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Vol. XIII No. 14 ~ EINet News Briefs ~ Jul 09, 2010


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

1. Influenza News
- Global: 2010 Cumulative number of human cases of avian influenza A/H5N1
- Global: WHO situation update on pandemic influenza H1N1
- Global: WHO confirms 500th H5N1 avian influenza case
- Global: WHO reports non-vaccine aid for needy nations’ pandemic response falls short
- Global:WHO pandemic review holds second meeting
- Australia: Outbreak of pandemic influenza H1N1 reported in Northwest Territories
- Bangladesh: US efforts help reduce H5N1 risk in more Bangladesh bird markets
- Chinese Taipei: New case pandemic influenza H1N1 confirmed
- India: Pandemic influenza H5N1 situation considered serious in five states
- India: 16 more H1N1 deaths
- India: Pandemic influenza H1N1 deaths on the upswing
- New Zealand: Rise in H1N1 pandemic influenza
- Chinese Taipei: CORRECTION: New case pandemic influenza H1N1 confirmed
- USA: 43% of pandemic influenza H1N1 vaccine may be destroyed
- Mexico: H1N1 pandemic influenza alert ended

2. Infectious Disease News
- Canada: New cases of tuberculosis
- Papua New Guinea: Efforts to combat increasing resistant tuberculosis
- Canada: Novovirus outbreak
- Chile (Maule): Hantavirus case

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

4. Articles
- Association of ABO blood groups with Chikungunya virus
- Opting In vs Opting Out of Influenza Vaccination
- Influenza-Associated Pneumonia in Children Hospitalized With Laboratory-Confirmed Influenza, 2003-2008
- Oseltamivir Dosing for Influenza Infection in Premature Neonates
- Trends for influenza and pneumonia hospitalization in the older population: age, period, and cohort effects
- Surveillance for outbreaks of influenza-like illness in the institutionalized elderly
- The Next Pandemic
- Pandemic (H1N1) 2009 influenza in the UK: clinical and epidemiological findings from the first few hundred (FF100) cases
- Vaccination against pandemic influenza A/H1N1 among healthcare workers and reasons for refusing vaccination in Istanbul in last pandemic alert phase
- Monitoring of perceptions, anticipated behavioral, and psychological responses related to H5N1 influenza
- Mortality Patterns Associated with the 1918 Influenza Pandemic in Mexico: Evidence for a Spring Herald Wave and Lack of Preexisting Immunity in Older Populations

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
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 / 4 (3)
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: 500 (296)
(WHO 07/05/10 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_07_05/en/index.html )

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

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

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

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Global: WHO situation update on pandemic influenza H1N1
As of 4 July 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18311 deaths.

Worldwide, overall pandemic influenza activity remains low. Active circulation of pandemic influenza virus persists in areas of the tropics, particularly in South and Southeast Asia, the Caribbean and West Africa. Overall pandemic and seasonal influenza activity has remained low during the early part of the current winter season in the temperate zone of the southern hemisphere. Low levels of seasonal influenza (H3N2 and type B) viruses were detected during June 2010 in South Africa, while Chile, Australia, and New Zealand, have all recently detected low levels of predominantly pandemic influenza virus. Increasing seasonal influenza activity has also recently been observed in several countries of Central America.

Although rates of respiratory disease have begun to increase in several countries of the temperate zone of the southern hemisphere, little pandemic or seasonal influenza activity has been seen so far during early part of the winter season. In South Africa, a sharp increase in the detection rate of influenza virus, primarily seasonal influenza H3N2 and type B, was observed during the later part of June and early July 2010 (> 40% of sentinel respiratory samples from patients with ILI tested positive for influenza during the first week of July 2010); however, levels of respiratory illness-related outpatient consultations and hospitalizations do not appear to be significantly elevated. In Australia, slight increases in the rates of ILI have been reported in recent weeks, however, the overall number of influenza virus detections (primarily pandemic H1N1 and seasonal H3N2) remain low. In New Zealand, rates of ILI have steadily increased over the month of June 2010; however, only small numbers of predominantly pandemic influenza virus have been detected so far. In both Australia and New Zealand, current levels of ILI are similar to those observed during the same period in 2008, when the influenza season was noted to have arrived and peaked late in winter. In Chile, overall levels of ILI remain very low; less than 5% of respiratory samples tested positive for influenza in late June 2010 (the majority were pandemic H1N1 virus with small numbers of seasonal influenza H3N2 and type B detected as well). In Argentina, overall levels of ILI remained low and below levels observed during the past three winter influenza seasons; only small numbers of seasonal influenza type B viruses have been detected during recent weeks. In both Chile and Argentina, RSV has been the predominant circulating respiratory virus since mid-April 2010.

In Asia, overall pandemic influenza activity remains low to sporadic, except in parts of India, Malaysia, and Singapore. In India, transmission of pandemic influenza virus remains active but stable in the southern state of Kerala; similar numbers of new, severe and fatal cases have been reported on a weekly basis since transmission first increased during mid-June 2010. Smaller increases in pandemic influenza virus circulation have also been observed since mid-June 2010 in other southern and western states of India. In Singapore, levels of ARI and pandemic influenza virus transmission declined during June 2010 after peaking in May 2010; the proportion of patients with ILI testing positive for pandemic influenza virus remained stable at 16% during the first week of July 2010. Of note, substantial co-circulation of pandemic and seasonal influenza H3N2 viruses was detected in Singapore throughout May and June 2010. In Malaysia, declining numbers of new cases of pandemic influenza continued to be reported suggesting that overall pandemic influenza activity continued to decline substantially in June 2010 after peaking during mid-April to mid-May 2010. Very low level of seasonal influenza type B viruses continue to circulate across China, Hong Kong SAR (China), Chinese Taipei and the Republic of Korea.

In the tropical regions of the Americas, overall pandemic and seasonal influenza activity remained low, except in parts of Central America, where there has been recent active co-circulation of pandemic and seasonal H3N2 viruses. In Panama, a sharp increase in the circulation influenza A viruses (particularly H3N2, but also small numbers of pandemic H1N1) was reported over the month of June 2010; during the most recent reporting week, a high intensity of respiratory diseases and a moderate impact on healthcare services was reported. In Nicaragua, recent active transmission of seasonal influenza H3N2 viruses, which began during late May 2010 and peaked during mid June 2010, appears to have largely subsided during recent weeks. In Colombia, a recent period of active pandemic influenza virus transmission, spanning mid May to mid June 2010, now appears to have largely subsided. Many countries in the region continue to report ongoing co-circulation of other respiratory viruses, most notably RSV.

In sub-Saharan Africa, the current situation is largely unchanged since the last update. Pandemic and seasonal influenza activity continues to be observed in several countries. Ghana, in West Africa, continues to have active circulation of pandemic influenza virus several months after activity peaked during early April 2010. Seasonal influenza type B viruses continue to circulate in parts of central and southern Africa, particularly in Cameroon. Small numbers of seasonal H3N2 viruses continue to be detected across Africa, particularly in eastern Africa; the most recent detections have been reported in Kenya and South Africa.

Overall, in the temperate regions of the northern hemisphere (North America and Europe), pandemic and seasonal influenza viruses have been detected only sporadically or at very low levels during the past month.
(WHO 07/09/2010)

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Global: WHO confirms 500th H5N1 avian influenza case
The World Health Organization (WHO) confirmed 4 July 2010 that the recent illness and death of an Indonesian woman from H5N1 avian influenza, pushing the global number of cases to 500. According to an Indonesian health ministry report to the WHO, the 34-year-old woman from South Jakarta got sick on 25 May 2010, was hospitalized on 27 May 2010, and died on 1 June 2010. A WHO statement on the woman's illness and death said she may have had environmental exposure to the virus from manure in her plant nursery. The woman's infection raises Indonesia's number of H5N1 cases to 166 and the number of deaths to 137, for an 83% case-fatality rate. The country has the world's highest number of cases and fatalities. Of the 500 global cases, 296 (59%) have been fatal.
[WHO statement: http://www.who.int/csr/don/2010_07_05/en/index.html]
(CIDRAP 07/06/2010)

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Global: WHO reports non-vaccine aid for needy nations’ pandemic response falls short
While donor countries and organizations have responded well to the need for pandemic flu vaccine for developing countries, the level of giving for other pandemic response efforts in needy countries so far has fallen short, the World Health Organization (WHO) said in a recent report.

The level of resources given for things like health system planning, healthcare worker training, strengthening communications, humanitarian readiness, and public-health decision-making has fallen well below the need that was estimated last fall, says the report, titled "Urgent Support for Developing Countries' Responses to the H1N1 Influenza Pandemic."

Following a formal assessment, last September the WHO estimated that 64 "least-resourced countries" needed a total of $1.48 billion of aid for vaccine, medicines and supplies, laboratory and surveillance services, communications capacity, and other activities to respond to the pandemic.

But the report acknowledges that the estimate of need assumed that the pandemic would be more severe than it has turned out to be so far. The report, completed 30 June 2010, is an update on contributions and activities from February through May of 2010. The next report is scheduled to be issued in June 2011.

The amount needed for general preparedness (called "country readiness" in the report) was estimated at $237.8 million, but the amount contributed so far totals only $102.2 million, the report says. The only item for which resources have met the need, at $25.4 million, is lab capacity.

The other areas show shortfalls: for health system readiness, $79.5 million needed versus $34.4 million raised; communication, $58.5 million needed, $24.7 million raised; "whole of society" and humanitarian readiness, $58.4 million needed, $9.2 million raised; and situation assessment, $16 million needed, $8.5 million raised.

The report catalogs various general preparedness activities the WHO has carried out in developing countries in recent months. Some examples include UNICEF (United Nations Children's Fund) support for the updating of national communication strategies in India, Bangladesh, Egypt, and Malawi; UNICEF support for the Lao government's vaccine deployment strategy; and "training the trainer" pandemic preparedness programs for small and medium-size businesses in Thailand.

The report also gives an update on H1N1 vaccine donations to developing countries, covering some information from a report issued in June but offering more details. It says that donors have promised to provide 200 million doses of vaccine, of which 127.4 million doses have been received so far, including 7.7 million since February 2010. Previous reports have said the WHO's goal was to provide enough vaccine for 10% of the populations of 95 developing countries. So far, 86 countries have requested vaccine and signed agreements with the WHO, the report notes.

Included is a list of vaccine donors and their contributions. GlaxoSmithKline and Sanofi Pasteur lead the list with 60 million and 20 million doses, respectively. Other donors are the United States, 15 million doses; France, 9.4 million; Canada, 5 million; the United Kingdom, 3.8 million; MedImmune, 3 million; CSL, 3 million; Italy, 2.4 million; Australia, 2.1 million; Switzerland, 1.5 million; Belgium, 1.26 million; and Norway, 940,000.

Along with vaccine, the WHO has received 45 million syringes and 500,000 safety boxes from the United States and 25 million syringes from AmeriCares. The vaccine doses and related supplies are valued at $335.7 million.

But to match the amount of vaccine pledged, the WHO still needs another 130 million syringes, according to the report. Also, another $14.6 million is needed to cover the cost of vaccine deployment, which is estimated at $62.6 million all told.

As for antiviral drugs, the WHO has distributed 4.7 million treatment courses of oseltamivir, donated by Roche, to 128 countries since the start of the pandemic, all of that before March of 2010. There have been no new donations of antiviral drugs and no further distribution from WHO stockpiles since then. The original estimate of need for the drugs was 78 million treatment courses.

No countries have requested antibiotics to treat flu patients with bacterial complications, and no one has donated antibiotics to the WHO for use in the pandemic. It was estimated last fall that 39 million treatment courses would be needed.

The report describes a number of mechanisms through which pandemic-related donations have reached needy countries, including direct contributions to the WHO Public Health Emergency Fund, contributions to other United Nations agencies, and direct contributions to governments.

Counting all of these mechanisms, the WHO estimates that a total of $536.2 million in cash and in-kind resources has been provided to help needy countries deal with the pandemic, according to a chart in the report. The largest item is the $335.7 million worth of vaccine and related supplies.

The second largest amount is $137.1 million that the WHO's Public Health Emergency Fund has received for vaccine deployment and global response since the start of the pandemic. That includes $15.4 million contributed since 1 February 2010.

The WHO estimates that donors have given $26.4 million directly to developing countries for pandemic response, but it says that the real total of this type of assistance is probably much greater.

[WHO report: http://un-influenza.org/files/June2010UNIPReport_0.pdf]
(CIDRAP 07/07/2010)

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Global:WHO pandemic review holds second meeting
An independent committee set up by the World Health Organization (WHO) to review its pandemic response wrapped up a three-day meeting on 2 July 2010, during which members heard testimony from widely divergent groups, including health officials and some of its most public critics.

At a media briefing following the Geneva meeting, Dr Harvey Fineberg, chairman of the group, told reporters that the committee, which is also tasked with assessing how the International Health Regulations (IHRs) functioned, is still in fact-finding mode. Fineberg, who is president of the Institute of Medicine in the US National Academy of Sciences, said the group agreed to add another meeting to take place at the end of September, though it will stick to the May 2011 deadline for submitting its final report.

The 27-member group was appointed by WHO Director-General Dr Margaret Chan and met for the first time in April 2010. Since the last meeting, two members withdrew from the committee due to concerns about their links to the WHO during its pandemic response, which they said might complicate the independent evaluation of the WHO's actions.

Since the review committee's first meeting, the Council of Europe's (COE's) Parliamentary Assembly has endorsed a report criticizing response to the H1N1 pandemic by the WHO and European governments. In addition, reports and an editorial in BMJ (formerly the British Medical Journal) raised questions about possible conflicts of interest among the WHO's pandemic advisors due to links with pharmaceutical companies.

Fineberg said over the three-day meeting the review group heard from Paul Flynn, a British member of parliament from the Labour Party who was instrumental in drafting the COE report and Dr Fiona Godlee, editor of BMJ. They were among several people to give 20-minute testimony. He said the committee also heard from health officials from several different countries, pharmaceutical industry representatives, and even a journalist.

He said the committee's next meeting will consist of a similar format, and he said the group hopes to hear from WHO officials, representatives from other health organizations, governmental health departments such as the European Centre for Disease Prevention and Control, and more journalists.

When questioned by reporters, Fineberg said he was struck by the chasm between the perceptions from health officials that the pandemic response worked well and the strong criticism from others who testified. He said the committee doesn't intend the proceeding to become a debate, and that the goal is to distill lessons learned from the WHO's pandemic response, not to affix blame.

Some reporters asked if the review committee would publicly post the written materials and reports that it has received and will consider in making its final report. Some groups have criticized the WHO for a lack of transparency in its pandemic response decision-making. Fineberg said the group would consider the request, but emphasized that all of the review committee's meetings have been public.

When asked about emerging themes that the group is gleaning from the testimony, Fineberg said it's clear that pandemic characterization is a big issue. Some have accused the WHO of changing the pandemic definition at the start of the pandemic, a charge it has strongly denied.

The agency has grappled with the possibility of using a severity index in its pandemic phase descriptions, because severity can vary from country to country and vary during the different pandemic waves. Instead, current pandemic definitions focus more on geographic spread patterns.

Describing the severity of the current pandemic virus has been controversial. The virus was mild for many groups, which has fed into critics' views that countries overreacted with costly stockpiles of vaccines and antivirals. However, the new virus has shown unusual patterns, exacting larger tolls on younger people and hitting some vulnerable groups particularly hard, such as pregnant women and people with underlying medical conditions.

Fineberg said the review group heard from a German health official, who suggested that in the future the WHO issue a global risk assessment and also offer threat assessments for individual nations or regions.
(CIDRAP 07/02/2010)

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Asia
Australia: Outbreak of pandemic influenza H1N1 reported in Northwest Territories
At least 29 pandemic H1N1 cases have been reported recently in Nhulunbuy, a town in Australia's Northwest Territories (NT). The NT Centre for Disease Control confirmed the cases and urged high-risk groups to get vaccinated. Prior to this outbreak, only two cases had been reported in the territory.
(CIDRAP 06/30/2010)

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Bangladesh: US efforts help reduce H5N1 risk in more Bangladesh bird markets
A US government agency and its Bangladeshi partners yesterday launched new efforts to decrease the risk of H5N1 avian influenza at live bird markets in Bangladesh, according to a press release from the US State Department. Funded by the US Agency for International Development (USAID), the STOP AI (Stamping Out Pandemic and Avian Influenza) Bangladesh project started conducting cleaning and disinfection at a live bird market in Sreepur in the country's Gazipur district. USAID collaborated with local and market officials to develop a plan to prevent the spread of H5N1 in birds and people. Improvements include renovating the water supply and adding a proper waste-disposal facility and a slaughterhouse. USAID had previously piloted cleaning and disinfection programs at two markets in Dhaka, which led to a program expansion that upgraded 19 more markets in Gazipur and Dinajpur districts.
(CIDRAP 07/07/2010)

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Chinese Taipei: New case pandemic influenza H1N1 confirmed
The Centers for Disease Control (CDC) reported 5 July 2010 that a new case of severe influenza A(H1N1) infection had been confirmed in southern Chinese Taipei.

The latest case brought to 938 the total number of severe swine flu cases recorded in the country since summer 2009.

According to CDC Deputy Director-General Chou Jih-haw, a nine-year-old girl was hospitalized 26 June 2010, two days after coming down with a fever and cough.

She was later admitted to an intensive care unit and is recovering after treatment, Chou said.

The patient had not been vaccinated against the new flu strain or received seasonal flu vaccine, the official said, adding that none of her family has been infected.

Chinese Taipei has touted its success in fighting H1N1, with a national immunization program under which 25 percent of the country's total population has been immunized.
(Taiwan Herald 07/06/2010)

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India: Pandemic influenza H5N1 situation considered serious in five states
The swine flu situation continues to be serious in the four southern states of Kerala, Karnataka, Tamil Nadu, Andhra Pradesh, and in Maharashtra, which have reported 366 of the 370 H1N1 infections in the last week, official figures show.

Kerala remains the worst affected state with 222 confirmed reports of swine flu. A rise in number of swine flu cases has been reported from all severely affected states with Maharashtra reporting 72 cases, Karnataka 31, Tamil Nadu 22, and Andhra Pradesh 19. During the week of 28 June - 2 July 2010, 16 people have died due to this infection, with 10 of these being reported from Kerala, four from Maharashtra and two from Andhra Pradesh.

A health ministry official said that with the launch of their first indigenous swine flu vaccine, they are definitely better prepared to handle the threat, and will be having three more vaccines soon. However when asked about the growing number of infections in the southern part of the country and the unpopularity of the vaccine, the official said that lack of awareness was to be blamed.

A total of three cases of swine flu have also been reported from Gujarat, while one case was reported from Uttar Pradesh last week. The national capital has so far been more or less free from the virus with only three minor cases being reported in over two months.

India's first indigenous swine flu vaccine was launched by Zydus Cadila in June 2010. The vaccine has however not proved to be popular till now with people and even health professionals being unaware and uncertain about its benefits and implications.

[ProMED note: It is likely that the distribution of pandemic (H1N1) influenza cases in India is a reflection of the greater severity of the effects of the monsoon season in the central and southern states of the country.]
(ProMED 07/05/2010)

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India: 16 more H1N1 deaths
India reported 16 pandemic-related deaths among 370 cases in the week of 5 July 2010. The state of Kerala had 10 deaths, Maharashtra four, and Andhra Pradesh two. Also today, the country has started retailing its first domestically produced nasal-spray pandemic vaccine, Nasovac, made by Serum Institute and approved for those four years old and older. A domestically produced injectable vaccine was made available June 2010.
(CIDRAP 07/06/2010)

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India: Pandemic influenza H1N1 deaths on the upswing
Swine flu deaths continued their upwards surge since the onset of monsoon with 17 fatalities reported due to the disease in the country since 21 June 2010, the largest numbers of which occurred in Kerala and Maharashtra. Both the states reported seven deaths each while Andhra Pradesh reported two and Uttar Pradesh one, health ministry officials said 28 June 2010.

All 345 cases reported during the week are indigenous cases. Up to the present, samples from 143 285 people have been tested for influenza H1N1 and 33 083 (23 per cent) of them have been found positive.

With the new cases, the swine flu toll in Kerala since the monsoon hit the state has risen to 32. Kerala reported 16 deaths from 15 May to 15 June 2010, prompting the Central government to send a three-member team to the state to assess the situation.
(ProMED 06/28/2010)

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New Zealand: Rise in H1N1 pandemic influenza
New Zealand is seeing gradually increasing flu activity to a level typically seen during July, its Ministry of Health (MOH) reported 1 July 2010. Although the country is still below the baseline influenza level for flu season, it is experiencing pandemic H1N1 flu in communities and offering free vaccine to all those in at-risk groups. Of the influenza viruses typed, most are pandemic H1N1, with some seasonal H3N2.
(CIDRAP 07/01/2010)

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Chinese Taipei: CORRECTION: New case pandemic influenza H1N1 confirmed
Correction: In EINet News Brief Vol. XIII No. 14, the article "Chinese Taipei: New case pandemic influenza H1N1 confirmed" was incorrectly titled "Chinese Taipei: New case avian influenza H5N1 confirmed." Accuracy is extremely important to APEC EINet, and we regret the error. EINet has corrected this error and sincerely apologizes for any confusion caused.

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Americas
USA: 43% of pandemic influenza H1N1 vaccine may be destroyed
About 40 million doses of H1N1 vaccine worth $260 million have expired and will be destroyed, and 30 million more will expire later and may also be tossed. This would amount to more than 43% of all US vaccine made. Bill Hall of the Department of Health and Human Services said that although there were many doses of vaccine that went unused, it was much more appropriate to have been prepared for the worst-case scenario than to have had too few doses.
(CIDRAP 07/02/2010)

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Mexico: H1N1 pandemic influenza alert ended
Mexico lifted its alert for pandemic H1N1 flu 28 June 2010, officially ending the health emergency that began 14 months ago in that country. Secretary of Health Jose Angel Cordova said only 10% of influenza cases in May 2010 were pandemic flu, down from 90% in October 2009. Mexico has officially logged 72,546 H1N1 cases and 1,289 deaths, the last in May 2010.
(CIDRAP 06/29/2010)

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2. Infectious Disease News

Asia
Canada: New cases of tuberculosis
Four new cases of tuberculosis have been confirmed in Déline, N.W.T., where an outbreak sparked panic shortly before the holidays in 2009.

Northwest Territories health officials say the new infections were caused by a person who had TB during the last outbreak in November, but was not detected.

That person infected three others, bringing the total number of TB cases to 13 in the remote community of about 500.

In light of the new cases, health officials are screening everyone in Déline, then plan to treat everyone who tests positive for TB.

The initial TB outbreak raised concerns in Déline because it began before the Christmas holidays, when people travel and host holiday gatherings, potentially raising the risk of more infections.

In addition to the 13 TB infections, health officials say 47 others in Déline are carriers of the Mycobacterium tuberculosisgerm.

Those 47 cases are latent, meaning those people are not showing any symptoms and they cannot transmit the germ unless it develops into the full-blown disease.

People who do show symptoms of TB are generally hospitalized and quarantined for about two weeks.

Afterwards, they are not considered infectious and they can then be treated at home. Patients must take TB medication, under the supervision of health workers, for up to nine months.
(07/07/2010)

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Papua New Guinea: Efforts to combat increasing resistant tuberculosis
Efforts to fight tuberculosis (TB) - one of Papua New Guinea’s leading killers - face an uphill battle as the disease becomes resistant to the first line of treatment and funding becomes inadequate. Medical doctors working with the National Tuberculosis Program (NTP) say the National Government and the national Department of Health must provide more support and funds to diffuse what they describe as a time bomb facing PNG. They warned that Multiple Drug Resistant tuberculosis (MDRTB), is on the rise in the country and it will require more expensive drugs to treat the patients with this new strain. PNG has the second highest prevalence rate of TB and the highest of any country in the Pacific. Every two hours, someone dies from TB in PNG, nearly 3800 per year and every year 16,000 new cases are detected including 2900 people who are co-infected with HIV. People in urban settlements are at more risk due to the overcrowding and the confined living conditions, while those in the rural areas are also vulnerable due to lack of access to medical facilities, poor transportation, not enough money and no awareness of the disease In a press conference in Lae on Friday, doctors Joe Bana Koiri, Evelyn Lavu, Paul Aia and Ma Imelda Quilapio stated that MDRTB is on the rise because patients were not following the strict treatment regime of the disease. The doctors said many TB patients had not completed their treatment despite the best efforts of health workers to treat and cure them of the illness. They said because the patients were already exposed to treatment, the TB bacilli was generating resistance against the first line of treatment. They said patients could not be cured unless placed on more toxic and more expensive second line drugs. Dr Bana Koiri said the emergence of the new strain of TB, which would be expensive to treat and posed greater risk to the people, was clinically diagnosed seven to 10 years ago. Sputum smear positive TB is airborne and is the most dangerous form of the disease. Dr Lavu, director for the Central Processing Health Laboratory (CPHL), says their workers have the qualification but lack the work experience and equipment to test this new strain of TB. Dr Lavu said TB is a highly infectious disease and proper diagnostic facilities must be put in place at CPHL to test the new strain.
(Post Courier 07/06/2010)

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Americas
Canada: Novovirus outbreak
A Norovirus outbreak at the Alberta Children's Hospital has left four children sick and sent at least 20 staff members home as health officials work to contain the illness to two affected units.

The first case was reported 30 June 2010.

Since then, three cases of the contagious virus have been confirmed and another child has a suspected case, said Don Stewart of Alberta Health Services.

The virus hasn't spread beyond two medical and surgical units in the hospital, Stewart said. The units remain open, though the children affected by the virus are isolated from other patients in the wards. Roughly 20 staff members have gone home sick as a precaution, though they haven't been tested to determine whether they have the virus.

A number of measures have been put in place in the hospital to deal with the virus, which causes diarrhea and vomiting, and is easily spread.

Playrooms in all of the units have been closed. Visitors on the affected wards have been limited just to immediate family members.

In Canada, between 300 and 400 outbreaks are reported each year.
(Calgary Herald 07/05/2010)

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Chile (Maule): Hantavirus case
A 13-year-old child is a new case of hantavirus infection in Maule. Health authorities reported 24 June 2010 that the child, from the O'Higgins region (Chimbarongo), is being treated in the Talca Hospital, in Maule region. At first, the child was attended in the Teno Hospital and later went to the Curico Base Hospital. Due to the seriousness of the disease he was sent to the Talca Hospital, where he is currently admitted in the UCI.

According to the epidemiological investigation being carried out by the Health SEREMI [Regional Ministerial Secretariat], the home of the youngster was visited, and it was reported that the child was exposed to places with high risk factors.

To date, there are seven confirmed hantavirus infections in Maule, which indicates an increase in infections of this virus. Of these seven cases, two people died.
(ProMED 06/25/2010)

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

- WHO regional offices
Africa: http://www.afro.who.int/
Americas: http://new.paho.org/hq/index.php?option=com_content&task=blogcategory&id=805&Itemid=569
Eastern Mediterranean: http://www.emro.who.int/csr/h1n1/
Europe: http://www.euro.who.int/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/

--Press Release: U.S. efforts to help reduce H5N1 risk in more Bangladesh bird markets
US State Department press release 6 July 2010
Available at http://dhaka.usembassy.gov/6-july-10-us.gov-assist-live-bird-markets-prevent-influenza.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
Chinese Taipei
On 29 June 2010, Taiwan CDC announced the eighth confirmed case of indigenous dengue fever since March 2010. The patient is a 48-year-old male who lives in Gushan District, Kaohsiung City, with no foreign travel record. He developed fever, cough, backache and diarrhea on 23 June 2010. He first visited two healthcare institutions, but was later hospitalized on 27 June 2010 as symptoms persisted. On 29 June 2010, the hospital notified Taiwan CDC about the case and Taiwan CDC then confirmed indigenous dengue fever in the case. According to the epidemiologic investigation, the case spends most of his time at his living and working places and he lives about 150 meters away from the residence of the sixth and seventh confirmed cases reported since March 2010. Relevant health authorities had promptly reacted to rectify the situation.

As of 29 June 2010, 122 confirmed cases of dengue fever, including 46 indigenous cases and 76 imported cases, have been reported in 2010. From March till July 2010 there have been eight cases and all of them live in Kaohsiung city. During the same period last year, only one case of indigenous dengue fever was confirmed during the same period in 2009.

Apart from a noticeable increase in the number of dengue fever cases, Taiwan CDC warns that dengue fever has also occurred earlier in 2010 than in 2009. The public should stay alert and take necessary self-protection such as preventing mosquito bites and seeking medical attention as soon as when suffering from suspicious symptoms. Moreover, Taiwan CDC urges the public to take part in the government’s preventive measures and clean up the vector breeding sites around their residences to effectively prevent the transmission of dengue fever and protect their health. When the vector breeding sites around residences are discovered, the authority will send the responsible residents a clean-up request. According to Article 70 of the Communicable Disease Control Act, failure to comply with such request is punishable by a fine.
(CDC ROC 07/05/2010)


India (Manipur)
An epidemic alert has been sounded in the state following reports of three fatal cases so far from suspected acute encephalitis syndrome (AES) in several parts of the state of Manipur. As per official surveillance reports, more than 100 cases of suspected AES have been found mostly in the valley districts of the state.

The patients with such syndrome have been admitted to RIMS [Regional Institute of Medical Sciences] and some other private hospitals. The official reports further revealed that three deaths were reported from Bishnupur, Khelakhong, and Mantripukhri. All of the victims were children below the age of one year.

Blood samples of some infected persons have already been sent to advanced laboratory at Dibugarh (Assam) for the confirmation of Japanese encephalitis [JE] and more blood samples would also be sent to the National Institute of Communicable Diseases (NICD), New Delhi, stated the source.

The official source further maintained that equipments for the diagnosis of Japanese encephalitis have already been installed at the JN Hospital, Porompat. However, at this crucial point of time the equipments are malfunctioning adding more hurdles to counter the suspected cases of acute encephalitis syndrome.

The state health services and district vector borne diseases control societies have taken up necessary steps to counter the outbreak of suspected AES in the state. Fogging of malathion chemical was widely done in those areas where there are cases of such syndrome.

Imphal East district vector borne diseases control society has already done fogging at Naorem Leikai, Uchekon Laikon, and Mantripukhri areas. Both urban and rural areas of the state have been widely fogged as a part of the emergency measures to counter outbreak of Japanese encephalitis which is carried by Culex mosquitoes.

As a precautionary measure, the state vector borne diseases control society would take up mass vaccination program for Japanese encephalitis for children between 0-14 years of age within few months.

[ProMED note:Cases of what this report termed as acute encephalitis syndrome (AES) continue in the Manipur area. It will be of interest to see if these and earlier cases are confirmed as Japanese encephalitis virus infections, or due to infection by some other virus(es). It is unfortunate that the equipment is not functioning for local laboratory diagnosis of JE virus infections. ProMED-mail awaits the results of the laboratory tests with interest. Effectively controlling the Culex JE virus vector mosquitoes over large geographic areas is difficult and expensive. Vaccination of the population at risk seems to be the better approach to reducing the number of encephalitis cases, should JE virus prove to be the etiological agent involved.
(ProMED 07/07/2010)


Indonesia
Health authorities are warning that Denpasar remains under threat from DHF, the frequently fatal form of the mosquito-borne infection. They say that while the official rainy season had ended, that did not mean dengue-carrying Aedes aegypti mosquitoes were no longer a threat. Three children have died of the disease in Denpasar June 2010. Sanglah Hospital, the chief treatment center for serious cases, remains busy with dengue patients.

This season's dengue outbreak in Bali is the worst in years. Health authorities say the outbreak in 2010 is worse than usual because extended rains have left a lot of standing water around Denpasar. They have warned residents to make sure their houses and gardens are clean and free of water suitable for mosquito breeding.
(ProMED 06/23/2010)


Japan
Prime Minister Naoto Kan held the eight meeting of the Headquarters Against Foot-and-Mouth Disease at the Prime Minister's Office. At the start of the meeting, the Prime Minister delivered an address, saying that what must be done first of all is to prevent the disease from spreading, for which he intended to make the utmost effort. It has been reported, he said, that the slaughtering and burial of infected and suspected animals which were spreading the disease was completed on 24 June 2010. He has heard that there have been no new suspected cases in the past 10 days. However, he said, we must not relax our vigilance at this stage. We must swiftly slaughter vaccinated animals., he said, and asked the relevant ministries to tackle the issue in a thorough manner.
(ProMED 07/01/2010)


Malaysia
Thousands of people from seven villages along the Baram river as well as Penan settlements along the Silat river are feared to be threatened by a malaria outbreak, with at least five confirmed cases in the last few days.

The seven villages in Ulu Baram comprise Long San, Long Selatong, Tanjong Tepalit, Long Apu, Long Julan, Long Anap and Long Palai.

Deputy Chief Minister Datuk Patinggi Tan Sri Dr George Chan confirmed the outbreak on 4 July 2010.

Without giving the full details, Dr Chan, who is also chairman of the State Disaster and Relief Management Committee, said quite a few of the people in the affected areas were suspected to have contracted the disease.

He said he has been informed by medical officers on the cases, and that a medical team has already been dispatched to the area to get a clearer picture of the outbreak.

Five villagers from Long Palai, including the village head, had been admitted to Miri Hospital in the last few days. All were confirmed to have contracted Plasmodium vivax malaria, a common type of malaria which normally occurs in temperate regions and is not life-threatening.

However, regarding one of the patients, a 60-year-old who was reported dead at about 1:00 AM on 2 July 2010, Dr Chan clarified that his death was not due to malaria but other health problems.

Meanwhile, Telang Usan assemblyman Lihan Jok, when contacted 2 July 2010, said he had been informed and had sent his men to go to the ground to get the full picture. The situation is under control at the moment, he said, urging the people in the affected areas not to panic.

[ProMED note: Plasmodium vivax is not as benign as stated in the paper, especially with people with little or no previous immunity to malaria, as recently reviewed by Baird JK (Severe and fatal vivax malaria challenges 'benign tertian malaria' dogma. Ann Trop Paediatr. 2009;29:251-2). There is no indication in the report on what triggered the increased transmission.
(ProMED 07/05/2010)


Malaysia
From January to last 29 June 2010, 80 dengue deaths were recorded, an increase compared to 62 deaths in the same period in 2009, Health Minister Datuk Seri Liow Tiong Lai said. He said that 23,626 cases were recorded so far in2010 compared to 24,817 last year.

We need to give serious attention to dengue fever because the number of fatalities is on the increase, he said after visiting the Penang Hospital 1 July 2010. He said that public apathy towards seeking immediate treatment was among the factors for the hike in casualties.
(ProMED 07/01/2010)


Singapore
69 cases of dengue have been reported in the Cairnhill area.

Of these, 42 cases involve construction workers in the area. They work at the Hilltops condominium construction site under Tiong Seng Contractors.

The National Environment Agency (NEA) said there are currently three clusters - Cairnhill Rise and Cairnhill Circle; Cairnhill Road; and Anthony Road and Monk's Hill Road clusters.

There are 54 cases at Cairnhill Rise/Circle, 12 cases at Cairnhill Road and 3 cases at Anthony Road/Monk's Hill Road.

NEA said 68 breeding habitats have been detected, with 13 at construction sites. The rest are areas inside and outside homes.

The agency has issued fines to the offending parties. It has also deployed officers to patrol the area daily.
(Channelnewsasia 07/07/2010)


Thailand
The Office of Disease Prevention and Control Five Nakorn Rachasima Director, Dr. Somchai Tungsupachai, revealed the situation of dengue infection in Thailand, reported by the Bureau of Epidemiology, Ministry of Public Health. There were 26,185 dengue infection cases nationwide and 30 fatalities between January 2010 and 26 June 2010.

In public health area 14, which consists of Nakhon Ratchasima, Buri Ram, Surin, and Chaiyaphum provinces, there were 2543 cases and two fatalities due to dengue infection between January 2010 and 26 June 2010. The highest number of cases was reported from Nakhon Ratchasima with 948 cases and one death -- an eight-year-old boy who died in March 2010 -- followed by Surin with 849 cases and no deaths reported, and Buri Rum with 532 cases and one death -- a 19-year-old mother with a nine-month-old baby -- and Chaiyaphum with 214 cases and no deaths reported.

Mr. Apirat Sokampang, chief of Vector Borne Infectious Diseases, office of disease control Five, stated that the number of dengue infection cases in four provinces of lower northeastern Thailand increased by one to two times compared to the same period in 2009. The highest attack rate per 100,000 population was reported in Surin, whereas the highest number of cases was reported in Nakhon Ratchasima (948 cases and one death); the majority of cases were reported in Muang district (228 cases), Dan Khun Thot (79), and Sikhio (18). Blood samples from the death case were sent for examination at the Medical Science center, Nakhon Ratchasima. The laboratory results showed the patient was infected with dengue types two and three, which caused the severe disease and eventually led to death.

For prevention strategies, the office of disease control five set up SRRTs (surveillance rapid response teams) in these four provinces; four teams at provincial level (one team per province) and a total of 80 teams at district level. Mr. Apirat alerts people to destroy any possible mosquito breeding sites around their residences, to sleep under mosquito bed nets, to wear repellent, and to immediately see a doctor if they become ill and suspect dengue fever.
(ProMED 06/26/2010)


Philippines
Davao City: With nearly three dozen deaths since January 2010 in at least two areas in Southern Mindanao alone, including this city, officials have rallied residents anew to seriously help in combating dengue.

In this city alone, 20 persons—mostly children—have died of dengue fever since January 2010, the Department of Health in Southern Mindanao had said.

Salvador Estrera, DOH assistant regional director, said more than half of the 2,100 dengue cases recorded region-wide since the start of the year came from this city, and that the situation is being considered an outbreak. Estrera expressed alarm over the fact that the number of cases has been climbing., and said there has been an increase of between 15-19 percent compared to the same period last year.

He said the DOH was puzzled at the sharp increase in the number of dengue cases this year, although officials earlier expected that dengue fever would strike with the start of the rainy season.

In Digos City, the high number of deaths since January 2010 had prompted the city disaster coordinating council (CDCC) to urge Mayor Joseph Peñas to issue an executive order declaring a state of calamity.

Milagros Sunga, city health officer, said since January to early July 2010, at least 13 dengue patients had already died while more than 600 others had been diagnosed with the disease.

Sunga said based on their assessment, dengue was most prevalent in the villages of Tres de Mayo, Zone 1, Zone 2, Zone 3, and Aplaya, and that out of the city’s 22 villages, only four barangay remained dengue-free.

Peñas said he already ordered the city legal officer to draft the executive order for the declaration of state of calamity. Peñas also pledged that the city government would help the Philippine National Red Cross blood bank in Digos City to acquire the machine needed to extract plasma and platelet from donated fresh blood.

Relatives of dengue fever patients have to go to Davao City to avail of the blood components that could help save their patients.

Dr. Azucena Dayanghirang, Davao del Sur health chief, said a dengue epidemic has already been declared all over the province. Davao del Sur Gov. Douglas Cagas declared the entire province under a state of calamity, she said. Cagas, in a separate interview, said the declaration would enable the provincial government to use its calamity fund in combating the disease.

In Tagum City, one patient died of dengue fever since the start of 2010 and 24 others had been hospitalized, said Dr. Arnel Florendo of the city health office.

Estrera said the DOH has been intensifying its campaign against dengue fever by urging residents to clean their surroundings.
(Philippine Daily Inquirer 07/07/2010)


Puerto Rico
Puerto Rico's top health official warned Monday that the U.S. island could face its worst-ever dengue fever outbreak if people don't act quickly to destroy breeding areas for disease-spreading mosquitoes.

Health Secretary Lorenzo Gonzalez Feliciano issued the warning after a 37-year-old woman from the northern town of Hatillo died of the hemorrhagic form of the tropical virus. Her death was the third fatality from dengue fever so far this year on the island.

Unless islanders take urgent measures to eradicate bug breeding areas by draining standing water near their houses, the Caribbean territory will experience a public health crisis in coming months, Gonzalez said.

Gonzalez said that if they do not act now, they will see a catastrophe in the months of August and September that could reach record numbers and would make it much more difficult to control. The government has dispatched trucks to neighborhoods and schools to spray a mist that kills mosquitoes, but Gonzalez said too many Puerto Ricans have let down their guard against the virus. He urged islanders to report neighbors to authorities if they leave stagnant water on their property.

Damp, hot weather creates favorable mosquito breeding conditions, so the situation may be worsened by the unusually wet weather that soaked Puerto Rico in May and June 2010.

Puerto Rico's worst dengue outbreak was in 1998, when the virus sickened 17,000 and caused 19 deaths.

Once thought to have been nearly eliminated from Latin America, dengue has gained strength in the region since the early 1980s, in part because tourism and migration are circulating four different strains, increasing the risk of multiple exposure and making it more likely victims will come down with the hemorrhagic form.
(Canada Press 07/05/2010)

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CHOLERA, DIARRHEA, and DYSENTARY
India (Chhattisgarh)
A mysterious disease has claimed at least a dozen lives and affected more than 150 people in a remote Chhattisgarh village, a health official said 14 Jun 2010.

I can confirm at least 12 deaths and more than 150 have been taken ill after a diarrhea-like disease broke out in Dharmpur village in Bijapur district close to the Andhra Pradesh border, a source in Raipur, the directorate of health services, told IANS.

The village is over 310 miles south of state capital Raipur. The source said that the deaths were reported in the past two or three days, but that more information will be available only when the medical team meets the affected people.
(ProMED 06/14/2010)


New Zealand
Giardia cases have risen almost 50 per cent nationwide in from May to July 2010, with concerns about an outbreak in the Wellington region. National giardia cases rose to 555 in the quarter from January to March 2010-- up on 375 cases the previous quarter (October-December 2009), and 470 in the same quarter (January-March) in 2009.

There were eight cases recorded in the Wellington region the week before the week of 1 June 2010, up on one the week before the week of 24 May 2010. But Regional Public Health has been quick to dismiss any suggestion of a serious problem.

The common symptoms make the parasite hard to diagnose but any stool sample tested positive for giardia must be notified to Regional Public Health, medical officer of health Stephen Palmer said.

Giardia cases fluctuated from week to week, but concerns were usually raised if there seemed to be a connection between the cases, such as if they were in the same geographic region. Palmer said there were no links as far as they could tell at this stage.

Wellington City Council was notified of six cases in April 2010 and five in May 2010. There have been six so far in June 2010.
(ProMED 07/02/2010)


Papua New Guinea (Manam Island)
Papua New Guineans have been sternly urged to forego all burial rituals when handling bodies of relatives who have succumbed to cholera. The warning is from Bogia's program manager health Camillus Dugumi following the deaths of 15 people, some of whom are understood to have died while mourning over their loved ones who had died from this fast-acting sickness.

When contacted by the Post-Courier, Mr Dugumi could not state how many of the deaths had been as a result of direct contact with the dead but said the deaths had been recorded over a 10-day period ending 28 June 2010. He said those who had died were all from Dugulava village on Manam Island and that two of them were children.

Reports received by the Post-Courier were that the deaths were not related to cholera as some of those who died did not present the usual clinical symptoms of cholera including acute severe watery diarrhea. Rather, they had complained of feeling cold from the soles of the feet, and the sensation working its way up the legs and to the rest of their body, including the stomach. They also complained of feeling intense hunger and the coldness eventually getting to them before collapsing and dying.

However, Dugumi said an outbreak of this disease had recently been reported on the island, especially in the affected village, where many had just been repatriated following the Tobenam incident on the north coast of Madang, where many Manams fleeing volcanic eruptions were living.
(ProMED 07/06/2010)


Papua New Guinea (Central Province)
Papua New Guinea's Central Province has reported 991 cases of cholera as of 20 June 2010. Central province administrator and cholera head Raphael Yipmaramba confirmed that the most affected villages were Waiori with 527, Wanigela with 329, Gavuone 29, Kupiano 3, Kalapi 2, and Maopa 1. The cumulative figure of 991 has been obtained since the outbreak the week of 7 June 2010.

Mr Yipmaramba said according to unconfirmed reports eight people had died from the disease in the areas. The administrator left for Agevairu, along the Hiritano highway to assess one unconfirmed cholera report from this area.
(ProMED 07/06/2010)


Thailand
Minister Jurin Laksanawisit ordered public health officials to monitor the spread of cholera after reports of five deaths. three cases were in Pattani and the rest in Songkhla and Tak.

Officials reported 982 people infected by the food-borne disease during the past six months [January-June 2010]. Among the infected, 708 were Thai, and 274 migrant workers.

The South region has the highest number of people infected with cholera with 505 cases, followed by the North with 279, the Northeast with 166, and the Central region with 32 cases.

A cholera outbreak in 2007 infected 986 people and seven people died. The number of infections was reduced in 2008 to 200, and in 2009 to 300 cases, with two-three deaths a year.

The Public Health Ministry has issued a warning to people to protect themselves from infection by eating cooked and hot food, using a middle spoon [a serving spoon to avoid everyone dipping their own spoon into a communal bowl, thus spreading the bacteria], and washing hands frequently.

For exported food products, Department of Disease Control's director-general Dr Manit Teeratantikanont said the department had strictly checked bacterial contamination among exports. Any food products with bacteria contamination would not be allowed to leave the country.
(ProMED 07/29/2010)


Thailand
89 refugees in Mae La Refugee Camp have been infected with cholera in two weeks and the number of cases is increasing, a source in Mae La Refugee Camp said on 11 Jun 2010. No deaths have been reported.

Since 27 May 2010, 87 refugees have been infected, and now another 2 patients arrived at the hospital," said Saw Nay Hsei, a health care coordinator at the Mae La Camp Hospital. The disease is concentrated in three areas of the camp.

As of 10 June 2010, 72 patients had been discharged from the hospital and 15 patients remain in the Cholera Treatment Center (CTC), he said.

Most of the patients were infected with the disease by drinking water collected from local wells and streams. Restaurants and food vendors in the camp have been banned until authorities can ensure that sites are hygienic and proper procedures are put in place.

Mae La is the largest of seven refugee camps along the Thai-Burma [Myanmar] border where nearly 40,000 refugees live. Most of the refugees in Mae La Camp are Karen, and ethnic minority.

According to the Mae La Camp Hospital, 28 people were infected by cholera in 2007.
(ProMED 07/11/2010)


Viet Nam (Bac Lieu province)
Dr Nguyen Thanh Dan, Director of Ca Mau Province Preventive Medicine Center, said two children who are four and two years old, siblings from Dinh Thanh commune, Dong Hai district, Bac Lieu province, were confirmed positive for V. cholerae. These two cases are the first cases of cholera reported in Ca Mau province.

The same day, 2 July 2010, Vo Huy Danh, Deputy Director of An Giang Province Preventive Medicine center, confirmed two more cases of acute diarrhea positive for Vibrio cholerae O1 Ogawa. These patients were from Vinh Thanh commune, Chau Thanh district and My Thoi Ward, Long Xuyen City. In June 2010, An Giang province reported 10 confirmed and one suspected case of cholera.
(ProMED 07/02/2010)


Viet Nam (North)
Cholera has broken out again in the northern region, the Health Ministry's Department of Preventive Medicine announced on 3 Jul 2010. The National Hospital for Tropical Diseases is treating 36 people infected with acute diarrhea, with 18 of them having tested positive for cholera.

The hospital director, Nguyen Van Kinh, revealed that most of the patients are from inner Hanoi. Two patients have suffered kidney failure because they were hospitalized too late, he noted. According to a recent report, most of the patients with cholera consumed unhygienic foods.

According to a recent study by the Preventive Health Department and the Central Institute for Epidemiology, the bacterium that has been causing cholera in Viet Nam since 2007 is growing more toxic and dangerous. The current strain of Vibrio cholera type O1 is different from that which caused the acute intestinal disease in Viet Nam before 2007, adding that the new type has a far longer lifespan in the environment. The current strain in Viet Nam is similar to the one that caused a pandemic in Laos, Cambodia, and Thailand.
(ProMED 07/05/2010)

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4. Articles
Association of ABO blood groups with Chikungunya virus
Kumar NCVM, Nadimpalli M, Vardhan VR, et al. Virology Journal. 25 June 2010;7:140. doi:10.1186/1743-422X-7-140
Available at http://www.virologyj.com/content/7/1/140

Abstract. Chikungunya virus (CHIKV) an emerging arboviral infection of public health concern belongs to the genus Alphavirus, family Togaviridae. Blood group antigens are generally known to act as receptors for various etiological agents. The studies defining the relationship between blood groups and CHIKV is limited and hence it is necessary to study these parameters in detail. In the present study 1500 subjects were enrolled and demographic data (Age, Gender, Blood group, CHIKV infection status, and CHIKV infection confirmation mode) was collected from them. The risk of acquiring CHIKV disease and its association with factors such as blood group, age and gender was analyzed statistically. The data of this study showed a possible association between blood group, age and gender of the study population with CHIKV infection. It is observed that CHIKV infections were higher in individuals with Rh positive blood group when compared to their Rh negative counterparts.CHIKV infections were found to be higher in Rh positive individuals of AB and A blood groups than that of Rh negative counterparts. Results also indicated that infections were higher in adults belonging to the age group >30 years and also higher in males as compared to females enrolled in this study. These data present further evidence for the association of the blood groups, age and gender to susceptibility to CHIKV infection. Further studies are needed to confirm these findings. This is the second study showing the possible association of blood groups with chikungunya.

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Opting In vs Opting Out of Influenza Vaccination
Chapman GB et al. JAMA. 2010; 304:43-44.
Available at http://jama.ama-assn.org/cgi/content/full/304/1/43

Letter. Changes in how a choice is presented can affect the actions of decision makers, who have a tendency to stick with the default option.1-3 For example, organ donation rates are much higher in an opt-out system (donor status is the default, explicitly opting out is required if a person does not want to donate) than in an opt-in system (nondonor status is the default, explicitly opting in is required if a person wants to be a donor).4 Both systems give decision makers autonomy to choose according to their personal principles, but the opt-out system provides a "nudge" toward donation.

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Influenza-Associated Pneumonia in Children Hospitalized With Laboratory-Confirmed Influenza, 2003-2008
Dawood FS, Fiore A, Kamimoto L, et al. Pediatric Infectious Disease Journal. July 2010; 29(7):585-590 doi: 10.1097/INF.0b013e3181d411c5.
Available at http://journals.lww.com/pidj/Abstract/2010/07000/Influenza_Associated_Pneumonia_in_Children.2.aspx

Background. Pneumonia is one of the most common complications in children hospitalized with influenza. We describe hospitalized children with influenza-associated pneumonia and associated risk indicators.

Methods. Through Emerging Infections Program Network population-based surveillance, children aged <18 years hospitalized with laboratory-confirmed influenza with a chest radiograph during hospitalization were identified during the 2003–2008 influenza seasons. A case with radiologically confirmed influenza-associated pneumonia was defined as a child from the surveillance area hospitalized with: (1) laboratory-confirmed influenza and (2) evidence of new pneumonia on chest radiograph during hospitalization. Hospitalized children with pneumonia were compared with those without pneumonia by univariate and multivariate analysis.

Results. Overall, 2992 hospitalized children with influenza with a chest radiograph were identified; 1072 (36%) had influenza-associated pneumonia. When compared with children hospitalized with influenza without pneumonia, hospitalized children with influenza-associated pneumonia were more likely to require intensive care unit admission (21% vs. 11%, P < 0.01), develop respiratory failure (11% versus 3%, P < 0.01), and die (0.9% vs. 0.3% P = 0.01). In multivariate analysis, age 6 to 23 months (adjusted OR: 2.1, CI: 1.6–2.8), age 2 to 4 years (adjusted OR: 1.7, CI: 1.3–2.2), and asthma (adjusted OR: 1.4, CI: 1.1–1.8) were significantly associated with influenza-associated pneumonia.

Conclusion. Hospitalized children with influenza-associated pneumonia were more likely to have a severe clinical course than other hospitalized children with influenza, and children aged 6 months to 4 years and those with asthma were more likely to have influenza-associated pneumonia. Identifying children at greater risk for influenza-associated pneumonia will inform prevention and treatment strategies targeting children at risk for influenza complications.

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Oseltamivir Dosing for Influenza Infection in Premature Neonates
Edward AP, Penelope J, Peter G, et al. The Journal of Infectious Diseases. 2010; 202:000–000DOI: 10.1086/654930.
Available at http://www.journals.uchicago.edu/doi/full/10.1086/654930

Abstract. Under the Emergency Use Authorization issued in April 2009, oseltamivir can be used to treat 2009 influenza A (H1N1) virus infection in children aged <1 year. No data exist on the dosing of oseltamivir in premature babies. A hospital health care worker inadvertently exposed 32 neonatal intensive care unit babies to 2009 influenza A (H1N1); a protocol was expeditiously implemented to collect samples for pharmacokinetics and dosage evaluation. Results suggest 1.0 mg/kg/dose twice daily in premature babies produces oseltamivir carboxylate exposures similar to that in older children receiving 3.0 mg/kg/dose twice daily. These results provide initial guidance on dosing oseltamivir in this vulnerable population.

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Trends for influenza and pneumonia hospitalization in the older population: age, period, and cohort effects
Cohen SA, Klassen AC, Ahmed S, et al. Epidemiology and Infection. Cambridge University Press 2010; 138:1135-1145doi:10.1017/S0950268809991506.
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7821856

Summary. Birth cohort has been shown to be related to morbidity and mortality from other diseases and conditions, yet little is known about the potential for birth cohort in its relation to pneumonia and influenza (P&I) outcomes. This issue is particularly important in older adults, who experience the highest disease burden and most severe complications from these largely preventable diseases. The objective of this analysis is to assess P&I patterns in US seniors with respect to age, time, and birth cohort. All Medicare hospitalizations due to P&I (ICD-9CM codes 480-487) were abstracted and categorized by single-year of age and influenza year. These counts were then divided by intercensal estimates of age-specific population levels extracted from the US Census Bureau to obtain age- and season-specific rates. Rates were log-transformed and linear models were used to assess the relationships in P&I rates and age, influenza year, and cohort. The increase in disease rates with age accounted for most of the variability by age and influenza season. Consistent relationships between disease rates and birth cohorts remained, even after controlling for age. Seasonal associations were stronger for influenza than for pneumonia. These findings suggest that there may be a set of unmeasured characteristics or events people of certain ages experienced contemporaneously that may account for the observed differences in P&I rates in birth cohorts. Further understanding of these circumstances and those resulting age and cohort groups most vulnerable to P&I may help to target health services towards those most at risk of disease.

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Surveillance for outbreaks of influenza-like illness in the institutionalized elderly
Rosewell A, Chiu C, Lindley R, et al. Epidemiology and Infection. Cambridge University Press 2010; 138:1126-1134 doi:10.1017/S0950268809991440.
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7821850

Summary. Respiratory outbreaks are common in aged-care facilities (ACFs), are both underreported and frequently identified late, and are often associated with considerable burden of illness and death. There is emerging evidence that active surveillance coupled with early and systematic intervention can reduce this burden. Active surveillance for influenza-like illness and rapid diagnosis of influenza were established in 16 ACFs in Sydney, Australia, prior to the winter of 2006. A point-of-care influenza test and laboratory direct immunofluorescence tests for common respiratory viruses were used for diagnosis. We achieved early identification of seven respiratory disease outbreaks, two of which were caused by influenza. For the influenza outbreaks, antiviral treatment and prophylaxis were initiated 4–6 days from symptom onset in the primary case. A simple active surveillance system for influenza was successfully implemented and resulted in early detection of influenza and other respiratory disease outbreaks. This enabled earlier implementation of prevention and control measures and increased the potential effectiveness of anti-influenza chemoprophylaxis.

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The Next Pandemic
Barry JM, World Policy Journal. 2010; 10-12.
Available at http://www.mitpressjournals.org/doi/pdf/10.1162/wopj.2010.27.2.10

Summary. In an assessment of how the world has handled the H1N1 pandemic, historian John M. Barry, author of a widely acclaimed 2004 book on the 1918 pandemic, praised the scientific and medical response but said the arrival of a pandemic that was milder than anticipated threw the world off balance, revealing flaws in some national health systems and in international relations. Barry's analysis appears in the summer issue of World Policy Journal, a publication from the Massachusetts Institute of Technology. He wrote that public health officials have learned many lessons, such as the potential usefulness of a pandemic severity scale and the need for better and faster vaccine technology, from the pandemic response. But he said countries don't seem as willing to learn political lessons from their experience. For example, he wrote that the World Health Organization (WHO) has become a scapegoat for critics of the response, whose charges of pharmaceutical industry influence he called "nonsense." Barry said some countries, out of fear or political reasons and against the advice of global health and agriculture groups, imposed unwarranted trade and travel restrictions. He criticized the United States for backpedaling on a commitment to share vaccine with developing countries, Egypt for slaughtering pigs, Indonesia for underestimating the disease threat, and China for efforts to brand the virus a "foreign disease." Barry wrote that such actions are counterproductive, hurt national credibility, and make the world vulnerable to other disease threats such as H5N1 avian influenza.

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Pandemic (H1N1) 2009 influenza in the UK: clinical and epidemiological findings from the first few hundred (FF100) cases
McLean E, Pebody RG, Campbell C, et al. Epidemiology and Infection. Cambridge University Press. 18 May 2010. doi:10.1017/S0950268810001366.
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7828772

Summary. The UK was one of few European countries to document a substantial wave of pandemic (H1N1) 2009 influenza in summer 2009. The First Few Hundred (FF100) project ran from April–June 2009 gathering information on early laboratory-confirmed cases across the UK. In total, 392 confirmed cases were followed up. Children were predominantly affected (median age 15 years, IQR 10–27). Symptoms were mild and similar to seasonal influenza, with the exception of diarrhoea, which was reported by 27%. Eleven per cent of all cases had an underlying medical condition, similar to the general population. The majority (92%) were treated with antiviral drugs with 12% reporting adverse effects, mainly nausea and other gastrointestinal complaints. Duration of illness was significantly shorter when antivirals were given within 48 h of onset (median 5 vs. 9 days, P=0•01). No patients died, although 14 were hospitalized, of whom three required mechanical ventilation. The FF100 identified key clinical and epidemiological characteristics of infection with this novel virus in near real-time.

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Vaccination against pandemic influenza A/H1N1 among healthcare workers and reasons for refusing vaccination in Istanbul in last pandemic alert phase
Torun SD, Torun F, et al. Vaccine. 30 June 2010. doi:10.1016/j.vaccine.2010.06.049.
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-50DYDN0-1&_user=582538&_coverDate=06%2F30%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000029718&_version=1&_urlVersion=0&_userid=582538&md5=d8bb37ff071701a65129dfd022ebd47a

Abstract. Coverage of the HCWs as target population is one of the important determinants for the impact of vaccination. To determine the vaccination against the pandemic influenza A/H1N1 among HCWs, we conducted a cross-sectional questionnaire survey in a public hospital in Istanbul from December 7 to December 22, 2009. Out of total 941 HCWs 718 (76.3%) completed the questionnaires. Nearly one-fourth (23.1%) of the participants were vaccinated against pandemic influenza A/H1N1. Occupation (being a doctor), receiving seasonal influenza vaccine in 2009, agreement with safety of pandemic influenza A/H1N1 vaccine and being comprehend that HCWs have a professional responsibility for getting vaccinated was the strongest independent predictive factor for accepting the pandemic influenza A/H1N1 vaccine (p < .0001). The most frequent reasons for refusing pandemic vaccine were fear of side effects and doubts about vaccine efficacy. Among HCWs 59.6% were recommending pandemic influenza vaccination to a patient even if indicated. In conclusion vaccination against pandemic influenza A/H1N1 is insufficient among HCWs. Misinformed or inadequately informed HCWs are important barrier to pandemic influenza vaccine coverage of the general public also. Educational campaigns concerning HCWs should include evidence based and comprehensible information about possible adverse effects and their incidence besides the advantages of vaccine.

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Monitoring of perceptions, anticipated behavioral, and psychological responses related to H5N1 influenza
Lau JTF, Tsui HY, Kim JH et al. Infection. 26 June 2010. doi:10.1007/s15010-010-0034-z.
Available at http://www.springerlink.com/content/r5803upw454q1464/fulltext.pdf

Background. The aim of this study was to monitor changes in behavioral and emotional responses to human H5N1 in the community over a 28-month period (from November 2005 to February 2008). Methods. A total of 3,527 Hong Kong Chinese adults were interviewed by telephone within the framework of six identical cross-sectional surveys carried out during the 28-month study period. Given a hypothetical scenario that two to three new human-to-human H5N1 cases had been reported in Hong Kong, the trends of the respondents in various H5N1-related risk perceptions, anticipated personal psychological responses, and anticipated personal preventive behaviors were investigated.

Results. Over time, a decreased proportion of the respondents (1) felt susceptible to contracting H5N1, (2) expected a large outbreak would eventually occur, (3) believed that the impacts of H5N1 were worse than those of severe acute respiratory syndrome (SARS), and (4) anticipated adopting more types of preventive measures and experiencing mental distress in the case of a small-scale outbreak in Hong Kong (AOR from 0.27 to 0.43, p < 0.001), but the public remained vigilant on public health behaviors, such as hand-washing. The prevalence of misconceptions on the mode of transmission declined, but remained high; perceptions on the fatality of H5N1 remained largely underestimated. The SARS experience and unconfirmed beliefs about the transmission modes were associated with variables on anticipated preventive behaviors and emotional distress.

Conclusion. Starting in 2005 through to 2008, respondents perceived a decreasing level of susceptibility, severity, and anticipated stress towards a hypothetical human-to-human H5N1 outbreak, possibly due to the low efficiency of transmission. The public’s general preparedness was still relatively good and rational, even though individual preventive behaviors were less common. However, misconceptions were prevalent among the respondents. Based on these results, public education is warranted to rectify these misconceptions.

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Mortality Patterns Associated with the 1918 Influenza Pandemic in Mexico: Evidence for a Spring Herald Wave and Lack of Preexisting Immunity in Older Populations
Chowell G, Viboud C, Simonsen L, et al. The Journal of Infectious Diseases. 2010;202:000-000 doi: 10.1086/654897.
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/654897

Background. Although the mortality burden of the devastating 1918 influenza pandemic has been carefully quantified in the United States, Japan, and European countries, little is known about the pandemic experience elsewhere. Here, we compiled extensive archival records to quantify the pandemic mortality patterns in 2 Mexican cities, Mexico City and Toluca.

Methods. We applied seasonal excess mortality models to age©\specific respiratory mortality rates for 1915¨C1920 and quantified the reproduction number from daily data.

Results. We identified 3 pandemic waves in Mexico City in spring 1918, autumn 1918, and winter 1920, which were characterized by unusual excess mortality among people 25¨C44 years old. Toluca experienced 2©\fold higher excess mortality rates than Mexico City but did not experience a substantial third wave. All age groups, including that of people 65 years old, experienced excess mortality during 1918¨C1920. Reproduction number estimates were <2.5, assuming a 3©\d generation interval.

Conclusion. Mexico experienced a herald pandemic wave with elevated young adult mortality in spring 1918, similar to the United States and Europe. In contrast to the United States and Europe, there was no mortality sparing among Mexican seniors 65 years old, highlighting potential geographical differences in preexisting immunity to the 1918 virus. We discuss the relevance of our findings to the 2009 pandemic mortality patterns.

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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