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EINet Alert ~ Jun 04, 2010


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

1. Influenza News
- Global: WHO situation update on pandemic influenza H1N1
- 2010 Cumulative number of human cases of avian influenza A/H5N1
- Global: WHO Director-General statement following the eighth meeting of the Emergency Committee
- Australia: H1N1 pandemic influenza-vaccine probe confirms increased reactions in small children
- Malaysia (Kuala Lumpur): 14 new cases of pandemic H1N1 influenza
- Singapore: Elevated numbers of H1N1 pandemic influenza cases
- Canada (Ottawa): Canadian provinces report failure of H1N1 Influenza Vaccination Program
- Costa Rica (San Jose): H1N1 influenza cases on rise
- Ghana (Eastern region): H1N1 influenza outbreak in second school

2. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA

3. Articles
- Global Migration Dynamics Underlie Evolution and Persistence of Human Influenza A (H3N2)
- Studies Needed to Address Public Health Challenges of the 2009 H1N1 Influenza Pandemic: Insights from Modeling
- A lower than expected adult Victorian community attack rate for pandemic (H1N1) 2009
- Avoidance behaviors and negative psychological responses in the general population in the initial stage of the H1N1 pandemic in Hong Kong
- Letter: Moral panic and pandemics
- Mass psychogenic illness in nationwide in-school vaccination for pandemic influenza A(H1N1) 2009, Taiwan, November 2009-January 2010
- The 2009 A (H1N1) influenza virus pandemic: A review
- Influence of country of study on student responsiveness to the H1N1 pandemic
- Assessing the role of contact tracing in a suspected H7N2 influenza A outbreak in humans in Wales
- High costs of influenza: Direct medical costs of influenza disease in young children

4. Notifications
- 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


1. Influenza News

Global
Global: WHO situation update on pandemic influenza H1N1
As of 30 May 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18,138 deaths.

Active but declining transmission of pandemic influenza virus continued to be detected in parts of the Caribbean and Southeast Asia. In the countries of temperate southern hemisphere there is no evidence yet to suggest that the winter influenza season has begun, however there has been limited localized pandemic influenza virus transmission in Chile. In the rest of the world, overall pandemic influenza virus transmission remains low. Seasonal influenza B viruses are currently the predominant type of influenza virus circulating globally, although at low levels. Of note, during the later part of May 2010, low but significant levels of predominantly seasonal influenza H3N2 viruses have been detected in several countries of East Africa.

In the tropical zone of the Americas, the most active areas of pandemic influenza virus transmission continue to be in parts of the Caribbean. In Cuba, pandemic influenza virus transmission has begun to decline after plateauing since mid-April 2010. In both Costa Rica and Columbia, there has been persistence of low level circulation of pandemic influenza virus since the beginning of 2010. Sporadic detections of pandemic and other seasonal influenza viruses, particularly type B, have been reported from several countries in the region during May 2010. Other respiratory viruses, for example RSV, are known to be circulating to varying extents in different countries across the region.

In Asia, the most active areas of pandemic influenza virus transmission currently are in parts of South and Southeast Asia, particularly in Singapore and Malaysia, and to a lesser extent in Bangladesh. In Singapore, during the last week of May 2010, levels of ARI fell below the epidemic threshold and the proportion of respiratory samples testing positive for pandemic influenza fell from 39% to 29%. In Malaysia and Bangladesh, the numbers of new cases reported per week have been relative stable for the past six and three weeks, respectively, suggesting stable persistence of low level pandemic virus circulation during the past month in these areas. Very low levels of pandemic influenza virus also continue to circulate in parts of western and southern India, and in parts of Thailand. Sporadic detections of pandemic influenza virus have been reported in many countries across the region during the past month. In East Asia, overall influenza activity remains low, however, seasonal influenza B viruses continue to circulate at low and declining levels across the region.

In Sub-Saharan Africa, active but declining levels of pandemic influenza virus transmission continue to be detected in parts of West Africa, most notably in Ghana. During the most recent reporting week, 15% of all respiratory samples tested positive for pandemic influenza virus in Ghana. Sporadic detections of seasonal influenza B continue to be reported in central Africa. Of note, low but significant numbers of seasonal H3N2 viruses were recently detected in Kenya (6 of 57 respiratory samples tested) and Tanzania (13 of 25 respiratory samples tested) during the most recent reporting week.

Overall, in the temperate regions of the northern and southern hemisphere, pandemic influenza viruses have been detected only sporadically during the past month. In the temperate southern hemisphere, Chile is the only country to recently report small number of pandemic influenza cases in a few areas of the country suggesting that overall transmission is currently limited. Other respiratory viruses, most notably RSV, are known to be circulating in Chile, Paraguay, and Argentina. There have been no recent detections of pandemic influenza virus in South Africa. In New Zealand and Australia, overall levels of ILI remain low; only sporadic detections of seasonal and pandemic influenza viruses have been recently reported in Australia.
(WHO 06/04/2010)

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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/)

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 Director-General statement following the eighth meeting of the Emergency Committee
The Emergency Committee held its eighth meeting by teleconference on 1 June 2010.

A global update was provided to the Committee on the pandemic situation, including a particular focus on developments in Africa and the Southern Hemisphere. The most active areas of pandemic influenza virus transmission are currently in tropical areas, primarily in parts of the Caribbean and Southeast Asia. These areas are now experiencing a relatively low level of resurgence of cases after experiencing more intense activity during July 2009. In temperate zones of the Southern Hemisphere, countries are not reporting increases in influenza activity above epidemic thresholds, or unusually early influenza activity. Pandemic influenza activity across the African continent is low or sporadic; data from West Africa indicates that the active transmission of pandemic influenza virus has largely subsided after peaking during February and March 2010.

After extensive discussions and questions, the Committee expressed the unanimous view that from a global perspective while pandemic activity is continuing, the period of most intense pandemic activity appears likely to have passed for many parts of the world. Committee members stressed that it remains critical for countries to continue to maintain vigilance concerning the pandemic, including all necessary public health measures for disease control as well as influenza virus and disease surveillance.

Following the advice of the Emergency Committee, the Director-General determined that while the period of most intense pandemic activity has passed, pandemic disease is expected to continue to occur and that a further meeting of the Emergency Committee to reassess the epidemiological situation would be convened by mid July 2010, when information from the winter influenza season in the Southern Hemisphere will be available.

On a separate issue, the Director-General noted that the secretariat is following the practice of the Organization for public disclosure of the names of the Emergency Committee members to take place once the work of the Committee had been completed. The purpose of this practice is to protect the integrity and independence of the Members while doing this critical work - but also to ensure transparency by publicly providing the names of the members as well as information about any interest declared by them at the appropriate time. The Committee Members strongly concurred with this approach.
(WHO 06/03/2010)

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Asia
Australia: H1N1 pandemic influenza-vaccine probe confirms increased reactions in small children
Australia's chief medical officer renewed his advice for clinicians to suspend seasonal flu vaccination for healthy children younger than five after national investigations confirmed higher-than-expected rates of fever and convulsions after immunization in that age-group.

Dr Jim Bishop said on 1 June 2010 that the reactions in younger children have been linked mainly to Fluvax, made by Australian producer CSL Ltd. Investigations by the country's drug regulator, its vaccine advisory group, and the National Center for Immunization Research and Surveillance found no clinical, biological, or epidemiologic factors that would explain the higher rates of fever with convulsion. The groups put the rate at nine per 1,000 children vaccinated, versus an expected rate of less than one in 1,000.

Bishop's statement prompted an announcement from CSL 1 June 2010 that it was pulling remaining doses of its vaccine from medical clinics and distributors and that it would alert doctors about Bishop's advice and the results so far of investigations into the increased rates of adverse events.

When reports of fever and convulsion first surfaced in April 2010, they were mainly concentrated in Western Australia, where children are eligible to receive free seasonal flu vaccination. Since then, further investigations have revealed similar findings across the country, Bishop said.

The CSL trivalent vaccine is an inactivated split-virus product that does not include an adjuvant. The pandemic H1N1 virus is one of the three flu strains covered by the vaccine.

Bishop said two other flu vaccines for children are used in Australia, Influvac, made by Solvay Biologicals, and Vaxigrip, made by Sanofi Pasteur, but too few doses of them have been administered to accurately determine if they are linked to similar rates of fever and convulsion.

Dr Darryl Maher, CSL's medical and research director, said that the safety profile of CSL vaccines has been well established after 40 years of manufacturing and testing. CSL will continue to work with authorities to find an explanation for the higher rates of fever and convulsion.

Bishop advised parents of young children with underlying medical conditions to talk to their doctors about weighing the risks and benefits of seasonal flu vaccination in 2010. He added that monovalent pandemic H1N1 vaccine is an option for both healthy children and those who have risk factors, because the adverse events are in line with expected rates.

Australian regulators will continue to work with overseas counterparts and the US Centers for Disease Control and Prevention to investigate possible reasons for the higher rates of adverse events in children.
(CIDRAP 06/01/2010)

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Malaysia (Kuala Lumpur): 14 new cases of pandemic H1N1 influenza
Fourteen new Influenza A(H1N1) positive cases were reported during 2 June 2010 nationwide, increasing the total number of cases thus far to 14,864 cases, said Director-general of Health Tan Sri Dr Mohd Ismail Merican.

One influenza-like illness (ILI) cluster case was also detected 2 June 2010 at SMK Jalan Bukit, Kajang, Selangor whereby one of the four patients were tested positive for A(H1N1).

Dr Mohd Ismail said 540 ILI cases were being treated in hospitals throughout the country and from the total, 45 or 8.3 per cent were confirmed A(H1N1) positive cases.

He said currently four H1N1 cases were being treated at the Intensive Care Units (ICU) where all the patients had high risk factor but the number of deaths remains at 87.
(Bernama 06/03/2010)

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Singapore: Elevated numbers of H1N1 pandemic influenza cases
The epidemic season has hit Singapore as the number of flu cases surged 27 May 2010. Although this has been a traditionally high season for influenza and colds collectively called acute respiratory infection [ARI], the number of people with the sniffles has been at epidemic, or near-epidemic levels for the past six weeks. A high of 18,420 people sought treatment for the flu at government health polyclinics the week of 17 May 2010, or 4,000 more patients a week than the norm for this time of the year.

Many of the flu cases involve the pandemic A (H1N1) strain. According to the Ministry of Health, 29 percent of patients in Singapore with flu-like symptoms the week of 17 May 2010 had pandemic H1N1 virus infection.

Also worrying is the higher number of patients turning up with pneumonia, a more severe form of upper respiratory tract infection. Pneumonia is the third biggest killer in Singapore, after cancer and heart disease accounting for more than 2,000 deaths in 2008.

In Singapore, levels of ARI have remained elevated since mid April 2010; during the week of 26 May 2010, levels of ARI exceeded the epidemic threshold and the proportion of patients with ILI [influenza-like illness] testing positive for pandemic influenza virus infection was 39 percent.
(ProMED 05/30/2010)

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Americas
Canada (Ottawa): Canadian provinces report failure of H1N1 Influenza Vaccination Program
More Canadian provinces are following Ontario’s declaration that the country’s Influenza A (H1N1) vaccination program could have been improved in their areas. The growing list includes Manitoba – which equaled Ontario’s record of only 38 percent vaccination – and Alberta, which logged the lowest immunization rate at 35 percent.

Provinces that had better swine flu immunization rates were Newfoundland and Labrador with 70 percent and New Brunswick, with 65 percent.

Health officials and experts said the reasons behind the low vaccination rates were the failure to communicate the risks of the pandemic and the safety of the shots, priority guidelines that were not followed by some provinces and the federal government’s failure to inform the provinces of weekly H1N1 vaccine supply.

As a result of the low immunization rates, some provinces such as Ontario and Alberta, are reviewing their provincial immunization programs. Canadian Chief Public Health Officer Dr. David Butler-Jones is studying the variations in vaccination rates yielded by the Canadian provinces.

Despite the low vaccination rates, overall influenza activity across Canada has weakened since the start of 2010, according to the Public Health Agency of Canada. For the third week of May, Canada registered only three positive influenza specimens across the country. Two were in Ontario and one in Alberta.
(AHN 06/03/2010)

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Costa Rica (San Jose): H1N1 influenza cases on rise
The A(H1N1) flu virus, which is mainly affecting children and has caused the death of 56 people in Costa Rica, has experienced a slight upturn, sanitary authorities reported 28 May 2010.

According to local Public Health Minister Maria Luisa Avila, in the last few days the presence of the virus has grown in several areas of the country. In the provinces of San José, Carthago and Alajuela, and in the metropolitan areas of Costa Rica, doctors have registered at least 50 cases per week.

The Central American nation experienced a similar outbreak in March, with slight increases in susceptible populations, including pregnant women, asthmatics and those with other breathing problems.
(Prensa Latina 05/28/2010)

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Africa
Ghana (Eastern region): H1N1 influenza outbreak in second school
A wave of (H1N1) influenza (swine flu) has hit another Eastern Region School, Aburi Presbyterian Senior High School, and over 80 students are believed to have been infected. This comes barely a week after over 170 students of the St. Martin's Senior High School at Adoagyire in the same district were diagnosed with the diseases.

Reports say the over 80 infected students of the Aburi Presbyterian SHS have been quarantined in one of the dormitories in the school. One of the female students alleged that the school authorities do not want their parents to know about the outbreak in the school.

The Eastern Regional Director of the Ghana Health Services (GHS), Dr. Erasmus Adongo, confirmed the disease’s presence, but explained that the situation is under control. He said that figures were not available, but that the District Director said the samples that were sent to Noguchi tested (H1N1)-positive, and that the situation is being monitored.

Dr. Adongo said that all the students who were infected at the St. Martin's SHS in Adoagyire have been treated and discharged.

[ProMED note: The Eastern Region in Ghana continues to experience increased transmission of pandemic (H1N1) virus in schools. As indicated in a previous posting (ProMED-EAFR 20100524.207546), we continue to see a communication gap between the school and health authorities on one part and the parents of the affected children on the other. This is critical for the success of the outbreak control interventions and avoiding unnecessary anxiety among the parents and the general public.]
(ProMED 05/29/2010)

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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/en/what-we-do/health-topics/diseases-and-conditions/influenza/pandemic-h1n1-2009
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.

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3. Articles
Global Migration Dynamics Underlie Evolution and Persistence of Human Influenza A (H3N2)
Bedford T, Cobey S, Beerli P, et al. PLoS Pathog. 27 May 2010;6(5): e1000918. doi:10.1371/journal.ppat.1000918
Available at http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1000918

Abstract. The global migration patterns of influenza viruses have profound implications for the evolutionary and epidemiological dynamics of the disease. We developed a novel approach to reconstruct the genetic history of human influenza A (H3N2) collected worldwide over 1998 to 2009 and used it to infer the global network of influenza transmission. Consistent with previous models, we find that China and Southeast Asia lie at the center of this global network. However, we also find that strains of influenza circulate outside of Asia for multiple seasons, persisting through dynamic migration between northern and southern regions. The USA acts as the primary hub of temperate transmission and, together with China and Southeast Asia, forms the trunk of influenza's evolutionary tree. These findings suggest that antiviral use outside of China and Southeast Asia may lead to the evolution of long-term local and potentially global antiviral resistance. Our results might also aid the design of surveillance efforts and of vaccines better tailored to different geographic regions.

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Studies Needed to Address Public Health Challenges of the 2009 H1N1 Influenza Pandemic: Insights from Modeling
Van Kerkhove MD, Asikainen T, Becker NG, et al. PLoS Med. 1 June 2010;7(6): e1000275. doi:10.1371/journal.pmed.1000275
Available at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000275

Summary. As the global epidemiology of the pandemic (H1N1) 2009 influenza (H1N1pdm) virus strain unfolds into 2010, substantial policy challenges will continue to present themselves for the next 12 to 18 months.

Here, we anticipate six public health challenges and identify data that are required for public health decision making: Measuring age-specific immunity to infection; accurately quantifying severity; improving treatment outcomes for severe cases; quantifying the effectiveness of interventions; capturing the full impact of the pandemic on mortality; and rapidly identifying and responding to antigenic variants.

Representative serological surveys stand out as a critical source of data with which to reduce uncertainty around policy choices for both pharmaceutical and nonpharmaceutical interventions after the initial wave has passed.

Continuing to monitor the time course of incidence of severe H1N1pdm cases will give a clear picture of variability in underlying transmissibility of the virus during population-wide changes in behavior such as school vacations and other nonpharmaceutical interventions.

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A lower than expected adult Victorian community attack rate for pandemic (H1N1) 2009
Grills N, Piers LS, Barr I, et al. Australian and New Zealand Journal of Public Health. 1 June 2010;34(3):228-231
Available at http://www3.interscience.wiley.com/journal/123489786/abstract?CRETRY=1&SRETRY=0

Objectives: To determine the community seropositivity of pandemic (H1N1) 2009 influenza in order to estimate immunity and the community attack rate.

Methods: Selected clusters of participants (n=706) in the 'Victorian Health Monitor' (VHM), from whom blood samples were taken between August and October 2009, were tested opportunistically for antibodies to pandemic (H1N1) 2009 influenza virus. A titre of ¡Ý1:40 was chosen as the cut-off for recording seropositivity. The proportion (95% CI) of seropositive participants, aged 18 to <65 years of age, were computed for groups of census collection districts (CDs) across metropolitan Melbourne.

Results: The observed pandemic (H1N1) 2009 seropositivity rates for all CDs tested in metropolitan Melbourne was 16.0% (95% CI:12.9-19.1%); in northern Melbourne subset was 14.4% (95% CI:12.4-16.3%); and in eastern subset was 16.2% (95% CI:9.7-22.6%). The pre-pandemic (H1N1) 2009 positivity rate was estimated at 6%.

Conclusion: Given this study's estimate of 16.0% seropositivity in adults in metropolitan Melbourne, and given the WHO laboratory's estimate of 6% pre-pandemic positivity, the estimated adult community attack rate was 10% for metropolitan Melbourne.

Implications: This community attack rate is lower than anticipated and suggests that levels of immunity to Pandemic (H1N1) 2009 might be lower than anticipated. Although limited by a low response rate of 34%, this study suggests low adult seropositivity, which may be useful for public health professionals when encouraging the community to get vaccinated.

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Avoidance behaviors and negative psychological responses in the general population in the initial stage of the H1N1 pandemic in Hong Kong
Lau JTF, Griffiths S, Choi K-C, et al. BMC Infect Dis. 28 May 2010;10:139. doi:10.1186/1471-2334-10-139
Available at http://www.biomedcentral.com/1471-2334/10/139/abstract

Background. During the SARS pandemic in Hong Kong, panic and worry were prevalent in the community and the general public avoided staying in public areas. Such avoidance behaviors could greatly impact daily routines of the community and the local economy. This study examined the prevalence of the avoidance behaviors (i.e. avoiding going out, visiting crowded places and visiting hospitals) and negative psychological responses of the general population in Hong Kong at the initial stage of the H1N1 epidemic.

Methods. A sample of 999 respondents was recruited in a population-based survey. Using random telephone numbers, respondents completed a structured questionnaire by telephone interviews at the 'pre-community spread phase' of the H1N1 epidemic in Hong Kong.

Results. This study found that 76.5% of the respondents currently avoided going out or visiting crowded places or hospitals, whilst 15% felt much worried about contracting H1N1 and 6% showed signs of emotional distress. Females, older respondents, those having unconfirmed beliefs about modes of transmissions, and those feeling worried and emotionally distressed due to H1N1 outbreak were more likely than others to adopt some avoidance behaviors. Those who perceived high severity and susceptibility of getting H1N1 and doubted the adequacy of governmental preparedness were more likely than others to feel emotionally distressed.

Conclusions. The prevalence of avoidance behaviors was very high. Cognitions, including unconfirmed beliefs about modes of transmission, perceived severity and susceptibility were associated with some of the avoidance behaviors and emotional distress variables. Public health education should therefore provide clear messages to rectify relevant perceptions.

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Letter: Moral panic and pandemics
Gilman SL. The Lancet. 29 May 2010;375(9729):1866-1867.
doi:10.1016/S0140-6736(10)60862-8
Available at http://www.thelancet.com/journals/lancet/article/PIIS0140673610608628/fulltext

Excerpt. On May 21, 2009, WHO's Director-General, Margaret Chan decided that influenza A (H1N1) was not going to become a pandemic. Not because of any epidemiological rationale but because the very term “pandemic” was feared to trigger global panic. “Swine flu” would have become a stage six pandemic on that date. But Chan observed that “I know that you have given me a lot of trust and flexibility, and this is not an easy task. I need to balance how science should play a role and not to forget about the people.” Not “science” but public response was the key to the rethinking of what our present outbreak of H1N1 should be labelled. By June 11, 2009, H1N1 was a designated pandemic. This too had its political dimension with medical consequences.
[For remainder of letter, please refer to link above.]

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Mass psychogenic illness in nationwide in-school vaccination for pandemic influenza A(H1N1) 2009, Taiwan, November 2009-January 2010
Huang WT, Hsu CC, Lee PI, et al. Eurosurveillance. 27 May 2010;15(21)
Available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19575

Abstract. From 16 November 2009 to 22 January 2010, Taiwan investigated 23 clusters of mass psychogenic illness after vaccination (MPIV) in the nationwide in-school vaccination programme against the 2009 pandemic influenza A(H1N1). The median age of the 350 ill students (68% female) was 13 years. Intense media coverage of these events has driven public concerns about the safety of the pandemic influenza vaccine. In the future, countries should incorporate surveillance and communication strategies for MPIV in their pandemic preparedness plans.

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The 2009 A (H1N1) influenza virus pandemic: A review
Girard MP, Tam JS, Assossou OM, et al. Vaccine. 27 May 2010.
doi:10.1016/j.vaccine.2010.05.031
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-505N6YR-1&_user=616288&_coverDate=05%2F27%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000032378&_version=1&_urlVersion=0&_userid=616288&md5=37ab9c3dbf28765d3ca348aa46140c68

Abstract. In March and early April 2009 a new swine-origin influenza virus (S-OIV), A (H1N1), emerged in Mexico and the USA. The virus quickly spread worldwide through human-to-human transmission. In view of the number of countries and communities which were reporting human cases, the World Health Organization raised the influenza pandemic alert to the highest level (level 6) on June 11, 2009. The propensity of the virus to primarily affect children, young adults and pregnant women, especially those with an underlying lung or cardiac disease condition, and the substantial increase in rate of hospitalizations, prompted the efforts of the pharmaceutical industry, including new manufacturers from China, Thailand, India and South America, to develop pandemic H1N1 influenza vaccines. All currently registered vaccines were tested for safety and immunogenicity in clinical trials on human volunteers. All were found to be safe and to elicit potentially protective antibody responses after the administration of a single dose of vaccine, including split inactivated vaccines with or without adjuvant, whole-virion vaccines and live-attenuated vaccines. The need for an increased surveillance of influenza virus circulation in swine is outlined.

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Influence of country of study on student responsiveness to the H1N1 pandemic
Griffiths SM, Wong AH, Kim JH, et al. Public Health. 26 May 2010.
doi:10.1016/j.puhe.2010.03.027
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B73H6-505FHTH-1&_user=582538&_coverDate=05%2F26%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000029718&_version=1&_urlVersion=0&_userid=582538&md5=e0bbf05215aeddd73faff914f4e6b1ae

Objectives. University students, both travelling abroad on holiday or exchange students entering a country, can serve as mobile carriers of infectious diseases during a pandemic, and thus require special attention when considering preventive measures. The objectives of this study were to evaluate student compliance and opinions on preventive measures of a university before and during an H1N1 influenza pandemic, and to explore environmental and behavioural factors that might contribute towards compliance.

Study design. Cross-sectional, self-administered questionnaire.

Methods. Local and foreign students attending an international summer school programme were invited to participate in a self-administered survey.

Results. Respondents complied with most of the preventive measures, excluding website viewing and mask wearing. Significant differences in compliance and perceived necessity were found amongst students from Singapore, Hong Kong and the USA. Singaporean students were significantly more likely to comply with all measures and consume antiviral medication in response to the pandemic than students studying in the US.

Conclusions. Students’ responses towards university pandemic measures were largely positive, but sensitivity towards these measures varied between groups by country of study. This should be considered in further comparative studies.

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Assessing the role of contact tracing in a suspected H7N2 influenza A outbreak in humans in Wales
Eames KTD, Webb C, Thomas K, et al. BMC Infect Dis. 28 May 2010;10:141. Doi:10.1186/1471-2334-10-141
Available at http://www.biomedcentral.com/1471-2334/10/141/abstract

Background. The detailed analysis of an outbreak database has been undertaken to examine the role of contact tracing in controlling an outbreak of possible avian influenza in humans. The outbreak, initiating from the purchase of infected domestic poultry, occurred in North Wales during May and June 2007. During this outbreak, extensive contact tracing was carried out. Following contact tracing, cases and contacts believed to be at risk of infection were given treatment/prophylaxis.

Methods. We analyse the database of cases and their contacts identified for the purposes of contact tracing in relation to both the contact tracing burden and effectiveness. We investigate the distribution of numbers of contacts identified, and use network structure to explore the speed with which treatment/prophylaxis was made available and to estimate the risk of transmission in different settings.

Results. Fourteen cases of suspected H7N2 influenza A in humans were associated with a confirmed outbreak among poultry in May-June 2007. The contact tracing dataset consisted of 254 individuals (cases and contacts, of both poultry and humans) who were linked through a network of social contacts. Of these, 102 individuals were given treatment or prophylaxis. Considerable differences between individuals' contact patterns were observed. Home and workplace encounters were more likely to result in transmission than encounters in other settings. After an initial delay, while the outbreak proceeded undetected, contact tracing rapidly caught up with the cases and was effective in reducing the time between onset of symptoms and treatment/prophylaxis.

Conclusions. Contact tracing was used to link together the individuals involved in this outbreak in a social network, allowing the identification of the most likely paths of transmission and the risks of different types of interactions to be assessed. The outbreak highlights the substantial time and cost involved in contact tracing, even for an outbreak affecting few individuals. However, when sufficient resources are available, contact tracing enables cases to be identified before they result in further transmission and thus possibly assists in preventing an outbreak of a novel virus.

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High costs of influenza: Direct medical costs of influenza disease in young children
Fairbrother G, Cassedy A, Ortega-Sanchez IR, et al. Vaccine. doi:10.1016/j.vaccine.2010.05.036
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-506R1G7-1&_user=582538&_coverDate=06%2F01%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000029718&_version=1&_urlVersion=0&_userid=582538&md5=1baf3db613dfd0f64de31c9490ceee00

Abstract. This study determined direct medical costs for influenza-associated hospitalizations and emergency department (ED) visits. For 3 influenza seasons, children <5 years of age with laboratory-confirmed influenza were identified through population-based surveillance. The mean direct cost per hospitalized child was $5402, with annual cost burden estimated at $44 to $163 million. Factors associated with high-cost hospitalizations included intensive care unit (ICU) admission and having an underlying high-risk condition. The mean medical cost per ED visit was $512, with annual ED cost burden estimated at $62 to $279 million. Implementation of the current vaccination policies will likely reduce the cost burden.

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4. Notifications
CDC 7th International Conference on Emerging Infectious Diseases
Atlanta, Georgia, USA 11-14 Jul 2010
The 2010 International Conference on Emerging Infectious Diseases (ICEID) is the principal meeting for emerging infectious diseases organized by CDC. This conference includes plenary and panel sessions, as well as oral and poster presentations, and covers a broad spectrum of infectious diseases of public health relevance. ICEID 2010 will also focus on the impact of various intervention and preventive strategies that have been implemented to address emerging infectious disease threats.
Additional information is available at http://www.iceid.org/.

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4th Ditan International Conference on Infectious Diseases
Beijing, China 15-18 July 2010
Ditan International Conference on Infectious Diseases is the annual conference holding in Beijing to provide platform for scientific exchange between Chinese and international experts.
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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 apecein@u.washington.edu