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EINet Alert ~ Apr 09, 2010


*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:

1. Influenza News
- 2010 Cumulative number of human cases of avian influenza A/H5N1
- Global: WHO situation update on pandemic influenza H1N1
- Egypt: Confirmed avian influenza H5N1 death
- Bangladesh: World Bank says avian influenza H5N1 stable but still risky
- Brunei: Second pandemic influenza H1N1 death
- Malaysia (Sibu): Two patients suspected infected with H1N1
- Malaysia: Outbreaks of pandemic influenza H1N1 at schools
- Viet Nam (Bac Kan Province): Confirmed case of H5N1 avian influenza
- USA (Florida): Four H1N1 pandemic influenza deaths
- Ghana: Outbreaks of pandemic influenza H1N1 in schools

2. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA

3. Articles
- Economic Appraisal of Ontario’s Universal Influenza Immunization Program: A Cost-Utility Analysis
- Monitoring the safety of pandemic H1N1 vaccine
- Association between the 2008-09 Seasonal Influenza Vaccine and Pandemic H1N1 Illness during Spring-Summer 2009: Four Observational Studies from Canada
- Letter: One Flu for One Health
- Household Transmission of Pandemic (H1N1) 2009, San Antonio, Texas, USA, April-May 2009
- 2009 Pandemic H1N1 Influenza Virus Replicates in Human Lung Tissues

4. Notifications
- Thailand Conference on Emerging Infectious and Neglected Diseases
- CDC 7th International Conference on Emerging Infectious Diseases
- Options for the Control of Influenza VII
- Influenza 2010: Zoonotic Influenza and Human Health
- Updated influenza guidance and information from the US CDC

5. To Receive EINet Newsbriefs
- Subscribe to EINet


1. Influenza News

Global
2010 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Egypt / 19 (7)
Indonesia / 1 (1)
Viet Nam 5 (2)
Total / 24 (9)

***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: 493 (292)
(WHO 4/9/10 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_04_09/)

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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Global: WHO situation update on pandemic influenza H1N1
As of 4 April 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17,700 deaths.

The current situation is largely unchanged since the last update. The most active areas of pandemic influenza virus transmission continue to be in parts of Southeast Asia, West Africa, and in the tropical zone of the Americas. In Chile, a country of the southern hemisphere temperate zone, there is evidence of early localized pandemic influenza virus transmission in advance of the usual start of the southern hemisphere winter influenza season. Seasonal influenza type B viruses continue to actively circulate in East Asia, but are also being detected at low levels across other parts of Asia and Europe.

In Southeast Asia, the most active transmission of pandemic influenza virus continues to be in Thailand, however, overall disease activity has declined substantially since peaking during late February 2009. During the most recent reporting week, 6.7% and 16% of sentinel respiratory samples from outpatients with ILI and patients hospitalized with pneumonia, respectively, were positive for pandemic influenza. Low levels of seasonal influenza H3N2 and type B viruses have also been detected in Thailand in recent weeks. In Malaysia, limited data suggests that recent pandemic influenza activity may be declining with fewer detections of new cases. In Indonesia, recent low level circulation of seasonal influenza H3N2 viruses appears to be subsiding.

In South Asia, limited data suggests the most active areas of pandemic influenza virus transmission continues to be in Bangladesh, where an increasing number of cases have detected since late February 2009. Overall pandemic influenza activity remained low across the rest of the subcontinent with persistence of low level circulation of pandemic influenza virus in western India.

In East Asia, pandemic influenza virus continues to circulate at very low levels as overall rates of respiratory diseases remained low across much of the region. In China, overall rates of ILI remained at expected seasonal levels while most current influenza activity was due to circulating seasonal influenza type B viruses (accounting for >90% influenza virus detections). In Mongolia, rates of ILI continued to decline after a recent peak of influenza activity associated with circulation of seasonal influenza type B viruses. Although overall rates of ILI and detections of influenza virus remain low in the Republic of Korea, Hong Kong SAR (China), and Chinese Taipei, an increasing proportion of virus isolates in recent weeks have been seasonal influenza type B viruses.

In Sub-Saharan Africa, limited data suggests that active circulation of pandemic influenza virus continues across parts of West and west-central Africa, and to a lesser extent in limited areas of East Africa. During early to mid-March 2009, 23% of respiratory sample tested positive for influenza in both Cote d'Ivoire and Ghana (the majority of virus isolates were pandemic H1N1). In Senegal, pandemic influenza transmission remains active but may be declining as the rate of sentinel specimens testing positive for pandemic influenza fell from a peak of 67% during early February 2009 to 17% during the most recent reporting week. In Cameroon, 38% (13/34) of respiratory samples tested positive for influenza during the past two weeks, of which 71% were pandemic and 29% were seasonal influenza type B viruses. Localized areas of active pandemic influenza transmission persist in areas of Eastern Africa, particularly Rwanda and Tanzania. Pandemic influenza virus continues to be the predominant influenza virus circulating in West and East Africa, however, small numbers of seasonal influenza H3N2 viruses have also been identified.

In Europe, low levels of pandemic influenza virus continue circulate across limited areas of Europe. The overall proportion of sentinel respiratory samples testing positive for influenza remained low (6.2%); the total number of sentinel influenza type B virus detections exceeded that of pandemic influenza virus during the most recent reporting week. In Italy, 31% of sentinel respiratory samples tested positive for influenza, all of which were seasonal influenza type B viruses. Most countries in the region reported a low intensity of respiratory diseases, and only Georgia reported geographically widespread influenza activity.

In tropical zone of the Americas, limited data suggests that overall influenza activity remains low but variable with localized areas of active transmission in several countries, including in Cuba, Guatemala, Peru, and Bolivia, all of which reported an increasing trend of respiratory diseases in association with localized to regional spread of influenza activity in at least one of the two recent reporting weeks. In Mexico, limited data suggests that localized active transmission of pandemic influenza virus continued to occur in several states throughout March 2010, particularly in parts of the Federal District which have reported recent increases in the number of severe and fatal pandemic H1N1 virus infections. In Brazil, increased levels of sentinel ILI have been reported across much of Brazil over the past month, however, most recent reports of severe and fatal illness due to pandemic influenza virus infection have been from the northern region.

In the northern temperate zones of the Americas, overall pandemic influenza transmission remained low as influenza virus continues to circulate at very low levels. In the United States, overall levels of ILI remained below the national baseline and were only slightly elevated above the regional baseline in the southwestern region (although this regional increase was not associated with increased sentinel detections of pandemic or other influenza viruses). The most active areas of pandemic influenza transmission in the United States currently appears to be in three southeastern states, all of which reported regional spread of influenza activity.

In temperate countries of the southern hemisphere, overall influenza activity remained low, with mostly sporadic detections of pandemic and seasonal influenza viruses. Of note, Chile has reported new detections of pandemic virus, including small numbers of severe cases, in at least three regions over the past two weeks; the significance of this early limited circulation of pandemic virus in advance of the usual winter influenza season is not yet known.

Sporadic detections of seasonal influenza H3N2 viruses continued to be reported across Asia, Africa, Australia, and the Americas, however, the most active (but overall low) circulation of seasonal H3N2 viruses has been reported in Indonesia.
(WHO 04/09/2010)

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Europe/Near East
Egypt: Confirmed avian influenza H5N1 death
The Ministry of Health of Egypt has announced a new human cases of A(H5N1) avian influenza infection.

The case is a 18 year-old female from Etsa district, Fayoum Governorate. She was admitted to hospital on 31 March where she received oseltamivir treatment. She died on 4 April.

Investigations into the source of infection indicated that the case had exposure to sick and dead poultry.

The case was confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network (GISN).

Of the 109 laboratory confirmed cases of Avian influenza A(H5N1) reported in Egypt, 34 have been fatal.
(WHO 04/09/2010)

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Asia
Bangladesh: World Bank says avian influenza H5N1 stable but still risky
The avian flu situation in Bangladesh has remained stable with significantly less outbreaks reported during 2009 and 2010, the World Bank said 04 April 2010.

The South Asian country has a large duck population (about 39 million) and is visited annually by about 21 species of migratory birds that can carry the virus; these characteristics, in addition to Bangladesh’s high population density, contribute to the risk of future avian flu outbreaks.

The World Bank expressed its concern in a statement on 04 April 2010, which comes after Bangladesh's authorities said in March 2010 that they have culled about 154,245 chickens so far this year following fresh outbreaks of bird flu. For example, some 117,000 chickens on a farm in the Thakurgaon district were culled in the first week of March 2010.

According to the World Bank, the Bangladeshi government has initiated the "Avian Influenza Preparedness and Response Project (AIPRP)", co-financed by the bank and Avian and Human Influenza Trust Fund, since October 2007 to address the threat posed by the virus to humans. Uninterrupted continuation of the ongoing surveillance activities in 260 sub-districts, and carrying out a coordinated training program for various stakeholders also remain top priorities at this phase of the project implementation.
(People’s Daily, 04/05/2010)

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Brunei: Second pandemic influenza H1N1 death
A 42-year-old foreign worker became the second person in Brunei to die from Influenza A (H1N1) infection, the Ministry of Health (MoH) reported 6 April 2010.

After being ill for a week, the foreign worker was admitted into a hospital in serious condition at on 23 March 2010 and died later that day.

The recent death is the second reported in the Sultanate since the first H1N1 case was detected last year.

According to the MoH spokesperson, the ministry was only able to release the information two weeks after the death when a full investigation had already been conducted.
(The Brunei Times 04/07/2010)

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Malaysia (Sibu): Two patients suspected infected with H1N1
Minister of Public Health and Environment Dato Sri Wong Soon Koh confirmed two persons, including a child, were suspected to be infected with H1N1 in Sibu this week. He said the condition of the sick adult had improved and been discharged from the hospital while the child had been admitted to the isolation ward.

Wong has earlier told reporters that there were 84 cases of H1N1 in Sibu in the first three months of this year. He also said that Kuching had the most cases with 252 cases.
(The Borneo Post 04/07/2010)

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Malaysia: Outbreaks of pandemic influenza H1N1 at schools
School outbreaks of influenza-like illnesses, some of which has been confirmed as pandemic H1N1, have spurred Malaysia's health ministry to asked state officials to boost flu education and prevention activities, particularly in schools and public areas. The country's health minister said illness clusters have been detected at seven schools and that students from six other schools have received outpatient treatment.
(CIDRAP 04/08/2010)

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Viet Nam (Bac Kan Province): Confirmed case of H5N1 avian influenza
The Director of the Bac Kan Provincial Health Department, Nong Quoc Chi, confirmed an A/H5N1-infected case on 5 Apr 2010. The 22-year-old male patient from Na Tao hamlet, Nhu Co commune, Cho Moi district, is currently in critical condition. He is being treated at the Central Hospital for Tropical Diseases.

The patient became sick on Tue 30 Mar 2010 with symptoms of high fever and cough. He was admitted to Bac Kan provincial hospital, and then sent to the Central Hospital for Tropical Diseases on Sat 3 Apr 2010, where he tested positive for A/H5N1 virus.

At present, 4 other people in Nhu Co commune show similar symptoms of high fever and cough. They are under quarantine and being treated at Bac Kan provincial hospital.
(ProMED 04/05/2010)

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Americas
USA (Florida): Four H1N1 pandemic influenza deaths
Four Floridians have died from H1N1 flu infections in the week beginning 29 March 2010, bringing the state's total to 24 deaths. The four deaths occurred in Sarasota, Miami-Dade, Volusia, and Indian River counties and were primarily among middle-aged people with underlying conditions such as respiratory or neurologic disease, a county health spokeswoman said. She said more than 90 people in the state have been hospitalized this year because of pandemic flu.
(CIDRAP 04/06/2010)

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Africa
Ghana: Outbreaks of pandemic influenza H1N1 in schools
Health groups in Ghana, along with its health ministry, issued a warning of a heightened pandemic flu threat in the wake of several school closures in several regions of the country. A statement from the groups said children are among the most vulnerable groups, and they advised the public to minimize crowding at social events targeted to children.
(CIDRAP 04/08/2010)

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

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

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

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

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

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3. Articles
Economic Appraisal of Ontario’s Universal Influenza Immunization Program: A Cost-Utility Analysis
Sander B, Kwong JC, Bauch CT, et al. PLoS Med. April 2010;7(4): e1000256. doi:10.1371/journal.pmed.1000256
Available at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000256

Background. In July 2000, the province of Ontario, Canada, initiated a universal influenza immunization program (UIIP) to provide free seasonal influenza vaccines for the entire population. This is the first large-scale program of its kind worldwide. The objective of this study was to conduct an economic appraisal of Ontario's UIIP compared to a targeted influenza immunization program (TIIP).

Methods and Findings. A cost-utility analysis using Ontario health administrative data was performed. The study was informed by a companion ecological study comparing physician visits, emergency department visits, hospitalizations, and deaths between 1997 and 2004 in Ontario and nine other Canadian provinces offering targeted immunization programs. The relative change estimates from pre-2000 to post-2000 as observed in other provinces were applied to pre-UIIP Ontario event rates to calculate the expected number of events had Ontario continued to offer targeted immunization. Main outcome measures were quality-adjusted life years (QALYs), costs in 2006 Canadian dollars, and incremental cost-utility ratios (incremental cost per QALY gained). Program and other costs were drawn from Ontario sources. Utility weights were obtained from the literature. The incremental cost of the program per QALY gained was calculated from the health care payer perspective. Ontario's UIIP costs approximately twice as much as a targeted program but reduces influenza cases by 61% and mortality by 28%, saving an estimated 1,134 QALYs per season overall. Reducing influenza cases decreases health care services cost by 52%. Most cost savings can be attributed to hospitalizations avoided. The incremental cost-effectiveness ratio is Can$10,797/QALY gained. Results are most sensitive to immunization cost and number of deaths averted.

Conclusions. Universal immunization against seasonal influenza was estimated to be an economically attractive intervention.

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Monitoring the safety of pandemic H1N1 vaccine
Huang WT, Chuang JH, Kuo SHS. The Lancet. 3 April 2010;375(9721): 1164. doi:10.1016/S0140-6736(10)60515-6
Available at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960515-6/fulltext

Letter. Steven Black and colleagues (Dec 19, p 2115) highlight the importance of developing locally relevant background rates of disease to aid assessment of pandemic H1N1 vaccine safety. Taiwan has the capacity to monitor H1N1 vaccine safety during mass immunisation campaigns.

Beginning on Nov 1, 2009, Taiwan began administering 15 million doses of H1N1 vaccine sequentially according to a priority list, with 12 target groups. National Health Insurance (NHI) in Taiwan enrols more than 99% of citizens. Using the same International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes listed in Black and colleagues' study, we searched the NHI claims database from Jan 1, 2004, to July 31, 2008, to estimate background rates of the selected medical events that might be temporally associated with the vaccine.
[For more information, please reference the letter’s link above.]

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Association between the 2008-09 Seasonal Influenza Vaccine and Pandemic H1N1 Illness during Spring-Summer 2009: Four Observational Studies from Canada
Skowronski DM, De Serres G, Crowcroft NS, et al. PLoS Med. April 2010;7(4): e1000258. doi:10.1371/journal.pmed.1000258
Available at http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000258#abstract1

Background. In late spring 2009, concern was raised in Canada that prior vaccination with the 2008–09 trivalent inactivated influenza vaccine (TIV) was associated with increased risk of pandemic influenza A (H1N1) (pH1N1) illness. Several epidemiologic investigations were conducted through the summer to assess this putative association.

Methods and Findings. Studies included: (1) test-negative case-control design based on Canada's sentinel vaccine effectiveness monitoring system in British Columbia, Alberta, Ontario, and Quebec; (2) conventional case-control design using population controls in Quebec; (3) test-negative case-control design in Ontario; and (4) prospective household transmission (cohort) study in Quebec. Logistic regression was used to estimate odds ratios for TIV effect on community- or hospital-based laboratory-confirmed seasonal or pH1N1 influenza cases compared to controls with restriction, stratification, and adjustment for covariates including combinations of age, sex, comorbidity, timeliness of medical visit, prior physician visits, and/or health care worker (HCW) status. For the prospective study risk ratios were computed. Based on the sentinel study of 672 cases and 857 controls, 2008–09 TIV was associated with statistically significant protection against seasonal influenza (odds ratio 0.44, 95% CI 0.33–0.59). In contrast, estimates from the sentinel and three other observational studies, involving a total of 1,226 laboratory-confirmed pH1N1 cases and 1,505 controls, indicated that prior receipt of 2008–09 TIV was associated with increased risk of medically attended pH1N1 illness during the spring–summer 2009, with estimated risk or odds ratios ranging from 1.4 to 2.5. Risk of pH1N1 hospitalization was not further increased among vaccinated people when comparing hospitalized to community cases.

Conclusions. Prior receipt of 2008–09 TIV was associated with increased risk of medically attended pH1N1 illness during the spring–summer 2009 in Canada. The occurrence of bias (selection, information) or confounding cannot be ruled out. Further experimental and epidemiological assessment is warranted. Possible biological mechanisms and immunoepidemiologic implications are considered.

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Letter: One Flu for One Health
Capua I, Cattoli G. Emerg Infect Dis. April 2010;16(4): DOI: 10.3201/eid1604.091593
Available at http://www.cdc.gov/EID/content/16/4/719a.htm

Letter. To the Editor: The emergence and spread of influenza A pandemic (H1N1) 2009 virus from the animal reservoir to humans raise questions about the future approach to influenza virus infections. The scientific community has evidence demonstrating that influenza virus genes migrate across continents and animal species and assemble themselves in combinations that are a threat to animal and human health, resulting in panzootics like that caused by influenza A virus (H5N1) or pandemics like that caused by pandemic (H1N1) 2009 virus. The latter virus emerged from the animal reservoir, containing a unique combination of genes donated by viruses originating from 3 species and 2 hemispheres. In a globalized environment, mapping gene movement across species and national borders and identifying mutations and gene constellations with pandemic potential or virulence determinants are essential to enact prevention and control strategies at a global level. This conclusion is in agreement with, and possibly the best example of, the One Health (http://un-influenza.org/node/2341) vision: a multidisciplinary collaborative approach to improving the health of humans, animals, and the environment. One Health is endorsed by the United Nations Food and Agriculture Organization, the World Organisation for Animal Health, and the World Health Organization.
[For the remainder of this letter, please refer to the link above.]

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Household Transmission of Pandemic (H1N1) 2009, San Antonio, Texas, USA, April-May 2009
Morgan OW, Parks S, Shim T, et al. Emerg Infect Dis. April 2010; DOI: 10.3201/eid1604.091658
Available at http://www.cdc.gov/eid/content/16/4/631.htm#cit

Abstract. To assess household transmission of pandemic (H1N1) 2009 in San Antonio, Texas, USA, during April 15–May 8, 2009, we investigated 77 households. The index case-patient was defined as the household member with the earliest onset date of symptoms of acute respiratory infection (ARI), influenza-like illness (ILI), or laboratory-confirmed pandemic (H1N1) 2009. Median interval between illness onset in index and secondary case-patients was 4 days (range 1–9 days); the index case-patient was likely to be <18 years of age (p = 0.034). The secondary attack rate was 4% for pandemic (H1N1) 2009, 9% for ILI, and 13% for ARI. The secondary attack rate was highest for children <5 years of age (8%–19%) and lowest for adults >50 years of age (4%–12%). Early in the outbreak, household transmission primarily occurred from children to other household members and was lower than the transmission rate for seasonal influenza.

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2009 Pandemic H1N1 Influenza Virus Replicates in Human Lung Tissues
Zhang J, Zhang Z, Fan X, et al. Journal of Infectious Diseases. 6 April 2010;201:000-000. DOI: 10.1086/650544
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/650544

Abstract. The replication activity of 2009 pandemic H1N1 influenza virus in human lung cells was evaluated in this study. Twenty two surgically removed human lung tissue samples were infected ex vivo with pandemic H1N1 influenza virus (A/California/04/2009), seasonal human H1N1 influenza virus (A/Shantou/92/09), or a highly pathogenic H5N1 influenza virus (A/Vietnam/1194/04). Examination of nucleoprotein expression and viral RNA replication in the infected human lung tissue samples showed that whereas the replication of pandemic H1N1 influenza virus varied between tissue samples, overall this virus replicated more efficiently than seasonal H1N1 influenza virus but less efficiently than H5N1 influenza virus. Double immunostaining for viral antigens and cellular markers indicated that pandemic H1N1 influenza virus replicates in type 2 alveolar epithelial cells.

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4. Notifications
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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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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Influenza 2010: Zoonotic Influenza and Human Health
Oxford, United Kingdom 22 Sep 2010
The Oxford influenza conference, Influenza 2010, will address most aspects of basic and applied research on zoonotic influenza viruses (including avian and swine) and their medical and socio-economic impact.
Additional information available at http://www.libpubmedia.co.uk/Conferences/Influenza2010/Home.htm.

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Updated influenza guidance and information from the US CDC
5 Things Caregivers of People with Disabilities Need To Know About the Flu
Released 8 April 2010
Available at http://www.cdc.gov/h1n1flu/disabilities/5_things_caregivers_people_disability.htm

5 Things People with Disabilities Need To Know About the Flu
Released 8 April 2010
Available at http://www.cdc.gov/h1n1flu/disabilities/5_things_people_disability.htm

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