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EINet Alert ~ May 21, 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: Pandemic Influenza H1N1 expert panel seeks to review confidential correspondence
- Global: WHO’s Chan welcomes H1N1 pandemic influenza review at start of World Health Assembly
- Global: Results of Second Scientific Consultation on Influenza and Other Emerging Infectious Diseases at the Human-Animal Interface
- Global: Action: Invitation to the World Open Health Assembly 2010 (WOHA 2010)
- Cambodia: Announces second round of pandemic H1N1 influenza vaccinations
- India (Mumbai) Health workers uninterested in H1N1 influenza vaccine
- India (New Delhi): Pandemic H1N1 influenza declining in India
- Malaysia (Kuala Lumpur): 13 more pandemic H1N1 influenza cases reported
- South Korea: Nation to offer free pandemic H1N1 vaccine to soccer fans

2. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA

3. Articles
- Global production of seasonal and pandemic (H1N1) influenza vaccines in 2009-2010 and comparison with previous estimates and global action plan targets
- Failure of Routine Diagnostic Methods to Detect Influenza in Hospitalized Older Adults
- Aerosol influenza transmission risk contours: A study of humid tropics versus winter temperate zone
- Letter: The reluctance of nurses to get vaccinated against influenza
- Perspective: The Public’s Response to the 2009 H1N1 Influenza Pandemic
- Outbreak of Novel Influenza A (H1N1-2009) Linked to a Dance Club
- Seasonal and Pandemic A (H1N1) 2009 influenza vaccination coverage and attitudes among health-care workers in a Spanish University Hospital
- Early Pandemic Influenza (2009 H1N1) in Ho Chi Minh City, Vietnam: A Clinical Virological and Epidemiological Analysis
- A computer simulation of vaccine prioritization, allocation, and rationing during the 2009 H1N1 influenza pandemic
- Letter: Pandemic (H1N1) 2009 influenza in an urban Aboriginal medical service
- Disproportionate impact of pandemic (H1N1) 2009 influenza on Indigenous people in the Top End of Australia’s Northern Territory

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 / 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 05/06/2010 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_05_06/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 16 May 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18,097 deaths.

The current situation is largely unchanged since the last update. The most active areas of pandemic influenza virus transmission currently are in parts of the Caribbean and Southeast Asia. In the temperate zone of the northern and southern hemisphere, overall pandemic influenza activity remains low to sporadic. In central Africa, there has been increased transmission of seasonal influenza type B viruses, accounting for 85% of all influenza isolates in the region. Influenza B also continues to be detected at low levels across parts of Asia and Europe, and has now been reported in Central America.

In the tropical region of the Americas, the most active areas of pandemic influenza virus transmission continue to be in parts of the Caribbean. In Cuba, a second period of active community transmission of pandemic influenza virus began during late February 2010, peaked during late April 2010, and has been declining since; this second period of transmission, although associated with severe and fatal cases, appears to be less intense overall than the first period of transmission which occurred during late September to late November 2009. In contrast, in the Dominican Republic, low to moderate intensity of respiratory diseases activity has been primarily associated with co-circulation of respiratory viruses other than influenza; only sporadic detections of seasonal influenza viruses have been reported. Low levels of pandemic influenza viruses have been circulating across parts of Central America and tropical areas of South America, for example, in Mexico since December 2009, in Colombia and Brazil since early 2010, and in Guatemala since early April 2010. Nicaragua and Honduras have also been recently reporting geographically regional spread of influenza viruses, however, the relative proportions of seasonal influenza, pandemic influenza, and other respiratory virus detections are not known. In contrast, in Panama, low levels of respiratory disease over the past three months have been primarily associated with circulating respiratory viruses other than influenza. Of note, Bolivia experienced a recent period of low but sustained transmission of seasonal influenza type B viruses between late February and early May 2010. There continues to be 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 are in parts of South and Southeast Asia, particularly in Bangladesh, Malaysia, and Singapore. In Malaysia, limited data suggests that a second period of active pandemic influenza virus transmission has been occurring since early April 2010, but overall activity may have recently stabilized and does not appear to exceed pandemic influenza activity seen during an earlier period of transmission lasting from July until early September 2009. In Singapore, levels of ARI have remained elevated since mid April 2010; during the most recent reporting week, levels of ARI exceeded the epidemic threshold and the proportion of patients with ILI testing positive for pandemic influenza virus infection was 39%. In Bangladesh increased co-circulation of pandemic influenza and seasonal influenza type B viruses has been detected since mid April 2010 but now appears to have stabilized. Low level circulation of pandemic influenza continues to persist in Thailand and in the western and southern parts of India; sporadic detection of pandemic influenza continue to be reported in Cambodia and in the Philippines. In East Asia, only sporadic detections of pandemic influenza virus are being reported; seasonal influenza type B viruses have been predominant in this region, however circulation appears to be declining in China and the Republic of Korea.

In the temperate regions of the northern and southern hemisphere, overall pandemic influenza activity remains low to sporadic. In Australia and New Zealand, slight increases in ILI activity were reported; however, in Australia, these increases have been attributed primarily to circulating respiratory viruses other than influenza. In the southern temperate regions of the Americas, only sporadic detections of influenza viruses have been reported, except in Chile, which continues to report localized areas of increased ILI activity (in the Los Lagos area) associated with co-circulation of pandemic influenza and other respiratory viruses. In Europe, very low to sporadic levels of pandemic and seasonal influenza type B viruses continue to be detected. Seasonal influenza type B virus persists mainly in parts of eastern and northern Europe. Georgia reported an increase in the number of respiratory disease consultations due to influenza-like-illness (ILI), mainly in children (under age 5) and school-age children (5-14 years old age group); whether this increase is associated with pandemic influenza A (H1N1) virus is not yet known.

In Sub-Saharan Africa, limited data from several countries suggest that active transmission of pandemic influenza virus in West Africa has now largely subsided. In Ghana, 6% of respiratory samples tested positive for pandemic influenza virus during the most recent reporting week. Across the rest of region, the pandemic influenza virus continues to be detected sporadically or at low levels, most recently in Angola and Rwanda. Sporadic detections of seasonal influenza H3N2 and influenza B viruses have been reported in western, central Africa and to a lesser extent southern Africa.

As of May 12 May 2010, four additional cases of oseltamivir resistant pandemic influenza A (H1N1) 2009 viruses have been reported. It brings the cumulative total to 289 so far. All but one of these have the H275Y substitution and are assumed to remain sensitive to zanamivir.
(WHO 05/21/2010)

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Global: Pandemic Influenza H1N1 expert panel seeks to review confidential correspondence
The 29-member expert panel convened to conduct an independent review of WHO's pandemic response has asked to review confidential correspondence between the agency and vaccine manufacturers. Dr. Harvey Fineberg, chair of the committee and president of the Institute of Medicine, said reviewing all records is necessary to address claims that pharmaceutical companies benefited inappropriately from contracts for vaccines and antivirals that went unused.
(CIDRAP 05/19/2010)

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Global: WHO’s Chan welcomes H1N1 pandemic influenza review at start of World Health Assembly
The World Health Assembly (WHA), the decision-making arm of WHO, opened in Geneva 17 May 2010 with director-general Dr. Margaret Chan praising the accomplishments of global partners with diseases such as smallpox and polio but noting that health officials got lucky with the pandemic H1N1 virus because it has not overwhelmed medical systems and is a good match with the vaccine.

The group is slated to hear an interim report from a 29-member independent WHO panel that was set up earlier this year to review the organization's pandemic response. The report will reflect the group's first meeting, a three-day session that was held in mid April.

One of its missions is to review how the International Health Regulations (IHR) functioned. Designed to guide response to global health threats, the IHR, passed by the WHA, took effect in 2007, and the H1N1 pandemic is the first major test of the rules.

Several elected officials, such as some members of the Council of Europe's Social Affairs Committee, have criticized the WHO's pandemic response as being an overreaction that wasted countries' resources on a vaccine that they say was pushed by pharmaceutical companies. About 200 elected officials who are members of the European Parliament have also signed a petition asking for an inquiry into the world's response to the flu pandemic.

However, during WHA sessions, representatives from some nations, such as France, India, and the United States, publicly defended the WHO's response.

Chan said during her speech that she welcomes the review.

Also on the agenda this year are such topics as sharing of influenza viruses, access to vaccines, intellectual property rights, progress of the WHO's Millennium Development Goals, food safety, and eradication of variola stocks, a component of smallpox eradication.

This year's meeting is the 63rd gathering of the group, which will wrap up its week-long meeting on 21 May 2010.
(CIDRAP 05/17/2010)

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Global: Results of Second Scientific Consultation on Influenza and Other Emerging Infectious Diseases at the Human-Animal Interface
From 27 to 29 April 2010, a group of experts and scientists from the Food and Agriculture Organization of the United Nations (FAO), the World Organization for Animal Health (OIE), and the World Health Organization (WHO) gathered in Verona, Italy to attend the “Second FAO-OIE-WHO Joint Scientific Consultation on Influenza and Other Emerging Infectious Diseases at the Human-Animal Interface."

This scientific consultation attempted to identify commonalities and similarities among emerging infectious diseases, including influenzas, which have arisen at the human-animal interface, through careful examination of disease events reported worldwide. The outcomes of this consultation provided the technical basis for developing or modifying policies and strategies to more effectively prepare for and respond to future disease events.

Given that the last twelve years have seen a fast resurgence of emerging infectious diseases such as Nipah Virus in 1998 in Malaysia, Severe Acute Respiratory Syndrome in early 2003 in China, Highly Pathogenic Avian Influenza from 2004 to 2010 mainly in Southeast Asia but also in Europe and Africa, and Pandemic Influenza A H1N1 in 2009 in Mexico and the United States, there is worldwide fear that more infectious diseases will strike in the future. This dire scenario is not at all unlikely, since it is estimated that 70 percent of emerging infectious diseases affecting humans have their origins in domestic or wild animals.

Moreover, these novel biological threats are rapidly flourishing against a background of security and economic challenges such as rising hunger, climate change, radicalism, terrorism, energy insecurity, unemployment, and recession; all of which cause concern and trepidation in countries around the globe as they tend to impact public health, social order, economic growth, and national security.

Back in 2008, the first joint technical consultation was convened to identify the current knowledge and existing gaps to better understand and respond to zoonotic influenza viruses and the multiple socio-ecological factors at the human-animal interface. This time, it aimed to further broaden its disease coverage while looking judiciously at the past to strategically build new paradigms for the future.

Findings and presentations at: http://www.fao.org/avianflu/en/conferences/verona_2010.html.
(FAO, 05/19/2010)

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Global: Action: Invitation to the World Open Health Assembly 2010 (WOHA 2010)
The World Health Organization (WHO) is governed by the World Health Assembly (WHA), its supreme decision-making body. It generally meets in Geneva in May each year, and is attended by delegations from all 193 Member States. Its main function is to determine the policies of the WHO. The sixty-third WHA, from 17-21 May 2010, had a special emphasis on the achievement of the health-related Millennium Development Goals.

It also addressed some fifty other health issues of concern to the WHO.

What is discussed and decided at the World Health Assembly has an impact on the well-being of all. Yet very few people outside of the Delegates, (governments of 193 countries), WHO personnel and a handful of NGOs are engaged with this meeting as 'stake-holders' - in fact, the vast majority of the world population has never even heard of any of this.

As health is everyone's concern, this important WHA should be more accessible to a wider audience. Towards this, the first World Open Health Assembly (WOHA) was held, online, to connect people from around the globe with the WHA in Geneva. WOHA was conceived just ten days before this year's WHA in face of growing pandemics and shrinking resources for health investments, a rapid-response was organized by the volunteers of the IMAXI Cooperative, a new NGO of innovative people coming together from two different spheres: public health activists and open-source IT developers.

The World Open Health Assembly connected the high level meeting in Geneva with anyone who wanted to learn more about health policy and practice, who may have wanted to get involved in improving the world's health and to have a voice that can be heard by the decision-makers. Reporting live from the World Health Assembly, and relaying the World Open Health Assembly participants' messages to the 'decision-makers', the IMAXI team made WOHA and WHA interactive, in real time. The new beta version of the WOHA website, at www.imaxi.org, was activated for the Official Opening of the WHA.

WOHA 2010 offered live Twitter and RSS feeds, blogs, background documentation from WHO and civil society organizations, and related video clips from You-Tube. This first (rushed) WOHA began the building of WOHA 2011, so that next year's World Health Assembly assembles more of the world.

For more information please refer to http://www.imaxi.org, http://twitter.com/imaxi_woha.
(IMAXI, 05/17/2010)

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Asia
Cambodia: Announces second round of pandemic H1N1 influenza vaccinations
Cambodia's ministry of health announced plans to administer 1.5 million doses of pandemic H1N1 vaccine by the end of May 2010. The new vaccine arrived recently from the World Health Organization. In March 2010 the country received 300,000 doses, which have been administered to high-risk groups.
(CIDRAP 05/20/2010)

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India (Mumbai) Health workers uninterested in H1N1 influenza vaccine
Over 2,000 city-based professionals, who had worked in isolation wards and screening centers when H1N1 virus had first struck India, had consented to taking the vaccine, but none turned up at the swine flu vaccination drive held in Mumbai. The Brihanmumbai Municipal Corporation vaccination program comes 11 months after Mumbai had its first swine flu case. Dr Shah, in charge of swine flu vaccination in Mumbai, said the vaccines are stored at 2-4°C in the EPI department. Before the vaccines were procured from French manufacturer Sanofi Pasteur by the Centre, experts had questioned whether medical professionals did need a vaccine and whether this vaccine, tested abroad, would be safe for Indians.

Some experts had expressed concern that the vaccine could have serious side effects like Guillain-Barre Syndrome (GBS) - a rare disease in which the body damages its own nerve cells, causing muscle weakness and sometimes paralysis.

Of the total 34,000 medical staff in the state working on swine flu cases, only about 5,000 have been willing to take the vaccine.
(Yahoo News, 05/19/2010)

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India (New Delhi): Pandemic H1N1 influenza declining in India
The H1N1 swine flu pandemic has killed over 1,500 Indians till now but the number of people who got infected with this novel virus is much higher — over 30,000.

However, the outbreak seems to be weakening. Health minister Ghulam Nabi Azad said H1N1 cases in the country had dropped in the past few weeks. He said up until 2 May 2010, there have been 1,501 laboratory confirmed deaths due to the pandemic, while 30,581 people have been affected with the virus in the country.

India reported its first swine flu death on 4 August 2009, while the first case was recorded on 16 May 2009.

Director general of Indian Council of Medical Research Dr V M Katoch encouraged India to remain cautious, as he said there could be a pandemic peak in winter 2010.

India, in the meantime, strengthened its laboratory network to test for influenza. When the outbreak first took place in India, the country had two major labs capable of testing for H1N1 infection. At present, there are 45 labs — 24 in the government sector and 19 in the private sector — testing clinical samples.

India has also procured 40 million capsules of Oseltamivir or Tamilfu — an anti-viral drug, of which 21 million were given to states.
(The Times of India, 05/16/2010)

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Malaysia (Kuala Lumpur): 13 more pandemic H1N1 influenza cases reported
Thirteen more influenza A(H1N1) cases were reported as of 18 May 2010, bringing the total cases since the start of the pandemic to 14,479, Health Director-General Tan Sri Dr Mohd Ismail Merican said. He said the ministry also received reports of five influenza-like illness (ILI) clusters in Penang, Perak, Pahang, Terengganu and Sarawak.

A total of 591 ILI patients were still being warded in hospitals nationwide, of whom 70 were tested positive for the illness.
(Bernama, 05/19/2010)

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South Korea: Nation to offer free pandemic H1N1 vaccine to soccer fans
South Korea will offer free H1N1 vaccine to tourists traveling to South Africa for the 2010 World Cup soccer tournament, which begins June 2010. Those interested in the shots should visit state-run clinics throughout the country, the Korea Centers for Disease Control and Prevention said. The first World Cup match is set for 11 Jun 2010.
(CIDRAP 05/17/2010)

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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
ProMED: http://www.promedmail.org/

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AVIAN INFLUENZA
- UN: http://www.undp.org/mdtf/influenza/overview.shtml UNDP’s web site for information on fund management and administrative services. This site also includes a list of useful links.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/
- UN FAO: http://www.fao.org/avianflu/en/index.html. View the latest avian influenza outbreak maps, upcoming events, and key documents on avian influenza H5N1.
- OIE: http://www.oie.int/eng/info_ev/en_AI_avianinfluenza.htm. Link to the Communication Portal gives latest facts, updates, timeline, and more.
- US CDC: Visit "Pandemic Influenza Preparedness Tools for Professionals" at: http://www.cdc.gov/flu/pandemic/preparednesstools.htm. This site contains resources to help health officials prepare for an influenza pandemic.
- The US government’s website for pandemic/avian flu: http://www.flu.gov/. “Flu Essentials” are available in multiple languages.
- CIDRAP: Avian Influenza page: http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- Link to the Avian Influenza Portal at:
http://influenza.bvsalud.org/php/index.php?lang=en. The Virtual Health Library’s Portal is a developing project for the operation of product networks and information services related to avian influenza.
- US National Wildlife Health Center: http://www.nwhc.usgs.gov
/disease_information/avian_influenza/index.jsp Read about the latest news on avian influenza H5N1 in wild birds and poultry.
- FAOAideNews Animal Influenza Disease Emergency Update 66:
http://www.fao.org/docrep/012/ak756e/ak756e00.pdf

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3. Articles
Global production of seasonal and pandemic (H1N1) influenza vaccines in 2009-2010 and comparison with previous estimates and global action plan targets
Partridge J, Kieny MP, WHO H1N1 Influenza Vaccine Task Force. Vaccine. 18 May 2010; doi:10.1016/j.vaccine.2010.04.083
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-503PMS2-1&_user=10&_coverDate=05%2F18%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=600cbd11a2f8b0f39b1e6866d7d072f3

Abstract. Immunization against influenza is considered among the most important interventions in reducing the public health impact of seasonal (inter-pandemic) and pandemic influenza infections. However, there are marked differences across countries with regards to production, supply and access to influenza vaccines. A global action plan (GAP) to increase supply of pandemic influenza vaccine was developed by the World Health Organization in May 2006 to reduce the anticipated gap between potential vaccine demand and supply during an influenza pandemic. To quantify the increase in global influenza vaccine production capacity and actual production in response to the influenza A(H1N1) 2009 pandemic, 3 years after the development of the GAP, the WHO conducted a survey of vaccine producers from December 2009 through February 2010, and compared the results of this survey with results from surveys conducted in 2006–2007 and May 2009.

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Failure of Routine Diagnostic Methods to Detect Influenza in Hospitalized Older Adults
Talbot HK, Williams JV, Zhu Y, et al. Infect Control Hosp Epidemiol. 2010;31;000-00. DOI: 10.1086/653202
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/653202

Objective. To define the utility of using routine diagnostic methods to detect influenza in older, hospitalized adults.

Design. Descriptive study.

Setting. One academic hospital and 1 community hospital during the 2006–2007 and 2007–2008 influenza seasons.

Participants. Hospitalized adults 50 years of age or older.

Methods. Adults who were 50 years of age or older and hospitalized with symptoms of respiratory illness were enrolled and tested for influenza by use of reverse-transcriptase polymerase chain reaction (RT-PCR). Using RT-PCR as the gold standard, we assessed the performances of rapid antigen tests and conventional influenza culture and the diagnostic use of the clinical definition of influenza-like illness.

Results. Influenza was detected by use of RT-PCR in 26 (11%) of 228 patients enrolled in our study. The sensitivity of the rapid antigen test performed at bedside by research staff members was 19.2% (95% confidence interval, 8.51%–37.9%); the sensitivity of conventional influenza culture was 34.6% (95% confidence interval, 19.4%–53.8%). The ability to detect influenza with both the rapid antigen test and culture was associated with patients with a higher viral load (P=.002 and P=.001, respectively). The ability to diagnose influenza by use of the clinical definition of influenza-like illness had a higher sensitivity (80.8%) but lacked specificity (40.6%).

Conclusion. Because rapid antigen testing and viral culture have poor sensitivity (19.2% and 34.6%, respectively), neither testing method is sufficient to use to determine what type of isolation procedures to implement in a hospital setting.

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Aerosol influenza transmission risk contours: A study of humid tropics versus winter temperate zone
Hanley B, Borup B. Virology Journal. 14 May 2010;7:98.
doi:10.1186/1743-422X-7-98
Available at http://www.virologyj.com/content/7/1/98

Background. In recent years, much attention has been given to the spread of influenza around the world. With the continuing human outbreak of H5N1 beginning in 2003 and the H1N1 pandemic in 2009, focus on influenza and other respiratory viruses has been increased. It has been accepted for decades that international travel via jet aircraft is a major vector for global spread of influenza, and epidemiological differences between tropical and temperate regions observed. Thus we wanted to study how indoor environmental conditions (enclosed locations) in the tropics and winter temperate zones contribute to the aerosol spread of influenza by travelers. To this end, a survey consisting of 632 readings of temperature (T) versus relative humidity (RH) in 389 different enclosed locations air travelers are likely to visit in 8 tropical nations were compared to 102 such readings in 2 Australian cities, including ground transport, hotels, shops, offices and other publicly accessible locations, along with 586 time course readings from aircraft.

Results. An influenza transmission risk contour map was developed for T versus RH. Empirical equations were created for estimating: 1. risk relative to temperature and RH, and 2. time parameterized influenza transmission risk. Using the transmission risk contours and equations, transmission risk for each country's locations was compared with influenza reports from the countries. Higher risk enclosed locations in the tropics included new automobile transport, luxury buses, luxury hotels, and bank branches. Most temperate locations were high risk.

Conclusion. Environmental control is recommended for public health mitigation focused on higher risk enclosed locations. Public health can make use of the methods developed to track potential vulnerability to aerosol influenza. The methods presented can also be used in influenza modeling. Accounting for differential aerosol transmission using T and RH can potentially explain anomalies of influenza epidemiology in addition to seasonality in temperate climates.

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Letter: The reluctance of nurses to get vaccinated against influenza
Wicker S, Rabenau HF. Vaccine. 2010. doi:10.1016/j.vaccine.2010.04.095
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-502WTXM-6&_user=616288&_coverDate=05%2F14%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000032378&_version=1&_urlVersion=0&_userid=616288&md5=e8e8e91ecf04a77ed0b196a805444a5f

Extract. Health care workers (HCWs) are at risk of occupational exposure to influenza and may transmit the infection to their patients and co-workers. Despite official recommendations – e.g. from the Centers for Disease Control and Prevention (CDC) in the U.S.A. and the Robert Koch Institute (RKI) in Germany – and the availability of an effective vaccine, low influenza vaccine acceptance among HCWs is a problem detailed in many studies from all over of the world.
[Please refer to link above for remainder of letter.]

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Perspective: The Public’s Response to the 2009 H1N1 Influenza Pandemic

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Outbreak of Novel Influenza A (H1N1-2009) Linked to a Dance Club
Chan PP, Subramony H, Lai FYL, et al. Ann Acad Med Singapore. 2010;39:209-302
Available at http://www.annals.edu.sg/pdf/39VolNo4Apr2010/V39N4p299.pdf

Introduction. This paper describes the epidemiology and control of a community outbreak of novel influenza A (H1N1-2009) originating from a dance club in Singapore between June and July 2009.

Materials and Methods: Cases of novel influenza A (H1N1-2009) were confirmed using in-house probe-based real-time polymerase chain reaction (PCR). Contact tracing teams from the Singapore Ministry of Health obtained epidemiological information from all cases via telephone.

Results. A total of 48 cases were identified in this outbreak, of which 36 (75%) cases were patrons and dance club staff, and 12 (25%) cases were household members and social contacts. Mathematical modeling showed that this outbreak had a reproductive number of 1.9 to 2.1, which was similar to values calculated from outbreaks in naïve populations in other countries.

Conclusion. This transmission risk occurred within an enclosed space with patrons engaged in intimate social activities, suggesting that dance clubs are places conducive for the spread of the virus.

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Seasonal and Pandemic A (H1N1) 2009 influenza vaccination coverage and attitudes among health-care workers in a Spanish University Hospital
Virseda S, Restrepo MA, Arranz E, et al. Vaccine. 2010.
doi:10.1016/j.vaccine.2010.04.101
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-502WTXM-9&_user=582538&_coverDate=05%2F14%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000029718&_version=1&_urlVersion=0&_userid=582538&md5=0fa676cb74b3541d84f3873794482fd9

Abstract. Influenza vaccination coverage among health-care workers (HCWs) remains the lowest compared with other priority groups for immunization. Little is known about the acceptability and compliance with the pandemic (H1N1) 2009 influenza vaccine among HCWs during the current campaign. Between 23 December 2009 and 13 January 2010, once the workplace vaccination program was over, we conducted a cross-sectional, questionnaire-based survey at the University Hospital 12 de Octubre (Madrid, Spain). Five hundred twenty-seven HCWs were asked about their influenza immunization history during the 2009–2010 season, as well as the reasons for accepting or declining either the seasonal or pandemic vaccines. Multiple logistic-regression analysis was preformed to identify variables associated with immunization acceptance. A total of 262 HCWs (49.7%) reported having received the seasonal vaccine, while only 87 (16.5%) affirmed having received the pandemic influenza (H1N1) 2009 vaccine. “Self-protection” and “protection of the patient” were the most frequently adduced reasons for acceptance of the pandemic vaccination, whereas the existence of “doubts about vaccine efficacy” and “fear of adverse reactions” were the main arguments for refusal. Simultaneous receipt of the seasonal vaccine (odds ratio [OR]: 0.27; 95% confidence interval [95% CI]: 0.14–0.52) and being a staff (OR: 0.08; 95% CI: 0.04–0.19) or a resident physician (OR: 0.16; 95% CI: 0.05–0.50) emerged as independent predictors for pandemic vaccine acceptance, whereas self-reported membership of a priority group was associated with refusal (OR: 5.98; 95% CI: 1.35–26.5). The pandemic (H1N1) 2009 influenza vaccination coverage among the HCWs in our institution was very low (16.5%), suggesting the role of specific attitudinal barriers and misconceptions about immunization in a global pandemic scenario.

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Early Pandemic Influenza (2009 H1N1) in Ho Chi Minh City, Vietnam: A Clinical Virological and Epidemiological Analysis
Hien TT, Boni MF, Bryant JE, et al. PLoS Med. 2010; 7(5): e1000277.
doi:10.1371/journal.pmed.1000277
Available at http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000277

Background. To date, little is known about the initial spread and response to the 2009 pandemic of novel influenza A (“2009 H1N1”) in tropical countries. Here, we analyse the early progression of the epidemic from 26 May 2009 until the establishment of community transmission in the second half of July 2009 in Ho Chi Minh City (HCMC), Vietnam. In addition, we present detailed systematic viral clearance data on 292 isolated and treated patients and the first three cases of selection of resistant virus during treatment in Vietnam.

Methods and Findings. Data sources included all available health reports from the Ministry of Health and relevant health authorities as well as clinical and laboratory data from the first confirmed cases isolated at the Hospital for Tropical Diseases in HCMC. Extensive reverse transcription (RT)-PCR diagnostics on serial samples, viral culture, neuraminidase-inhibition testing, and sequencing were performed on a subset of 2009 H1N1 confirmed cases. Virological (PCR status, shedding) and epidemiological (incidence, isolation, discharge) data were combined to reconstruct the initial outbreak and the establishment of community transmission. From 27 April to 24 July 2009, approximately 760,000 passengers who entered HCMC on international flights were screened at the airport by a body temperature scan and symptom questionnaire. Approximately 0.15% of incoming passengers were intercepted, 200 of whom tested positive for 2009 H1N1 by RT-PCR. An additional 121 out of 169 nontravelers tested positive after self-reporting or contact tracing. These 321 patients spent 79% of their PCR-positive days in isolation; 60% of PCR-positive days were spent treated and in isolation. Influenza-like illness was noted in 61% of patients and no patients experienced pneumonia or severe outcomes. Viral clearance times were similar among patient groups with differing time intervals from illness onset to treatment, with estimated median clearance times between 2.6 and 2.8 d post-treatment for illness-to-treatment intervals of 1–4 d, and 2.0 d (95% confidence interval 1.5–2.5) when treatment was started on the first day of illness.

Conclusions. The patients described here represent a cross-section of infected individuals that were identified by temperature screening and symptom questionnaires at the airport, as well as mildly symptomatic to moderately ill patients who self-reported to hospitals. Data are observational and, although they are suggestive, it is not possible to be certain whether the containment efforts delayed community transmission in Vietnam. Viral clearance data assessed by RT-PCR showed a rapid therapeutic response to oseltamivir.

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A computer simulation of vaccine prioritization, allocation, and rationing during the 2009 H1N1 influenza pandemic
Lee BY, Brown ST, Korch G, et al. Vaccine. 2010.
doi:10.1016/j.vaccine.2010.05.002
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-50396K8-2&_user=10&_coverDate=05%2F16%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=e23d6205cd2734975fef2f994bde95ca

Abstract. In the fall 2009, the University of Pittsburgh Models of Infectious Disease Agent Study (MIDAS) team employed an agent-based computer simulation model (ABM) of the greater Washington, DC, metropolitan region to assist the Office of the Assistant Secretary of Public Preparedness and Response, Department of Health and Human Services, to address several key questions regarding vaccine allocation during the 2009 H1N1 influenza pandemic, including comparing a vaccinating children (i.e., highest transmitters)—first policy versus the Advisory Committee on Immunization Practices (ACIP)—recommended vaccinating at-risk individuals-first policy. Our study supported adherence to the ACIP (instead of a children-first policy) prioritization recommendations for the H1N1 influenza vaccine when vaccine is in limited supply and that within the ACIP groups, children should receive highest priority.

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Letter: Pandemic (H1N1) 2009 influenza in an urban Aboriginal medical service
Herceg A, Sharp PG, Arther CG, et al. The Medical Journal of Australia. 2010;192(10):623
Available at http://www.mja.com.au/public/issues/192_10_170510/her10074_fm.html

Extract. Aboriginal and Torres Strait Islander people were more at risk of hospitalisation, admission to intensive care units and death during the 2009 influenza A pandemic than non-Indigenous Australians. We conducted a descriptive analysis of our response to the pandemic at Winnunga Nimmityjah Aboriginal Health Service (Winnunga) — an Aboriginal community controlled health service in Canberra, Australian Capital Territory, which provides comprehensive primary health care to more than 3500 patients per year. Data were sourced from the Winnunga electronic patient record system, pathology laboratories and ACT Health. The Winnunga Board approved this analysis and report for publication.
[Refer to link for rest of letter]

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Disproportionate impact of pandemic (H1N1) 2009 influenza on Indigenous people in the Top End of Australia’s Northern Territory
Flint SM, Davis JS, Su J-Y, et al. The Medical Journal of Australia. 2010;192(10):617-622
Available at http://www.mja.com.au/public/issues/192_10_170510/fli10103_fm.html

Objective: To describe the impact of pandemic (H1N1) 2009 influenza (nH1N1) on Indigenous people in the Top End of the Northern Territory at community, hospital and intensive care unit (ICU) levels.

Design, setting and participants. We analysed influenza notifications for the Top End from 1 June to 31 August 2009, as well as data on patients admitted through Top End emergency departments with an influenza-like illness. In addition, data on patients with nH1N1 who were admitted to Royal Darwin Hospital (RDH) and the RDH ICU were prospectively collected and analysed.

Main outcome measures. Age-adjusted notification rates for nH1N1 cases, Top End hospital admission rates for patients with nH1N1 and RDH ICU admission rates for patients with nH1N1, stratified by Indigenous status.

Results. There were 918 nH1N1 notifications during the study period. The age-adjusted hospital admission rate for nH1N1 was 82 per 100 000 (95% CI, 68–95) estimated resident population (ERP) overall, with a markedly higher rate in the Indigenous population compared with the non-Indigenous population (269 per 100 000 versus 29 per 100 000 ERP; adjusted incidence rate ratio, 12 [95% CI, 7.8–18]). Independent predictors of ICU admission compared with hospitalisation were hypoxia (adjusted odds ratio [aOR], 4.5; CI, 1.5–13.1) and chest x-ray infiltrates (aOR, 4.3; CI, 1.5–12.6) on hospital admission.

Conclusions. Pandemic (H1N1) 2009 influenza had a disproportionate impact on Indigenous Australians in the Top End, with hospitalisation rates higher than those reported elsewhere in Australia and overseas. These findings have implications for planning hospital and ICU capacity during an influenza pandemic in regions with large Indigenous populations. They also confirm the need to improve health and living circumstances and to prioritise vaccination in this population.

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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 held in Beijing to provide platform for scientific exchange between Chinese and international experts.
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
CDC Guidance for Day and Residential Camp Responses to Influenza during the 2010 Summer Camp Season
Released 17 May 2010
Available at http://www.cdc.gov/h1n1flu/camp.htm/?date=051810

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