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EINet Alert ~ Apr 23, 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
- Bangladesh: H1N1 pandemic influenza case surge
- Cambodia (Prey Veng): First H5N1 avian influenza fatality
- Indonesia (West Sumatra): Four-year-old H5N1 avian influenza suspect
- Malaysia (Putrajaya): Nine students positive for pandemic influenza H1N1
- New Zealand: Volcanic ash halts vaccination efforts
- Viet Nam (Bac Kan): Confirmed H5N1 avian influenza cases not due to human-to-human transmission
- Chile: Reports of low vaccine uptake
- USA: CDC updates estimates of pandemic influenza H1N1
- Nigeria: Vaccine shortage threatens pandemic influenza H1N1 control
- South Africa: Reports of vaccine pinch

2. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA

3. Articles
- Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States
- Why do I need it? I am not at risk! Public perceptions towards the pandemic (H1N1) 2009 vaccine
- Low Acceptability of A/H1N1 Pandemic Vaccination in French Adult Population: Did Public Health Policy Fuel Public Dissonance?
- CIDRAP Report Summary: Reports presented at National Immunization Conference support usefulness of school-based flu vaccine
- Seasonal Synchronization of Influenza in the United States Older Adult Population
- Structural Basis of Preexisting Immunity to the 2009 H1N1 Pandemic Influenza Virus

4. Notifications
- Thailand Conference on Emerging Infectious and Neglected Diseases
- CDC 7th International Conference on Emerging Infectious Diseases
- 4th Ditan International Conference on Infectious Diseases
- 2nd International Swine Flu Conference
- 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 7 (2)
Total / 27 (10)

***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: 495 (292)
(WHO 4/21/10: http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_04_21/en/)

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 18 April 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17,853 deaths.As of 18 April 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17,853 deaths.

Currently the most active areas of transmission of pandemic influenza are in parts of West and Central Africa but transmission is also still occurring in South East Asia, and Central America. Pandemic influenza activity remains low in much of the temperate zone of both the northern and southern hemispheres. Seasonal influenza type B viruses have been increasingly detected over a larger area and are now the predominant circulating influenza viruses across East Asia, Central Africa and Northern and Eastern Europe. Very small numbers of type B viruses have also recently been detected in Central America. Seasonal influenza H3N2 is still being detected in South and Southeast Asia (mainly Indonesia), as well as sporadically in several countries of West Africa, and Eastern Europe.

In Europe, most countries reported a low intensity of respiratory diseases with only 6.8% of respiratory specimens testing positive for influenza. This week the total number of influenza B virus detections continued to exceed that of influenza A, as in recent weeks, although at low levels. Of note, some sporadic detections of seasonal H1N1 and H3N2 viruses were reported in Eastern Europe.

In East Asia, very few pandemic influenza viruses are being detected. In China, Mongolia, and Republic of Korea most influenza like illness (ILI) cases are now due primarily to influenza type B viruses. In China, overall influenza activity continues to decline and no pandemic influenza virus was detected this week. In Mongolia, influenza type B virus continues to circulate but is declining since a recent peak. An increased trend of respiratory disease activity associated with increasing circulation of influenza type B viruses has been reported in the Republic of Korea during the past few weeks. Small numbers of seasonal influenza H1N1 and H3N2 viruses continue to be sporadically reported in some countries of the region.

In South and Southeast Asia, the most active areas of transmissions of pandemic influenza are in Malaysia, Singapore, and Thailand. Although pandemic influenza virus is the predominant circulating influenza virus in the region, influenza H3N2 and influenza type B continue to co-circulate in Singapore and Thailand and Indonesia. In Singapore, rates of influenza-like illness (ILI) and acute respiratory infections (ARI) increased compared to previous week but are still below the epidemic threshold. In Indonesia, in contrast to other countries of the area, the predominant virus circulating continues to be influenza H3N2, with few detections of influenza type B and pandemic influenza viruses. In Malaysia, an increase in the number of respiratory disease consultations due to influenza-like-illness (ILI) was reported in the majority of the states compared to previous week. In Bangladesh, a small but slightly increased (compared to the previous week) numbers of pandemic influenza cases continues to be detected.

Limited available data from North Africa suggests that respiratory disease activity there remains low. In sub-Saharan Africa, available data suggests ongoing community transmission of pandemic influenza virus in West Africa. Transmission appears to have peaked in Senegal in February but Ghana continues to have active, though decreasing, transmission. Cote d`Ivoire and Niger reported increasing trends of respiratory disease activity but no virological data were available. In central Africa, low levels of pandemic influenza activity continue to be reported in Cameroon. In addition, small numbers of seasonal influenza H3N2 virus detections were reported by Angola. In eastern Africa, pandemic influenza virus continues to be detected in declining numbers in Rwanda with persistent reporting of small numbers of seasonal influenza H3N2 in Rwanda and Kenya. No increase in respiratory disease activity or detections of pandemic influenza viruses have yet been noted in Southern Africa. Influenza type B has been increasingly detected in some countries of central Africa.

In the tropical zone of the Americas, Ecuador, El Salvador and Guatemala, reported increases in respiratory diseases activity. In Guatemala, the number of respiratory disease consultations increased 80% compared to the previous week. Of note, co-circulation of other respiratory viruses, including respiratory syncytial virus (RSV), parainfluenza, and adenovirus has been detected in addition to small numbers of pandemic influenza virus. In Mexico, during early April 2010, the sentinel surveillance system reported a 38.6% decrease in the number of influenza-like-illness (ILI) and severe acute respiratory illness (SARI) cases compared to the previous week.

In the temperate zone of the southern hemisphere, Chile reported regional increases in ILI activity for the past four weeks. While the national ILI levels remain below the epidemic threshold, in Los Lagos, Tarapacá, and in some southern regions, the ILI level is above epidemic threshold. For the most recent reporting week, 6.8% of sentinel surveillance samples tested positive for respiratory viruses. Of these, 52.9% for respiratory syncytial virus (RSV), 23.5% for adenovirus, and 11.8% were positive for pandemic influenza virus. In Australia and New Zealand, there is no evidence yet of the start of winter-time community transmission of influenza viruses. Australia has had sporadic detections of pandemic H1N1 viruses and seasonal influenza type B viruses in low numbers.
(WHO 04/23/2010)

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Asia
Bangladesh: H1N1 pandemic influenza case surge
Bangladesh is reporting rapid spread of pandemic flu this month and has placed health officials across the country on alert. A health official said the virus was sustained at a lower level in Bangladesh during the January-March 2010 period, but has since shown a rising trend since the beginning of April 2010. Case numbers were not specified.
(CIDRAP 04/20/2010)

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Cambodia (Prey Veng): First H5N1 avian influenza fatality
A 27 year old man in eastern Cambodia has died of bird flu, the country's first fatality in 2010 and its eighth since the virus started to sweep through Asia almost seven years ago.

Cambodia's Health Ministry said in a statement issued jointly on 21 April 2010 with the World Health Organization that the man in Prey Veng province had died 17 April 2010. It was the country's 10th human case of the disease.

The statement says there have been 494 laboratory-confirmed cases of the disease in 15 countries since 2003, with 293 fatalities. The Cambodian man's death was the 11th worldwide in 2010.

The Health Ministry said it was investigating the case, and stepping up a campaign for preventative health measures.
(ProMED 04/20/2010)

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Indonesia (West Sumatra): Four-year-old H5N1 avian influenza suspect
A four year old girl from Lubuk Basung, Kabupaten Agam, West Sumatra has been treated for suspected bird flu (avian influenza A (H5N1) virus infection) at the Central Public Hospital (RSUP) M Djamil in Padang, West Sumatra.

The patient was transferred to the M Djamil hospital on 20 April 2010, and began treatment in the avian influenza isolation unit, said the medical treatment director of the M Djamil hospital, Dr Ira Yanti. The patient is still under observation due to high fever and shortness of breath.

The patient was reported to have contact history with a dead chicken close to her house. The dead chicken has tested positive for avian influenza A (H5N1) virus infection by a rapid test. A blood sample from the patient has been sent to the Research and Development Laboratory of Ministry of Health, and the result is expected within a week.
(ProMED 04/20/2010)

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Malaysia (Putrajaya): Nine students positive for pandemic influenza H1N1
Nine students from a religious school in Kuala Kangsar were among 12 people tested positive for Influenza A(H1N1) 19 April 2010.

The nine from SM Agama Ad-Diniah Al-Islamiah were among 21 students in the school down with influenza-like illness. Others who tested positive for the flu were two students from SJKC Sin Hwa in Batu Pahat, Johor, and a case at the immigration quarters in Padang Besar, Perlis.

Health director-general Tan Sri Dr Ismail Merican said six cluster cases of influenza-like illness, involving 43 people, had also been recorded by health authorities.
(The Star, 04/19/2010)

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New Zealand: Volcanic ash halts vaccination efforts
New Zealand's Ministry of Health has halted clinic and workplace influenza vaccinations because of supply issues related to the volcanic ash cloud over Europe. Although demand for seasonal influenza vaccine, which includes the pandemic strain, has been "unprecedented" for this time of year, the ash cloud has disrupted vaccine shipments from Paris. An immunization manager said the country has 80,000 vaccine doses in stock.
(Radio New Zealand, 04/20/2010)

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Viet Nam (Bac Kan): Confirmed H5N1 avian influenza cases not due to human-to-human transmission
The Ministry of Health has reported two new confirmed human cases of A(H5N1) avian influenza infection on 6 and 9 April 2010. These cases were confirmed at the National Institute for Hygiene and Epidemiology.

The first case is a 22 year old male from Nhu Co commune, Bac Kan province. He developed symptoms on the 28 of March 2010 and was transferred to the National Hospital of Tropical Diseases in severe condition. Confirmatory test results for influenza A (H5) were obtained on 3 April.

The initial epidemiological investigations show that there were sick/dead poultry at the patient's home and in the surrounding areas.

The second case is a 2 year old girl residing in Cho Moi district, Bac Kan province. She developed symptoms on 2 April 2010. On 4 April, she was transferred to Cho Moi District Hospital for treatment where she is in a stable condition. Confirmatory test results for influenza A (H5) were obtained on 7 April.

The initial epidemiological investigations show that there were sick/dead poultry at the patient's home and in the surrounding areas. The patient's family slaughtered the sick poultry to eat.

There is no epidemiological link between these two cases that would indicate human-to-human transmission.

Of the 119 cases confirmed to date in Viet Nam, 59 have been fatal.
(WHO 04/21/2010)

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Americas
Chile: Reports of low vaccine uptake
Health officials in Chile are concerned that only 600,000 of a hoped-for four million people have received the H1N1 vaccine in a country that saw 300,000 cases and 1,800 hospitalizations in 2009. The 27 February 2010 earthquake destroyed 5,000 hospital beds in the central region. One university faculty member explained that getting the shot early is essential to prevent overloading of hospitals, because immunity takes about 2 weeks to build.
(CIDRAP 04/19/2010)

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USA: CDC updates estimates of pandemic influenza H1N1
The US Centers for Disease Control and Prevention (CDC) yesterday updated its estimates for the number of pandemic H1N1 illnesses, hospitalizations, and deaths, adding another month of data and bumping up the totals slightly.

From April 2009 to 13March 2010, the CDC estimates about 60 million people were infected with the pandemic H1N1 virus, about 270,000 were hospitalized, and about 12,270 died.

The totals reflect small increases in disease burden that are in line with very low levels of flu activity across most parts of the nation for the past several weeks. The new estimates add 1 million more infections, 5,000 more hospitalizations, and 270 more fatalities to the total since the agency's 12 March 2010 update.

Continuing a pattern seen throughout the pandemic, the CDC's numbers show that the flu is exacting the greatest toll on younger age groups. It estimated 19 million cases occurred in children though age 17, representing about 25.7 % of this age-group, leading to 86,000 hospitalizations and 1,270 deaths. For adults ages 18 through 64 the estimate is 35 million cases, representing about 18.5% of this population, with 158,000 hospitalizations and 9,420 deaths.

The new estimates for people ages 65 or older—who are thought to have some protection because of past flu exposures—rose to 6 million cases, about 15.8% of the population, with hospitalizations rising to 26,000 and deaths to 1,580. In the CDC's last estimate, the percentage of older people infected with the virus was put at 13%.

All the numbers represent the midpoints of ranges of estimates the CDC produced with a new estimation method that it unveiled in November 2010. Estimating the true burden is difficult, because many people who have the flu don't seek care, and only a few who see their doctors are tested for the virus. The CDC has said the number of confirmed cases greatly undercounts the true number of infections.
(CIDRAP 04/20/2010)

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Africa
Nigeria: Vaccine shortage threatens pandemic influenza H1N1 control
Despite the recent outbreak of the pandemic H1N1 virus in Ghana, Nigeria has yet to receive stocks of vaccine to prepare for a possible outbreak in the country.

Meanwhile, two Nigerians have so far died of the virus and 11 cases have been confirmed by the Federal Ministry of Health (FMOH). A nine-year-old American girl was the first case of HINI in Nigeria, which was reported in November 2009.
(Nigerian Guardian News, 04/20/2010)

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South Africa: Reports of vaccine pinch
Just weeks before it hosts the World Cup, South Africa is reporting a shortage of H1N1 vaccine. Doctors and pharmacies have run out of the vaccine, imported from Australia, and say no more is available. The country received 1.3 million doses, which are being used for "front line" port-of-entry workers and certain HIV patients. A further 3.5 million doses donated by the World Health Organization (WHO) will be used on pregnant women and others at high risk.
(CIDRAP 04/19/2010)

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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
Address by Health and Human Services Secretary Kathleen Sibelius Speech at 44th National Immunization Conference, Atlanta, Georgia, USA:
http://www.hhs.gov/secretary/speeches/sp20100419.html]

- 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
Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States
Siston Am, Rasmussen SA, Honein MA, et al. JAMA. 2010;303(15):1517-1525.
Available at http://jama.ama-assn.org/cgi/content/short/303/15/1517

Context. Early data on pandemic 2009 influenza A(H1N1) suggest pregnant women are at increased risk of hospitalization and death.

Objective. To describe the severity of 2009 influenza A(H1N1) illness and the association with early antiviral treatment among pregnant women in the United States.

Design, Setting, and Patients. Surveillance of 2009 influenza A(H1N1) in pregnant women reported to the Centers for Disease Control and Prevention (CDC) with symptom onset from April through December 2009.

Main Outcome Measures. Severity of illness (hospitalizations, intensive care unit [ICU] admissions, and deaths) due to 2009 influenza A(H1N1) among pregnant women, stratified by timing of antiviral treatment and pregnancy trimester at symptom onset.

Results. We received reports on 788 pregnant women in the United States with 2009 influenza A(H1N1) with symptom onset from April through August 2009. Among those, 30 died (5% of all reported 2009 influenza A[H1N1] influenza deaths in this period). Among 509 hospitalized women, 115 (22.6%) were admitted to an ICU. Pregnant women with treatment more than 4 days after symptom onset were more likely to be admitted to an ICU (56.9% vs 9.4%; relative risk [RR], 6.0; 95% confidence interval [CI], 3.5-10.6) than those treated within 2 days after symptom onset. Only 1 death occurred in a patient who received treatment within 2 days of symptom onset. Updating these data with the CDC's continued surveillance of ICU admissions and deaths among pregnant women with symptom onset through December 31, 2009, identified an additional 165 women for a total of 280 women who were admitted to ICUs, 56 of whom died. Among the deaths, 4 occurred in the first trimester (7.1%), 15 in the second (26.8%), and 36 in the third (64.3%)

Conclusions. Pregnant women had a disproportionately high risk of mortality due to 2009 influenza A(H1N1). Among pregnant women with 2009 influenza A(H1N1) influenza reported to the CDC, early antiviral treatment appeared to be associated with fewer admissions to an ICU and fewer deaths.

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Why do I need it? I am not at risk! Public perceptions towards the pandemic (H1N1) 2009 vaccine
Seale H, Heywood AE, McLaws M-L, et al. BMC Infectious Diseases. 19 April 2010;10:99. doi:10.1186/1471-2334-10-99
Available at http://www.biomedcentral.com/1471-2334/10/99/abstract

(Provisional Abstract) Background. On the 30th September 2009, the pandemic (H1N1) 2009 influenza vaccine was made available to adults and children aged 10 years and over, in Australia. Acceptance of a novel vaccine is influenced by perceptions of risk including risk of infection, risk of death or severe illness and risk of serious vaccine side-effects. We surveyed a sample of residents from Sydney, Australia to ascertain their risk perception, attitudes towards the pandemic and willingness to accept the pandemic (H1N1) 2009 influenza vaccine.

Methods. We sampled residents using a cross-sectional intercept design during the WHO Phase 6. Members of the public were approached in shopping and pedestrian malls to undertake the survey during September and October 2009. The survey measured perceived risk, seriousness of disease, recent behavioural changes, likely acceptance of the pandemic (H1N1) 2009 vaccine and issues relating to uptake and perceived safety.

Results. Of the 627 respondents, the majority felt that they had a "very low to low" (332/627, 52.9%) risk of acquiring H1N1. 24.5% (154/627) of respondents believed that the disease would "very seriously or extremely" affect their health. Nearly half (305/627, 48.6%) reported that in response to the "swine flu" outbreak they had undertaken one or more of the investigated behavioural changes. Overall, the self-reported likelihood of accepting vaccination against novel H1N1 was 54.7% (343/627).

Conclusions. While, most participants did not believe they were at high risk of acquiring pandemic H1N1 2009, over half of the sample indicated that they would accept the vaccine. Participants who were vaccinated against the seasonal influenza were more likely to receive the H1N1 vaccine. Concerns about safety, the possibility of side effects and the vaccine development process need to be addressed.

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Low Acceptability of A/H1N1 Pandemic Vaccination in French Adult Population: Did Public Health Policy Fuel Public Dissonance?
Schwarzinger M, Flicoteaux R, Cortarenoda S, et al. PLoS One. 2010;5(4): e10199.
doi:10.1371/journal.pone.0010199
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0010199

Background. In July 2009, French public health authorities embarked in a mass vaccination campaign against A/H1N1 2009 pandemic-influenza. We explored the attitudes and behaviors of the general population toward pandemic vaccination.

Methodology/Principal Findings. We conducted a cross-sectional online survey among 2,253 French representative adults aged 18 to 64 from November 17 to 25, 2009 (completion rate: 93.8%). The main outcome was the acceptability of A/H1N1 vaccination as defined by previous receipt or intention to get vaccinated (“Yes, certainly”, “Yes, probably”). Overall 17.0% (CI 95%, 15.5% to 18.7%) of respondents accepted A/H1N1 vaccination. Independent factors associated with acceptability included: male sex (p = .0001); older age (p = .002); highest or lowest level of education (p = .016); non-clerical occupation (p = .011); having only one child (p = .008); and having received seasonal flu vaccination in prior 3 years (p<.0001). Acceptability was also significantly higher among pregnant women (37.9%) and other at risk groups with chronic diseases (34.8%) (p = .002). Only 35.5% of respondents perceived A/H1N1 influenza illness as a severe disease and 12.7% had experienced A/H1N1 cases in their close relationships with higher acceptability (p<.0001 and p = .006, respectively). In comparison to 26.0% respondents who did not consult their primary care physician, acceptability was significantly higher among 8.0% respondents who were formally advised to get vaccinated, and lower among 63.7% respondents who were not advised to get vaccinated (respectively: 15.8%, 59.5% and 11.7%- p<.0001). Among respondents who refused vaccination, 71.2% expressed concerns about vaccine safety.

Conclusions/Significance. Our survey occurred one week before the peak of the pandemic in France. We found that alarming public health messages aiming at increasing the perception of risk severity were counteracted by daily personal experience which did not confirm the threat, while vaccine safety was a major issue. This dissonance may have been amplified by having not involved primary care physicians in the mass vaccination campaign.

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CIDRAP Report Summary: Reports presented at National Immunization Conference support usefulness of school-based flu vaccine
Some reports released during the National Immunization Conference the week of 19 April 2010 support the idea that school-based influenza vaccination programs are a workable way to get flu doses into the arms and noses of more school children faster.

More than 120,000 New York City children received pandemic H1N1 flu vaccine doses at school in the fall of 2009, and school-based immunization against H1N1 was practiced widely in Massachusetts as well, according to abstracts of studies being presented at the Atlanta conference.
(for complete report summary, please access
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/apri1910school.html)

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Seasonal Synchronization of Influenza in the United States Older Adult Population
Wenger JB, Naumova EN. PLoS One. April 2010;5(4) e10187.
doi:10.1371/journal.pone.0010187
Available at http://www.plosone.org/article/info:doi/10.1371/journal.pone.0010187

Background.In temperate regions, influenza epidemics occur annually with the highest activity occurring during the winter months. While seasonal dynamics of the influenza virus, such as time of onset and circulating strains, are well documented by the Centers for Disease Control and Prevention Influenza Surveillance System, an accurate prediction of timing, magnitude, and composition of circulating strains of seasonal influenza remains elusive. To facilitate public health preparedness for seasonal influenza and to obtain better insights into the spatiotemporal behavior of emerging strains, it is important to develop measurable characteristics of seasonal oscillation and to quantify the relationships between those parameters on a spatial scale. The objectives of our research were to examine the seasonality of influenza on a national and state level as well as the relationship between peak timing and intensity of influenza in the United States older adult population.

Methodology/Principal Findings. A total of 248,889 hospitalization records were extracted from the Centers for Medicare and Medicaid Services for the influenza seasons 1991–2004. Harmonic regression models were used to quantify the peak timing and absolute intensity for each of the 48 contiguous states and Washington, DC. We found that individual influenza seasons showed spatial synchrony with consistent late or early timing occurring across all 48 states during each influenza season in comparison to the overall average. On a national level, seasons that had an earlier peak also had higher rates of influenza (rs = −0.5). We demonstrated a spatial trend in peak timing of influenza; western states such as Nevada, Utah, and California peaked earlier and New England States such as Rhode Island, Maine, and New Hampshire peaked later.

Conclusions/Significance.Our findings suggest that a systematic description of influenza seasonal patterns is a valuable tool for disease surveillance and can facilitate strategies for prevention of severe disease in the vulnerable, older adult population.

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Structural Basis of Preexisting Immunity to the 2009 H1N1 Pandemic Influenza Virus
Xu R, Ekiert DC, Krause JC, et al. Science. 16 April 2010;328:5976, 357-360. DOI: 10.1126/science.1186430
Available at http://www.sciencemag.org/cgi/content/abstract/328/5976/357

Abstract. The 2009 H1N1 swine flu is the first influenza pandemic in decades. The crystal structure of the hemagglutinin from the A/California/04/2009 H1N1 virus shows that its antigenic structure, particularly within the Sa antigenic site, is extremely similar to those of human H1N1 viruses circulating early in the 20th century. The cocrystal structure of the 1918 hemagglutinin with 2D1, an antibody from a survivor of the 1918 Spanish flu that neutralizes both 1918 and 2009 H1N1 viruses, reveals an epitope that is conserved in both pandemic viruses. Thus, antigenic similarity between the 2009 and 1918-like viruses provides an explanation for the age-related immunity to the current influenza pandemic.

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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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4th Ditan International Conference on Infectious Diseases
Beijing, China 15-18 July 2010
Ditan International Conference on Infectious Diseases is the annual conference held in Beijing to provide a platform for scientific exchange between Chinese and international experts.
“Focus on China, Impact on the World!”
Additional information is available at http://www.bjditan.org/.

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2nd International Swine Flu Conference

Washington DC, USA 18-19 August 2010
The continuous occurrence of deadly human-to-human transmissions of H1N1 virus worldwide is the reason for the 2nd International Swine Flu Conference.

The 2nd ISFC builds on the success of the 1st ISFC held in August 2009 and attended by over 500 distinguished scientists, public health officials, law enforcers, first responders, and key decision-makers of major health companies from the United States, Europe, Asia, and the Middle East.

Participation in the 2nd ISFC will allow you to know the latest and crucial pandemic prevention, preparedness, response, and recovery strategies designed by international bodies to end the human-to-human transmission of H1N1.
Additional information is available at http://www.new-fields.com/2ndISFC/

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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
Question & Answer: 2009 H1N1 and Pregnancy
Released 21 April 2010
Available at http://www.cdc.gov/H1N1flu/in_the_news/pregnancy_qa.htm

CDC estimates of 2009 H1N1 related cases, hospitalizations and deaths in the United States from April 2009-March 13, 2010
Released 16 April 2010
Available at http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm

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