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Vol. XIII No. 10 ~ EINet News Briefs ~ May 14, 2010


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

1. Influenza News
- 2010 Cumulative number of human cases of avian influenza A/H5N1
- Global: WHO situation update on pandemic influenza H1N1
- Global: WHO to reassess H1N1 pandemic influenza status
- Europe: EU Parliament members call for H1N1 pandemic influenza investigation
- Ireland: More than 1,600 pandemic influenza H1N1 vaccine reactions reported
- Australia: Pandemic influenza H1N1 remains quiet
- Australia (Victoria): Seasonal pandemic influenza H1N1 vaccine running low
- Hong Kong: Pandemic influenza H1N1 alert level to be lowered
- Chinese Taipei: Pandemic influenza H1N1 reported in army barracks
- New Zealand: More than 900,000 pandemic influenza H1N1 vaccine doses administered
- Thailand: One more H1N1 pandemic influenza death
- Tonga: Island to get enough pandemic influenza H1N1 vaccine for all
- Brazil: 50 pandemic influenza H1N1 deaths reported
- Canada (Quebec): Pandemic influenza H1N1 death

2. Infectious Disease News
- Russia (Amur Oblast): Measles outbreak
- Chile: Hantavirus infection
- Canada (British Columbia): Measles outbreak
- United States (California): Cases of mumps on the rise
- United States (Nebraska, Iowa): Mumps outbreak
- United States (New Mexico): Hantavirus case
- United States (Washington) Two cases of drug resistant tuberculosis

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

4. Articles
- Childhood Hib vaccination and pneumonia and influenza burden in US seniors
- Pandemic Influenza (H1N1) 2009 Is Associated with Severe Disease in India
- Factors influencing the uptake of 2009 H1N1 influenza vaccine in a multiethnic Asian population
- Commentary: Vaccinate before the next pandemic?
- The impact of H1N1 influenza A virus pandemic on the blood donations in Hyogo Prefecture, Japan
- Factors in association with acceptability of A/H1N1 vaccination during the influenza A/H1N1 pandemic phase in the Hong Kong general population
- Oseltamivir-resistant pandemic (H1N1) 2009 in Yemin – case report
- Monitoring of risk perceptions and correlates of precautionary behavior related to human avian influenza during 2006-2007 in the Netherlands: results of seven consecutive surveys
- The Origin and Prevention of Pandemics

5. 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
- 4th Vaccine and ISV Annual Global Congress

6. 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 / 3 (2)
Viet Nam / 7 (2)
Total / 30 (12)

***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: 498 (294)
(WHO 5/6/10 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_05_06/)

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 9 May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18,036 deaths.

The most active areas of pandemic influenza virus transmission currently are in parts of the Caribbean and Central America, and to a lesser extent in West Africa and South 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 at low levels across parts of Asia, Africa, and Europe.

In the tropical region of the Americas, pandemic influenza virus transmission remains most active in parts of the Caribbean, and to a lesser extent in Central America. In Cuba, pandemic influenza activity continued to decline after a recent period of intense transmission which began during late February 2010 and may have peaked during late April 2010. Geographically widespread pandemic influenza activity was reported in Jamaica (during much of February through May 2010) and in the Dominican Republic (since late April); however, other respiratory viruses are known to be co-circulating in the region and overall respiratory disease activity during this period was reported to remain low to moderate. The overall SARI** rate from sentinel sites in selected Caribbean countries (Dominica and Jamaica) increased since mid April 2010, however, the extent to which this was due circulating pandemic influenza virus versus other respiratory viruses is not known. In Central America and the tropical regions of South America: Nicaragua, Honduras, Guatemala, Columbia, Bolivia, and Peru all reported regional spread of influenza during one or more weeks since late April 2010 suggesting that low levels of circulating pandemic influenza virus persist in the region. In addition, there is evidence from several countries in this region that there is ongoing co-circulation of influenza with other respiratory viruses (including respiratory syncytial virus (RSV), and adenovirus).

In Asia, the most active areas of pandemic influenza virus transmission currently are in parts of South and Southeast Asia, particularly in Bangladesh, Malaysia, and Singapore. In Bangladesh, a consistently increasing trend of respiratory disease associated with co-circulation of pandemic influenza and seasonal influenza type B viruses have been reported since mid April 2010; however, the overall intensity of respiratory diseases activity remains low to moderate. In Malaysia, limited data suggest that recent pandemic influenza activity began during early April 2010 and has been stably elevated since mid April 2010. In Singapore, the overall level of ARI remained stably elevated above baseline since early April 2010; 38% of respiratory specimens tested positive for pandemic influenza virus infection during the most recent reporting week. In Thailand, a recent period of sustained transmission of pandemic virus, extending from January until early April 2010, appears to have largely subsided. In India, low levels of pandemic influenza virus continued to be detected in several western and southern states, however, the overall level of respiratory diseases in the population remains low. In Indonesia, a period of low level circulation of seasonal H3N2 viruses which began during early February 2010 now appears to be subsiding. In East Asia, pandemic influenza virus is being detected only sporadically, however, persistent but declining levels of circulating seasonal influenza type B viruses continued to be reported, particularly in China, Hong Kong SAR (China), and in Chinese Taipei.

In Sub-Saharan Africa, limited data from several countries suggest that active transmission of pandemic influenza virus continues to decline in parts of West Africa, while low levels of seasonal influenza type B viruses continue to circulate in parts of Central Africa and to a lesser extent in East Africa. In Ghana, pandemic influenza virus detections continued decline after peaking during early April 2010; during the most recent reporting week, 10%of respiratory specimens tested positive for pandemic influenza virus. There was no report of influenza activity in Senegal where a peak of pandemic influenza activity was observed in late February 2010. In central Africa, Cameroon continued to report co-circulation of pandemic and seasonal influenza type B viruses; the latter continued to be predominant during the most recent reporting week with approximately 31% of all respiratory samples testing positive for seasonal influenza type B and 4% testing positive for pandemic influenza virus. Sporadic detections of seasonal influenza H3N2 and influenza B viruses have been reported across eastern and western Africa over the past month.

In the northern and southern temperate regions of the Americas, only sporadic detections of influenza viruses have been reported, except in Chile, which continued to report localized areas of increased ILI activity associated with co-circulation of pandemic influenza and other respiratory viruses.

In Europe, pandemic influenza virus continues to be detected sporadically as the overall intensity of respiratory diseases remained low across the continent. Low level circulation of seasonal influenza type B virus persists in parts of southern and eastern Europe, notable in the Russian Federation and in Italy.
(WHO 05/14/2010)

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Global: WHO to reassess H1N1 pandemic influenza status
The Emergency Committee of the WHO will wait for winter in the Southern Hemisphere before again reviewing the status of the H1N1 pandemic. The 15-member expert committee will likely meet later in May 2010 or early June 2010, after the WHO's governing World Health Assembly the week of 17 May 2010. The panel may maintain the status quo, declare a transitional "post-peak" phase, or declare that the pandemic is over.
(CIDRAP 05/11/2010)

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Europe/Near East
Europe: EU Parliament members call for H1N1 pandemic influenza investigation
More than 200 deputies of the European Parliament have signed a proposal calling for a special committee to look into the European Union's (EU's) response to the H1N1 pandemic, including an evaluation of the EU's dependence on the WHO. Signers claim that steps taken undermined EU credibility, that the amount spent on vaccines was unwarranted, and that officials should have changed course early on.
(CIDRAP 05/11/2010)

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Ireland: More than 1,600 pandemic influenza H1N1 vaccine reactions reported
More than 1,600 adverse reactions to the pandemic H1N1 vaccine were reported to the Irish Medicines Board. Two deaths were also reported, in people who had underlying conditions, but a link to the vaccine has not been proven. Fifteen people reported an "anaphylactic"-type reaction. Less serious reactions included injection-site problems, stomach upset, flu-like symptoms, dizziness, fainting, and limb weakness.
(CIDRAP 05/10/2010)

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Asia
Australia: Pandemic influenza H1N1 remains quiet
Australia so far in 2010 has confirmed 492 cases of influenza, of which 13% have been subtyped as pandemic H1N1; another 73% were influenza A but not subtyped. Less than 1% were A/H3N2, and 11% were type B, according to the country's Department of Health and Ageing (DHA). Two H1N1 patients were hospitalized. Levels of influenza-like illness (ILI) in the community remained relatively low, and reporting from laboratories indicated that little of this ILI is due to influenza, the DHA said.
(CIDRAP 05/10/2010)

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Australia (Victoria): Seasonal pandemic influenza H1N1 vaccine running low
Supplies of seasonal influenza vaccine, which contains the pandemic strain, are running low in Victoria, Australia's second most populous state. Australia's CSL, which makes most of the country's flu vaccine, rushed new doses to wholesalers to help meet demand, which has remained high even after the country banned use of the vaccine in those under five years old after some had adverse events. CSL warned that more shortages may loom.
(CIDRAP 05/07/2010)

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Hong Kong: Pandemic influenza H1N1 alert level to be lowered
Hong Kong officials announced 11 May 2010 that they will lower their flu response level from "emergency" to "alert" on 24May 2010, pending any signals indicating otherwise that might arise from the World Health Organization's World Health Assembly the week of 17 May 2010. Officials said their decision is based on flu activity that has been declining since late September 2009 and has remained low, even during the area's winter flu season. It also said it has detected no change in clinical severity.
(CIDRAP 05/12/2010)

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Chinese Taipei: Pandemic influenza H1N1 reported in army barracks
The army has reported two influenza A (H1N1) cluster infections, with testing by the Department of Health’s Centers for Disease Control confirming that 16 soldiers have the disease.

Ninety-seven soldiers at the Chiayi Recruit Training Center and 47 at the Houli Barracks in Taichung County displayed flu-like symptoms as of the evening of 9 May 2010. The cluster infection at the Chiayi base is the largest this year. Three recruits have developed pneumonia and have been hospitalized with influenza A.

DOH statistics show 12 cluster flu infections in the last month, nine of which were type B flu. Most occurred at schools, with only one home cluster infection. The influenza A cluster infection, which was not in the army, took place in a kindergarten attached to an elementary school.

In related news, the DOH 8 May 2010 reported the death of a 15-year-old junior high school girl related to influenza A. She had a history of Type 1 diabetes, and the flu is believed to have brought on diabetic ketoacidosis. This is the first influenza A death in three months, and the 42nd fatality in Chinese Taipei.
(Taiwan Today 05/10/2010)

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New Zealand: More than 900,000 pandemic influenza H1N1 vaccine doses administered
New Zealanders in 2010 have received more than 900,000 doses of seasonal flu vaccine, covering more than 20% of the population, the government said 11 May 2010. Health Minister Tony Ryall said that including protection against the pandemic swine flu in the seasonal vaccine drove the unprecedented demand. In 2009, a record 960,000 doses were distributed in 30 weeks. Ryall estimated New Zealand would reach that mark in 11 weeks.
(CIDRAP 05/11/2010)

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Thailand: One more H1N1 pandemic influenza death
Thailand had one more death case due to the A(H1N1) influenza, bringing the country's death toll to 226.

The A(H1N1) outbreak in Thailand has continued, especially at the anti-government rally site in central Bangkok. During last week, some 23 people were confirmed to have an A(H1N1) influenza infection.
(Xinhua 05/10/2010)

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Tonga: Island to get enough pandemic influenza H1N1 vaccine for all
The WHO announced 11 May 2010 that the Pacific Island nation of Tonga will receive 90,000 doses of donated H1N1 vaccine on top of the 10,000 doses it received in March 2010, which will provide enough to cover its entire population. Funds will be provided to help administer the doses, and ancillary items, such as syringes, will also be shipped.
(CIDRAP 05/11/2010)

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Americas
Brazil: 50 pandemic influenza H1N1 deaths reported
A total of 50 Brazilians have died and 361 others have been hospitalized due to the A/H1N1 flu in the country since 3 April 2010.

Among the deaths, 76 percent were women, 32 percent of whom were pregnant.

In the campaign against A/H1N1 virus, 47.5 million people have been vaccinated so far, about 81 percent of the government's target.

The next stage of the campaign is aiming at the people aged between 30 and 39, with estimated 30 million people to be vaccinated.
(Trend 05/08/2010)

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Canada (Quebec): Pandemic influenza H1N1 death
A Quebec man who recently returned from a trip to Cuba has died after contracting the H1N1 virus.

The Shawinigan resident, who was in his fifties, was not vaccinated against the virus. Public health officials said the man fell ill after returning from Cuba last week. He went to a local hospital and was transferred to a bigger centre in Montreal, where he died 9 May 2010.

His death is an isolated case, and does not mark a third epidemic wave of swine flu, said Quebec's public health agency.

According to the Public Health Agency of Canada's FluWatch for 25 April to 1 May 2010, only 14 hospitalizations (in British Columbia, Ontario, Quebec and Nova Scotia) and two deaths (in Ontario) have been reported since the beginning of 2010.
(CBC News 05/12/2010)

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2. Infectious Disease News

Asia
Russia (Amur Oblast): Measles outbreak
The Rospotrebnadzor, the Russian equivalent of a health protection agency, has reported that between 15 April and 4 May 2010, a total of 31 cases of measles were registered in the Amur Oblast, 17 of which have been confirmed by laboratory testing. 27 people have been admitted to infectious diseases wards, and three have been discharged as of 4 May 2010. The outbreak investigation indicated that cases may have originated from China.

An emergency immunization program has been initiated for the 18-55 age group, and 925 people have been immunized so far. Contacts have been traced and are under medical observation. The outbreak raises doubts about Russia’s intention to achieve certification as a measles-free country.
(ProMED 05/08/2010)

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Americas
Chile: Hantavirus infection
The Epidemiology Unit of the Los Lagos Health SEREMI [Regional Ministerial Secretariat] has reported the case of a 25 year old woman suspected of having contracted a hantavirus infection, being treated at the Base Hospital of Puerto Montt. The woman, a resident of the Colaco sector (Callbuco community), is a direct family member of a previous case of a hantavirus infection, who was also admitted to the Puerto Montt Base Hospital. This case was a man of 39 years, who died in April 2010.

An epidemiological team began carrying out an environmental and epidemiological investigation 7 May 2010 in order to determine the risk factors which could have caused the infection, which has not been confirmed by the ISP [Instituto de Salud Publica - Public Health Institute].
(ProMED 05/10/2010)

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Canada (British Columbia): Measles outbreak
Following a confirmed case of measles in Calgary and a recent measles outbreak in British Columbia, Alberta Health Services is reminding Albertans of the importance of MMR (measles, mumps, rubella) vaccination.

Dr. Gerry Predy, AHS Medical Officer of Health, said there are pockets of the province where Alberta reports low vaccination rates, which puts non-immunized individuals in these areas at increased risk for certain diseases, including measles.

Because of these low rates, the area has experienced both mumps and whooping-cough outbreaks over the past two years. In 2000, the Lethbridge area had a significant measles outbreak, which forced the closure of a private school.

The latest numbers from the B.C. Centre for Disease Control show 71 confirmed cases of measles. In the B.C. outbreak, non-immunized children under five years of age were most affected. In Alberta, MMR is a two-dose vaccine with the first immunization at 12 months and the second between four and six years.
(Vauxhall Advance 05/13/2010)

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United States (California): Cases of mumps on the rise
The L.A. County Department of Public Health is saying cases of the mumps are on the rise this year. At least nine cases of mumps have already been reported in Los Angeles County this year, six of which have been confirmed. By comparison, seven cases were confirmed countywide in all of 2009, seven in 2008, and five in 2007.

Four of the confirmed L.A. County cases have occurred over the past two months and are suspected of being related to an outbreak affecting the Hasidic Jewish population first seen on the East Coast in the U.S.
(LAist 05/12/2010)

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United States (Nebraska, Iowa): Mumps outbreak
The state of Nebraska is monitoring an outbreak of mumps in the central part of that state, where several cases have been linked to a basketball tournament in Columbus. The Department of Health and Human Services reported on 7 May 2010 that it has been notified of 20 confirmed or probable cases of mumps. So far, six of those cases have been confirmed by the state through lab testing. The Department said that 18 of the cases were traced to an alumni basketball tournament held on 26-27 March 2010 at Columbus Scotus High School. One of the cases involved an Arizona resident, and one a Colorado resident.

On 5 May 2010, Iowa health officials issued a warning about a small outbreak of mumps in the north west part of that state. Nebraska officials say that it not yet known whether the outbreaks are related.
(ProMED 05/08/2010)

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United States (New Mexico): Hantavirus case
The New Mexico Department of Health announced on 06 May 2010 that a 44-year-old woman from McKinley County has been hospitalized in critical condition at UNM Hospital in Albuquerque with the state’s first case of Hantavirus Pulmonary Syndrome this year.
(New Mexico Department of Health, 05/07/2010)

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United States (Washington) Two cases of drug resistant tuberculosis
Two people in Snohomish County have been diagnosed with multi-drug resistant tuberculosis.

The county health officer expects it will cost $140,000 to treat the two people and investigate whether the disease has spread to others.
(Seattle Times 05/06/2010)

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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/

CIDRAP Novel H1N1 Influenza Update
7 May 2010:
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/biofacts/swinefluoverview.html

CIDRAP Personal Pandemic Preparedness Resource List
10 May 2010:
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/resources/personpanprep.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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VECTOR-BORNE DISEASE
Australia
Queensland Health has confirmed a resident from Wongaling Beach and three people from Tully have been diagnosed with locally acquired cases of dengue. Health officials believe the cases are part of the Tully outbreak, which occurred in March 2010. It was the first time Tully had a dengue outbreak in 20 years. The new cases bring the total number of dengue victims in the Far North to seven. It follows the worst epidemic of dengue in 50 years in North Queensland last wet season, when a record 931 cases of dengue type 3 were confirmed.
(ProMED 05/10/2010)

Brunei Darussalam
From January to the first week of April 2010, 77 people contracted dengue fever. The number surpasses the 37 cases recorded for all of 2009, according to the Ministry of Health.

Senior Public Health Officer Kamaludin Mohamad Yassin from the Entomology and Parasitology Unit under the ministry's Environment Health Services, said the increase in the number of cases is alarming. This marks a rise of 24 cases during the first week of April 2010 alone. For the first time, Brunei has reported two cases of dengue hemorrhagic fever, which is a more virulent form of dengue.

The majority of cases were from Kampong Ayer, where pools of stagnant water can be found due to poor sewage management. Of the total 77 cases recorded in 2010, 67 were from the Brunei-Muara District. Kuala Belait had five cases, followed by Tutong with four and Temburong, one case. As much as 86 percent of this year's infection was recorded from Kampong Ayer, a change in trend compared to the previous five years when only an average of 13 percent of the Sultanate's cases were from the water village.
(ProMED 05/10/2010)

Indonesia (Bali)
Two children died at Sanglah Hospital the week of 25 Apr 2010 during the yearly dengue fever outbreak. At least six people -- four of them children -- have died of the disease at the hospital in 2010. Both children who died had toxic shock syndrome.
(ProMED 05/10/2010)

Malaysia
Malaria cases in the state of Marudi have risen by 44 per cent in 2010, with 934 cases reported from January to April 2010, compared to 526 in the same period of 2009.

Three people have died from malaria in 2010– an 18-year-old girl from Sri Aman, a man from Sibu and another man from Kanowit. Last year, a total of eight patients died due to malaria.

From the total cases in 2010, 477 or 51 per cent were from the Marudi District.

The Belaga District was next with 121 cases (13 per cent), followed by Bintulu with 72 cases (7.7 per cent).

Last year, 2,189 Malaria cases were recorded in Sarawak.
(The Borneo Post 05/06/2010)

Thailand
Dr. Narinrat Pichayakamin, a Public Health Doctor of Phuket, said that the rising temperature in Phuket had made an increase of dengue fever patients likely. From the beginning of 2010, there were 123 dengue fever patients admitted into hospitals on the island.

The total number of reported cases of dengue infection in Thailand since 1 Jan 2010 is 13,973 cases and 17 deaths; 5,986 dengue fever (DF) cases, 7,735 cases and 5 fatalities of dengue hemorrhagic fever (DHF), and 252 cases and 12 fatalities of dengue shock syndrome (DSS).

Regarding dengue fever, the total number of reported cases in Thailand between 1 Jan 2010 and 3 May 2010 is 5,986 cases with no deaths, including 40 cases reported from Phuket province. Cases were reported from 76 provinces.

The attack rate of dengue fever nationwide was 9.42 per 100,000 population. The highest attack rate (per 100,000 population) was reported in the south region (16.46), followed by the central region (12.10), northeastern region (6.32), and north region (4.95). The top 5 provinces that had high attack rates of dengue fever (per 100 000 population) were Yala province (41.22), Satun (38.89), Trad (29.09), Rayong (25.81), and Chantaburi (24.06).
(ProMED 05/10/2010)

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CHOLERA, DIARRHEA, and DYSENTARY
Hong Kong
The Center for Health Protection is investigating a cholera case involving a 53-year-old man who joined a tour group to India from 24 April to 1 May 2010. Laboratory tests showed that he has cholera. His family members have no symptoms. The center is contacting his tour group members.

This is the first cholera case reported in 2010. There were seven cholera cases in 2008, three cholera cases in 2007, one in 2006 and five in 2005.
(News.gov.hk, 05/08/2010)

Papua New Guinea
A public health emergency has been declared in Papua New Guinea's capital after five people died from cholera. In recent weeks cholera has killed three people in a coastal village in Port Moresby and there have been two deaths in villages further along the coast.

About 40 people have been treated for the disease at a cholera treatment center set up outside the St John hospital.

Health minister Sasa Zibe says the declaration of a public health emergency gives authorities greater powers to deal with the outbreak. Officials will be able to shut down food and drink stalls and prevent people moving to and from infected areas.

Extra chlorine has been added to the city's water supplies as a precaution against contamination.

The WHO in Papua New Guinea says it will still be some time before officials can verify that a cholera outbreak in the capital has been contained.

The country has been battling cholera in the northern provinces of Madang, Morobe and East Sepik since August 2009.

The WHO’s representative in PNG, Dr. Eigel Sorensen says there is still ongoing transmission in two or three communities in the capital, mostly in coastal villages.
(Radio New Zealand and ABC News 05/08/2010 and 05/10/2010)

Viet Nam
Three more patients have been diagnosed with cholera in the northern province of Ha Nam, and Ho Chi Minh City said it has admitted a patient from the southern province of Tay Ninh.

So far cholera has affected seven provinces and cities in the north and south, including Hanoi and the southern hub.

The three patients in Ha Nam were among 47 people who fell sick with acute cholera after attending a wedding party on 22 April 2010. An initial inspection showed that some food at the party was infected.
(Thanh Nien News 05/05/2010)

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4. Articles
Childhood Hib vaccination and pneumonia and influenza burden in US seniors
Cohen SA, Ahmed S, Klassen AC, et al. Vaccine. 8 May 2010; doi:10.1016/j.vaccine.2010.04.035
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-501JWFJ-1&_user=10&_coverDate=05%2F08%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=d0bdfaf491dac101dbcceb6238c39bf1

Abstract. This analysis examines the potential for the elderly to receive indirect protection from pneumonia and influenza (P&I) from vaccination of children. Using data from the Centers for Medicare and Medicaid Services, the National Immunization Survey, and the Behavioral Risk Factor Surveillance System, mixed-effects models were used to assess associations between vaccination coverage and P&I on the state level overall and by urbanicity and income. As vaccination coverage in children increased, the state-level P&I rates in seniors decreased (â = −0.040, −0.074 to 0.006), where â represents the expected change in the logged age-associated rate of disease increase for a one-percentage point increase in vaccination coverage. Increasing vaccination coverage in the elderly was associated with an increase in P&I rates (â = 0.045, 0.011–0.077) in seniors. The degree of association was more prominent in urban and high income areas. The consistent associations between influenza in the elderly and vaccination coverage in children suggest that routine vaccination of children may impart some indirect protection to the elderly.

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Pandemic Influenza (H1N1) 2009 Is Associated with Severe Disease in India
Mishra AC, Chadha MS, Choudhary ML, et al. PLoS ONE. 7 May 2010;5(5): e10540. doi:10.1371/journal.pone.0010540
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0010540

Background. Pandemic influenza A (H1N1) 2009 has posed a serious public health challenge world-wide. In absence of reliable information on severity of the disease, the nations are unable to decide on the appropriate response against this disease.

Methods. Based on the results of laboratory investigations, attendance in outpatient department, hospital admissions and mortality from the cases of influenza like illness from 1 August to 31 October 2009 in Pune urban agglomeration, risk of hospitalization and case fatality ratio were assessed to determine the severity of pandemic H1N1 and seasonal influenza-A infections.

Results. Prevalence of pandemic H1N1 as well as seasonal-A cases were high in Pune urban agglomeration during the study period. The cases positive for pandemic H1N1 virus had significantly higher risk of hospitalization than those positive for seasonal influenza-A viruses (OR: 1.7). Of 93 influenza related deaths, 57 and 8 deaths from Pune (urban) and 27 and 1 death from Pune (rural) were from pandemic H1N1 positive and seasonal-A positive cases respectively. The case fatality ratio 0.86% for pandemic H1N1 was significantly higher than that of seasonal-A (0.13%) and it was in category 3 of the pandemic severity index of CDC, USA. The data on the cumulative fatality of rural and urban Pune revealed that with time the epidemic is spreading to rural areas.

Conclusions. The severity of the H1N1 influenza pandemic is less than that reported for ‘Spanish flu 1918’ but higher than other pandemics of the 20th century. Thus, pandemic influenza should be considered as serious health threat and unprecedented global response seems justified.

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Factors influencing the uptake of 2009 H1N1 influenza vaccine in a multiethnic Asian population
Wong LP, Sam I-C. Vaccine. 6 May 2010; doi:10.1016/j.vaccine.2010.04.043
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-50150SV-2&_user=10&_coverDate=05%2F06%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=71970e3110f8da15c6f118dd9d1d122c

Abstract. The study aimed to determine factors influencing the uptake of 2009 H1N1 influenza vaccine in a multiethnic Asian population. Population-based, cross-sectional survey was conducted between October and December 2009. Approximately 70% of overall participants indicated willingness to be vaccinated against the 2009 H1N1 influenza. Participants who indicated positive intention to vaccinate against 2009 H1N1 influenza were more likely to have favorable attitudes toward the 2009 H1N1 vaccine. A halal (acceptable to Muslims) vaccine was the main factor that determined Malay participants’ decision to accept vaccination, whereas safety of the vaccine was the main factor that influenced vaccination decision for Chinese and Indian participants. The study highlights the challenges in promoting the 2009 H1N1 vaccine. Ethnic-sensitive efforts are needed to maximize acceptance of H1N1 vaccines in countries with diverse ethnic communities and religious practices.

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Commentary: Vaccinate before the next pandemic?
Stöhr, K. Nature. 12 May 2010;465(161): doi:10.1038/465161a Available at http://www.nature.com/nature/journal/v465/n7295/full/465161a.html

Introduction. The past 12 months are testimony that alternative ways are needed to prepare for pandemics. When swine influenza spread around the world from Mexico during April and May last year, governments and vaccine producers faced the same dilemma: no one knew how much vaccine to order or produce.
[Please visit the web link for the remainder of the opinion letter.]

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The impact of H1N1 influenza A virus pandemic on the blood donations in Hyogo Prefecture, Japan
Tsubokura M, Nakada H, Matsumura T, et al. Transfusion. 3 May 2010. doi: 10.1111/j.1537-2995.2010.02641.x
Available at http://www3.interscience.wiley.com/journal/123411150/abstract?CRETRY=1&SRETRY=0

Background. The impact of the H1N1 influenza on blood donation is unknown.

Study design and methods. We examined number of blood donors presenting to blood donation centers or bloodmobiles using a blood donation database of Red Cross Hyogo Prefectural Blood Center between 4 weeks before and after May 16, 2009, respectively, when the first case of H1N1 influenza was confirmed in Kobe. The numbers of blood donors per donation site (i.e., blood donation centers and bloodmobiles) and per blood products (i.e., red blood cells [RBCs], platelet [PLT]-poor plasma, and PLTs) were also examined.

Results. The number of blood donors decreased by 21% and whole blood donations declined by 1329 units within 1 week of the first case of H1N1 influenza. While number of blood donors showed a rapid decrease, blood donations returned to the normal level within 1 week. This quick recovery was attributed to the diligent efforts made by Red Cross Centers, including the use of e-mail to encourage blood donation, on-the-street campaigns, and requesting new bloodmobile drives in workplaces and universities. RBCs that were donated in bloodmobiles was predominantly affected; the number of blood donors in bloodmobiles decreased by 39%.

Conclusion. H1N1 influenza pandemic had a great but transient impact on blood donation.

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Factors in association with acceptability of A/H1N1 vaccination during the influenza A/H1N1 pandemic phase in the Hong Kong general population
Lau JTF, Yeung NCY, Choi KC, et al. Vaccine. 8 May 2010; doi:10.1016/j.vaccine.2010.04.076
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-501JWFJ-3&_user=10&_coverDate=05%2F08%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=323b10b638b42ebbef1b6ba58c67ccbb

Abstract. A random population-based telephone survey (n = 301) was conducted among the Hong Kong general population in July 2009. Past history of seasonal influenza vaccination (OR = 2.59–3.13) was associated with intention to take up A/H1N1 vaccination under three hypothetical scenarios (provided at HK$200). Adjusting background variables, other significant factors were identified by stepwise models: perceived side effects (OR = 0.33), family members’ recommendations and friends’ acceptability toward the vaccine (OR = 2.80–4.74). In contrast to other studies on seasonal influenza and A/H1N1 vaccination, perceived susceptibility and perceived severity related to influenza A/H1N1 were non-significant. Cultural differences may therefore exist.

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Oseltamivir-resistant pandemic (H1N1) 2009 in Yemin – case report
Thabet AAK, Al-Bahlooli SH, Al-Kohlani A, et al. Virology Journal. 8 May 2010;7(88): doi:10.1186/1743-422X-7-88
Available at http://www.virologyj.com/content/7/1/88

Background. During the influenza season of 2007-08, oseltamivir-resistant influenza A (H1N1) viruses emerged in several countries in Europe, North America, and Asia. Despite substantial prevalence of oseltamivir-resistant viruses, few data are available on the clinical profile of subjects infected with these viruses. Objectives: to describe the first oseltamivir-resistant (H1N1) influenza virus pandemic 2009 from the Eastern Mediterranean Region including Yemen and to determine the evidence by clinical presentation of children infected with these oseltamivir - resistant viruses. Methodology: History, physical examination and laboratory investigations including Complete Blood Count, chest x-ray, blood cultures, CSF examination, LFTs, RFTs, blood for sugar, H1N1 test and oseltamivir resistance test.

Results. Nasal swabs indicated positivity on both H1N1 test and the RNP gene (Human R Nase P gene that serves as internal positive control for Human RNA. Both clinical specimens presented the mutation S31N in the M2 gene associated with resistance to adamantanes and H274Y in NA gene associated with resistance to oseltamivir. This was the first diagnosed case of resistance to oseltamivir in Yemen and also it is the first reported case of oseltamivir resistance virus in the Eastern Mediterranean Region.

Conclusion. The pattern of resistance found in the oseltamivir resistant isolate collected from Yemen is the same as has been reported elsewhere in other WHO regions. Clinical description and outcomes are not different from what is described elsewhere.

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Monitoring of risk perceptions and correlates of precautionary behavior related to human avian influenza during 2006-2007 in the Netherlands: results of seven consecutive surveys
de Zwart o, Veldhuijzen IK, Richardus JH, et al. BMC Infectious Diseases. 12 May 2010;10(114): doi:10.1186/1471-2334-10-114
Available at http://www.biomedcentral.com/1471-2334/10/114

Background. Avian influenza (AI) is a public health challenge because of ongoing spread and pandemic potential. Non-pharmaceutical measures are important to prevent the spread of AI and to contain a pandemic. The effectiveness of such measures is largely dependent on the behaviour of the population. Risk perception is a central element in changing behaviour. This study aimed to investigate perceived vulnerability, severity and precautionary behaviour related to AI in the Netherlands during seven consecutive surveys in 2006 - 2007 as well as possible trends in risk perception and self-reported precautionary behaviours.

Methods. Seven web-based surveys were conducted including 3,840 respondents over a one-year period. Time trends were analyzed with linear regression analyses. Multivariate analysis was used to study determinants of precautionary behaviour.

Results. While infection with AI was considered a very severe health problem with mean score of 4.57 (scale 1 - 5); perceived vulnerability was much lower, with a mean score of 1.69. While perceived severity remained high, perceived vulnerability decreased slightly during a one-year period covering part of 2006 and 2007. Almost half of the respondents (46%) reported taking one or more preventive measures, with 36% reporting to have stayed away from (wild) birds or poultry. In multivariate logistic regression analysis the following factors were significantly associated with taking preventive measures: time of the survey, higher age, lower level of education, non-Dutch ethnicity, vaccinated against influenza, higher perceived severity, higher perceived vulnerability, higher self efficacy, lower level of knowledge, more information about AI, and thinking more about AI. Self efficacy was a stronger predictor of precautionary behaviour for those who never or seldom think about AI (OR 2.3, 95% CI 1.9 - 2.7), compared to those who think about AI more often (OR 1.5, 95% CI 1.2 - 1.9).

Conclusions. The fact that perceived severity of AI appears to be high and remains so over time offers a good point of departure for more specific risk communications to promote precautionary actions. Such communications should aim at improving knowledge about the disease and preventive actions, and focus on perceived personal vulnerability and self efficacy in taking preventive measures.
[The complete article is available as a provisional PDF.]

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The Origin and Prevention of Pandemics
Pike BL, Saylors KE, Fair JN, et al. Emerging Infections. 7 May 2010;50:000-000:DOI: 10.1086/652860
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/652860

Abstract. Despite the fact that most emerging diseases stem from the transmission of pathogenic agents from animals to humans, the factors that mediate this process are still ill defined. What is known, however, is that the interface between humans and animals is of paramount importance in the process. This review will discuss the importance of the human]animal interface to the disease emergence process. We also provide an overview of factors that are believed to contribute to the origin and global spread of emerging infectious diseases and offer suggestions that may serve as future prevention strategies, such as social mobilization, public health education, behavioral change, and communication strategies. Because there exists no comprehensive global surveillance system to monitor zoonotic disease emergence, the intervention measures discussed herein may prove effective temporary alternatives.

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5. 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 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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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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