Vol. XII No. 12 ~ EINet News Briefs ~ Jun 11, 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:
- ***EINet Notice***

1. Influenza News
- 2010 Cumulative number of human cases of avian influenza A/H5N1
- Global: WHO situation update on pandemic influenza H1N1
- Global: BMJ, European group criticize WHO pandemic actions
- Canada: Pandemic exposed possible gaps in Canada’s planning
- China: Avian influenza H5N1 death
- Chinese Taipei: Four cases of H1N1 pandemic influenza
- India (New Delhi): Nine pandemic influenza H1N1 deaths recorded in June 2010
- Malaysia: 18 new cases of pandemic influenza H1N1
- New Zealand: H1N1 pandemic influenza infection rates surprise health officials

2. Infectious Disease News
- Australia (Queensland): Hendra virus infections
- Australia (Perth): Potential measles outbreak
- Philippines (Luzon): Potential anthrax epidemic
- Russia (Chelyabinsk): Polio confirmed in two Tajik children
- Russia (Uzbekistan): Confirmed polio death
- USA (California): Spike in pertussis cases
- USA (Missouri): Paragonimiasis infections

3. Updates

4. Articles
- [Editorial] Conflicts of interest and pandemic flu
- WHO and the pandemic flu “conspiracies”
- Inactivation of influenza A virus H1N1 by disinfection process
- Comparative Epidemiology of Pandemic and Seasonal Influenza A in Households
- [Editorial] 2009 H1N1 Virus Transmission and Outbreaks
- Oseltamivir Ring Prophylaxis for Containment of 2009 H1N1 Influenza Outbreaks
- Prevalence of preventive behaviors and associated factors during early phase of the H1N1 influenza epidemic
- If You Ask Them, Will They Come? Predictors of Quarantine Compliance During a Hypothetical Avian Influenza Pandemic: Results From a Statewide Survey

5. 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
- 4th Vaccine and ISV Annual Global Congress

***EINet Notice***
As of this issue, due to the waning H1N1 pandemic, APEC EINet will discontinue the bi-monthly Influenza Alert. The bi-monthly News Brief will continue.


1. Influenza News

2010 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Cambodia / 1 (1)
China / 1 (1)
Egypt / 19 (7)
Indonesia / 3 (2)
Viet Nam 7 (2)
Total / 31 (13)

***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: 499 (295)
(WHO 06/08/10 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_06_08/)

Avian influenza age distribution data from WHO/WPRO (last updated 02/08/10): 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 05/06/10):

WHO’s timeline of important H5N1-related events (last updated 03/16/10):


Global: WHO situation update on pandemic influenza H1N1
As of 6 June 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18,156 deaths.

Active but declining transmission of pandemic influenza virus persists in limited areas of the tropics, particularly in Southeast Asia and the Caribbean. As countries of the temperate southern hemisphere enter winter, only sporadic influenza activity has been detected so far, except in Chile and Uruguay, both of which have recently reported small numbers of pandemic influenza virus detections. Although seasonal influenza B viruses have been the predominant type of influenza virus circulating worldwide since the end of February 2010, there have been increasing but low level detections of seasonal influenza H3N2 viruses, particularly in South America and in East Africa.

In the tropics of the Americas, overall pandemic influenza activity is low, however, both seasonal influenza H3N2 and type B viruses are actively circulating in parts of tropical South America. Active but declining transmission of pandemic influenza virus continues to be detected primarily in Cuba. Since early 2010, pandemic influenza virus has circulated at low levels in Costa Rica. Sporadic detections of pandemic influenza virus continue to be reported in Brazil. During the most recent reporting week (last week of May 2010), both Brazil and Venezuela reported regional spread of influenza activity associated with an increasing trend of respiratory diseases. In Venezuela, recent influenza activity (which began during early May 2010) has been predominantly due to circulating seasonal influenza A viruses. In Bolivia, circulation of seasonal influenza viruses, predominantly type B, was observed between March and May 2010 and now appears to be subsiding.

In Asia overall pandemic influenza virus transmission remains low, except in parts of tropical South and Southeast Asia, particularly Singapore, Malaysia, and Bangladesh. In Singapore, overall levels of ARI remained slightly below the epidemic threshold and the proportion of respiratory samples testing positive for pandemic influenza virus increased slightly to 34%. In Malaysia, limited data suggests that pandemic influenza virus transmission has begun to decline since plateauing during May 2010. In Bangladesh, there has been stable persistent low level co-circulation of pandemic and seasonal influenza B viruses since March 2010. Sporadic detections of pandemic influenza virus continued to be reported across other parts of Asia. In East Asia, overall influenza activity remains low, however, seasonal influenza B viruses continue to circulate at low and declining levels.

In Sub-Saharan Africa, pandemic influenza virus continued to circulate at low levels in parts of West Africa, most notably in Ghana. During the most recent reporting week, 13% of all respiratory samples tested positive for pandemic influenza virus in Ghana. Small but significant numbers of seasonal H3N2 viruses have been detected in Kenya and Tanzania since late May 2010.

Overall, in the temperate regions of the northern hemisphere, pandemic influenza viruses have been detected only sporadically during the past month. In the temperate southern hemisphere, only two countries, Chile and Uruguay, have recently reported small numbers of pandemic influenza virus detections. In Chile, there was low level geographically limited circulation of pandemic influenza virus during May 2010; 3.4% of respiratory samples tested positive for pandemic influenza virus during the last week of May 2010. Of note, in Uruguay, 11 (44%) of 25 samples tested positive for pandemic influenza during the most recent reporting week (the last week of May 2010); however, the corresponding intensity of respiratory diseases in the population is not yet known. Other respiratory viruses, most notably RSV, are known to be circulating in Chile 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 06/11/2010)


Global: BMJ, European group criticize WHO pandemic actions
An article published by the British Medical Journal says three scientists who helped frame World Health Organization (WHO) guidance on pandemic influenza preparedness had consulted for pharmaceutical companies that stood to profit from the WHO guidance and that the WHO did not disclose the scientists' industry ties.

The lengthy report, published online 3 June 2010, says the scientists had declared their industry connections in other publications, but the WHO did not reveal them in its guidance document, WHO Guidelines on the Use of Antivirals and Vaccines During an Influenza Pandemic, issued in 2004.

The report also raises other questions about the WHO's transparency and its management of potential conflicts of interest. In particular, it is critical of the WHO's refusal to reveal the names of the members of its Emergency Committee, which was set up to help guide the WHO response to the H1N1 pandemic, including when to change pandemic alert phases. The secrecy fuels conspiracy theories about issues such as the triggering of vaccine contracts, the article says.

In related developments, a committee of the Parliamentary Assembly of the Council of Europe (PACE) today approved a report that denounced the response of the WHO and European national health agencies to the pandemic as an "unjustified scare" that led to a waste of public resources, according to a Council of Europe press release. PACE's social, health, and family affairs committee approved the report in Paris today, setting the stage for a debate on 24 June 2010 during PACE's summer session.

The WHO in recent months has repeatedly rejected charges of undue pharmaceutical company influence on its pandemic preparations and response and has said it has appropriate procedures for managing potential conflicts of interest. The agency recently commissioned a group of independent experts to review the WHO response to the pandemic.

The WHO was defended by Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, which publishes CIDRAP News.

Osterholm said the WHO needs to rely on leading experts on issues such as antivirals, and such experts will often have some ties to industry. He also said the BMJ writers presented no evidence that the industry connections of its advisors led to any inappropriate actions or recommendations by the WHO.

Osterholm said that today it is very easy to do science witch hunts or character assassination by inference. There's no evidence whatever that any of these individuals acted improperly, nor did WHO.

Osterholm said he is very supportive of transparency and disclosure, while asserting that the WHO has systems in place to prevent conflicts of interest from distorting recommendations or votes. Ultimately, he said, the relevant decisions were made by the WHO itself, not by its expert advisors.

Dr Harvey Fineberg, chairman of the WHO’s pandemic review committee, said the group would consider new reports published by the British Medical Journal and the Council of Europe that are critical of the WHO's H1N1 response. He said the committee's second meeting will be 30 June to 2 July 2010 in Geneva. The two reports, dismissed by some experts, say conflicts of interest may have swayed WHO decisions on vaccines and antivirals.

BMJ article: http://www.bmj.com/cgi/content/short/340/jun03_4/c2912
BMJ editorial: http://www.bmj.com/cgi/content/short/340/jun03_4/c2947
WHO Response:
(CIDRAP 06/04/2010; 06/07/2010)


Canada: Pandemic exposed possible gaps in Canada’s planning
Canada's response to the H1N1 pandemic was one of confusion, says a white paper presented 6 June 2010 at the World Conference on Disaster Management in Toronto. Serious gaps in the country's pandemic planning and unrealistic management guidelines were exposed, it says. Dr. Allan Holmes, who moderated the roundtable discussion on which the report was based, said a single pan-Canadian approach to planning is needed, along with a severity index to put future outbreaks in context.
(CIDRAP 06/08/2010)


China: Avian influenza H5N1 death
On 4 Jun 2010, China's Ministry of Health reported a human case of highly pathogenic avian influenza H5N1 virus infection in Hubei Province. The victim was 22 years old, female, four months pregnant. She fell ill on 23 May 2010 and died on 3 Jun 2010.

Epidemiological investigation by local health agencies found that the patient had contact with sick and dead poultry prior to falling ill. Work teams and specialist teams sent by China's Ministry of Agriculture will launch investigations and laboratory tests on poultry, in conjunction with Hubei veterinary agencies. No outbreaks of avian influenza in poultry have been found so far. Close contacts of the patient are being monitored.

Of the 39 cases confirmed to date in China, 26 have been fatal.
(ProMED 06/04/2010; 06/08/2010)


Chinese Taipei: Four cases of H1N1 pandemic influenza
Cases of A(H1N1) infections have not waned with the warming weather. On 8 June 2010, the Centers for Disease Control (CDC) recorded four new cases of swine flu in the nation in less than three months. CDC statistics showed that since April 2010, there have been 44 reported cases of influenza, among which four were found to be caused by the A(H1N1) influenza virus. All four victims were residents of a nursing home in which a total of 26 people had suffered from diarrhea and were subsequently sent to the hospital.

According to the CDC, of the 44 influenza cases, 36 infections were diagnosed as the seasonal influenza B. However, the cases of swine flu are seen as a sign of the disease regaining traction, CDC officials said.

Lin Tzou-yien, superintendent of the Chang Gung Children's Hospital in Linkou pointed out that small waves of flu outbreaks occur every summer and this year is no exception.

Lin Ding, deputy director general of the CDC, said out of the 44 influenza patients, a reported 31 people caught the virus in classrooms, with the highest rate occurring in elementary and junior high schools. Nursing homes have also been identified as prime influenza infection sites, which was brought to public attention by recent reports of nursing home residents experiencing collective diarrhea, four of which were later tested and found to have swine flu.
(The China Post 06/08/2010)


India (New Delhi): Nine pandemic influenza H1N1 deaths recorded in June 2010
Nine swine flu deaths have been reported from across the country in the week beginning 7 June 2010, the health ministry said 9 June 2010.

Of these, one death has been reported from Karnataka while four deaths each have been reported from Maharashtra and Kerala.

Health ministry officials say that the government is prepared as the monsoon is expected to increase the number of cases once again.

Last week, out of the 47 reported cases, 22 were from Maharashtra while 19 were from Kerala, five from Tamil Nadu, and one each from Karnataka and Jammu and Kashmir.

Maharashtra has so far reported the greatest number of deaths due to swine flu with the number standing at 470 since April 2009.
(NewKerala.com 06/09/2010)


Malaysia: 18 new cases of pandemic influenza H1N1
Eighteen new cases of Influenza A(H1N1) were confirmed over 24 hours up to the evening of 8 June 2010, taking the total number of cumulative cases to 14,987 so far, Director-General of Health Tan Sri Dr Mohd Ismail Merican said 9 June 2010.

There were no deaths and the death toll stood at 88, he added.

He said the Health Ministry received one report of a cluster incident of Influenza-like Illness (ILI) in Penang and all the cases had been administered anti-viral treatment and treated as outpatients.

Dr Mohd Ismail said the number of ILI cases under treatment in hospitals throughout the country was 502, of which 51 cases or 10.2 per cent were confirmed as Influenza A(H1N1).
(Bernama 09 June 2010)


New Zealand: H1N1 pandemic influenza infection rates surprise health officials
An estimated 18% of the population of New Zealand were infected by pandemic H1N1 from November 2009 through March 2010, including 1 in 3 children aged 5 to 19 years and 1 in 4 preschoolers. Results of the study, commissioned by the country's ministry of health, showed far higher rates than expected. About 45.2% of infected individuals had no symptoms. Age was found to be the most important risk factor. The current prevalence of H1N1 immunity in the New Zealand population is estimated at 29%.

Ministry of Health Press Release:
(CIDRAP 06/04/2010)


2. Infectious Disease News
Australia (Queensland): Hendra virus infections
An experimental drug for Hendra virus has been offered to a mother and daughter on Queensland's Sunshine Coast who have been exposed to the deadly disease. Queensland's chief health officer Dr Jeannette Young says the drug from the US has successfully prevented Hendra virus in ferrets and monkeys.

The treatment has only been used once as an attempt to save the life of a Rockhampton veterinarian before he died from Hendra virus while hospitalized in 2009. It has been offered to mother and her 12-year-old daughter, whose horse was infected with Hendra virus at a Tewantin property on the Sunshine Coast. The horse was euthanized.

Mother and daughter have yet to decide whether they will go ahead with the treatment. Dr Young said the drug prevents the infection from developing.

Queensland Health says the other nine people tested for the virus did not have enough exposure to warrant being offered the drug. The department says all 11 people who came into contact with the infected horse face another two rounds of tests. Ten of the 11 people exposed to the virus were not showing signs of the virus in the first round of testing. On 26 May 2010, Queensland Health confirmed the 11th person, who is interstate, had also returned a negative initial result.
(ProMED 06/27/2010)


Australia (Perth): Potential measles outbreak
The Western Australia (WA) Health Department has issued a warning about a potential measles outbreak in Royal Perth Hospital's emergency department. A patient treated in the department the week of 1 June 2010 has tested positive for measles infection and it is believed others may have been exposed to the highly infectious virus. Health authorities are attempting to contact about 90 patients who visited the department between 5:00 pm on the afternoon of Tuesday, 1 Jun 2010, and 3:00 pm 2 June 2010.

Paul Effler from the Health Department says most of the patients have been contacted, but that the holiday weekend may prevent the department from contacting everyone.

People particularly at risk include infants, unimmunized pregnant women and those with weak immunity. Paul Effler is encouraging anyone who may be at risk to get preventative treatment.

It is the second case of measles diagnosed in Perth in two weeks.
(ProMED 06/07/2010)


Philippines (Luzon): Potential anthrax epidemic
Health officials warned of a possible anthrax epidemic after it was confirmed that the 41 people who ate infected meat from two caraboas (a type of water buffalo) in Abra, Philippines had gastrointestinal anthrax and not just the cutaneous type of the disease. It is possible that they had cutaneous lesions as well from cutting up and handling the infected meat.

In Bangued, Abra, according to the town officials, 38 people were hospitalized and confined since 8 May 2010 after being infected with anthrax. According to reports, residents acquired the virus after eating two infected carabaos in the town of Villaviciosa.

No deaths were reported due to timely aid given to the infected individuals by health sectors.

Provincial veterinarian Diosdado Taverner said the Villaviciosa cases were isolated, and the spread of the pathogen was in control.

Taverner also led a group of officials from the Department of Health to investigate further the cases. Taverner warned the public from eating livestock from the area at the moment, because of the high risk of acquiring the virus from local animals. To stop spread of the disease, the provincial officials started vaccinating livestock in the area.

Head of the Animal Services of the Livestock division of the Department of Agriculture Dr. Arlene Sagayo visited the area and further investigated the condition of the livestock in Bangued to help prevent possible outbreaks in the area.

In the northern part of Ilocos, another suspected case of anthrax was reported after livestock, including carabaos and pigs, started dying in the area. However, officials have yet to confirm the cause of death but still put the possibility of anthrax as top priority in their investigation.

Dr. Amelita Pangilinan of the regional DOH based in Baguio said the Abra cases were "suspected" as anthrax from symptoms exhibited by the victims. Pangilinan said if the animal is already dead, it should not be eaten, because the animal might have had an illness before it died.
(ProMED 06/03/2010; 06/07/2010)


Russia (Chelyabinsk): Polio confirmed in two Tajik children
Laboratory tests have proved polio diagnosis in two Tajik children in Russia’s Urals Chelyabinsk region on 10 June 2010.

According to the Rospotrebnadzor administration, one of the sick children was eight years old, the other one 17. Both were illegal migrants. One lived in Magnitogorsk, the other in Chelyabinsk.

Neither of the two left Russia in 2010 and might have contracted the disease while staying on the territory of the Chelyabinsk region through contacts with other Tajik citizens arriving from Tajikistan. Local health authorities were taking measures to contain polio hotbeds. It is highly likely that the local health administration will stage polio inoculation of all Tajik citizens residing in the Chelyabinsk region.

These are not the first polio cases to be registered in Russia’s Urals region. Previously, poliomyelitis was diagnosed in a 20-year-old Tajik citizen, who was then hospitalized, and now, according to medics, is in a stable condition.

The polio situation is worsening both in Tajikistan and Russia. According to Rospotrebnadzor, more than 500 polio cases have been registered in Tajikistan, and 15 polio patients have died.
(Itar Tass 06/10/2010)


Russia (Uzbekistan): Confirmed polio death
The Sverdlovsk Rospotrebnadzor (Russian Federal Agency for Protection of Consumer Rights and Human Welfare) confirmed a death from polio. A citizen of Uzbekistan who came to the Urals on 25 May 2010 died 7 Jun 2010 in Yekaterinburg . He was suspected of having had acute poliomyelitis. Specimens have been sent to the Moscow National Laboratory Center for diagnosis of poliomyelitis. All citizens, with whom he had contact, were examined by infectious disease specialists and vaccinated against polio.

Meanwhile, according to the spokesperson of the Rospotrebnadzor Voropaeva, Moscow experts confirmed that the cause of death was polio.

Currently, there is an active vaccination of migrants, mostly citizens of Tajikistan. According to representatives of Rospotrebnadzor, the epidemiological situation of polio is under control.
(ProMED 06/08/2010)


USA (California): Spike in pertussis cases
Fresno County health officials said they're concerned about a sudden spike in whooping cough (pertussis) cases. The number of suspected cases has doubled in recent weeks.

Dr. Harsh Saigal said at least four of the patients at his Fresno pediatric practice have been diagnosed with this respiratory infection that leads to convulsive coughs lasting up to at least six weeks.

So far in 2010, 76 cases have been confirmed and another 77 are under investigation by the Department of Public Health. Even more startling is the fact that 72 of those suspected cases happened in May alone. In all of 2009, the county only had 27 confirmed cases.

David Luchini with the Department of Public Health said whooping cough is cyclical but even he was perplexed by last month's dramatic spike, and said the last spike was observed in 2005.
(ABC Local 06/04/2010)


USA (Missouri): Paragonimiasis infections
Physicians at Washington University School of Medicine in St. Louis, Missouri, have diagnosed a rare parasitic infection in six people who had consumed raw crayfish from streams and rivers in Missouri. The cases occurred over the past three years, but three have been diagnosed since September 2009; the latest in April 2010. Before these six, only seven such cases had ever been reported in North America, where the parasite, Paragonimus kellicotti, is common in crayfish.

The infection, called paragonimiasis, is very rare, so it's extremely unusual to see this many cases in one medical center in a relatively short period of time, said Washington University infectious diseases specialist Gary Weil, MD, professor of medicine and of molecular microbiology, who treated some of the patients. He is almost certain there are other people out there with the infection who haven't been diagnosed.

The recent infections, which occurred in patients ages 10-32, have prompted the Missouri Department of Health and Senior Services to issue a health advisory alerting doctors across the state. The department also printed posters warning people not to eat raw crayfish and placed them in campgrounds and canoe rental businesses near popular Missouri streams. Thoroughly cooking crayfish kills the parasite and does not pose a health risk.

Paragonimiasis is far more common in East Asia, where many thousands of cases are diagnosed annually in people who consume raw or undercooked crab that contain Paragonimus westermani, a cousin to the parasite in North American crayfish.
(ProMED 05/29/2010)


3. Updates
Influenza A/H1N1: http://www.who.int/csr/disease/swineflu/en/index.html
Influenza A/H1N1 frequently asked questions:
Pandemic Influenza Preparedness and Response - A WHO Guidance Document
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-influenza
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:
ProMED: http://www.promedmail.org/


- 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:
- 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:
Read about the latest news on avian influenza H5N1 in wild birds and poultry.


Chinese Taipei
The Department of Health (DOH) has asked the public to take precautions against dengue fever as the disease's second wind seems to be gaining strength. Lin Ting, deputy director general of the DOH's Centers for Disease Control, said that 2010’s dengue fever outbreak has come in two waves. Some 38 cases were recorded in the first round, which started in 2009 and extended into the spring of 2010.

After the outbreak eased off for more than one month, a second wave has struck, and the number of dengue fever cases has risen to seven, mainly in Kaohsiung City. Because no vaccine exists for the disease, Lin said the most effective step that can be taken against it is to eliminate potential breeding grounds for the mosquitoes by cleaning up containers with standing water.
(ProMED 06/01/2010)

Papua New Guinea
Papua health agency has sent a team to Intan Jaya regency to verify reports of malaria outbreak which is said to have killed 40 people in the highland region since April 2010.

Team member Paminto Widodo of the Papua Health Crisis Center said 9 June 2010 that the medical workers would focus their mission on Degesiga and Bamba villages, where the disease reportedly affected the most people.

The regional health agency has conducted fogging to prevent the disease from spreading across the regency.

Papua legislative council member Julius Miagoni, who reported the outbreak to the health authorities, said the fatalities resulting from malaria were first detected in April 2010.
(The Jakarta Post 06/09/2010)

Philippines (Cagayan)
Health authorities here warned local residents and tourists on the sudden surge in the number of dengue fever cases in the province after the local department recorded a 111-percent rise in dengue fever cases over the first five months of 2010 as compared with the same period in 2009.

From 90 cases for the first five months of 2009 the dengue fever cases this year increased to 191 which forced concerned authorities to issue the necessary advisories to the public to take the necessary preventive measures in order to abate the expected increase in the dreaded disease.

With the onset of the rainy season, provincial and health officials believe there will be a continuous rise in dengue fever cases because of the increase in stagnant water which is the favorite breeding ground of the dengue-carrying mosquitoes.
(Manila Bulletin 06/10/2010)

Philippines (Western Visayas)
A team from the Epidemiologic Surveillance Unit (ESU) of Iloilo Provincial Health Office (IPHO) visited Barangay neighborhood Cadapdap of this town 25 May 2010 to check the status of 15 suspected dengue cases initially reported from the neighborhood. According to IPHO assistant chief Maria Socorro Quinon, once her team confirms that those cases are positive, it means the area has a dengue outbreak.

A total of four deaths were already recorded in Iloilo province from January 2010 up to the present. Casualties came from the towns of Guimbal, Oton, Pototan, and one component of the city of Passi. Last year from 1 January-10 June 2009 a total of 286 dengue cases were recorded by the IPHO.

So far, Quinon said that they are expecting the number of dengue cases will increase during rainy season. June is considered the month of the rainy season.

In Western Visayas region, the Department of Health 6 (DOH-6) has so far recorded a total of 1,311 cases, four times the January-June 2009 total -- with 7 deaths -- from January to 8 May 2010. Negros Occidental has the highest number of recorded cases at 380 with two deaths, followed by Bacolod City with 266 cases. Iloilo Province has 231 cases with four deaths, while Iloilo City has 126 cases. There were 194 cases in Capiz, 79 in Aklan, with one death, 16 in Guimaras, and 12 in Antique.
(ProMED 06/01/2010)

The incidence of Lyme disease [borreliosis] has increased in Russia. The most affected area is Moscow city. However, the specialists consider that most cases of tick bites in Muscovites occur outside the city's border and there is no need for tick control chemicals in the Moscow city parks.

Rospotrebnadzor [Federal Service for Consumer Affairs and Human Welfare] reports that the numbers of tick-borne encephalitis and borreliosis cases are significantly higher in 2010. The incidence of both diseases was up in 2009 by 32.4 percent and 26 percent respectively, compared with 2008 data. This underlines the continuous worsening of the situation over the recent years. The area of borreliosis spread is larger than that of tick-borne encephalitis. Out of 732 tick-borne borreliosis cases in 2009 only 10 (1.4 percent) were acquired within the Moscow city territory; 56 percent of cases were acquired from Moscow oblast region, 40 percent of cases were acquired from other regions of Russia, and 2.7 percent of cases came from foreign countries.

Rospotrebnadzor reports that the four-month incidence of tick-borne borreliosis was 0.11 per 100,000 population versus 0.08 for a similar period in 2009. There were 158 Lyme disease cases in 2010, including 109 cases from January to April. Most cases occurred in Moscow city (30), followed by Ulyanovsk oblast (17 cases), Lypetsk and Kaliningrad oblasts (14 each), Moscow oblast (11), and the Republic of Mordovia (8).
(ProMED 05/30/2010)

A total of 4912 people in the Altai Krai territory have been bitten by ticks so far in 2010. A total of 21 individuals received hospital treatment on suspicion of tick-borne encephalitis (TBE) virus infection. In addition 238 suspected cases of tick-borne rickettsiosis were registered in the Altai Krai.

A survey of ticks revealed that 24 of 319 ticks examined were tick-borne encephalitis virus vectors. Fifty-eight of 60 regions of the Oblast are endemic for tick-borne encephalitis.
(ProMED 06/03/2010)

Thailand's Public Health Ministry reported 7 June 2010 that dengue fever infected 17,587 people and claimed 20 lives nationwide since February 2010, with the infection number increasing by nearly 60 percent year-on-year.

The ministry's permanent secretary Paiji Warachit said that the number of dengue fever patients in 2010 has increased by 58 percent when compared with the same period in 2009.

Paiji said the dengue fever outbreak would peak during Thailand 's rainy season from June to August 2010.

Most dengue victims were aged between 10 to 24 years, the ministry said. The Central region was the hardest hit with 7,945 cases, followed by 4,264 in the South, 3,753 in the Northeast, and 1,625 in the North.

The Department of Disease Control's director general Manit Teeratantikanont said the dengue virus type 1 has been widely spreading this year, but people are also at risk as most do not have immunity against dengue virus type 2 and type 3.

To tackle the outbreak, the ministry has set up a committee teamed up with 23 people from state agencies including the Bangkok Metropolitan Administration and the Ministry of Interior. The committee will be chaired by the ministry's deputy permanent secretary Siriwat Thiptaradol.

Talking about specific measures, Paiji said the health officials are required to report any disease cases found within 24 hours and mobile teams will be sent immediately to counter the outbreak.

Local authorities have been advised to spray insecticide at least once a week to eradicate the dengue-bearing adult Aedes Aegypti mosquito which bites humans in the daylight hours, he said.
(Xinhau 06/08/2010)

As of 25 May 2010, Dr Yorn Jiranakorn, chief of Pattani provincial health office, alerted people that dengue may be fatal, and prepared the SRRT (surveillance rapid response team) to investigate and control a dengue outbreak in the province after more than 400 hospitalized cases were reported since 1 Jan 2010. The districts with the most reported cases are Muang, Mayo and Nong Jik district.

The number of dengue outbreaks in Pattani province has been continuously rising. Recently, Pattani ranks second among Thai provinces in terms of the number of dengue fever patients. Therefore, the Pattani Public Health Office has requested people to destroy any possible habitats for the mosquitoes around their residences every seven days in order to stop the mosquitoes from breeding.

According to the dengue surveillance data from the Bureau of Epidemiology (BOE), Ministry of Public Health, Thailand website dated 25 May 2010, the total number of reported cases of dengue infection in Thailand since 1 Jan 2010 is 16,110 cases and 20 deaths: 7,032 dengue fever (DF) cases and one fatality; 8,795 cases of dengue hemorrhagic fever (DHF) and five fatalities; and 283 cases of dengue shock syndrome (DSS) and 14 fatalities.

A total of 397 cases and one death were attributed to dengue infection in Pattani province between 1 Jan 2010 and 17 May 2010. There were 118 cases of DF, 272 cases of DHF, and 7 cases with one death of DSS.

Regarding dengue fever (DF), the nationwide attack rate was 11.07 per 100,000 persons. The highest attack rate (per 100 000 population) was reported in the south region (20.75), followed by the central region (13.32), the northeastern region (7.60), and the north region (6.06). The five provinces with the highest attack rates of dengue fever (per 100 000 population) were Yala (51.01), Satun (44.69), Trat (38.63), Chantaburi (31.69), and Rayong (29.73). About 50 percent of DF cases were in the 10-24 year old age group; 25.9 percent were 10-14 years old; and 25.1 percent were 15-24 years old.
(ProMED 06/01/2010)

Thailand (province of Ranong)
Over 640 people, both Thai and Burmese nationals, have been found ill with malaria in the latest outbreak in the southern province of Ranong.

The Public Health Office of Ranong revealed that the accumulated number of malaria-infected patients since 1 January 2010 had reached 644. Out of this number, 61% are Thai while the rest are Burmese.No casualties have been reported.

A health personnel in Ranong said that malaria patients could be found throughout the year but the disease usually spreads heavily during the rainy season. Medical teams have been dispatched to risky areas in the province to provide blood test and prescribe medication to those infected free of charge in order to control the spread.

Teams of disease controlling unit have been dispatched to spray houses with disinfectant and to encourage people to protect themselves against malaria.

The suppression however faces some difficulties as Burmese workers living in risky areas along the Thai-Burmese border are frequent migrants. The weather condition and southern terrains also favor the reproduction of the malaria transmitter, Anopheles mosquito. People are advised to seek blood checks at district disease-control units if they have high fever.
(ReliefWeb 06/10/2010) U.S. Virgin Islands
Health commissioner Julia Sheen on 2 Jun 2010 said the Department of Health has confirmed the U.S. Virgin Islands' first case of dengue fever. The case was reported in the St Thomas-St John district, and follow-up testing confirmed the disease.

Sheen said the islands went through both the hurricane and rainy seasons of 2009 without a positive case of dengue being reported, and with this confirmed case she urges residents to be vigilant.

DOH epidemiologist Dr Eugene Tull said that the Department issued a fogging schedule as part of its mosquito abatement program during the week of 3 Jun 2010, in light of recent rains.
(ProMED 06/07/2010)


Canada (Ontario)
The County of Lambton Community Health Services Department continues to investigate an outbreak of Cyclospora infection in people who attended the Big Sisters of Sarnia-Lambton Chef's Challenge on 12 May 2010. Of the 270 attendees interviewed, 193 have reported being ill with symptoms consistent with Cyclospora infection. There are currently 40 laboratory confirmed cases.

The investigation into the source of this outbreak is ongoing in cooperation with the Ontario Ministry of Health and Long-Term Care, Public Health Agency of Canada, and Canadian Food Inspection Agency.
(Eat, Drink, and Be 06/10/2010)

USA (Kentucky)
State health officials say three children were hospitalized in western Kentucky in an unusually large outbreak of a bacterial infection that causes watery diarrhea and spreads easily.

Janie Cambron, regional epidemiologist for the Green River District Health Department, said 9 June 2010 the children have since been released after contracting shigella, a bacterial infection spread through just a tiny amount of infected fecal matter.

Cambron says there were 80 reported cases of the disease as of Friday in Daviess County, and three in adjacent Ohio County.

Dr. William Hacker, commissioner of the state public health department, says shigella is common and usually affects children. He says some years in Kentucky, as few as 50 or many as 500 cases are seen sporadically.

Cambron says tests have shown the disease was not caused by contaminated water or food.
(AP 06/10/2010)


4. Articles
[Editorial] Conflicts of interest and pandemic flu
BMJ. 3 June 2010. doi:10.1136/bmj.c2947
Available at http://www.bmj.com/cgi/content/short/340/jun03_4/c2947

Excerpt. The world should of course be thankful that the 2009 influenza A/H1N1 pandemic proved such a damp squib. With so many fewer lives lost than had been predicted, it almost seems ungrateful to carp about the cost. But carp we must because the cost has been huge. Some countries—notably Poland—declined to join the panic buying of vaccines and antivirals triggered when the World Health Organization declared the pandemic a year ago this week. However, countries like France and the United Kingdom who have stockpiled drugs and vaccines are now busy unpicking vaccine contracts, selling unused vaccine to other countries, and sitting on huge piles of unused oseltamivir. Meanwhile drug companies have banked vast profits—$7bn (£4.8bn; {euro}5.7bn) to $10bn from vaccines alone according to investment bank JP Morgan.
[for remainder of the article, please refer to the link above.]


WHO and the pandemic flu “conspiracies”
Cohen D, Carter P. BMJ. 3 June 2010. doi:10.1136/bmj.c2912
Available at http://www.bmj.com/cgi/content/short/340/jun03_4/c2912

Summary. Key scientists advising the World Health Organization on planning for an influenza pandemic had done paid work for pharmaceutical firms that stood to gain from the guidance they were preparing. These conflicts of interest have never been publicly disclosed by WHO, and WHO has dismissed inquiries into its handling of the A/H1N1 pandemic as "conspiracy theories." Deborah Cohen and Philip Carter investigate.


Inactivation of influenza A virus H1N1 by disinfection process
Jeong EK, Bae JE, Kim S. AJIC. June 2010;38(5):354-360
Available at http://www.ajicjournal.org/article/PIIS0196655310001872/abstract

Background. Because any patient, health care worker, or visitor is capable of transmitting influenza to susceptible persons within hospitals, hospital-acquired influenza has been a clinical concern. Disinfection and cleaning of medical equipment, surgical instruments, and hospital environment are important measures to prevent transmission of influenza virus from hospitals to individuals. This study was conducted to evaluate the efficacy of disinfection processes, which can be easily operated at hospitals, in inactivating influenza A virus H1N1 (H1N1).

Methods. The effects of 0.1 mol/L NaOH, 70% ethanol, 70% 1-propanol, solvent/detergent (S/D) using 0.3% tri (n-butyl)-phosphate and 1.0% Triton X-100, heat, and ethylene oxide (EO) treatments in inactivating H1N1 were determined. Inactivation of H1N1 was kinetically determined by the treatment of disinfectants to virus solution. Also, a surface test method, which involved drying an amount of virus on a surface and then applying the inactivation methods for 1 minute of contact time, was used to determine the virucidal activity.

Results. H1N1 was completely inactivated to undetectable levels in 1 minute of 70% ethanol, 70% 1-propanol, and solvent/detergent treatments in the surface tests as well as in the suspension tests. H1N1 was completely inactivated in 1 minute of 0.1 mol/L NaOH treatment in the suspension tests and also effectively inactivated in the surface tests with the log reduction factor of 3.7. H1N1 was inactivated to undetectable levels within 5 minutes, 2.5 minutes, and 1 minute of heat treatment at 70, 80, and 90°C, respectively in the suspension tests. Also, H1N1 was completely inactivated by EO treatment in the surface tests.

Conclusion. Common disinfectants, heat, and EO tested in this study were effective at inactivating H1N1. These results would be helpful in implementing effective disinfecting measures to prevent hospital-acquired infections.


Comparative Epidemiology of Pandemic and Seasonal Influenza A in Households
Cowling BJ, Chan KH, Fang VJ, et al. New Engl J Med. 10 June 2010;362(23):2175-2184)
Available at http://content.nejm.org/cgi/content/full/362/23/2175

Background. There are few data on the comparative epidemiology and virology of the pandemic 2009 influenza A (H1N1) virus and cocirculating seasonal influenza A viruses in community settings.

Methods. We recruited 348 index patients with acute respiratory illness from 14 outpatient clinics in Hong Kong in July and August 2009. We then prospectively followed household members of 99 patients who tested positive for influenza A virus on rapid diagnostic testing. We collected nasal and throat swabs from all household members at three home visits within 7 days for testing by means of quantitative reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay and viral culture. Using hemagglutination-inhibition and viral-neutralization assays, we tested baseline and convalescent serum samples from a subgroup of patients for antibody responses to the pandemic and seasonal influenza A viruses.

Results. Secondary attack rates (as confirmed on RT-PCR assay) among household contacts of index patients were similar for the pandemic influenza virus (8%; 95% confidence interval [CI], 3 to 14) and seasonal influenza viruses (9%; 95% CI, 5 to 15). The patterns of viral shedding and the course of illness among index patients were also similar for the pandemic and seasonal influenza viruses. In a subgroup of patients for whom baseline and convalescent serum samples were available, 36% of household contacts who had serologic evidence of pandemic influenza virus infection did not shed detectable virus or report illness.

Conclusions. Pandemic 2009 H1N1 virus has characteristics that are broadly similar to those of seasonal influenza A viruses in terms of rates of viral shedding, clinical illness, and transmissibility in the household setting.


[Editorial] 2009 H1N1 Virus Transmission and Outbreaks
Uyeki TM. New Engl J Med. 10 June 2010;362(23):2221-2223
Available at http://content.nejm.org/cgi/content/full/362/23/2221

Excerpt. The emergence of 2009 pandemic influenza A (H1N1) virus prompted early questions about how the virus was spreading and how easily it was transmitted, along with uncertainty about disease severity, clinical complications and risk factors for severe disease, and the effectiveness of antiviral treatment and control measures. Without a vaccine against the 2009 H1N1 virus, early control measures included both pharmaceutical interventions (the use of antiviral agents) and nonpharmaceutical interventions (e.g., school closures, isolation, and quarantine), depending on the specific outbreak setting, available resources, and goals. The use of these interventions varied according to country and the evolution of the pandemic. It was determined quickly that the 2009 H1N1 virus was resistant to the adamantane antiviral agents but susceptible to neuraminidase inhibitors (oseltamivir and zanamivir), which could be used for treatment and chemoprophylaxis.
[for the remainder of the editorial, please refer to the link above.]


Oseltamivir Ring Prophylaxis for Containment of 2009 H1N1 Influenza Outbreaks
Lee VJ, Yap J, Cook AR, et al. New Engl J Med. 10 June 2010;362(23);2166-2174
Available at http://content.nejm.org/cgi/content/full/362/23/2166

Background. From June 22 through June 25, 2009, four outbreaks of infection with the pandemic influenza A (H1N1) virus occurred in Singapore military camps. We report the efficacy of ring chemoprophylaxis (geographically targeted containment by means of prophylaxis) with oseltamivir to control outbreaks of 2009 H1N1 influenza in semiclosed environments.

Methods. All personnel with suspected infection were tested and clinically isolated if infection was confirmed. In addition, we administered postexposure ring chemoprophylaxis with oseltamivir and segregated the affected military units to contain the spread of the virus. All personnel were screened three times weekly both for virologic infection, by means of nasopharyngeal swabs and reverse-transcriptase–polymerase-chain-reaction assay with sequencing, and for clinical symptoms, by means of questionnaires.

Results. A total of 1175 personnel were at risk across the four sites, with 1100 receiving oseltamivir prophylaxis. A total of 75 personnel (6.4%) were infected before the intervention, and 7 (0.6%) after the intervention. There was a significant reduction in the overall reproductive number (the number of new cases attributable to the index case), from 1.91 (95% credible interval, 1.50 to 2.36) before the intervention to 0.11 (95% credible interval, 0.05 to 0.20) after the intervention. Three of the four outbreaks showed a significant reduction in the rate of infection after the intervention. Molecular analysis revealed that all four outbreaks were derived from the New York lineage of the 2009 H1N1 virus and that cases within each outbreak were due to transmission rather than unrelated episodes of infection. Of the 816 personnel treated with oseltamivir who were surveyed, 63 (7.7%) reported mild, nonrespiratory side effects of the drug, with no severe adverse events.

Conclusions. Oseltamivir ring chemoprophylaxis, together with prompt identification and isolation of infected personnel, was effective in reducing the impact of outbreaks of 2009 H1N1 influenza in semiclosed settings.


Prevalence of preventive behaviors and associated factors during early phase of the H1N1 influenza epidemic
Lau JTF, Griffiths S, Choi K-C, et al. AJIC. June 2010;38(5);374-380
Available at http://www.ajicjournal.org/article/PIIS0196655310001860/abstract

Background. The community plays an important role in controlling influenza A/H1N1. There is a dearth of data investigating adoption of preventive behaviors in the initial phase of the A/H1N1 pandemic.

Methods. Three round of random, population-based, anonymous telephone survey were conducted in Hong Kong during the pre-community outbreak phase (May 7 to June 6, 2009) of the influenza A/H1N1 pandemic in Hong Kong (n = 999).

Results. Respectively, 46.65%, 88.75%, and 21.5% washed hands more than 10 times/day, wore face masks when having influenza-like illness (ILI), and wore face masks regularly in public areas. Perceptions related to bodily damages, efficacy of frequent handwashing, nonavailability of effective vaccines, high chance of having a large scale local outbreak, and mental distress because of influenza A/H1N1 were associated with frequent handwashing (odds ratio [OR], 1.46 to 2.15). Perceived vaccine availability was associated with face mask use when having ILI (OR, 1.60). Perceived fatality, efficacy of wearing face masks, and mental distress because of influenza A/H1N1 were associated with face mask use in public areas (OR, 1.53 to 2.52).

Conclusion. Preventive behaviors were prevalently adopted by the public and were associated with cognitive and affective factors. Prevention efforts should take public perceptions into account, and emerging infectious diseases provide good chances for promoting hygiene.


If You Ask Them, Will They Come? Predictors of Quarantine Compliance During a Hypothetical Avian Influenza Pandemic: Results From a Statewide Survey
Bass SB, Ruzek SH, Ward L., et al. Disaster Med Public Health Prep. 4 June 2010.
Available at http://www.dmphp.org/cgi/content/abstract/4/2/135

Background. An influenza pandemic, such as that of the H1N1 virus, raises questions about how to respond effectively to a lethal outbreak. Most plans have focused on minimizing impact by containing the virus through quarantine, but quarantine has not been used widely in the United States and little is known about what would be the public's response. The purpose of this study was to investigate factors that influence an individual's decision to comply with a hypothetical avian influenza quarantine order.

Methods. A total of 1204 adult Pennsylvania residents participated in a random digit dial telephone sample. The residents were interviewed regarding their attitudes about and knowledge of avian influenza and about compliance with quarantine orders, including staying at home or traveling to a government-designated facility.

Results. Analysis of variance showed differences among demographic groups in willingness to comply with quarantine orders, with women and individuals not presently employed more willing to stay at home or to travel to a government-designated facility if ordered. Those who did not regularly attend religious services were significantly less willing than those who did attend regularly to comply with any type of quarantine order. Regression analysis indicated that demographic variables, overall knowledge of avian influenza, attitudes about its severity, and the belief that the respondent and/or his or her significant other(s) may contract it were predictive.

Conclusions. The results of this study can provide health planners and policy makers with information for improving their efforts to conduct a quarantine successfully, including crafting messages and targeting information to certain groups of people to communicate risk about the epidemic.


5. Notifications
CDC 7th International Conference on Emerging Infectious Diseases
Atlanta, Georgia, USA 11-14 July 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/.


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.
Additional information is available at http://www.bjditan.org/


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.


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.


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