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Vol. XIII No. 13 ~ EINet News Briefs ~ Jun 25, 2010


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

1. Influenza News
- 2010 Cumulative number of human cases of avian influenza A/H5N1
- Global: WHO situation update on pandemic influenza H1N1
- Global: Two who helped WHO's pandemic response quit review panel
- Global: Pandemic officially a year old
- India: Increase in pandemic influenza H1N1 activity
- India (Hyderabad): state reopens pandemic influenza H1N1 isolation wards
- Australia (Brisbane): Girl’s autopsy shows no vaccine link
- India (Kerala): Health Ministry to probe increases in cases
- New Zealand: Record numbers vaccinated against pandemic influenza H1N1
- Vietnam: Considers lowering pandemic influenza H1N1 alert level
- Latin America: Widespread pandemic influenza H1N1 activity
- USA: As EUAs expire, HHS says pandemic emergency is over
- USA: CDC looks at tying public health alerts to medical records

2. Infectious Disease News
- Chinese Taipei: Suspected measles outbreak
- Honk Kong (Fanling): School advised to close, due to hand, foot and mouth disease outbreak
- New Zealand (Kaikoura): Whooping cough outbreak
- Russia: Confirmation of polio cases in Tajikistan
- Thailand: Warning against rabies issued
- USA (California): An epidemic of whooping cough declared
- USA (Texas): Rare cases of hepatitis E

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

4. Articles
- The Re-Emergence of H1N1 Influenza Virus in 1977: A Cautionary Tale for Estimating Divergence Times Using Biologically Unrealistic Sampling Dates
- Prevalence of influenza vaccination and assocated factors among pregnant women in Hong Kong
- Comparative age distribution of influenza morbidity and mortality during seasonal influenza epidemics and the 2009 H1N1 pandemic
- Editorial: A pandemic of hindsight?
- Press Release: Employers took many measures to protect employees and avoid business impact of H1N1 flu outbreak
- Outbreak of Influenza A (2009) H1N1 among Thai Healthcare Workers: Is It Time to Integrate a Vaccination Program?
- Community-Based Measures for Mitigating the 2009 H1N1 Pandemic in China
- Transmissibility of 2009 Pandemic Influenza A(H1N1) in New Zealand: Effective reproduction of number and influence of age, ethnicity and importations
- Zoonotic transmission of avian influenza virus (H5N1), Egypt, 2006-2009
- Editorial: Polio returns to Tajikistan

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


1. Influenza News

Global
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: 498 (295)
(WHO 06/08/10 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_04_09/)

Avian influenza age distribution data from WHO/WPRO (last updated 2/8/10):
http://www.wpro.who.int/sites/csr/data/data_Graphs.htm

WHO's map showing world's areas affected by H5N1 avian influenza (status as of 2/12/10):
http://gamapserver.who.int/mapLibrary/Files/Maps/Global_H5N1Human_2010_FIMS_20100212.png.

WHO’s timeline of important H5N1-related events (last updated 1/4/10):
http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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Global: WHO situation update on pandemic influenza H1N1
As of 13 June 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18,172 deaths.

WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and Member States and through monitoring of multiple sources of information.

The situation remains largely unchanged since the last update. Overall pandemic influenza activity remains low worldwide with geographically limited circulation of pandemic influenza virus in parts of the tropics, particularly in parts of Central America and the Caribbean and in parts of South and Southeast Asia. Seasonal influenza type B viruses continue to circulate at low levels across Asia and to a lesser extent across parts of Africa and South America. Recently re-emerged seasonal influenza H3N2 viruses continue to circulate in East Africa. As countries of the temperate southern hemisphere enter winter, overall only sporadic influenza activity has been detected so far.

In tropical region of the Americas, low or waning circulation of pandemic virus has been primarily reported in Costa Rica (since early 2010) and in Cuba (last reported at the end of May 2010), respectively. In Cuba and to a lesser extent in Costa Rica, recent pandemic influenza activity has been associated with small numbers of fatal cases. In Colombia, during the first week of June 2010, an increasing trend of respiratory diseases was associated with regional spread of pandemic influenza activity and a small number of new fatal cases, likely reflecting increasing but low level circulation of pandemic influenza virus. Throughout the rest of the region, there have been only sporadic detections of pandemic influenza virus during the past month. In several countries of the region, there has been recent circulation of seasonal influenza viruses including type A (Venezuela since May 2010) and B (Bolivia since March 2010). Throughout the region there has been variable ongoing co-circulation of other respiratory viruses, particularly RSV.

In Asia, pandemic influenza virus continues to actively circulate in Malaysia, Singapore, and to a much lesser extent in parts of India, Bangladesh, and Bhutan. In Malaysia, limited data suggest that virus transmission persists but continues to decline; the number of new cases reported per week plateaued during mid-April 2010 and began to decline at the end of May 2010. In Singapore, during the second week of June 2010, the levels of ARI remained near the warning level but below the epidemic threshold; approximately 28% of respiratory samples from patients with ILI tested positive for pandemic influenza virus. In South Asia, low level circulation of pandemic influenza virus has persisted in western India (since early 2010) and Bangladesh (since late February 2010); in India but not Bangladesh, regional, low intensity transmission during 2010 has been associated with small numbers of fatal cases over time. Seasonal influenza type B viruses continue to co-circulate with pandemic influenza virus in Bangladesh and have only recently emerged and become predominant in India, although at low levels. Of note, there have been recent media reports of increasing pandemic influenza activity in the southern Indian state of Kerala and more information is expected to become available soon. In Bhutan, there have recent reports of school outbreaks of pandemic influenza virus infection in three separate areas of the country, however, the overall intensity of respiratory diseases in the population was reported to be low.

In Sub-Saharan Africa, pandemic influenza virus continued to circulate at low levels in limited areas of East and West Africa. During the first week of June 2010, 10% and 16% of all respiratory samples tested positive for pandemic influenza virus in Tanzania and Ghana, respectively. Small but significant numbers of seasonal H3N2 viruses continue to be 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. Other respiratory viruses, most notably RSV, are known to be circulating in Chile and Argentina. During first two weeks of June 2010, small numbers of seasonal influenza H3N2 and type B viruses have been detected 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 06/18/2010)

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Global: Two who helped WHO's pandemic response quit review panel
Two experts have resigned from the committee reviewing the WHO’s pandemic response because their involvement in the response itself may appear to compromise the independence of the review, the WHO said 21 June 2010.

The two experts are Dr. John MacKenzie, an Australian virologist who chairs the WHO Emergency Committee, which has been advising the agency on its pandemic response, and Dr. Anthony Evans, chief of the aviation medicine section at the International Civil Aviation Association, based in Montreal.

Two members have withdrawn from the committee due to their concerns that their close association with the work of WHO during the H1N1 pandemic could be perceived as inconsistent with the Committee's role in providing an independent evaluation of this work, the WHO said in an update on the pandemic review committee's work; the WHO also said that although they are no longer members of the committee, both Professor John MacKenzie and Dr. Tony Evans will continue to contribute to the work of the Review Committee when called upon to do so as expert witnesses.

The review committee was launched in April 2010 and assigned to evaluate the WHO's pandemic response and the functioning of the revised International Health Regulations (IHR), which took effect in 2007. The evaluation was started amid considerable criticism that the WHO and many governments overreacted to the H1N1 virus, along with suggestions from some quarters that the response was improperly influenced by pharmaceutical companies hoping to profit from the pandemic.

These criticisms were renewed early in June 2010 with an investigative report in BMJ, formerly the British Medical Journal, and a report from a committee of the Council of Europe, a human rights organization. Both raised questions about the WHO's transparency and its management of potential conflicts of interest in relation to the pandemic. The BMJ report noted that three WHO advisors who helped develop pandemic guidance had some industry ties, and also noted that MacKenzie, chair of the WHO Emergency Committee, was also on the committee reviewing the pandemic response.

In response to the criticisms, the WHO has strongly defended its pandemic response and denied any improper industry influence, but the agency has agreed that it needs to strengthen its policies on transparency and on relations with the pharmaceutical industry.

In noting the resignations of MacKenzie and Evans, the WHO did not refer to MacKenzie's leadership of the Emergency Committee or specify Evans' role in WHO activities related to the pandemic. The agency has kept the names of members of its Emergency Committee, other than MacKenzie, confidential to protect them from pressure, a policy that has drawn criticism. The names will be released after the panel's work is done, WHO officials have said.

The review committee will hold its second meeting 30 June 2010 through 2 July 2010 in Geneva, the WHO said. The panel will begin interviewing key people at that time, including government officials, WHO staff members, industry and media representatives, and critics. Additional interviews will be conducted the summer and fall of 2010.

The review committee's five technical subcommittees held rounds of teleconferences early in May 2010 and again in early June 2010, the agency said. The subcommittees are addressing pandemic capacity and preparedness, alert and risk assessment, and response. A fourth subcommittee is examining the functioning of the IHR, and the fifth subcommittee is studying communication issues related to both the pandemic and the IHR.
(CIDRAP 06/22/2010)

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Global: Pandemic officially a year old
11 June 2010 marks the passage of a year since the World Health Organization (WHO) declared a pandemic of H1N1 influenza. WHO Director Margaret Chan declared phase six on 11 June 2009, about seven weeks after the virus had surfaced. The WHO hesitated to take the step because of concern that it would cause undue alarm, given that H5N1 avian flu had led the public to associate "pandemic" with high death rates. Although H1N1 activity is now low in most of the world, the WHO has maintained the phase six alert.
(CIDRAP 06/11/2010)

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India: Increase in pandemic influenza H1N1 activity
Monsoon rains have increased pandemic H1N1 flu activity in India, with 13 deaths and 233 flu cases reported in the week of 14 June 2010. Kerala has been hit the hardest, with 9 deaths the week of 14 June 2010 and 14 deaths the week of 7 June 2010, but the situation is becoming "grave" in Maharashtra, Karnataka, and Andhra Pradesh states. A health ministry official said India is prepared to handle the threat with adequate doses of Tamiflu and available vaccines.
(CIDRAP 06/22/2010)

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India (Hyderabad): state reopens pandemic influenza H1N1 isolation wards
Citing the reemergence of pandemic flu and other viral diseases with the rainy season, Hyderabad, India, health officials announced they would reopen H1N1 isolation wards in all 28 hospitals in the state. Health Secretary P. V. Ramesh said the government was on top of the situation and urged people to seek medical attention for persistent or severe flu symptoms.
(CIDRAP 06/21/2010)

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Asia
Australia (Brisbane): Girl’s autopsy shows no vaccine link
Autopsy results show no evidence linking the April 2010 death of a two-year-old Brisbane girl to the trivalent seasonal flu vaccine she had received a day earlier. But no clear cause of death was found, leaving some observers unconvinced. Because of increased adverse reactions, the seasonal vaccine is on hold for Australian children under five.
(CIDRAP 06/14/2010)

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India (Kerala): Health Ministry to probe increases in cases
A team from India's health ministry will assess a rise in pandemic flu illnesses and deaths in Kerala state that occurred over the month of June 2010 after a monsoon hit the area. Since 15 May 2010, 201 cases and 16 deaths have been reported, of which nine were pregnant women. An official said extra antiviral medication and vaccines are being deployed to the area. Four flu deaths were also recently reported from two other Indian states, Maharashtra and Karnataka.
(CIDRAP 06/16/2010)

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New Zealand: Record numbers vaccinated against pandemic influenza H1N1
The health minister of New Zealand says more than 1 million in the country have received flu vaccinations in 2010, setting a record. Last year 960,000 people were vaccinated. This year's flu shot includes the H1N1 pandemic strain. Cases of flu-like illness have increased in New Zealand since the week of 7 June 2010, with 18 pandemic H1N1 cases so far in 2010, and health officials are continuing to promote vaccination.
(CIDRAP 06/15/2010)

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Vietnam: Considers lowering pandemic influenza H1N1 alert level
The deputy minister of health in Vietnam has suggested lowering the alert level for pandemic H1N1 flu there, given that Vietnam has had no reports of the disease for more than two months. WHO has not suggested this move, but the minister said the the health ministry had "heard" that the WHO had blown the pandemic out of proportion at the urging of pharmaceutical companies, an accusation the WHO strongly refutes.
(CIDRAP 06/14/2010)

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Americas
Latin America: Widespread pandemic influenza H1N1 activity
Widespread influenza activity has been reported in Jamaica, while Cuba, Bolivia, Colombia, Peru, Venezuela, Brazil, and Chile reported regional flu activity. Bolivia reported a trend of increased acute respiratory disease for the first time, while Colombia reported two consecutive weeks and Venezuela three consecutive weeks of increased acute respiratory disease.
(CIDRAP 06/22/2010)

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USA: As EUAs expire, HHS says pandemic emergency is over
Federal officials 23 June 2010 allowed the public health emergency declaration that was prompted by the H1N1 influenza outbreak last year to lapse, signaling an end to emergency authorizations for certain special uses of antiviral drugs and other items.

The Department of Health and Human Services (HHS) first declared the emergency 26 April 2009, and has renewed it quarterly since then, the last time on 26 March 2010. A statement released by HHS 23 June 2010 says the current March 26 determination is scheduled to expire on June 23 2010, and, based on the current circumstances, will not be renewed.

The decision to let the declaration expire comes after several months of low flu activity. The HHS statement says the decision was based on many factors, including low pandemic flu activity, a low level of hospitalizations for flu-like illness, and the vaccination of 80 million Americans. The statement also said that there is no longer a significant demand for the medical countermeasures that required a public health emergency declaration and emergency use authorizations, and that it is likely that other countries will be taking similar actions in the coming weeks and months based on their own assessments."

The HHS move comes as the World Health Organization maintains its full phase six pandemic alert. After a meeting of its Emergency Committee on 1 June 2010, the WHO said peak H1N1 activity had probably passed for much of the world but that the virus continued to circulate in some regions. The committee is due to meet again in July 2010 to consider whether to change the alert level.

HHS says the end of the emergency declaration does not mean that Americans should stop taking H1N1 or seasonal flu seriously, as the virus is still circulating. Vaccination remains a good idea, particularly for people traveling to the Southern Hemisphere, currently in its winter flu season, and for children heading for summer camps, the statement says.

With the end of the emergency declaration, emergency use authorizations (EUAs) for certain antiviral drugs, medical tests, and respiratory protection devices also come to an end 23 June 2010. They were issued by the Food and Drug Administration (FDA).

The EUAs covered the use of the licensed antiviral oseltamivir (Tamiflu) in babies under one year old and the use of intravenous (IV) peramivir—an unlicensed antiviral still in the testing stages—in critically ill patients. Such uses will still be possible henceforward, but may be more complicated.

Another health emergency could be declared in the event of a new wave of H1N1 infections.

Andrew Pavia, MD, a pediatric infectious disease expert at the University of Utah, told CIDRAP News 23 June 2010 that the EUAs for the antivirals filled an important need.

Pavia, chair of the pandemic flu task force for the Infectious Diseases Society of America, said the EUA for use of oseltamivir in infants allowed clinicians to feel comfortable using this drug, based on good data.

The FDA issued the peramivir EUA October 2009 to make an IV antiviral drug available for H1N1 flu patients. The licensed antivirals indicated for H1N1 are oseltamivir, taken orally, and zanamivir (Relenza), which is inhaled. Those routes of administration may not be feasible for critically ill patients, especially those on ventilators. (An IV formulation of zanamivir is being tested and has been available under special "emergency investigational new drug rules," but the FDA did not announce an EUA for it.)

Pavia said the EUA for IV peramivir was potentially very important in providing an IV formulation for critically ill patients, and that there were some real successes in terms of getting drugs to patients on a timely basis.

With the end of the EUA for oseltamivir in infants less than a year old, clinicians can still prescribe it, but it will be an off-label use, Pavia said. Pavia said he doesn't think the end of the peramivir EUA will be a problem, because physicians will still be able to access the drug by participating in ongoing clinical trials.

More than 1,000 people have been treated successfully with IV peramivir, according to an HHS document supporting a 2011 budget request.

Jon Stonehouse, president and CEO of BioCryst Pharmaceuticals, maker of peramivir, said the end of the peramivir EUA is giving the company more motivation to get the drug licensed.

Peramivir is currently in a phase three trial. Stonehouse said that he thinks a reasonable target for approval is in time for the 2012-13 flu season, assuming the company can enroll enough patients in the ongoing trial and the results continue to be positive.

Other expiring EUAs covered the use of some lots of oseltamivir and zanamivir beyond their labeled expiration dates. Others covered the use of certain N-95 respirators to protect wearers against airborne pathogens and the use of certain in vitro diagnostic tests for the pandemic virus. The Centers for Disease Control and Prevention (CDC) has posted information about the various authorizations, including some guidance for the handling of leftover supplies: http://www.cdc.gov/h1n1flu/eua/
(CIDRAP 06/23/2010)

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USA: CDC looks at tying public health alerts to medical records
An informatics expert from the US Centers for Disease Control and Prevention (CDC) spoke 22 June 2010 with clinicians about possible public health connections to electronic medical records, which she said could have been useful during the H1N1 pandemic and might ease information flow during future public health events.

The discussion follows recent federal investments to promote greater use of health information technology.

In March 2010, Health and Human Services (HHS) Secretary Kathleen Sebelius announced the award of $162 million in economic stimulus funding designed to ease health information exchange and further health information technology (IT). The funding is part of a wider $2 billion effort to encourage more meaningful use of health IT and an electronic health record (EHR) for every citizen by the year 2014, according to a 15 March 2010 HHS press release.

In a clinicians conference call, Nedra Garrett, acting director of the CDC's division of informatics practice, policy, and coordination, said recent health IT and EHR incentives present tremendous opportunities for pubic health. She said challenges are to connect public health alerts and guidance to relevant patient data in the EHR and to make sure systems have a meaningful impact on point-of-care practices, such as ordering lab tests and distributing educational information to patients.

She said the CDC envisions working with other government agencies to employ other public health EHR-based IT applications such as food recalls and vaccine adverse event reporting.

As an example of how the system would work, a patient presenting to a doctor's office with flu symptoms such as cough, chills, and fever would generate an anonymous electronic patient profile containing the symptoms and the provider and patient's zip code that transmit to a central alert repository, which would send the physician diagnosis, treatment, and prevention resources targeted to the patient.

Garrett added that the anonymous patient profile could also include useful public health data such as the patient's occupation or recent travel history.

Having public health systems interface with EHR might be able to prevent clinicians from being bombarded during health emergencies, as they were during the H1N1 pandemic with multiple sources, some of which provided contradictory information.

Garrett said clinicians will be most likely to find EHR-based public health alerts useful if they strike a balance of providing the most relevant information at the right time. She said an alert system would also likely include a severity scale to help clinicians gauge the urgency of the notices.

Though the concept is still in its infancy, Garrett said the CDC has launched a small pilot program in an ambulatory setting. The CDC is collaborating with 10 providers of a GE Healthcare customer site in Chicago. The project is focusing on foodborne disease alerts, and Garrett said the CDC hopes to have preliminary findings by the end of the year.

During the question-and-answer part of the conference call, clinicians seemed eager to broaden the public health applications for EHR beyond just public health alerts to include functions such as surveillance and disease reporting. However, they also had concerns about local health and emergency medical service officials being included in the system, the scope of the information that the public health system might pull from medical records, and the interoperability between different EHR systems.

Garrett said there are several complicated issues to sort out, such as making sure rules and governance issues are addressed.
(CIDRAP 06/22/2010)

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2. Infectious Disease News

Asia
Chinese Taipei: Suspected measles outbreak
The Department of Health announced three confirmed local cases of measles in Taipei City 22 June 2010, including two university students and one private security guard, raising concerns of a possible outbreak.

Following investigations, the Centers for Disease Control under the DOH has estimated that the three individuals may have come into contact with more than 1,500 people since being infected.

CDC Deputy Director-General Lin Ting said that as the number of people with whom they had contact is so high, the DOH can only start by trying to track down those who are at higher risk of being infected.

According to the CDC, the two infected students are both female and 21 years old. One of the young women studies at a national university, while the other takes classes at a technology university in the evenings.

Lin said both students used public transportation to commute to school and their part-time jobs before discovering that they were infected. In addition, the public university student took a Graduate Record Examination language test 12 June 2010, coming into contact with dozens of other students who were also taking the test.

Lin estimated that the two students probably came into contact with more than 1,000 people before being diagnosed with measles.

Meanwhile, the 39-year-old male security guard reportedly went to work every day between14-18 June 2010, a period during which the CDC suspects he was already infected. As the guard rode the elevator while patrolling the building where he works during each shift, the center estimated that more than 500 individuals had come into contact with the patient.

The CDC believes that the man was infected last week when he headed to hospital to pick up some medicine. The pharmacist on duty at the time was later announced by the DOH as having measles.

According to CDC tallies, there have been 12 confirmed cases of measles in Chinese Taipei so far this year, half of which are imported cases and rest are local.

A point of concern for the center is not only that the average age of the infected individuals is relatively higher than in the past, but also that the infection source of four of the cases has not been determined.

Lin urged all citizens who begin displaying symptoms of measles, including fever, rash, conjunctivitis, or inflammation of the nose and throat with increased production of mucus, to begin wearing a surgical mask to prevent a spread of the virus and visit the hospital immediately.

He also called for doctors to be on increased alert when examining patients and to report any suspected cases to authorities at once in order to help prevent a possible outbreak.
(Taiwan Today 06/23/2010)

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Honk Kong (Fanling): School advised to close, due to hand, foot and mouth disease outbreak
Ka Fuk Baptist Church Pre-school in Fanling has been advised to suspend classes 24 June 2010 for two weeks until 7 July 2010 following an investigation by the Department of Health's Centre for Health Protection (CHP) into a hand, foot and mouth disease (HFMD) outbreak at the school affecting 12 pupils. From 24 May 2010, five boys and seven girls aged between two and five developed symptoms of HFMD. All of them sought medical treatment.

They are now in stable condition and no hospitalization was required. The stool samples of two girls aged two and five tested positive for enterovirus 71. The school management has stepped up cleaning measures according to CHP's advice following their visits on 1 and 14 June 2010.

As one more student was reported 23 June 2010 to be affected with HFMD, the school was advised to suspend classes for thorough disinfection. A CHP spokesman reminded the public to maintain strict personal and environmental hygiene during the current HFMD outbreaks.
(HKSAR Government 06/23/2010)

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New Zealand (Kaikoura): Whooping cough outbreak
Kaikoura has been hit by a whooping cough epidemic, with 15 cases confirmed by the Kaikoura Medical Centre since the beginning of April 2010.

Centre practice manager Wendy Campbell said the outbreak was under control with no new cases reported for two weeks.

One of the confirmed cases was a baby under one. Babies were especially vulnerable to the disease, which could be deadly, Mrs Campbell said. She thinks it is likely that there are more undiagnosed cases in the community.

Kaikoura Medical Centre doctor Andrea Judd said these kinds of epidemics were more likely when parents did not have their children immunized. She is concerned whooping cough might become more prevalent. Dr Judd praised early childhood centres and schools for being aware of the epidemic and working to control the outbreak.

Nelson Marlborough District Health Board medical officer of health Jill Sherwood said health practices were legally required to report suspected cases of whooping cough, also called pertussis. One probable case of whooping cough in Marlborough had been reported to the public health service this year.

Canterbury medical officer of health Ramon Pink said babies should be vaccinated and kept away from anyone with whooping cough.
(The Malborough Express 06/23/2010)

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Russia: Confirmation of polio cases in Tajikistan
The Russian Health and Social Affairs Ministry has confirmed seven cases of polio that it says likely originate from an outbreak in Tajikistan in May 2010, RFE/RL's Russian Service reports.

Gennady Onishchenko, Russia's chief public health official, said on 21 June 2010 that polio cases have been registered in Irkutsk, Chelyabinsk, the Sverdlovsk region, and Moscow.

They are the first cases of polio in Russia in 15 years.

The outbreak of viral polio in April in Tajikistan prompted Russian officials to ban the import of dried fruit and nuts from Tajikistan. Children under six were also prohibited from entering Russia from Tajikistan.

Polio epidemics were common in the West until the 1950s, and the disease has been eradicated in most parts of the world. Only about 1,000 cases of it are reported per year, almost exclusively in developing countries.
(Radio Free Europe 06/23/2010)

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Thailand: Warning against rabies issued
The Ministry of Public Health has cautioned people to beware of the current rabies spread in the country after 13 fatalities have been confirmed in the first five months of 2010 thus far.

According to Deputy Public Health Minister, Phansiri Kullanartsiri, 13 people from seven provinces have died from rabies. Twelve of the patients who died were bitten by dogs with owners; one person died by being bitten from a stray cat.

Six patients were from Bangkok alone while two were from the western province of Kanchanaburi. Saraburi, Samut Prakan, Suphan Buri, Tak, and Chon Buri shared one case each. Bangkok and Kanchanaburi were classified in the dangerous zone for rabies spread.

Meanwhile, Disease Control Department Director-General, MD Manit Teeratantikanont, warned people about raising dogs aged less than three months old, especially stray puppies because they might be infected with rabies but did not show symptoms.

MD Manit explained that some dogs showed symptoms of infection within one to two months but it could be prolonged to even six months for some.
(NNT 06/21/2010)

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Americas
USA (California): An epidemic of whooping cough declared
Whooping cough is now an epidemic in California, and is on pace to break a 50-year record for infections for 2010.

As of 15 June 2010, California had 910 recorded cases of the highly contagious disease, and five babies -- all under three months of age -- have died from the disease this year.

The 2010 surge in cases of whooping cough, also known as pertussis, is a fourfold increase from the same period in 2009, when 219 cases were recorded.

At least 600 additional cases are under investigation by local health departments. Officials fear that with the number of known and suspected cases at 1,510, the state is on track to beat 1958's record 3,847 cases; midway through that year, 1,200 cases had been reported.

Nationally, 23 weeks into 2010, there were 4,656 cases of whooping cough, compared with 6,017 cases in the same period in 2009, according to the Centers for Disease Control and Prevention.

The declaration of epidemic is made after a significant increase in the number of illnesses to a broad swath of the state's population, said state health department spokesman Ken August.
(CBS2 06/23/2010)

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USA (Texas): Rare cases of hepatitis E
Two cases of hepatitis E, thought rare in the United States, have been reported in Texas and blamed for one death, health officials say.

The San Antonio, Texas, cases of hepatitis E, a viral liver infection, usually considered a problem mostly in developing countries, have gotten the attention of state and local health officials.

One of the cases was a 21-year-old woman who died during a liver transplant, the other a 44-year-old nurse's aide who suffered some liver damage from the disease.

Roger Sanchez, senior epidemiologist with Metro Health, said at a public health meeting in Austin that it was not known how the patients became infected. He said that none of them had any foreign travel history, and that they were previously healthy.

Hepatitis E is usually spread through contaminated food or water. Serious outbreaks of hepatitis E have taken place in Mexico, Asia and Africa.

Some U.S. researchers say hepatitis E is more common in the United States than previously thought. What remains a mystery, they say, is why some people get sick from the virus but most do not.
(UPI.com 06/22/2010)

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3. Updates
INFLUENZA A/H1N1
- WHO
Influenza A/H1N1: http://www.who.int/csr/disease/swineflu/en/index.html
Influenza A/H1N1 frequently asked questions:
http://www.who.int/csr/disease/swineflu/frequently_asked_questions/en/index.html
Pandemic Influenza Preparedness and Response - A WHO Guidance Document http://www.who.int/csr/disease/influenza/pipguidance2009/en/index.html
International Health Regulations (IHR) at http://www.who.int/ihr/en/index.html.

- WHO regional offices
Africa: http://www.afro.who.int/
Americas:
http://new.paho.org/hq/index.phpoption=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:
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/biofacts/swinefluoverview.html
ProMED: http://www.promedmail.org/

- CDC H1N1 Influenza Update
Questions and Answers about Updating Guidance on Infection Control Measures for Influenza in Healthcare Settings:
http://www.cdc.gov/h1n1flu/guidance/control_measures_qa.htm

- CDC Press Release: New CDC Test to Detect Human Infections with the 2009 H1N1 Influenza Virus Authorized for Use by FDA:
http://cdc.gov/media/pressrel/2010/r100622.htm

- Regional PAHO update: http://www.reliefweb.int/rw/rwb.nsf/db900sid/MYAI-86N3SK/$File/full_report.pdf

- WHO update: A year has passed since the inception of the 2009 H1N1 influenza pandemic:
http://www.who.int/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/en/index.html/?date=061110

- H1N1 Influenza update:
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/biofacts/swinefluoverview.html

- - H1N1 Resource List:
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/resources/swineflures.html

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

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VECTOR-BORNE DISEASE
India (Kerala)
One person has died of dengue fever in Kozhikode district 20 June 2010. The deceased has been identified as a resident of Meppayoor. The number of fever-affected patients in the State is increasing day by day; the death toll is also increasing.
(ProMED 06/20/2010)


India (Mumbai)
Cutting across party lines, corporators slammed the civic health department for inefficiency in controlling the spread of malaria.

In the last 20 days, out of 40,105 people examined 3,356 have tested positive for malaria, according to data given by the Brihanmumbai Municipal Corporation (BMC).

Rajhans Singh, Congress corporator, said that the BMC health department was not doing enough to curb the spread of the disease.

Upendra Doshi, Congress corporator, said the BMC should consider taking help from the private practioners of each ward to curb the menace. BJP corporator Yogesh Sagar said the BMC must suspend pest control officers of a ward if larvae breeding sites are found in that ward. He added that civic medical officers are not fogging under construction sites marked as high-risk zones as there are water puddles and tanks around which act as breeding zones for mosquitoes.

Labourers working at one site carry the malaria virus with them, when they migrate to other sites, observed the BMC. Additional Municipal Commissioner, Ashish Kumar Singh, said the BMC was fogging larvae breeding sites every ten days and conducting health camps.
(Hindustan Times 06/25/2010)


Philippines
The week of 7 Jun 2010 in Bontoc, two girls died after contracting dengue, prompting provincial health officials to raise a heightened alert for the disease. The Provincial Health Office (PHO) in Bontoc said one girl was seven, and one 13; both were from Barangay Samoki.

In raising the dengue alert in this province, the PHO cited an Increase of 87 percent in the number of cases of the disease in 2010 compared to 2009. Bontoc General Hospital officials said as of 14 June 2010 that the medical facility was packed with suspected dengue patients.

During the dry months aggravated by El Nino, the PHO warned residents against storing water that could be the breeding ground of dengue-causing mosquitoes. This time, residents are being warned against allowing rainwater to settle in puddles and household items that could hold water as these are the favorite places for mosquitoes to lay their eggs.
(ProMED 06/22/2010)


Philippines (Mountain Province)
In the week of 7 Jun 2010 in Bontoc, two girls died after suffering from dengue, prompting provincial health officials to raise a heightened dengue alert. The Provincial Health Office (PHO) cited an 87 percent increase in the number of cases in 2010, compared to 2009.
(ProMED 05/15/2010)


Peru (San Martin)
The Ministry of Health has become aware of more than 160 cases of people affected by an outbreak of Oropouche virus, reported by the office of the Director General of Epidemiology (DGE) in Bagazan, Pachica district in the Mariscal Caceres province in San Martin at the end of May 2010.

Of these cases, 48 per cent were male and 52 per cent female. By age, 31 per cent were children up to 10 years, 23 per cent 11-20 years, 27 per cent 21-30 years, 13 per cent 31-40 years, and 6 per cent 41 years and over, as reported by the DGE of the Ministry of Health [MINSA]. School absences have been numerous (about 68 students).

Specialists explained that Oropouche virus is transmitted mainly by a hematophagous (blood-sucking) midge named Culicoides paraensis. The fever caused by the viral infection is similar to that caused by dengue. In some patients, it can cause a clinical picture of asceptic meningitis, but thanks to timely medical attention, this type of serious case has not been reported in the current outbreak.

Currently, MINSA action includes active case searching, taking of samples and processing of samples taken from affected individuals. The 26 samples taken were sent to the reference laboratory in Tarapoto. From there, they were taken to the National Institutes of Health, where they were processed for studies of etiologies of febrile syndromes. The results confirmed 16 cases (61 per cent) positive for Oropouche virus infection.

The office of the San Martin Regional Health Director sent health personnel of the Juanjui Hospital and of the Pachiza Health Post to the area of the outbreak, to help with medical attention for the cases and in their investigation. In addition, specialists in infectious diseases were sent there to attend the cases. Also, analgesics and antibiotics were provided to the health unit in Bagazan and the Juanjui Hospital. Meanwhile, the DGE is carrying out the follow up for the outbreak in coordination with the Epidemiology Office of the San Martin DIRESA [Direccion Regional de Salud; Regional Health Directorate].

Oropouche virus was isolated in Peru for the 1st time in 1992 from febrile patients in Iquitos. In 1994, this virus caused an epidemic in the south east area of the Amazon region.
(ProMED 06/18/2010)


USA (Arizona): West Nile virus present in mosquitoes
Forty-five confirmed cases of the insects carrying the West Nile Virus have shown up in Maricopa County in the past three weeks, with all but one being in three East Valley cities.

John Townsend of the County of Environmental Services Department says the other case is in Wickenburg, but there may be a few reasons for why the majority of the cases are in the East Valley.

We have a little bit more flood irrigation in some of those areas, a little bit more standing water, he said, but thought it was just a combination of swimming pools that are bad and excess water.

Townsend said there have been no confirmed human cases of the virus so far this year, but there will likely be some in the future.
(KTAR.com 06/22/2010)


USA (Washington State)
State officials have identified 2010’s first known case of West Nile virus in mosquitoes.

In a statement made Tuesday, 22 June 2010, the state Health Department says the virus was detected in mosquitoes in Grant County.

West Nile virus has been present in the United States since 1999, and in Washington state since 2005. The virus is carried by birds, picked up by mosquitoes and can be passed to horses and people.

Most people show no symptoms, but it can cause brain damage in serious cases. Last year was the most active West Nile season yet in Washington. The Health Department says dozens of people were infected in 2009, leading to one death.
(AP 06/22/2010)


Viet Nam
According to the Preventive Health Department under the Ministry of Health, seven people have died of viral encephalitis in the country in the last month. A total of 120 people have been infected so far in 15 provinces and cities including Ha Noi and HCM City and Nam Dinh, Bac Giang, Nghe An, Thanh Hoa, Dak Lak, and Dong Nai.

Dr Tran Nhu Duong, deputy head of the National Institute of Hygiene and Epidemiology, said the disease usually spreads most rapidly in both the north and south between May and August. The northern provinces had reported the highest incidence, he said.

Japanese encephalitis [JE] is a very common disease among children aged under 15, with the fatality rate topping 30 per cent if patients are not treated in time. Duong dispelled a misconception that eating litchi causes the disease, explaining it is caused by a virus or hypersensitivity to a virus or foreign protein.
(ProMED 06/17/2010)

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CHOLERA, DIARRHEA, and DYSENTARY
New Zealand
Raphael Yipmaramba, who has been overseeing the response to a cholera emergency in Papua New Guinea’s Central Province, says the outbreak is now under control.

There have been six deaths and nearly eighteen-hundred cases reported to health authorities in the province since the disease struck mid-April 2010.

Cholera had earlier hit nearby Port Moresby, after striking the north coast provinces in 2009.

Mr Yipmaramba says the daily number of new cholera cases in Central Province has declined from 30 to five and the authorities are now addressing cultural factors contributing to the spread of the disease. Authorities are also distributing pamphlets to spread the message about boiling water, cooking food properly, and recommending that villages build latrines.
(Radio New Zealand International 06/21/2010)


Vietnam
Four Mekong delta provinces of Ben Tre, Tien Giang, An Giang and City Can Tho reported cases. Ben Tre is one of eight provinces with fifty cases and over 500 acute diarrhea patients.

Meanwhile An Giang after three month hiatus, medical workers confirmed four cholera cases in Long Xuyen City and district Cho Moi. Thefirst cholera case is reportedly positive for the virulent vibrio cholera virus in Tien Giang’s district Cai Be.

69 cholera cases have been reported in nine provinces and cities this year, including Hanoi and Ho Chi Minh City, deputy minister Trinh Quan Huan said on 7 June 2010.

The bacterium that has been causing cholera in Vietnam since 2007 is growing more toxic and dangerous, the Ministry of Health reported on 7 June 2010.

The ministry noted that the current strain of V.chlerae and type O1 is different from that which caused the acute intestinal disease in Vietnam before 2007, adding that the new type has a far longer lifespan in the environment. Mr. Huan pointed out the current strain in Vietnam is similar that caused pandemic in Laos, Cambodia and Thailand.
(Vietnam Net 06/20/2010)

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4. Articles
The Re-Emergence of H1N1 Influenza Virus in 1977: A Cautionary Tale for Estimating Divergence Times Using Biologically Unrealistic Sampling Dates
Wertheim JO. PLoS ONE. June 2010;5(6): e11184. doi:10.1371/journal.pone.0011184
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0011184

Abstract. In 1977, H1N1 influenza A virus reappeared after a 20-year absence. Genetic analysis indicated that this strain was missing decades of nucleotide sequence evolution, suggesting an accidental release of a frozen laboratory strain into the general population. Recently, this strain and its descendants were included in an analysis attempting to date the origin of pandemic influenza virus without accounting for the missing decades of evolution. Here, we investigated the effect of using viral isolates with biologically unrealistic sampling dates on estimates of divergence dates. Not accounting for missing sequence evolution produced biased results and increased the variance of date estimates of the most recent common ancestor of the re-emergent lineages and across the entire phylogeny. Reanalysis of the H1N1 sequences excluding isolates with unrealistic sampling dates indicates that the 1977 re-emergent lineage was circulating for approximately one year before detection, making it difficult to determine the geographic source of reintroduction. We suggest that a new method is needed to account for viral isolates with unrealistic sampling dates.

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Prevalence of influenza vaccination and assocated factors among pregnant women in Hong Kong
Lau JTF, Cai J, Tsui HY, et al. Vaccine. June 2010; doi:10.1016/j.vaccine.2010.05.071
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-508VDM2-1&_user=10&_coverDate=06%2F11%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=3e10c908a0f8f6b555ce57e904913467

Abstract. A total of 568 pregnant women in Hong Kong were interviewed. Of them, 85.4% had heard of influenza vaccine, 21.3% had ever been vaccinated, 3.9% self-reported receiving influenza vaccination (IV) in the 2005/2006 flu season, and 33% were inclined toward receiving IV in the coming year. Multivariate analysis showed that those who had been recommended by health care professionals to receive IV during pregnancy were more likely than others to have received IV. Other variables related to the Health Belief Model were significantly associated with having ever been vaccinated or inclined toward receiving IV in the coming year.

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Comparative age distribution of influenza morbidity and mortality during seasonal influenza epidemics and the 2009 H1N1 pandemic
Lemaitre M, Carrat F. BMC Infectious Diseases. 2010;10:162. doi:10.1186/1471-2334-10-162
Available at http://www.biomedcentral.com/1471-2334/10/162

Background. Several studies have shown a relatively high mortality rate among young people infected by the 2009 pandemic influenza A (H1N1) virus. Here we compared the age distributions of morbidity and mortality during two seasonal influenza epidemics (H1N1 and H3N2) in France and the United States with those of the 2009 H1N1 pandemic waves in the same countries.

Methods. Age-standardized ratios were used to compare the age distribution of morbidity and mortality due to influenza between the two countries and across the different years. Non parametric analysis of variance was used to compare these ratios between epidemic and pandemic influenza.

Results. Age distribution of morbidity was similar between the 2009 pandemic and seasonal epidemics due to H1N1 (p=0.72) and H3N2 viruses (p=0.68). In contrast, the proportion of under-60s among influenza deaths was markedly higher during the 2009 pandemic (peak <20 years) than during the seasonal epidemics (respectively p=0.007 and p=0.0008).

Conclusions. Young age was a principal mortality risk factor due to the 2009 H1N1 pandemic.

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Editorial: A pandemic of hindsight?
Nature. 24 June 2010;465(985): doi:10.1038/465985a
Available at http://www.nature.com/nature/journal/v465/n7301/full/465985a.html

Excerpt. Late this week, the Council of Europe's parliamentary assembly, a 47-member-state body that promotes democracy and human rights in Strasbourg, France, is scheduled to vote on a resolution expressing alarm over the World Health Organization's (WHO's) handling of the H1N1 influenza pandemic.
[For the remainder of the editorial, please refer to the link above.]

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Press Release: Employers took many measures to protect employees and avoid business impact of H1N1 flu outbreak
Harvard School of Public Health. 22 June 2010
Available at http://www.hsph.harvard.edu/news/press-releases/2010-releases/businesses-took-measures-to-protect-employees-from-h1n1-flu.html

Excerpt. In response to the H1N1 flu, most employees at U.S. businesses say their company took measures to protect them from illness, such as encouraging sick employees to stay home, according to a national poll of employees by researchers from the Harvard Opinion Research Program at Harvard School of Public Health (HSPH). Smaller, but notable, percentages of employees reported that their company took other actions such as creating back-up systems for employees to cover each others’ work and expanding leave policies.
[for the rest of the press release, please refer to the link above.]

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Outbreak of Influenza A (2009) H1N1 among Thai Healthcare Workers: Is It Time to Integrate a Vaccination Program?
Apisarnthanarak A, Mundy LM. Infect Control Hosp Epidemiol. 2010;31:000-000. DOI: 10.1086/655019
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/655019

Abstract. We report an outbreak of influenza A (2009) H1N1 among healthcare workers in a coronary care unit in Thailand. The attack rate was 32% (7 of 32 healthcare workers) after detection of influenza A (2009) H1N1 pneumonia in the index patient. Estimated costs for the outbreak investigation and control plan were 12]fold higher than estimated costs of vaccination for healthcare workers.

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Community-Based Measures for Mitigating the 2009 H1N1 Pandemic in China
Tang S, Xiao Y, Yang Y, et al. PloS One. 2010;5(6): e10911. doi:10.1371/journal.pone.0010911
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0010911?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosone%2FPLoSONE+(PLoS+ONE+Alerts%3A+New+Articles)&utm_content=Google+Reader

Abstract. Since the emergence of influenza A/H1N1 pandemic virus in March–April 2009, very stringent interventions including Fengxiao were implemented to prevent importation of infected cases and decelerate the disease spread in mainland China. The extent to which these measures have been effective remains elusive. We sought to investigate the effectiveness of Fengxiao that may inform policy decisions on improving community-based interventions for management of on-going outbreaks in China, in particular during the Spring Festival in mid-February 2010 when nationwide traveling will be substantially increased. We obtained data on initial laboratory-confirmed cases of H1N1 in the province of Shaanxi and used Markov-chain Monte-Carlo (MCMC) simulations to estimate the reproduction number. Given the estimates for the exposed and infectious periods of the novel H1N1 virus, we estimated a mean reproduction number of 1.68 (95% CI 1.45–1.92) and other A/H1N1 epidemiological parameters. Our results based on a spatially stratified population dynamical model show that the early implementation of Fengxiao can delay the epidemic peak significantly and prevent the disease spread to the general population but may also, if not implemented appropriately, cause more severe outbreak within universities/colleges, while late implementation of Fengxiao can achieve nothing more than no implementation. Strengthening local control strategies (quarantine and hygiene precaution) is much more effective in mitigating outbreaks and inhibiting the successive waves than implementing Fengxiao. Either strong mobility or high transport-related transmission rate during the Spring Festival holiday will not reverse the ongoing outbreak, but both will result in a large new wave. The findings suggest that Fengxiao and travel precautions should not be relaxed unless strict measures of quarantine, isolation, and hygiene precaution practices are put in place. Integration and prompt implementation of these interventions can significantly reduce the overall attack rate of pandemic outbreaks.

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Transmissibility of 2009 Pandemic Influenza A(H1N1) in New Zealand: Effective reproduction of number and influence of age, ethnicity and importations
Paine S, Mercer GN, Kelly PM, et al. Eurosurveillance. 17 June 2010;15(24).
Available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19591

Abstract. The first wave of pandemic influenza A(H1N1) has subsided in New Zealand as in other southern hemisphere countries. This study aimed to estimate the effective reproduction number (R) of 2009 pandemic influenza A(H1N1) taking into account imported cases. It also aimed to show the temporal variation of R throughout the New Zealand epidemic, changes in age- and ethnicity-specific cumulative incidence, and the effect of school holidays. Using a new modelling method to account for imported cases, we have calculated the peak R during the containment phase of the pandemic as 1.55 (95% confidence interval: 1.16 to 1.86). This value is less than previously estimated in the country early in the pandemic but in line with more recent estimates in other parts of the world. Results also indicated an increase in the proportion of notifications among school-age children after the school holiday (3–19 July 2009). This finding provides support for the potential effectiveness of timely school closures, although such disruptive interventions need to be balanced against the severity of the pandemic.

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Zoonotic transmission of avian influenza virus (H5N1), Egypt, 2006-2009
Kandeel A, Manoncourt S, Abd el Kareem E, et al. Emerging Infectious Diseases. July 2010;16(7).
Available at http://www.cdc.gov/eid/content/16/7/1101.htm

Abstract. During March 2006–March 2009, a total of 6,355 suspected cases of avian influenza (H5N1) were reported to the Ministry of Health in Egypt. Sixty-three (1%) patients had confirmed infections; 24 (38%) died. Risk factors for death included female sex, age >15 years, and receiving the first dose of oseltamivir >2 days after illness onset. All but 2 case-patients reported exposure to domestic poultry probably infected with avian influenza virus (H5N1). No cases of human-to-human transmission were found. Greatest risks for infection and death were reported among women >15 years of age, who accounted for 38% of infections and 83% of deaths. The lower case-fatality rate in Egypt could be caused by a less virulent virus clade. However, the lower mortality rate seems to be caused by the large number of infected children who were identified early, received prompt treatment, and had less severe clinical disease.

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Editorial: Polio returns to Tajikistan
Editors. CMAJ. 15 June 2010.
Available at http://www.cmaj.ca/earlyreleases/15june10_polio-returns-to-tajikistan.dtl

Excerpt. A polio outbreak in once polio-free Tajikistan is serving as a reminder to the rest of the world that the deadly illness is only a plane trip away.

“As poliovirus is highly infectious travelling long distances, the key lessons learned are that all countries need to maintain high quality surveillance to detect a potential importation of wild poliovirus until global poliomyelitis eradication is declared, and all children should be vaccinated against poliovirus,” Cristiana Salvi, a spokeswoman for the World Health Organization’s (WHO) regional office for Europe, writes in an email. “Countries should have preparedness plans to respond to a possible importation which identify the target group and vaccine to be used in mounting a response.”
[for the rest of the editorial, please refer to the link above.]

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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/.

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4th Ditan International Conference on Infectious Diseases
Beijing, China 15-18 July 2010
Ditan International Conference on Infectious Diseases is the annual conference held in Beijing to provide a platform for scientific exchange between Chinese and international experts.
Additional information is available at http://www.bjditan.org/

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Options for the Control of Influenza VII
Hong Kong 3-7 Sep 2010
Options for the Control of Influenza VII is the largest forum devoted to all aspects of the prevention, control, and treatment of influenza. As it has for over 20 years, Options VII will highlight the most recent advances in the science of influenza. The scientific program committee invites authors to submit original research in all areas related to influenza for abstract presentation. Accepted abstracts will be assigned for oral or poster presentation.
Additional information is available at http://www.controlinfluenza.com.

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Influenza 2010: Zoonotic Influenza and Human Health
Oxford, United Kingdom 22 Sep 2010
The Oxford influenza conference, Influenza 2010, will address most aspects of basic and applied research on zoonotic influenza viruses (including avian and swine) and their medical and socio-economic impact.
Additional information available at http://www.libpubmedia.co.uk/Conferences/Influenza2010/Home.htm.

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4th Vaccine and ISV Annual Global Congress
Vienna, Austria 3-5 October 2010
Now in its fourth year, the annual Vaccine Congress has become the forum for the exchange of ideas to accelerate the rate at which vaccines can come to benefit the populations that need them. Organized by: Vaccine – the pre-eminent journal for those interested in vaccines and vaccination – in collaboration with the International Society for Vaccines.
Deadline for abstracts/proposals: 18 June 2010
Additional information available at http://www.vaccinecongress.com

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 apecein@u.washington.edu