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Vol. XIII No. 9 ~ EINet News Briefs ~ Apr 30, 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
- Global: WHO situation update on pandemic influenza H1N1
- 2010 Cumulative number of human cases of avian influenza A/H5N1
- Australia: Suspected adverse reactions to influenza vaccine
- China (Macao): Pandemic influenza H1N1 at local school
- Malaysia (Bentong): Eight confirmed cases of pandemic influenza H1N1
- Malaysia (Johor Baru): Six new pandemic influenza H1N1 clusters identified
- New Zealand: Children convulsing after influenza vaccination
- Southeast Asia: Meeting report—SE Asia aims to eradicate avian influenza H5N1 by 2020
- Philippines: Vaccine campaign launched
- Cuba: Rise in pandemic influenza H1N1 infections
- USA: HHS vaccine advisors to probe GBS-vaccine findings

2. Infectious Disease News
- China (Beijing): Hand-foot-mouth fatality
- China (Qinghai province): Fight against plague outbreak escalated
- Philippines (Santiago City): Two measles outbreaks contained
- Russia (Kursk Oblast): Hemorrhagic fever case
- Russia (Moscow): Hepatitis incidence on the rise
- Canada (British Columbia): Measles update
- Chile (Los Rios): Fatal case of hantavirus
- Peru: Bubonic plague a concern
- USA (Oregon): Cryptococcus gatii outbreak
- Chile: Health officials concerned about hantavirus

3. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA
- VECTOR-BORNE DISEASE
- CHOLERA, DIARRHEA, and DYSENTARY

4. Articles
- Emergence and Pathogenicity of Highly Virulent Cryptococcus gattii Genotypes in the Northwest United States
- H1N1 Vaccinations, Fall 2009: Model School-Located Vaccination Clinics
- Healthcare Worker Knowledge and Attitudes Regarding Influenza Immunization and Childhood Vaccination
- Influenza A viral loads in respiratory samples collected from patients infected with pandemic H1N1, seasonal H1N1 and H3N2 viruses
- Mild form of 2009 H1N1 influenza infection detected by active surveillance: Implications for infection control
- A rapid method for assessing social versus independent interest in health issues: A case study of ‘bird flu’ and ‘swine flu’
- Novel H1N1 Influenza (Swine Flu)
- Recipients of Vaccine against the 1976 "Swine Flu" Have Enhanced Neutralization Responses to the 2009 Novel H1N1 Influenza Virus
- Guest Editorial: The 1918-1919 Influenza Pandemic in the United States: Lessons Learned and Challenges Exposed
- Influenza: The Once and Future Pandemic
- Transmissibility and geographic spread of the 1889 influenza pandemic: Research findings from nonpharmaceutical intervention studies for pandemic influenza and current gaps in the research

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
- 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
- 4th Vaccine and ISV Annual Global Congress

6. To Receive EINet Newsbriefs
- ***Suscribe to EINet


1. Influenza News

Global
Global: WHO situation update on pandemic influenza H1N1
As of 25th of April, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17,919 deaths.

The current situation is largely unchanged since the last update. The most active areas of transmission of pandemic influenza H1N1 virus continue to be parts of West and Central Africa with some focal areas of activity in South and Southeast Asia. Pandemic influenza activity H1N1 remains low in much of the temperate areas of both the northern and southern hemispheres. Seasonal influenza type B virus is the predominant influenza virus, though also at low levels of circulation, across East Asia, Northern and Eastern Europe. Influenza type B viruses have also been detected in Central Africa and this week in West Africa. Seasonal influenza H3N2 viruses have continued to be detected in South and Southeast Asia, as well as sporadically in some countries of West and Central Africa, and Eastern Europe.

In Sub-Saharan Africa, data from a limited number of countries suggests that active transmission of pandemic influenza H1N1 virus is declining across West and West-central Africa. Ghana is reporting moderate amounts of pandemic virus (16 % of all clinical specimens tested were positive for pandemic influenza) but smaller numbers of cases continue to be detected in Senegal, Niger and Cameroon. In East Africa, influenza activity has returned to low levels. Only Rwanda has detected small numbers of pandemic virus in the past week. In addition, a few seasonal influenza H3N2 viruses are seen in Ghana. Influenza type B has been increasingly detected in the area, notably in Ghana and Cameroon.

In East Asia, pandemic influenza H1N1 virus circulation is now sporadic. In China, Mongolia, and Republic of Korea most influenza like illness cases continued to be primarily due to seasonal influenza type B viruses. In China and Mongolia influenza detections have continued to decline compared to previous recent weeks. The Republic of Korea reported increasing levels of respiratory disease activity associated with increasing detections of seasonal influenza type B in respiratory specimens over five consecutive weeks. Of note, small numbers of pandemic influenza H1N1, seasonal H3N2 and H1N1 viruses continued to be sporadically detected in some countries of the region.

In Southeast Asia, overall levels of influenza activity were low. Although the predominant influenza virus circulating was still pandemic influenza H1N1, there was co-circulation of seasonal influenza type B and, to a lesser extent, H3N2 viruses in several countries including Singapore, Cambodia, Indonesia and Thailand. Malaysia has reported increasing levels of respiratory diseases activity associated with pandemic influenza H1N1 laboratory confirmed cases. Media sources have also reported school closures in the country. In Singapore, influenza-like-illness levels are still below the seasonal epidemic threshold but have increased compared to previous week.

In South Asia, Bangladesh reported an increase in respiratory diseases activity associated with increasing numbers of pandemic influenza H1N1 laboratory confirmed cases since beginning of April. India reported pandemic influenza activity in the states of Maharashtra and recently Karnataka. Levels of respiratory diseases activity in both of these countries appear much less intense than in the initial wave of transmission which occurred late 2009. Although pandemic influenza is the predominant virus circulating in the region, seasonal influenza type B viruses continued to be detected in Iran and Bangladesh.

In the tropical zone of the Americas, limited data suggested that pandemic influenza H1N1 activity remains low but with a few localized areas of transmission. Jamaica, Panama and Guatemala, reported increasing trends in respiratory disease activity. In Cuba, all provinces reported an increase in numbers of acute respiratory diseases cases in the last two weeks, mainly from the city of Havana. In Peru, the number of pneumonia cases in children under 5 years of age in Lima has been increasing since six consecutive weeks and remained above the epidemic threshold. However, the extent to which these pneumonia cases have been due to pandemic influenza H1N1 virus is not known. Notably, respiratory syncitial virus (RSV) has been reported to be circulating in the area.

In the temperate zone of the Northern Hemisphere, overall pandemic influenza H1N1 activity remained low. In United States, the proportion of outpatient visits for influenza-like illness was below the national baseline. No influenza B is reported by countries of North America. In Europe, pandemic influenza activity is at very low intensity in all countries. The overall proportion of sentinel respiratory samples testing positive for influenza remained stable at about 4.5%. For the current week, the total number of sentinel influenza B detections continued to exceed that of influenza A, mainly due to viral detections from Eastern Europe: Central, Siberian, Far Eastern regions of the Russian Federation and Kazakhstan.

In the temperate countries of the Southern Hemisphere, influenza-like illness activity remained low and at the levels experienced at the same time in previous years. Australia has continued to report sporadic detections of pandemic influenza H1N1, seasonal influenza B and H3N2 viruses in low numbers in recent weeks.

The cumulative total for reports of antiviral resistant isolates of pandemic (H1N1) 2009 virus remains at 285. There have been no new cases reported since the situation update on 16 April 2010.

For the reporting week of 15-28 April 2010, no additional cases of oseltamivir resistant pandemic influenza A (H1N1) 2009 viruses have been reported. The cumulative total remains at 285 so far. All but one of these have the H275Y substitution and are assumed to remain sensitive to zanamivir.
(WHO 04/30/2010)

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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 4/21/201)
http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_04_21/en/index.html

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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Asia
Australia: Suspected adverse reactions to influenza vaccine
In the latest developments surrounding suspected adverse reactions to the seasonal flu vaccine in Australian children, an autopsy revealed no clear link to immunization in the death of a two-year-old, and vaccine maker CSL said it has found no evidence of a bad batch connected to cases reported so far.

The adverse events that the country's health officials are investigating involve CSL's seasonal flu vaccine, which covers the pandemic H1N1 virus. So far most of the reports are concentrated in West Australia state, which unlike other states offers free seasonal flu vaccine for children under age five.

West Australian officials have received 250 reports of possible adverse reactions. Queensland has also received some adverse-event reports and is investigating the death of a two-year-old Brisbane girl who died about 12 hours after receiving the vaccine.

The events prompted Australian health officials on 23 April 2010 to ask health providers to stop giving children under age five the vaccine while it investigated fever and convulsions in some children who had received it. At the same time CSL said it stopped shipping the pediatric version of its Fluvax vaccine while it and health authorities investigate the events.

Dr Jeanette Young, Queensland's chief medical officer, said today that the initial autopsy on the Brisbane child revealed no evidence that her death was linked to the seasonal flu shot, but further tests are needed.

Meanwhile, CSL, which makes flu vaccine for Australia but is not the country's sole provider, said 27 April 2010 that a check of vaccine batch numbers on the adverse-event reports does not indicate that a single batch is responsible for the suspected reactions. CSL stated that it was continuing to work with regulators and West Australian health officials to investigate the adverse-reaction reports.

On 27 April 2010 South Australia's chief medical officer, Dr. Paddy Phillips, said that despite the seasonal flu vaccine ban in children younger than five, they can still receive the monovalent pandemic H1N1 vaccine, which has not been linked to increased adverse-event reports.

The adverse event reports have sparked a round of speculation among Australia infectious disease experts. Dr. Peter Collignon of Australian National University said children's exposure to the pandemic flu virus last summer might be predisposing them to an aggressive response to a vaccine that contains the strain.

However, Dr. Terry Nolan, who was part of a research team that explored children's reactions to the pandemic flu vaccine, countered that Collignon's explanation seemed unlikely, because adverse reactions weren't seen in children who received the second of two recommended pandemic H1N1 vaccine doses last season.

Australia is currently in the midst of its seasonal flu vaccine campaign in advance of the winter flu season, which typically begins in May. Australia has had one wave of pandemic flu, which occurred during its normal flu season last year. Health officials fear Australia and other countries might experience a second pandemic flu wave, especially since the pandemic virus has become the dominant H1N1 strain across the globe.

Last September the WHO recommended that the Southern Hemisphere's seasonal flu vaccine cover the pandemic H1N1, a Perth-like strain of influenza A/H3N2, and a Brisbane-like influenza B strain. In February the WHO recommended similar strains for the Northern Hemisphere's next flu season.
(CIDRAP 04/27/2010)

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China (Macao): Pandemic influenza H1N1 at local school
The Health Bureau of Macao 26 April 2010 said that it has recorded 12 cases of flu infection at a local school. The patients were all seven-year-old students at the same class of a local school and all of them have received medical treatments at a local hospital, according to the Bureau. The school has been ordered by the Bureau to implement flu control measures.

Aside from flu cases, some 22 people were inoculated with the A/ H1N1 flu vaccines on 26 April 2010 alone, which was initiated by the Bureau in late November last year, and a total of 115,887 people have been inoculated so far. The SAR government previously announced that it has purchased some 700,000 doses of A/H1N1 vaccine.
(Xinhua, 04/27/2010)

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Malaysia (Bentong): Eight confirmed cases of pandemic influenza H1N1
Eight students from Maktab Rendah Sains Mara (MRSM) Bentong were confirmed as Influenza A (H1N1) positive said Health Minister Datuk Seri Liow Tiong Lai.

Liow said the eight were among 35 students from the college who were classified as a cluster case of Influenza Like Illness (ILI) since April 23.

"On April 23, six girls from MRSM Bentong were initially identified as ILI cluster case but the number increased to 16 on the same day. As of today, 35 were classified and kept in an isolated room in the school for treatment.

Liow said samples taken from the eight students, tested positive for H1N1, and 15 others received anti-viral treatment while the rest were given symptomatic treatment.
(Bernama, 04/27/2010)

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Malaysia (Johor Baru): Six new pandemic influenza H1N1 clusters identified
Six new influenza A(H1N1) clusters have been identified in the state; four clusters have been found at various schools in Kluang, Batu Pahat and Johor Baru, said state Women, Family, Health and Community Development Committee chairman Dr. Robia Kosai.

One cluster was found at a kindergarten and a residential area in Batu Pahat, she added. She said that rumors about people being admitted in the intensive care unit for influenza were false.

Dr Robia said the state had recorded 168 confirmed A(H1N1) cases. Only one death was recorded and the bulk of cases were detected in Batu Pahat (71 cases) and Johor Baru (48 cases.
(The Star, 04/24/2010)

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New Zealand: Children convulsing after influenza vaccination
New Zealand children have suffered convulsions from a flu vaccination following reports of similar reactions in Australia.

The week of 19 Apr 2010, the NZ Ministry of Health advised doctors against using Fluvax on children. On 28 Apr 2010, New Zealand's Health Ministry chief adviser for child and youth health Pat Tuohy told politicians that five children had been reported to have suffered febrile convulsions in New Zealand since 23 Apr 2010.

Australia's chief medical officer had already suspended seasonal flu vaccinations for children under five following concerns stemming from a significant rise in the number of Australian children developing a fever after receiving the vaccine. A two-year-old child was found dead in her cot on 9 Apr 2010, one day after she and her twin sister were given the seasonal flu vaccination by a private Brisbane GP. The case continues to be investigated.

As of 6 pm on 27 Apr 2010, Queensland Health had received 95 notifications of Queenslanders who'd had adverse reactions after receiving the seasonal flu vaccine. Of those 95 cases, 41 related to children aged five and under. And in Western Australia, flu shots have caused adverse reactions in 251 children under five.

The NZ Health Ministry was in regular contact with its Australian counterpart and a teleconference was scheduled to try and garner more information, he said. On present advice there was no reason for children, especially those at high risk, to stop receiving other types of flu vaccines, Dr. Tuohy said. Children at a high risk were considered to be those who had an underlying chronic condition, such as asthma or diabetes, or those at risk for other reasons including those from low socio-economic families.

While there had been more reports of severe reactions, including the five febrile convulsions, there were also more children receiving the vaccine and people were more likely to report reactions due to the media attention.

Australia, New Zealand, and Singapore were the only countries to use the Fluvax vaccine so far in 2010. Most northern hemisphere countries begin flu vaccines in the lead up to winter. Over 260,000 Fluvax doses were administered in March 2010, and the ministry said supplies were now likely to be low. More supplies of an alternative vaccine -- Vaxigrip -- were expected from Europe the week of 26 Apr 2010.
(ProMED 04/28/2010)

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Southeast Asia: Meeting report—SE Asia aims to eradicate avian influenza H5N1 by 2020
A multi-national meeting aimed at freeing Southeast Asia from H5N1 avian flu within 10 years wrapped up deliberations yesterday with a call for cooperation to keep animal diseases from crossing national borders.

The First Technical Working Group Meeting on Highly Pathogenic Avian Influenza (HPAI) Roadmap, a project of the Association of Southeast Asian Nations (ASEAN), met for two days in Jakarta to work out mutually agreed plans—the "roadmap"—that will be submitted to the 10 member countries later this year.

In the meeting's opening remarks 26 April 2010, H.E. S. Pushpanathan, ASEAN's deputy secretary-general, recalled the deep damage done to the Southeast Asian economy by the first sustained outbreak of H5N1 starting in 2003, in which 200 million poultry were culled and nations recorded a collective $10 billion in losses.

The draft produced by the end of the meeting points the member countries toward establishing a single regional economic market in livestock and animal products by 2015 and eradicating H5N1 from the region by 2020. It pays particular attention to instituting a "One World, One Health" approach (a concept backed by 38 national and international health organizations) of treating animal and human diseases as a continuum that requires consistent policy responses across government and development agencies.

The move to strengthen Southeast Asian responses to avian flu comes at a time when H5N1, which had slipped behind novel H1N1 in activity and in public health attention, appears to be rising again in both realms.

Vietnam's Department of Animal Health reported yesterday that the country's central province of Quang Tri has recorded an outbreak that killed 250 ducks out of 1,500 on one farm. Three other provinces have had recent outbreaks, including Quang Ngai (three provinces to the south of Quang Tri), and Bac Kan and coastal Quang Ninh in northern Vietnam.

Bangladesh announced plans to upgrade 19 live-bird markets in Dhaka (the capital) and 11 other cities, using a $575,000 grant from the UN Food and Agriculture Organization (FAO) that funds worker training and sanitation improvements. Five other markets in the capital have already been upgraded.

The need in Bangladesh is critical: According to the World Organization for Animal Health (OIE), there have been 12 new farm and village outbreaks in Bangladesh since the beginning of March.

And in Indonesia, the Metro Riau news site in Riau province on Sumatra is reporting illness among chickens, believed to be flu, that may have spread to children in a family.
(CIDRAP 04/28/2010)

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Philippines: Vaccine campaign launched
The Philippines launched its pandemic vaccine campaign today, with the top priority of immunizing about 420,000 of the country's healthcare workers. The next priority is 2.5 million pregnant women, health officials said, adding that the disease threat remains, especially in advance of the country's rainy season in July. So far the country has seen no recent evidence of community transmission.
(CIDRAP 04/26/2010)

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Americas
Cuba: Rise in pandemic influenza H1N1 infections
Cuba's number of pandemic H1N1 infections continues to grow for the fifth week in a row, with 93 new cases reported to the country's national flu lab. The rising infections prompted a warning from national health authorities for the public to follow hygiene measures and seek medical care at the first sign of flu-like symptoms. Cuba recently launched its pandemic vaccination campaign, and health workers have so far immunized 981,130 people from high-risk groups.
(CIDRAP 04/24/2010)

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USA: HHS vaccine advisors to probe GBS-vaccine findings
The vaccine advisory group of the US Department of Health and Human Services voted unanimously to explore recent findings that may suggest a Guillain-Barré syndrome link to the pandemic vaccine. A member of the National Vaccine Advisory Committee said the possible link would likely disappear with further analysis and that no other safety monitoring systems detected such a link. The initial GBS findings were presented at a neurology meeting in mid April.
(CIDRAP 04/24/2010)

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2. Infectious Disease News

Asia
China (Beijing): Hand-foot-mouth fatality
Beijing health authorities are telling the public not to panic following the capital's first death caused by hand-foot-mouth disease (HFMD) in 2010. An infant was the first fatality in Beijing this year.

The Beijing Municipal Bureau of Health said 582 HFMD cases were reported the week of 5 Apr 2010, a 36.62 percent increase from the week of 29 Mar 2010. The Ministry of Health added that 94 people had died nationwide of the disease, as of 11 Apr 2010.

The bureau also pointed out that looking at the overall picture was important. There were 2,250 reported cases in 2010 in Beijing by 13 Apr 2010, a drop of 15.54 percent from the same period in 2009.

My Yanming, deputy director of the bureau, said HFMD is now approaching its peak infection rate. It is predicted to fall between May and July. The health bureau launched a "2010 Beijing HFMD monitoring program" on 13 Apr 2010 to tighten prevention against the disease. Primary schools and kindergartens in Beijing are being asked to be on the alert. The monitoring program states that if a serious case or one that results in death appears in any class, or two cases occur within one week in a single class, the school should suspend classes for at least 10 days. "Morning check-ups", which refer to a temperature test on children as they enter school, have also been implemented by most kindergartens and primary schools, Ma said. Sterilization of toys, classrooms, and tableware are being emphasized in kindergartens.
(ProMED 04/16/2010)

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China (Qinghai province): Fight against plague outbreak escalated
The Ministry of Health has called for increased measures to be taken in the earthquake zone in Northwest China's Qinghai province to prevent an outbreak of marmot plague after Himalayan marmots were detected in the area.

The marmots were found in the Horse Racing Ground, a temporary settlement for quake survivors in Gyegu township of the Yushu Tibetan autonomous prefecture in Qinghai, the ministry said. So far no outbreak of major epidemics, including the plague, has been reported, but epidemiological experts said the challenges in averting and controlling an outbreak of marmot plague in the quake-hit area were considerable.

The marmots, a type of ground squirrel indigenous to the region, have woken from hibernation, increasing the possibility of an outbreak of the fatal disease among quake survivors, the ministry said on Monday.

The plague is particularly virulent because it can be passed to other people via coughing. If left untreated, mortality rates range from 50 to 90 percent, according to the World Health Organization.

The ministry has been closely monitoring marmots' activities in a 600-hectare area in the quake zone, which has a record of plague outbreaks.

In the past five decades, Yushu has seen 20 outbreaks of human-to-human transmission of plague, the latest in 2004 claiming six lives, according to Yu Dongzheng, a researcher specializing in epidemic prevention with the Chinese Center for Disease Control and Prevention (China CDC).

To help raise public awareness, China CDC has so far delivered 80,000 bilingual disease prevention brochures in Chinese and Tibetan, and 10,000 plague prevention leaflets to the quake zone, with more on the way.

More than 3,000 people, including medical experts and monks, were trained on how to control and prevent marmot plague.
(China Daily 04/27/2010)

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Philippines (Santiago City): Two measles outbreaks contained
The Cagayan Valley Department of Health has reported that the reported measles outbreak in Santiago City, has been contained through mass vaccination conducted by the city health officials.

Floro Orata, Health Education Promotions officer of DOH-CHD [Department of Health-Center for Health Development] confirmed that at least seven cases of measles were reported to be positive from January to March 2010.
(ProMED 04/24/2010)

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Russia (Kursk Oblast): Hemorrhagic fever case
A case of hemorrhagic fever with renal syndrome (HFRS) has been recorded recently in the Kursk Oblast. The first case of HFRS in the oblast was registered in 1997, and the five year cumulative incidence in Kursk was 39. The press service of Rospotrebnadzor [the Russian Federal Agency for Protection of Customer Rights and Human Welfare] has stated that stable reservoirs of HFRS are present in several regions of the oblast. This has been confirmed by serological surveys of rodent populations and the regular occurrence of human cases in these territories.
(ProMED 04/28/2010)

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Russia (Moscow): Hepatitis incidence on the rise
The incidence of hepatitis A virus infection and acute intestinal infections has increased markedly in Moscow. According to the medical authorities, there have been more than 930 cases in the first 3 months of 2010. This is two-fold greater than for the same period in 2009. The overall incidence of acute intestinal infections has increased by almost 50 percent.

The regional Rospotrebnadzor [the Russian equivalent of a Public Health Service] has attributed this situation to poor quality tap-water. This is also cited by the WHO as the most frequent source of hepatitis A virus infection and other intestinal infections.

According to Gennady Onishchenko [Russian Chief Public Health Inspector], transmission by water is related to the poor state of maintenance of the public water supply and violation of regulations for the domestic use water supply. Such a situation has been prevalent for some time elsewhere in Russia, in the Khabarovsk Krai, the Republic of Dagestan, and the Ryazan Oblast.
(ProMED 04/29/2010)

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Americas
Canada (British Columbia): Measles update
A total of 54 cases of measles have been reported in BC since the second week of March 2010. This is the highest number reported since the year 2000 when 42 cases were reported. From 2002 through 2009, fewer than five cases were reported each year.

Cases have occurred in all regions of BC, with the majority in Vancouver Coastal and Fraser health regions, the southern parts of which are known as 'the lower mainland'. They range in age from five months to 64 years with a mean of 22 years. Several are linked to recognized clusters including one large household based cluster with connections to several communities outside of the lower mainland area. Four cases have become infected in hospital emergency rooms including one health care worker. 17 cases (31%) have had unknown vaccination history, 19 (35%) are unimmunized, 8 (15%) likely had one dose of MMR, 2 (4%) had documentation of one dose of MMR and 4 (7%) were two-dose recipients.

The outbreak is thought to have started after importation of measles to Vancouver in two separate events in late February through early March. Two distinct measles virus genotypes have been identified from early Vancouver based cases. One had onset on 9 March 2010 with genotype H1 identified and the other with onset on 17 March had a D8 genotype. A separate importation occurred to the interior outbreak of BC in late February 2010 in a traveler returning from India, also a D8 genotype, but not known to be associated with subsequent transmissions.
(Press release from BC Center for Disease Control, 04/16/2010)

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Chile (Los Rios): Fatal case of hantavirus
A laboratory test gave positive hantavirus results for a blood sample sent to the Public Health Institute (ISP) during the week of 18 April 2010. The report is of a 31-year-old male resident of the Hueima locale, in the Lanco commune, who died on 9 Apr 2010 in the hospital of that commune.

Health professionals of the Health SEREMI (Regional Ministerial Secretariat) are carrying out the respective epidemiological investigations: visiting his home and environment, and finding risk factors in areas neighboring the house.

In the Los Rios region to date, there have been four confirmed hantavirus cases -- a four-year-old girl of the rural sector of San Jose de La Mariquina, two young men, aged 20 and 23 from the Corral and Futrono communes respectively, and a 20-year-old woman from the Panguipulli commune. However, this is the first hantavirus death during 2010.
(ProMED 04/27/2010)

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Peru: Bubonic plague a concern
The outbreak of bubonic plague in the Chicama district of La Libertad, Peru has been increasing rapidly, specifically in the Libertad settlement, where three new cases of infection have been confirmed.

This was revealed by the chief epidemiologist of the Belen Hospital, Pedro Diaz Camacho, who came to that area to assess the critical condition of those affected, aged eight, nine, and 14. He said the presence of rats in the settlement has increased, and intervention from local and regional authorities is requested.

Diaz Camacho also said that the nine-year-old patient is in serious condition and the prognosis is guarded.
(ProMED 04/28/2010)

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USA (Oregon): Cryptococcus gatii outbreak
A newly discovered strain of an airborne fungus has caused several deaths in Oregon; it could spread to California and other adjacent areas, according to scientists at Duke University Medical Center.

"This novel fungus is worrisome because it appears to be a threat to otherwise healthy people," said Edmond Byrnes III, a graduate student in the Duke Department of Molecular Genetics and Microbiology. The fungal disease is typically associated with transplant recipients and HIV-infected patients.

The mortality rate for recent C. gattii cases in the Pacific Northwest is running at approximately 25 percent out of 21 cases analyzed in the United States, compared to a mortality rate of 8.7 percent out of 218 cases in British Columbia, Canada, the researchers said. Most have a more complicated clinical course than people infected with the more common Cryptococcus neoformans.

Because the strain is so virulent when it infects some humans and animals, the researchers are calling for greater awareness and vigilance. Testing involves culturing the fungus and then sequencing its DNA to learn whether it is the virulent or more benign strain, which could affect treatment plans.

Some strains of C. gattii are not more virulent than C. neoformans, for example, but doctors need to know what type they are dealing with, Byrnes said. Using molecular techniques, the geneticists uncovered clues that showed the Oregon-only fungal type most likely arose recently, in addition to an outbreak of C. gattii that began in Canada in 1999 that has now spread into Washington and Oregon.

Symptoms can appear two to several months after exposure, and may include a cough lasting weeks, sharp chest pain, shortness of breath, headache (related to meningitis), fever, nighttime sweats, and weight loss. While C. gattii can be treated, it cannot be prevented; there is no vaccine.

The new type of C. gattii reproduces both sexually and asexually. The more virulent strain may have genetically recombined with related but less harmful strains. This novel genotype is highly virulent compared with similar isolates of Cryptococcus that are not causing disease outbreaks. The researchers found that the novel genotype (VGIIc) is now a major source of C. gattii illness in Oregon. Because C. gattii types had been found in tropical areas before, researchers speculate that environmental changes may be responsible for the evolution and emergence of this pathogen.

Determining the exact origin of the VGIIc type is difficult, and sampling thus far has failed to turn up isolates in Oregon soil, water, or trees. Cell components called mitochondria may play a role in the increased virulence of certain types.

VGIIc, the new Oregon strain, has yielded dozens of isolates in many specimens, including from domesticated animals: cats, dogs, an alpaca, and a sheep.
(ProMED 04/26/2010)

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Chile: Health officials concerned about hantavirus
Health officials the week of 18 Apr 2010 expressed concern about the resurgence of hantavirus infections, especially in the earthquake stricken southern parts of Chile. Between January and April 2010, 30 cases have been reported, one third of them resulting in death. During the same period in 2009, only 17 cases were reported.

The Andes hantavirus causes high fevers and respiratory problems, and often results in death. The virus was first detected in Chile in the mid-1990s and in recent years has occurred mostly in southern parts of the country -- regions such as Bio Bio, Araucania, Aysen, and Los Lagos.

The Health Ministry reports that the increase in hantavirus cases is probably due to increased rainfall during the last months of 2009 -- creating conditions that cause the rats who act as vectors to seek shelter in houses or other areas where humans become exposed.

The Health Ministry called for a special alert for people showing Andes hantavirus symptoms, and for earthquake victims living in outdoor tents.
(ProMED 04/27/2010)

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

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

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

- Other useful sources
CIDRAP: Influenza A/H1N1 page:
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/biofacts/swinefluoverview.html
ProMED: http://www.promedmail.org/
H1N1 Lessons Learned Series CIDRAP Reports:
--23 April 2010: Pandemic underscored influenza’s unpredictability:
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/apr2310pandemic-jw.html
--26 April 2010: Vaccine production foiled, confirmed experts’ predictions
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/apr2610h1n1vax.html

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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.
-U.S. Embassy Press Release: Partnership Reduces the Risk of Bird Flu (28 April 2010):
http://jakarta.usembassy.gov/press_rel/Apr10/birdflu.html

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VECTOR-BORNE DISEASE


Australia (Queensland)
A new outbreak of dengue fever has hit Townsville, Queensland. Two women from the suburbs of North Ward and Deeragun, have been diagnosed with type two of the dengue virus, the first locally-acquired cases in the city since December 2009.

Queensland Health's Dr. Steven Donohue said given the six-mile distance between the two cases, it was likely more cases would come to light. Dr. Donohue said one of the women had recovered, and the other was still being treated.

Three Queensland Health teams and council officers are visiting properties to check for mosquitoes and breeding sites, such as car tires, saucers and potted plant stands.

The city experienced two small outbreaks in 2009, which affected 13 residents. Those outbreaks were declared over early March 2010.
(ProMED 04/20/2010)


Malaysia (Kuala Lumpur)
Four deaths due to dengue were reported from among the 1,639 cases of the disease recorded so far in 2010 in the city. Kuala Lumpur City Hall Director of Health Dr. Sallehuddin Abu Bakar said the 1,639 cases were higher than the 1,447 recorded for the corresponding period of 2009. The places regarded as active breeding areas of the mosquito in Kuala Lumpur included Cheras, Setapak, Kepong and Jalan Klang Lama.
(ProMED 04/26/2010)


Philippines (Mindanao)
At least 43 cases of malaria have been monitored in North Cotabato, Mindanao, since January 2010, prompting officials to adopt measures aimed at fighting the spread of the mosquito-borne disease. In a report released 21 Apr 2010, the Integrated Provincial Health Office said cases of malaria were recorded in the towns of Tulunan, President Roxas, Carmen, Banisilan, and in Kabacan. Tulunan town registered the most cases with 30 individuals acquiring the illness.

Dr Sherlito Pineda, medical officer of the Father Tulio Favali Hospital in Tulunan, said the health office has already oriented local health workers on conduct of residual spraying to kill mosquitoes. Mosquito nets have also been distributed to the villages. But Gante admitted that more needs to be done to minimize, if not totally put under control, the disease. He said the cooperation of villagers was needed.
(ProMED 04/24/2010)


USA (Florida)
With the first case of dengue fever reported in the Keys since mid-October 2009, Monroe County health officials are warning Key West residents to take precautions.

The most recent case, reported in a 41-year-old member of the U.S. Navy, was confirmed through lab tests in Miami after the man initially sought treatment from military doctors on 6April 2010. Officials believe the case was contracted locally, as the man reported no out-of-country travel in the past year.

Naval Air Station Key West spokesman Jim Brooks confirmed that the man, whom officials didn't identify, lived in base housing in Key West and that "areas where he lived and worked have been tested and sprayed."

An initial outbreak June 2009 -- the first cases documented in Florida in 40 years -- prompted researchers at the Centers for Disease Control and Prevention dengue lab in Puerto Rico to blood test some 240 cooperative Old Town residents. The survey found that 99 people tested positive for dengue or associated antibodies.

More than 100 million people worldwide have contracted the disease, which is endemic in some tropical areas including Puerto Rico and Central America.
(KeysNet.com, 04/21/2010)

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CHOLERA, DIARRHEA, and DYSENTARY


Viet Nam (Ho Chi Minh City)
Two more people tested positive for the Vibrio cholerae bacterium, the People 115 hospital in Ho Chi Minh City has said.

The two patients are a 25-year-old man, who experienced the symptoms of cholera on 14 Apr 2010 and his 18-month-old son.

On 19 Apr 2010, health workers from the city Preventive Medicine Center came to Te Canal in district seven where the patient and his son live to take samples for tests after the hospital announced that two patients had contracted the disease.

Health workers disinfected the area, raised awareness about the disease and provided residents with a 5,000 liter safe water tank because people living in boats lack hygienic water for drinking.

The city has so far reported seven cholera cases.
(ProMED 04/21/2010)

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4. Articles
Emergence and Pathogenicity of Highly Virulent Cryptococcus gattii Genotypes in the Northwest United States
Byrnes III EJ, Li W, Lewit Y, et al. PLoS Pathog. 22 April 2010;6(4): e1000850. doi:10.1371/journal.ppat.1000850
Available at http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1000850

Abstract. Cryptococcus gattii causes life-threatening disease in otherwise healthy hosts and to a lesser extent in immunocompromised hosts. The highest incidence for this disease is on Vancouver Island, Canada, where an outbreak is expanding into neighboring regions including mainland British Columbia and the United States. This outbreak is caused predominantly by C. gattii molecular type VGII, specifically VGIIa/major. In addition, a novel genotype, VGIIc, has emerged in Oregon and is now a major source of illness in the region. Through molecular epidemiology and population analysis of MLST and VNTR markers, we show that the VGIIc group is clonal and hypothesize it arose recently. The VGIIa/IIc outbreak lineages are sexually fertile and studies support ongoing recombination in the global VGII population. This illustrates two hallmarks of emerging outbreaks: high clonality and the emergence of novel genotypes via recombination. In macrophage and murine infections, the novel VGIIc genotype and VGIIa/major isolates from the United States are highly virulent compared to similar non-outbreak VGIIa/major-related isolates. Combined MLST-VNTR analysis distinguishes clonal expansion of the VGIIa/major outbreak genotype from related but distinguishable less-virulent genotypes isolated from other geographic regions. Our evidence documents emerging hypervirulent genotypes in the United States that may expand further and provides insight into the possible molecular and geographic origins of the outbreak.

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H1N1 Vaccinations, Fall 2009: Model School-Located Vaccination Clinics
Jenlink CH, Kuehnert P, Mazyck D. J Sch Nurs. 2010;0: 1059840510368960v1. doi:10.1177/1059840510368960 Available at http://jsn.sagepub.com/cgi/content/abstract/1059840510368960v1

Abstract. The 2009 H1N1 influenza virus presented a major challenge to health departments, schools, and other community partners to effectively vaccinate large numbers of Americans, primarily children. The use of school-located vaccination (SLV) programs to address this challenge led health departments and schools to become creative in developing models for successful SLV implementation. Successful models are explored in this article.

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Healthcare Worker Knowledge and Attitudes Regarding Influenza Immunization and Childhood Vaccination
Myers AL, Lantos J, Douville L, et al. Infect Control Hosp Epidemiol. 23 April 2010;31:000-000. DOI: 10.1086/652777
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/652777

Abstract. We surveyed healthcare workers (HCWs) about influenza vaccination and routine childhood vaccinations. We found that most HCWs' children received vaccinations, despite concerns regarding safety and efficacy. HCWs who received influenza vaccine were more likely to immunize their children against influenza, although a substantial proportion of HCWs' children did not receive influenza vaccination.

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Influenza A viral loads in respiratory samples collected from patients infected with pandemic H1N1, seasonal H1N1 and H3N2 viruses
Ngaosuwankul N, Noisumdaeng P, Komolsiri P, et al. Virology Journal. 20 April 2010;7:75. doi:10.1186/1743-422X-7-75
Available at http://www.virologyj.com/content/7/1/75

Background. Nasopharyngeal aspirate (NPA), nasal swab (NS), and throat swab (TS) are common specimens used for diagnosis of respiratory virus infections based on the detection of viral genomes, viral antigens and viral isolation. However, there is no documented data regarding the type of specimen that yields the best result of viral detection. In this study, quantitative real time RT-PCR specific for M gene was used to determine influenza A viral loads present in NS, NPA and TS samples collected from patients infected with the 2009 pandemic H1N1, seasonal H1N1 and H3N2 viruses. Various copy numbers of RNA transcripts derived from recombinant plasmids containing complete M gene insert of each virus strain were assayed by RT-PCR. A standard curve for viral RNA quantification was constructed by plotting each Ct value against the log quantity of each standard RNA copy number.

Results. Copy numbers of M gene were obtained through the extrapolation of Ct values of the test samples against the corresponding standard curve. Among a total of 29 patients with severe influenza enrolled in this study (12 cases of the 2009 pandemic influenza, 5 cases of seasonal H1N1 and 12 cases of seasonal H3N2 virus), NPA was found to contain significantly highest amount of viral loads and followed in order by NS and TS specimen. Viral loads among patients infected with those viruses were comparable regarding type of specimen analyzed.

Conclusion. Based on M gene copy numbers, we conclude that NPA is the best specimen for detection of influenza A viruses, and followed in order by NS and TS.

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Mild form of 2009 H1N1 influenza infection detected by active surveillance: Implications for infection control
Jeong M, Lee C-H, Kim DK, et al. American Journal of Infection Control. 24 April 2010. doi:10.1016/j.ajic.2010.02.006

Available at http://www.ajicjournal.org/article/S0196-6553(10)00185-9/abstract

Background. Screening patients with suspected influenza is a key step for infection control within communities and institutions. By analyzing the clinical characteristics of mild 2009 H1N1 influenza cases detected by active surveillance, we assessed the utility of the commonly used influenza case definition.

Methods. We retrospectively reviewed medical records of 44 patients who were hospitalized and quarantined and who tested positive for the 2009 H1N1 virus using real-time reverse-transcriptase polymerase chain reaction between May 29 and July 28, 2009.

Results. Patient median age was 17 years (range, 8-79 years), and 37 patients were male (84%). Common symptoms included cough (34/44; 77.3%), subjective fever (23/44; 52.3%), rhinorrhea or nasal congestion (22/44; 50%), sore throat (19/44; 43.2%), and diarrhea (7/44; 15.9%). All patients were treated with oseltamivir after the onset of initial symptoms (mean, 2.6 days). Common laboratory test results included leucopenia (23/44; 52.3%) and mildly elevated C-reactive protein (26/44; 59.1%).

Conclusion. There were many mild afebrile cases of the 2009 pandemic H1N1 influenza. Cough, mild leukopenia, and mildly elevated C-reactive protein were relatively common clinical manifestations. Thus, case-based surveillance for the index cluster of 2009 pandemic influenza is not an effective method for infection control in communities or hospital settings.

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A rapid method for assessing social versus independent interest in health issues: A case study of ‘bird flu’ and ‘swine flu’
Bentley RA, Ormerod P. Social Science & Medicine. 24 April 2010.
doi:10.1016/j.socscimed.2010.03.042
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4YXP1G7-3&_user=10&_coverDate=04%2F24%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5255910a87a4933b2136491242e22f75

Abstract. Effective communication strategies regarding health issues are affected by the way in which the public obtain their knowledge, particularly whether people become interested independently, or through their social networks. This is often investigated through localized ethnography or surveys. In rapidly-evolving situations, however, there may also be a need for swift, case-specific assessment as a guide to initial strategy development. With this aim, we analyze real-time online data, provided by the new ‘Google Trends’ tool, concerning Internet search frequency for health related issues. To these data we apply a simple model to characterise the effective degree of social transmission versus decisions made individually. As case examples, we explore two rapidly-evolved issues, namely the world-wide interest in avian influenza, or ‘bird flu’, in 2005, and in H1N1, or ‘swine flu’, from late April to early May 2009. The 2005 ‘bird flu’ scare demonstrated almost pure imitation for two months initially, followed by a spike of independent decision that corresponded with an announcement by US president George Bush. For ‘swine flu’ in 2009, imitation was the more prevalent throughout. Overall, the results show how interest in health scares can spread primarily by social means, and that engaging more independent decisions at the population scale may require a dramatic announcement to push a populace over the ‘tipping point’.

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Novel H1N1 Influenza (Swine Flu)
[CIDRAP-authored overview, 23 April 2010. Available at http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/biofacts/swinefluoverview.html]

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Recipients of Vaccine against the 1976 "Swine Flu" Have Enhanced Neutralization Responses to the 2009 Novel H1N1 Influenza Virus
McCullers JA, Van De Velde L-A, Allison KJ, et al. Clinical Infectious Diseases. 23 April 2010;50:000-000.
DOI: 10.1086/652441
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/652441

Background. The world is facing a novel H1N1 influenza pandemic. A pandemic scare with a similar influenza virus in 1976 resulted in the vaccination of nearly 45 million persons. We hypothesized that prior receipt of the 1976 "swine flu"± vaccine would enhance immune responses to the 2009 novel H1N1 influenza strain.

Methods. A prospective, volunteer sample of employees aged 55 years at a children's cancer hospital in August 2009 was assessed for antibody responses to the 2009 pandemic H1N1 influenza virus and the 2008¨C2009 seasonal H1N1 influenza virus.

Results. Antibody responses by hemagglutination©\inhibition assay were high against both the seasonal influenza virus (89.7% had a titer considered seroprotective) and pandemic H1N1 influenza virus (88.8% had a seroprotective titer). These antibodies were effective at neutralizing the seasonal H1N1 influenza virus in 68.1% of participants (titer 40), but only 18.1% had detectable neutralizing titers against the pandemic H1N1 influenza virus. Of 116 participants, 46 (39.7%) received the 1976 "swine flu"± vaccine. Receipt of this vaccine significantly enhanced neutralization responses; 8 (17.4%) of 46 vaccine recipients had titers 160, compared with only 3 (4.3%) of 70 who did not receive the vaccine ( by ¦Ö2 test).

Conclusions. In this cohort, persons aged 55 years had evidence of robust immunity to the 2008¨C2009 seasonal H1N1 influenza virus. These antibodies were cross-reactive but nonneutralizing against the 2009 pandemic H1N1 influenza strain. Receipt of a vaccine to a related virus significantly enhanced the neutralization capacity of these responses, suggesting homologous vaccination against the 2009 pandemic H1N1 influenza virus would have a similar effect.

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Guest Editorial: The 1918-1919 Influenza Pandemic in the United States: Lessons Learned and Challenges Exposed
Stern, AM, Cetron MS, Markel H. Public Health Reports Supplement 3. 2010;125:6-8.
Available at http://www.publichealthreports.org/archives/issueopen.cfm?articleID=2434

Few have described the influenza pandemic of 1918–1919 better than Dr. Victor Clarence Vaughan, the portly dean of the University of Michigan Medical School and advisor to the U.S. Surgeon General during World War I. In early September 1918, upon surveying the destruction wrought not from bullets but rather from microbes at a military camp outside of Boston, Vaughan bemoaned that influenza had “. . . encircled the world, visited the remotest corners, taking toll of the most robust, sparing neither soldier nor civilian, and flaunting its red flag in the face of science.”

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Influenza: The Once and Future Pandemic
Taubenberger JK, Morens DM. Public Health Reports Supplement 3. 2010;125:16-26.
Available at http://www.publichealthreports.org/archives/issueopen.cfm?articleID=2436

Summary. Influenza A viruses infect large numbers of warm-blooded animals, including wild birds, domestic birds, pigs, horses, and humans. Influenza viruses can switch hosts to form new lineages in novel hosts. The most significant of these events is the emergence of antigenically novel influenza A viruses in humans, leading to pandemics. Influenza pandemics have been reported for at least 500 years, with inter-pandemic intervals averaging approximately 40 years.

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Transmissibility and geographic spread of the 1889 influenza pandemic: Research findings from nonpharmaceutical intervention studies for pandemic influenza and current gaps in the research
Aiello AE, Coulborn RM, Aragon TJ, et al. AJIC. May 2010;38;4(251-258).
Available at http://www.ajicjournal.org/article/S0196-6553(10)00039-8/abstract

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

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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/.

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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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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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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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