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Vol. XIII, No. 4 ~ EINet News Briefs ~ Feb 19, 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 recommends viruses for influenza vaccines for use in the 2010-2011 northern hemisphere influenza season
- Global: WHO ponders move to post-peak pandemic phase
- Egypt: Two new human cases of avian influenza H5N1
- Australia: Pandemic H1N1 vaccine lifts CSL profits
- Cambodia (Kandal): Efforts to control avian influenza H5N1 outbreak launched
- Indonesia (Jakarta): New case of human H5N1 avian influenza infection
- Singapore: Pandemic alert level lowered
- Viet Nam: Avian influenza H5N1 update details 13 outbreaks
- Canada: H1N1 rapid tests most sensitive in young children
- Canada: Comparison of impacts of H1N1 and seasonal influenza
- Chile: Pandemic H1N1 vaccine bought for southern flu season
- USA: Department of Health and Human Services lauds pandemic partnerships
- USA: Study links pandemic spread to gaps in paid sick leave
- USA (Nevada): Health officials try luck with casino H1N1 vaccine clinics
- South Africa: Pandemic H1N1 vaccination campaign scheduled

2. Infectious Disease News
- Indonesia (Lampung): Chikungunya outbreak declared an emergency
- Chile: 10 cases of hantavirus cardiopulmonary syndrome
- USA: Red pepper cited as Salmonella-linked recall expands
- USA (New York / New Jersey): Mumps Outbreak update

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

4. Articles
- Vaccines for preventing influenza in the elderly
- Outbreak of 2009 Pandemic Influenza A (H1N1) on a Peruvian Navy Ship--June--July 2009
- Bordetella pertussis Clones Identified by Multilocus Variable-Number Tandem-Repeat Analysis
- Update on human cases of highly pathogenic avian influenza A (H5N1) infection: 2009
- Racial Disparities in Receipt of Influenza and Pneumococcus Vaccinations Among US Nursing-Home Residents
- Fulminant Myocarditis Associated With Pandemic H1N1 Influenza A Virus in Children
- A virus-like particle vaccine for epidemic Chikungunya virus protects nonhuman primates against infection
- Infant deaths associated with human parechovirus infection in Wisconsin

5. Notifications
- Emerging Infectious Diseases in Response to Climate Change
- 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 / 9 (3)
Indonesia / 1 (1)
Total / 10 (4)

***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: 478 (286)
(WHO 2/17/10 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_02_17/en/)

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 14 February 2010, worldwide more than 212 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15921 deaths.

The situation is largely unchanged since the previous update. In the temperate zone of the northern hemisphere, active but declining pandemic influenza transmission persists in limited areas of eastern and southern Europe, South Asia, and in East Asia. Several countries in West Africa reported increases in the number of cases but there is as yet insufficient evidence to conclude that widespread community transmission is occurring. An increasing trend in respiratory diseases activity was reported in Thailand and Jamaica, however the cause of the respiratory disease is uncertain at this point.

In Southeast Asia, several countries reported an increasing trend of respiratory diseases activity but overall intensity remained low. After several months of sporadic influenza activity, Thailand reported increasing respiratory diseases activity marked by increased ILI in 24 provinces; however, the overall intensity of activity nationally remains low. In Myanmar and Indonesia, localized geographic spread of influenza activity, an increasing trend of respiratory diseases, and low overall intensity was reported. In South Asia, influenza activity persists in the northern and western states of India, however, overall influenza activity continued to decline or remained low in India, Nepal, Bangladesh, and Sri Lanka. In East Asia, transmission of pandemic influenza virus persists but has been steadily declining in most countries of region (China, Japan, and the Republic of Korea), with the exception of North Korea, where an increasing trend of respiratory diseases activity was reported. In West Asia, pandemic influenza virus continues to circulate in many countries, however, the overall intensity of current activity remains low in the region.

In North Africa, pandemic influenza transmission persists but substantial declines in activity continue to be reported over the past month. In Sub-Saharan Africa, limited data suggest that pandemic influenza virus transmission may be sporadic in most areas of the continent. Several countries in West Africa continue to report increases in the numbers of confirmed cases of pandemic influenza, however, currently, no countries in the region are reporting an increasing trend in respiratory diseases activity.

In Europe, pandemic influenza virus continues to circulate across central and southeastern Europe, but the overall intensity of activity remained low in most places; only Greece, Bulgaria, Turkey, Slovakia, the Republic of Moldova, and the Russian Federation reported a moderate intensity of respiratory diseases activity. Several weeks of increases in ARI/ILI were reported in Slovakia and in the Russian Federation, but increased activity in these countries may be associated with other circulating respiratory viruses. Among 12 countries testing at least twenty sentinel respiratory specimens, only Hungary reported that greater than 20% specimens had tested positive for influenza.

In the Americas, both in the tropical and northern temperate zones, pandemic influenza virus continues to circulate at low levels but overall pandemic influenza activity continued to decline or remain low in most places. In Central America and the Caribbean, pandemic influenza virus transmission persists but overall activity remains low or unchanged in most places. Jamaica reported an increasing trend of respiratory diseases activity but the overall intensity remains low.

Pandemic influenza (H1N1) 2009 virus continues to be the predominant influenza virus circulating worldwide. In addition to the increasing proportion of seasonal influenza type B viruses recently detected in China, low levels of seasonal H3N2 and type B viruses are circulating in parts of Africa, and Asia.
(WHO 02/19/2010)

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Global: WHO recommends viruses for influenza vaccines for use in the 2010-2011 northern hemisphere influenza season
The WHO recommends that the following viruses be used for influenza vaccines in the 2010-2011 influenza season (northern hemisphere):

  • - an A/California/7/2009 (H1N1)-like virus;
  • - an A/Perth/16/2009 (H3N2)-like virus;*
  • - a B/Brisbane/60/2008-like virus.
* A/Wisconsin/15/2009 is an A/Perth/16/2009 (H3N2)-like virus and is a 2010 southern hemisphere vaccine virus

The full report is available at http://www.who.int/csr/disease/influenza/201002_Recommendation.pdf.
(WHO 2/18/2010)

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Global: WHO ponders move to post-peak pandemic phase
With pandemic flu activity continuing to ease except in a few hot spots, the WHO said it will convene its emergency group of experts at the end of the month to discuss a move to the post-peak phase of the pandemic.

Keiji Fukuda, special adviser to the WHO director-general on pandemic flu, told reporters that though overall activity is declining in the Northern Hemisphere, it's clear that the pandemic H1N1 virus is still causing disease and deaths in many parts of the world. For example, West African countries have reported very little pandemic flu activity, but the WHO recently received reports of community spread in Senegal. Fourteen cases have been confirmed there, where the disease has been mild with no reports of deaths, Fukuda said.

The WHO will ask its emergency committee to consider if the pandemic activity has moved to the next phase, which Fukuda described as a transition period during which the pandemic continues, but the scientific evidence suggests that the worst is probably over. The WHO's official explanation of the pandemic phases describes the post-peak period as a time when "levels of pandemic influenza in most countries with adequate surveillance have dropped below peak levels." It's the last phase before the post-pandemic period.

Fukuda said a question that often arises is why the WHO can't just declare that the pandemic is over. "Ending of a pandemic can't be considered on or off abruptly. Patterns are different in different countries," he said, adding that designating a post-peak period is a way of helping national authorities look ahead and take the next planning steps.
(CIDRAP 2/11/2010)

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Europe/Near East
Egypt: Two new human cases of avian influenza H5N1
The Ministry of Health of Egypt has announced two new cases of human H5N1 avian influenza infection.

The first case is a 32 year-old male from Ashmon district in Menofya Governorate. He developed symptoms on 6 February 2010 and was hospitalized on 8 February 2010, where he received oseltamivir treatment. He is in a stable condition.

The second case is a 29 year-old pregnant female from Elsadat District, Menofya Governorate. She developed symptoms on 6 February 2010 and was hospitalized on 12 February 2010, where she received oseltamivir treatment. She died on 13 February.

Investigations into the source of infection indicated that both cases had exposure to sick and dead poultry. The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network (GISN).

Egyptian authorities have also reported that two deaths have occurred in the previously announced cases; the 37 year-old male from Helwan District, Helwan Governorate who developed symptoms on 31 January 2010 and the 29 year-old female from Elsadat District, Menofya Governorate who developed symptoms on 27 January 2010.
(WHO 2/17/2010)

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Asia
Australia: Pandemic H1N1 vaccine lifts CSL profits
Australian vaccine manufacturer CSL Ltd. posted higher-than-expected profits for the second half of 2009, largely due to sales of H1N1 vaccine. The company's net income was $617.4 million in Australian dollars, above analyst estimates that averaged $530 million. In the six-month period, CSL earned $160 million just on H1N1 vaccine. Cancellations of some orders did not affect profits, the company said.
(CIDRAP 2/17/2010)

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Cambodia (Kandal): Efforts to control avian influenza H5N1 outbreak launched
Authorities in Kandal province have launched a campaign to contain a recent outbreak of the H5N1 influenza virus that led to large-scale culls of chickens and ducks in neighboring Takeo province during the first week of February 2010. As part of the campaign, officials have been spraying vehicles travelling along National Road 1 to Phnom Penh with liquid TH4, a virucidal, bactericidal, and fungicidal disinfectant. The campaign was designed to prevent the virus from spreading during Chinese New Year, which began on 14 February 2010.
(ProMED 2/14/2010)

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Indonesia (Jakarta): New case of human H5N1 avian influenza infection
The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 25-year-old female from South Jakarta District, DKI Jakarta Province died on 25 January 2010. Laboratory tests were positive for H5N1 virus infection. The case was possibly infected from direct contact with poultry.

Of the 163 cases confirmed to date in Indonesia, 135 have been fatal.
(ProMED 2/12/2010)

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Singapore: Pandemic alert level lowered
Singapore's health ministry announced 12 February 2010 that it was lowering its pandemic H1N1 flu alert from yellow to green. The country raised the alert to yellow and then orange in late April but moved back to yellow in May. Doctor's visits for respiratory infection have been below baseline since August. The ministry vowed to continue monitoring the disease but said dialing back the level will make it easier for people to visit hospitals and nursing homes.
(CIDRAP 2/12/2010)

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Viet Nam: Avian influenza H5N1 update details 13 outbreaks
Animal health officials in Vietnam have confirmed 13 H5N1 avian influenza outbreaks in poultry since 20 January 2010, according to a 13 February 2010 report from the World Organization for Animal Health (OIE). The outbreaks span seven different provinces, with five of them in Ha Tinh in central Vietnam. All but one of the outbreaks occurred on farms. In total, the virus killed 6,033 birds, and 14,304 more were culled to control the outbreaks. Investigations into outbreak sources found that introduction of new animals, illegal movement of birds, and fomites probably contributed to the spread of the virus.
(CIDRAP 2/15/2010)

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Americas
Canada: H1N1 rapid tests most sensitive in young children
A prospective study of the accuracy of rapid diagnostic tests for H1N1 influenza has found that the test returns more accurate results for children and teenagers than it previously has for adults. The study among 820 children treated at Toronto's Hospital for Sick Children found that the test was sensitive to H1N1 flu for 62% of the children tested and was most sensitive in children who were younger than five or whose symptoms had begun less than two days earlier.
(CIDRAP 2/15/2010)

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Canada: Comparison of impacts of H1N1 and seasonal influenza
The Canadian Institute for Health Information says that 8,507 Canadians were hospitalized with H1N1 flu from April 2009 through January, compared with 2,614 hospitalized for seasonal flu in 2007-08. The median age of hospitalized H1N1 patients was 28 and the median for fatalities was 53; the corresponding ages for seasonal flu patients were 71 and 83. One in six H1N1 hospital patients needed intensive care, versus one in seven seasonal flu hospital patients.
(ProMED 2/12/2010)

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Chile: Pandemic H1N1 vaccine bought for southern flu season
The health ministry of Chile announced it has purchased two million doses of H1N1 flu vaccine in anticipation of the start of the Southern Hemisphere's flu season, adding to 500,000 the government already has on hand. The Latin American Herald Tribune reported the shots will be used for healthcare workers, chronic-illness patients, pregnant women, and children younger than 2. Those over 60 will not be eligible for government shot campaigns but can obtain the shots through private providers.
(CIDRAP 2/17/2010)

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USA: Department of Health and Human Services lauds pandemic partnerships
As pandemic flu activity across the nation wanes, federal health officials are reviewing the government's response and lessons learned to help blunt the impact of the next national public health emergency, Kathleen Sebelius, secretary of the US Department of Health and Human Services (HHS) said 16 February 2010.

She said that HHS will look for new ways to accomplish public health goals with outside partners such as public schools, universities, or businesses. She pointed to a survey revealing that almost one third of parents said their children got vaccinated at schools, which do not typically operate within the public health community. Key partnerships with state and local health departments also helped federal officials expand the scope of the pandemic immunization campaign, she said.

Perhaps the toughest lesson for federal officials has been the limits of current vaccine technology, she said. For the next threat, the government would like to develop, produce, and deliver a vaccine within weeks, not months, Sebelius added. "We worked to squeeze every last bit of efficiency and dependability out of a safe, but outdated technology," she said.

Sebelius credited past pandemic and all-hazards planning with putting the nation in a good position to respond, particularly with countermeasures and hospital surge capacity. "This combination of preparation and partnership has allowed us to have a successful response to the H1N1 flu so far," she said.
(CIDRAP 2/17/2010)

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USA: Study links pandemic spread to gaps in paid sick leave
Employees without paid sick days were more likely to work when they were sick during the peak of the fall pandemic wave and may have extended the outbreak by infecting their coworkers, according to the Institute for Women's Policy Research (IWPR), a research group.

Using data from the US CDC and the US Department of Labor, the investigators estimate that almost 26 million employed Americans age 18 and older may have been infected with the pandemic H1N1 virus from September through November. They projected that nearly 18 million took at least a part of a week off due to illness and that eight million apparently worked while they were sick and may have infected as many as seven million coworkers.

The United States is one of a few developed nations that doesn't have universal paid sick days, which the IWPR and others have said impairs the nation's response to infectious disease outbreaks. The full report is available at http://www.iwpr.org/pdf/B284sickatwork.pdf.
(CIDRAP 2/16/2010)

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USA (Nevada): Health officials try luck with casino H1N1 vaccine clinics
In an effort to offer the pandemic flu vaccine where people congregate, health officials in Carson City, Nevada, are immunizing people at area casinos. A casino clinic on 6 February 2010 immunized 174 people, and other similar events are scheduled. A Health department spokeswoman said earlier in the outbreak people were more likely to come to vaccination locations, but now that the holidays have passed it's easier to bring the shots to the people.
(CIDRAP 2/12/2010)

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Africa
South Africa: Pandemic H1N1 vaccination campaign scheduled
The government of South Africa will launch a national flu-vaccination campaign 15 March 2010, to ensure maximum immunity before the start of the 2010 FIFA World Cup in June. The country will use a total of 4.8 million doses in two rounds beginning 15 March 2010 and 3 May 2010. Both rounds will be aimed primarily at front-line healthcare personnel and high-risk groups, including children and pregnant women.
(CIDRAP 2/17/2010)

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2. Infectious Disease News

Asia
Indonesia (Lampung): Chikungunya outbreak declared an emergency
At least 420 people in Sidomulyo, South Lampung regency, have been infected with chikungunya virus since early January 2010, prompting local health authorities to declare the outbreak an emergency. A top official at the local health agency, Kristi Endrawati, said on 16 February 2010 that the disease had spread from one village to another within a relatively short time. She said the Aedes aegypti mosquito, which carries the chikungunya virus, was rapidly reproducing in cacao plantation areas in the regency. "The cacao pod can hold water and become a mosquito nest which contributes to the spread of the Aedes aegypti mosquito. It is impossible to fog all the plantations since they are too big and it is not effective. We only fog residential areas," she said.

Since mid-December 2009, 12,000 people in Lampung were recorded to have contracted the disease, the highest recorded number in the last 10 years.
(ProMED 2/16/2010)

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Americas
Chile: 10 cases of hantavirus cardiopulmonary syndrome
During 2010, 10 new cases of hantavirus cardiopulmonary syndrome have presented, confirmed by the Institute of Public Health of Chile (National Reference Laboratory): eight in January 2010, and two so far in February 2010. Of these, four have died (case fatality rate so far of 40 percent). All cases have been in the extreme southern part of the country.
(ProMED 2/15/2010)

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USA: Red pepper cited as Salmonella-linked recall expands
Daniele Inc., based in the state of Rhode Island, said it is recalling 115,000 pounds of "Hot Salame Panino" product, a type of salami wrapped in mozzarella cheese and sprinkled with red pepper, produced between 5 November 2010 and 15 February 2010. According to the US Department of Agriculture's Food Safety and Inspection Service (FSIS), on the basis of preliminary testing, "the company believes crushed red pepper may be a possible source of Salmonella contamination." The latest recall includes six different products sold under various names, all labeled with "EST. 459" inside the USDA mark of inspection. They have sell-by dates ranging from 3 February through 26 May 2010 and were distributed to retail stores nationwide.
(CIDRAP 2/17/2010)

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USA (New York / New Jersey): Mumps Outbreak update
State and local health departments, in collaboration with CDC, continue to investigate a mumps outbreak that began in New York in June 2009. As of 29 January 2010, a total of 1,521 cases had been reported, with onset dates from 28 June 28 2009 through 29 January 2010, a substantial increase from the 179 cases reported as of 30 October 2009. The outbreak has remained confined primarily to the tradition-observant Jewish community, with <3% of cases occurring among persons outside the community. The largest percentage of cases (61%) has occurred among persons aged 7--18 years, and 76% of the patients are male. Among the patients for whom vaccination status was reported, 88% had received at least one dose of mumps-containing vaccine, and 75% had received two doses. This is the largest mumps outbreak that has occurred in the United States since 2006.
(CDC MMWR 2/12/2010)

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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
Indonesia (Banten)
According to the Jakarta city health agency, the number of dengue fever cases reached 914 as of 3 February 2010, a 25 percent decline from the same period in 2009. The first two months of 2009 saw 1,202 cases, with total incidents reaching 18,000.
(ProMED 2/8/2010)

Malaysia (Selangor)
Selangor health officials are bracing to contain an anticipated sharp increase in dengue cases following 11 deaths, eight of which happened in the state during January 2010. There were 1,895 cases in Selangor during January 2010, according to state health executive councilor, Dr. Xavier Jayakumar.
(ProMED 2/8/2010)

Mexico (Guerrero)
After at least three dengue hemorrhagic fever deaths have been registered among the inhabitants of the Ometepec city center, the citizens are facing an outbreak that could evolve into an epidemic.
(ProMED 2/8/2010)

Philippines (Cebu)
A vaccine being developed to protect against the dengue virus is currently being tested in children aged six to 14 years old in Cebu City where the incidence of dengue cases is increasing. The city had 217 cases of dengue and six deaths recorded from January to mid-February 2010.
(Philippine Information Agency 2/18/2010)

Singapore
During the week of 23 January 2010, dengue fever cases in Singapore rose to 131 -- a sharp 70 percent increase from the previous week.
(ProMED 2/8/2010)

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CHOLERA, DIARRHEA, and DYSENTARY
Mexico (Chiapas)
The Secretariat of Health in Chiapas has declared an alert as a result of an outbreak of rotavirus infection and has deployed multidisciplinary teams to the communities where cases have been confirmed. The number of cases of acute diarrheal disease in 2010 has increased by 30 percent compared with the corresponding period in 2009.
(ProMED 2/10/2010)

Papua New Guinea (East Sepik, Morobe, Madang)
Papua New Guinea's cholera outbreak has spread to 2,000 people, a WHO official said on 8 February 2010 as he warned that poor water sanitation was making the disease hard to contain. The country's first cholera outbreak in 50 years emerged in northern Morobe province in July 2009. Within months it had spread along the north coast to Madang and East Sepik, WHO representative Eigil Sorensen said.
(ProMED 2/12/2010)

Russia (Murmansk)
The incidence of enteric infections has increased in Murmansk. There were 87 cases in January 2010 compared with 23 in December 2009. This represents an increase of about 20-40 percent above the annual average rate and is a consequence of rotavirus infections. There have been seven outbreaks in Murmansk preschools.
(ProMED 2/15/2010)

Russia (Yekaterinburg: Sverdlovsk Region)
There have been 1,507 cases of acute enteric infections in Yekaterinburg in January 2010, which represent a 1.3-fold increase from December 2009. The annual average rates also have exceeded 1.4-fold according to the Regional Rosportebnadzor [Regional Human Welfare Protection Agency]. 12 percent of preschools and 15 percent of schools reported enteric infections. There were 178 acute enteric infection cases in the schools in January 2010, which is twice the annual average. Out of 664 food samples that have been taken for laboratory tests, 44 were microbiologically contaminated. The drinking water samples (502) also were contaminated in 0.6 percent of cases.
(ProMED 2/15/2010)

Russia (Yakutia)
The Office of Rospotrebnadzor in Yakutia has suspended the activity of the Yakutsk dairy factory for five days. The factory had recently produced contaminated milk which poisoned at least 155 people, including 108 children. According to the representative of Rospotrebnadzor, 33 individuals had a bacteriologically confirmed diagnosis of dysentery caused by Shigella flexneri.
(ProMED 2/12/2010)

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4. Articles
Vaccines for preventing influenza in the elderly
Jefferson T, Di Pietrantonj C, Al-Ansary LA, et al. Cochrane Database of Systematic Reviews. 2010;2. Art. No.: CD004876. DOI: 10.1002/14651858.CD004876.pub3.
Available at http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004876/frame.html.

Background. Vaccines have been the main global weapon to minimise the impact of influenza in the elderly for the last four decades and are recommended worldwide for individuals aged 65 years or older. The primary goal of influenza vaccination in the elderly is to reduce the risk of complications among persons who are most vulnerable.

Objectives. To assess the effectiveness of vaccines in preventing influenza, influenza-like illness (ILI), hospital admissions, complications and mortality in the elderly. To identify and appraise comparative studies evaluating the effects of influenza vaccines in the elderly. To document types and frequency of adverse effects associated with influenza vaccines in the elderly.

Search strategy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register (The Cochrane Library 2009, issue 4); MEDLINE (January 1966 to October Week 1 2009); EMBASE (1974 to October 2009) and Web of Science (1974 to October 2009).

Selection criteria. Randomised controlled trials (RCTs), quasi-RCTs, cohort and case-control studies assessing efficacy against influenza (laboratory-confirmed cases) or effectiveness against influenza-like illness (ILI) or safety. Any influenza vaccine given independently, in any dose, preparation or time schedule, compared with placebo or with no intervention was considered.

Data collection and analysis. We grouped reports first according to the setting of the study (community or long-term care facilities) and then by level of viral circulation and vaccine matching. We further stratified by co-administration of pneumococcal polysaccharide vaccine (PPV) and by different types of influenza vaccines. We analysed the following outcomes: influenza, influenza-like illness, hospital admissions, complications and deaths.

Main results. We included 75 studies. Overall we identified 100 data sets. We identified one RCT assessing efficacy and effectiveness. Although this seemed to show an effect against influenza symptoms it was underpowered to detect any effect on complications (1348 participants). The remainder of our evidence base included non-RCTs. Due to the general low quality of non-RCTs and the likely presence of biases, which make interpretation of these data difficult and any firm conclusions potentially misleading, we were unable to reach clear conclusions about the effects of the vaccines in the elderly.

Authors' conclusions. The available evidence is of poor quality and provides no guidance regarding the safety, efficacy or effectiveness of influenza vaccines for people aged 65 years or older. To resolve the uncertainty, an adequately powered publicly-funded randomised, placebo-controlled trial run over several seasons should be undertaken.

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Outbreak of 2009 Pandemic Influenza A (H1N1) on a Peruvian Navy Ship--June--July 2009
Vera D, Gonzaga V, Hora R, et al. MMWR. 19 February 2010:59(06);162-165.
Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5906a3.htm.

Introduction. On June 25, 2009, a naval cadet reported to the infirmary of a 355-crewman Peruvian Navy ship with a febrile acute respiratory infection (FARI) 5 days after the ship docked in San Francisco, California. Pandemic 2009 influenza A (H1N1) virus was suspected as the cause because it was circulating in the city at that time. A test for pandemic H1N1 by real-time reverse transcription--polymerase chain reaction (rRT-PCR) was positive. During the subsequent 3 weeks, as the ship continued its cruise, 77 additional crew members developed confirmed pandemic H1N1 influenza. The U.S. Naval Medical Research Center Detachment (NMRCD), in collaboration with the Peruvian Navy, conducted an investigation to describe the outbreak and determine the attack rate for pandemic H1N1 influenza on the ship. This report summarizes the results of that investigation, which indicated that, of the 85 patients with FARI, 78 (92%) tested positive for pandemic H1N1 by rRT-PCR. The attack rate for confirmed pandemic H1N1 influenza was 22.0%. The most frequent symptoms, other than fever, were cough, headache, nasal congestion, and malaise. No complications or deaths occurred. Patients were treated according to World Health Organization (WHO) influenza treatment guidelines; six patients received antiviral medication because of preexisting comorbidities. A shipboard respiratory surveillance program, which had been implemented aboard the ship before its departure from Peru, permitted the early detection of the outbreak. Subsequent implementation of control measures might have slowed the outbreak. Laboratory disease surveillance and adequate outbreak control procedures might reduce transmission of pandemic H1N1 influenza aboard ships.

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Bordetella pertussis Clones Identified by Multilocus Variable-Number Tandem-Repeat Analysis
Kurniawan J, Maharjan R, Chan W, et al. Emerg Infect Dis. February 2010;16(2):297-300.
Available at http://www.cdc.gov/eid/content/16/2/297.htm.

Abstract. Multilocus variable-number tandem-repeat analysis (MLVA) of 316 Bordetella pertussis isolates collected over 40 years from Australia and 3 other continents identified 66 MLVA types (MTs), including 6 predominant MTs. Typing of genes encoding acellular vaccine antigens showed changes that may be vaccine driven in 2 MTs prevalent in Australia.

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Update on human cases of highly pathogenic avian influenza A (H5N1) infection: 2009
WHO. Weekly Epidemiological Record Bulletin. 12 February 2010; 85(7): 49-56.
Available at http://www.who.int/wer/2010/wer8507.pdf.

Summary. During 2009, 73 laboratory-confirmed cases of human infection with highly pathogenic avian influenza A (H5N1) virus were reported to the WHO from 5 countries. This report summarizes these cases.

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Racial Disparities in Receipt of Influenza and Pneumococcus Vaccinations Among US Nursing-Home Residents
Li Y, Mukamel DB. Am J Public Health. 10 February 2010. [Epub ahead of print]
Available at http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2009.173468v1.

Objectives. We examined racial disparities in receipt and documentation of influenza and pneumococcus vaccinations among nursing-home residents.

Methods. We performed secondary analyses of data from a nationally representative survey of White (n=11448) and Black (n=1174) nursing-home residents in 2004. Bivariate and multivariate analyses determined racial disparities in receipt of influenza vaccination in 2003 and 2004, receipt of pneumococcus vaccination ever, and having a documented history for each vaccination.

Results. The overall vaccination rate was 76.2% for influenza and 48.5% for pneumococcus infection. Compared with Whites, Blacks showed a 13% lower vaccination rate and a 5% higher undocumentation rate for influenza, and a 15% lower vaccination rate and a 7% higher undocumentation rate for pneumococcus. For influenza, the odds ratio (OR) for Blacks being unvaccinated was 1.84 (P<.001), and the OR for Blacks having undocumented vaccination was 1.85 (P=.001). For pneumococcus infection, the OR for Blacks being unvaccinated was 1.70 (P<.001), and the OR for Blacks having undocumented vaccination was 1.95 (P<.001). Stratified analyses confirmed persistent racial disparities among subpopulations.

Conclusions. Racial disparities exist in vaccination coverage among US nursing-home residents. Targeted interventions to improve vaccination coverage for minority nursing-home residents are warranted.

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Fulminant Myocarditis Associated With Pandemic H1N1 Influenza A Virus in Children
Bratincsák A, El-Said H, Bradley J, et al. J Am Coll Cardiol. 10 February 2010; doi:10.1016/j.jacc.2010.01.004. (references removed)
Available at http://content.onlinejacc.org/cgi/content/full/j.jacc.2010.01.004v1.

To the Editor: Acute myocarditis is a well-recognized, albeit rare, manifestation of numerous viral infections with a broad spectrum of symptoms and clinical features. Fulminant myocarditis may present with fatal arrhythmias, atrioventricular block, and/or varying degrees of cardiogenic shock. The prevalence of myocardial involvement in influenza infection ranges from 0 to 11% depending on the diagnostic criteria used to define myocarditis. Fulminant myocarditis is an uncommon complication, typically diagnosed in association with circulatory collapse or at autopsy in patients with influenza-associated fatal outcomes. A few case reports and series represent the incidental diagnoses of influenza-associated acute fulminant myocarditis, but the true prevalence remains unknown.

Here we present the first known report of acute myocarditis in pediatric population associated with the present pandemic H1N1 influenza A virus infection. Four cases occurred within a 30-day period, and 3 of them were diagnosed as fulminant myocarditis with fatal or near-fatal outcomes.

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A virus-like particle vaccine for epidemic Chikungunya virus protects nonhuman primates against infection
Akahata W, Yang ZY, Andersen H, et al. Nat Med. 28 January 2010. [Epub ahead of print]
Available at http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.2105.html.

Abstract. Chikungunya virus (CHIKV) has infected millions of people in Africa, Europe and Asia since this alphavirus reemerged from Kenya in 2004. The severity of the disease and the spread of this epidemic virus present a serious public health threat in the absence of vaccines or antiviral therapies. Here, we describe a new vaccine that protects against CHIKV infection of nonhuman primates. We show that selective expression of viral structural proteins gives rise to virus-like particles (VLPs) in vitro that resemble replication-competent alphaviruses. Immunization with these VLPs elicited neutralizing antibodies against envelope proteins from alternative CHIKV strains. Monkeys immunized with VLPs produced high-titer neutralizing antibodies that protected against viremia after high-dose challenge. We transferred these antibodies into immunodeficient mice, where they protected against subsequent lethal CHIKV challenge, indicating a humoral mechanism of protection. Immunization with alphavirus VLP vaccines represents a strategy to contain the spread of CHIKV and related pathogenic viruses in humans.

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Infant deaths associated with human parechovirus infection in Wisconsin
Sedmak G, Nix W, Jentzen J, et al. Clin Infect Dis. 1 February 2010;50(3):357-61.
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/649863.

Background. From December 1987 through August 2004, lung tissue, nasopharyngeal swabs, and colon swab specimens obtained during 1263 autopsies of infants and young children were examined to assess the role of viruses in deaths of children aged <2 years.

Methods. Multiple cell cultures were used to isolate viruses. With 4 exceptions, virus isolates were identified by neutralization, immunofluorescence assay, or enzyme immunoassay. RNA extracted from these 4 isolates and associated autopsy specimens was tested using parechovirus-specific real-time polymerase chain reaction (RT-PCR) and sequencing assays.

Results. Specimens from 426 (34%) autopsies were positive for at least 1 virus; enteroviruses and adenoviruses were the most commonly identified. Human parechoviruses (HPeVs) were identified antigenically in isolates from 18 decedents (all HPeV type 1) and by RT-PCR in isolates and multiple autopsy specimens from 4 decedents with untypeable virus isolates. Sequencing of the VP1 region identified these 4 HPeVs as HPeV type 3 ([Formula: see text]) and HPeV type 6 ([Formula: see text]). Despite the detection of HPeV, the deaths of decedents 3 and 4 were determined to have been from noninfectious causes.

Conclusions. These are the first confirmed HPeV type 3 and HPeV type 6 detections in the United States. This is also the initial report of fatal cases with associated HPeV type 3 infection. These results support prior findings associating HPeVs with serious disease in young children. Clinical testing for HPeVs and routine HPeV surveillance by public health laboratories will help determine the burden of disease caused by HPeVs.

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5. Notifications
Emerging Infectious Diseases in Response to Climate Change
New York City, USA, 2 March 2010
This symposium examines the complex relationship between the climate, environment, and infectious diseases.
Additional information and registration available at http://www.nyas.org/Events/Detail.aspx?cid=aa4086a1-6917-4cd3-b14f-7317214ed96c.

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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.
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
Flu-Related Hospitalizations and Deaths in the United States from April 2009 - January 30, 2010: Questions & Answers
Released 17 February 2010
Available at http://www.cdc.gov/h1n1flu/hosp_deaths_ahdra.htm.

2009 H1N1 and Seasonal Influenza and Hispanic Communities: Questions and Answers
Released 16 February 2010
Available at http://www.cdc.gov/h1n1flu/qa_hispanic.htm.

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 apecein@u.washington.edu