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Vol. XIII No. 15 ~ EINet News Briefs ~ Jul 23, 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: WHO may meet to consider announcing end of H1N1 pandemic influenza outbreak
- Global: WHO may delay H1N1 pandemic influenza status meeting
- India: Pandemic influenza H1N1 increases
- India (Karnataka): Union Health Ministry asks state to expedite H1N1 pandemic influenza vaccination program
- India (Mumbai): Pandemic influenza H1N1 no longer localized
- Indonesia (Sukoharjo): Suspected case of avian influenza H5N1
- Mauritius: Confirms first H1N1 pandemic influenza death
- Saudi Arabia: Economy was waived H1N1 pandemic influenza vaccination requirement for pilgrims

2. Infectious Disease News
- Mexico (Tijuana): Pediatric cases of meningococcal meningitis
- Peru (Trujillo): Pneumonic plague outbreak
- Peru (Datem del Marañon): Hepatitis B outbreak in indigenous communities
- USA (California): Pertussis cases on the rise
- USA (California): Whooping cough cases increase
- USA (Georgia): Whooping cough cases increasing
- USA (New York): CDC reports that mumps outbreak continues in New York
- USA (Michigan): Pertussis (whooping cough) cases on rise

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

4. Articles
- Same influenza vaccination strategies but different outcomes across US cities?
- Vaccination coverage against 2009 seasonal influenza in chronically ill children and adults: Analysis of population registries in primary care in Madrid (Spain)
- Seasonal influenza vaccination campaigns for health care personnel: systematic review
- Importance of vaccination habit and vaccine choice on influenza vaccination among healthy working adults
- Evaluation of seasonal influenza vaccination effectiveness based on antibody efficacy among the institutionalized elderly in Japan
- The impact of illness and the impact of school closure on social contact patterns
- Influenza A/H1N1v in pregnancy: an investigation of the characteristics and management of affected women and the relationship to pregnancy outcomes for mother and infant
- The impact of communications about swine flu (influenza A H1N1v) on public responses to the outbreak: results from 36 national telephone surveys in the UK
- Community Transmission of Pandemic Influenza A (H1N1) in China
- Epidemiological aspects of 2009 H1N1 influenza: the accumulating experience from the Northern Hemisphere
- Novel findings from the second wave of adult PH1N1 in the United States
- Risk factors of poultry outbreaks and human cases of H5N1 avian influenza virus infection in West Java Province, Indonesia

5. Notifications
- 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)
Egypt / 19 (7)
Indonesia / 5 (4)
Viet Nam 7 (2)
Total / 33 (15)

***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: 501 (297)
(WHO 07/22/10:
http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_07_22/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 18 July 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18,366 deaths.

Globally pandemic influenza activity remains low. The most active areas of influenza transmission remained in the tropical zones; primarily in West Africa, Central America, the Caribbean, and South and Southeast Asia, although activity is localized to relatively small areas in each region. In the temperate zone of the southern hemisphere, Australia and New Zealand have showed signs of increased respiratory disease in recent weeks. Both countries have continued to detect low levels of predominantly pandemic H1N1 influenza virus. In South Africa, the influenza season is well under way and is predominantly associated with seasonal influenza B and H3N2 viruses and small numbers of pandemic H1N1 influenza viruses.

In the temperate zone of the southern hemisphere, overall influenza activity remained low but with notable increases in recent weeks in some areas. South Africa had been experiencing a sharp increase in the proportion of respiratory samples testing positive for influenza viruses since late June 2010. For the current reporting week, 30-40% of sentinel respiratory samples from patients with severe acute respiratory infections (SARI)/influenza-like-illness (ILI) tested positive for influenza. Respiratory disease activity was associated primarily with seasonal influenza B and H3N2 viruses, with a much smaller number of pandemic H1N1 influenza viruses. Australia has reported a gradual increase in the number of respiratory disease consultations due to ILI since end of June to early July 2010 although this is of similar to the levels experienced in 2008. This increase of respiratory disease activity may be accounted for in part by circulation of respiratory syncytial virus (RSV). Influenza viruses in Australia have been about 2/3 pandemic H1N1 influenza and 1/3 seasonal influenza H3N2. In New Zealand, rates of ILI have markedly increased compared to the previous reporting week but still remained below the seasonal baseline, primarily associated with pandemic H1N1 influenza virus. In Chile and Argentina, national rates of ILI remained low relative to last year at the same period of time.

In Asia, overall pandemic influenza activity remained low. The most active areas of pandemic H1N1 influenza virus transmission are in India, Cambodia and Singapore. Significant transmission of pandemic H1N1 influenza is occurring in the Southern states of Kerala and the Western state of Maharashtra, India. Cambodia has recently observed an increase in the proportion of respiratory samples testing positive for influenza virus (primarily pandemic H1N1 influenza and seasonal influenza H3N2) since early June 2010. In Singapore, rates of ILI and acute respiratory infections (ARI) increased compared to previous week and reached the epidemic threshold. The proportion of patients with ILI testing positive for pandemic H1N1 influenza continues to be stable (15%) associated with co-circulation of pandemic H1N1 influenza, seasonal influenza H3N2, and influenza type B viruses.

In sub-Saharan Africa, the current situation was largely unchanged since the last update. Pandemic H1N1 and seasonal influenza activity continued to be observed in several countries. Ghana has had a sustained circulation of pandemic H1N1 influenza virus since June 2010. Small numbers of seasonal influenza H3N2 viruses continued to be detected in eastern Africa.

In the tropical regions of the Americas, the situation has remained similar to the previous week. Overall pandemic and seasonal influenza activity were low, except in pockets of Central and South America with co-circulation of pandemic and seasonal influenza H3N2 viruses (Costa Rica had predominantly pandemic H1N1 influenza virus, while Nicaragua and Panama had predominantly influenza H3N2 virus).

In the temperate regions of the Northern hemisphere, pandemic and seasonal influenza viruses have been detected only sporadically or at very low levels during the past month.
(WHO 07/23/2010)

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Global: WHO may meet to consider announcing end of H1N1 pandemic influenza outbreak
WHO may meet next week to review infection data from the Southern Hemisphere and recommend that the agency announce an end to the pandemic. WHO spokesman Gregory Hartl said that Director-General Margaret Chan will decide on whether to declare a post-pandemic phase guided by how the virus behaves, adding that the agency hasn't set a date for an announcement.
(CIDRAP 07/20/2010)

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Global: WHO may delay H1N1 pandemic influenza status meeting
The expert committee advising the WHO on whether to lower the pandemic alert level from phase six might not meet until August 2010. It had originally planned to meet in mid July 2010. WHO Director-General Margaret Chan said the committee will wait to see what happens in the Southern Hemisphere, which usually sees its peak influenza activity in August.
(CIDRAP 07/15/2010)

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Asia
India: Pandemic influenza H1N1 increases
The swine flu virus which has been on a resurgent course since the beginning of monsoons, increased during the week of 12 July 2010, with 21 deaths being reported from various parts.

Kerala and Maharashtra again bore the brunt during the week of 13 July 2010, with these states reporting 8 and 11 cases, respectively. One death was reported from Delhi and another from Gujarat.

The two states had reported 16 out of the total of 17 deaths during the week of 7 July 2010. Out of the 332 cases reported during the week, only one case is an imported case and the rest are indigenous cases.

Up to the present, samples from 14,7250 people have been tested for influenza pandemic A(H1N1) virus infection in government laboratories and a few private laboratories across the country, and 34,115 of them have been found positive.
(ProMED 07/20/2010)

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India (Karnataka): Union Health Ministry asks state to expedite H1N1 pandemic influenza vaccination program
Almost 60 percent of the H1N1 vaccine received from the Center in March 2010 in the state of Karnataka still remains unused, compelling the Union Health Ministry to ask the state to expedite the vaccination program.

With a new H1N1 pandemic influenza outbreak in Kerala, the Ministry has now prodded Karnataka to use the stock to vaccinate the health care workers at the earliest time possible. In March 2010, 124,200 doses (around 60,000 vials) of H1N1 vaccine, manufactured by Sanofi Pasteur, was supplied to the state.

Union health secretary, K Sujatha Rao, has asked the state to make vaccination mandatory for all health workers without fail. He says the vaccination program should be administered quickly, before the vaccine, which has a shelf life of a year, expires. In a letter to Raman Reddy, principle secretary of health, Rao said that with the onset of monsoon and the winter season, the probability of a major influenza H1N1 outbreak cannot be ruled out.

The vaccines are intended for doctors, nurses, para-medical and support staff working in areas most vulnerable to the infection. In March 2010, the Karnataka health officials had said about 54,000 health workers in government hospitals would be vaccinated, although there would not be any compulsion.
(ProMED 07/20/2010)

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India (Mumbai): Pandemic influenza H1N1 no longer localized
Pandemic flu in Mumbai, India in 2010 has reached 150 cases and is no longer localized, prompting officials to alter their strategy. During the 2009 wave they could identify pockets of flu and focus efforts, but now they say the virus is in the air, and they'll shift to informing the public on how best to prevent the disease. We are getting swine flu patients from everywhere in the city, an official said, and said that they have to maintain vigilance all over. The city's slums have been hardest hit.
(CIDRAP 07/13/2010)

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Indonesia (Sukoharjo): Suspected case of avian influenza H5N1
On 17 July 2010, a Sukoharjo district health official said the death of a 14-year old girl in early July 2010 proved to have been caused by avian influenza A (H5N1) virus infection. He said samples of the girl's body fluids had been sent to the Health Ministry's laboratory in Jakarta for tests, and that the test results received in Sukoharjo on 16 July 2010 had shown that the junior high-school student was positively infected with the bird flu virus. He said it was so far not known where the virus came from, but that the victim had previous contact with a dead chicken.

He said his office had taken preventive measures, especially at and around the victim's residence, after knowing the cause of her death. He also appealed to the people to be alert to the possible spread of the virus and to improve cleanliness.

[ProMED note: If confirmed by the World Health Organization, this will bring the total number of cases of avian influenza (H5N1) virus infection recorded in Indonesia to 167 and the number of fatalities to 138. Contact with a diseased fowl is suspected.

This will be the fifth case and fourth death reported in Indonesia so far in 2010. Overall, it brings the global total of cases of avian influenza (H5N1) virus infection to 501 and the death toll to 297.]
(ProMED 07/18/2010)

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Mauritius: Confirms first H1N1 pandemic influenza death
Mauritius, a small island nation east of Madagascar, has recorded its first pandemic H1N1 death of 2010. A 51-year-old government official died 10 July 2010 after having lab-confirmed pandemic flu for about 15 days. The country has seen several suspected cases of A/H1N1 virus in both private and public medical centers.
(CIDRAP 07/10/2010)

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Saudi Arabia: Economy was waived H1N1 pandemic influenza vaccination requirement for pilgrims
Saudi Arabia in 2010 has waived the requirement that Hajj and Umrah pilgrims traveling to the country be vaccinated against pandemic H1N1 flu. In 2009 the country's health ministry had recommended the vaccine for all pilgrims. The Hajj pilgrimage takes place in November, while Muslims can make an Umrah pilgrimage any time of year.
(CIDRAP 07/14/2010)

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2. Infectious Disease News

Americas
Mexico (Tijuana): Pediatric cases of meningococcal meningitis
Enrique Chacon Cruz, infectious disease specialist from the Department of Pediatrics at Tijuana General Hospital, said that more than 20 cases of meningococcal meningitis, most of whom are minors, have been reported in the state.

[ProMED note: It is not possible to calculate a primary attack rate in Tijuana from the data presented in the news release above: we don't know if a common serogroup is involved, the period of time in which the cases occurred, how many of the 20 cases are primary, and the size of the population at risk (that is, whether the cases were restricted to an organization or neighborhood, or were dispersed throughout the city.

Tijuana is the largest city in the Mexican state of Baja California, with a population of 1,483 992 (2005), and is situated on the US-Mexico border adjacent to the US city of San Diego, California. It is estimated that the two border crossing stations in Tijuana account for 300, 000 daily border crossings.]
(ProMED 07/15/2010)

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Peru (Trujillo): Pneumonic plague outbreak
An outbreak of pneumonic plague, a virulent disease with a high mortality rate, was detected in Trujillo. Doctors are striving to save the lives of three patients, including a resident doctor and a medical student whose health conditions are serious.

According to the regional manager of Health, Victor Peralta Chavez, this is the first time this disease has been recorded in the country.

A woman aged 29, from Mariposa Leyva sector, district Chocope (Ascope), 40 minutes north of Trijillo, contracted the disease. The first symptoms occurred five days prior to her family taking her to Trujillo, where she was admitted at the Regional Teaching Hospital.

The patient was treated for both pneumonia and for potential influenza A (H1N1) (with antibiotics and antivirals), but there was no improvement. The results of a test to detect possible pneumonic plague were negative.

A resident doctor, who treated and intubated the patient during her critical condition, developed the same symptoms as the infected woman. He was immediately hospitalized and treated, but his health is critical. In this regard, Peralta Chavez said that the patient's progress is not good. Multiple organ failure has occured while the patient has been treated in hospital intensive care at Victor Lazarte Echegaray.

On 13 July 2010, a 4th-year student of Human Medicine at the Universidad Nacional de Trujillo (UNT), who also had contact with the infected woman, was hospitalized at the Regional Teaching Hospital. This patient tested positive for pneumonic plague. His condition is also very delicate, Chavez said.

With these results, Peralta Chavez summoned the press and warned of a possible outbreak of pneumonic plague at the hospital or in the Trujillo Regional Teaching Hospital, although he clarified that this is an imported case from Chocope.
(ProMED 07/18/2010)

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Peru (Datem del Marañon): Hepatitis B outbreak in indigenous communities
Lawmaker Jorge Foinquinos Mera made an appeal to governmental authorities, to the Prime Minister Javier Velasquez Quesquen and to the Minister of Health, Oscar Ugarte, to declare a sanitary emergency and adopt urgent measures seeking to control the hepatitis outbreak in the Marañon indigenous communities.

Residents from several indigenous communities locates in San Lorenzo, in the province of Datem del Marañon, have died of hepatitis B, and according to the lawmaker the figures are increasing.

Reports from native leaders state that 36 Candoshis and 38 Shapras have died due to this disease, and many others are currently infected and are lacking proper treatment, since the area almost does not have equipped medical facilities.
(LivinginPeru.com 07/20/2010)

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USA (California): Pertussis cases on the rise
With a pertussis epidemic poised to become California's worst in 50 years, state health officials on 18 July 2010 expanded recommendations for the tetanus, diphtheria, and pertussis (Tdap) vaccine. In a statement, the California Department of Public Health (CDPH) said it recommends an adolescent-adult Tdap booster vaccine for anyone age seven or older who is not fully immunized, including those over age 64, as well as for women of childbearing age before, during, or after pregnancy and for those who have contact with pregnant women or infants. So far in 2010 California has confirmed nearly 1,500 pertussis cases, a fivefold increase from the same time last year and up from 910 cases the state reported in mid June 2010. About 700 more cases are under investigation. Five babies, all under three months, have died from the disease. State officials are offering free postpartum Tdap vaccination at hospitals, have developed bilingual educational materials for the public, and have teamed up with the Centers for Disease Control and Prevention (CDC) to investigate the epidemic in the particularly hard-hit Central Valley.
(CIDRAP 07/19/2010)

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USA (California): Whooping cough cases increase
Whooping cough, which has been declared an epidemic in California in 2010, continues to spread in Monterey County.

Health department officials say the number of reported cases in the county rose by six in the week beginning 12 July 2010, to a total of 32 so far in 2010.

In 2009 the number of infections in the county in July were at five. Whooping cough tends to break out in cycles of about five years. County officials said that during 2004, the most recent "high year" for the region, a total 29 cases had been reported by mid-July.

State and local health officials urge all teens and adults to get booster shots to prevent the spread of whooping cough, also known as pertussis. The shots have been administered since 2005 as part of a tetanus and diphtheria booster, known as the Tdap.
(Californian.com 07/15/2010)

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USA (Georgia): Whooping cough cases increasing
Some Georgia health officials are warning parents to vaccinate children after cases of whooping cough have increased in Georgia.

Health officials are looking into cases of possible whooping cough, or pertussis, in Tift, Turner and Grady counties.
(AP 07/19/2010)

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USA (New York): CDC reports that mumps outbreak continues in New York
The Center for Disease Control [CDC] has issued a preliminary set of data regarding mumps cases for 2010 in the United States. The data are the latest available. However, the figures are unofficial and will not be certified by the public health officials of various states or the CDC until 2011.

The data provided cover the first 25 weeks of 2010, through 26 June 2010. According to the data, New York City's mumps outbreak continues, though the number of new mumps cases in upstate New York and New Jersey appears to have declined. Preliminary numbers indicate that New York City has reported 927 cases of mumps in 2010 through 26 June 2010. Upstate New York has reported 644 cases, with an additional 257 reported in New Jersey. The CDC has had reports of 2106 cases of mumps nationwide, with 87 percent of those from New York and New Jersey.

The CDC reports that mumps vaccines are the best way to prevent mumps, and that vaccine effectiveness has been estimated at 62 to 91 percent for one dose and 76 to 95 percent for 2 doses.
(ProMED 07/13/2010)

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USA (Michigan): Pertussis (whooping cough) cases on rise
More people are getting pertussis in Michigan and across the nation.

Fatima Mamou is an epidemiologist with Genesee County Health Department. She says pertussis is most often transmitted by adults, who get the illness, but pass it off as a bad cold. She said that adults can transmit pertussis to infants, and that infants less than age one are too young to be fully protected by the vaccine, which means they can get pertussis and severe complications that can even result in death.

There have been more than 600 cases of pertussis in Michigan so far this year. That's compared to only 278 last year by this time.
(NPR Michigan 07/13/2010)

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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/

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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
Canada (Manitoba)
Manitoba health officials have found the first mosquitoes carrying the West Nile virus this summer season.

The adult Culex tarsalis mosquitoes are the only mosquitoes that contract and transmit the potentially lethal virus were trapped in West St. Paul just north of Winnipeg, the province said on Wednesday.

The number of Culex tarsalis trapped in the week of 4 July 2010 increased throughout southern Manitoba. While the mosquito numbers are highest in the Red River Valley and southeast Manitoba, the potential for human exposure to West Nile is present throughout the entire south of the province, health officials said.

No human contractions of the virus have been reported in 2010.

Preliminary trap counts for this week show the number of Culex tarsalis has declined slightly.

West Nile can cause fatal inflammation of the brain (encephalitis) or the membranes covering the brain or spinal cord (meningitis) in more than 100 bird species and nine mammals, including humans, horses and gorillas.
(CBC.ca 07/14/2010)


Chinese Taipei
The Taiwan Centers for Disease Control (CDC) announced 9 July 2010 that three more cases of Japanese encephalitis [JE] had been reported in Chinese Taipei, bringing the number to 14 in 2010. One of the three confirmed cases was acquired overseas, marking the first imported case of Japanese encephalitis in 2010, CDC deputy director-general Chou Jih-haw said.

A 52-year-old man living in Miaoli County fell ill 14 June 2010 soon after he returned from a business trip to China's Guangdong Province, Chou said. The man first sought medial treatment for a headache at a clinic, but turned to a hospital in Taipei City after his illness became worse, Chou said, adding that the man was released from the hospital on 8 July 2010. Doctors determined the businessman was infected with the mosquito-borne Japanese encephalitis virus during his stay in Guangdong, a known risk area, Chou said.

Chou said another patient -- a male in Pingtung County -- remains in an intensive ward after developing symptoms of Japanese encephalitis on 29 June 2010.

The third case is a man in Hualien County who visited a clinic on 27 June 2010 with a headache and a fever. On 1 July 2010, he was rushed to a hospital because of continuous high fever, and he is still being treated at the hospital, Chou said.
(ProMED 07/3/2010)


India
At least 15 people have died of suspected Japanese encephalitis (JE), and more than 100 others are undergoing treatment in Manipur.

Dr Y. Yaima, Director, Health Services, said blood samples had been sent to the Regional Medical Research Centre in Dibrugarh, Assam, and the National Institute of Communicable Diseases, New Delhi to ascertain whether Japanese encephalitis was the cause of the deaths.

Y. Mohen, Medical Superintendent at the Regional Institute of Medical Sciences here, said that the number of patients with symptoms of JE was increasing. He attributed the alarming outbreak of this disease to widespread rearing of pigs in villages and urban residential areas.

Official reports said hospitals only had stocks of Acyclovir medicine, which treats the disease, that had expired several months ago. Efforts were on to airlift the drug from Delhi, sources said.

[ProMED note: The suspected JE outbreak in Manipur state continues and may be intensifying. The 6 July 2010 ProMED post (archive no. 20100707.2261) reported just three fatalities. The current report states that there are now at least 15. ProMED-mail continues to await the results of the laboratory tests.

Pigs are amplifying hosts of JE virus. The virus is maintained in wild birds, such as night herons, and is transmitted by Culex tritaeniorhynchus and Culex vishnui groups, which breed particularly in flooded rice fields. Effectively controlling the Culex JE virus vector mosquitoes over large geographic areas is not practical. 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. Unfortunately, contrary to the above report, there is no effective antiviral treatment for JE virus infections. Only intensive supportive treatment is indicated.]
(ProMED 07/11/2010)


Indonesia: Yogyakarta
Around 45 community units in 14 sub districts in Yogyakarta have become dengue fever endemic areas since 2007. The number of patients has increased as well. In 2009, there were 688 cases, with five deaths. Up until 19 July 2010, there have been 814 patients and one death.
(ProMED 20 July 2010)


Malaysia: Sarawak
Sarawak will intensify efforts to curb dengue fever, following an increase in cases and deaths in the state. Deputy Chief Minster Tan Sri Dr George Chan said from January to June of 2010, a total of 2478 cases of dengue and 11 deaths -- five in Sibu, two in Kuching, and one each in Samarahan, Betong, Miri, and Serian -- were recorded in the state. He said the number of deaths had already exceeded the 2009 death toll of seven, and said the area must take concerted effort to fight dengue. Dr Chan, who is also the state Disaster and Relief Management Committee Chairman, said Miri and Sibu recorded 550 and 536 dengue cases respectively for the first six months of 2010.
(ProMED 07/13/2010)


Philippines: Cebu
The number of dengue cases in Cebu City has risen dramatically in the first half of 2010 compared to 2009. Statistics from the Department of Health in Central Visayas showed that dengue cases in city surged by 51 percent to 546 cases and six deaths from 1 January - 10 July in 2010 from only 362 cases and 10 deaths in the same period in 2009. Cebu City topped other cities in the entire Central Visayas in the number of dengue cases and deaths. A report by the Regional Epidemiology and Surveillance Unit (RESU) of the DOH [Department of Health] in Central Visayas showed that a total of 2461 dengue cases and 18 deaths were recorded between 1 January - 10 July 2010. This was 10 percent higher compared to the 2225 dengue cases and 26 deaths the previous year. Most of the victims in the region were children between 6 - 10 years old. About half or 53 percent of the victims were male. The majority of the dengue cases were from Cebu City at 22.4 percent, followed by Talisay City with 5.4 percent, Tagbilaran City with 4.9 percent, Danao City with 4.26 percent and Lapu-Lapu City with 4.1 percent. Dr. Jocelyn Abella, Dengue Prevention Coordinator for Central Visayas, said the increase and decrease of dengue cases in certain areas depends on the advocacy and health campaign of the local government units against dengue. Central Visayas reported a total of 7123 dengue cases for the whole of 2009. The Integrated Provincial Health Office, however, presented different statistics on the dengue cases in Cebu province.
(ProMED 07/18/2010)


Philippines: Zamboanga City
The City Health Office has declared a "very high alert level" due to the soaring cases of dengue in the city. Dr. Rodel Agbulos, city health officer, said a total of 1,052 dengue cases have been recorded in this city from January - June of 2010, with nine fatalities, which already surpassed the total number of cases and fatalities registered in 2009. This compares with the 1,029 cases and eight fatalities for the entire year of 2009. Agbulos said that the number of registered cases has not reached the outbreak level as of yet. He called on every resident of the city prevent the spread of the virus. City Health Office records showed that there were 156 cases of dengue in January, 158 in February, 149 in March, 93 in April, 123 in May, 302 in June and 71 for the first week of July 2010. Agbulos said barangay Campo Islam, a slum village west of Zamboanga City, registered the most number of dengue fever cases since the first month of this year. Zamboanga City experienced an outbreak of dengue fever in 2007, when cases of dengue soared to more than 3,000 and Agbulos warned that if nothing is done, the present situation might reach the same level as it did three years ago.
(ProMED 07/18/2010)


Russia: Stavropol
The epidemic season for Crimean-Congo hemorrhagic fever (CCHF) continues in the Stavropol oblast. The cumulative number of cases was 25 in the oblast so far in 2010. The first case was a man who removed ticks from cattle with his bare hands and crushed them. According to Rospotrebnadzor (the Federal Agency for Consumer Protection and Welfare), CCHF cases were recorded in 11 regions of the Stavropol oblast. Most cases occurred in the Ipatovski and Neftekumski regions. There have been 8000 reports of tick bites. A survey revealed that only five percent of ticks were CCHF virus carriers, but this is a significantly greater number than recorded in 2009.
(ProMED 07/14/2010)


Russia
Rospotrebnadzor [Federal Service for Consumer Affairs and Human Welfare] office in Primorsky Krai territory has given details of two fatal cases of tick-borne encephalitis (TBE). Both victims were unemployed men who went into forested areas in search of wild berries.

In 2009 there were seven fatal TBE cases in the Primorsky Krai. In 2010, 4833 people, including 1005 children, have experienced tick bites. In total 3,202 ticks were tested for TBE virus. In 255 cases of TBE virus infection immune globulin was administered, and 68 people were hospitalized because of suspected TBE (15 of whom were children). In 13 cases (of whom four were children), a diagnosis of TBE was confirmed by laboratory analysis.

TBE vaccine coverage was 76 percent of those individuals judged to be at high risk of infection, representing 5 percent (46 499 people) of the total population.
(ProMED 07/12/2010)


Thailand: Nakhon Ratchasima
The Nakhon Ratchasima Provincial Public Health Office has warned local residents of the prevalence of dengue fever, with over 1,000 infected patients and three fatalities so far. According to the latest report, more than 1,000 people in Nakhon Ratchasima province have been infected with dengue fever, three of whom have died. Over 300 of the total patients were reported in June 2010 alone. Dr. Varunyu Sattayawongtip, medical service officer of the Nakhon Ratchasima Provincial Public Health Office, stated that public health officials in all 32 districts of the province had already been tasked with educating the locals on how to protect themselves from the disease. All stagnant waters in the area, which could serve as mosquito breeding grounds, are also being sprayed with larvicide on a continuous basis. As reported by the Bureau of Epidemiology, 4,000 people living in the lower northeastern part of Thailand, such as Nakhon Ratchasima, Chaiyaphum, Buri Ram and Surin provinces, have been infected with dengue fever virus, while four of them have died.
(ProMED 07/16/2010)


USA: Florida
Dengue fever warnings in Florida have now spread to the central portion of the state. The Marion County Health Department has received confirmation of a case in the county. The confirmation prompted a request by the Marion County Commission to begin conducting a mosquito spray in Citra, an unincorporated community in the northeastern part of the county. Dr. Nathan Grossman, director of the Marion County Health Department, said that the risk of transmission from this mosquito-borne disease is very low, but as part of the mission to protect the health of Marion County citizens, the department is taking additional steps to further reduce possible transmission. Advisories were already in effect in Broward and Palm Beach counties 15 July 2010.
(ProMED 07/16/2010)


Viet Nam
So far in 2010, dengue fever outbreaks in Viet Nam's central region have sickened thousands and claimed several lives, officials said. The worst to be hit was the Khanh Hoa province, with 2,170 reported cases of the mosquito-borne illness, the provincial authorities reported 9 July 2010. According to the local Center for Preventive Health, this year's outbreak was fueled by poor mosquito eradication efforts. Health officials in Binh Dinh have reported a 50 percent increase in dengue cases, compared with the 2009 season. Binh Dinh officials say there have been 676 cases, including two deaths. The week of 5 July 2010, officials in the Phu Yen province announced reports of 929 cases and one death. New reports come in daily from Quang Ngai, Kon Tum and Gia Lai. Experts and officials blamed the recent outbreak on hot weather accompanied by rain: ideal conditions for Aedes aegypti mosquitoes to breed. Furthermore, locals lack the knowledge needed to implement preventative measures (such as the covering or drainage of standing water around the home), officials said.
(ProMED 7/17/2010)

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CHOLERA, DIARRHEA, and DYSENTARY
Vietnam
Another three cases of Vibrio cholerae infection have been diagnosed in Rach Goc town, Ngoc Hien district, Ca Mau province, raising the total number of patients with the bacteria to five, reported the provincial centre for preventive medicine. On 15 July 2010, Ngoc Hien General Hospital received three patients suspected of having cholera. The provincial centre for preventive medicine took samples from them, which later tested positive for V. cholerae. The patients are now isolated and being treated at the district hospital. Ca Mau has had more than 2,500 cases of acute diarrhea treated at its hospitals from the beginning of 2010, most of them children. In the face of a possible cholera outbreak, the provincial health department and Ngoc Hien district have worked together to raise public awareness of the issue and to take preventive measures such as spraying chemicals to disinfect contaminated areas, giving antibiotic to local inhabitants, and treating water supplies that are used daily by local people. The province is also encouraging people to adopt hygienic practices with food, and is preparing medicine and medical staff for the worst possible scenario.
(ProMED 07/21/2010)

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4. Articles
Same influenza vaccination strategies but different outcomes across US cities?
Taylor C, Marathe A, Beckman R. Int J Infect Dis. 21 July 2010.
doi:10.1016/j.ijid.2010.02.2267.
Available at http://www.ijidonline.com/article/S1201-9712(10)02405-7/abstract

Objectives. This research aimed to determine if the same influenza vaccination strategies would have the same level of effectiveness when applied to two different US metropolitan areas, Miami and Seattle, where the composition of the population differs significantly in age distribution and household size distribution. Methods. We used an individual-based network modeling approach in which every pair of individuals connected in the social network is represented. Factorial design experiments were performed to estimate the impact of age-targeted vaccination strategies to control the transmission of a ‘flu-like’ virus.

Results. The findings showed that: (1) age composition of the city matters in determining the effectiveness of a vaccination strategy and (2) vaccinating school children outperforms every other strategy

Conclusion. The most significant policy implication of this research is that there may not be a universal vaccination strategy that works across all cities with the same level of effectiveness. Secondly, given the important role of school children in the transmission of influenza, the US Government should consider the vaccination of school children a top priority.

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Vaccination coverage against 2009 seasonal influenza in chronically ill children and adults: Analysis of population registries in primary care in Madrid (Spain)
Rodriguez-Rieiro C, Dominguez-Berjon F, Esteban-Vasallo M, et al. Vaccine. 10 July 2010. doi:10.1016/j.vaccine.2010.07.013.
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-50K4PPN-1&_user=10&_coverDate=07%2F20%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=136c6b8329dde173501b00ebbd6eb32e

Abstract. Using electronic clinical records in primary care (ECRPC) of the entire population living in the Autonomous Community of Madrid, Spain (5,102,568 persons) as a data source, this study aimed to ascertain seasonal anti-influenza vaccination coverage in the chronically ill at-risk children (aged 6 months to14 years) and adults (15–59 years).Of the total population aged 6 months to 59 years with a medical card in the Autonomous Community of Madrid, 10.3% (n = 528,095 patients) had a chronic condition for which anti-influenza vaccination was indicated. In children with chronic conditions, coverage was 27.1% and it was particularly high among diabetics (41.1%) and particularly low in children with “other pulmonary conditions” (15.2%). In adults with chronic conditions, coverage was 22.1% and in patients with diagnosed heart failure coverage reached 39.1%; with the lowest coverage was observed in patients suffering neuromuscular diseases (12.8%).The factors associated with vaccination among children and adults suffering a chronic condition included: having been vaccinated during the previous campaign, national origin (lower among immigrants), and having more than one chronic condition. In conclusion, our study shows that vaccination coverage for 2009 seasonal influenza in children and adults with chronic conditions living in Madrid (Spain) was less than acceptable.

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Seasonal influenza vaccination campaigns for health care personnel: systematic review
Lam P, Chambers LW, Pierrynowski MacDougall DM, et al. CMAJ. 19 July 2010. doi: 10.1503/cmaj.091304.
Available at http://www.cmaj.ca/cgi/content/abstract/cmaj.091304v1

Background. In Canada, vaccination coverage for seasonal influenza among health care personnel remains below 50%. The objective of this review was to determine which seasonal influenza vaccination campaign or campaign components in health care settings were significantly associated with increases in influenza vaccination among staff.

Methods. We identified articles in eight electronic databases and included randomized controlled trials, controlled before-and-after studies and studies with interrupted time series designs in our review. Two reviewers independently abstracted the data and assessed the risk of biases. We calculated risk ratios and 95% confidence intervals for randomized controlled trials and controlled before-and-after studies and described interrupted time series studies.

Results. We identified 99 studies evaluating influenza vaccination campaigns for health care workers, but only 12 of the studies were eligible for review. In nonhospital health care settings, including long-term care facilities, campaigns with a greater variety of components (including education or promotion, better access to vaccines, legislation or regulation and/or role models) were associated with higher risk ratios (i.e, favouring the intervention group). Within hospital settings, the results reported for various types of campaigns were mixed. Many of the criteria for assessing risk of bias were not reported.

Interpretation. Campaigns involving only education or promotion resulted in minimal changes in vaccination rates. Further studies are needed to determine the appropriate components and combinations of components in influenza vaccination campaigns for health care personnel.

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Importance of vaccination habit and vaccine choice on influenza vaccination among healthy working adults
Lin CJ, Nowalk MP, Toback SL, et al. Vaccine. 16 July 2010.
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-50J8WRH-8&_user=10&_coverDate=07%2F16%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=fecfc034b586cd07ca2d07b384530269

Abstract. This randomized cluster trial was designed to improve workplace influenza vaccination rates using enhanced advertising, choice of vaccine type (intranasal or injectable) and an incentive. Workers aged 18–49 years were surveyed immediately following vaccination to determine factors associated with vaccination behavior and choice. The questionnaire assessed attitudes, beliefs and social support for influenza vaccine, demographics, and historical, current, and intentional vaccination behavior. Of the 2389 vaccinees, 83.3% received injectable vaccine and 16.7% received intranasal vaccine. Factors associated with previous influenza vaccination were older age, female sex, higher education and greater support for injectable vaccine (all P < .02). Current influenza vaccination with intranasal vaccine vs. inactivated vaccine was associated with higher education, the study interventions, greater support for the intranasal vaccine and nasal sprays, less support of injectable vaccine, more negative attitudes about influenza vaccine, and a greater likelihood of reporting that the individual would not have been vaccinated had only injectable vaccine been offered (all P < .01). Intentional vaccine choice was most highly associated with previous vaccination behavior (P < .001). A key to long term improvements in workplace vaccination is to encourage first time influenza vaccination through interventions that include incentives, publicity and vaccine choice.

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Evaluation of seasonal influenza vaccination effectiveness based on antibody efficacy among the institutionalized elderly in Japan
Hara M, Tanaka K, Kase T, et al. Vaccine. 10 July 2010. Available at http://www.ncbi.nlm.nih.gov/pubmed/20600482

Abstract. Influenza vaccination efficacy was evaluated in 114 institutionalized elderly people in 2002/03. Strain A/H3N2 was isolated; 44 and 8 subjects had sudden-onset fever (¡Ý37.8 ¡ãC) and kit-diagnosed influenza, respectively. Odds ratios adjusted for age, sex, comorbidity, and vaccine strain (ORadj) were determined using multiple logistic regression. Seroprotected patients (haemagglutination-inhibition antibody titre ¡Ý1:40) had lower incidence of fever (ORadj, 0.35; 95% confidence interval [CI], 0.09¨C1.28) and kit-diagnosed influenza (ORadj, 0.35; 95% CI, 0.03¨C4.64) than patients without seroprotection (antibody efficacy, 65%). Seroprotective levels of vaccination-induced antibodies probably prevent influenza among the institutionalized elderly, although statistical significance could not be confirmed owing to the sample size.

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The impact of illness and the impact of school closure on social contact patterns
Eames KT, Tilston NL, White PJ, Adams E, Edmunds WJ. Health Technol Assess July 2010; 14(34):267-312. Available at http://www.unboundmedicine.com/medline/ebm/record/20630125/abstract/The_impact_of_illness_and_the_impact_of_school_closure_on_social_contact_patterns_

Background. Mathematical models, based on data describing normal patterns of social mixing, are used to understand epidemics in order to predict patterns of disease spread and plan interventions and responses. However, individuals who are ill show behavioural changes that affect their social mixing patterns and predictive models should take into account these changes if they are to be effective.

Objectives. To describe and quantify the changes in (1) social contact behaviour experienced by individuals when they are ill with pandemic H1N1 influenza (swine flu) and (2) mixing patterns of school children that take place as a result of swine flu-related school closures.

Methods. For the first part of the study, a self-completed questionnaire-based study was carried out in the autumn/winter of 2009-10. The study population was individuals who had been diagnosed with swine flu and who received a swine flu antiviral prescription from an antiviral distribution centre (ADC). It consisted of an initial survey to be filled in when participants were symptomatic with swine flu and a follow-up survey to be filled in when they had recovered. Each part of the questionnaire had two sections: patient details and a contact diary. The second part of the study was adapted to quantify the difference in mixing patterns of pupils between the school term and the half-term holiday as school closures did not occur during the study period. Eight schools participated and questionnaire packs were distributed to them, containing two surveys: one to be filled in during the school term and one during the spring half-term holiday.

Results. For the patient study, approximately 3800 surveys were distributed by 31 ADCs. Overall, 317 responses to the initial survey were received and 179 participants returned the follow-up survey. For all types of a contact, except contacts made at home, there were highly significant differences in contact behaviour (Wilcoxon signed-rank test, p < 0.001). Individuals made substantially fewer contacts when they were ill than when they were well. Analysis showed that returning to work was the most significant predictor of increased numbers of contacts. Also, the greater the change in the number of symptoms reported, the greater the change in the number of contacts. For the school study, approximately 1100 questionnaire packs were distributed and 134 responses were received, with 119 paired contact diaries. Pupils reported on average 18.51 contacts each day during term time and 9.24 during the half-term holiday - a reduction of over 50% and a highly significant change (Wilcoxon signed-rank test, p < 0.0001).

Conclusions. The evidence from this study suggests that ill individuals make substantial changes to their social contact patterns. These changes are strongly linked to absence from work and the severity of the reported illness. Epidemiological modellers should therefore consider the implications of illness-related behavioural changes on model predictions. Future studies to measure the extent of behavioural change in a broader cross-section of infected cases could be valuable, along with more detailed studies of the social contact patterns of school children, focusing on differences between school terms and school holidays.

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Influenza A/H1N1v in pregnancy: an investigation of the characteristics and management of affected women and the relationship to pregnancy outcomes for mother and infant
Yates L, Pierce M, Stephens S, et al. Health Technol Assess July 2010; 14(34):109-82. Available at http://www.unboundmedicine.com/medline/ebm/record/20630123/abstract/Influenza_A/H1N1v_in_pregnancy:_an_investigation_of_the_characteristics_and_management_of_affected_women_and_the_relationship_to_pregnancy_outcomes_for_mother_and_infant_

Background. In April 2009 a novel influenza A virus (AH1N1v) of swine origin (swine flu) emerged, spreading rapidly and achieving pandemic status in June 2009. Pregnant women were identified as being at high risk of severe influenza-related complications and as a priority group for vaccination against AH1N1v. Limited information was available about the maternal and fetal risks of AH1N1v infection or of antiviral drug or AH1N1v vaccine use in pregnancy.

Objectives. To assess rates of and risk factors for adverse outcomes following AH1N1v infection in pregnancy and to assess the adverse effects of the antiviral drugs and vaccines used in prevention and management.

Methods. Prospective national cohort studies were conducted to identify pregnant women who were (1) suspected to be infected with AH1N1v or being treated with antiviral medication in primary care; (2) vaccinated against AH1N1v; and (3) admitted to hospital with confirmed AH1N1v. Characteristics of women with influenza-like illness (ILI) in primary care were compared with those of women without symptoms accepting or declining immunisation. Characteristics of women admitted to hospital with confirmed AH1N1v infection in pregnancy were compared with a historical cohort of over 1200 women giving birth in the UK who were uninfected with AH1N1v. Outcomes examined in hospitalised women included maternal death, admission to an intensive care unit, perinatal mortality and preterm birth. Risk factors for hospital and intensive care unit admission were examined in a full regression model.

Results. The weekly incidence of ILI among pregnant women averaged 51/100,000 over the study period. Antiviral drugs were offered to 4.8% [95% confidence interval (CI) 4.0% to 5.9%] and vaccination to 64.8% (95% CI 64.7% to 68.9%) of registered pregnant women. Ninety pregnant women with ILI presenting in primary care were reported to the research team, 55 of whom were prescribed antiviral drugs and in 42 (76%) cases this was within 2 days of symptom onset. After comparison with 1329 uninfected pregnant women offered vaccination, pre-existing asthma was the only maternal factor identified as increasing risk of ILI presentation [adjusted odds ratio (OR) 2.0, 95% CI 1.0 to 3.9]. Maternal obesity and smoking during pregnancy were also associated with hospital admission with AH1N1v infection. Overall, 241 pregnant women were admitted to hospital with laboratory-confirmed AH1N1v infection. Eighty-three per cent of these women were treated with antiviral agents, but only 6% received antiviral treatment before hospital admission. Treatment within 2 days of symptom onset was associated with an 84% reduction in the odds of admission to an intensive therapy unit (OR 0.16, 95% CI 0.08 to 0.34). Women admitted to hospital with AH1N1v infection were more likely to deliver preterm; a three times increased risk was suggested compared with an uninfected population cohort (OR 3.1, 95% CI 2.1 to 4.5).

Conclusions. Earlier treatment with antiviral agents is associated with improved outcomes for pregnant women and further actions are needed in future pandemics to ensure that antiviral agents and vaccines are provided promptly to pregnant women, particularly in the primary care setting. Further research is needed on longer-term outcomes for infants exposed to AH1N1v influenza, antiviral drugs or vaccines during pregnancy.

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The impact of communications about swine flu (influenza A H1N1v) on public responses to the outbreak: results from 36 national telephone surveys in the UK
Rubin GJ, Potts HW, Michie S. Health Technol Assess. July 2010; 14(34):183-266.
Available at http://www.unboundmedicine.com/medline/ebm/record/20630124/abstract/The_impact_of_communications_about_swine_flu__influenza_A_H1N1v__on_public_responses_to_the_outbreak:_results_from_36_national_telephone_surveys_in_the_UK_

Objectives. To assess the association between levels of worry about the possibility of catching swine flu and the volume of media reporting about it; the role of psychological factors in predicting likely uptake of the swine flu vaccine; and the role of media coverage and advertising in predicting other swine flu-related behaviours.

Design. Data from a series of random-digit-dial telephone surveys were analysed. A time series analysis tested the association between levels of worry and the volume of media reporting on the start day of each survey. Cross-sectional regression analyses assessed the relationships between likely vaccine uptake or behaviour and predictor variables.

Setting. Thirty-six surveys were run at, on average, weekly intervals across the UK between 1 May 2009 and 10 January 2010. Five surveys (run between 14 August and 13 September) were used to assess likely vaccine uptake. Five surveys (1-17 May) provided data relating to other behaviours.

Participants. Between 1047 and 1173 people aged 16 years or over took part in each survey: 5175 participants provided data about their likely uptake of the swine flu vaccine; 5419 participants provided data relating to other behaviours.

Main Outcome Measures. All participants were asked to state how worried they were about the possibility of personally catching swine flu. Subsets were asked how likely they were to take up a swine flu vaccination if offered it and whether they had recently carried tissues with them, bought sanitising hand gel, avoided using public transport or had been to see a general practitioner, visited a hospital or called NHS Direct for a flu-related reason.

Results. The percentage of 'very' or 'fairly' worried participants fluctuated between 9.6% and 32.9%. This figure was associated with the volume of media reporting, even after adjusting for the changing severity of the outbreak [chi2(1) = 6.6, p = 0.010, coefficient for log-transformed data = 2.6]. However, this effect only occurred during the UK's first summer wave of swine flu. In total, 56.1% of respondents were very or fairly likely to accept the swine flu vaccine. The strongest predictors were being very worried about the possibility of oneself [adjusted odds ratio (aOR) 4.7, 95% confidence interval (CI) 3.2 to 7.0] or one's child (aOR 8.0, 95% CI 4.6 to 13.9) catching swine flu. Overall, 33.1% of participants reporting carrying tissues with them, 9.5% had bought sanitising gel, 2.0% had avoided public transport and 1.6% had sought medical advice. Exposure to media coverage or advertising about swine flu increased tissue carrying or buying of sanitising hand gel, and reduced avoidance of public transport or consultation with health services during early May 2009. Path analyses showed that media coverage and advertising had these differential effects because they raised the perceived efficacy of hygiene behaviours but decreased the perceived efficacy of avoidance behaviours.

Conclusions. During the swine flu outbreak, uptake rates for protective behaviours and likely acceptance rates for vaccination were low. One reason for this may in part be explained by was the low level of public worry about the possibility of catching swine flu. When levels of worry are generally low, acting to increase the volume of mass media and advertising coverage is likely to increase the perceived efficacy of recommended behaviours, which, in turn, is likely to increase their uptake.

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Community Transmission of Pandemic Influenza A (H1N1) in China
Liu W, Jiang T, Li XF, et al. Infect Control Hosp Epidemiol. 16 July 2010;31:000–000. doi: 10.1086/655020.
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/655020

Abstract. Prophylaxis and treatment with oseltamivir effectively controlled a community outbreak of pandemic influenza A (H1N1) in China. The genetic makeup of strains of different generations seemed to be stable. Travel in confined settings might accelerate the transmission of pandemic influenza in a community outbreak.

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Epidemiological aspects of 2009 H1N1 influenza: the accumulating experience from the Northern Hemisphere
Falafas ME, Cholevas NV, Kapaskelis AM, et al. European Journal of Clinical Microbiology & Infectious Diseases. 13 July 2010. doi: 10.1007/s10096-010-1002-3.
Available at http://springerlink.com/content/3q733tn261432013

Abstract. Preliminary data regarding the experience of countries of the Northern Hemisphere with pandemic 2009 A(H1N1) influenza have already appeared in the literature. We aimed to evaluate the available published literature describing the epidemiological features of pandemic influenza. We searched PubMed; 35 studies (14 referred to European countries, eight to the USA, five to Mexico, four to Canada, two to Japan, one to Colombia, and one reviewed relevant data reported worldwide) were included. Considerably high hospitalization, intensive care unit (ICU) admission, and fatality rates (up to 93.8, 36.4, and 38.5%, respectively) among the evaluated cases were reported across studies with available relevant data. Young and middle-aged adults constituted the majority of the evaluated pandemic cases, with different disease severity (as indicated by the level of care and outcome). Yet, substantial percentages of elderly individuals were reported among more severely afflicted cases. Otherwise healthy patients constituted substantial percentages among evaluated cases with different disease severity. Pregnant women, obese, and morbidly obese patients also constituted substantial percentages of the cases involved in the included studies. The evaluation of the currently available published evidence contributes to the clarification of the epidemiological features of pandemic 2009 A(H1N1) influenza, which is useful in terms of the individual and public health perspectives.

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Novel findings from the second wave of adult PH1N1 in the United States
Satterwhite L, Mehta A, Martin GS. Critical Care Medicine. 9 July 2010. doi: 10.1097/CCM.0b013e3181eb96dc.
Available at http://journals.lww.com/ccmjournal/Abstract/publishahead/Novel_findings_from_the_second_wave_of_adult_PH1N1.98662.aspx

Objective. To describe the impact of novel PH1N1 virus in Atlanta, GA, for inpatient and intensive care services, including lung lavage data and determinants of disease outcome, from the earliest group of infected US population after initial cases.

Design. An observational review of all patients with laboratory-confirmed PH1N1 disease hospitalized in four Atlanta hospitals from August 1 through October 31, 2009. Data reviewed included demographics, anthropometrics, clinical laboratory, and respiratory physiology.

Measurements and Main Results. A total of 109 patients were admitted during surveillance period and intensive care unit care was required in 23 patients (21%) among which there were six deaths (26%). Only eight of the 109 (7%) patients were without medical comorbidity; 34% of the 65 female patients were pregnant and none died or required intensive care unit care. Patients with respiratory failure undergoing bronchoalveolar lavage exhibited neutrophilic predominance (average 64%) and negative bacterial cultures. Body mass index was >30 kg/m2 in 35 of 81 (43%) of patients with anthropometric data and 16 of 23 (70%) patients requiring intensive care unit care (p = .03). The 16 patients who required mechanical ventilation (70% of intensive care unit patients) were characterized by severe hypoxemia (requiring high levels of inspired oxygen and positive end-expiratory pressures), reduced lung compliance, and high lung injury scores.

Conclusions. This first report of the second wave of US PH1N1 disease from Atlanta, GA, shares epidemiologic characteristics of earlier cohorts but differs by having an even greater prevalence of obesity and fewer patients who were free from chronic medical conditions. Importantly, lung lavage fluid in severe PH1N1 disease is predominantly neutrophilic and culture-negative. Further reports are needed to validate these new findings regarding PH1N1 disease in the United States.

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Risk factors of poultry outbreaks and human cases of H5N1 avian influenza virus infection in West Java Province, Indonesia
Yupiana Y, Vlas, SJ, Adnan NM, et al. International Journal of Infectious Diseases. 16 July 2010. doi:10.1016/j.ijid.2010.03.014.
Available at http://www.ijidonline.com/article/S1201-9712(10)02407-0/abstract

Background. The purpose of this study was to determine the association of potential risk factors to the spread and maintenance of the highly pathogenic avian influenza (HPAI) H5N1 virus in poultry and humans at the district level in West Java Province, Indonesia.

Methods. The association of demography and environmental risk factors including poultry density, human density, road density, percentage of paddy field, and percentage of swamp, dyke and pond with both HPAI human cases and HPAI outbreaks in poultry were assessed using a descriptive epidemiological design. We also assessed the association of HPAI outbreaks in poultry with HPAI human cases. Poisson regression (generalized linear modeling and generalized estimating equations) was used to analyze the data corrected for over-dispersion.

Results. There were 794 HPAI outbreaks in poultry covering 24 of the 25 districts in our study during 2003–2008 and 34 HPAI human cases involving 12 districts during 2005–2008. We found that two risk factors – poultry density and road density – had a statistically significant correlation with the number of HPAI outbreaks in poultry. The number of poultry outbreaks had a negative association with poultry density (29% effect) and a positive association with road density (67% effect). The number of human cases was significantly associated with the number of poultry outbreaks (34% effect), but with none of the other risk factors considered.

Conclusions. We conclude that the most effective way to prevent human HPAI cases is to intervene directly in the poultry sector. Our study further suggests that implementing preventive measures in backyard chicken farming and limiting transport of live poultry and their products are promising options to this end.

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5. Notifications
Options for the Control of Influenza VII
Hong Kong 3-7 September 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 September 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