include: a 20-year-old woman from Beni Suef governorate, a 1-year-old boy from Dakahalya governorate, a 3-year-old boy from Assuit governorate, and a 45-year-old man from Sharkia governorate.
The four H5N1 cases bring Egypt's total to 94, of which 27 have been fatal. They are the first cases to be reported in 2010. Last year Egypt reported 39 avian flu cases, up dramatically from eight in 2008. However, the number of deaths for both years was the same, at 4. The new cases raise the world's H5N1 count to 471 cases, including 282 deaths.
(CIDRAP 1/28/2010)

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Israel: Avian influenza H5N1 outbreak among poultry
An outbreak of bird flu was discovered 26 January 2010 at a henhouse in Kibbutz Ein Shemer. The disease was found in a henhouse containing about 43 000 hens. Agriculture Ministry workers began marking off the birds to be culled. All agricultural production in the area has been shut down until further notice. The event, confirmed by the national laboratory to be caused by the highly pathogenic avian influenza H5N1 virus, affected a broiler-type breeder pullet farm in Kibbutz Ein Shemer (Haifa District). The plant is known to have maintained appropriate precautionary biosecurity management; the source of infection is under investigation.

According to "Haaretz" daily of 27 January 2010, the personnel of the plant are already undergoing, preventively, Tamiflu treatment. No human cases have been recorded. All 43 000 chickens in the plant are to be culled.

The full report made to the World Organisation for Animal Health (OIE) is available at http://www.oie.int/wahis/public.php?page=single_report&pop=1&reportid=8888.
(ProMED 1/27/2010)

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Switzerland: Novartis profits rise as it issues warning to nations
Swiss pharmaceutical company Novartis announced an 8% increase in profits from 2008 to 2009, driven largely by sales of H1N1 vaccine. But during the announcement in Basel, outgoing CEO Daniel Vasella warned that the company could retaliate against governments now trying to cancel flu-shot contracts. Countries reneging on payment for vaccines that have already been delivered will not receive a priority response during the next pandemic, he said.
(CIDRAP 1/28/2010)

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Asia
ASEAN: Southeast Asian officials confer on vaccine, antivirals
Health officials from the Association of Southeast Asian Nations (ASEAN) plus three countries gathered in Singapore to open a 3-day meeting on antiviral drugs and pandemic flu vaccines. The conference, supported by the Australian Agency for International Development, will update members on drug and vaccine supplies, provide a forum for discussing issues such as access and technology transfer, and discuss how the nations can share resources, according to an ASEAN statement.
(ProMED 1/27/2010)

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Bangladesh: H5N1 avian influenza outbreak on poultry farm
Some 531 chickens were culled at a poultry farm in Joypurhat district on 25 January 2010, after it was affected by H5N1 avian influenza virus. On 24 January 2010 the Field Disease Investigation Laboratory at Joypurhat District confirmed that the virus affected Lata Poultry farm at Khetlal sub district. Earlier in January 2010, another poultry farm in the same sub district was affected with the virus. The district livestock authorities culled some 932 chickens and 183 eggs to contain the spread of the virus within 12 hours of confirmation.
(ProMED 1/27/2010)

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Hong Kong: No plans to sell or donate H1N1 influenza vaccine
Hong Kong has no plans to sell or donate its remaining doses of H1N1 vaccine, Secretary for Food and Health Dr. York Chow said, according to the country's news.gov.hk site. Noting that Hong Kong's stockpiled vaccines will expire in October, Chow encouraged people in five high-risk groups to get vaccinated.
(CIDRAP 1/28/2010)

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Hong Kong: Centre for Health Protection finds H1N1 influenza vaccine safe for fetuses
Despite receiving reports of four recent spontaneous abortions in vaccinated women, Hong Kong has seen no increase in fetal death among women receiving the H1N1 vaccine, according to a press release from Hong Kong's Centre for Health Protection. The normal rate of fetal mortality in Hong Kong is 0.3% to 0.5% of total deliveries, compared with a rate so far of 0.2% in pregnant women receiving the vaccine.
(CIDRAP 1/25/2010)

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Indonesia: Poultry slaughterhouses to be relocated due to H5N1 influenza threat
To control the spread of H5N1 avian flu, the city government of South Jakarta, Indonesia, has ordered 90 chicken slaughterhouses to move from the prime residential district of Kebayoran Lama. The moves must be completed by late April 2010. Potential locations include subdistricts elsewhere in South Jakarta as well as in the neighboring municipality of East Jakarta, including Rawa Kepiting, Pulogading, Cakung, Srengseng Raya and Petukangan Utara. The moves are part of a larger plan by local governments to control avian influenza, which sickened 11 people in South Jakarta last year and one so far this year. Vehicles that transport poultry are being inspected and, last year, two markets that sell pet and exotic birds were relocated as well.
(CIDRAP 1/25/2010)

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Vietnam: Multiple Avian influenza outbreaks reported
H5N1 avian influenza has broken out in the Vietnamese provinces of Ha Tinh in the center of the country and Dien Bien on the northwest border, according to media reports confirmed by the World Organisation for Animal Health (OIE). In Ha Tinh, 200 birds died and 378 more were destroyed, and authorities imposed a local ban on the sale, slaughter and transport of poultry. In Dien Bien, 1,400 poultry were culled. In addition, an outbreak in Ca Mau has reportedly led to the infection of 3,000 chickens, ducks and swans with H5N1 influenza.
(CIDRAP 1/25/2010, 1/28/2010)

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Americas
Bahamas: First pandemic H1N1 vaccines received
After months of delay, the Bahamas has received its first shipment of H1N1 influenza vaccines-just as cases of the pandemic virus trend down in much of the world. The Nassau Guardian reported that the 30,000-dose shipment, purchased through the Pan American Health Organization arrived 20 January 2010, two months late. The Bahamas has recorded 41 cases of novel H1N1 since the pandemic began.
(CIDRAP 1/26/2010)

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Canada: Five million H1N1 vaccine doses given to WHO
Canada has announced it will give five million doses of H1N1 vaccine and $6 million to the World Health Organization to combat the pandemic in developing countries. The doses amount to 10% of Canada's total vaccine order, a donation in line with those from other developed countries, the government said. Health Minister Leona Aglukkaq said Canada can donate vaccine because it has met its own immediate needs.
(CIDRAP 1/28/2010)

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USA (Florida): Tampa health agencies vaccinating homeless people with H1N1 vaccine
Public health agencies in and around Tampa, Florida, are working with homeless outreach organizations to vaccinate homeless people against H1N1 flu. With the virus still circulating, the Centers for Disease Control and Prevention has urged communities across the nation to focus attention on the homeless.
(CIDRAP 1/25/2010)

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USA (Kentucky): State shuts down its pandemic H1N1 hotline
After receiving about 10,000 calls since it began in October, Kentucky's hotline for questions on pandemic and seasonal influenza has been shut down as demand has waned. Public health officials say the hotline can be reactivated if needed, but in the meantime those seeking flu-related answers can go to the state's Health Alerts Web site.
(CIDRAP 1/25/2010)

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2. 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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3. Articles
Mask Use, Hand Hygiene, and Seasonal Influenza-Like Illness among Young Adults: A Randomized Intervention
Aiello AE, Murray GF, Perez V, et al. J Infect Dis. 15 February 2010;201(4):491-8.
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/650396.

Background. During the influenza A(H1N1) pandemic, antiviral prescribing was limited, vaccines were not available early, and the effectiveness of nonpharmaceutical interventions (NPIs) was uncertain. Our study examined whether use of face masks and hand hygiene reduced the incidence of influenza-like illness (ILI).

Methods. A randomized intervention trial involving 1437 young adults living in university residence halls during the 2006-2007 influenza season was designed. Residence halls were randomly assigned to 1 of 3 groups-face mask use, face masks with hand hygiene, or control- for 6 weeks. Generalized models estimated rate ratios for clinically diagnosed or survey-reported ILI weekly and cumulatively.

Results. We observed significant reductions in ILI during weeks 4-6 in the mask and hand hygiene group, compared with the control group, ranging from 35% (confidence interval [CI], 9%-53%) to 51% (CI, 13%-73%), after adjusting for vaccination and other covariates. Face mask use alone showed a similar reduction in ILI compared with the control group, but adjusted estimates were not statistically significant. Neither face mask use and hand hygiene nor face mask use alone was associated with a significant reduction in the rate of ILI cumulatively.

Conclusions. These findings suggest that face masks and hand hygiene may reduce respiratory illnesses in shared living settings and mitigate the impact of the influenza A(H1N1) pandemic.

Trial Registration. ClinicalTrials.gov identifier: NCT00490633 .

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2009 H1N1 Influenza A and Pregnancy Outcomes in Victoria, Australia
Hewagama S, Walker SP, Stuart RL, et al. Clin Infect Dis. 25 January 2010. [Epub ahead of print]
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/650460.

Background. Pregnant women have been identified as a group at risk of increased morbidity and mortality associated with the pandemic H1N1 influenza A 2009 (H1N1/09) outbreak.

Methods. Six hospitals in the state of Victoria, Australia, contributed retrospective and prospective demographic and clinical data, reason for admission data, and maternal and fetal outcome data for women with laboratory?confirmed H1N1/09 admitted to the hospital from 20 May 2009 through 31 July 2009.

Results. Forty?three cases were reported during the study period, including 8 intensive care unit admissions, 1 maternal death, 2 fetal deaths, and 1 neonatal death. The most common reason for admission was uncomplicated influenza?like illness. Patients hospitalized for uncomplicated influenza?like illness had a length of stay significantly less than those with confirmed pneumonia. Thirty?six percent of women delivered during the hospitalization. Of the women delivering before 37 weeks' gestation, almost all had pneumonia. Almost half of our case series had no other comorbidity, a large proportion (77%) of women received antivirals, and 56% received antibiotics. The incidence of hospitalization was estimated at 0.46% (95% confidence interval, 0.31%?0.66%) of all 6094 pregnant women in the third trimester during the 3?month study period. The incidence of hospitalization in the second trimester was estimated at 0.21% (95% confidence interval, 0.11%?0.36%).

Conclusions. This case series confirms a high number of complications in pregnant women due to pandemic H1N1/09. Many of these women had comorbidities, although almost 50% of the women in this case series who required hospitalization did not have an additional risk factor other than being pregnant.

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Distribution of Airborne Influenza Virus and Respiratory Syncytial Virus in an Urgent Care Medical Clinic
Lindsley WG, Blachere FM, Davis KA, et al. Clin Infect Dis. 25 January 2010. [Epub ahead of print]
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/650457.

Background. Considerable controversy exists with regard to whether influenza virus and respiratory syncytial virus (RSV) are spread by the inhalation of infectious airborne particles and about the importance of this route, compared with droplet or contact transmission.

Methods. Airborne particles were collected in an urgent care clinic with use of stationary and personal aerosol samplers. The amounts of airborne influenza A, influenza B, and RSV RNA were determined using real-time quantitative polymerase chain reaction. Health care workers and patients participating in the study were tested for influenza.

Results. Seventeen percent of the stationary samplers contained influenza A RNA, 1% contained influenza B RNA, and 32% contained RSV RNA. Nineteen percent of the personal samplers contained influenza A RNA, none contained influenza B RNA, and 38% contained RSV RNA. The number of samplers containing influenza RNA correlated well with the number and location of patients with influenza ([Formula: see text]). Forty-two percent of the influenza A RNA was in particles 4.1 mum in aerodynamic diameter, and 9% of the RSV RNA was in particles 4.1 mum.

Conclusions. Airborne particles containing influenza and RSV RNA were detected throughout a health care facility. The particles were small enough to remain airborne for an extended time and to be inhaled deeply into the respiratory tract. These results support the possibility that influenza and RSV can be transmitted by the airborne route and suggest that further investigation of the potential of these particles to transmit infection is warranted.

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Face masks to prevent transmission of influenza virus: a systematic review
Cowling BJ, Zhou Y, Ip DK, et al. Epidemiol Infect. 22 January 2010; 22:1-8.
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7108172.

Summary. Influenza viruses circulate around the world every year. From time to time new strains emerge and cause global pandemics. Many national and international health agencies recommended the use of face masks during the 2009 influenza A (H1N1) pandemic. We reviewed the English-language literature on this subject to inform public health preparedness. There is some evidence to support the wearing of masks or respirators during illness to protect others, and public health emphasis on mask wearing during illness may help to reduce influenza virus transmission. There are fewer data to support the use of masks or respirators to prevent becoming infected. Further studies in controlled settings and studies of natural infections in healthcare and community settings are required to better define the effectiveness of face masks and respirators in preventing influenza virus transmission.

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Correlates of severe disease in patients with 2009 pandemic influenza (H1N1) virus infection
Zarychanski R, Stuart TL, Kumar A, et al. CMAJ. 21 January 2010. [Epub ahead of print]
Available at http://www.cmaj.ca/cgi/content/abstract/cmaj.091884v1.

Background. In the context of 2009 pandemic influenza (H1N1) virus infection (pandemic H1N1 influenza), identifying correlates of the severity of disease is critical to guiding the implementation of antiviral strategies, prioritization of vaccination efforts and planning of health infrastructure. The objective of this study was to identify factors correlated with severity of disease in confirmed cases of pandemic H1N1 influenza.

Methods. This cumulative case-control study included all laboratory-confirmed cases of pandemic H1N1 influenza among residents of the province of Manitoba, Canada, for whom the final location of treatment was known. Severe cases were defined by admission to a provincial intensive care unit (ICU). Factors associated with severe disease necessitating admission to the ICU were determined by comparing ICU cases with two control groups: patients who were admitted to hospital but not to an ICU and those who remained in the community.

Results. As of Sept. 5, 2009, there had been 795 confirmed cases of pandemic H1N1 influenza in Manitoba for which the final treatment location could be determined. The mean age of individuals with laboratory-confirmed infection was 25.3 (standard deviation 18.8) years. More than half of the patients (417 or 52%) were female, and 215 (37%) of 588 confirmed infections for which ethnicity was known occurred in First Nations residents. The proportion of First Nations residents increased with increasing severity of disease (116 [28%] of 410 community cases, 74 [54%] of 136 admitted to hospital and 25 [60%] of 42 admitted to an ICU; p < 0.001), as did the presence of an underlying comorbidity (201 [35%] of 569 community cases, 103 [57%] of 181 admitted to hospital and 34 [76%] of 45 admitted to an ICU; p < 0.001). The median interval from onset of symptoms to initiation of antiviral therapy was 2 days (interquartile range, IQR 1-3) for community cases, 4 days (IQR 2-6) for patients admitted to hospital and 6 days (IQR 4-9) for those admitted to an ICU (p < 0.001). In a multivariable logistic model, the interval from onset of symptoms to initiation of antiviral therapy (odds ratio [OR] 8.24, 95% confidence interval [CI] 2.82-24.1), First Nations ethnicity (OR 6.52, 95% CI 2.04-20.8) and presence of an underlying comorbidity (OR 3.19, 95% CI 1.07-9.52) were associated with increased odds of admission to the ICU Abstract (i.e., severe disease) relative to community cases. In an analysis of ICU cases compared with patients admitted to hospital, First Nations ethnicity (OR 3.23, 95% CI 1.04-10.1) was associated with increased severity of disease.

Interpretation. Severe pandemic H1N1 influenza necessitating admission to the ICU was associated with a longer interval from onset of symptoms to treatment with antiviral therapy and with the presence of an underlying comorbidity. First Nations ethnicity appeared to be an independent determinant of severe infection. Despite these associations, the cause and outcomes of pandemic HINI influenza may involve many complex and interrelated factors, all of which require further research and analysis.

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Influenza pandemic preparedness and severity assessment of pandemic (H1N1) 2009 in South-east Asia
Kamigaki T, Oshitani H. Public Health. 19 January 2010. [Epub ahead of print]
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B73H6-4Y6B1V0-3&_user=10&_coverDate=01%2F19%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=54fa4b16b22bb28289dabed7903d53df,

Summary. Pandemic (H1N1) 2009 poses a serious global health threat. However, the global impact of this new pandemic remains uncertain. Past pandemics had different impacts on mortality which varied between countries. Several countries in South-east Asia have already developed their national pandemic preparedness plans. However, these plans have focused on surveillance for and response to the highly pathogenic avian influenza (H5N1), including the rapid containment of H5N1. The newly emerged pandemic (H1N1) 2009 is different from H5N1 in terms of severity and requires different approaches. There are several factors that can potentially affect the severity of pandemic (H1N1) 2009, including a population's vulnerability and response capacity. The pattern of severity appears to be changing with the spread of pandemic (H1N1) 2009, which can be conceptualized in a step-wise manner based on observation of the current situation. The overall impact of pandemic (H1N1) 2009 remains unknown and it is difficult to assess its severity. However, there is an urgent need to assess its potential severity based on the available data so that appropriate responses can be provided in order to mitigate its impact.

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Research and development of universal influenza vaccines
Du L, Zhou Y, Jiang S. Microbes Infect. 2010 January 15. [Epub ahead of print]
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VPN-4Y5GY3W-1&_user=10&_coverDate=01%2F15%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2d2f20d76f3f0461ffe58caf424e0e46.

Abstract. The continuous threat of influenza pandemics determines the urgency and necessity to develop safe and effective vaccines against divergent influenza viruses. This review describes the advancements in the research and development of universal influenza vaccines based on the relatively conserved sequences of M2e, HA, and other proteins of influenza viruses.

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Community-acquired pneumonia due to pandemic A(H1N1)2009 influenza virus and methicillin resistant Staphylococcus aureus co-infection
Murray RJ, Robinson JO, White JN, et al. PLOS One. 14 January 2010;5(1):e8705.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0008705.

Background. Bacterial pneumonia is a well described complication of influenza. In recent years, community-onset methicillin-resistant Staphylococcus aureus (cMRSA) infection has emerged as a contributor to morbidity and mortality in patients with influenza. Since the emergence and rapid dissemination of pandemic A(H1N1)2009 influenza virus in April 2009, initial descriptions of the clinical features of patients hospitalized with pneumonia have contained few details of patients with bacterial co-infection.

Methodology/Principal Findings. Patients with community-acquired pneumonia (CAP) caused by co-infection with pandemic A(H1N1)2009 influenza virus and cMRSA were prospectively identified at two tertiary hospitals in one Australian city during July to September 2009, the period of intense influenza activity in our region. Detailed characterization of the cMRSA isolates was performed. 252 patients with pandemic A(H1N1)2009 influenza virus infection were admitted at the two sites during the period of study. Three cases of CAP due to pandemic A(H1N1)2009/cMRSA co-infection were identified. The clinical features of these patients were typical of those with S. aureus co-infection or sequential infection following influenza. The 3 patients received appropriate empiric therapy for influenza, but inappropriate empiric therapy for cMRSA infection; all 3 survived. In addition, 2 fatal cases of CAP caused by pandemic A(H1N1)2009/cMRSA co-infection were identified on post-mortem examination. The cMRSA infections were caused by three different cMRSA clones, only one of which contained genes for Panton-Valentine Leukocidin (PVL).

Conclusions/Significance. Clinicians managing patients with pandemic A(H1N1)2009 influenza virus infection should be alert to the possibility of co-infection or sequential infection with virulent, antimicrobial-resistant bacterial pathogens such as cMRSA. PVL toxin is not necessary for the development of cMRSA pneumonia in the setting of pandemic A( H1N1) 2009 influenza virus co-infection.

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Outside the Box and Into Thick Air: Implementation of an Exterior Mobile Pediatric Emergency Response Team for North American H1N1 (Swine) Influenza Virus in Houston, Texas
Cruz AT, Patel B, Distefano MC, et al. Ann Emerg Med. January 2010; 55(1):23-31.
Available at http://www.annemergmed.com/article/S0196-0644%2809%2901400-0/abstract.

Study objective. We describe the implementation of a mobile pediatric emergency response team for mildly ill children with influenza-like illnesses during the H1N1 swine influenza outbreak.

Methods. This was a descriptive quality improvement study conducted in the Texas Children's Hospital (Houston, TX) pediatric emergency department (ED), covered, open-air parking lot from May 1, 2009, to May 7, 2009. Children aged 18 years or younger were screened for viral respiratory symptoms and sent to designated areas of the ED according to level of acuity, possibility of influenza-like illness, and the anticipated need for laboratory evaluation.

Results. The mobile pediatric emergency response team experienced 18% of the total ED volume, or a median of 48 patients daily, peaking at 83 patients treated on May 3, 2009. Although few children had positive rapid influenza assay results and the morbidity of disease in the community appeared to be minimal for the majority of children, anxiety about pandemic influenza drove a large number of ED visits, necessitating an increase in surge capacity. Surge capacity was augmented both through utilization of existing institutional resources and by creating a novel area in which to treat patients with potential airborne pathogens. Infection control procedures and patient safety were also maximized through patient cohorting and adaptation of social distancing measures to the ED setting.

Conclusion. The mobile pediatric emergency response team and screening and triage algorithms were able to safely and effectively identify a group of low-acuity patients who could be rapidly evaluated and discharged, alleviating ED volume and potentially preventing transmission of H1N1 influenza.

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4. 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
Q & A: Vaccine against 2009 H1N1 Influenza Virus
Released 27 January 2010
Available at http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm.

Seasonal and 2009 H1N1 Flu Vaccines Questions and Answers for Businesses
Released 27 January 2010
Available at http://www.cdc.gov/h1n1flu/business/business_qa.htm.

Key Facts About 2009 H1N1 Flu Vaccine
Released 27 January 2010
Available at http://www.cdc.gov/h1n1flu/vaccination/vaccine_keyfacts.htm.

Guidance from Pediatric Stakeholders: A Coordinated Approach to Communicating Pediatric-related Information on Pandemic Influenza at the Community Level
Released 27 January 2010
Available at >http://www.cdc.gov/h1n1flu/guidance/pediatrics_tool.htm.

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 apecein@u.washington.edu