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EINet Alert ~ May 07, 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
- Australia: No contamination reported in pandemic H1N1 vaccine
- Australia (Queensland): Vaccinations in children ceased
- Indonesia (Riau): H5N1 avian influenza death
- Malaysia (Perak): Man dies of H1N1 pandemic influenza
- USA: 71 million H1N1 pandemic influenza doses remain

2. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA

3. Articles
- Information Technology and Global Surveillance of Cases of 2009 H1N1 Influenza
- Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus Infection
- Fatalities Associated with the 2009 H1N1 Influenza A Virus in New York City
- Letter: An audit of pandemic (H1N1) 2009 influenza vaccine wastage in general practice
- Clinical Attack Rate and Presentation of Pandemic H1N1 Influenza versus Seasonal Influenza A and B in a Pediatric Cohort in Nicaragua
- Negotiating Equitable Access to Influenza Vaccines: Global Health Diplomacy and the Controversies Surrounding Avian Influenza H5N1 and Pandemic Influenza H1N1
- Ambient Influenza and Avian Influenza Virus during Dust Storm Day and Background Days
- Socio-economic Impacts of Avian Influenza Outbreaks on Small-scale Producers in Indonesia
- Interaction Between Research and Diagnosis and Surveillance of Avian Influenza Within the Caribbean Animal Health Network (CaribVET)
- A rapid method for assessing social versus independent interest in health issues: A case study of ‘bird flu’ and ‘swine flu’

4. Notifications
- Second APEC Senior Officials’ Meeting (SOM II)
- Thailand Conference on Emerging Infectious and Neglected Diseases
- CDC 7th International Conference on Emerging Infectious Diseases
- 4th Ditan International Conference on Infectious Diseases
- Options for the Control of Influenza VII
- Influenza 2010: Zoonotic Influenza and Human Health
- Updated influenza guidance and information from the US CDC

5. To Receive EINet Newsbriefs
- ***Subscribe to EINet


1. Influenza News

Global
2010 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Cambodia / 1 (1)
Egypt / 19 (7)
Indonesia / 1 (1)
Viet Nam 7 (2)
Total / 28 (11)

***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: 496 (293)
(WHO 5/04/10
http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_05_04/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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Global: WHO situation update on pandemic influenza H1N1
As of 2 May 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18,001 deaths.

The most active areas of pandemic influenza virus transmission currently are in parts of West Africa, the Caribbean, and Southeast Asia. In the temperate zone of the northern and southern hemisphere, overall pandemic influenza activity remains sporadic. Seasonal influenza virus type B continues to be detected sporadically across Asia, Africa, Europe, and the Americas, however, low levels of late season virus circulation have primarily detected in East and Central Asia, southern Europe, and central Africa.

In Sub-Saharan Africa, limited data from several countries suggest that active transmission of pandemic influenza virus persists in parts of West Africa while low levels of seasonal influenza type B viruses continue to circulate in parts of central Africa. In Ghana, pandemic influenza virus detections may be declining after peaking during early April 2010; during the most recent reporting week, 14% of respiratory specimens tested positive for pandemic influenza virus. In Cameroon, low levels of pandemic and seasonal influenza type B virus continue to co-circulate, though the latter have been predominant during April 2010. In the Democratic Republic of Congo, circulation of seasonal influenza H3N2 viruses during February and mid-March 2010 has been largely replaced by circulation of seasonal influenza type B viruses during April 2010. Localized, low level pandemic influenza virus circulation continues to be observed in parts of East Africa, particularly in Rwanda and Tanzania. Sporadic detections of seasonal influenza H3N2 viruses continue to be reported across eastern, central, and western Africa.

In tropical zone of the Americas, limited data suggest that pandemic influenza virus transmission remains active in several countries. In Central America, Guatemala reported three consecutive weeks of an increasing trend of respiratory diseases activity associated with regional spread of pandemic influenza virus and detection of severe cases. In Cuba, detections of pandemic virus and numbers of severe cases have increased since late March, however overall pandemic influenza activity may have recently peaked during the most recent reporting week. In Peru, the number of pneumonia cases in children under 5 years of age in the capital area has been increasing for the past seven weeks and remains above the epidemic threshold; however, the extent to which these pneumonia cases have been due to pandemic influenza H1N1 virus versus other respiratory viruses circulating in the region, is not known. Although the overall intensity of respiratory diseases across the region remained low to moderate during April 2010, for short periods of time, circulation of pandemic influenza virus was reported to widespread (in Cuba and Barbados) or regional (in Mexico, Honduras, Nicaragua, Columbia, Venezuela, Brazil, Ecuador and Bolivia).

In Southeast Asia, pandemic influenza virus continues to actively circulate in several countries of the region, however, respiratory disease trends in the region are variable. In Malaysia, limited data suggest that pandemic influenza virus transmission persists with ongoing reports of new cases (including severe cases) and media reports of several school outbreaks, particularly during late April and early May 2010. In Singapore, the national level of ARI has been steadily increasing since early April 2010 and now exceeds the epidemic threshold; 37% of sentinel respiratory specimens tested positive for influenza during the most recent reporting week. In Thailand, the proportion of sentinel outpatients with ILI and sentinel inpatients with pneumonia testing positive for pandemic influenza virus infection has declined significantly since peaking during late March 2010.

In South Asia, the most active area of pandemic influenza virus transmission continues to be in Bangladesh, which continues to report increasing respiratory diseases activity associated with co-circulation of pandemic and seasonal influenza type B viruses since mid April 2010. However, persistent low level co-circulation of both viruses has been detected since late February 2010. In India, localized low level circulation of pandemic influenza virus continues to be detected in parts of western and southern India.

In East Asia, very low levels of pandemic influenza virus continue to be detected. Although overall rates of respiratory illness remain low across the region, recent low levels of influenza activity in a number of countries in the region have been largely due to circulating seasonal influenza type B viruses. Three countries in region, Mongolia, China, and South Korea, each experienced a period of sustained seasonal influenza type B virus circulation following an earlier, generally more intense, wintertime period of pandemic influenza virus transmission. China and South Korea continue observe active but declining levels of seasonal influenza type B virus circulation.

In the temperate zone of the southern hemisphere, overall pandemic and seasonal influenza activity remains sporadic, except in Chile, where there is evidence of low level community circulation of pandemic influenza virus, including detection of small numbers of severe cases; however it too early to know if this signals an early start to wintertime influenza season. The national level of ILI in Chile remained near baseline; however, in at least two southern regions the region specific level of ILI was elevated above baseline, and in one region, Los Lagos, the region specific baseline has been elevated slightly above the epidemic threshold for the past four weeks. Of note, 6% of sentinel respiratory samples in Chile tested positive for a respiratory virus, of these 32% were positive for respiratory syncytial virus (RSV), and 27% were positive for influenza viruses (half of which were subtyped as pandemic H1N1 virus).

In Europe, overall influenza activity remained low with very low level co-circulation of pandemic and seasonal influenza type B viruses. The overall proportion of sentinel respiratory samples testing positive for influenza remained stable at about 5.3%; and the total number of sentinel influenza B virus detections continued to exceed that of influenza A viruses, primarily due to low level seasonal influenza type B virus circulation in the Russian Federation and Kazakhstan.

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.
(WHO 05/07/2010)

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Asia
Australia: No contamination reported in pandemic H1N1 vaccine
Australian health authorities said today they have found no abnormalities in their current flu vaccine, despite the apparent spike in fever and convulsions among young children recently vaccinated against flu. Tests by manufacturers, a government body, and independent experts have found no contamination. Authorities said the cases may be a statistical artifact of many more shots being given than in past years; Western Australia, where the cases have occurred, has administered two million doses.
(CIDRAP 04/30/2010)

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Australia (Queensland): Vaccinations in children ceased
Queensland Health has moved to stop GPs and vaccine providers from giving all children under the age of five the seasonal flu vaccine.

The move comes after Western Australia suspended the vaccination of all children after several became seriously ill after being given the vaccine.

So far this year 41 cases of adverse reactions to the seasonal flu vaccine have been reported in Queensland alone.

Of those, 15 have been in children aged five years and under, with symptoms including high temperatures and febrile convulsions.

One child required hospitalization but was later released.

Queensland's chief health officer Dr. Jeannette Young said the figures were higher than usual for so early in the flu season.

Dr. Young said Queensland Health was being "super cautious" but had decided to follow the warnings from the commonwealth chief medical officer, who strongly recommended that the seasonal flu vaccine not be given to children aged five years and under.
(National Indigenous Times 04/29/2010)

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Indonesia (Riau): H5N1 avian influenza death
A four-year-old girl, a resident of Jalan Sidomulyo, Kelurahan Padangbulan, Kecamatan Senapelan, Kota Pekanbaru died of confirmed avian influenza (H5N1) virus infection.

Arifin Achmad hospital is currently treating three other bird flu suspect patients, a 40-year-old woman, her 14-year-old daughter, and an 8-year-old neighbor. They reside in Sungai Apit Kabupaten Siak.
(ProMED 05/02/2010)

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Malaysia (Perak): Man dies of H1N1 pandemic influenza
A 40-year-old man died of influenza A (H1N1) today, said Health director-general Tan Sri Dr. Mohd Ismail Merican.

He said although the victim did not have any risk factors, he was down with fever and cough for six days before he was admitted to the Raja Permaisuri Bainun Hospital in Ipoh on April 27.

This brings the number of Influenza A (H1N1) casualties to 82, he said in a statement.

Ismail said eight influenza-like illness (ILI) clusters were reported in Kuala Lumpur, Negeri Sembilan, Melaka, Johor and Selangor.
(New Straits Times 05/05/2010)

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Americas
USA: 71 million H1N1 pandemic influenza doses remain
The US has 71 million doses of H1N1 vaccine remaining, according to the Department of Health and Human Services (HHS). States should keep offering doses until the seasonal flu vaccine, which will contain the pandemic strain, is available this fall, HHS spokesman Bill Hall said. Hall said the remaining doses have varying expiration dates, some as early 2011.
(CIDRAP 05/04/2010)

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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
CDC Interim Results: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5916a1.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
CIDRAP update 30 April 2010:
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/biofacts/swinefluoverview.html
ProMED: http://www.promedmail.org/
H1N1 Lessons Learned 30 April 2010: (#3 of a three-part report series).
Vaccination campaign weathered rough road, paid dividends
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/apr3010campaign.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.

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3. Articles
Information Technology and Global Surveillance of Cases of 2009 H1N1 Influenza
Brownstein JS, Freifeld CC, Chan EH. N Engl J Med. 06 May 2010;362(18);1731-1735 Available at http://content.nejm.org/cgi/content/full/362/18/1731?rss

Abstract. The widespread adoption of increasingly sophisticated forms of information technology has paralleled the increase in rapid and far-reaching international travel. The emergence and global spread of the 2009 pandemic influenza A (H1N1) virus illustrated not only the hazards of an interconnected world, but also the powerful role of new methods for detecting, tracking, and responding to infectious diseases. Although formal reporting, surveillance, and response structures remain essential to protecting public health, a new generation of freely accessible, online, and real-time informatics tools for disease tracking are expanding the ability of public health professionals to detect weak signals across borders and to raise earlier warnings of emerging disease threats.

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Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus Infection
Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza. N Engl J Med. 06 May 2010;362(18):1708-1719 Available at http://content.nejm.org/cgi/content/full/362/18/1708

Abstract. During the spring of 2009, a novel influenza A (H1N1) virus of swine origin caused human infection and acute respiratory illness in Mexico. After initially spreading among persons in the United States and Canada, the virus spread globally, resulting in the first influenza pandemic since 1968 with circulation outside the usual influenza season in the Northern Hemisphere (see the Supplementary Appendix, available with the full text of this article at NEJM.org). As of March 2010, almost all countries had reported cases, and more than 17,700 deaths among laboratory-confirmed cases had been reported to the World Health Organization (WHO). The number of laboratory-confirmed cases significantly underestimates the pandemic's impact. In the United States, an estimated 59 million illnesses, 265,000 hospitalizations, and 12,000 deaths had been caused by the 2009 H1N1 virus as of mid-February 2010. This article reviews virologic, epidemiologic, and clinical data on 2009 H1N1 virus infections and summarizes key issues for clinicians worldwide.

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Fatalities Associated with the 2009 H1N1 Influenza A Virus in New York City
Lee EH, Wu C, Lee EU, et al. Clinical Infectious Diseases. 2010;50:1498-1504. DOI: 10.1086/652446
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/652446

Background. When the 2009 H1N1 influenza A virus emerged in the United States, epidemiologic and clinical information about severe and fatal cases was limited. We report the first 47 fatal cases of 2009 H1N1 influenza in New York City.

Methods. The New York City Department of Health and Mental Hygiene conducted enhanced surveillance for hospitalizations and deaths associated with 2009 H1N1 influenza A virus. We collected basic demographic and clinical information for all patients who died and compared abstracted data from medical records for a sample of hospitalized patients who died and hospitalized patients who survived.

Results. From 24 April through 1 July 2009, 47 confirmed fatal cases of 2009 H1N1 influenza were reported to the New York City Department of Health and Mental Hygiene. Most decedents (60%) were ages 18¨C49 years, and only 4% were aged 65 years. Many (79%) had underlying risk conditions for severe seasonal influenza, and 58% were obese according to their body mass index. Thirteen (28%) had evidence of invasive bacterial coinfection. Approximately 50% of the decedents had developed acute respiratory distress syndrome. Among all hospitalized patients, decedents had presented for hospitalization later (median, 3 vs 2 days after illness onset; P<.05) and received oseltamivir later (median, 6.5 vs 3 days; P<.01) than surviving patients. Hospitalized patients who died were less likely to have received oseltamivir within 2 days of hospitalization than hospitalized patients who survived (61% vs 96%; P<.01).

Conclusions. With community-wide transmission of 2009 H1N1 influenza A virus, timely medical care and antiviral therapy should be considered for patients with severe influenza©\like illness or with underlying risk conditions for complications from influenza.

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Letter: An audit of pandemic (H1N1) 2009 influenza vaccine wastage in general practice
Turnour CE, Conaty SJ, Cretikos MA. MJA. 2010;192(9):541
Available at
http://www.mja.com.au/public/issues/192_09_030510/letters_030510_fm-1.html

To the Editor: From 30 September 2009, the Australian Government began offering free pandemic (H1N1) 2009 influenza vaccine (Panvax, CSL Limited, Melbourne, VIC), using either 10-dose (5 mL) or 20-dose (10 mL) vials. Multidose vials are not used routinely in Australia, and are designed for high-volume vaccination clinics. Once pierced, a Panvax vial must be used within 24 hours or discarded. We investigated vaccine wastage in general practice during the first month of the vaccine’s availability.
[for the remainder of the letter, please refer to the link above]

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Clinical Attack Rate and Presentation of Pandemic H1N1 Influenza versus Seasonal Influenza A and B in a Pediatric Cohort in Nicaragua
Gordon A, Saborio S, Videa E, et al. Clinical Infectious Diseases. 2010;50:1462-1467. DOI: 10.1086/652647
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/652647

Background. Little is known about the clinical presentation and epidemiology of influenza A H1N1pdm in children in developing countries. We assessed the severity of influenza A H1N1pdm in children in Nicaragua by comparing H1N1pdm cases to seasonal influenza cases in an ongoing cohort study.

Methods. The Nicaraguan Influenza Cohort Study was established in June 2007 to study the burden and seasonality of pediatric influenza in a tropical developing country. During the period from June 2007 through November 2009, a total of 4391 children aged 2–14 years participated in the cohort. We examined the attack rate of clinical influenza and assessed symptoms at first presentation in febrile patients with H1N1pdm versus those with seasonal influenza A or B.

Results. The estimated clinical attack rate of H1N1pdm in the cohort was 20.1%, compared to 11.7% and 15.1% for seasonal influenza A and 11.9% and 24.2% for seasonal influenza A and B in 2007 and 2008, respectively. Symptoms significantly associated with H1N1pdm cases versus seasonal influenza A cases were sore throat (adjusted odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2–2.5), wheezing (OR, 5.1; 95% CI, 1.3–19.0), rhonchi (OR, 4.6; 95% CI, 1.4–15.0), crepitations (OR, 16.2; 95% CI, 2.1–128.7), pneumonia (OR, 8.0; 95% CI, 1.7–37.3), nausea (OR, 2.8; 95% CI, 1.5–5.1), and loss of appetite (OR, 2.1; 95% CI, 1.4–3.1). In addition, 3 concurrent influenza and dengue virus coinfections were identified.

Conclusions. Children with influenza A H1N1pdm presented with significantly more symptoms of lower respiratory infection and gastrointestinal symptoms than children with seasonal influenza. The clinical influenza attack rate was high in both pandemic and seasonal years.

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Negotiating Equitable Access to Influenza Vaccines: Global Health Diplomacy and the Controversies Surrounding Avian Influenza H5N1 and Pandemic Influenza H1N1
Fidler FP. PLoS Med. 2010;7(5): e1000247. doi:10.1371/journal.pmed.1000247
Available at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000247

Introduction. One of the most controversial areas of global health diplomacy over the past five years has involved negotiations to increase equitable access to vaccines for highly pathogenic avian influenza A (H5N1) (HPAI-H5N1) and pandemic 2009 influenza A (H1N1) (2009-H1N1). The limited results produced by these negotiations have stimulated calls for a new global framework to improve equitable access to influenza vaccines. The prospects for such a framework are not, however, promising, because the national interests of most developed states vis-à-vis dangerous influenza strains favor retaining the existing imbalanced, reactive, and ad hoc approach to vaccine access. This article examines why negotiating equitable access to influenza vaccines in the context of HPAI-H5N1 and 2009-H1N1 has been, and promises to continue to be, a difficult diplomatic endeavor.

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Ambient Influenza and Avian Influenza Virus during Dust Storm Day and Background Days
Chen P-S, Tsai FT, Lin CK, et al. Environ Health Perspect. 2010. doi:10.1289/ehp.0901782
Available at http://ehsehplp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.0901782

Background: The spread of influenza and highly pathogenic avian influenza (H5N1) presents a significant threat to human health. Avian influenza outbreaks in downwind areas of Asian dust storms (ADS) suggest that viruses might be transported by dust storms.

Objectives: The purpose of our study is to develop a technique to measure ambient influenza and avian influenza virus, and then use this technique to measure concentrations of ambient influenza and avian influenza virus on ADS days and background days. The relationships between ambient influenza and avian influenza virus and air pollutants were also assessed.

Methods: A high-volume air sampler was used in parallel with a filter cassette to evaluate spiked samples and unspiked samples. Then, air samples were monitored during ADS season using filter cassette coupled with a real-time qPCR assay.

Results: Ambient influenza virus was successfully quantified using the filtration/real-time qPCR method during ADS days and background days. To our knowledge, this is the first report describing the concentration of influenza virus in ambient air. In both the spiked samples and unspiked samples, the concentration of influenza virus sampled using the filter cassette was higher than that using the high-volume sampler. The concentration of ambient influenza A virus was significantly higher during the ADS days than during the background days.

Conclusions: Our data implied the possibility of long-range transport of influenza virus.

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Socio-economic Impacts of Avian Influenza Outbreaks on Small-scale Producers in Indonesia
Basuno E, Yusdja Y, Ilham N. Transboundary and Emerging Diseases. 23 April 2010;57(1-2):7-10. doi. 10.1111/j.1865-1682.2010.01121
Available at http://www3.interscience.wiley.com/journal/123371442/abstract?CRETRY=1&SRETRY=0

Abstract. Since its first introduction in 2003 until January 2009 highly pathogenic avian influenza (HPAI) was reported in 31 of 33 provinces of Indonesia. In addition, 115 fatal human cases have been reported in the same period and about 11 million chickens had died or been culled. In 2005 alone, about 60% of farms stopped their operations. The objective of this paper is to describe the socio-economic impact of HPAI on small producers in Indonesia. Simultaneous surveys were conducted in three provinces representing low, medium and high incidence areas, with total respondents of 720 farms. Socio-economic information before, during and after the HPAI outbreak were collected. Results indicated that poultry-raising decreased due to HPAI by 25–80% for broiler, 7–93% for layer and 48% for ducks. Overall, the number of farms stopping operations was 30% and in the high incidence area nearly 70%. The proportion of income from poultry for daily household expenditure decreased from 75–91% before to 38–82% after the HPAI outbreak. We observed more loan requests and less saving in the HPAI-infected farms. Direct impact of HPAI was also seen by decrease in expenditures for education and daily consumption in particular in the high incidence farms. The high proportion of income in pre-HPAI infection indicated the poultry enterprise as the main source of income. HPAI caused significant losses in all study areas through high mortality, lower production and lower demand for poultry products. However, levels of social relationship, social networking, social trust, social organization and decision making remained unchanged. To re-establish the poultry enterprise, the best target are low incidence areas that are less densely populated with humans and poultry.

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Interaction Between Research and Diagnosis and Surveillance of Avian Influenza Within the Caribbean Animal Health Network (CaribVET)
Lefrancois T., Hendrikx P, Vachiery N. et al. Transboundary and Emerging Diseases. 23 April 2010;57(1-2):7-10. doi. 10.1111/j.1865-1682.2010.01120
Available at http://www3.interscience.wiley.com/journal/123371418/abstract?CRETRY=1&SRETRY=0

Abstract. The Caribbean region is considered to be at risk for avian influenza (AI) because of predominance of the backyard poultry system, important commercial poultry production, migratory birds and disparities in the surveillance systems. The Caribbean animal health network (CaribVET) has developed tools to implement AI surveillance in the region: (i) a regionally harmonized surveillance protocol, (ii) specific web pages for AI surveillance on http://www.caribvet.net, and (iii) a diagnostic network for the Caribbean including AI virus molecular diagnostic capability in Guadeloupe and technology transfer. Altogether 303 samples from four Caribbean countries were tested between June 2006 and March 2009 by real time PCR either for importation purposes or following clinical suspicion. Following AI H5N2 outbreaks in the Dominican Republic in 2007, a questionnaire was developed to collect data for risk analysis of AI spread in the region through fighting cocks. The infection pathway of Martinique commercial poultry sector by AI through introduction of infected cocks was designed and recommendations were provided to the Caribbean veterinary services to improve fighting cock movement controls and biosecurity measures. Altogether, these CaribVET activities contribute to strengthen surveillance of AI in the Caribbean region and may allow the development of research studies on AI risk analysis.

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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 Sciences & 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=582538&_coverDate=04%2F24%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000029718&_version=1&_urlVersion=0&_userid=582538&md5=6eb6d0c459bcbcbcf3b84be37ed58867

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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4. Notifications
Second APEC Senior Officials’ Meeting (SOM II)
Sapporo, Japan, 26 May 2010 – 4 June 2010.
APEC Senior Officials will discuss progress on the main tasks for the year. Topics will include: developing APEC's New Growth Strategy of balanced, inclusive, sustainable and knowledge-based growth; addressing the Bogor Goals Assessment; supporting the multilateral trading system; and accelerating regional economic integration. The Senior Officials will also develop recommendations for APEC Ministers and APEC Economic Leaders.
Additional Information available at
http://www.apec.org/apec/enewsletter/apr_issue22/upcomingevents.html#

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Thailand Conference on Emerging Infectious and Neglected Diseases
Pattaya, Thailand, 3-4 June 2010
Outbreaks of various diseases, including SARS, avian influenza, influenza H1N1 pandemics, and the most recently chikungunya fever, continue to challenge our abilities to prepare for the emerging infectious disease threats. This conference, therefore, will facilitate national and international updating and sharing of knowledge, experiences, and scientific expertise which is crucial for handling these global threats.
Additional information and registration available at http://nstda.or.th/eid2010/.

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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 holding in Beijing to provide 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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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
UPDATE: Questions and Answers about Updating Guidance on Infection Control Measures for Influenza in Healthcare Settings
Released 3 May 2010
Available at http://www.cdc.gov/h1n1flu/guidance/control_measures_qa.htm.

2009 H1N1 Flu: Situation Update
Released 30 April 2010
Available at http://www.cdc.gov/h1n1flu/update.htm

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