Vol. XIII No. 8 ~ EINet News Briefs ~ Apr 16, 2010

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

1. Influenza News
- 2010 Cumulative number of human cases of avian influenza A/H5N1
- Global: WHO situation update on pandemic influenza H1N1
- Global: Expert panel begins review of WHO’s pandemic response
- Hong Kong: Death reported from A/H1N1 influenza
- India (Chopal): Six test positive for H1N1 pandemic influenza
- Malaysia (Kuala Lumpur): Four new clusters of A(H1N1) influenza cases
- Malaysia (Putrajaya): Influenza A(H1N1) death
- Malaysia (Penang): Three trainees positive for A(H1N1) influenza
- Viet Nam (Bac Kan province): Awaiting test results in suspected H5N1 avian influenza cluster
- Namibia (Swakopmund): Two new cases of pandemic H1N1 influenza reported

2. Infectious Disease News
- China: Leader calls for research into hand, foot and mouth disease after 40 children died in March 2010
- China: Health ministry warns of outbreak of marmot plague in quake zone
- Chinese Taipei: Hantavirus infection
- New Zealand (Hokianga): Measles outbreak
- Philippines: Measles 351.8 percent higher this year
- Canada (British Columbia): Measles outbreak
- Chile (Angofagasta): Fatal hantavirus case
- USA (New York, Pennsylvania): Nine confirmed cases of mumps

3. Updates

4. Articles
- 2009 Influenza A(H1N1) Seroconversion Rates and Risk Factors Among Distinct Adult Cohorts in Singapore
- Cross-reactive antibodies to pandemic (H1N1) 2009 virus, Singapore
- 20th European Congress of Clinical Microbiology and Infectious Diseases Conference findings on H1N1
- Law, ethics and pandemic preparedness: the importance of cross-jurisdictional and cross-cultural perspectives
- Satellite-tracking of Northern Pintal Anas acuta during outbreaks of the H5N1 virus in Japan: implications for virus spread
- Prophylactic and Therapeutic Efficacy of Avian Antibodies Against Influenza Virus H5N1 and H1N1 in Mice

5. 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
- 4th Vaccine and ISV Annual Global Congress

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1. Influenza News

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 / 25 (10)

***For data on human cases of avian influenza prior to 2010, go to:

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):


Global: WHO situation update on pandemic influenza H1N1
As of 11 April 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17,798 deaths.

The most active areas of pandemic influenza virus transmission currently are in parts of the tropical zones of the Americas, West Africa, Eastern Africa and South East Asia. Although pandemic influenza continues to be the predominant circulating influenza virus worldwide, seasonal influenza type B virus circulation continues to be predominant in East Asia, and is being detected across other parts of Asia, and Europe at low levels. Sporadic detections of seasonal influenza H3N2 viruses have been reported across Asia, Eastern Europe and Eastern Africa most notably in recent weeks in Indonesia and Tanzania. Few seasonal H1N1 viruses were reported in the Russian Federation and Northern China in the last week.

In East Asia, pandemic influenza activity continued to decline and is now at very low levels. The predominant virus associated with influenza-like-illness in the area is now influenza type B viruses, which continue to circulate in China, Mongolia, and Republic of Korea. The Republic of Korea reports an increasing trend of respiratory disease activity associated with detections of influenza type B viruses and small numbers of pandemic H1N1. In China, outbreaks of acute respiratory infections associated with B virus detections are reported but none due to pandemic H1N1. The overall level of respiratory disease activity is similar to the level observed during the same period of 2007-2008 and 2008-2009 seasons. Small numbers of seasonal H3N2 and sporadic seasonal H1N1 viruses were detected in Northern China. In Mongolia, rates of influenza-like illness (ILI) continue to decline and are associated with influenza type B only.

In South and Southeast Asia, the most active areas of influenza transmission are Thailand and Singapore, where pandemic H1N1 is the dominant influenza virus, with co-circulation at lower levels of influenza type B and H3N2. Overall, the intensity of transmission is relatively low. In Thailand, respiratory disease activity has decreased since the previous week. Four percent of sentinel respiratory samples from ILI patients and 2.6% of sentinel respiratory samples from hospitalized patients with pneumonia were found to be positive for pandemic H1N1. Malaysia continues to report occasional outbreaks of respiratory disease in three states, Johor, Pahang, and Melaka. Only Melaka state has reported pandemic H1N1 laboratory confirmed cases, with 4 cases treated in the Intensive Care Unit (ICU). In India overall pandemic H1N1 activity is very low in most states, although in western India pandemic H1N1 cases continue to be reported in low numbers.

In Europe, pandemic influenza activity has continued to decrease in recent weeks and is at very low intensity in all countries. The overall proportion of sentinel respiratory samples testing positive for influenza remained low (5.4%), and the number of influenza type B virus detections exceeded that of influenza A. In Italy, 50% (7/14) of sentinel respiratory samples tested positive for influenza, all of which were seasonal influenza type B viruses.

In the northern temperate zones of the Americas, overall pandemic influenza transmission remained low as pandemic influenza H1N1 virus continues to circulate at very low levels in some areas. In temperate countries of the southern hemisphere, overall respiratory disease activity remained low.

In tropical zone of the Americas, limited data suggests that overall influenza activity remains low with localized areas of active transmission in a number of countries. In Cuba, a slight increase of confirmed cases of pandemic virus was reported during the most recent reporting week. In Mexico, available data suggests that localized active transmission of pandemic influenza virus continues to occur around Mexico City but is very low nationally. In Peru, the number of pneumonia cases has increased over the last two weeks, especially in children less than five years of age, however there is no virological information available to indicate the cause of these cases. The lack of an associated increase in other age groups may indicate a cause other than influenza. Increased levels of ILI have also been reported across much of Brazil over the previous two weeks particularly in northern Brazil.

In North Africa limited available data suggests that respiratory disease activity remained low. In sub-Saharan Africa, West Africa continues to see community transmission of pandemic influenza virus with Ghana currently being the primary focus of transmission (45% of all clinical specimens tested were positive for pandemic influenza) but smaller numbers of cases were also seen in Senegal and Niger. Pandemic influenza virus transmission appears to have peaked in Senegal approximately one month ago. Guinea has now reported their first cases of pandemic H1N1. In East Africa, cases of pandemic influenza H1N1 continue to be detected in Rwanda, though in declining numbers. Small numbers of seasonal influenza H3N2 and influenza type B viruses were detected during the last week in Rwanda, Kenya and South Africa. Notably, Tanzania has also recently reported significant transmission of seasonal influenza H3N2. No increases in respiratory disease activity or pandemic influenza have yet been noted in South Africa.

In the South pacific, Vanuatu and Nauru reported an increasing trend of respiratory diseases activity for this week, but this trend was not associated with laboratory confirmed detections of pandemic H1N1 virus.

In other temperate countries out of the southern hemisphere, Australia and New Zealand, influenza activity continues to be low, with mostly detections of pandemic H1N1 and sporadic seasonal influenza viruses.
(WHO 04/16/2010)


Global: Expert panel begins review of WHO’s pandemic response
A committee of experts appointed by the World Health Organization (WHO) convened to begin evaluating the agency's and the world's response to the H1N1 influenza pandemic, with WHO Director-General Margaret Chan urging the group to pull no punches.

The start of the review comes almost a year after the novel H1N1 virus emerged and in the wake of considerable criticism that the WHO and many governments overreacted to the virus. Some critics have charged that the response was improperly influenced by drug companies hoping to profit from the epidemic—a charge that the WHO and public health authorities strongly reject.

As the panel convened a three-day meeting in Geneva, the WHO released the names of its 29 members, who the agency said are some of the leading experts in their fields and combine scientific expertise and public health experience. Numerous developed and developing countries are represented.

The panel will review the pandemic response in the context of a broader examination of the functioning of the International Health Regulations (IHR). The regulations, designed to guide responses to potential international health threats, took effect in 2007 and are due for a review this year. The panel's official name is the International Health Regulations Review Committee.

On the basis of the committee's findings, Chan will present an interim report to the World Health Assembly next month and a final report to the assembly in May 2011, the WHO said.

The committee's three stated goals are to review the functioning of the IHR; to assess the ongoing global response to the H1N1 pandemic, including the WHO's role; and to identify lessons for improving preparedness for future pandemics and other emergencies.

Dr. Keiji Fukuda, director of the WHO's influenza program, told the committee today that the agency's six-stage pandemic alert system caused confusion, since the H1N1 virus turned out to be far less deadly than the H5N1 avian flu virus. The H5N1 virus had long been seen as the most likely cause of the next pandemic.

According to a Canadian Press report, Fukuda said the review committee will not second-guess the WHO's decision last June to declare the H1N1 epidemic a pandemic.

The WHO's declaration of the pandemic was controversial at the time as well as afterward. Because the idea of a pandemic was strongly associated with the H5N1 virus, many feared that declaring H1N1 a pandemic would cause undue fear. But the WHO said the pandemic declaration was not meant to convey anything about the severity of the illness, only that the virus was capable of spreading globally.

The members of the review committee are not WHO staff members and are not paid by the WHO for their participation, the agency said. They were chosen from the roster of experts under the IHR structure or other WHO committees.

Because the group is considered a WHO expert committee, the agency said, it must follow WHO regulations, which include rules designed to prevent conflicts of interest.

[Margaret Chan’s speech may be accessed at http://www.who.int/dg/speeches/2010/ihr_20100412/en/index.html]
(CIDRAP 04/12/2010)


Hong Kong: Death reported from A/H1N1 influenza
Hong Kong has reported one more death case from A/H1N1 influenza, bringing the city's death toll to 80.

A 58-year-old man with diabetes mellitus was sent to Princess Margaret Hospital's Accident and Emergency Department at midnight on 11 April 2010 after collapsing at home and was certified dead on arrival.

The hospital was informed by the Center for Health Protection of Hong Kong on Wednesday that the test result of the patient was positive for A/H1N1 influenza.
(Xinhua 04/15/2010)


India (Chopal): Six test positive for H1N1 pandemic influenza
On 13 April 2010, the government sent three medical teams to Chopal, Shimla district, after villagers tested positive for H1N1 influenza infection.

Oseltamivir (Tamiflu) sufficient for 300 to 500 people has been rushed to the five villages where the samples tested positive. Three ambulances have also been deputed to rush patients to hospital, if required.

Four of the six patients who tested positive for swine flu are in the age group of six to 12 years. They have been put on home quarantine. Two of the children are from a family in Judu Shalal village in Kupvi, which lost two girls last week to high fever.
(India Express.com 04/14/2010)


Malaysia (Kuala Lumpur): Four new clusters of A(H1N1) influenza cases
Health Ministry director-general Tan Sri Dr. Ismail Merican said four new ILI clusters have been detected in Johor, Pahang and Malacca.

In Johor, a family of three from Taman Johor and three siblings from another family in Gelang Patah were admitted to a hospital for suspected H1N1.

In Pahang, 20 prisoners and a staff member of Penor Jail, Kuantan were taken to a hospital when they showed symptoms of the disease. The prisoners were given outpatient treatment and placed in an isolation room in the prison with a prison medical team monitoring them. The prison staff member was sent home after being given outpatient treatment at the same hospital.

In Malacca, two children in a family residing at Taman Bemban Utama, Jasin have been hospitalized. One has been confirmed positive for pandemic H1N1 infection.

As of 11 April 2010, there were 677 people admitted to hospitals nationwide of whom 58 were confirmed positive for H1N1. Four of the confirmed cases were treated in intensive care units. The death toll stands at 80.

With the National Influenza Pandemic Preparedness Plan (NIPPP) having been put in place by the Health Ministry following the rising number of the Influenza A(H1N1) cases, members of the H1N1 technical committee will meet by Wednesday to be updated on the current situation, Health Minister Datuk Seri Liow Tiong Lai said.

The ministry will strengthen the vaccination drive to get as many people with co-morbid conditions to get the vaccine dose, free of charge, at the 104 identified government facilities nationwide.
(New Straits Times 04/13/2010)


Malaysia (Putrajaya): Influenza A(H1N1) death
Another death due to Influenza A (H1N1) was reported in the country involving a 42-year-old lawyer from Johor.

Director-General of Health Tan Sri Dr. Ismail Merican said Tuesday the man died while receiving treatment at a private hospital in Johor Baru. He said it was the first death due to H1N1 this year, bringing the death toll to 78 since the outbreak last year.

As of 5.30 p.m. 12 April 2010, Dr Ismail said, 678 patients with influenza-like-illness (ILI) were still being treated in hospitals nationwide. Of the total, 66 cases were tested positive for H1N1, while five were being treated in the ICU.
(Bernama 04/13/2010)


Malaysia (Penang): Three trainees positive for A(H1N1) influenza
Three National Service (NS) Training Programme trainees at Syruz Camp in Machang Bubok, Bukit Mertajam are confirmed to have contracted the influenza A (H1N1) virus.

Penang Health, Welfare and Caring Society Committee chairman Phee Boon Poh said the trio were quarantined and treated by the camp's medical officer, adding that they were in stable condition.
(Bernama 04/10/2010)


Viet Nam (Bac Kan province): Awaiting test results in suspected H5N1 avian influenza cluster
Two patients who are part of a suspected H5N1 avian influenza case cluster in northern Vietnam's Bac Kan province are still hospitalized, with 11 others isolated for flu-like symptoms, health officials said.

The two hospitalized patients include a 22-year-old man and a 27-month-old girl.

Hoang Van Linh, deputy director of northern Bac Kan's health department, said some of the isolated group includes relatives of the two hospitalized patients. Hoang said the 11 people in isolation recovered after treatment with oseltamivir (Tamiflu) and that he is awaiting test results to see if any were infected with the H5N1 virus.

Vietnam's health ministry said dead chickens were reported at the homes of the two hospitalized patients and that the toddler's family reportedly slaughtered and ate some of the infected poultry. A provincial infectious disease official said that all of the isolated patients had contact with sick birds.

Bac Kan province, a mountainous area in northern Vietnam, was among two areas cited in H5N1 outbreak reports that the country's agriculture ministry submitted to the World Organization for Animal Health (OIE) on 10 April 2010. The outbreak in Bac Kan started on 19 March 2010, killing 318 of 550 birds in the affected village. The remaining 142 birds were destroyed to control the spread of the virus.

The country also reported that the virus struck birds in a village in Quang Ninh province, located on Vietnam's northeastern coast, killing 1,231 of 1,554 birds. The remaining poultry were destroyed.

An investigation into the source of the events suggested that introduction of new animals, illegal movement of birds, and fomites were linked to the two H5N1 outbreaks, the OIE report said.

Geographic and family H5N1 clusters are relatively rare, and they raise fears that the virus has improved its ability to infect humans, which could increase the risk that the virus could become a pandemic flu strain.
(CIDRAP 04/13/2010)


Namibia (Swakopmund): Two new cases of pandemic H1N1 influenza reported
At least two cases of the H1N1 flu have been confirmed at Swakopmund. They are the first cases of the flu strain reported in Namibia in 2010, and come at a time when the health authorities are preparing a national H1N1 vaccination campaign due to start in May 2010.

A group of 13 Swakopmunders returned to Namibia from a golf vacation in Phuket, Thailand, and on arrival at Hosea Kutako Airport in Windhoek, most of them were suffering from flu-like symptoms. According to one of the possible patients, who is still awaiting the results of his test, they went to their respective doctors who took swabs and sent the samples to local pathology centers. Four days later, it was confirmed that two of the people had the H1N1 virus, but it is believed that more could have tested positive.

220,000 doses of H1N1 vaccine will arrive from the WHO soon, after which a national vaccination campaign will be launched in May 2010.
(ProMED 04/11/2010)


2. Infectious Disease News

China: Leader calls for research into hand, foot and mouth disease after 40 children died in March 2010
A top Chinese leader called for stepped-up research into vaccines and drugs for hand, foot and mouth disease after 40 children died from outbreaks March 2010. The Ministry of Health reported 77,756 cases of the disease in March 2010. The number of deaths increased sharply, up from 10 in February 2010.

China sees deadly outbreaks of hand, foot and mouth disease every spring and summer, particularly in rural areas where hygiene is poor. There were 353 deaths from the disease in 2009, according to Health Ministry figures.

Vice Premier Li called for more research into vaccines and drugs to fight the disease, plus stronger prevention and control efforts. Outbreaks were reported in southern China's Guangxi Autonomous Region as well as Guangdong, Henan, Hebei and Shandong provinces.

Currently, there is no vaccine or specific treatment for the virus, but most children recover quickly without problems.
(ProMED 04/09/2010)


China: Health ministry warns of outbreak of marmot plague in quake zone
China's Health Ministry said the country faced "relatively severe" challenges in preventing and controlling an outbreak of marmot plague in a recent quake zone.

The Tibetan Autonomous Prefecture of Yushu in northwest China's Qinghai Province was jolted by a 7.1-magnitude earthquake 14 April 2010, leaving 617 people dead, 9,110 injured and 313 missing.

Yushu is a natural source of marmot plague and infections of the disease among animals have been frequent in recent years, according to a notice posted on the ministry's website.

Marmots emerge from hibernation in April, which strengthens the urgency of efforts to prevent and control marmot plague after the quake.

The ministry has asked experts from the Chinese Center for Disease Control and Prevention to go to the quake zone, and gauge the situation to devise and implement effective measures for prevention and control of a plague outbreak.
(Xinhua 04/15/2010)


Chinese Taipei: Hantavirus infection
The Department of Health's Centers for Disease Control confirmed on 9 April 2010 that a 36-year-old man in Chinese Taipei County's Wugu Township had contracted the Category 2 contagion hantavirus hemorrhagic fever with renal syndrome.

Lin Kuo-ning, head of the Chinese Taipei County Public Health Bureau's Disease Control Division, said the man first experienced nosebleeds and coughing on 8 March 2010 and went to the emergency room on 18 March 2010 with a high fever. Upon complete recovery, he was released on 26 March 2010, and blood tests showed his was the first confirmed case of hantavirus hemorrhagic fever since 2009.

On 13 April 2010 the hantavirus case was confirmed as attributable to Seoul virus.

Although none of the man's family members living with him showed any symptoms, blood samples were taken, and health workers set rodent traps in the man's home and workplace to try to locate the source of the virus. The Public Health Bureau will coordinate with the Environmental Protection Bureau to eradicate rats in the area.

According to CDC statistics, from 1997 to 2007, 382 cases of possible HFRS were reported in Chinese Taipei, with nine cases verified. Two cases of HPS out of 115 reported cases were confirmed in that time.
(ProMED 04/12/2010, 04/13/2010)


New Zealand (Hokianga): Measles outbreak
Parents are being urged to ensure their children are vaccinated against measles after confirmation of a large outbreak in Northland. The Northland District Health Board says of 30 patients believed to have measles in the Hokianga area, five have been confirmed.

Medical officer of health Jonathan Jarman says the affected European community is quite isolated and normally does not have a lot to do with traditional health services.

Jarman said his main concern was that the virus might spread to the wider Hokianga community.
(ProMED 04/06/2010)


Philippines: Measles 351.8 percent higher this year
On 9 April 2010, the Department of Health (DoH) released its latest data on measles incidence in the country which has reached 1,473 since 1 Jan 2010. This is 351.8 percent higher than the number of cases in the same period last year. Health experts recorded a total of 3,648 suspect measles cases but discarded 1,380 as non-measles while the results of 795 are pending in the laboratory.

The DoH recorded eight deaths resulting from the disease during the covered period this year while there were only three deaths in 2009 in the same given period. The DoH said five of the fatalities were less than 12 months of age and two cases belonged to the one to four years age group. One case belonged to the 10 to 14 years age range.

The list identified the regions with the most number of measles cases. These included the National Capital Region (NCR), Calabarzon, Central Luzon and Bicol. Outbreaks of laboratory-confirmed measles were also seen in NCR, Ilocos region, Central Luzon, Calabarzon and CAR. DoH Secretary Esperanza I. Cabral said cases have to go down in the following weeks before the DoH can declare that the measles season is over.
(ProMED 04/09/2010)


Canada (British Columbia): Measles outbreak
Three cases of measles have been confirmed in the British Columbia interior on the heels of an outbreak during March 2010 in the Metro Vancouver area. The Interior Health Authority said the three cases are in Vernon, Lillooet and Williams Lake.

One has been traced back to overseas exposure, but health officials say the other two people hadn't travelled outside their communities. These two may not be connected to the measles outbreak in the Vancouver area, in which there were 10 confirmed cases of the disease, eight of them from a single household.

The B.C. Centre for Disease Control said at the time it suspected that two international visitors brought measles into Vancouver sometime in February 2010 during the Olympics, or in early March 2010.

It may be that the presence of travelers from measles endemic areas abroad are revealing inadequately vaccinated communities in the population of British Columbia. Determination of the genotypes of the viruses isolated from these individuals may provide an indication of the origin of the viruses responsible for these apparently unconnected cases.
(ProMED 04/07/2010)


Chile (Angofagasta): Fatal hantavirus case
The health authority confirmed the death of a 29-year-old patient infected by hantavirus. The young man, who worked for some years in a mining company, contracted the fatal disease during a trip to Biobio, where his family members live. When he returned to the city, the worker had the first symptoms of the disease, which led to his admission to a private medical assistance center, where he rapidly became worse and finally died on 31 Mar 2010.
(ProMED 04/07/2010)


USA (New York, Pennsylvania): Nine confirmed cases of mumps
Health officials say there are now more confirmed cases of mumps virus infection at Plattsburgh State College. School officials say there are nine confirmed cases with six more pending. Affected students are reportedly only showing mild symptoms like fever, aches and swollen glands.
(ProMED 04/06/2010)


3. Updates
- 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
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/


- 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.



Brunei Darussalam
The Ministry of Health assured the public that dengue was under control and was not showing any serious outbreak patterns despite a recent sharp rise in cases in the first three months of 2010. Since January 2010, the ministry has recorded a total of 53 positive cases. Only 38 cases were recorded in 2009. Most cases were detected among residents in the Brunei-Muara district, particularly villages in Kampong Ayer.

There were more dengue cases in 2010 due to patterns of mosquito breeding through global warming and alternating seasons in the country, said Dr Rahmah Hj Md Said, Director-General at the Health Services Department.

Dr Hjh Rahmah said the ministry was hard at work and in the process of identifying the type of dengue strain circulating in the country. She added that the identification of more than one strain would be a "more worrying factor.”
(ProMED 04/04/2010)

Indonesia (Bali)
The yearly dengue fever outbreak claimed the lives of two children at Sanglah Hospital last week. The two victims were a 4-year-old from Badung regency who died 1 April 2010, and an 11-year-old from Karangasem regency who died 2 April 2010. Both patients had only been treated for a day.

At least six people -- four of them children -- have died of the disease at the hospital in 2010.
(ProMED 04/05/2010)

Peru (Piura)
Dengue is now epidemic. Although it is certain that dengue cases at a regional level are less in comparison with those of 2009, the Piura Regional Health Director, Dr. Cesar Moron, considers Piura and Castilla to be in an epidemic. There are more infected individuals, and the number of fatal victims now totals two.

These statements were given 03 April 2010, after participation in a meeting of the Committee for Emergencies of the regional government. There was agreement to sign a resolution to declare a "red alert" in the region in order to increase responsibility and response in facing dengue. As a result, for 90 days, health units and hospitals will be on alert to attend any emergency, said the Director of Health. The regional council will be requested to waive usual buying processes for purchase of materials such as abate larvicide and insecticide. Between 8-30 Apr 2010, health professionals will be involved with 120,000 properties to carry out control actions and identification of larvae and positive human dengue cases.
(ProMED 04/04/2010)

A drug-resistant strain of the disease malaria—first detected about 18 months ago near the Thailand-Cambodia border -- is now showing up again along Thailand's border with Myanmar.

Many patients in the region taking anti-malarial drugs are now taking much longer to respond to treatment. Medics fear the resistant strain could eventually spread to Africa, where most of the world's malaria cases and deaths occur.
(ProMED 04/06/2010)

USA (Puerto Rico)
Dengue deaths in Puerto Rico so far in 2010 increased to two after confirmation of a new death, the Subsecretary of Health, Concepcion Quinones de Longo, announced 6 April 2010. In the week of 5 March 2010, 189 cases of this disease were confirmed in Puerto Rico. The municipalities most affected are Naguabo, Humacao, Las Piedras, Yabucoa, Juncos, Arecibo, Hatillo and Santa Isabel.

The Puerto Rican health authorities this past March 2010 declared a dengue epidemic on this Caribbean island after the threshold number for the established number of registered cases of this disease for two consecutive weeks was exceeded.

The combination of high temperatures and rain during the month of January 2010 favored massive reproduction of the Aedes aegypti mosquito, especially on the northern coasts and east of the country.
(ProMED 04/06/2010)



The Antofagasta regional hospital diagnosed an 18-month old infant girl with cholera on 12 April 2010. Dr. Antonio Cárdenas, Chief of Pediatrics, testified that the infant had Vibrio cholerae.

Before the discovery, the child’s blood samples were sent to Chile’s Public Health Institute (ISP) in Santiago to find out whether or not is was an epidemic strain of cholera. The diagnosis is the first of its kind in 12 years. The last time someone was diagnosed with the epidemic bacteria was in 1998.

Undersecretary of Public Health Liliana Jadue said there is no risk of an epidemic in the region and there is no reason to call it a sanitary emergency.

Antofagasta has been affected by a diarrhea epidemic caused by Norovirus, which has affected around 13,000 people.
(Santiago Times 04/07/2010)

Papua New Guinea
More than 2,900 people in Papua New Guinea have been infected with cholera since an outbreak began eight months ago.

The country’s first cholera outbreak in 50 years is affecting three adjoining northern provinces: Madang, Morobe and East Sepik.

The World Health Organization’s representative in PNG, Dr. Eigil Sorensen, says 500 people got the disease in the second half of March, but the infection rate has since eased. Dr. Sorensen says there were about 10 new infections over the last fortnight.

Government officials say the outbreak shows signs of subsiding. In response, the government has begun scaling back its activities in some areas.
(Radio NZ 04/12/2010 and IRIN Asia 04/15/2010)

Viet Nam (Bac Ninh, Ho Chi Minh)
The northern province of Bac Ninh has officially confirmed its first case of the bacteria Vibrio cholerae. The 50-year-old male patient, living in Huu Ai hamlet, Tan Lang commune, Luong Tai district, said he had only eaten pig blood puddings and shrimp paste. He is now in a stable condition.

In Ho Chi Minh City, the number of patients infected with acute diarrhea is on the increase. In March 2010, Children's Hospital Number 2 discovered 870 serious cases among its 4,960 diagnosed cases, an increase of 10 percent from 2009. In the first three months of 2010 the Hospital for Tropical Diseases treated more than 800 patients infected with the same disease.
(ProMED 04/13/2010)

Viet Nam (Ho Chi Minh)
A total of five people have been infected with Vibrio cholerae in Ho Chi Minh City so far, according to an official from the municipal health department.

The fifth case was a female pupil from Hong Bang junior high school in District 5, who tested positive for the bacterium on 12 Apr 2010. She is the sister of a male student who contracted the disease on 9 Apr 2010.

The local medical watchdog called an urgent meeting with the relevant agencies on 13 April 2010 to discuss countermeasures.

The results of an epidemiological survey have shown that all these cases of infection are related to food vendors operating near schools, which usually do not meet hygiene requirements.

Ho Chi Minh City has launched a hygiene campaign to raise public awareness of this and to closely monitor people suspected of having the disease.
(ProMED 04/13/2010)


4. Articles
2009 Influenza A(H1N1) Seroconversion Rates and Risk Factors Among Distinct Adult Cohorts in Singapore

Chen MIC, Lee VJM, Lim W-Y, et al. JAMA. 2010;303(14):1383-1391.
Available at http://jama.ama-assn.org/cgi/content/short/303/14/1383?home

Context. Singapore experienced a single epidemic wave of 2009 influenza A(H1N1) with epidemic activity starting in late June 2009 and peaking in early August before subsiding within a month.

Objective. To compare the risk and factors associated with H1N1 seroconversion in different adult cohorts.

Design, Setting, and Participants. A study with serial serological samples from 4 distinct cohorts: general population (n = 838), military personnel (n = 1213), staff from an acute care hospital (n = 558), and staff as well as residents from long-term care facilities (n = 300) from June 22, 2009, to October 15, 2009. Hemagglutination inhibition results of serum samples taken before, during, and after the epidemic and data from symptom questionnaires are presented.

Main Outcome Measures. A 4-fold or greater increase in titer between any of the 3 serological samples was defined as evidence of H1N1 seroconversion.

Results. Baseline titers of 40 or more were observed in 22 members (2.6%; 95% confidence interval [CI], 1.7%-3.9%) of the community, 114 military personnel (9.4%; 95% CI, 7.9%-11.2%), 37 hospital staff (6.6%; 95% CI, 4.8%-9.0%), and 20 participants from long-term care facilities (6.7%; 95% CI, 4.4%-10.1%). In participants with 1 or more follow-up serum samples, 312 military personnel (29.4%; 95% CI, 26.8%-32.2%) seroconverted compared with 98 community members (13.5%; 95% CI, 11.2%-16.2%), 35 hospital staff (6.5%; 95% CI, 4.7%-8.9%), and only 3 long-term care participants (1.2%; 95% CI, 0.4%-3.5%). Increased frequency of seroconversion was observed for community participants from households in which 1 other member seroconverted (adjusted odds ratio [OR], 3.32; 95% CI, 1.50-7.33), whereas older age was associated with reduced odds of seroconversion (adjusted OR, 0.77 per 10 years; 95% CI, 0.64-0.93). Higher baseline titers were associated with decreased frequency of seroconversion in community (adjusted OR for every doubling of baseline titer, 0.48; 95% CI, 0.27-0.85), military (adjusted OR, 0.71; 95% CI, 0.61-0.81), and hospital staff cohorts (adjusted OR, 0.50; 95% CI, 0.26-0.93).

Conclusion. Following the June-September 2009 wave of 2009 influenza A(H1N1), 13% of the community participants seroconverted, and most of the adult population likely remained susceptible.


Cross-reactive antibodies to pandemic (H1N1) 2009 virus, Singapore

Tang JW, Tambyah PA, Wilder-Smith A, et al. Emerg Infect Dis . May 2010; DOI: 10.3201/eid1605.091678 [Epub ahead of print]
Available at http://www.cdc.gov/eid/content/16/5/pdfs/09-1678.pdf

Letter. To the Editor: Accumulating evidence suggests that the degree of serologic cross-reactivity to pandemic (H1N1) 2009 virus varies between populations worldwide. To assess potential serologic cross-reactivity in Singapore, we obtained serum samples during May–June 2009 from 50 randomly recruited, healthy volunteers born mostly before 1958 (i.e., potentially those with some natural exposure to the then circulating H1N1/1918-like subtype viruses) before widespread transmission of pandemic (H1N1) 2009 virus in Singapore. Standard serologic hemagglutination-inhibition (HI) tests (1) were performed in 2 reference laboratories (Singapore during July–October 2009 and Melbourne, Australia, in January 2010), and microneutralization (MN) tests (2) were performed in 1 reference laboratory (Singapore) for each serum sample against pandemic (H1N1) 2009 virus (A/Auckland/1/2009) and seasonal influenza (H1N1) virus (A/Brisbane/59/2007). The study was reviewed and approved by the National Healthcare Group Domain-Specific Review Board (ref no. E/09/289, J.W.T. principal investigator).
[for the rest of the letter, please refer to the link above.]


20th European Congress of Clinical Microbiology and Infectious Diseases Conference findings on H1N1

A variety of new findings concerning diagnostic issues and other aspects of pandemic H1N1 influenza were among the hundreds of studies presented at the 20th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), which concluded 13 April 2010 in Vienna, Austria. Here is a sampling:

Levels of C-reactive protein (CRP) in the blood, measured at admission, can provide an early indicator that patients may need intensive care. Of 191 H1N1 patients admitted to a Tel Aviv hospital, 17 were admitted to the intensive-care unit, 8 required mechanical ventilation, and 3 died. Serum CRP levels at admission were three times higher in those who later needed ICU care and ventilation than in those who did not. (Zimmerman, et al. )

Gastrointestinal illness and diarrhea separate patients with H1N1 flu from patients with seasonal flu, according to researchers at Bangkok’s Chulalongkorn Memorial Hospital. Among 167 patients with the 2009 pandemic strain seen last July and August, 16.3% had diarrhea, compared with 5.3% of the 57 patients with seasonal flu seen during the same period. The two groups experienced the same rates of all other flu symptoms: fever, cough, sore throat, aches, and breathing difficulties. (Thiansukhon, et al. )

Test results from a cohort of patients evaluated for flu in Greece established that fever cannot be considered a diagnostic sign for novel H1N1 flu, as patients with very mild disease and no fever were tested positive by polymerase chain reaction for that flu strain, while patients with more pronounced symptoms proved not to have flu. (Kalpakou, et al. )

Oseltamivir resistance, marked by the H274Y mutation, emerged in a 2-year-old flu patient in Pavia, Italy, who was already suffering from acute lymphatic leukemia. The mutation was detected after she was treated with antivirals for 17 days yet still remained positive for flu-virus RNA. The child recovered; the finding marks Italy’s first known drug-resistant strain. (Campanini, et al. )

The microblogging service Twitter.com may provide an early-warning signal for the emergence of novel syndromes, if algorithms can be worked out to filter useful information, location clustering, and social networks, according to a British analysis. Between May and August 2009, Twitter carried more than 1 million 140-character "tweets" mentioning flu, while the phrase "I have swine flu" appeared 2,888 times and "I have flu" appeared 1,530 times. (Kostkova, et al. )

Conference findings available at http://www.congrex.ch/eccmid2010/.
(CIDRAP 04/13/2010)


Law, ethics and pandemic preparedness: the importance of cross-jurisdictional and cross-cultural perspectives

Bennet B, Carney T. Australian and New Zealand Journal of Public Health. 8 April 2010;34(2):106-112. DOI: 10.1111/j.1753-6405.2010.00492.x
Available at http://www3.interscience.wiley.com/journal/123344451/abstract?CRETRY=1&SRETRY=0

Objective. To explore social equity, health planning, regulatory and ethical dilemmas in responding to a pandemic influenza (H5N1) outbreak, and the adequacy of protocols and standards such as the International Health Regulations (2005).

Approach. This paper analyses the role of legal and ethical considerations for pandemic preparedness, including an exploration of the relevance of cross-jurisdictional and cross-cultural perspectives in assessing the validity of goals for harmonisation of laws and policies both within and between nations. Australian and international experience is reviewed in various areas, including distribution of vaccines during a pandemic, the distribution of authority between national and local levels of government, and global and regional equity issues for poorer countries.

Conclusion. This paper finds that questions such as those of distributional justice (resource allocation) and regulatory frameworks raise important issues about the cultural and ethical acceptability of planning measures. Serious doubt is cast on a 'one size fits all' approach to international planning for managing a pandemic. It is concluded that a more nuanced approach than that contained in international guidelines may be required if an effective response is to be constructed internationally.

Implications. The paper commends the wisdom of reliance on 'soft law', international guidance that leaves plenty of room for each nation to construct its response in conformity with its own cultural and value requirements.


Satellite-tracking of Northern Pintal Anas acuta during outbreaks of the H5N1 virus in Japan: implications for virus spread

Yamaguchi N, Hupp JW, Higuchi H, et al. Ibis. April 2010;152(2):262-271. DOI 10.1111/j.1474-919X.2010.01010.x
Available at http://www3.interscience.wiley.com/journal/123326020/abstract

Abstract: We fitted Northern Pintail Anas acuta in Japan with satellite transmitters and monitored their spring migration movements relative to locations where the highly pathogenic H5N1 avian influenza virus was detected in Whooper Swans Cygnus cygnus in 2008. Pintails were assumed not to be infected with the H5N1 virus at the time they were marked because capture occurred between 2 and 5 months before reported outbreaks of the virus in Japan. We assessed spatial and temporal overlap between marked birds and occurrence of the virus and tracked Pintails after they departed outbreak locations. Eight of 66 (12.1%) Northern Pintails marked with satellite transmitters used wetlands in Japan where the H5N1 virus was detected in Whooper Swans. Apparent survival did not differ between Pintails that used H5N1 sites and those that did not. However, the proportion of Pintails that migrated from Japan was significantly lower among birds that used H5N1 sites compared with those that did not (0.50 vs. 0.79). Northern Pintails were present at the H5N1 sites from 1 to 88 days, with five birds present at the sites from 0 to 7 days prior to detection of the virus in Swans. The six Pintails observed to depart H5N1 sites did so within 2–77 days of the reported outbreaks and moved between 6 and 1200 km within 4 days of departure. Four Pintails migrated to eastern Russia. After their departure from outbreak sites, Northern Pintails made long-distance migrations within the period when newly infected ducks would shed the H5N1 virus. This supports a hypothesized mechanism by which a highly pathogenic avian influenza virus could be spread by migratory birds.


Prophylactic and Therapeutic Efficacy of Avian Antibodies Against Influenza Virus H5N1 and H1N1 in Mice

Nguyen HH, Tumpey TM, Park H-J, et al. PLoS ONE. April 2010;5(4):
e10152. doi:10.1371/journal.pone.0010152
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0010152

Background. Pandemic influenza poses a serious threat to global health and the world economy. While vaccines are currently under development, passive immunization could offer an alternative strategy to prevent and treat influenza virus infection. Attempts to develop monoclonal antibodies (mAbs) have been made. However, passive immunization based on mAbs may require a cocktail of mAbs with broader specificity in order to provide full protection since mAbs are generally specific for single epitopes. Chicken immunoglobulins (IgY) found in egg yolk have been used mainly for treatment of infectious diseases of the gastrointestinal tract. Because the recent epidemic of highly pathogenic avian influenza virus (HPAIV) strain H5N1 has resulted in serious economic losses to the poultry industry, many countries including Vietnam have introduced mass vaccination of poultry with H5N1 virus vaccines. We reasoned that IgY from consumable eggs available in supermarkets in Vietnam could provide protection against infections with HPAIV H5N1.

Methods and Findings. We found that H5N1-specific IgY that are prepared from eggs available in supermarkets in Vietnam by a rapid and simple water dilution method cross-protect against infections with HPAIV H5N1 and related H5N2 strains in mice. When administered intranasally before or after lethal infection, the IgY prevent the infection or significantly reduce viral replication resulting in complete recovery from the disease, respectively. We further generated H1N1 virus-specific IgY by immunization of hens with inactivated H1N1 A/PR/8/34 as a model virus for the current pandemic H1N1/09 and found that such H1N1-specific IgY protect mice from lethal influenza virus infection.

Conclusions. The findings suggest that readily available H5N1-specific IgY offer an enormous source of valuable biological material to combat a potential H5N1 pandemic. In addition, our study provides a proof-of-concept for the approach using virus-specific IgY as affordable, safe, and effective alternative for the control of influenza outbreaks, including the current H1N1 pandemic.


5. 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/.


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/.


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.


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.


4th Vaccine and ISV Annual Global Congress

Vienna, Austria 3-5 October 2010
Now in its fourth year, the annual Vaccine Congress has become the forum for the exchange of ideas to accelerate the rate at which vaccines can come to benefit the populations that need them. Organized by: Vaccine – the pre-eminent journal for those interested in vaccines and vaccination – in collaboration with the International Society for Vaccines
Deadline for abstracts/proposals: 18 June 2010
Additional information available at http://www.vaccinecongress.com


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