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Vol. XIII No. 17 ~ EINet News Briefs ~ Aug 20, 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 says H1N1 influenza pandemic is over
- Finland: Link suspected between H1N1 pandemic influenza vaccine and narcolepsy
- India (Mumbai): Influenza B virus cases
- Indonesia: Avian influenza H5N1 in poultry and humans
- New Zealand: Rising pandemic H1N1 flu may exhaust vaccine supply
- New Zealand: Fifth pandemic influenza H1N1 death
- New Zealand (Bay of Plenty): Pandemic influenza H1N1 activity strains hospital
- Southeast Asian nations test severe pandemic scenario
- USA (Maryland): Joint venture to develop universal H5 pandemic vaccine announced
- USA: BARDA puts $6.4 million toward expanding vaccine capacity
- USA: Economy pledges $26 million to help FAO fight H5N1 avian flu
- Egypt: Confirmed report of H5N1 avian influenza

2. Infectious Disease News
- Hong Kong: Investigation of upper respiratory tract infection outbreak
- India (Karnataka): Chikungunya outbreak
- India (Jammu and Kashmir): Measles cases
- New Zealand (Auckland): Measles outbreak suspected
- Philippines (Kudarat): Measles outbreak and continuing dengue
- Americas: WHO Americas region completes lab inventory of polio materials
- California (Amador): Three confirmed cases of pertussis
- California (Bakersfield): Number of pertussis cases up to 227
- Canada (Wellington North Township): Public health investigating increase in tuberculosis
- Peru (Lima): Pneumonic plague deaths
- Peru (Amazonas): Rabid bat attacks
- USA (Texas): Scientists seek test determining if pathogens are lab-grown

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

4. Articles
- Multiple Infections with Seasonal Influenza A Virus Induce Cross Protective Immunity against A(H1N1) Pandemic Influenza Virus in a Ferret Model
- Historical thoughts on influenza viral ecosystems, or behold a pale horse, dead dogs, failing fowl, and sick swine
- Severe, critical and fatal cases of 2009 H1N1 influenza in China
- Mobile Messaging as Surveillance Tool during Pandemic (H1N1) 2009, Mexico
- The end of the pandemic – what will be the pattern of influenza in the 2010-11 European winter and beyond?
- School Opening Dates Predict Pandemic Influenza A(H1N1) Outbreaks in the United States
- Original Article: Assessing physicians’ in training attitudes and behaviors during the 2009 H1N1 influenza season: a cross-sectional survey of medical students and residents in an urban academic setting
- Influenza in Refugees on the Thailand–Myanmar Border, May–October 2009
- All-Cause Mortality during First Wave of Pandemic (H1N1) 2009, New South Wales, Australia, 2009
- Multi-agent modeling of the South Korean avian influenza epidemic
- Influenza A (H5N1) Viruses from Pigs, Indonesia
- An assessment of the effect of statin use on the incidence of acute respiratory infections in England during winters 1998–1999 to 2005–2006
- Knowledge, attitudes and practices towards pandemic influenza among cases, close contacts, and healthcare workers in tropical Singapore: a cross-sectional survey
- Emerging, Novel, and Known Influenza Virus Infections in Humans
- The Effect of Mask Use on the Spread of Influenza During a Pandemic
- After the pandemic

5. Notifications
- Options for the Control of Influenza VII
- Influenza 2010: Zoonotic Influenza and Human Health
- 4th Vaccine and ISV Annual Global Congress
- International TB Symposium (ITBS-2010): TB Diagnostics – Innovating to Make an Impact


1. Influenza News

Global
2010 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Cambodia / 1 (1)
China / 1 (1)
Egypt / 21 (8)
Indonesia / 6 (5)
Viet Nam 7 (2)
Total / 36 (17)

***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: 504 (299)
(WHO 08/03/10 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_08_12/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
The situation in New Zealand and India remains largely unchanged since the last update. Influenza H1N1 (2009) virus transmission remains locally intense in parts of India and New Zealand.

In New Zealand, during the first week of August 2010, the national consultation rate for ILI** increased sharply. Influenza H1N1 (2009) virus transmission appears to be locally intense in parts of the country that were less affected during last winter's pandemic wave; however, to date, the overall national rate of ILI consultations and the numbers of severe and fatal cases of H1N1 (2009) remain below levels observed during the 2009 winter pandemic wave. The majority of influenza viruses detected during the current winter epidemic have been H1N1 (2009).

In India, community transmission of H1N1 (2009) remained active and moderately intense in several states, most notably in the states of Maharashtra but also in several other western and southern states (Gujarat, Andhra Pradesh, Karnataka, and Tamil Nadu). Between mid-June 2010 and the second week of August 2010, the state of Maharashtra reported consecutive weekly increases in the number of new cases, including numbers of new fatal cases; the epidemic does not appear to have peaked in Maharashtra but the rate of increase in the numbers of new cases appears to have slowed. The epidemic appears to have stabilized or begun to decline in several other affected states. Seasonal influenza B viruses are also known to be currently circulating in India, although at lower levels than H1N1 (2009) viruses.

Except in South Africa and New Zealand, overall influenza activity and rates of respiratory diseases remained low in other countries of the temperate southern hemisphere (Australia, Chile, and Argentina). In South Africa, active circulation of seasonal influenza H3N2 and type B viruses was observed during June through mid-August 2010. In Argentina, there are unconfirmed media reports of localized influenza outbreaks in at least one part of the country.
(WHO 08/20/2010)

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Global: WHO says H1N1 influenza pandemic is over
The head of the World Health Organization (WHO) 10 August 2010 declared the H1N1 influenza pandemic over, saying worldwide flu activity has returned to typical seasonal patterns and many people have immunity to the virus.

The world is no longer in phase six of influenza pandemic alert, said WHO Director-General Margaret Chan. She said that the H1N1 virus has largely run its course.

But she cautioned that the virus has not gone away and bears continued watching, commenting, She said it is expected that the H1N1 virus will take on the behavior of a seasonal influenza virus and continue to circulate for some years to come.

The WHO's Emergency Committee recommended that the agency move to the post-pandemic phase, Chan said, adding that she fully supports the step.

The declaration comes almost exactly 14 months after the WHO moved to a full phase six pandemic alert on 11 June 2009, and about a month and a half after US health officials called off their public health emergency declaration on 23 June 2010. Many had expected the WHO to take the step months ago, but the Emergency Committee said in June and again in July 2010 that it was waiting for more information on the Southern Hemisphere's flu season.

Considerable H1N1 activity has been reported recently in India, New Zealand, and a few other places, with 942 new cases confirmed in India. But the current global picture is one of fairly typical seasonal flu activity, Chan said.

Globally, the levels and patterns of H1N1 transmission now being seen differ significantly from what was observed during the pandemic, she said. She said that out-of-season outbreaks are no longer being reported in either the Northern or Southern Hemisphere. Influenza outbreaks, including those primarily caused by the H1N1 virus, show an intensity similar to that seen during seasonal epidemics.

She said that during the pandemic, the H1N1 virus crowded out other influenza viruses to become the dominant virus. This is no longer the case. Many countries are reporting a mix of influenza viruses, again as is typically seen during seasonal epidemics.

Chan added that recent studies show that 20% to 40% of populations in some areas gained some immunity to the H1N1 virus through infection. Further, many countries report good vaccination coverage, especially in high-risk groups, and this coverage further increases community-wide immunity.

The WHO move is not expected to have a big impact on public health measures in the United States, the Centers for Disease Control and Prevention (CDC) said 10 August 2010, noting that the public health emergency declaration ended 23 June 2010.

The CDC said the only impact of the WHO step is that the CDC will stop sending weekly reports of flu activity to the WHO and the Pan American Health Organization, in accord with the International Health Regulations.

There are no changes for the United States in terms of CDC's recommendations for the upcoming influenza season, and the United States is already proceeding with the understanding that the 2009 H1N1 virus is now part of seasonal influenza circulation, the agency said.

The trivalent flu vaccine for the upcoming flu season includes the pandemic H1N1 virus along with H3N2 and influenza B strains, the statement noted.

Looking forward, Chan said that it is likely that the virus will continue to cause serious disease in younger age groups, at least in the immediate post-pandemic period. Groups identified during the pandemic as at higher risk of severe or fatal illness will probably remain at heightened risk, though hopefully the number of such cases will diminish.

She added that a small percentage of people infected during the pandemic, including young and healthy people, developed a form of severe viral pneumonia that is not usually seen during seasonal epidemics. It is not known whether this pattern will change during the post-pandemic period, further emphasizing the need for vigilance, she said.

Chan reflected that the world was helped by "pure good luck" in this pandemic: The virus did not mutate during the pandemic to a more lethal form. Widespread resistance to oseltamivir did not develop. The vaccine proved to be a good match with circulating viruses and showed an excellent safety profile.

Some critics, particularly in Europe, have accused the WHO of exaggerating the pandemic threat, with some arguing that the agency was improperly influenced by profit-hungry pharmaceutical companies. As she has previously, Chan defended the WHO's record, but also acknowledged that it has learned some lessons from the episode, particularly concerning communication and flexibility.

Insisting that the WHO did not overreact to the virus, Chan said, that the WHO has been very consistent with its messages. Even at the outset and in subsequent messages, we mentioned we are dealing with a pandemic of moderate severity, and most people will recover from the disease and many will recover without treatment, she said.

At the same time, the WHO pointed out the virus's ability to cause severe disease in young adults, including some with no underlying health problems, and in pregnant women, she said, adding that she believes the agency has struck the right balance.

As for lessons learned, Chan said in response to a question, that number one, for WHO as well as for many of my member states, communication is a big challenge. Now we need to adapt the way we do communication, and learn how to work with social media and social networks.

Second, she said the WHO's pandemic preparedness guidelines were developed by experts under threat of the H5N1 avian influenza virus, and that gave them the sense that collectively we should plan for the worst and hope for the best. One of the lessons is that perhaps we need more flexibility in our future pandemic planning. We need to be able to have a best-case, an intermediate-case, and a worst-case scenario to allow flexibility and adjustment as we track the evolution of the pandemic.

In a related development, the WHO released the names of members of its Emergency Committee, as Chan promised it would do after the pandemic ended. The agency previously had withheld the names of all except the committee chair, saying it wanted to protect the panel from inappropriate pressures.

The WHO had been criticized for keeping the names secret and for its general policies on communicating about and managing potential conflicts of interest among its expert advisors. WHO defenders have said it would be very difficult to find top flu experts who have not done any consulting work for the pharmaceutical industry or received industry report for research.

In releasing the names of the committee members, the WHO also listed a declaration of interests. This shows that out of 15 members, four (plus one committee advisor) have done consulting work for vaccine manufacturers or other pharmaceutical companies and/or received industry support for research.

In other WHO comments, Dr. Keiji Fukuda, special assistant to Chan for pandemic influenza, noted that the number of deaths due to confirmed 2009 H1N1 cases worldwide has reached about 18,500. The agency has said all along that the true number of H1N1-related is much higher, since many people who die of flu-related causes are not tested.

We expect that over the next two years the more usual ways of counting deaths from this pandemic will be applied, he said. We consider this current number to be minimum number of deaths. Over the next two years the numbers will be higher, but we don't know what they are now.

In her statement, Chan praised the recent responses of health officials in New Zealand and India to H1N1 activity as models of how countries should deal with the virus in the post-pandemic period. She cited their alertness, quick detection and treatment of cases, and promotion of vaccination.

She added later that these countries maintained the vigilance at a time when many countries, had become quite complacent.

The WHO 10 August 2010 released a set of recommendations for disease surveillance, vaccination, and clinical management for the post-pandemic period.

In commenting on the WHO's action, Jim Blumenstock of the US Association of State and Territorial Health Officials (ASTHO) said public health officials shouldn't let down their guard concerning flu.

Even though we're in the post-pandemic phase, it doesn’t mean we let our guard down, he said. We still need to maintain a high degree of vigilance. We are literally weeks away from the next flu season, so the public health system still needs to be on alert to rapidly detect any outbreak that could occur and have programs and services in place to address those most vulnerable, said Blumenstock, ASTHO's chief program officer for public health practice.

He added that if current projections hold up, as many as 170 million doses of seasonal flu vaccine will be available this fall and winter, an unprecedented number. The public health system will need to work closely with private-sector physicians and others to promote safe and effective administration of the vaccine, he said.

Blumenstock commented that the value of public-private partnerships for public health has been one of the important lessons of the pandemic. For example, he said pharmacies, in their role as vaccinators and trusted community resources, made a very valuable contribution to the nation's response.

The public health system should explore ways to capitalize on their resources, their respect and position in the community, to help us do a better job in providing services, he said.

Another lesson of the pandemic is the benefits of and need for steady funding for public health, Blumenstock said. The nation's response to the pandemic was fueled in large part by emergency funding, he asserted, adding, that what we built a year ago is now being dismantled because the funding is no longer there.

While not advocating for maintaining "an army of national vaccinators as in the past year," Blumenstock said dependable funding is needed for maintaining surveillance, situational awareness, lab detection, and communication, especially with the goal of reaching disenfranchised groups.
(CIDRAP 08/12/2010)

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Europe/Near East
Finland: Link suspected between H1N1 pandemic influenza vaccine and narcolepsy
Experts in Finland met 18 August 2010 to explore a suspected link between narcolepsy and the pandemic H1N1 vaccine. The suspicion of a link arose when a Finnish pediatric neurologist noted a slight increase in narcolepsy cases in 2010. The report said a similar pattern has been noted in Sweden. Tehri Kilpi, director of the National Institute for Health and Welfare's vaccine department, said that she doubted the existence of a connection but said the question should be examined.
(CIDRAP 08/18/2010)

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Asia
India (Mumbai): Influenza B virus cases
[ProMED note: In the following report statements by officials do not clearly distinguish the different seasonal influenza viruses and the pandemic H1N1 influenza virus. This uncertainty is compounded by the fact that the pandemic H1N1 virus has now become the H1N1 component of the new seasonal influenza virus vaccine. Only the statements concerning influenza B virus are unequivocal.]

There are three types of influenza viruses circulating in Mumbai, with the most "potent and predominant" (presumably pandemic) H1N1 virus affecting people even more than the seasonal flu, experts said, providing a possible explanation for the deluge of fever and cold complaints at city's hospitals.

This observation about the three strains was made by virologists working with Haffkine Research Institute, who, between June and August of 2010, studied 500 patients admitted for influenza-related ailments in various hospitals. Of the 500 patients studied, the institute found that about 23 per cent tested positive for pandemic H1N1, while about 11 per cent were positive for the seasonal flu (that is, non-pandemic H1N1 and/or H3N2). Surprisingly, eight per cent of the samples tested positive for influenza B virus, a relatively less virulent influenza virus that did not surface in Mumbai in 2009.

In the first ten days of August 2010, about 99 people have tested positive for H1N1 in the city, while about 500 had tested positive in July 2010. Three virus types are circulating in Mumbai air, but so far there are fortunately no cases where one person is suffering from any two types together, said Dr Abhay Chaudhary, director of the Haffkine Research Institute.

Chaudhary added that the pandemic H1N1 virus has surpassed the seasonal flu in afflicting the wider public, a finding echoed by the National Institute of Virology (NIV) in Pune. The director of NIV, Dr A C Mishra, said that samples tested at the laboratory were primarily testing positive for H1N1. As much as 40 per cent of the samples are testing positive for the pandemic H1N1 virus, whereas just about 10 per cent are found to be affected by the seasonal flu, Mishra said, adding that traces of influenza B type were also found in Pune.

Virologists said they were surprised that the milder influenza B type virus has managed to affect people. It is amazing that B type has actually managed to find its place amidst stronger strains like the pandemic and seasonal one, added Chaudhary. In 2008, incidentally, influenza B type virus was the more dominant strain to affect Mumbai.

But does that mean that influenza B virus has gained in potency?, infectious diseases expert Dr Om Srivastava asked: Clinical features of virus types are undergoing tremendous change. Even influenza B virus can have crippling effects, but it still remains milder than the other influenza types.

Some experts differ with Chaudhary and Mishra about pandemic H1N1's dominance. Dr Jayanthi Shastri, the head of BMC's [Brihanmumbai Municipal Corporation] PCR lab at Kasturba Hospital, said, the magnitude of the pandemic virus cannot be judged as only those who are hospitalized are getting tested. Shastri added that there is no community sampling to deduce such a conclusion. Mishra, however, countered that in Pune even outdoor [that is, not hospitalized] patients were tested. Our deduction can easily be upheld as indicative of the entire community, he said.
(ProMED 08/11/2010)

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Indonesia: Avian influenza H5N1 in poultry and humans
A total of three regencies in Bengkulu Province have been affected by bird flu (avian influenza or H5N1) virus, according to a local official. The three regencies were Kepahiang, Central Bengkulu (Benteng) and Bengkulu city, Emran Kuswadi, a coordinator of the bird flu eradication program, said 12 Aug 2010. Thousands of chickens and ducks have been culled so far in order to prevent the spread of the bird flu virus, he said.

Local authorities have also carried out disinfectant spray in areas where bird flu cases were found. Bird flu virus has spread at 30 urban villages in Bengkulu city. The latest case was found in Tanjung Jaya, Sungai Serut sub district, Bengkulu city, where 85 chickens were found dead suddenly.

Meanwhile, some 4559 chickens have died of suspected bird flu virus over the past two months in Bengkulu. Some of the chickens had died suddenly due to bird flu virus (H5N1), Emran Kuswadi, bird flu disease control coordinator, confirmed recently. Over the past one month in Kepahiang District (Central Bengkulu) and Bengkulu City, 559 chickens had been confirmed of being infected with bird flu virus and had died, he said. However, 4000 others had died suddenly two months ago in Seluma District, Bengkulu Province, but no bird flu virus was confirmed in the poultry's deaths, he continued.

Last 17 July 2010, a Sukuharjo district health official in Central Java, confirmed that the death of 14 year old girl a few weeks ago had been caused by bird flu. The official said samples of the patient's body fluids had been sent to the Health Ministry's laboratory in Jakarta for tests. The test results had shown the junior high school student had been positively infected with the bird flu virus. The victim was a resident of Menjing village, and had contact with a dead chicken before.

[ProMED note: Indonesia continues to report the majority of new outbreaks in poultry that occur in the world. This emphasizes the magnitude of the problem there, although the intense efforts made through Participatory Disease Surveillance Programs may lead to higher number of reported cases in Indonesia as compared to other countries that don't engage in such intensive surveillance activities.

Nonetheless, it is clear that both Indonesia and Egypt remain separate but significant foci for outbreaks in poultry populations.

In this regard it is interesting to note that the number of human cases and deaths in Indonesia has moderated substantially in 2010 compared with the previous two years. In 2008, there were 24 cases resulting in 20 deaths, in 2009 there were 21 human cases resulting in 19 deaths. So far this year, there have been only six cases and five deaths.]
(ProMED 08/14/2010)

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New Zealand: Rising pandemic H1N1 flu may exhaust vaccine supply
New Zealand's health ministry said 16 August 2010 that a continued rise in pandemic flu activity has prompted the government to begin issuing public updates twice a week rather than weekly. Calls to New Zealand's flu phone line are running 35% higher than the normal seasonal level, with about 1,400 calls each day over the weekend, according to a ministry statement. Ten people are being treated in intensive care units (ICUs). Six deaths so far this year have been reported as linked to pandemic H1N1 flu, but four of those have not yet been confirmed. School surveillance, however, suggests that absenteeism rates are normal for this time of year. The health ministry is urging the public to get vaccinated, though it warned that only about 6,400 doses remain, enough to last through the end of August 2010. Officials are exploring options for extending immunizations.
(CIDRAP 08/16/2010)

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New Zealand: Fifth pandemic influenza H1N1 death
A 22-year-old Hawke's Bay man's death is believed to be the fifth related to swine flu in New Zealand in 2010.

The man, who had an underlying health condition, died on 10 August 2010 in hospital.

Hawke's Bay District Health Board said his death was suspected to be from H1N1 influenza, though it was yet to be confirmed by the Coroner.

The man's death came just hours before the World Health Organization (WHO) announced the swine flu pandemic was over and the world had entered a post-pandemic phase.

The step to downgrade followed advice given by the WHO's advisory emergency committee of 15 external scientists, who heard presentations from health officials from countries reporting cases of H1N1, including New Zealand.

WHO director-general Margaret Chan said the virus had not gone away, and recognized that New Zealand was still experiencing the effects of a second wave of the H1N1 virus.

Deputy director of public health Darren Hunt yesterday said the country was still seeing a significant level of swine flu, and New Zealanders still needed to remain vigilant as there had been significant outbreaks of influenza in some areas.

While some countries have seen H1N1 virus decline or crowded out by other strains, this is not the case in New Zealand, he said. He added that the pandemic influenza strain is the predominant strain circulating this winter. They are seeing higher levels of hospitalization in areas that weren't severely affected last year.

To date, there had been over 300 people admitted to hospital this year with confirmed H1N1, which includes over 30 people admitted to intensive care, Dr Hunt warned.

The week of 9 August 2010, a Christchurch woman, 44, and a Wellington man, 38, died, their deaths following those of a Northland man, 51, last month, and a Tauranga woman, 48, in June 2010.

Worldwide more than 214 countries and overseas territories have reported cases of H1N1, and there have been more than 18,440 deaths.
(NZPA 08/12/2010)

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New Zealand (Bay of Plenty): Pandemic influenza H1N1 activity strains hospital
A surge in people presenting with flu-like illness at a New Zealand hospital's emergency department on 16 August 2010 almost prompted the facility to trigger its crisis plan. Bay of Plenty is on the northern coast of New Zealand's North Island. An official with the Bay of Plenty District Health Board said that the emergency department saw 182 patients during a 24-hour period that started at 8 am on 16 August 2010. He said 66 of the patients were admitted to the hospital. Crisis measures would have included, for example, discharging patients early and canceling elective surgeries. New Zealand is among the countries currently reporting high levels of pandemic H1N1 activity. Elsewhere in the country, a primary school in Christchurch, the largest city on New Zealand's South Island, closed after one of its students was diagnosed with the H1N1 virus. The school's janitors are disinfecting surfaces at the school, including tables, chairs, and computers.
(CIDRAP 08/18/2010)

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Southeast Asian nations test severe pandemic scenario
Ten countries that are part of the Association of Southeast Asian Nations (ASEAN) began a four-day exercise 16 August 2010 to gauge for the first time how a severe pandemic would affect essential services in each country and the whole region. The group is meeting in Phnom Penh, Cambodia; the United Nations is cohosting the event with ASEAN. The simulation is designed to test how a pandemic would affect a range of services, especially energy, transportation, and healthcare. The scenario features a communicable disease that arises on the continent of Pandemica, with five countries having economic and infrastructure conditions resembling those of Southeast Asia.
(CIDRAP 08/16/2010)

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Americas
USA (Maryland): Joint venture to develop universal H5 pandemic vaccine announced
Emergent BioSolutions, a pharmaceutical company based in Rockville, Md., 10 August 2010 unveiled that it has entered a joint venture with a Singapore company to develop and produce a universal pandemic flu vaccine targeted to a broad range of H5 viruses. The vaccine will be based on multiple antigens held by Temasek Life Sciences Ventures and Emergent's MVAtor vaccine delivery system. Emergent said the cell culture vaccine will incorporate three H5 antigens, including the Vietnam strain that most other H5N1 vaccines are based on. It said the new vaccine will allow long-term stability for bulk stockpiling. The company said the two companies will also work together to develop a monoclonal antibody treatment for H5 influenza infections. For the vaccine, the goal is to produce enough vaccine in 2011 for clinical trials slated to begin in 2012.
(CIDRAP 08/12/2010)

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USA: BARDA puts $6.4 million toward expanding vaccine capacity
The US Biomedical Advanced Research Development Authority (BARDA), an arm of the Department of Health and Human Services that manages the development of countermeasures for bioterror attacks and pandemics, announced 10 August 2010 that it has awarded the WHO a $6.4 million grant to continue developing flu vaccine manufacturing capacity in 10 developing and emerging-economy nations. Details about the grant appeared in 10 August 2010’s Federal Register. The effort to expand vaccine production capacity in developing nations, first launched in 2006, is designed to boost global and domestic preparedness for a flu pandemic. The latest BARDA award will help support the program through September 2013. In its Federal Register notice, BARDA said the WHO is the only global organization with the experience and scientific base to spearhead the expansion of global vaccine production capacity.
(CIDRAP 08/12/2010)

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USA: Economy pledges $26 million to help FAO fight H5N1 avian flu
The United States has renewed its support for the United Nations Food and Agriculture Organization's (FAO's) efforts to stop H5N1 avian influenza and other emerging disease threats, pledging $26.3 million for the period from October 2011 through September 2012. The funds from the US Agency for International Development (USAID) will be used to support FAO technical assistance for surveillance and outbreak response capacities in countries where H5N1 persists, including Bangladesh, China, Egypt, Indonesia, and Vietnam. The money will also be used to strengthen veterinary lab, animal surveillance, and response capacities for other emerging disease threats in "hot spot" regions. Juan Lubroth, the FAO's chief veterinary officer, said the FAO-USAID partnership has been at the forefront of efforts to prevent and control H5N1 and other animal disease threats. He said the USAID has contributed $132.5 million to the effort since 2005, benefiting more than 90 countries.
(CIDRAP 08/17/2010)

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Africa
Egypt: Confirmed report of H5N1 avian influenza
Egypt's health ministry announced an H5N1 avian influenza infection in a two-year-old girl from Cairo. She got sick on 2 August 2010 and was hospitalized the same day and treated with oseltamivir (Tamiflu). The girl is still in the hospital. An investigation into the source of her illness revealed that she had been exposed to sick and dead poultry. Her illness raises Egypt's number of H5N1 cases to 111, of which 35 have been fatal. This latest confirmation pushes the world's number of H5N1 cases to 504, including 299 deaths.
(CIDRAP 08/12/2010)

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2. Infectious Disease News

Asia
Hong Kong: Investigation of upper respiratory tract infection outbreak
The Centre for Health Protection (CHP) of the Department of Health is investigating an outbreak of respiratory tract infection affecting 19 children and a staff member of a kindergarten in Causeway Bay.

The affected, comprising 14 males and six females, developed symptoms of upper respiratory tract infection, including fever, cough, runny nose and sore throat since 21 July 2010.

Six of them were hospitalized but have now been discharged. Nasopharyngeal aspirate specimens taken from four infected children tested positive for adenovirus.

All affected persons are in stable condition. CHP staff have visited the center and provided health advice to the management. A CHP spokesman said adenovirus was a group of viruses that commonly cause viral infection in children. The symptoms may vary from respiratory symptoms such as fever, cough and sore throat, to gastroenteritis illnesses such as vomiting and diarrhea. There may be associated conjunctivitis.

Adenovirus infection is usually transmitted by direct contact or fecal-oral transmission. It can occur throughout the year, the spokesman said.

While most infections were mild and required no therapy or only symptomatic treatment, strict attention to good hygiene practices was effective for preventing adenovirus-associated diseases, he said.

Members of the public, particularly children, elderly people and those with chronic diseases, should wear face masks and consult their doctors for medical advice promptly if they develop symptoms of respiratory tract infection.
(HealthMap.org 08/13/2010)

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India (Karnataka): Chikungunya outbreak
Bijapur district minister Murugesh Nirani has instructed health department staff to be aware of the epidemic diseases affecting people of late and take suitable measures to curb them. 67 suspected and 65 confirmed cases of chikungunya have been detected in the district.
(ProMED 08/09/2010)

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India (Jammu and Kashmir): Measles cases
A child died and at least 12 others have been taken ill due to measles at a village in Billawar tehsil [sub-district] of Kathua district, a health official said on 12 August 2010.

Over a dozen of people were taken ill over the past week due to measles at Nathi village, about 250 km [155 miles] from Jammu, chief medical officer (CMO) Kathua Dr Ashok Chandyal said. Among these, a child died 11 August 2010 before he could receive treatment, he said, adding that a team of doctors along with medical supplies have been sent to the area to treat the affected.
(ProMED 08/13/2010)

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New Zealand (Auckland): Measles outbreak suspected
People are being warned to be vigilant about the spread of measles, after two apparently unconnected cases in two families were confirmed in the Auckland region. Auckland Regional Public Health Service (ARPHS) is expecting more measles cases after these cases were reported, and is urging people to take measles seriously.

Dr Brad Novak, medical officer of health at Auckland Regional Public Health Service, said measles can spread easily through the air, especially from coughing and sneezing -- and is highly infectious. It commonly causes ear infections and pneumonia, and may lead to other serious complications. It can, in some cases, be fatal, Dr Novak said.

He advised parents to check their children's immunization record and get their children immunized. He urged people who were not up-to-date with immunizations to contact their general practitioner (GP) or practice nurse and arrange to catch up as soon as possible.

[In early April 2010 an outbreak of measles was reported in the North Island of New Zealand confined to members of a community who on account of of their philosophical convictions have declined vaccination and been at risk of measles virus infection. The source of their infection, presumably somewhere in the general community, had not been established.

Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases. Most measles-related deaths are caused by complications associated with the disease.
(ProMED 08/10/2010)

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Philippines (Kudarat): Measles outbreak and continuing dengue
Local health authorities placed a community in Palimbang town in Sultan Kudarat under quarantine following a measles outbreak that already downed at least 70 children in the area.

Palimbang Mayor Abubakar Maulana said personnel from the Department of Health (DoH) and the Sultan Kudarat Provincial Health Office sealed off a portion of Barangay Poblacion in a bid to control the spread of the virus that caused the disease.

The outbreak has so far slowed down and our health personnel are working double time to stop it from further spreading, he said.

Maulana said they initially monitored the outbreak late last week and confirmed at least 47 cases by 2 August 2010. He said the number of confirmed measles infection rose to at least 70 cases during the last three days beginning with 10 August 2010, but they have not recorded any casualties so far.

Meanwhile, the local health department in Zamboanga City Friday admitted that cases of dengue continue to increase as it has already claimed 20 lives, mostly children in the City of Flowers.

In Midsayap, North Cotabato, four more kids died of dengue, increasing the death toll to 11 of the highly preventable killer disease in North Cotabato this year.

Seven more dengue cases were reported in the province in July, according to the Provincial Epidemiology and Surveillance Unit (PESU).

The Zamboanga City Health Office has recorded the highest number of dengue cases in July with 428 – a figure which had almost led health officials here to declare an outbreak of the disease.

Almost all hospitals in Zamboanga City are filled with patients mostly experiencing dengue symptoms, City Health Officer Rodel Agbulos said.

As this developed, Agbulos warned local residents that if nothing is done in the household level, cases of dengue will continue to rise during this rainy season.
(Mb.com.ph 08/13/2010)

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Americas
Americas: WHO Americas region completes lab inventory of polio materials
In regions that have eradicated wild poliovirus (WPV), completing an inventory of remaining lab virus materials for destruction of WPV stocks is a final step in formal eradication certification. The WHO Americas region recently completed phase one of the inventory and reported the findings August 2010 in Morbidity and Mortality Weekly Report (MMWR). Of more than 67,000 biomedical facilities in the region, about 23% were classified as high or medium risk and were included in the survey. According to the report, about 85% of the remaining low-risk facilities were surveyed. Though some labs voluntarily destroyed their WPV materials, 215 in nine countries reported they still had them as of March. The last case of WPV infection was confirmed in the Americas in 1991, and the area was certified as polio-free in 1994. However, four years later global health officials announced that progress toward WPV lab containment was a precondition for regional certification. By the time phase one inventory began in 2001, many labs in the Americas had already shifted to measles eradication. Member states were able to use the experiences of two other regions that had completed the surveys, European and Western Pacific. Three more regions still need to complete phase one activities. The report said phase two activities, which involve destruction of WPV materials and long-term containment plans, are scheduled to begin as soon as one of four remaining WPV endemic countries reports the interruption of transmission.
(CIDRAP 08/12/2010)

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California (Amador): Three confirmed cases of pertussis
Amador County Public Health has confirmed diagnosed cases of pertussis (whooping cough) in three unimmunized children.

A significant rise in illness in California due to pertussis, commonly known as whooping cough, urges awareness and prevention in Amador County. The number of whooping cough cases reported in 2010 is seven times greater than last year in the state. All seven deaths reported in California were infants under three months old.

This is a reminder to the community on how important it is to get immunized against a potentially potent lethal germ, said Dr. David J. Stone, pediatrician. Pertussis is the leading vaccine-preventable disease.
(Ledger Dispatch 08/16/2010)

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California (Bakersfield): Number of pertussis cases up to 227
An additional 17 cases of whooping cough were reported the week of 9 August 2010 in Kern County, bringing the total to 227 for 2010, according to the Kern County Department of Public Health.

To help stem the tide of cases, the department is holding a series of "back to school" vaccination drives throughout Kern for children and adults who bring in kids for vaccination. The administrative fee of $13 will be waived for anyone without third-party insurance.

The monthly rate of cases of whooping cough, also known as pertussis, in Kern County has been going up and up in 2010, though no deaths have been reported. The weekly rate has, since 23 May 2010, ranged from five between 30 May and 5 June to 33 between 27 June 27 and 3 July, according to Public Health.

Of the 227 Kern cases, 182 were reported in Bakersfield.

The reason for the uptick is unclear but it's happening across the state so health officials are just trying to get the word out about the need for vaccination, said Denise Smith, Public Health's assistant director of disease control.

Officials have said the incidence of whooping cough is cyclical. In Kern there were six reported cases in all of 2009 and eight in 2008.

Many adults aren't protected because the vaccination they received as children has worn off and the adult version -- contained in the so-called Tdap vaccine -- has only been licensed for five years.
(The Bakersfield Californian 08/16/2010)

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Canada (Wellington North Township): Public health investigating increase in tuberculosis
A higher than usual number of active tuberculosis cases in Wellington North Township has the Wellington Dufferin Guelph Public Health issuing a reassurance there is little danger to the general public.

TB, as it is commonly known, is uncommon but it continues to be diagnosed in Ontario. There were 683 new cases diagnosed in 2007.

For Wellington North, Public Health officials have found four cases in the last two years. Mercer said when that number of cases runs “close together,” Public Health issues a statement “for information purposes.

She said TB is spread through the air from someone with and active disease to others. She emphasized it requires spending a prolonged period of time breathing the same air for TB to be spread.

Mercer said family members or health care workers are most likely to be at risk in cases of active TB. A positive TB skin test or chest x-ray con­firms a person has been infected by the germ, called a bacillus. However, at that stage, spread of the disease is rare and is not a risk to others. A very small percentage of people move from the infected stage to the active stage of the disease.

Mercer said people exposed to the bacillus at a young age have about a 5% chance of developing full blown tuberculosis. After that, it is a 5% chance for the rest of their lives. She said, though, it is possible for someone who fought in Europe in World War II to have been exposed to it there, and develop TB at age 75.

She said all medical personnel are screened for TB when they are hired, and the other place where it is regularly found is in prisons.

While TB is a communicable disease, the risk to the community is low, she said. Public health identifies those who may be at risk of exposure and confidentially screens individuals and offers treatment where necessary.”

While the disease is uncommon, Mercer said there is a monthly clinic held in Guelph, and there could be a couple of people a month being treated.
(The Wellington Advertiser 08/11/2010)

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Peru (Lima): Pneumonic plague deaths
The death of a 29 year old woman from pneumonic plague has brought the number of plague victims in Peru to three in two months, the health ministry said. The woman, who had been seriously ill for 36 days before succumbing to the plague in the coastal province of Ascope, some 325 miles (520 kilometres) north west of Lima, died in hospital on 12 August 2010.

Since late June 2010 another two deaths were from bubonic plague, officials said; and 31 more people have been infected. Health minister Oscar Ugarte blamed the situation on the expansion of farming in the region that had prompted rodent infestations in nearby towns.

The last outbreak of bubonic plague in northern Peru was in 1994, which killed 35 people and infected more than 1100 others.

[ProMED note: There have been discrepancies in the reports of the number of total cases, 21 or 31 and the number of fatalities. This posting reports 31 total cases and a now third fatality, a previously reported case.]
(ProMED 08/13/2010)

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Peru (Amazonas): Rabid bat attacks
Rabid vampire bats have attacked more than 500 people in Peru's Amazon. The attacks occurred in the village of Urakusa, in north eastern Peru, where the indigenous Aguaruna tribe lives. At least four people previously reported to be children are believed to have succumbed to rabies as a result. Medical supplies and vaccines to treat those infected with rabies have been sent to the tribe. Health teams are looking for people in communities within six miles (10 km) of the outbreak who were attacked by bats any time in the last six months.

Jose Bustamante, a Health Ministry official, said 97 per cent of the 508 people who were bitten have begun receiving an anti-rabies vaccination. It is expected that the rest -- some of whom have rejected treatment -- will be vaccinated in the next few days.
(ProMED 08/13/2010)

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USA (Texas): Scientists seek test determining if pathogens are lab-grown
Scientists at Rice University in Houston have won a Department of Defense grant to develop a test to tell whether a pathogen causing a disease outbreak is natural or was grown in a lab by terrorists, according to a university press release. The three-year grant, awarded by the Defense Threat Reduction Agency, is worth $800,000, said Jade Boyd, a university spokesperson. The goal of the project is to find signs that an organism has become accustomed to living in a biology lab, the university said. Yousif Shamoo, director of Rice's Institute for Biosciences and Bioengineering, said bacteria can progress through hundreds of generations in a few weeks and quickly adapt to new conditions, giving telltale signs of their domestication in a lab. He said they expect that organisms will lose certain genes that allow them to get nutrition from the soil or the gut or wherever they came from, simply because they won't need them anymore. He and his students plan to gather wild strains of Enterococcus faecalis and Escherichia coli and grow them in their lab; they will take "genomic snapshots" of them as they evolve and analyze them for patterns. The hope is that the project will generate information that will help public health officials quickly determine how to respond to disease outbreaks. (CIDRAP 08/17/2010)

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3. Updates

Asia
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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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/

WHO H1N1 pandemic influenza update 113:
http://www.who.int/csr/don/2010_08_13/en/index.html

Public Health Emergency Medical Countermeasures Enterprise Review:
http://www.phe.gov/Preparedness/mcm/enterprisereview/Pages/default.aspx

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VECTOR-BORNE DISEASE
India (Maharashtra)
As per Pune Municipal Corporation (PMC) (Maharashtra state) health department figures, 59 dengue cases have been recorded since January 2010. In 2006 there were 78 dengue cases, in 2007 90, in 2008 65, and in 2009 179.
(ProMED 08/07/2010)


India (Delhi)
A total of 215 people have been infected by the mosquito-borne disease in the city in 2010. Twenty-one more people have tested positive for dengue in Delhi though no one died on 14 August 2010, said Municipal Corporation of Delhi's chief medical officer NK Yadav. One person has died due to dengue in 2010 in Delhi.
(ProMED 08/14/2010)


Malaysia
The number of fatalities due to dengue fever continues to increase with 67 deaths recorded since January 2010 until 6 August 2010, from 67 deaths during the corresponding period in 2009.

Health minister Datuk Seri Liow Tiong Lai said a total of 29,255 cases of dengue fever had been reported during the period this year compared with 27,989 cases last year. The increase of 38.8 per cent in deaths due to dengue fever and 4.5 per cent increase in cases of dengue fever is worrying. It is a serious threat and should be given attention to by the public, he told reporters. [ProMED note:Paragraph 1 shows numbers of deaths to be identical in 2009 and 2010. There's a mistake somewhere.]

Liow advised the public to take necessary measures, like ensuring the cleanliness of their surroundings, to prevent the spread of dengue. I have instructed my officers to step up enforcement against those responsible for breeding of the Aedes mosquitoes, he added.
(ProMED 08/07/2010)


Philippines (Capiz)
The Sangguniang Panlungsod [provincial legislature] has declared a dengue outbreak after its dengue hemorrhagic fever cases reached 444, with five deaths. Last week, the Sangguniang Panlalawigan, in its special session, approved a resolution declaring a state of calamity in Capiz and its component city, Roxas City, because of the high number of dengue cases in the province. Mayor Angel Alan Celino requested the City Council to conduct a special session 7 August 2010 to declare a dengue outbreak.
(ProMED 08/09/2010)


Philippines (Ifugao)
The local legislators had declared 3 Aug 2010 a dengue outbreak in five barangays [neighborhood political units] of this municipality. The declaration is the offshoot of the rising dengue cases within a span of 21 days that alarmed health authorities and municipal officials to act before it affects the other barangays. Recently, the Ifugao Provincial Health Office (IPHO) has confirmed the outbreak of 75 cases of dengue in barangay of Cudog and the four clustered barangays of Poblacion, Lagawe in the month of July 2010 alone.

Mayor Ceasario Cabbigat stressed that concerted efforts between and among local government units and the public are needed to combat and mitigate the mosquito-borne disease. The MDB will spearhead the information advocacy on dengue in all barangays, schools, and the general public to create awareness among the populace about the dreaded disease. It will also plan and implement programs on dengue fever and lead the search and destroy activity of the brigade such as clean-up drives and destruction of mosquito breeding sites.
(ProMED 08/07/2010)


Russia (Tyumen)
Some 12,490 people have sustained tick bites in the Tyumen oblast since the beginning of the epidemic season in 2010, including 59 cases during the week of 16 August 2010.

Rospotrebnadzor [the Federal Agency for Human Health and Welfare] has announced that 345 suspected cases of tick-borne encephalitis (TBE), 63 of whom were children under 14 years of age, have been admitted to hospital.

As of 12 August 2010, the number of confirmed cases of TBE was 81, whereas during the same period in 2009, only 45 cases were recorded. None of the cases had been immunized against TBE virus infection, and 26 percent of cases received emergency immune globulin treatment.

The increase of TBE morbidity can be explained by the current abundance of ticks as a consequence of their three-year development cycle. The regional laboratory which carries out surveys on ticks has reported that in 2010, 5.4 percent of ticks are carrying TBE virus, and 15.2 percent are carrying Borellia (the causative agent of Lyme disease).
(ProMED 08/18/2010)


South Korea (Seoul)
The number of patients infected with malaria jumped nearly 60 percent from 2009 to 165 in the first seven months of 2010. It is also nearly 50 percent higher than the three-year average of 111.

Over the last few years the number of malaria patients has fluctuated ¯ 494 in 2000, 136 in 2004, 313 in 2007 and 178 in 2009.

In Korea, most patients are diagnosed with Plasmodium vivax malaria, which spreads via the female Anopheles mosquito. The incubation period of the disease ranges from a week to 12 months.

The symptoms of Plasmodium vivax malaria include a fever and chills, accompanied by headaches and diarrhea.

The Anopheles mosquitoes inhabit stagnant water in rice paddies or thickets and were found in 22 places spanning Incheon City, Gyeonggi and Gangwon Province.

We are reinforcing quarantine regulations against malaria in Eunpyeong, Yangcheon, Gangseo and Guro Districts close to the malaria danger zones, a city official said.
(The Korea Times 08-18-2010)


Thailand
There have been 383 cases of dengue fever in 2010 in Phuket, but no deaths, the Ministry of Public Health says. Dr Wiwat Seetamanotch, deputy director of the Phuket Public Health Office and an expert on the disease, said the total of 383 cases so far in 2010 has already surpassed the total number of cases in 2009, when 309 were recorded. The incidence rate ranks Phuket at number 20 out of Thailand's 77 provinces, he said.

That the disease is spreading more quickly under wet, monsoon-season conditions is evidenced by the fact that there were just 213 cases of dengue reported in Phuket from 1 January 2010 to 12 June 2010.

We must accept that despite our efforts to eradicate them, the mosquitoes that vector this disease are getting more difficult to control, in part due to increasing resistance to pesticide sprays, Dr Wiwat said.

He specified a four-point strategy that is effective at limiting breeding opportunities for the Aedes aegypti mosquito that spreads misery in the form of chikungunya and yellow fever, as well dengue.
- Place lids on all water containers to prevent mosquito from layingeggs in them;
- Change the water in all containers every seven days;
- Release guppies or other small fish into ponds to feed on mosquito larvae;
- Limit potential breeding sites in and around residences.

The spread of dengue is far worse in the Deep South, where some 6,500 people in five provinces contracted the disease from 1 January 2010 to 29 July 2010, with 13 deaths. In Songkhla Province alone, 2592 people were reported ill with the fever and six died over the same period.

The latest victim was a 11-month-old baby who died on 27 July 2010 in Haad Yai. Children under two years of age are especially at risk of dying from the disease.

[ProMED note: According to the Thai Ministry of Public Health, Bureau of Epidemiology (BOE)'s report of situation of dengue infection in Thailand between 1 January 2010 and 6 August 2010, a total of 48,514 cases and 53 deaths were reported nationwide. The attack rate was 76.37 per 100,000 population, which is 1.8 times higher than the attack rate during the same period in 2009. The case fatality rate was 0.11 percent.

Regarding the 383 cases of dengue infection in Phuket province between 1 January 2010 to 31 July 2010, there were 115 cases of dengue fever (DF), 264 cases of dengue hemorrhagic fever (DHF), and four cases of dengue shock syndrome (DSS). No deaths were reported.

Comparing over the same time period between 2009 and 2010, the number of cases due to dengue infection in Thailand was higher in 2010 than 2009 by 83 percent, and the most prevalent of cases were reported in the South, followed by the Central and the Northeast.
(ProMED 08/11/2010)


Thailand
The Ministry of Public Health (MOPH) has voiced concern over the spread of dengue fever in all provinces nationwide after the number of infections was found higher than in 2009 by 83 percent.

Public Health minister Jurin Laksanawisit considered the ongoing spread of dengue fever a worrying issue. He said the Ministry had been monitoring the epidemic spread closely from June 2010 to August 2010, and the week of 2 August 2010 accumulated the number of patients at 41,413, higher than the previous week by 3000, along with 10 confirmed fatalities. The disease in 2010 has been found most prevalent in the South, followed by the Central and the Northeast.

The minister hence has assigned related units to exterminate spawning sites and larvae of mosquitoes and suggested that people protect themselves from mosquito bites.

[ProMED note: According to the Thai Ministry of Public Health, Bureau of Epidemiology (BOE)'s report on the situation of dengue infection in Thailand as of 6 August 2010, a total of 48,514 cases and 53 deaths have been reported during 2010, with an attack rate of 76.37 per 100,000 population. The highest attack rate was in 10-14 years old age group (256.75 per 100 000 population). Songkhla province has reported the highest number of cases followed by Narathiwat, Chantaburi, Pattani, and Tak provinces.]
(ProMED 08/10/2010)


Thailand (Ubon Ratchathani)
More than 800 people in the north eastern province of Ubon Ratchathani have been infected with dengue fever, reported the Ministry of Public Health. Dr Suraporn Loiha of the Ubon Ratchathani Provincial Public Health said 882 people have so far come down with the fever, and two have died. The outbreak has been reported in the districts of Nam Yuen, Na Ja Luay, Nam Kun and Buntharik, near the border area.

Dr Suraporn has also expected that the situation in 2010 would be more serious than 2009’s, as the infection rate has now climbed to 51 per 100 000 people.
(ProMED 08/09/2010)


USA (Florida)
The tropical dengue fever virus has spread to Broward mosquitoes, health officials said 12 August 2010, after tests confirmed the first known case of the disease being contracted in the county. An adult who had not left Broward for weeks came down with the mosquito-borne disease in August of 2010, meaning Broward is now the second place in the continental United States -- after Key West -- where locally acquired dengue fever exists.

Broward County Health Department officials would not identify the person or disclose where the person lives, but said the county would step up mosquito spraying and hammer harder on its message to prevent mosquito bites -- especially since Florida has logged a few cases of other mosquito diseases such as West Nile virus.

In Key West, at least 53 dengue cases have been reported since the outbreak began in September 2009, including a Wilton Manors woman infected while visiting the island.

Carina Blackmore, a mosquito-disease specialist with the Florida Department of Health, said she was certain the local mosquito got the virus by biting someone in Broward who had contracted dengue fever while traveling in the Caribbean, South America, or a country where the disease is prevalent. Blackmore said she was certain because the person in Broward caught the type-three strain of dengue virus. The strain circulating in Key West is called type-one virus, so the new case could not be related to Key West. So far in 2010, 57 Floridians have contracted dengue while traveling outside the country, state figures show.
(ProMED 08/13/2010)


USA (Florida)
Four Florida residents have died from a mosquito-borne disease that normally afflicts horses, health officials reported 17 August 2010 as the swampy state enters peak season for mosquito-borne illnesses.

Health officials said last month that two Tampa-area residents had died from eastern equine encephalitis, a viral disease that inflames the brain.

Two additional deaths from the disease known as EEE have since been confirmed, one in the state capital of Tallahassee and one in the northwest Florida town of Sopchoppy.

The disease mostly affects unvaccinated horses but a handful of human deaths are recorded each year, according to the Centers for Disease Control and Prevention. There is no human vaccine for the disease, which kills a third of its human victims and often leaves survivors with significant brain damage.

The Florida Department of Health is also tracking two other less deadly mosquito-borne diseases, West Nile virus and dengue fever.

EEE and West Nile virus have been detected in 43 of Florida's 67 counties, while dengue cases have been confirmed in two south Florida counties, Monroe and Broward, according to the state Department of Health.

The dengue virus began showing up in Florida in 2009 after an absence since its last major outbreak in 1934. At least 28 confirmed cases of domestically transmitted dengue fever have been reported in Florida in 2010, along with 67 foreign-acquired cases. The disease is more prevalent in Central and South America.

Carina Blackmore, state public health veterinarian, said the number of mosquito bites to people, horses and livestock resulting in EEE or West Nile appears consistent with the last several years.
(TVNZ 08/18/2010)


Vietnam
Many children with dengue fever have suffered serious complications as the disease is spreading through out the country, said Pediatrics Hospital No.1 on 8 August 2010.

The hospital's emergency room has received many children with serious complications recently, as the number of dengue fever patients is rising. Around 10 percent of the children suffering from dengue fever have experienced complications, according to the hospital's deputy director Le Thi Bich Lien. Dr. Lien warned parents to take their children to hospital immediately if they suddenly develop a high fever, rash, muscle and joint pain, nausea, or vomiting.

Most dengue infections result in relatively mild illnesses, but some can progress to dengue hemorrhagic fever. With dengue hemorrhagic fever, the blood vessels start to leak and cause bleeding from the nose, mouth, gums, or vagina in girls.

[ProMED note: Local media reports not only an increase in the number of dengue fever (DF) and dengue hemorrhagic fever (DHF) cases in many provinces, especially in southern, central, and highland central provinces, but also in the number of complications of DF/DHF.

The most updated report from Viet Nam Ministry of Health reported a decrease in the number of DF and DHF in the whole country compared with the same period in 2009.

According to the WHO Regional Office for the Western Pacific , there were a total of 105,370 cases and 87 deaths from DF/DHF reported in Viet Nam during 2009.]
(ProMED 08/09/2010)


Vietnam
Dr Nguyen Dac Tho, vice director of the Ho Chi Minh City Preventive Medicine center, said most city districts, including districts one and three, had recorded significant increases in the incidence of the mosquito-borne disease in July 2010 over June 2010. On average, the increase was at least double the June 2010 figures, but some districts have recorded three to four times the number of cases, Tho said.

The increase in dengue fever cases showed that districts have not controlled the epidemic properly, Le Truong Giang, vice director of the city's Department of Health told the meeting.

The city's neighboring provinces like Binh Phuoc have also reported increases in dengue fever, with 700 cases, including two deaths, so far in 2010. To Duc Sinh, director of the provincial Center of Preventive Health, said at the moment more than 100 people are being hospitalized with dengue fever every day.

In Dong Nai Province to the north east of HCMC, more than 1000 people have been afflicted dengue fever so far in 2010, and three have died.
(ProMED 08/06/2010)

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CHOLERA, DIARRHEA, and DYSENTARY
China
The Center for Health Protection (CHP) of the Department of Health on 7 August 2010 investigated a confirmed case of cholera and reminds people to observe good personal, food, and environmental hygiene, whether in Hong Kong or travelling abroad. The case involved a 66 year old woman who was a food collateral of a cholera case (index case) confirmed on 5 August 2010. She developed diarrhea on 2 August 2010.

Her symptoms subsided after one day without seeking medical attention. Her stool specimen collected by CHP during the investigation of the index case on 5 August 2010 grew Vibrio cholera 7 August 2010. CHP's investigation revealed that the woman shared meals with the index case on 5 August 2010 in four food premises during the incubation period.

Both of them are now being treated in isolation at Princess Margaret Hospital, and are in a stable condition. The woman did not have history of recent travel. She lives in Sham Shiu Po and her home contacts have no symptoms of cholera. Investigation continues and contacts of the patients are under medical surveillance. This is the fifth case of cholera reported in 2010. There were seven cholera cases in 2008, three cholera cases in 2007, one in 2006, and five in 2005.
(ProMED 08/07/2010)

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4. Articles
Multiple Infections with Seasonal Influenza A Virus Induce Cross Protective Immunity against A(H1N1) Pandemic Influenza Virus in a Ferret Model
Laurie L, Carolan LA,Middleton D, et al. J Infect Dis.17 August 2010.doi:10.1086/656188.
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/656188

Background. An age bias toward children and young adults has been reported for infection and hospitalizations with pandemic H1N1 influenza (A[H1N1]pdm) in the 2009 and 2010 influenza seasons in the Southern and Northern Hemispheres. Serological analysis of prepandemic samples has shown a higher incidence of cross©\reactive antibodies to A(H1N1)pdm virus in older populations; conserved T cell epitopes between viruses have been identified. The contribution of preexisting immunity to seasonal influenza to protection against A(H1N1)pdm infection was analyzed in a ferret model.

Methods. Ferrets were pre©\infected with influenza A viruses and/or vaccinated with inactivated influenza viruses with adjuvant. Infection after challenge was assessed by measuring shedding virus, transmission to naive animals, and seroconversion.

Results. Homologous vaccination reduced the incidence of infection and delayed transmission. Pre-infection with virus induced sterilizing immunity to homologous challenge. One prior infection with seasonal influenza A virus improved clearance of A(H1N1)pdm virus. Prior infection with A(H1N1)pdm virus reduced shedding after seasonal influenza A challenge. Two infections with seasonal influenza A viruses reduced the incidence of infection, the amount and duration of virus shedding, and the frequency of transmission following A(H1N1)pdm challenge.

Conclusion. These data suggest the reduced incidence and severity of infection with A(H1N1)pdm virus in the adult population during the 2009¨C2010 influenza season may be a result of previous exposure to seasonal influenza A viruses.

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Historical thoughts on influenza viral ecosystems, or behold a pale horse, dead dogs, failing fowl, and sick swine
Morens DM, Taubenberger JK. Influenza Other Respi Viruses. 4 August 2010.doi: 10.1111/j.1750-2659.2010.00148.x.
Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1750-2659.2010.00148.x/abstract

Objectives. To understand human influenza in a historical context of viral circulation in avian species, mammals, and in the environment.

Design. Historical review.

Setting. Global events in a variety of circumstances over more than 3,000 years time.

Sample. Comprehensive review of the historical literature including all major publications on pandemic and panzootic influenza.

Main Outcome Measures. Influenza pandemics, panzootics, major epidemics and epizootics, and instances of interspecies transmission of influenza A.

Results. Extensive documentation of human and animal influenza over many centuries suggests that influenza A viruses have adapted to a variety of species and environmental milieu and are capable of switching between many different hosts under widely varying circumstances.

Conclusions. The genetic elements of influenza A viruses circulate globally in an extensive ecosystem comprised of many avian and mammalian species and a spectrum of environments. Unstable gene constellations found in avian species become stable viruses only upon switching to secondary hosts, but may then adapt and circulate independently. It may be desirable to think of influenza A viruses as existing and evolving in a large ecosystem involving multiple hosts and environments. Implications for understanding human influenza are discussed.

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Severe, critical and fatal cases of 2009 H1N1 influenza in China
Yang P, Deng Y, Pang X, et al. J Infect Dis. 11 August 2010. doi:10.1016/j.jinf.2010.07.010.
Available at http://www.journalofinfection.com/article/S0163-4453(10)00207-0/abstract

Objective. For severe, critical and fatal cases of 2009 H1N1 influenza in the winter in the Northern Hemisphere, the detailed features are not fully known. The aim of this study was to examine these features through describing these cases in Beijing, China in 2009.

Methods. Data on severe, critical and fatal cases were collected via the Notifiable Disease Surveillance System and a designated surveillance system for managing 2009 H1N1 influenza cases in Beijing. The characteristics and risk factors of these cases were elucidated.

Results. A total of 475 severe cases, 73 critical ones and 69 deaths were identified in 2009. The proportion of obesity was low, as well as pregnancy. About half of them had no underlying disease. Most of deaths had multi-organ failure, with a median interval from illness onset to death of ten days. Delay in visiting hospital, cardiovascular disease and allergy predicted a higher risk of severe disease, and cases aged 6–17 years were at lower risk. Cases not promptly receiving neuraminidase inhibitors were at increased risk of death.

Conclusions. Age and underlying disease are significantly associated with severity of outcomes of 2009 H1N1 influenza; prompt presentation to hospital and use of neuraminidase inhibitor were protective.

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Mobile Messaging as Surveillance Tool during Pandemic (H1N1) 2009, Mexico
Lajous M, Danon L, Lopez-Ridaura R, et al. Emerg Infect Dis. 11 August 2010.doi: 10.3201/eid1609.100671.
Available at http://www.cdc.gov/eid/content/16/9/PDFs/10-0671.pdf

To the Editor. Pandemic (H1N1) 2009 highlighted challenges faced by disease surveillance systems. New approaches to complement traditional surveillance are needed, and new technologies provide new opportunities. We evaluated cell phone technology for surveillance of influenza outbreaks during the outbreak of pandemic (H1N1) 2009 in Mexico.

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The end of the pandemic – what will be the pattern of influenza in the 2010-11 European winter and beyond?
Nicoll A, Sprenger M. Euro Surveill. 12 August 2010.15(32):pii=19637.
Available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19637

Abstract. On 10 August 2010 Margaret Chan, the Director-General of the World Health Organization (WHO), announced that the world has moved into the post-pandemic period [1]. Following the advice of the Emergency Committee, which based its assessment on the global situation, WHO declared that there has been a pandemic phase change and that the WHO post-pandemic definition, ‘Levels of influenza activity have returned to the levels seen for inter-pandemic influenza in most countries with adequate surveillance’, has been met [2]. In order to come to this conclusion it has been important to observe the pattern of influenza in the southern hemisphere temperate countries which are now experiencing their winter. What does this mean for the 2010-11 winter in Europe and winters beyond?

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School Opening Dates Predict Pandemic Influenza A(H1N1) Outbreaks in the United States
Chao DL, Halloran EM, Longini Jr IM. J Infect Dis. 15 September 2010;202:877-880.doi: 10.1086/655810.
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/655810

Abstract. The opening of schools in the late summer of 2009 may have triggered the fall wave of pandemic influenza A(H1N1) in the United States. We found that an elevated percentage of outpatient visits for influenza]like illness occurred an average of 14 days after schools opened in the fall of 2009. The timing of these events was highly correlated (Spearman correlation coefficient, 0.62; ). This result provides evidence that transmission in schools catalyzes community]wide transmission. School opening dates can be useful for future pandemic planning, and influenza mitigation strategies should be targeted at school populations before the influenza season.

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Original Article: Assessing physicians’ in training attitudes and behaviors during the 2009 H1N1 influenza season: a cross-sectional survey of medical students and residents in an urban academic setting
May L, Katz R, Johnston L, et al. Influenza Other Respi Viruses. September 2010;4(5):267-275.doi: 10.1111/j.1750-2659.2010.00151.x.
Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1750-2659.2010.00151.x/full

Background. Despite concern for hospital-based transmission of influenza, little research has been carried out on perceptions and behaviors of physicians in training with regard to influenza-like illness (ILI), especially in light of the recent H1N1 pandemic.

Objectives. We aimed to evaluate self-reported episodes of ILI among medical students and residents to determine the impact of ILI on school and clinical performance, absenteeism, and patterns of preventive measures used by this population both in and out of the healthcare setting.

Methods. We anonymously surveyed medical students and residents at an urban institution between November 3 and December 11, 2009. Data were analyzed separately for medical students and residents for frequency of close-ended responses. Open-ended answers were analyzed thematically. Our Institutional Review Board exempted this study from review.

Results. Forty-five percent of medical students and 53% of resident respondents perceived the risk of acquiring H1N1 at school or work as high, and although 43% of medical students and 66% of resident respondents had received the influenza vaccination and most reported increasing non-pharmaceutical preventive measures, 9% of medical students and 61% of residents with one or more episodes of ILI chose to continue to attend class or work when ill.

Conclusions. Although students and residents report high risk of infection because of work- or school-related activities, many involved in patient care activities do not comply with recommended infection control precautions. Educational campaigns should be developed and infection control guidelines should be included in routine medical student and resident curricular activities.

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Influenza in Refugees on the Thailand–Myanmar Border, May–October 2009
Turner P, Turner CL, Watthanaworawit W, et al. Emerg Infect Dis. September 2010.doi: 10.3201/eid1609.100220.
Available at http://www.cdc.gov/eid/content/16/9/1366.htm#cit

Abstract. We describe the epidemiology of influenza virus infections in refugees in a camp in rural Southeast Asia during May–October 2009, the first 6 months after identification of pandemic (H1N1) 2009 in Thailand. Influenza A viruses were detected in 20% of patients who had influenza-like illness and in 23% of those who had clinical pneumonia. Seasonal influenza A (H1N1) was the predominant virus circulating during weeks 26–33 (June 25–August 29) and was subsequently replaced by the pandemic strain. A review of passive surveillance for acute respiratory infection did not show an increase in acute respiratory tract infection incidence associated with the arrival of pandemic (H1N1) 2009 in the camp.

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All-Cause Mortality during First Wave of Pandemic (H1N1) 2009, New South Wales, Australia, 2009
Muscatello DJ, Cretikos MA, MacIntyre RC. Emerg Infect Dis. September 2010.doi: 10.3201/eid1609.091723.
Available at http://www.cdc.gov/eid/content/16/9/1396.htm#cit

Abstract. In temperate countries, death rates increase in winter, but influenza epidemics often cause greater increases. The death rate time series that occurs without epidemic influenza can be called a seasonal baseline. Differentiating observed death rates from the seasonally oscillating baseline provides estimated influenza-associated death rates. During 2003¨C2009 in New South Wales, Australia, we used a Serfling approach with robust regression to estimate age-specific weekly baseline all-cause death rates. Total differences between weekly observed and baseline rates during May¨CSeptember provided annual estimates of influenza-associated death rates. In 2009, which included our first wave of pandemic (H1N1) 2009, the all-age death rate was 6.0 (95% confidence interval 3.1¨C8.9) per 100,000 persons lower than baseline. In persons ¡Ý80 years of age, it was 131.6 (95% confidence interval 126.2¨C137.1) per 100,000 lower. This estimate is consistent with a pandemic virus causing mild illness in most persons infected and sparing older persons.

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Multi-agent modeling of the South Korean avian influenza epidemic
Kim T-Y, Hwang W-C, Zhang A-D, et al. BMC Infect Dis. 10 August 2010; 10:236. doi:10.1186/1471-2334-10-236.
Available at http://www.biomedcentral.com/1471-2334/10/236

Background. Several highly pathogenic avian influenza (AI) outbreaks have been reported over the past decade. South Korea recently faced AI outbreaks whose economic impact was estimated to be 6.3 billion dollars, equivalent to nearly 50% of the profit generated by the poultry-related industries in 2008. In addition, AI is threatening to cause a human pandemic of potentially devastating proportions. Several studies show that a stochastic simulation model can be used to plan an efficient containment strategy on an emerging influenza. Efficient control of AI outbreaks based on such simulation studies could be an important strategy in minimizing its adverse economic and public health impacts.

Methods. We constructed a spatio-temporal multi-agent model of chickens and ducks in poultry farms in South Korea. The spatial domain, comprised of 76 (37.5 km x 37.5 km) unit squares, approximated the size and scale of South Korea. In this spatial domain, we introduced 3,039 poultry flocks (corresponding to 2,231 flocks of chickens and 808 flocks of ducks) whose spatial distribution was proportional to the number of birds in each province. The model parameterizes the properties and dynamic behaviors of birds in poultry farms and quarantine plans and included infection probability, incubation period, interactions among birds, and quarantine region.

Results. We conducted sensitivity analysis for the different parameters in the model. Our study shows that the quarantine plan with well-chosen values of parameters is critical for minimize loss of poultry flocks in an AI outbreak. Specifically, the aggressive culling plan of infected poultry farms over 18.75 km radius range is unlikely to be effective, resulting in higher fractions of unnecessarily culled poultry flocks and the weak culling plan is also unlikely to be effective, resulting in higher fractions of infected poultry flocks.

Conclusions. Our results show that a prepared response with targeted quarantine protocols would have a high probability of containing the disease. The containment plan with an aggressive culling plan is not necessarily efficient, causing a higher fraction of unnecessarily culled poultry farms. Instead, it is necessary to balance culling with other important factors involved in AI spreading. Better estimations for the containment of AI spreading with this model offer the potential to reduce the loss of poultry and minimize economic impact on the poultry industry.

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Influenza A (H5N1) Viruses from Pigs, Indonesia
Nidom CA, Takano R, Yamada S, et al. Emerg Infect Dis. October 2010;[Epub ahead of print].doi:10.3201/eid1610.100508.
Available at http://www.cdc.gov/eid/content/16/10/PDFs/10-0508.pdf

Abstract. Pigs have long been considered potential intermediate hosts in which avian influenza viruses can adapt to humans. To determine whether this potential exists for pigs in Indonesia, we conducted surveillance during 2005–2009. We found that 52 pigs in 4 provinces were infected during 2005–2007 but not 2008–2009. Phylogenetic analysis showed that the viruses had been introduced into the pig population in Indonesia on at least 3 occasions. One isolate had acquired the ability to recognize a human-type receptor. No infected pig had influenza-like symptoms, indicating that influenza A (H5N1) viruses can replicate undetected for prolonged periods, facilitating avian virus adaptation to mammalian hosts. Our data suggest that pigs are at risk for infection during outbreaks of influenza virus A (H5N1) and can serve as intermediate hosts in which this avian virus can adapt to mammals.

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An assessment of the effect of statin use on the incidence of acute respiratory infections in England during winters 1998–1999 to 2005–2006
Fleming DM, Verlander NQ, Elliot AJ, et al. Epidemiol Infect. September 2010; 138:1281-1288.doi:10.1017/S0950268810000105.
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7849252

Summary. Statins reduce cardiovascular mortality and related risks associated with pneumonia suggesting potentially beneficial use in influenza pandemics. We investigated the effect of current statin use on acute respiratory infections in primary care. Data from anonymized electronic medical records of persons aged ⩾45 years were examined for statin use, chronic morbidity, respiratory diagnoses, vaccination procedures, and immune suppression. Logistic regression models were used to calculate odds ratios (ORs) for statin users vs. non-users in respiratory infection outcomes. A total of 329 881 person-year observations included 18% statin users and 46% influenza vaccinees. Adjusted ORs for statin users vs. non-users were: influenza-like illness, 1•05 (95% CI 0•92–1•20); acute bronchitis, 1•08 (95% CI 1•01–1•15); pneumonia, 0•91 (95% CI 0•73–1•13); all acute respiratory infections, 1•03 (95% CI 0•98–1•07); and urinary tract infections, 0•91 (95% CI 0•85–0•98). We found no benefit in respiratory infection outcomes attributable to statin use, although uniformly higher ORs in non-vaccinated statin users might suggest synergism between statins and influenza vaccination.

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Knowledge, attitudes and practices towards pandemic influenza among cases, close contacts, and healthcare workers in tropical Singapore: a cross-sectional survey
Yap J, Lee VJ, Yau T-Y, et al. BMC Public Health. 28 July 2010;10:442.doi:10.1186/1471-2458-10-442.
Available at http://www.biomedcentral.com/1471-2458/10/442

Background. Effective influenza pandemic management requires understanding of the factors influencing behavioral changes. We aim to determine the differences in knowledge, attitudes and practices in various different cohorts and explore the pertinent factors that influenced behavior in tropical Singapore.

Methods. We performed a cross-sectional knowledge, attitudes and practices survey in the Singapore military from mid-August to early-October 2009, among 3054 personnel in four exposure groups - laboratory-confirmed H1N1-2009 cases, close contacts of cases, healthcare workers, and general personnel.

Results. 1063 (34.8%) participants responded. The mean age was 21.4 (SE 0.2) years old. Close contacts had the highest knowledge score (71.7%, p = 0.004) while cases had the highest practice scores (58.8%, p < 0.001). There was a strong correlation between knowledge and practice scores (r = 0.27, p < 0.01) and knowledge and attitudes scores (r = 0.21, p < 0.01). The significant predictors of higher practice scores were higher knowledge scores (p < 0.001), Malay ethnicity (p < 0.001), exposure group (p < 0.05) and lower education level (p < 0.05). The significant predictors for higher attitudes scores were Malay ethnicity (p = 0.014) and higher knowledge scores (p < 0.001). The significant predictor for higher knowledge score was being a contact (p = 0.007).

Conclusion. Knowledge is a significant influence on attitudes and practices in a pandemic, and personal experience influences practice behaviors. Efforts should be targeted at educating the general population to improve practices in the current pandemic, as well as for future epidemics.

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Emerging, Novel, and Known Influenza Virus Infections in Humans
Tang JW, Shetty N, Lam TTY, et al. Infect Dis Clin North Am. September 2010; 24(3):603-617.
Available at http://www.id.theclinics.com/article/S0891-5520(10)00028-0/abstract

Abstract. Influenza viruses continue to cause yearly epidemics and occasional pandemics in humans. In recent years, the threat of a possible influenza pandemic arising from the avian influenza A(H5N1) virus has prompted the development of comprehensive pandemic preparedness programs in many countries. The recent emergence of the pandemic influenza A(H1N1) 2009 virus from the Americas in early 2009, although surprising in its geographic and zoonotic origins, has tested these preparedness programs and revealed areas in which further work is necessary. Nevertheless, the plethora of epidemiologic, diagnostic, mathematical and phylogenetic modeling, and investigative methodologies developed since the severe acute respiratory syndrome outbreak of 2003 and the subsequent sporadic human cases of avian influenza have been applied effectively and rapidly to the emergence of this novel pandemic virus. This article summarizes some of the findings from such investigations, including recommendations for the management of patients infected with this newly emerged pathogen.

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The Effect of Mask Use on the Spread of Influenza During a Pandemic
Brienen NCJ, Timen A, Wallinga J, et al. Risk Anal. 4 August 2010.doi:10.1111/j.1539-6924.2010.01428.x.
Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1539-6924.2010.01428.x/abstract

Abstract. Face masks have traditionally been used in general infection control, but their efficacy at the population level in preventing transmission of influenza viruses has not been studied in detail. Data from published clinical studies indicate that the infectivity of influenza A virus is probably very high, so that transmission of infection may involve low doses of virus. At low doses, the relation between dose and the probability of infection is approximately linear, so that the reduction in infection risk is proportional to the reduction in exposure due to particle retention of the mask. A population transmission model was set up to explore the impact of population-wide mask use, allowing estimation of the effects of mask efficacy and coverage (fraction of the population wearing masks) on the basic reproduction number and the infection attack rate. We conclude that population-wide use of face masks could make an important contribution in delaying an influenza pandemic. Mask use also reduces the reproduction number, possibly even to levels sufficient for containing an influenza outbreak.

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After the pandemic
Nature Publishing Group. Nature. 19 August 2010; 466(903). doi:10.1038/466903b.
Available at http://www.nature.com/nature/journal/v466/n7309/full/466903b.html

Abstract. Earlier this month, Margaret Chan, director-general of the World Health Organization (WHO) in Geneva, confirmed two things that many scientists already knew to be true: the H1N1 influenza pandemic is over, and the world was lucky. A disease that could have mutated into a highly lethal strain turned out to be comparatively mild.

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5. Notifications
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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International TB Symposium (ITBS-2010): TB Diagnostics – Innovating to Make an Impact
New Delhi, India 16-17 December 2010
The Symposium will take stock of current status of TB diagnostics and unravel future directions for translating research results into reliable and efficient point-of-care methods of TB diagnosis.
Additional information available at http://www.icgeb.org/meetings-2010.html

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 apecein@u.washington.edu