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Vol. XIII, No. 6 ~ EINet News Briefs ~ Mar 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
- Egypt: Two new cases of human H5N1 avian influenza infection
- Bulgaria: Nation reacts to Romanian bird flu outbreak
- Denmark: Avian influenza in poultry
- Romania: HPAI H5N1 outbreak on poultry farm
- Australia: H1N1 vaccine could go unused in Australia
- Bhutan: H5N1 outbreak being monitored in Chhukha province
- Bangladesh: Avian influenza outbreak
- China (Qinghai): Avian influenza outbreak
- India: Pandemic H1N1 mutation in India resembles Dutch findings
- Nepal: Avian influenza suspected among backyard birds
- Thailand: Government bans the import of poultry from nations affected by bird flu
- Viet Nam (Binh Duong): New suspected case of human H5N1 avian influenza infection
- Viet Nam (Bac Ninh): Avian influenza outbreak among poultry
- Canada: Nation ponders multiple pandemic vaccine suppliers
- USA: Report on mandatory vs. recommended flu vaccination for health workers
- USA (Texas): Unidentified avian influenza in ducks
- USA: Flu activity on US campuses drops
- USA (Kentucky): State seeks to prevent flu absences from hurting school aid
- USA: Firm gets DARPA funds for plant-based vaccine
- Rwanda: Nation reports H1N1 contained

2. Infectious Disease News
- Philippines: Measles death in Manila
- Thailand: Rabies death toll higher than last year's

3. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA

4. Articles
- Genomic Signature and Mutation Trend Analysis of Pandemic (H1N1) 2009 Influenza A Virus
- Pathologic Findings in Novel Influenza A (H1N1) Virus ("Swine Flu") Infection: Contrasting Clinical Manifestations and Lung Pathology in Two Fatal Cases
- Self-reported anticipated compliance with physician advice to stay home during pandemic (H1N1) 2009: Results from the 2009 Queensland Social Survey
- Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease
- Research findings from nonpharmaceutical intervention studies for pandemic influenza and current gaps in the research
- Pandemic Dynamics and the Breakdown of Herd Immunity

5. Notifications
- ISHEID Symposium on HIV and Emerging Infectious Diseases
- Thailand Conference on Emerging Infectious and Neglected Diseases
Pattaya, Thailand, 3-4 June 2010

- 28th Annual Infectious Disease Seminar for Physicians, Pharmacists and Other Healthcare Professionals
- CDC 7th International Conference on Emerging Infectious Diseases
Atlanta, Georgia, USA 11-14 Jul 2010

- Options for the Control of Influenza VII
Hong Kong, 3-7 Sep 2010

- 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 / 16 (5)
Indonesia / 1 (1)
Viet Nam / 4 (1)
Total / 21 (6)

***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: 489 (289)
(WHO 3/4/10 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_03_16/)

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

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WHO situation update on pandemic influenza H1N1
As of 14 March 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 16,813 deaths.

The most active areas of pandemic influenza transmission continue to be in Southeast Asia and West Africa. Limited data suggests that pandemic influenza activity may be increasing across parts of Central America and the Caribbean. Low levels of pandemic influenza virus continue to circulate across southern and south-eastern Europe and in East, West, and South Asia. Although pandemic influenza virus continues to be the predominant influenza virus circulating worldwide, seasonal influenza B viruses are predominate in East Asia, and have been detected at low levels across southeast Asia and eastern Africa.

In south and southeast Asia, the most active areas of pandemic influenza transmission continue to be in Thailand; over the past month approximately 25-30% of sentinel respiratory samples from patients with ILI and 10-35% of sentinel respiratory samples from hospitalized patients with pneumonia tested positive for influenza (predominantly pandemic H1N1, but also small numbers of seasonal B viruses). Recent pandemic influenza activity in Thailand, while associated with severe and fatal illness, does not appear to exceed activity observed during an earlier period of peak transmission between June and September 2009. In Myanmar, respiratory disease activity may be declining after a period of increased activity associated with increased detection of pandemic H1N1 cases during February 2010. In Bangladesh, an increasing trend in respiratory diseases activity was reported for the past two weeks in association with increased numbers of confirmed cases and increased geographical spread of pandemic influenza virus. In India, low level of pandemic influenza virus continues to circulate in western India.

In East Asia, pandemic influenza activity continued to decline substantially as rates of illness returned to baseline or remained low in Japan, Republic of Korea, Hong Kong (SAR), and Chinese Taipei. In China, pandemic influenza activity has waned substantially, however, influenza type B viruses continue to circulate. In Mongolia, a recent sharp increase in ILI activity was associated almost exclusively with increased circulation of influenza B viruses. In addition, increasing but low levels of circulation of seasonal influenza B viruses has been observed across other parts of East and Southeast Asia (Japan, Republic of Korea, Chinese Taipei, the Philippines, Thailand, Vietnam, Indonesia, Bangladesh). Small numbers of seasonal H3N2 viruses have also been detected in several countries of East and Southeast Asia.

In West Africa, limited data suggest that active transmission of pandemic influenza virus remains sustained across much of the region without clear evidence of a peak in activity. In Ghana, 38% of respiratory specimens collected during the past week tested positive for influenza, and of these, approximately 70% were pandemic H1N1. Limited sentinel surveillance data from Nigeria suggest that levels of ILI have increased over the past two months in conjunction with increased detections of pandemic influenza H1N1 virus. Localized outbreaks of pandemic H1N1 influenza have also been recently reported in parts of East Africa, particularly in Rwanda. Pandemic influenza virus continues to be the predominant influenza virus circulating in West and East Africa, however, small numbers of seasonal H3N2 and seasonal B viruses have also been identified.

In the tropical zone of the Americas, particularly in Central America and the Caribbean, limited data suggest that pandemic influenza virus transmission may be active. Geographically regional to widespread pandemic influenza activity was reported across Central America and the Caribbean with mixed trends in the pattern of respiratory diseases activity (increasing activity in Jamaica, Bahamas, Nicaragua, Panama; and decreasing activity in Costa Rica, Guatemala). Honduras continues to report several outbreaks of respiratory disease in schools with limited laboratory confirmation of pandemic influenza virus infection. In Brazil, over the past two weeks, an increasing trend of respiratory diseases with low overall intensity was reported in association with regional spread of influenza virus.

In North Africa and Western Asia, limited data suggests that pandemic influenza virus continues to circulate at low levels across the region. An increasing trend of respiratory diseases activity in association with regional spread of influenza was reported for past three weeks in Afghanistan and the past two weeks in Iraq; however, overall intensity of activity remains low to moderate in both countries. Localized to regional spread of pandemic was also reported in Morocco, Libyan Arab Jamahiriya, Egypt, Jordan, Yemen, and Oman.

In Europe, overall pandemic influenza transmission continued to decline as low levels of pandemic virus continue to circulate in parts of eastern and south-eastern Europe. The overall percentage of sentinel respiratory specimens testing positive for influenza remained low (5.1%). Pandemic H1N1 2009 virus continues to be the predominant circulating influenza virus in the European region, except in Sweden and the Russian Federation, where seasonal influenza B viruses have been reported as co-dominant or dominant.

In the northern and the southern temperate zones of the Americas, overall pandemic influenza transmission remained low as influenza virus continued to circulate at low levels.

In the temperate zone of the southern hemisphere, overall influenza activity remained low, with sporadic detections of pandemic and seasonal influenza viruses.
(WHO 03/19/2010)

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

The first case is a 20 year-old pregnant female from El Khanka district, Qaliobia Governorate. She was hospitalized on 5 March 2010 where she received oseltamivir treatment and died on 9 March 2010.

The second case is a one and a half year-old male from Elhamool district, Kfr Elsheikh Governorate. He was hospitalized on 2 March 2010, where he received oseltamivir treatment. He is in a stable condition.

Investigations into the source of infection indicated that the two 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 the death of a previously announced case; the 53 year-old male from Shobra Elkhima district, Qaliobia Governorate who developed symptoms on 27 February 2010.

Of the 106 laboratory confirmed cases of Avian influenza A(H5N1) reported in Egypt, 32 have been fatal.
(WHO 3/14/2010)

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Bulgaria: Nation reacts to Romanian bird flu outbreak
Bulgaria's Minister of Agriculture has ordered the National Veterinary Service to monitor an outbreak of avian flu in neighboring Romania. Minister Miroslav Naydenov has announced that the National Veterinary & Medical Service (NVMS) will tighten controls at its regional centers, and will take all measures necessary to monitor and limit the spread of the virus. The veterinarians have also been alerted to the risk of transmission across to Bulgaria by migratory and wild birds.
(Sofia News, 03-16-2010)

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Denmark: Avian influenza in poultry
A reoccurrence of low pathogenic avian influenza broke out on a Danish farm on 5 March 2010. A previous outbreak had occurred 23 May 2008. In the most recent outbreak, positive samples were taken from among a population of 190 mallards and five hens in connection with the surveillance program for avian influenza. Control measures to be applied include a one km restriction zone around the affected premises.
(ProMed 03/13/2010)

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Romania: HPAI H5N1 outbreak on poultry farm
Romania has identified an outbreak of bird flu at a poultry farm close to Ukraine and enforced a 20 km-wide surveillance zone around it, the European Union's executive said. The outbreak of the H5N1 virus in the commune of Letea near the Ukrainian border is the first detected in Europe since it was found in a wild duck in Germany a year ago.

The new outbreak was confirmed by the European Commission to be the highly pathogenic H5N1 strain of avian influenza. Romanian authorities followed EU protocol by slaughtering all birds on the farm, and a 6km-wide protection zone surrounded by a 20 km-wide "high risk" surveillance zone with strict movement controls will have to be implemented.
(ProMED 03/16/2010)

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Australia: H1N1 vaccine could go unused in Australia
Australians are opting for newly available, broader seasonal flu vaccine rather than the monovalent H1N1 flu vaccine offered free of charge by the government. About 21 million doses of the latter were purchased; about seven million have been distributed, and 2.1 million have been committed to developing countries. The vaccine has a shelf life of 12 months, raising concern that many doses will go to waste. H1N1 flu has hospitalized close to 5,000 Australians, with at least 190 deaths so far.
(CIDRAP 03/17/2010)

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Asia
Bhutan: H5N1 outbreak being monitored in Chhukha province
H5N1 was reported in Chhukha province among free-range chickens. Susceptible birds were culled, and the situation is being monitored.
(OIE 03/15/2010)

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Bangladesh: Avian influenza outbreak
Livestock officials culled 117,600 chickens in the town of Thakurgaon, in northern Bangladesh Sunday, after lab tests confirmed the presence of avian flu. According to reports, an abnormally large number of birds were found dead last week in poultry sheds owned by Kazi Farms, the nation's largest producer of eggs and poultry. A Kazi spokesperson said that 2,000 eggs were also destroyed at a total loss of $6 million to the company.
Around 1.25 million birds have been culled in Banglaesh since 2007 when avian flu was first reported. The disease has since spread to 47 of the country's 64 districts. No human deaths have been reported.
(Epoch Times, 03/15/2010)

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China (Qinghai): Avian influenza outbreak
As a precaution, 23,693 susceptible birds were destroyed in Qinghai province. Control methods were practiced.
(OIE 03/17/2010)

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India: Pandemic H1N1 mutation in India resembles Dutch findings
Researchers from India's National Institute of Virology (NIV) yesterday announced that they detected a small mutation in pandemic H1N1 virus in samples from three patients, fueling speculation that it may be the same change that surfaced in two Dutch patients last fall.

The E627K mutation in PB2 had previously been linked to increased replication and possible virulence changes in other influenza A viruses. Though the mutation has been rarely seen in avian-derived viruses, it had been associated with fatal H5N1 cases and H7N7 infections in humans.

Although the mutation they found has been linked to increased replication and virulence changes in other influenza A viruses, they did not detect any increased virulence or replication in the isolates they studied.
(CIDRAP 03/16/2010)

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Nepal: Avian influenza suspected among backyard birds
Around 500 backyard birds have died in Jhyalbas and Deurali VDCs of Nawalparasi district in the past few weeks. A team of veterinarians was dispatched to the VDCs for a stamping out operation. Culling did not occur, because the team did not have a written order from the Department of Livestock Services.

Sources said the birds of a local resident of Jhyalbas had tested positive for H5N1 virus in the central veterinary laboratory, Tripureswor.
(ProMED 03/14/2010)

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Thailand: Government bans the import of poultry from nations affected by bird flu
Bird flu has recently been detected in India, Bangladesh, Vietnam, Israel, Cambodia, Burma, Nepal and Bhutan. The World Organisation for Animal Health also announced that 18 people had come down with bird flu in Indonesia, Egypt and Vietnam this year. Of the 18, five have succumbed to the disease. Vehicles and people at border checkpoints are being monitored. Anyone smuggling fowls from the affected countries will find the birds seized and exterminated.

All cars, motorcycles and trolleys coming from the avian-flu hit countries are being sprayed with disinfectant as a measure to prevent the outbreak of the disease in Thailand. For the past 490 days no bird flu has been detected in Thailand.

Provincial governors, particularly those in border provinces, have been informed to remain alert, and to alert the government if fowls die en masse in a suspicious manner, and to alert livestock officials if anyone is caught smuggling fowls.
(The Nation, 03/19/2010)

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Viet Nam (Binh Duong): New suspected case of human H5N1 avian influenza infection
The Ho Chi Minh City Department of Health announced a suspected case of bird flu virus. The patient, a 3-year-old child from Thuan An district, Binh Duong province, was hospitalized with symptoms of petechial fever, but she then tested positive for the A/H5N1 virus and is now under quarantine for treatment at Nhi Dong hospital, Ho Chi Minh City.

The Hospital for Tropical Diseases and Pasteur Institute have sent medical experts to Nhi Dong hospital for consultation and samples have been taken for medical tests.

The Pasteur Institute will send officials to the patient's living quarters for inspection and put those who had contact with her in quarantine.
(ProMED 03/16/2010)

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Viet Nam (Bac Ninh): Avian influenza outbreak among poultry
Authorities in Bac Ninh Province said an avian influenza outbreak killed more than 200 chickens owned by a family in Da Cau Hamlet, Nam Son Commune. An additional 200 birds had to be culled. The local Animal Health Unit vaccinated all of the remaining birds in the commune, set up check-up points and postponed all poultry sales at markets in the commune.

The director of the Preventive Medicine and Environment Department under the Ministry of Health, Nguyen Huy Nga, said that there was a high risk the flu could spread to other localities because winter-spring weather conditions would create favorable conditions for the flu virus to develop.
(Viet Nam Net Bridge, 03/16/2010)

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Americas
Canada: Nation ponders multiple pandemic vaccine suppliers
Canadian officials yesterday said they plan to move to a multiple-source supplier for pandemic vaccines. For the past 10 years the nation has relied on only GlaxoSmithKline (GSK), which has a plant in Canada, for pandemic vaccine, as well as much of its seasonal vaccine. During the H1N1 pandemic, GSK's Quebec plant experienced production delays. According to yesterday's notice, officials are considering "a second pandemic supply contract, if feasible and of demonstrated value to Canada."
(CIDRAP 03/16/2010)

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USA: Report on mandatory vs. recommended flu vaccination for health workers
Requiring healthcare workers to get vaccinated against influenza is one effective way to boost their vaccination rates, and another may be to target immunization messages to workers who are relatively isolated from coworkers, according to reports being presented this week at a conference on healthcare-associated infections.

Flu vaccination has long been recommended for health workers as a way to protect themselves and their patients and coworkers, but immunization rates have hovered in the 40% range for years. Three reports on the issue were released 17 March 2010 by the groups sponsoring the Fifth Decennial International Conference on Healthcare-Associated Infections, which will run from Mar 18 to 22 in Atlanta.

Hospital Corporation of America (HCA), a leading healthcare chain, reported that it raised its employees' flu immunization rate to nearly 97% by requiring vaccination for the 2009-10 season.

Jonathan Perlin, MD, PhD, HCA's chief medical officer, said flu vaccination is important for health workers because a person can transmit the virus for 24 hours before having any symptoms. Speaking at a press conference held last week in advance of the Decennial meeting, Perlin also cited a study suggesting that 50% of flu-infected health workers have no symptoms.

HCA's policy required all employees to be vaccinated. Those who could not be immunized because of an egg allergy or history of Guillain-Barre syndrome or refused for nonmedical reasons were reassigned to non-patient contact roles or required to wear surgical masks, according to a press release.

Workers vaccinated under the mandate numbered about 150,000, HCA reported. The chain has 163 hospitals, 112 outpatient clinics, and nearly 400 practices.

HCA previously used a combination of education, conveniently offered immunizations, and declination forms to induce workers to get their flu shot. These tactics yielded modest improvements but were inadequate for complete patient safety, the press release said.

The mandatory policy was developed by representatives of many disciplines. It was accompanied by prevention efforts such as promoting cough etiquette, proper hand hygiene, sick-visitor guidelines, and environmental cleaning, HCA reported.

At Children's Mercy Hospital and Clinics in Kansas City, a less coercive approach-requiring employees either to be vaccinated or to decline in writing-boosted vaccination coverage to 90.5%, according to Robyn Livingston, MD, the hospital's director of infection control and prevention. The hospital's immunization rate in 2004 was 63%. The system introduced the vaccination/declination policy in 2008, which increased coverage to 85% that year, according to a press release. For the 2009-10 season, officials stiffened the policy by adding consequences, including a forced leave of absence, for those who didn't take the vaccine or formally decline. As a result, the vaccination rate rose to 90.5%, and 98.8% of workers complied with the policy.

In another study featured at the meeting, researchers from University of Iowa Health Care in Iowa City said they determined that health workers were more likely to be vaccinated if their near coworkers were vaccinated.
(CIDRAP 03/17/2010)

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USA (Texas): Unidentified avian influenza in ducks
A flock of 3,500 ducks in Gonzales County, Texas, was destroyed earlier this year after an unidentified avian influenza virus was detected, but the situation was not made public until now, according to a report yesterday in the local newspaper. Andy Schwartz, epidemiologist with the Texas Veterinary Medical Diagnostic Laboratory (TVMDL), said the virus was found in routine testing last November. Texas A&M University detected the virus and sent the samples to the National Veterinary Services Laboratory in Ames, Iowa, for further testing. The national lab ruled out H5 and H7 viruses, which can be highly pathogenic, but the story did not state whether the Ames lab identified the subtype involved. Schwartz said no birds were sick. The state ordered the owner to stop sending the ducks to market, but he was reluctant to allow them to be destroyed until the Texas Poultry Federation offered to buy out the flock. A TVMDL official said the Gonzales area has the state's largest concentration of poultry, about eight million birds.
(CIDRAP 03/16/2010)

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USA: Flu activity on US campuses drops
Influenza-like illness (ILI) at US colleges dropped by more than half from the previous week, to an attack rate of 1.3 cases/10,000 students, in the 17 March 2010 surveillance report from the American College Health Association (ACHA). Nationally, the reported disease incidence has remained below 5 cases/10,000 students for three months. "At this point we continue to see no definitive evidence of a third wave of ILI disease, even on a regional basis," said Dr. James C. Turner, president of the ACHA.
(CIDRAP 03/17/2010)

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USA (Kentucky): State seeks to prevent flu absences from hurting school aid
Kentucky's Senate unanimously approved a measure yesterday to protect schools from funding cuts due to student absenteeism during the flu pandemic, the Huntington, W.V., Herald-Dispatch reported. The bill would allow schools to choose their highest attendance averages from the last three years to help determine state aid allocations. Some districts that had high absence rates were in danger of losing some state funding. The measure now goes to House lawmakers.
(CIDRAP 03/16/2010)

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USA: Firm gets DARPA funds for plant-based vaccine
Fraunhofer USA's Center for Molecular Biotechnology announced that it received a $4.4 million award from the Defense Advanced Research Projects Agency (DARPA) to develop a pandemic H1N1 vaccine using its plant-based recombinant technology. The award, Fraunhofer's third from DARPA, allows the vaccine to enter phase 1 trials. The technology is designed to enable a more rapid response to military and civilian disease threats. Fraunhofer opened a new production facility in late 2009.
(CIDRAP 03/16/2010)

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Africa
Rwanda: Nation reports H1N1 contained
Most cases of flu now being reported in Rwanda are of the seasonal variety, including type B, which is common in the rainy season, according to health officials there. The number of H1N1 cases is decreasing significantly, and samples are no longer being sent routinely for laboratory diagnosis. Preventive measures, such as hand washing and covering coughs, continue to be encouraged. Rwanda saw its first case of H1N1 last October, and total cases number nearly 400, with no reported deaths.
(CIDRAP 03/16/2010)

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2. Infectious Disease News

Asia
Philippines: Measles death in Manila
A seven-month-old baby boy from Baguio is the latest to die of measles, bringing to six the total number of measles deaths in the Philippines between January 1 and March 6, 2010.

The Department of Health earlier said measles caused the deaths of three eight-month-old baby boys and two girls, aged two and one. Four of the victims were from Tondo while the two-year-old girl was from Quiapo.

Health Secretary Esperanza Cabral also announced there are now 19 areas with measles outbreak. The latest areas to be added to the list are Lumba-Bayabao in Lanao del Sur and Baguio City.

Cabral said the DOH has recorded 878 cases of measles from January 1 to March 6. The number is 264% higher than the number of measles cases recorded during the same period last year.

The health department said it has vaccinated over 100,000 children nationwide since the outbreaks began.
(ABS CBN News 03/16/2010)

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Thailand: Rabies death toll higher than last year's
The Ministry of Public Health warns people of rabies as the number of casualties from the infection has already surpassed that of last year.

Public Health Minister Jurin Laksanawisit said since the beginning of this year, nine people have been reported dead from the disease and most of the cases were because of mere negligence. One of the two late victims were infected from a cat while the other refused to see doctor after he was bitten by a dog he rescued from an accident.
(NNT 03/19/2010)

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3. Updates

Global
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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4. Articles
Genomic Signature and Mutation Trend Analysis of Pandemic (H1N1) 2009 Influenza A Virus
Chungen P, Cheung B, Tan S, et al. PLoS ONE. March 2010; 5(3): e9549.
doi:10.1371/journal.pone.0009549
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0009549.

Abstract. A novel swine-origin pandemic influenza A(H1N1) virus (H1N1pdm, also referred to as S-OIV) was identified as the causative agent of the 21st century's first influenza pandemic, but molecular features conferring its ability of human-to-human transmission has not been identified. Here we compared the protein sequences of 2009 H1N1pdm strains with those causing other pandemics and the viruses isolated from humans, swines and avians, and then analyzed the mutation trend of the residues at the signature and non-signature positions, which are species- and non-species-associated, respectively, in the proteins of H1N1pdm during the pandemic of 2009. We confirmed that the host-specific genomic signatures of 2009 H1N1pdm, which are mainly swine-like, were highly identical to those of the 1918 H1N1pdm. During the short period of time when the pandemic alert level was raised from phase 4 to phase 6, one signature residue at the position of NP-100 mutated from valine to isoleucine. Four non-signature residues, at positions NA-91, NA-233, HA-206, and NS1-123, also changed during the epidemic in 2009. All these mutant residues, except that at NA-91, are located in the viral functional domains, suggesting that they may play roles in the human adaption and virulence of 2009 H1N1pdm.

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Pathologic Findings in Novel Influenza A (H1N1) Virus ("Swine Flu") Infection: Contrasting Clinical Manifestations and Lung Pathology in Two Fatal Cases
Mukhopadhyay S, Philip AT, Stoppacher R. American Journal of Clinical Pathology. 2010; 133, 380-387.
Available at http://ajcp.ascpjournals.org/content/133/3/380.abstract.

Abstract. Although novel influenza A (H1N1) virus infection has assumed pandemic proportions, there are few reports of the pathologic findings. Herein we describe the pathologic findings of novel influenza A (H1N1) infection based on findings in 2 autopsy cases. The first patient, a 36-year-old man, had flu-like symptoms; oseltamivir (Tamiflu) therapy was started 8 days after onset of symptoms, and he died on day 15 of his illness. At autopsy, the main finding was diffuse alveolar damage with extensive fresh intra-alveolar hemorrhage. The second patient, a 46-year-old woman with alcoholism, was found unresponsive in a basement and brought to the hospital intoxicated and confused. Her condition deteriorated rapidly, and she died 4 days after admission. The main autopsy finding was acute bronchopneumonia with gram-positive cocci, intermixed with diffuse alveolar damage. The pathologic findings in these contrasting cases of novel influenza A (H1N1) infection are similar to those previously described for seasonal influenza. The main pathologic abnormality in fatal cases is diffuse alveolar damage, but it may be overshadowed by an acute bacterial bronchopneumonia.

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Self-reported anticipated compliance with physician advice to stay home during pandemic (H1N1) 2009: Results from the 2009 Queensland Social Survey
Brown LH, Aitken P, Leggat PA, Speare R. BMC Public Health. 16 March 2010; 10:138doi:10.1186/1471-2458-10-138
Available at http://www.biomedcentral.com/1471-2458/10/138.

Background. One strategy available to public health officials during a pandemic is physician recommendations for isolation of infected individuals. This study was undertaken during the height of the Australian pandemic (H1N1) 2009 outbreak to measure self-reported willingness to comply with physician recommendations to stay home for seven days, and to compare responses for the current strain of pandemic influenza, avian influenza, seasonal influenza, and the common cold.

Methods. Data were collected as part of the Queensland Social Survey (QSS) 2009, which consisted of a standardized introduction, 37 demographic questions, and research questions incorporated through a cost-sharing arrangement. Four questions related to respondents' anticipated compliance with a physician's advice to stay home if they had a common cold, seasonal influenza, pandemic (H1N1) 2009 influenza or avian influenza were incorporated into QSS 2009, with responses recorded using a balanced Likert scale ranging from "very unlikely" to "very likely." Discordance between responses for different diseases was analysed using McNemar's test. Associations between demographic variables and anticipated compliance were analysed using Pearson's chi-square or chi-square for linear-by-linear association, and confirmed using multivariate logistic regression; p<0.05 was used to establish statistical significance.

Results. Self-reported anticipated compliance increased from 59.9% for the common cold to 71.3% for seasonal influenza (p<.001), and to 95.0% for pandemic (H1N1) 2009 influenza and 94.7% for avian influenza (p<0.001 for both versus seasonal influenza). Anticipated compliance did not differ for pandemic (H1N1) 2009 and avian influenza (p=0.815). Age and sex were both associated with anticipated compliance in the setting of seasonal influenza and the common cold. Notably, 27.1% of health and community service workers would not comply with physician advice to stay home for seasonal influenza.

Conclusions. Ninety-five percent of people report they would comply with a physicians' advice to stay home for seven days if they are diagnosed with pandemic (H1N1) 2009 or avian influenza, but only 71% can be expected to comply in the setting of seasonal influenza and fewer still can be expected to comply if they are diagnosed with a common cold. Sub-populations that might be worthwhile targets for public health messages aimed at increasing the rate of self-imposed isolation for seasonal influenza include males, younger people, and healthcare workers.

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Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease
Morgan OW, Bramley A, Fowlkes A, et al. PLoS ONE. 15 March 2010; 5(3):e9694
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0009694?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosone%2FPLoSONE+.

Background. Severe illness due to 2009 pandemic A(H1N1) infection has been reported among persons who are obese or morbidly obese. We assessed whether obesity is a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1), independent of chronic medical conditions considered by the Advisory Committee on Immunization Practices (ACIP) to increase the risk of influenza-related complications.

Methodology/Principal Findings. We used a case-cohort design to compare cases of hospitalizations and deaths from 2009 pandemic A(H1N1) influenza occurring between April-July, 2009, with a cohort of the U.S. population estimated from the 2003-2006 National Health and Nutrition Examination Survey (NHANES); pregnant women and children <2 years old were excluded. For hospitalizations, we defined categories of relative weight by body mass index (BMI, kg/m2); for deaths, obesity or morbid obesity was recorded on medical charts, and death certificates. Odds ratio (OR) of being in each BMI category was determined; normal weight was the reference category. Overall, 361 hospitalizations and 233 deaths included information to determine BMI category and presence of ACIP-recognized medical conditions. Among =20 year olds, hospitalization was associated with being morbidly obese (BMI=40) for individuals with ACIP-recognized chronic conditions (OR = 4.9, 95% CI 2.4-9.9) and without ACIP-recognized chronic conditions (OR = 4.7, 95%CI 1.3-17.2). Among 2-19 year olds, hospitalization was associated with being underweight (BMI=5th percentile) among those with (OR = 12.5, 95%CI 3.4-45.5) and without (OR = 5.5, 95%CI 1.3-22.5) ACIP-recognized chronic conditions. Death was not associated with BMI category among individuals 2-19 years old. Among individuals aged =20 years without ACIP-recognized chronic medical conditions death was associated with obesity (OR = 3.1, 95%CI: 1.5-6.6) and morbid obesity (OR = 7.6, 95%CI 2.1-27.9).

Conclusions/Significance. Our findings support observations that morbid obesity may be associated with hospitalization and possibly death due to 2009 pandemic H1N1 infection. These complications could be prevented by early antiviral therapy and vaccination.

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Research findings from nonpharmaceutical intervention studies for pandemic influenza and current gaps in the research
Aiello A, Coulborn R, Aragon T, et al. American Journal of Infection Control. March 2010; 38:2
Available at http://www.ajicjournal.org/article/S0196-6553(10)00039-8/abstract.

Abstract. In June 2006, the Centers for Disease Control and Prevention released a request for applications to identify, improve, and evaluate the effectiveness of nonpharmaceutical interventions (NPIs)-strategies other than vaccines and antiviral medications-to mitigate the spread of pandemic influenza within communities and across international borders (RFA-CI06-010). These studies have provided major contributions to seasonal and pandemic influenza knowledge. Nonetheless, key concerns were identified related to the acceptability and protective efficacy of NPIs. Large-scale intervention studies conducted over multiple influenza epidemics, as well as smaller studies in controlled laboratory settings, are needed to address the gaps in the research on transmission and mitigation of influenza in the community setting. The current novel influenza A (H1N1) pandemic underscores the importance of influenza research.

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Pandemic Dynamics and the Breakdown of Herd Immunity
Katriel G, Stone L (2010) PLoS ONE. September 2009; 5(3):e9565. doi:10.1371/journal.pone.0009565
Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762810/.

Abstract: In this note we discuss the issues involved in attempting to model pandemic dynamics. More specifically, we show how it may be possible to make projections for the ongoing H1N1 pandemic as extrapolated from knowledge of seasonal influenza. We derive first-approximation parameter estimates for the SIR model to describe seasonal influenza, and then explore the implications of the existing classical epidemiological theory for the case of a pandemic virus. In particular, we note the dramatic nonlinear increase in attack rate as a function of the percentage of susceptibles initially present in the population. This has severe consequences for the pandemic, given the general lack of immunity in the global population.

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5. Notifications
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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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/.

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28th Annual Infectious Disease Seminar for Physicians, Pharmacists and Other Healthcare Professionals
Hilton Head, SC, USA. 7-9 April 2010
This seminar is designed to provide practical, cutting-edge information to practicing physicians and other health care providers concerning evaluation and management of common infectious diseases as well as those making headlines.
Additional information available at http://www.neoucom.edu/ce.

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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
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.

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 apecein@u.washington.edu