Login   

Vol. XIII, No. 5 ~ EINet News Briefs ~ Mar 05, 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
- Egypt: Five new cases of human H5N1 avian influenza infection
- Norway: Pandemic H1N1 mutation's proposed link to severe illness debated
- China: Pandemic H1N1 influenza peak has passed
- Hong Kong: Swine influenza virus reassorted with pandemic H1N1 virus isolated from pig
- South Korea: Travelers from Viet Nam to be scrutinized for influenza
- Viet Nam: Three new cases of human H5N1 avian influenza infection
- Viet Nam: Avian influenza H5N1 detected in more flocks
- USA: FDA Issues Final Guidance to Boost Development of Cell-based Viral Vaccines

2. Infectious Disease News
- Chinese Taipei: Three cases of imported chikungunya
- Hong Kong: Possible respiratory syncytial virus (RSV) outbreak among elderly
- Indonesia (Lampung): Special alert for chikungunya virus declared
- Philippines (Cagayan): Possible anthrax outbreak
- Philippines (Tarlac): Measles outbreaks in six areas
- Russia: Hemorrhagic fever with renal syndrome outbreak
- Russia (Kakuga): Lyme disease epidemic continues
- Thailand (Bangkok): Rabies animal vaccination campaign planned after human death
- USA (Colorado): Second ever death in Colorado county caused by a hantavirus
- USA: Salmonella risk in flavoring may drive host of food recalls
- USA: Mumps outbreak climbs to 2,336 cases

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

4. Articles
- Household Transmission of 2009 Influenza A (H1N1) Virus after a School-Based Outbreak in New York City, April-May 2009
- Observed association between the HA1 mutation D222G in the 2009 pandemic influenza A(H1N1) virus and severe clinical outcome, Norway 2009-2010
- Effective Detection of the 2009 H1N1 Influenza Pandemic in U.S. Veterans Affairs Medical Centers Using a National Electronic Biosurveillance System
- Human Infection with a Triple-Reassortant Swine Influenza A(H1N1) Virus Containing the Hemagglutinin and Neuraminidase Genes of Seasonal Influenza Virus
- Livestock-associated Methicillin-Resistant Staphylococcus aureus Sequence Type 398 in Humans, Canada
- Evolutionary pattern of pandemic influenza (H1N1) 2009 virus in the late phases of the 2009 pandemic

5. Notifications
- 14th International Congress on Infectious Diseases (ICID)
- International Conference on Healthcare-Associated Infections 2010
- International Swine Flu Conference (ISFC)
- ISHEID Symposium on HIV and Emerging Infectious Diseases
- Thailand Conference on Emerging Infectious and Neglected 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: 486 (287)
(WHO 3/4/10 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_03_04/)

Avian influenza age distribution data from WHO/WPRO (last updated 2/8/10): 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 2/12/10): http://gamapserver.who.int/mapLibrary/Files/Maps/Global_H5N1Human_2010_FIMS_20100212.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

^top

WHO situation update on pandemic influenza H1N1
As of 28 February 2010, more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 16,455 deaths.

In the temperate zone of the northern hemisphere, transmission of virus persists in some areas of Europe and Asia but influenza activity is declining and at low level in the most areas. The most active areas of transmission are currently observed in parts of Southeast Asia and East and South-eastern Europe. Recently, influenza type B is increasingly reported in Asia.

Pandemic influenza virus continues to circulate in South and Southeast Asian countries. In Thailand, activity has increased and Myanmar continues to report regionally circulating pandemic virus. However, the overall intensity of activity nationally is still low in both countries. Respiratory disease activity is declining in all other countries of the area. In East Asia, transmission of pandemic influenza virus persists at low levels in most countries including Hong Kong and Chinese Taipei or has returned to baseline levels (Japan and the Republic of Korea). Of note, seasonal influenza B virus activity has been increasing in the area and is now the predominant influenza virus in Mongolia, China, and parts of South East Asia. Japan has also reported clusters of influenza B related cases.

In Australia and New Zealand, overall influenza activity remains low and at the levels experienced at the same time in previous years. No new cases of H1N1 influenza have been reported this week from the island nations of the South Pacific.

Influenza activity is low in Western Europe and has largely returned to baseline levels. However, many countries of Eastern Europe (Russian Federation, Bulgaria, Armenia and Moldova) are still reporting some increased respiratory disease activity compared to their baselines. The percentage of respiratory specimens testing positive for influenza decreased further in week 7 to around 3.5%. The majority of those were positive for pandemic influenza and only a very few seasonal influenza H3N2 and influenza type B viruses were detected.

In the northern temperate zones of the Americas, pandemic influenza virus continues to circulate at very low levels yielding an overall low and declining pattern of pandemic influenza activity. However, in Mexico and Peru, there is a slight increase in respiratory disease activity, though the overall intensity remains low and it is unclear how much is related to pandemic influenza. In Central America and the Caribbean, overall respiratory disease activity remains low in most places.

In North Africa and West Asia, influenza activity is low. However, respiratory tract infections in the north western area of Pakistan and Afghanistan are reportedly increasing. Whether this increased activity is due to circulation of influenza is not known.

In Sub-Saharan Africa, several West African countries are increasingly reporting pandemic influenza cases, though surveillance data from the area is quite limited. Data from the rest of Africa suggests that influenza activity in most countries is low and transmission continues to be sporadic. Some detections of seasonal influenza H1N1, H3N2, and influenza type B are still being reported.
(WHO 3/5/2010)

^top


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

The first case is a 53 year-old male from Shobra Elkhima district, Qaliobia Governorate. He developed symptoms on 27 February 2010 and was hospitalized on 27 February 2010, where he received oseltamivir treatment. He is in a critical condition.

The second case is a one year-old male from Banha district, Qaliobia Governorate. He developed symptoms on 22 February 2010 and was hospitalized on 23 February 2010, where he received oseltamivir treatment. He is in stable condition.

The third case is a 10 year-old male from Meet Ghamr district, Dakalia Governorate. He developed symptoms on 10 February 2010 and was hospitalized on 14 February 2010, where he received oseltamivir treatment. He is in moderate condition.

The fourth case is a 30 year-old female from Kellin District, Kafr El-Sheik Governorate. She developed symptoms on 10 February 2010 and was hospitalized on 11 February 2010, where she received oseltamivir treatment. She is in stable condition.

The fifth case is a 13 year-old male from Kafr El-Sheik District, Kafr El-Sheik Governorate. He developed symptoms on 10 February 2010 and was hospitalized on 14 February 2010 where he received oseltamivir treatment. He is in stable condition.

Investigations into the source of infection indicated that the five 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).
(WHO 3/4/2010)

^top

Norway: Pandemic H1N1 mutation's proposed link to severe illness debated
Norwegian scientists have reported a pandemic H1N1 virus mutation that appears to be associated with severe disease, but a leading US flu expert said global data on the mutation don't show a clear connection with severe illness. A team from the Norwegian Institute of Public Health in Oslo reports that it found the mutation in 11 of 61 severe illness cases that were analyzed between July and December 2009. The mutation was not found in any of 205 mild cases that were analyzed between May 2009 and January 2010. "This difference is statistically significant and our data are consistent with a possible relationship between this mutation and the clinical outcome," says the report by A. Kilander and colleagues, published 4 March 2010 in Eurosurveillance. [See abstract below.]

However, Dr. Nancy Cox, director of the Influenza Division at the US Centers for Disease Control and Prevention (CDC), said global H1N1 data so far do not show a clear association between the mutation and severe illness. "If you look globally you can see that this mutation is neither necessary nor sufficient for a severe or fatal outcome," Cox said. She pointed to possible holes in the Norwegian analysis, along with global surveillance data and experimental data. "They haven't adjusted for a whole variety of confounders that could influence the appearance of the mutation, such as time between onset of illness and collection of specimens, which might differ in mild and severe cases," she said. Another possible confounder, she added, is the fact that some of the patients with severe illness had underlying conditions, which increase the risk of severe flu. Cox also said a lab experiment in ferrets did not support a causal link with severe disease.
(CIDRAP 3/4/2010)

^top


Asia
China: Pandemic H1N1 influenza peak has passed
The pandemic A (H1N1) influenza outbreak, which has killed nearly 800 people on the Chinese mainland, has passed its peak in the autumn-winter flu season, the Ministry of Health said 2 March 2010.

The mainland saw a sharp drop in the proportion of A/H1N1 in all flu cases, down from 36.6 percent in January 2010 to 11.1 percent in February 2010. The disease had killed 793 people by 28 February 2010, including 18 last month. Experts spotted no mutations in the virus, and an estimated 30 percent of the population had immunity against the strain.

The Ministry, however, warned that though a pandemic was unlikely to occur in the near future, localized spreading of the disease could not yet be ruled out, especially in crowded public venues such as schools. The Ministry said flu prevention measures should not be eased as the population still had limited access to immunization against the A/H1N1 flu strain. As of 28 February 2010, more than 82 million Chinese people had been inoculated with the A/H1N1 flu vaccine.
(ProMED 3/3/2010)

^top

Hong Kong: Swine influenza virus reassorted with pandemic H1N1 virus isolated from pig
Through its regular influenza virus surveillance program, the University of Hong Kong (HKU) has discovered a swine influenza virus that picked up a pandemic H1N1 gene by genetic reassortment. The sample was taken from a pig at the Sheung Shui slaughterhouse on 7 January 2010.

This is the first time that reassortment of swine influenza virus with the pandemic H1N1 virus has been found in the surveillance program. That such a reassortament was found was not entirely unexpected. These events are likely occurring worldwide and its detection in Hong Kong was purely the consequence of intensive surveillance. Further tests are being conducted by HKU to determine if there are any particular characteristics of this strain.
(ProMED 3/2/2010)

^top

South Korea: Travelers from Viet Nam to be scrutinized for influenza
The government of South Korea said it will increase inspection of any travelers from Vietnam in response to deaths in Viet Nam from H5N1 avian influenza. Tourists and others who travel from Viet Nam into South Korea will be subject to mandatory temperature checks to detect fever. South Koreans visiting Viet Nam are being asked to stay away from any chickens or other poultry. The government said the moves were triggered by the death of a 38-year-old Vietnamese woman, that country's first H5N1-related fatality and second case in 2010.
(CIDRAP 3/3/2010)

^top

Viet Nam: Three new cases of human H5N1 avian influenza infection
The Ministry of Health has reported three new confirmed cases of human infection with the H5N1 avian influenza virus, including one fatality. Two cases have been confirmed at the National Institute of Hygiene and Epidemiology (NIHE) and one case has been confirmed at the Pasteur Institute, Ho Chi Minh City.

The first case is a three year-old female residing in Ninh Hoa District, Khanh Hoa Province. She was hospitalized at Ninh Hoa district hospital on 28 January 2010 is recovering well.

The second case was a 38 year-old female residing in Cai Be District, Tien Giang Province. The patient was admitted to the Sa Dec Hospital in Dong Thap Province on 21 February 2010 where she died two days later.

The third case is a 17 year-old female residing in Son Duong District, Tuyen Quang Province. She was taken to the Son Duong District General Hospital on 24 February 2010 where she is currently being treated for mild breathing difficulties.

Investigations into the source of infection indicated that the latter two cases had exposure to sick and dead poultry.
(WHO 3/4/2010)

^top

Viet Nam: Avian influenza H5N1 detected in more flocks
Vietnam's agriculture ministry has reported H5N1 avian influenza outbreaks in two more provinces, Tuyen Quang and Ha Giang, both in the northern part of the country. The outbreaks involved chickens in family poultry holdings. The two outbreaks were included in a report from the World Organization for Animal Health (OIE) that detailed seven outbreaks that occurred near the end of February. The virus hit two farms and birds in five villages. Affected provinces were Tuyen Quang, Nghe An, Ha Giang, Ca Mau, and Khanh Hoa. The outbreaks killed about 2,800 birds, and 5,300 more were culled to contain the disease.
(CIDRAP 3/4/2010)

^top


Americas
USA: FDA Issues Final Guidance to Boost Development of Cell-based Viral Vaccines
The US Food and Drug Administration issued final guidance to help manufacturers who are developing safe and effective cell-based viral vaccines to address emerging and pandemic threats. Titled "Guidance for Industry: Characterization and Qualification of Cell Substrates and Other Biological Materials Used in the Production of Viral Vaccines for Infectious Disease Indications," the document will aid manufacturers who wish to use new cell substrates for vaccine production, such as for influenza vaccines. Currently, all licensed influenza vaccines are produced in chicken eggs.

The complete guidance document is available at http://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Vaccines/UCM202439.pdf.
(US Health & Human Services Press Office 3/2/2010)

^top


2. Infectious Disease News

Asia
Chinese Taipei: Three cases of imported chikungunya
The Chinese Taipei Centers for Disease Control announced that three imported cases of chikungunya virus infection have been confirmed in 2010. The age of the cases ranged from 5-27 years; two were male. Their disease onsets were between 2 and 22 February 2010. All cases were found through fever screening when they landed at the airport. The cases came from Jakarta, Sumatra, and Surabaya, Indonesia. During the same period in 2008 and 2009, only one case each from Indonesia and Malaysia were reported.

Chikungunya disease became a category 2 notifiable disease on 15 Oct 2007. By the end of 2009, a total of 20 cases were confirmed. All were imported. Of these, 18 were found through fever screening, one found through routine testing by a reference laboratory, and one was reported by a hospital. The majority of the cases came from Indonesia (9 cases) and Malaysia (5 cases).

Since Chinese Tapiei has Aedes aegypti mosquitoes, competent vectors of chikungunya virus, these importations are of concern. Chinese Taipei has experienced dengue virus transmission, so local transmission of chikungunya virus is a possibility if incoming travelers infected with chikungunya virus are viremic on arrival. This is yet another example of the risk of introduction of an exotic pathogen through rapid commercial air travel.
(ProMED 3/2/2010)

^top

Hong Kong: Possible respiratory syncytial virus (RSV) outbreak among elderly
The Centre for Health Protection is investigating an outbreak of upper respiratory tract infection affecting 19 residents, aged 73 to 100, and two staff at a Sha Tin home for the elderly. The 21 affected women developed symptoms between 15 February and 1 March 2010. All are stable. One of the residents was admitted to a hospital and tested positive for respiratory syncytial virus.
(ProMED 3/3/2010)

^top

Indonesia (Lampung): Special alert for chikungunya virus declared
Health authorities in South Lampung have declared a special alert for the chikungunya virus in Bakauheni district, after 121 residents contracted the disease. The alert was issued following an increase in the number of infected residents.
In South Kalimantan regency of Banjar [Borneo], at least 4,500 people were infected with the disease over the past 40 days. Banjar Disease Prevention Agency chief Endah Labati said recently that the number was expected to increase because the mosquitoes were breeding quickly in the wet season.
(ProMED 2/24/2010)

^top

Philippines (Cagayan): Possible anthrax outbreak
Two people died while scores were hospitalized in a remote Cagayan village in what authorities said was a case of ingesting contaminated animal meat during 27-28 February 2010. Doctors at the Cagayan Provincial Hospital feared the deaths might have been caused by anthrax bacteria following reports that residents in San Pedro village in Lasam town had been downed after eating spoiled meat. Cagayan health officer Danilo Alonzo said "The spread [of the disease] has developed into epidemic proportions but we are now doing all we can to contain the situation".
(ProMED 3/1/2010)

^top

Philippines (Tarlac): Measles outbreaks in six areas
With almost 700 cases of measles reported around the country in less than two months, health authorities have heightened alert and declared outbreaks in six areas. The Department of Health on 22 February 2010 said that measles outbreaks had been declared in the following areas: Baseco Compound and Moriones in Tondo, Manila province; Barangay Pulang Lupa in Las Pinas City; Central Market in Dasmarinas, Cavite province; San Francisco town in Quezon province; and Balabagan town in Lanao del Sur province.

According to health secretary Esperanza Cabral, the country has already recorded a total of 669 cases, 99 of which were reported in the second week of February 2010. Cabral disclosed that the number of measles cases recorded from 1 January to 13 February 2010 is 70 percent higher than the same period of the previous year.

The World Health Organization (WHO) has earlier warned the Philippines over the possibility of reemergence of measles in the country. Subsequent to the Ligtas Tigdas 2004 campaign (a door-to-door campaign, which vaccinated children against measles during February 2004), when 100 per cent of children in the Philippines in the age group nine months to seven years were thought to have been vaccinated, no measles cases were reported from June 2004 to December 2006. Prior to the Tigdas Ligtas campaign, an estimated 6,000 Filipino children died from measles in 2003.
(ProMED 2/23/2010)

^top

Russia: Hemorrhagic fever with renal syndrome outbreak
Public Health physicians are alarmed that the incidence of HFRS (hemorrhagic fever with renal syndrome, also known locally as mouse fever) is 90 times greater than the average for this time of year. The press office of the Regional Rospotrebnadzor (health protection agency) announced that there had been 60 cases of HFRS in the Ashinsky region between November 2009 and January 2010. This is three times the incidence in the same territory in 2008. The increase is attributed to the severe weather of the recent winter, which has induced small rodents to move into human habitations.
(ProMED 3/4/2010)

^top

Russia (Kakuga): Lyme disease epidemic continues
The head sanitary doctor of Kaluga oblast reports that the epidemic situation regarding Lyme disease remains unfavorable. There were 148 registered cases in 2009, which equates to 14.72 cases per 100,000 population. The doctors consider the rise in incidence to be connected to more gardening, tourism development, and urbanization of endemic lands. Unauthorized landfills also contribute their part. Landfills are feeding places for many rodents which carry ticks. All this has caused an expansion of the endemic areas.

The average incidence of Lyme disease in Russia was 6.82/100,000 in 2009 (9,686 cases). The highest incidence was registered in Ural and Northwest federal districts.
(ProMED 2/28/2010)

^top

Thailand (Bangkok): Rabies animal vaccination campaign planned after human death
City Hall is preparing 400,000 doses of the rabies vaccine for dogs and cats in Bangkok to prevent the spread of the disease among animals during the hot season. The move is aimed at allaying public fears after a woman died from rabies on 14 February 2010. The woman was a Public Health Ministry official and owner of a pet shop. She died from rabies after being bitten by one of her dogs.
(ProMED 2/25/2010)

^top


Americas
USA (Colorado): Second ever death in Colorado county caused by a hantavirus
Colorado health officials say Weld County recorded its second-ever death caused by a hantavirus carried by deer mice (Peromyscus maniculatus). The death happened during February 2010, but officials said 2 March 2010 that the Colorado Department of Public Health and Environment performed blood tests and confirmed that the person had contracted the virus. It is the fifth case ever documented in the county.
(ProMED 3/4/2010)

^top

USA: Salmonella risk in flavoring may drive host of food recalls
Potentially thousands of food products are at risk of being recalled because they contain an ingredient that may have been contaminated with a strain of Salmonella, the Food and Drug Administration (FDA) said 4 March 2010. Representatives of the FDA and other federal health agencies said that a batch of hydrolyzed vegetable protein (HVP) made by Basic Food Flavors was found by a purchaser to be contaminated. The FDA inspected the Basic Food Flavors plant and found Salmonella Tennessee on processing equipment, and the company stopped production and recalled all the HVP it has made since Sept. 17, 2009.

No illnesses have been linked to the product, officials said, but they added that the Centers for Disease Control and Prevention (CDC) is scrutinizing reports coming into its existing Salmonella surveillance system for any signs of increased illness. The Tennessee strain, like other strains of Salmonella, can cause fever, abdominal pain, nausea and vomiting, and diarrhea, and can be fatal in the young, elderly, and frail or immune-compromised.

The officials were unable to say how many products could be caught up in the recall, though Virginia Scott of the FDA's Center for Food Safety and Applied Nutrition said during the briefing that it is "likely to be in the thousands of products."
(CIDRAP 3/4/2010)

^top

USA: Mumps outbreak climbs to 2,336 cases
USA: Mumps outbreak climbs to 2,336 cases The number of cases linked to a June 2009 mumps outbreak at a New York summer camp has climbed to 2,336, CDC officials reported during the Advisory Committee on Immunization Practices (ACIP) meeting during 24-25 February 2010. After initial spread into other populations throughout the state and areas of New Jersey, CDC epidemiologist Kathleen Gallagher said the disease has now been exported to Connecticut, Quebec, and Israel.

Incidence remains highest among boys in the Hasidic community because they usually spend longer hours at private schools, Gallagher said, mostly around other people belonging to this population. In addition to day students, these schools also board students from a variety of other regions and states. Therefore, boys potentially exposed to mumps may inadvertently spread the disease among other communities when they return home for holidays, emphasizing the importance of up-to-date, 2-dose vaccinations in this age group.

The potential for a 3-dose measles, mumps, and rubella vaccine (MMR II, Merck) was also a focal point at the meeting. Currently, officials in Orange County, New York have tried administering a third dose to children in efforts to control the outbreak. Although little data are available, Gallagher said studies to evaluate the efficacy of a 3-dose vaccine regimen are ongoing.
(ProMED 2/26/2010)

^top


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/

^top

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.

^top

DENGUE
Australia (Queensland)
A locally acquired case of dengue fever has been reported in the north Queensland town of Tully -- the first in the town in at least two decades. Townsville has also recorded 13 locally acquired cases of the potentially deadly mosquito-borne disease in two separate outbreaks this season.
(ProMED 3/2/2010)

USA (Puerto Rico)
Health officials in Puerto Rico have declared an epidemic of dengue fever. Health Secretary Lorenzo Gonzalez said 210 cases have been confirmed for January 2010, more than triple the number in the same month of 2007. That year proved the worst for the US Caribbean territory in nearly a decade, with 11,000 cases. Gonzalez says no one has died in the latest outbreak. Only three hemorrhagic dengue cases have been reported since January.
(Associated Press 2/26/2010)

Malaysia (Penang)
The State Health Department has identified four areas in Penang as hotspots for Aedes mosquito breeding. State deputy director of health Dr Yasmin Sulaiman said the Kampung Melayu flats in Air Itam, Taman Seri Sari in Relau, and Villa Sri Kenanga as well as the Desa Riang flats in Batu Uban were hotspots which had recorded at least two cases of dengue fever.
(ProMED 2/22/2010)

Indonesia (East Java)
Dengue fever has killed two residents of the East Java town of Kediri. Director of Gambiran Public Hospital, Sentot Imam Suprapto, said on 18 February 2010 that the four year old had been in bad condition when he was admitted to the hospital. "We have done our best to save him," he said. The other, a university student, was admitted to Dr Soetomo public hospital in East Java capital of Surabaya but the doctors failed to save him. He died 18 February 2010.

Over the past two months, 103 Kediri residents had suffered from the fever, usually transmitted by the Aedes aegypti and Aedes albopictus mosquitoes. The number of dengue fever patients being treated at Gambiran public hospital tended to increase.
(ProMED 2/22/2010)

Indonesia (West Java)
Heavy rains and floods have caused a spike of dengue fever cases in Bekasi, West Java, with around 90 patients admitted with the virus infection during the first two weeks of February 2010. Bekasi health agency head Retni Yonti said that a patient had died after suffering a combination of dengue fever and another unidentified illness. Some 170 dengue fever cases were reported in January 2010, a significant increase compared to the 30-cases-per-month through the Jun-Dec period at the end of 2009, she added.
(ProMED 2/22/2010)

^top

CHOLERA, DIARRHEA, and DYSENTARY
South Korea
South Korean health authorities on 19 February 2010 confirmed the country's first cholera patient of 2010. The unidentified patient who had visited Jakarta and Bali showed symptoms of the disease upon arrival and was checked by the quarantine office at Incheon International Airport, the Korea Centers for Disease Control and Prevention [KCDC] said. The checkup showed the person testing positive for Vibrio cholerae O1, biotype Ogawa.
(ProMED 2/19/2010)

Russia (Sverdlovsk)
Children falling ill at a residential school in the town of Lesnoy in the Sverdlovsk Region (Oblast) have been diagnosed with rotavirus infection. Two children have died. According to Arkady Bielyavski, the Regional Health Minister, this type of illness has been common among children in Lesnoy at the end of winter. All the children attending the particular residential school have health problems and disabilities and all have impaired immune systems.
(ProMED 3/3/2010)

^top


4. Articles
Household Transmission of 2009 Influenza A (H1N1) Virus after a School-Based Outbreak in New York City, April-May 2009
France AM, Jackson M, Schrag S, et al. J Infect Dis. 2010 Apr 1;201(7):984-92.
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/651145.

Abstract. In April 2009, an outbreak due to infection with the 2009 pandemic influenza A (H1N1) virus (pH1N1) was investigated in a New York City high school. We surveyed household contacts of ill students to characterize the extent of transmission within households, identify contact groups at highest risk for illness, and assess the potential for preventing household transmission. Influenza-like illness (ILI) was reported by 79 of 702 household contacts (11.3% attack rate). Multivariate analysis showed that older age was protective: for each increasing year of age, the risk of ILI was reduced 5%. Additional protective factors included antiviral prophylaxis and having had a household discussion about influenza. Providing care for the index case patient and watching television with the index case patient were risk factors among parents and siblings, respectively. Fifty percent of cases occurred within 3 days of onset of illness in the student. These factors have implications for mitigating the impact of pH1N1 transmission.

^top

Observed association between the HA1 mutation D222G in the 2009 pandemic influenza A(H1N1) virus and severe clinical outcome, Norway 2009-2010
Kiland A, Rykkvin R, Dudman SG, et al. Eurosurveillnace. 4 March 2010;15(9):2
Available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19498.

Abstract. Infection with the recently emerged pandemic influenza A(H1N1) virus causes mild disease in the vast majority of cases, but sporadically also very severe disease. A specific mutation in the viral haemagglutinin (D222G) was found with considerable frequency in fatal and severe cases in Norway, but was virtually absent among clinically mild cases. This difference was statistically significant and our data are consistent with a possible causal relationship between this mutation and the clinical outcome.

^top

Effective Detection of the 2009 H1N1 Influenza Pandemic in U.S. Veterans Affairs Medical Centers Using a National Electronic Biosurveillance System
Schirmer P, Lucero C, Oda G, et al. PLoS ONE. 4 March 2010; 5(3):e9533.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0009533.

Background. The 2008-09 influenza season was the time in which the Department of Veterans Affairs (VA) utilized an electronic biosurveillance system for tracking and monitoring of influenza trends. The system, known as ESSENCE or Electronic Surveillance System for the Early Notification of Community-based Epidemics, was monitored for the influenza season as well as for a rise in influenza cases at the start of the H1N1 2009 influenza pandemic. We also describe trends noted in influenza-like illness (ILI) outpatient encounter data in VA medical centers during the 2008-09 influenza season, before and after the recognition of pandemic H1N1 2009 influenza virus.

Methodology/Principal Findings. We determined prevalence of ILI coded visits using VA's ESSENCE for 2008-09 seasonal influenza (Sept. 28, 2008-April 25, 2009 corresponding to CDC 2008-2009 flu season weeks 40-16) and the early period of pandemic H1N1 2009 (April 26, 2009-July 31, 2009 corresponding to CDC 2008-2009 flu season weeks 17-30). Differences in diagnostic ICD-9-CM code frequencies were analyzed using Chi-square and odds ratios. There were 649,574 ILI encounters captured representing 633,893 patients. The prevalence of VA ILI visits mirrored the CDC's Outpatient ILI Surveillance Network (ILINet) data with peaks in late December, early February, and late April/early May, mirroring the ILINet data; however, the peaks seen in the VA were smaller. Of 31 ILI codes, 6 decreased and 11 increased significantly during the early period of pandemic H1N1 2009. The ILI codes that significantly increased were more likely to be symptom codes. Although influenza with respiratory manifestation (487.1) was the most common code used among 150 confirmed pandemic H1N1 2009 cases, overall it significantly decreased since the start of the pandemic.

Conclusions/Significance. VA ESSENCE effectively detected and tracked changing ILI trends during pandemic H1N1 2009 and represents an important temporal alerting system for monitoring health events in VA facilities.

^top

Human Infection with a Triple-Reassortant Swine Influenza A(H1N1) Virus Containing the Hemagglutinin and Neuraminidase Genes of Seasonal Influenza Virus
Bastien N, Antonishyn N, Brandt K, et al. J Infect Dis. 3 March 2010; doi:10.1086/651507.
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/651507.

Abstract. A reassortant influenza A(H1N1) virus of swine origin distinct from the pandemic H1N1 2009 strain was isolated from 3 patients, all of whom worked at the same large hog operation in Saskatchewan, Canada. The genomic composition of the isolates has not been previously reported, to our knowledge, and was the product of a genetic reassortment between seasonal H1N1 and triple-reassortant influenza virus that emerged in North American swine during the late 1990s. The neuraminidase and hemagglutinin genes of A/Saskatchewan/5350/2009, A/Saskatchewan/5351/2009, and A/Saskatchewan/5131/2009 were derived from human H1N1 virus and were closely related to those of A/Brisbane/59/2007.

^top

Livestock-associated Methicillin-Resistant Staphylococcus aureus Sequence Type 398 in Humans, Canada
Golding GR, Bryden L, Levett PN, et al. Emerg Infect Dis. 3 March 2010; doi:10.3201/eid1604.091435.
Available at http://www.cdc.gov/eid/content/16/4/pdfs/09-1435.pdf.

Abstract. Rates of colonization with livestock-associated methicillin-resistant Staphylococcus aureus (MRSA) sequence type 398 have been high for pigs and pig farmers in Canada, but prevalence rates for the general human population are unknown. In this study, 5 LA-MRSA isolates, 4 of which were obtained from skin and soft tissue infections, were identified from 3,687 tested MRSA isolates from persons in Manitoba and Saskatchewan, Canada. Further molecular characterization determined that these isolates all contained staphylococcal cassette chromosome (SCC) mecV, were negative for Panton-Valentine leukocidin, and were closely related by macrorestriction analysis with the restriction enzyme Cfr91. The complete DNA sequence of the SCCmec region from the isolate showed a novel subtype of SCCmecV harboring clustered regularly interspaced short palindromic repeats and associated genes. Although prevalence of livestock-associated MRSA seems to be low for the general population in Canada, recent emergence of infections resulting from this strain is of public health concern.

^top

Evolutionary pattern of pandemic influenza (H1N1) 2009 virus in the late phases of the 2009 pandemic
Valli M, Meschi S, Selleri M, et al. PLoS Currents: Influenza. 24 February 2010 [revised 3 March 2010]:PMC2832123.
Available at http://knol.google.com/k/maria-beatrice-valli/evolutionary-pattern-of-pandemic/ql0y91xwcxnj/1#.

Abstract. Influenza A( H1N1)v has spread rapidly in all parts of the globe in 2009 as a true pandemic, although fortunately a clinically mild one. The relevant evolutionary steps for the new virus to adapt to human populations occurred very early during the pandemic, before the end of April. Of the several resulting clades or clusters, clade 7 appeared later and proved more successful, substituting all other early clades before the bulk of the worldwide infections occurred.

^top


5. Notifications
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/.

^top

International Conference on Healthcare-Associated Infections 2010
Atlanta, Georgia, USA, 18-22 Mar 2010
Be a part of the meeting that will set the agenda for healthcare-associated infection (HAI) prevention for the next decade.
*Updates on the scientific evidence in such areas as antimicrobial resistance, surveillance strategies, emerging infections, environmental transmission, new technologies.
* Translation of research and epidemiologic, organizational, and implementation principles into quality improvement practices.
Additional information and registration available at http://www.decennial2010.com/.

^top

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/.

^top

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

^top

Thailand Conference on Emerging Infectious and Neglected Diseases
Pattaya, Thailand, 3-4 June 2010
Outbreaks of various diseases, including SARS, avian influenza, influenza H1N1 pandemics, and the most recently chikungunya fever, continue to challenge our abilities to prepare for the emerging infectious disease threats. This conference, therefore, will facilitate national and international updating and sharing of knowledge, experiences, and scientific expertise which is crucial for handling these global threats.
Additional information and registration available at http://nstda.or.th/eid2010/.

^top

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/.

^top

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.

^top

Updated influenza guidance and information from the US CDC
CDC Estimates of 2009 H1N1 Influenza Cases, Hospitalizations and Deaths in the United States, April 2009 - January 16, 2010
Released 4 March 2010
Available at http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm.

^top

 apecein@u.washington.edu